05-000009PL Roberta Felici-Cook, O.D., Faao vs. Department Of Health, Board Of Optometry Status: Closed Recommended Order on Thursday, June 30, 2005.

Summary: Petitioner should be awarded additional points for the clinical portion of the optometry licensure examination.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

ROBERTA FELICI - COOK, O.D., )

FAAO, )

)

Petitioner, )

)

vs. ) Case No. 05 - 0009PL

)

DEPARTMENT OF HEALTH, BOARD OF )

OPTOMETRY, )

)

Respondent. )

)

RECOMMENDED ORDER

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

on March 16, 2005, in Tallahassee, Florida, before Susan B.

Harrell, a designated Administrative Law Judge of the Division

of Administrative Hearings.

APPEARANCES

For Petitioner: Edwin A. Bayó, Esquire

Gray Robinson

301 South Bronough Street , Suite 600

Post Office Box 11189

Tallahassee, Florida 32302 - 3189

For Respondent: Allen R. Roman, Esquire

Department of Health

Office of General Counsel

4052 Bald Cypress Way, Bin A02

Tallahassee, Florida 32399 - 1703

STATEMENT OF THE ISSUE

Whether Petitioner should receive a passing grade for the

Florida Op tometry Licensure Examination taken on July 23

through 25, 2004.

PRELIMINARY STATEMENT

Petitioner, Roberta Felici - Cook, O.D. (Dr. Cook), received

from Respondent, Department of Health, Board of Optometry

(Department), a Florida Department of Health Testin g Services

Examination Grade Report , mail - dated August 20, 2004, advising

her that she received a score of 75.75 on the Optometry

Licensure Exam 2 given on July 23 through 25, 2004. The minimum

passing score was an 80. Dr. Cook requested an administrativ e

hearing, and the case was forwarded to the Division of

Administrative Hearings on January 4, 2005.

The final hearing was originally scheduled for March 15,

2005. On February 2, 2005, the Department filed a motion for

continuance, which was granted. The final hearing was

rescheduled for March 16, 2005.

The parties filed a Joint Pre - Hearing Statement and agreed

to certain facts contained in section ( e) of the stipulation.

Those facts have been incorporated into this Recommended Order.

At the final hearin g, Dr. Cook testified on her own behalf.

Petitioner's Exhibits 1 through 7 were admitted in evidence.

The Department called Priscilla Martin and Dr. Gary McDonald as

its witnesses. Respondent's Exhibits 1 through 11 were admitted

in evidence, and Respon dent's Exhibits 1 through 6 were sealed.

The parties agreed to file their proposed recommended

orders within ten days of the filing of the Transcript, which

was filed on June 6, 2005. Dr. Cook filed Petitioner's Proposed

Recommended Order on June 14, 200 5. The Department filed

Respondent's Proposed Recommended Order on June 15, 2005. Both

proposed recommended orders have been considered in rendering

this Recommended Order.

FINDINGS OF FACT

1. Dr. Cook is a licensed optometrist in the State of

Michigan . She received her Doctor of Optometry degree in 1985,

and became licensed in the same year. Dr. Cook has taken the

Michigan, Illinois, and Wisconsin state licensure examinations

and passed all three examinations on her first try.

2. For 17 years, Dr. C ook practiced optometry at the

University of Michigan Health Services. This was a

comprehensive practice, including eye examinations with

dilation, treatment of eye diseases, emergency care, and the

monitoring and follow - up care of patients with glaucoma,

cataracts, and other diseases. E xcept for providing care to

family members, Dr. Cook has not practiced professionally, on a

regular basis, since August 2001, when she moved to Florida.

3. Dr. Cook is a Fellow of the American Academy of

Optometry. She w as accepted at the final hearing as an expert

in optometry.

4. Dr. Cook desires to become licensed in Florida to

practice optometry. As part of the process to apply for

licensure in Florida, Dr. Cook is required to retake parts one

and two of the nationa l board examinations and to pass the

Florida examination for licensure. She retook the national

board examinations and passed on the first try. In August 2003,

she took the clinical portion of the Florida examination and

failed.

5. In July 2004, Dr. Co ok retook the clinical portion of

the Florida examination. A passing score on the clinical

portion is 80. She scored 75.75 on the July 2004 examination ,

and, thus, failed the clinical portion.

6. For the clinical examination, Dr. Cook was required to

br ing her own "patient" upon whom some of the examination's

required procedures were required to be performed. Some of the

procedures are performed on "patients" brought by other

candidates taking the examination.

7. The grading on each procedure in the clinical

examination is done by two examiners who are licensed,

practicing optometrists. A candidate will be graded by a

different set of examiners for the morning and afternoon

sessions. The examiners are chosen by the Board of Optometry

and trained by the Department's Testing Services Unit and

outside practitioner consultants prior to the administration of

each examination. The examiners are provided with a set of

Grading Standards for their use during the grading of the

examination. The purpose of th e training and standards is to

make the grading process objective and to provide grading

uniformity and consistency.

8. The examiners are required to grade and mark their

scores independently. They are not to compare or discuss their

scoring with other e xaminers at any time. If both examiners'

grades agree, the candidate is given either no credit or full

credit, depending on whether the examiners considered the

procedures were properly performed. If the examiners disagree

on the grading, the candidate i s given the average of the two

grades actually awarded, which is the sum of the two grades

divided by two.

9 . If an examiner considers that a procedure is properly

performed, the examiner marks the grade sheet with a "Y,"

indicating a yes. Examiners are taught to give the candidates

the benefit of the doubt in borderline cases. If an examiner

feels that the performance was borderline, the examiner must

indicate "borderline" in the comment section on the grade sheet

and specify the reason. If an examiner determines that the

candidate did not properly perform the procedure, the examiner

marks the grade sheet with a n "N," indicating a no. An examiner

is required to specify the reason for a no grade in the comment

section on the grading sheet.

10 . Some of the procedures are performed once for both

examiners . Other procedures are performed in groups , meaning

that the procedures are performed twice, once before each of the

examiners. In grouped procedures, the first examiner will read

the directions for a p rocedure, and the candidate will perform

the procedure after the directions are given. The first

examiner will read the directions for the next procedure, and

the candidate will perform the procedure after the directions

are read. This format continues u ntil the grouped segment is

completed. The same procedures will then be performed for the

second examiner, following the same format used by the first

examiner. No records are kept to indicate which examiner graded

first or second during any part of the examination. The

examination candidate has control over when each examiner grades

the candidate. When the candidate is ready to be graded, the

candidate is required to say, "Grade me now."

1 1 . Dr. Cook has challenged the grades that she received

for the following procedures: confrontational field test;

measurement of pupil size; rating patient's response to light;

demonstrating the equator and posterior pole during the

binocular indirect ophthalmoscopy examination; the anterior

vitreous portion of the b iomicroscopy examination of the

anterior segment; the choroidal crescent, posterior vitreous

detachment, A - V three crossings out find and reflex, and

hypertensive changes portion of the biomicroscopy examination of

the fundus; and measuring eye pressure us ing a Goldmann

Tonometer.

1 2 . A confrontational field test is a gross neurological

field test in which the candidate compares h er visual field to

the patient's to pick up gross neurological defects. The

Candidate Information Booklet (CIB) states that th e

confrontational field test is to be performed as described in

Clinical Opthalmology by J.D. Duane. In order to perform this

test, the candidate sits in front of the patient about a meter

away. The patient covers one eye and looks at the candidate's

eye , nose , or other structure so that the patient's gaze is not

moving around. The candidate puts h er non - moving fingers in

different quadrants to test the patient's ability to see the

fingers. It is important to keep the fingers stationary while

performing the test because moving fingers could be detected by

the patient even in a blind field. In other words, a patient

who is not able to see a stationary finger may be able to detect

a finger that is moving because the motion contributes to the

detection.

1 3 . Dr. Cook performed the confrontational field test for

both examiners simultaneously. She received .75 points out of a

possible 1.5 points for the confrontation field test.

Examiner 202 gave Dr. Cook full credit for the examination.

Examiner 239 gave Dr. Cook no credit and noted the following in

the comment section: "Moving fingers -- Init performed 'wiggling

fingers' while moving target fingers." Examiner 239 also noted

"Did very brief static CF test but fingers moving not

stationary." Dr. Cook admi tted that she did wiggle her fingers

during part of the performance of the examination, claiming that

she was testing the patient's peripheral vision, which was not

part of the examination. The examination was to be performed

within the central 30 degrees . The preponderance of the

evidence does not establish that Dr. Cook tested the four

quadrants with non - moving fingers. Dr. Cook's score of .75

points is correct.

1 4 . As part of the clinical examination, the candidates

are required to measure the size o f the patient's pupil. In

order to measure the pupil, the candidate must not sit in front

of the patient. Sitting in front of the patient creates a

stimulus for accommodation, which is a phenomenon where the

pupil size changes unless the patient can look and focus on a

target at a distance.

1 5 . Dr. Cook measured the pupil size of her patient

simultaneously for both examiners. Examiner 202 gave Dr. Cook

full credit for her performance in measuring the pupil size, and

Examiner 239 did not give Dr. Cook cr edit for her performance.

Examiner 239 noted in the comment section, "candidate sat in

front of pt." Dr. Cook received .5 points out of a possible one

point for measuring the pupil size during the pupillary

examination.

1 6 . Dr. Cook claims that she sat off to the side of the

patient, lined up her right eye with the patient's right eye ,

and asked the patient to sight at a target at a distance. The

examiners were off to the side when Dr. Cook performed the

procedure. The preponderance of the evidence doe s not establish

that Dr. Cook was in the correct position when she measured the

patient's pupil size. Dr. Cook's score of .5 is correct.

1 7 . As part of the examination, candidates are required to

rate the patient's pupillary response to light on a pupill ary

scale. The CIB states, "Pupillary examinations, muscle balance,

and motility, should be done on both eyes (including dilated

eye)." Examiner 202 gave Dr. Cook full credit for rating the

pupil, but indicated that her performance was borderline.

Exami ner 202 stated in the comment section: "borderline - she

was confused about 0 to 4, but eventually got it." Examiner

239 gave Dr. Cook no credit for her performance, and stated in

the comment section: "4 but did not indicate eye, not used to

using 0 t o 4 scale." Dr. Cook received .5 points out of a

possible one point for rating the pupil on a pupillary scale.

She gave the same answer simultaneously to both examiners.

1 8 . When Dr. Cook was asked to rate the pupils of her

patient, Dr. Cook was uncerta in which scale to use, the Marcus

Gunn scale or a true light reflex scale. She indicated that she

gave a response for both scales and that one of the responses

was 4. Dr. Cook stated at the final hearing that the left

pupil was fixed and dilated, but sh e did not indicate that she

rated the left eye as "0." The preponderance of the evidence

does not establish that Dr. Cook advised the examiners of her

rating of the left pupil. The score of .5 was correct.

1 9 . The binocular indirect ophthalmoscope (BIO) is an

instrument used to examine the fundus, which is the inside back

part of the eye. The BIO sits on the candidate's head. There

is a small mirror attached, through which another viewer may see

the view being seen by the candidate. The candidate hold s a

condensing lens, which is like a magnifying glass, to evaluate

structures in the eye. Examining the fundus with the BIO is a

simple procedure, which Dr. Cook performed 14 to 16 times every

clinical day for over 17 years.

20 . Dr. Cook wore contact len s es during the examination.

With the use of contact lens es , Dr. Cook has perfect vision.

Dr. Cook adjusted the instrument before the testing procedure

started, including adjusting the angle of light and setting the

illumination.

2 1 . As part of the exami nation on the use of the BIO, a

candidate is to demonstrate the equator and the posterior pole.

In these procedures, the candidate finds the view of the

applicable area, one examiner looks through the mirror after the

candidate says "Grade me now," and th en steps back. The second

examiner then looks at the mirror after the candidate again says

"Grade me now."

2 2 . Examiner 239 did not give full credit to Dr. Cook in

demonstrating the equator. For the portion of the performance

which requires the candid ate to demonstrate an equator landmark,

Examiner 239 gave Dr. Cook a "no" and stated in the comment

section: "No clear view through the mirror @ 'Grade me now.'"

Examiner 239 also gave Dr. Cook a "no" for an acceptable view of

an equator landmark and sta ted in the comment section: "Dim

illumination." Examiner 202 gave Dr. Cook credit for these two

performance areas.

2 3 . In the portion of the examination in which the

candidate is to demonstrate the posterior pole, the candidate is

told that the disc a nd macula should be seen simultaneously.

Examiner 239 did not give Dr. Cook credit for the portion of the

examination where the disc and macula are to be view ed

simultaneously. Examiner 239 stated in the comment section:

"very dim view vis'd ONH not mac ula." Examiner 202 gave

Dr. Cook credit for this portion of the examination.

2 4 . Between the first and second examiners' viewings for

the equator and the posterior pole, the patient did not move,

Dr. Cook held the focused view still, there was no chang e in

illumination or intensity, and Dr. Cook did not change her

position. Thus, it is more likely than not that Examiner 239

was mistaken. Dr. Cook received 3.5 points out of a possible

seven points for examining the views of the equator and

posterior po le during the binocular indirect ophthalmoscopy

examination. She should be credited with an additional 3.5

points.

2 5 . As part of the examination, the candidates were asked

to perform an examination using a biomicroscope, which is a

microscope combined w ith a light source that is used to view

different structures on the outside and inside of the eye. It

is also called a slit lamp. For purposes of the licensure

examination, the biomicroscope has a teaching tube attached

through the left ocular, and when the examiner looks through the

tube s he sees the same view the candidate sees through the left

ocular.

2 6 . A portion of the examination using the biomicroscope

includes grouped procedures . The last procedure on one of the

grouped procedures was focusing on the anterior vitreous of the

patient's eye.

2 7 . The vitreous is made up of hyaluronic acid and

contains vitreal strands made of collagen. As a person ages,

the vitreal strands will increase and become more visible. A

young patient may have vitreal strands that would be so

difficult to see that on viewing the strands the view would

appear to be "optically empty." In other words, the vitreous

would appear clear on examination. Dr. Cook's patient was a

healthy premed student in his early twenties. T he patient did

not have visible vitreal strands.

2 8 . Before performing the group of procedures, which

included the focus of the anterior vitreous, Dr. Cook adjusted

the height and width of the light. She set for a direct focal

illumination, meaning the l ight was focused where she was

looking. The patient remained still between the procedures, and

Dr. Cook did not change the illumination between each grading.

2 9 . Examiner 216 gave Dr. Cook no credit for her focus of

the anterior vitreous, stating the ill umination was "too dim"

and the "vit not seen." Examiner 268 gave Dr. Cook full credit

for that part of the examination. Dr. Cook received 1.25 points

out of a possible 2.5 points for her performance related to the

anterior vitreous portion of the biomic roscopy exam of the

anterior segment.

30 . Based on the patient 's having no visible vitreal

strands; the patient not moving between the grading procedures,

and Dr. Cook not changing the illumination between grading

procedures, it is more likely than not th at Examiner 216 was

mistaken. Dr. Cook should be awarded 1.25 points for

performance of the focus on anterior vitreous.

3 1 . Dr. Cook received 3.5 points out of a possible seven

points for her performance related to the choroidal crescent,

posterior vitre ous detachment, A - V three crossing outs , find and

reflex, and hypertensive changes portion of the biomicroscopy

exam of the fundus.

3 2 . One of the grouped portions of the examination using

the biomicroscope included demonstrating whether a choroidal

cresc ent was present. Determining the presence of a choroidal

crescent was the fourth procedure in this grouped segment. A

choroidal crescent can be seen when the candidate is looking at

the optic nerve and the retina does not come all the way up to

the nerve . The choroidal crescent will appear at the edge of

the optic nerve.

3 3 . Examiner 268 did not give Dr. Cook any credit for

determining whether the choroidal crescent was present, and

stated in the comment section, "Did not focus on the edges of

the ONH [ optic nerve head]." Examiner 216 gave Dr. Cook full

credit for the procedure. Dr. Cook did not demonstrate by the

greater weight of the evidence that she should be given

additional credit for this procedure. Unlike the evidence

presented concerning the anterior vitreous, she did not

establish that there was no change in illumination, her

position, or the patient's position between the grading of the

grouped segments. In order to perform the grouped procedures in

which she was tested on the presence of t he choroidal crescent,

Dr. Cook had to move the focus and illumination to different

locations related to the optic nerve.

3 4 . The last procedure in the same grouped segment

involving the choroidal crescent was demonstrating posterior

vitreous separation. Vitreous gel is attached to the back of

the eye in several places. When the attachment points for the

vitreous are pulled away or become loose, a ring - like structure

can be seen where the vitreous pulled loose. Dr. Cook was asked

to demonstrate and indi cate whether a vitreous separation was

present after she performed the procedure involving the

choroidal crescent. The proper procedure for checking for

posterior vitreous attachment would be to set the proper

illumination, focus on the optic nerve, and p ull back slightly

on the "joy stick."

3 5 . Examiner 268 did not give Dr. Cook any credit for the

procedure involving a demonstration of a posterior vitreous

separation, stating in the comment section, "Did not pull back."

Examiner 216 gave Dr. Cook full credit for the procedure.

Again, Dr. Cook failed to establish by a preponderance of the

evidence that she should be given additional credit for this

portion of the examination. There was no showing that all

conditions remained the same when each examine r graded this

grouped segment of procedures.

3 6 . Another grouped segment of the examination called for

Dr. Cook to start at the optic disc and follow a temporal arcade

for a distance of approximately three disc diameters and

demonstrate an AV crossing. D r. Cook was to then indicate

whether there were any characteristic hypertensive changes at

the crossing. A vascular arcade is a curved shape with blood

vessels coming out and arcing toward one another. Most of the

blood vessels in the eye are located in this area. Some

diseases such as diabetes and hypertension cause changes where

the blood vessels in the arcade cross.

3 7 . In order to perform the AV crossing procedure, a

candidate has to coordinate the microscope, going up and down

and side by side. L ining up is critical on this procedure.

Adjustments have to occur separately, once for each examiner.

Examiner 268 did not give credit to Dr. Cook for this portion of

the examination, stating in the comment section, "No view in the

tube." Examiner 216 g ave Dr. Cook full credit for the

procedure. Dr. Cook has failed to establish that she is

entitled to additional points for this portion of the

examination. The AV crossing procedure involves making

adjustments for each of the examiners as part of the

exa mination, Dr. Cook has not demonstrated by a preponderance of

the evidence that all conditions remained the same for each

examiner.

3 8 . As part of the examination, candidates are tested on

the use of the Goldmann Tonometer, which is a device used to

measu re eye pressure. The grading on this portion is divided

into four categories: illumination at the proper angle, mires

alignment, thickness of alignment, and the pressure measurement.

Examiner 268 gave Dr. Cook full credit for all categories.

Examiner 2 16 did not give credit to Dr. Cook for having the

correct mires alignment, and gave full credit for the remaining

categories, indicating that the mires width and the reading of

the pressure were borderline. In the comment section,

Examiner 216 drew the al ignment which he viewed. The mires were

not aligned correctly. Dr. Cook received 1.24 - 1.50 points out

of a possible 2.5 - 3.0 points for the use of the Goldmann

Tonometer.

3 9 . Dr. Cook argues that because she was given credit for

the pressure reading that it would be impossible for the mires

alignment to be incorrect. The reading of the pressure is to

test the candidate's ability to read the dial on the tonometer ;

it is not to determine whether the reading that is on the dial

is the actual pressure of the patient. The grading standards

require that the examiner put down the reading that he saw

during the viewing if it is different from the reading that the

candidate gives as a response. Thus, it is possible to be given

credit for the pressure reading wit hout having the mires aligned

correctly. Dr. Cook has not demonstrated by a preponderance of

the evidence that she should be given additional credit for this

portion of the examination.

40 . None of the examiners testified at the final hearing.

The Depar tment did call Dr. Gary McDonald, who was accepted as

an expert in optometry.

CONCLUSIONS OF LAW

4 1 . 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. (2004).

4 2 . Florida Administrative Code Rule 64B13 - 4.001 provides

that a candidate "must attain a score of 80 percent or better in

order to secure a passing grade on the clinical portion of the

practical examination."

43. As the applicant for a license, Dr. Cook has the

burden to establish by a preponderance of the evidence that she

has passed the examination. See Pershing Industries, I nc. v.

Department of Banking and Finance , 591 So. 2d 991 (Fla. 1st DCA

1991); Florida Department of Transportation v. J .W.C. Co. , 396

So. 2d 778 (Fla. 1st DCA 1981).

4 4 . Dr. Cook did establish by a preponderance of the

evidence that she should be given an additional 3.5 points for

demonstrating the equator and posterior pole during the BIO

portion of the examination and a n additional 1.25 points for the

focus of the anterior vitreous. The testimony was unrebutted

that Dr. Cook had perfect vision with her contact lenses, which

she wore during the examination; she did not make adjustments

for these procedures between the gr ading by the examiners; and

the patient did not move between the gradings. Additionally,

the patient did not have visible vitreal strands.

4 5 . The testing of the equator, posterior pole, and

anterior vitreous was similar to those in Martuccio v.

Departme nt of Professional Regulation, Board of Optometry , 622

So. 2d 607 (Fla. 1st DCA 1993). In Martuccio , the candidate was

qualified to practice optometry in another state, had

successfully passed the written examination, had failed the

clinical portion of th e examination, had retaken the clinical

portion of the examination, and was qualified as an expert in

optometry at the final hearing. The appellate court upheld the

hearing officer's recommendation that Dr. Martuccio should be

given additional credit base d on the following findings:

As to the binocular indirect

opthalmoscopy [sic] , the hearing officer

accepted Dr. Martuccio's testimony that the

subject patient remained still during the

examination process and thus concluded that

one of the graders made a mistake in his

evaluation that this demonstration was "out

of focus." On the anterior biomicroscopy 4

examination, the applicant is required to

use a slit lamp to project a beam of light

into the patient's eye. One grader

concluded that Dr. Martuccio erroneously

projected an optic section rather than a

parallelpiped [sic] from the slit lamp.

Dr. Martuccio testified, however, that he

did not change the adjustment on the lamp

which controls the width of the beam of

light. Accepting this testimony, the

hearing officer decided that one of the

examiners rather than Dr. Martuccio, was

mistaken. For anterior biomicroscopy 9, the

applicant is required to focus on vitreous

strands on the anterior vitreous of the eye.

In healthy patients, such vitreous strand s

are not present, and the anterior vitreous

will appear clear when illuminated by a beam

of light from the slit lamp. The examiner

who failed Dr. Martuccio on this procedure

observed that vitreous stands were not

visible. Dr. Martuccio explained, howeve r,

that the subject patient had a healthy eye

which did not have vitreous strands. The

hearing officer accepted this testimony and

concluded that the examiner's comment

concerning vitreous strands was

inappropriate, indicating he used an

erroneous criteri on. On the gonioscopy

examination, one of the examiners commented

that the structures of the eye which are

examined in this procedure were out of

focus. The hearing officer accepted

Dr. Martuccio's testimony that the subject

patient did not move, and acc ordingly that

the structures remained in focus during the

examination.

Id. at 608 - 609.

4 6 . Dr. Cook has failed to establish by a preponderance of

the evidence that she should be given additional points for the

remaining portions of the examination which she challenged and

did not receive full credit for the reasons set forth in the

findings of fact.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law, it is

RECOMMENDED that a final order be entered awarding Dr. Cook

an addition al 4.75 points for the clinical portion of the

optometry licensure examination given on July 23 through 25,

2004, resulting in a passing grade of 80.25.

DONE AND ENTER ED this 30th day of June , 2005 , 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

(850) 488 - 9675 SUNCOM 278 - 9675

Fax Filing (850) 921 - 6847

www.doah.state.fl.us

F iled with the Clerk of the

Division of Administrative Hearings

this 30th day of June , 2005 .

COPIES FURNISHED :

Edwin A. Bay ó , Esquire

Gray Robinson

301 South Bronough Street, Suite 600

Post Office Box 11189

Tallahassee, Florida 32302 - 3189

Allen R. Rom an, Esquire

Department of Health

Office of General Counsel

4052 Bald Cypress Way, Bin A02

Tallahassee, Florida 32399 - 1703

Joe Baker, Jr., Executive Director

Board of Optometry

Department of Health

4052 Bald Cypress Way, Bin C07

Tallahassee, Florida 3239 9 - 1701

R. S. Power, Agency Clerk

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 written exceptions within

15 days from the date of this Reco mmended Order. Any exceptions

to this Recommended Order should be filed with the agency that

will issue the Final Order in this case.