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


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

1STATE OF FLORIDA

4DIVISION OF ADMINISTRATIVE HEARINGS

8DEPARTMENT OF HEALTH, BOARD )

13OF MEDICINE, )

16)

17Petitioner, )

19)

20vs. ) Case Nos. 01 - 2115PL

27) 01 - 3795P L

32ROBERT M. KNIGHT, M.D., ) 01 - 3796PL

40) 01 - 3797PL

44Respondent. )

46)

47RECOMMENDED ORDER

49On January 22, 2002, a formal administrative hearing in

58this case was held in Naples, Florida, before William F.

68Quattlebaum, Administrative Law Judge, Division of

74Administrative Hearings.

76APPEARANCES

77For Petitioner: Kathryn E. Price, Esquire

83Agency for Health Care Administration

88Office of the General Counsel

93Post Office Box 14229

97Tallahassee, Florida 32317 - 4229

102Fo r Respondent: No Appearance

107STATEMENT OF THE ISSUE

111The issue in the case is whether the allegations in the

122Administrative Complaints are correct and, if so, what penalty

131should be imposed.

134PRELIMINARY STATEMENT

136On May 3, 2000, the Department of Health, Board of

146Medicine, (Petitioner) filed an Administrative Complaint against

153Robert M. Knight, M.D. (Respondent) alleging that he violated

162applicable statutes and rules in providing medical care for a

172patient. The Respondent filed a request for formal heari ng.

182The request was forwarded to the Division of Administrative

191Hearings, which scheduled a formal hearing. Prior to the

200hearing, legal counsel for the Respondent withdrew from the

209case, and the hearing was continued. Subsequently, the

217Petitioner filed additional Administrative Complaints against

223the Respondent. The Respondent requested formal hearings in the

232additional cases, and the request was forwarded to the Division

242of Administrative Hearings. The cases were consolidated and

250scheduled for hearing .

254At the commencement of the hearing, the Petitioner

262voluntarily dismissed the Administrative Complaint filed in Case

270Number 01 - 2115PL. Accordingly, jurisdiction is hereby

278relinquished to the Petitioner for entry of an appropriate Final

288Order in Case Nu mber 01 - 2115PL. This Recommended Order

299addresses the allegations set forth in the remaining

307Administrative Complaints.

309During the hearing, the Petitioner presented the testimony

317of four witnesses and had Exhibits numbered 1 - 9 admitted into

329evidence. Th e Respondent did not attend the hearing and was not

341represented by counsel.

344A Transcript of the hearing was filed on March 4, 2002.

355The Petitioner sought and was granted an extension of time for

366filing a Proposed Recommended Order, which was timely filed and

376was considered in the preparation of this Recommended Order.

385FINDINGS OF FACT

3881. At all times material to this case, the Respondent was

399a licensed physician in the State of Florida, holding license

409number ME0039986.

411DOAH Case Number 01 - 3795PL

4172. B etween May 22 and June 5, 1998, the Respondent ordered

429a series of diagnostic lab tests for Patient C. H., a 63 - year -

444old female.

4463. As to the care provided to Patient C. H., the

457Petitioner presented the testimony of Hamilton Fish, M.D., whose

466testimony wa s persuasive and is credited.

4734. According to Dr. Fish, many of the tests performed on

484Patient C. H. were not medically indicated according to a review

495of the information set forth in the patient's medical records,

505and the medical treatment care provide d by the Respondent to the

517patient was inappropriate and failed to meet the applicable

526standard of care.

5295. According to the hemoglobin test performed on

537Patient C. H., the patient was diabetic and the diabetes was

548uncontrolled. The Respondent did not provide proper treatment

556to the patient for the diabetes.

5626. According to one of the lab tests, Patient C. H. was

574deficient in calcium. The Respondent did not provide

582appropriate treatment for the calcium deficiency.

5887. Although there was no medical indication that Patient

597C. H. had a thyroid problem, the Respondent prescribed a thyroid

608hormone medication. The thyroid medication was inappropriate

615and could have exacerbated the diabetic condition.

622DOAH Case Number 01 - 3796PL

6288. The Petitioner introdu ced into evidence an

636advertisement that appears to have been published in the June

64625, 1999, edition of the "Sun - Sentinel Community News."

6569. There is no evidence that the Respondent created, read,

666placed, or paid for the advertisement in the newspaper.

67510. The ad offered a complementary consultation with the

684Respondent, who was identified in the ad as a diplomate of the

"696American Board of Anti - Aging."

70211. Florida law requires that a disclaimer appear in such

712advertisements advising a patient of the right to essentially

721decline non - free services that are recommended on the basis of

733the free consultation. The cited advertisement did not include

742the disclaimer.

74412. The Petitioner's administrative rules prohibit

750advertisement of affiliation with grou ps not "recognized" by the

760Petitioner. The Petitioner has not approved of the "American

769Board of Anti - Aging."

774DOAH Case Number 01 - 3797PL

780Patient D. E.

78313. On or about July 21, 1998, the Respondent ordered a

794series of diagnostic lab tests for Patient D. E ., a 53 - year - old

810male.

81114. According to the records, Patient D. E. had complained

821of impotency and loss of sexual desire.

82815. As to the care provided to Patient D. E., the

839Petitioner presented the testimony of Timothy Shapiro, M.D.,

847whose testimony was persuasive and is credited.

85416. According to Dr. Shapiro, many of the tests performed

864on Patient D. E. were not medically indicated according to a

875review of the information set forth in the patient's medical

885records.

88617. At least one of the tests perf ormed on several of the

899patients referenced herein (the "Barnes Basil Temperature Test")

908is not recognized in the medical community as providing valid

918information for the conventional diagnosis or treatment of any

927disorder.

92818. On or about August 18, 1998 , the Respondent diagnosed

938Patient D. E. with hypothyroidism, panhypothyroidism, food

945allergies, and impotence of organic origin. He prescribed

953Cytomel, Armour Thyroid, and testosterone gel for the patient.

96219. According to the testimony of Dr. Shapiro , the

971prescribed medications were inappropriate because the medical

978record fails to indicate any deficiencies being addressed by the

988medication.

98920. The course of treatment provided for the patient is

999not documented by the medical records and is below the standard

1010of care.

1012Patient J. N.

101521. On or about August 27, 1998, the Respondent ordered a

1026series of diagnostic lab tests for Patient J. N., a 50 - year - old

1041female.

104222. According to the records, Patient J. N.'s symptoms

1051included fatigue, numbness, tin gling and burning in the

1060extremities, muscle and head aches, insomnia, swelling,

1067depression and easy bruising.

107123. As to the care provided to Patient J. N., the

1082Petitioner presented the testimony of Hamilton Fish, M.D., whose

1091testimony was persuasive and is credited.

109724. According to Dr. Fish, many of the tests performed on

1108Patient J. N. were not medically indicated according to a review

1119of the information set forth in the patient's medical records.

112925. On or about September 10, 1998, the Respondent

1138diagnosed Patient J. N. with chronic fatigue, probable

1146hypothyroidism, and unspecified liver disorder. An existing

1153diagnosis of ischemic heart disease was confirmed; he prescribed

1162various medications for the patient.

116726. According to the testimony of Dr. Fish, the prescribed

1177drugs (Cytomel, Hydrocortisone, Rezulin, and a female hormonal

1185transdermal gel) were inappropriate and below the standard of

1194care, and the medical records do not justify the course of

1205treatment provided by the Respondent.

1210Patie nt T. B.

121427. On or about October 8, 1998, the Respondent ordered a

1225series of diagnostic lab tests for Patient T. B. (also

1235identified as T. P.) a 49 - year - old female.

124628. According to the records, Patient T. B.'s symptoms

1255included muscle ache, migraines, i nsomnia, vaginal discharge,

1263and neck, back and stomach pain.

126929. As to the care provided to Patient T. B., the

1280Petitioner presented the testimony of Hamilton Fish, M.D., whose

1289testimony was persuasive and is credited.

129530. According to Dr. Fish, many of the tests performed on

1306Patient T. B. were not medically indicated according to a review

1317of the information set forth in the patient's medical records,

1327and the medical treatment care provided by the Respondent to the

1338patient was inappropriate and failed to meet the applicable

1347standard of care.

135031. On or about October 21, 1998, the Respondent diagnosed

1360Patient T. B. with hyperthyroidism, migraine headaches, chronic

1368fatigue, yeast infection, and unspecified disorder of the

1376intestines, stomach, and duodenum . He prescribed various

1384medications for the patient.

138832. According to the testimony of Dr. Fish, the prescribed

1398drugs (Cytomel and Armour Thyroid) were inappropriate and below

1407the standard of care, and the medical records do not justify the

1419course of t reatment provided by the Respondent.

142733. The Respondent failed to perform a pelvic examination

1436or to refer the patient to a gynecologist despite the diagnosis

1447that she was suffering a yeast infection, and therefore failed

1457to meet the applicable standar d of care.

146534. The diagnosis of unspecified disorder of the stomach,

1474duodenum, and intestines was apparently based on described pain.

1483There is nothing in the medical record indicating that

1492appropriate testing to determine causality was ordered or

1500perfo rmed.

1502Patient A. M.

150535. On or about August 26, 1998, the Respondent ordered a

1516series of diagnostic lab tests for Patient A. M.

152536. According to the records, Patient A. M.'s symptoms

1534included muscle and head ache, constipation, cramps and

1542menstrual irre gularity, decreased libido, sore throat and sinus

1551problems.

155237. As to the care provided to Patient A. M., the

1563Petitioner presented the testimony of Hamilton Fish, M.D., whose

1572testimony was persuasive and is credited.

157838. According to Dr. Fish, many of the tests performed on

1589Patient A. M. were not medically indicated according to a review

1600of the information set forth in the patient's medical records,

1610and the medical treatment care provided by the Respondent to the

1621patient was inappropriate and failed to meet the applicable

1630standard of care.

163339. On or about September 9, 1998, the Respondent

1642diagnosed Patient T. B. with hypothyroidism, chronic fatigue,

1650hyperinsulinemia, and unspecified ovarian dysfunction. The lab

1657test results do not support the dia gnosis.

166540. On December 2, 1998, the Respondent prescribed various

1674medications for the patient. According to the testimony of

1683Dr. Fish, the prescribed drugs (Cytomel, Rezulin, Glucophage,

1691glycine, and fish oil) were inappropriate for the patient and

1701below the standard of care, and the medical records do not

1712justify the course of treatment provided by the Respondent.

1721CONCLUSIONS OF LAW

172441. The Division of Administrative Hearings has

1731jurisdiction over the parties to and subject matter of this

1741proce eding. Section 120.57(1), Florida Statutes.

174742. The Petitioner has the burden of proving by clear and

1758convincing evidence the allegations against the Respondent.

1765Ferris v. Turlington, 510 So. 2d 292 (Fla. 1987).

177443. The burden has not been met in Ca se Number 01 - 3796.

1788There is no evidence that the Respondent created, read, placed,

1798or paid for the advertisement in the newspaper.

180644. As set forth in the preceding Findings of Fact, the

1817burden has been met in DOAH Cases Numbered 01 - 3795 and 01 - 3797.

1832The Respondent failed to keep records justifying the course of

1842treatment for the patients identified herein, offered diagnoses

1850without adequate or appropriate testing, and prescribed

1857inappropriate medications to the patients based on the

1865inadequate diagnos es.

186845. Section 458.331, Florida Statutes, provides in

1875relevant part as follows:

1879458.331 Grounds for disciplinary action;

1884action by the board and department. --

1891* * *

1894(m) Failing to keep legible, as defined by

1902department rule in consultation with the

1908board, medical records that identify the

1914licensed physician or the physician extender

1920and supervising physician by name and

1926professional title who is or are responsible

1933for rendering, ordering, supervising, or

1938billing for each diagnostic or treatment

1944proc edure and that justify the course of

1952treatment of the patient, including, but not

1959limited to, patient histories; examination

1964results; test results; records of drugs

1970prescribed, dispensed, or administered; and

1975reports of consultations and

1979hospitalizations.

1980* * *

1983(q) Prescribing, dispensing,

1986administering, mixing, or otherwise preparing

1991a legend drug, including any controlled

1997substance, other than in the course of the

2005physician's professional practice. For the

2010purposes of this paragraph, it shall be

2017lega lly presumed that prescribing,

2022dispensing, administering, mixing, or

2026otherwise preparing legend drugs, including

2031all controlled substances, inappropriately or

2036in excessive or inappropriate quantities is

2042not in the best interest of the patient and

2051is not in the course of the physician's

2059professional practice, without regard to his

2065or her intent.

2068* * *

2071(t) Gross or repeated malpractice or the

2078failure to practice medicine with that level

2085of care, skill, and treatment which is

2092recognized by a reasonably pru dent similar

2099physician as being acceptable under similar

2105conditions and circumstances. The board

2110shall give great weight to the provisions of

2118s. 766.102 when enforcing this paragraph. As

2125used in this paragraph, "repeated

2130malpractice" includes, but is not limited to,

2137three or more claims for medical malpractice

2144within the previous 5 - year period resulting

2152in indemnities being paid in excess of

2159$25,000 each to the claimant in a judgment or

2169settlement and which incidents involved

2174negligent conduct by the phys ician. As used

2182in this paragraph, "gross malpractice" or

"2188the failure to practice medicine with that

2195level of care, skill, and treatment which is

2203recognized by a reasonably prudent similar

2209physician as being acceptable under similar

2215conditions and circums tances," shall not be

2222construed so as to require more than one

2230instance, event, or act. Nothing in this

2237paragraph shall be construed to require that

2244a physician be incompetent to practice

2250medicine in order to be disciplined pursuant

2257to this paragraph.

226046 . In these cases, the evidence establishes that the

2270Respondent failed to keep records justifying the course of

2279treatment provided to the patients identified herein and

2287therefore has violated Section 458.331(1)(m), Florida Statutes.

229447. The evidence estab lishes that the Respondent

2302inappropriately prescribed medications as set forth herein and

2310therefore has violated Section 458.331(1)(q), Florida Statutes.

231748. The evidence establishes that the Respondent has

2325failed to practice medicine with that level of c are, skill, and

2337treatment which is recognized by a reasonably prudent similar

2346physician as being acceptable under similar conditions and

2354circumstances and has therefore violated Section 458.331(1)(t),

2361Florida Statutes.

236349. Rule 64B8 - 8.001, Florida Admin istrative Code, sets

2373forth guidelines for imposition of disciplinary penalties based

2381upon violation of applicable statutes.

238650. For a first time violation of Section 458.331(1)(m),

2395Florida Statutes, the rule provides a range of penalties from a

2406repriman d to denial or two years' suspension followed by

2416probation, and an administrative fine from $1,000 to $10,000.

242751. For a first - time violation of Section 458.331(1)(q),

2437Florida Statutes, the rule provides a range of penalties from

2447one year probation to revocation or denial, and an

2456administrative fine from $1,000 to $10,000.

246452. For a first time violation of Section 458.331(1)(t),

2473Florida Statutes, the rule provides a range of penalties from

2483two years' probation to revocation or denial, and an

2492adminis trative fine from $1,000 to $10,000.

2501RECOMMENDATION

2502Based on the foregoing Findings of Fact and Conclusions of

2512Law, it is recommended that the Agency for Health Care

2522Administration, Board of Medicine, enter a final order suspending

2531the medical license o f Robert M. Knight, M.D., for a period of

2544one year followed by five - year period of probation, and imposing

2556an administrative fine of $5,000.

2562DONE AND ENTERED this 19th day of April, 2002, in

2572Tallahassee, Leon County, Florida.

2576____________________________ _______

2578WILLIAM F. QUATTLEBAUM

2581Administrative Law Judge

2584Division of Administrative Hearings

2588The DeSoto Building

25911230 Apalachee Parkway

2594Tallahassee, Florida 32399 - 3060

2599(850) 488 - 9675 SUNCOM 278 - 9675

2607Fax Filing (850) 921 - 6847

2613www.doah.state.fl.us

2614Filed with the Clerk of the

2620Division of Administrative Hearings

2624this 19th day of April, 2002.

2630COPIES FURNISHED :

2633Kathryn E. Price, Esquire

2637Agency for Health Care Administration

2642Post Office Box 14229

2646Tallahassee, Florida 32317 - 4229

2651Robert M. Knight, M.D.

265556 50 Camino del Sol, Number 101

2662Boca Raton, Florida 33433

2666William W. Large, General Counsel

2671Department of Health

26744052 Bald Cypress Way, Bin A02

2680Tallahassee, Florida 32399 - 1701

2685Mr. R. S. Power, Agency Clerk

2691Department of Health

26944052 Bald Cypress Way, Bin A02

2700Tallahassee, Florida 32399 - 1701

2705Tanya Williams, Executive Director

2709Board of Medicine

2712Department of Health

27154052 Bald Cypress Way, Bin A02

2721Tallahassee, Florida 32399 - 1701

2726NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

2732All parties have the right to submit wri tten exceptions within

274315 days from the date of this Recommended Order. Any exceptions

2754to this Recommended Order should be filed with the agency that

2765will issue the Final Order in this case.

Select the PDF icon to view the document.
PDF
Date
Proceedings
PDF:
Date: 07/01/2002
Proceedings: Final Order filed.
PDF:
Date: 06/21/2002
Proceedings: Agency Final Order
PDF:
Date: 04/19/2002
Proceedings: Recommended Order
PDF:
Date: 04/19/2002
Proceedings: Recommended Order issued (hearing held January 22, 2002) CASE CLOSED.
PDF:
Date: 04/19/2002
Proceedings: Recommended Order cover letter identifying hearing record referred to the Agency sent out.
PDF:
Date: 03/18/2002
Proceedings: Order issued (the parties shall file their proposed recommended orders by March 24, 2002).
PDF:
Date: 03/15/2002
Proceedings: Notice of Voluntary Dismissal without Prejudice (filed by Petitioner via facsimile).
PDF:
Date: 03/15/2002
Proceedings: Petitioner`s Proposed Recommended Order (filed via facsimile).
PDF:
Date: 03/12/2002
Proceedings: Amended Motion for Extension of Time to File Proposed Recommended Order (filed by Petitioner via facsimile).
PDF:
Date: 03/12/2002
Proceedings: Motion for Extension of time to File Proposed Recommended Orders (filed by Petitioner via facsimile).
Date: 03/04/2002
Proceedings: Transcript filed.
PDF:
Date: 01/30/2002
Proceedings: Notice of Filing Original Exhibit filed by Petitioner.
Date: 01/22/2002
Proceedings: CASE STATUS: Hearing Held; see case file for applicable time frames.
PDF:
Date: 01/14/2002
Proceedings: Petitioner`s Witness List (filed via facsimile).
PDF:
Date: 01/10/2002
Proceedings: Notice of Appearance (filed by S. Cyrus via facsimile).
PDF:
Date: 01/08/2002
Proceedings: Notice of Substitution of Counsel (filed by K. Price via facsimile).
PDF:
Date: 12/14/2001
Proceedings: Notice of Serving Petitioner`s First Set of Interrogatories (filed via facsimile).
PDF:
Date: 10/04/2001
Proceedings: Amended Notice of Hearing issued. (hearing set for January 22 through 25, 2002; 9:00 a.m.; Naples, FL, amended as to date).
PDF:
Date: 10/01/2001
Proceedings: Order of Pre-hearing Instructions issued.
PDF:
Date: 10/01/2001
Proceedings: Notice of Hearing issued (hearing set for January 21 through 25, 2002; 9:00 a.m.; Naples, FL).
PDF:
Date: 09/28/2001
Proceedings: Order Granting Consolidation issued. (consolidated cases are: 01-002115PL, 01-003795PL, 01-003796PL, 01-003797PL)
PDF:
Date: 09/27/2001
Proceedings: Initial Order issued.
PDF:
Date: 09/26/2001
Proceedings: Notice of Apperance, Requesting a Hearing (filed via facsimile).
PDF:
Date: 09/26/2001
Proceedings: Unopposed Motion to Consolidate (filed via facsimile).
PDF:
Date: 09/26/2001
Proceedings: Administrative Complaint (filed via facsimile).
PDF:
Date: 09/26/2001
Proceedings: Agency referral (filed via facsimile).

Case Information

Judge:
SUSAN BELYEU KIRKLAND
Date Filed:
09/26/2001
Date Assignment:
09/27/2001
Last Docket Entry:
07/01/2002
Location:
Naples, Florida
District:
Middle
Agency:
ADOPTED IN TOTO
Suffix:
PL
 

Counsels

Related Florida Statute(s) (3):