05-003133PL Department Of Health vs. Scott Drizin, D.C. Status: Closed Recommended Order on Wednesday, November 30, 2005.

Summary: Photography without the patient`s consent and of limited diagnostic value is a violation of the standard of care.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF HEALTH, )

)

Petitioner, )

)

vs. ) Case No. 05 - 3133PL

)

SCOTT DRIZIN, D.C., )

)

Respondent. )

)

RECOMMENDED ORDER

On October 17, 2005 , an administrative hearing in this case

was held in St. Petersburg, Florida, before William F.

Quattlebaum, Administrative Law Judge, Division of

Administrative Hearings.

APPEARANCES

For Petitioner: Ephraim D. Livingston, Esquire

Depa rtment of Health

4052 Bald Cypress Way, Bin C - 65

Tallahassee, Florida 32399 - 3265

For Respondent: Louis Kwall, Esquire

Kwall, Showers, Coleman & Barack, P.A.

133 North Fort Harrison Aven ue

Clearwater, Florida 33755

STATEMENT OF THE ISSUE S

The issue s in the case are whether the allegations of the

Administrative Complaint are correct, and , if so, what penalty

should be imposed.

PRELIMINARY STATEMENT

By Administrative C omplaint dated May 26, 2005, the

Department of Health (Petitioner) alleged that Scott Drizin,

D.C. (Respondent) , violated certain Florida Statutes related to

the provision of chiropractic services. The Respondent disputed

the allegations and requested a f ormal administrative hearing.

The Petitioner forwarded the matter to the Division of

Administrative Hearings, which scheduled the hearing to commence

on October 17, 2005.

At the hearing, the Petitioner presented the testimony of

two witnesses and had Ex hibits 1 and 2 admitted into evidence.

The Respondent presented the testimony of two witnesses and

testified on his own behalf, and had Exhibits 1 through 5, 7, 10

through 12, 14, and 1 5 admitted into evidence.

The hearing T ranscript was filed on Octobe r 31, 2005. Both

parties filed Proposed Recommended Orders that have been

considered in the preparation of this Recommended Order.

FINDINGS OF FACT

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

a licensed chiropractic physician, holding Fl orida license

number CH 5839.

2. In addition to his chiropractic training, the

Respondent has completed a course of study in biomechanics and

has received a "Masters of Professional Studies" degree from

Lynn University in Human Biomechanical Trauma. He advertised

services related to "Human Biomechanical Trauma" to other

chiropractic physicians practicing in the same geographic area.

3. On November 29, 2001, a twenty - nine - year - old female

(referred to hereinafter as the patient) presented herself to

th e Respondent's office complaining of back pain of

approximately two weeks duration.

4. The patient was a former gymnast with many years of

training. Her regular exercise routine included weight lifting ,

and the onset of her back pain occurred while she w as lifting

weights. Initially the pain was in the area of her mid - back and

during the subsequent weeks had progressed to her lower back,

and to her upper back and neck.

5. The patient also had a history of migraine - type

headaches unrelated to the weight lifting and for which she had

sought previous treatment with limited success from another

physician.

6. On November 29, 2001, the Respondent completed a

medical history and performed an evaluation of the patient's

condition. The Respondent provided tre atment and adjustment.

7. During the time the patient received treatment, she

removed all clothing but for her underpants, at the Respondent's

direction. A robe was provided inside the treatment room for

her to wear after undressing and before the trea tment was

provided.

8. After providing the treatment on November 29, the

Respondent referred the patient to another facility for a series

of x - rays.

9. On November 30, 2001, the patient returned for

additional treatment at which time the Respondent per formed an

adjustment to the patient's neck and back. After the treatment

was completed and the Respondent exited the room, the patient

began to dress, at which point the Respondent entered the room

holding a digital camera.

10. The patient testified th at the Respondent removed her

robe, leaving her clad only in her underpants, that the

Respondent told her that the photography was a routine office

practice, and that he could not continue the treatment unless

the photographs were taken.

11. The patient testified that the Respondent was

aggressive while the photographs were taken, speaking with a

"raised voice" and moving quickly, instructing her on how to

pose, and moving her arms and legs into position.

12. The patient testified that during the inci dent she was

scared and in a "dazed state," and that she didn't know how many

photos were taken or how much time elapsed during the photo

session. She made no attempt to leave the examination room

until after the photos were taken.

13. The Respondent d enied that he told the patient that

the photographic evaluation was a routine office procedure. The

Respondent testified that he discussed the photographic

evaluation with the patient and that she permitted the photos to

be taken. He testified that he bo th verbally directed and

demonstrated by example, the positions in which he sought to

photograph the patient. He further testified that some of the

positions came from the patient when describing her "activities

of daily living." He testified that s he pa rticipated in the

photography willingly and without protest.

14. Other than the Respondent and the patient, no one else

was in the room during the time the photographs were taken.

15. The Respondent's offices consisted of a small suite of

rooms located in a strip shopping center. Based on the physical

structure of the offices described at the hearing, it is

unlikely that voices could be raised to the point of "yelling"

without others in the office being aware of the situation.

There is no evidence tha t the patient was physically prevented

from leaving the office.

16. Although the patient signed a generic release for

treatment when she began seeing the Respondent, the patient

testified that the release was essentially blank at the time she

signed.

17. In addition to the generic consent for treatment form,

the Respondent's office had prepared a separate "Consent

Agreement Concerning Biomechanic Photographic Evaluation" which

provided as follows:

Dear Patient:

Holistic Healthcare Centers offers

Biom echanic Photographic Evaluation for the

purpose of specific biomechanic assessment

of the patient. The procedure will include

some or all of the following:

1. Digital photos of the patient in various

positions, movements and activities. These

photograp hs will be taken with the patient

partially or completely unclothed, as

determined by the physician(s).

2. Processing and analysis of these

photographs on computers either on the

premises or at another location, to be

determined by the physician(s).

3. Reportage to the patient as to the

results of the analyses.

Restrictions on the use of these photographs

include:

1. Photographic data will be kept in

password protected locations and will be

accessible only by Dr. Scott Baker and Dr.

Scott Drizin.

2 . Appropriate hard copies of photographs

will be kept in the patient's confidential

case file, if needed.

3. The photographic data will not be

published either in print or electronically

without the patient's express written

consent.

4. Utilizations o f photographs, data and

analyses results can be used educationally

while protecting the privacy of the patient.

I HAVE READ, UNDERSTAND AND CONSENT TO THE

ABOVE. Under the conditions indicated, I

hereby place myself under your care for

those procedures as described above as

indicated in your professional judgment.

18. The "Consent Agreement Concerning Biomechanic

Photographic Evaluation" provided a space for the signature of

the person from whom consent is being sought and for the

signature of a witnes s.

19. The patient did not sign the photographic consent

form. At no time did the patient sign any written release

specifically allowing the Respondent to take photographs.

20. According to his note handwritten on the "Consent

Agreement Concerning B iomechanic Photographic Evaluation," the

Respondent became aware at some point that the patient had not

signed the photo consent form.

21. A few days after the photos were taken, the patient

returned to the Respondent's office and inquired about the

photo graphs. By that time, the digital photo files had been

transferred from the camera used to take the photos to a

computer located in the Respondent's office.

22. After the patient requested to view the photos, the

Respondent went to a computer where the digital photo files were

stored. The Respondent and the patient reviewed the photographs

for about 45 minutes. During the photo review, the Respondent

made comments that could be construed as relating to the

patient's posture. According to the patient' s testimony, such

comments included "you're standing a little to the left on this

one and you should be standing more upright on this one" and

"see, you're standing crooked, you should be standing straight."

23. During the photo review, the Respondent tol d the

patient that he and his partner, Dr. Scott Baker, were

interested in writing a book and pursuing additional medical

training. The patient testified that the Respondent may have

used the word "biomechanics" during the photo review, but was

not certai n.

24. After the photos were reviewed, the patient asked for

a copy of the digital image files. Initially the Respondent

declined to produc e the files, but by the end of the

appointment, after receiving additional therapeutic treatment

and adjustments, t he Respondent provided to the patient a disc

containing the photo files. According to the patient, the

Respondent advised the patient not to show the photographs to

anyone.

25. After the patient received a copy of the photo files,

she did not again see t he Respondent in a therapeutic setting.

She cancelled her remaining appointments with the Respondent,

obtained her X - rays from the Respondent's practice, and sought

treatment elsewhere.

26. After the patient cancelled the appointments, she

received at least one call from the Respondent's secretary

inquiring as to the reason for the cancellation. During the

call, the Respondent spoke to the patient and inquired as to

whether there were problems, at which point the patient advised

that s he would not retu rn to the Respondent for treatment.

27. At the hearing, the Petitioner presented the expert

testimony of Dr. Michael Major, a Florida - licensed chiropractic

physician. Although Dr. Major appears to be knowledgeable about

biomechanics, he has not underta ken any advanced education in

biomechanics.

28. Dr . Major testified one of the reasons to use

photography i n a chiropractic setting would be to observe

structural changes that could occur related to treatment.

Dr. Major testified that such photos are g enerally taken from

front, side, or rear perspectives, and utilize spinal or

anatomical "landmarks" for purposes of comparing pre - treatment

and post - treatment conditions.

29. Dr. Major further testified that he has used digital

photography in his practi ce, generally placing subjects in front

of a grid - pattern marked on a wall. Dr. Major's grid system

also includes a bilateral scale to identify weight - bearing

issues. By using the photo of the subject in front of the grid

and on the scale, a chiropractic physician is able to show to a

photographic subject various spinal or postural conditions.

Dr. Major has used this system in marketing services to

prospective clients.

30. Dr. Major termed photos taken from positions other

than in front of, to the sid e of, or from behind a patient as

"oblique" angle photos. Dr. Majors testified that such photos

had very little analytical value because of the difficulty in

accurately reproducing at a subsequent date, the angles from

which the original photographs were taken, thus making

comparison between the sets of photographs difficult.

31. Dr. Major testified that, when taking a later set of

photos, w h ere the angle of camera placement relative to the body

is different from the original camera placement by only a few

degrees, the later photograph would offer little comparative

value because the landmarks would not be located appropriately.

32. A review of the photographs in evidence indicates that

the patient was photographed in a routine examination room,

posed in various positions, and unclothed but for her

underpants.

33. At the hearing, Dr. Major reviewed the photos offered

into evidence and opined that although some of the photos taken

by the Respondent of the patient provided appropriate diagnostic

infor mation, others did not.

34. Dr. Major testified where the photos did not contain

appropriate diagnostic information, the Respondent violated the

applicable standard of care by not utilizing the best techniques

in order to isolate planes of motion suffic iently to provide

useful information.

35. Dr. Major also testified that the failure to obtain

the patient's consent prior to taking photographs was a

violation of the applicable standard of care.

36. Dr. Major opined without elaboration that taking the

photographs without the patient's consent also constituted

sexual misconduct.

37. According to Dr. Major, the failure to have another

female present in the room during an exam was not a violation of

the applicable standard of care.

38. The Respondent o ffered evidence related to his use of

photography and the development of a "protocol" that he and his

partner were creating to document biomechanical evaluations of

certain patients.

39. In addition to the Respondent's testimony, the

Respondent presente d the testimony of Scott M. Baker, D.C., who

was in practice with the Respondent at the time of the events at

issue.

40. At some point in the mid - 1990's, Dr. Baker and the

Respondent became interested in continuing their education in

biomechanics, and b oth completed the additional biomechanics

training referenced herein. Part of their interests included

conducting research to develop a "protocol" for biomechanical

evaluation.

41. Part of the protocol included photographic evaluations

of patients. Th e model apparently being followed referenced

radiological studies where multiple X - rays from different angles

were taken of a patient during diagnostic testing.

42. However, although the Respondent asserted that the

photographs were part of the treatmen t offered to the patient,

Dr. Baker testified that the photos were not actually taken for

diagnostic purposes. The alleged purpose of the photos was to

educate a patient on existing conditions with the ability to

demonstrate at a later date, visible progr ess though the use of

comparative photography.

43. Dr. Baker testified that after the Respondent took the

photos of the patient, he and the Respondent reviewed the photos

and indexed them by reference to anatomical characteristics.

Dr. Baker acknowledg ed that some of the photos "weren't useful , "

but that it was preferable to err towards taking too many photos

rather than too few, and that the intent was to discard those

photos that were not useful.

44. The consent form specific to the photographic st udy

also indicates that the photos may be used for educational

purposes with appropriate protection of a patient's privacy.

45. Dr. Baker acknowledged that the protocol was in

preliminary stages of development and that greater specificity

would be requi red as development continued. Prior to the

patient in this case, only one other chiropractic client had

been photographed based on the protocol.

46. When the photographs of the patient were taken, the

position from which each photo was taken was not re corded.

Dr. Baker testified that when subsequent photos were taken for

comparative purposes, the photo subject would have to be

repositioned based on the earlier photograph, using an

anatomical point of reference.

47. No visible grid pattern was presen t in the room where

the patient's photos were taken and no grid is present in the

photos taken of the patient by the Respondent.

48. In order to view the photos, the Respondent planned to

use a graphics software program called "Paint Shop Pro" which

could allow a grid to be superimposed on a photograph. Whether

the computer imposition of a grid pattern on a photo taken

subsequently would provide specific anatomical references

sufficient to compare the photos is unknown.

49. The asserted reason why the patient wore only

underpants in the photos was that wearing a bra would alter the

center of gravity being measured. The Respondent further

testified that wearing a bra could cause a "cutaneous sensory

response" that could lead to a "reflex muscle spasm wh ich would

alter the center of gravity." The evidence fails to establish

why the same reasoning was not applicable to the underpants that

the Respondent directed the patient to leave on.

CONCLUSIONS OF LAW

50. The Division of Administrative Hearings ha s

jurisdiction over the parties to and the subject matter of this

proceeding. §§ 120.569 and 120.57, Fla . Stat . (2001).

51. The Petitioner is the state agency charged with the

regulation of licensed chiropractic physicians in the State of

Florida. See C h. 456 and 460 , Fla. Stat . (2001).

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

convincing evidence the allegations set forth in the

Administrative Complaint against the Respondent. Department of

Banking and Finance v. Osborne Stern and Comp any , 670 So . 2d

932, 935 (Fla. 1996) ; Ferris v. Turlington , 510 So. 2d 292 (Fla.

1987). Clear and convincing evidence is that which is credible,

precise, explicit , and lacking confusion as to the facts in

issue. The evidence must be of such weight that i t produces in

the mind of the trier of fact the firm belief of conviction,

without hesitancy, as to the truth of the allegations.

Slomowitz v. Walker , 429 So. 2d 797, 800 (Fla. 4th DCA 1983).

53. Count One of the Administrative Complaint alleges that

t he Respondent failed to practice chiropractic care with the

level of care, skill, and treatment recognized by a reasonable

prudent similar chiropractic physician, by requiring the patient

to disrobe and pose for "biomechanical profile" photographs

and/or b y failing to obtain written consent for the photographs.

54. S ubs ection 460.413(1)(r), Florida Statutes (2001),

provides as follows :

(1) The following acts constitute grounds

for denial of a license or disciplinary

action, as specified in s. 456.072(2):

* * *

(r) Gross or repeated malpractice or the

failure to practice chiropractic medicine at

a level of care, skill, and treatment which

is recognized by a reasonably prudent

chiropractic physician as being acceptable

under similar conditions and cir cumstances.

The board shall give great weight to the

standards for malpractice in s. 766.102 in

interpreting this provision. A recommended

order by an administrative law judge, or a

final order of the board finding a violation

under this section shall sp ecify whether the

licensee was found to have committed "gross

malpractice," "repeated malpractice," or

"failure to practice chiropractic medicine

with that level of care, skill, and

treatment which is recognized as being

acceptable under similar conditions and

circumstances" or any combination thereof,

and any publication by the board shall so

specify.

55. Section 766.102, Florida Statutes (2001), provides in

relevant part as follows :

766.102 Medical negligence; standards of

recovery. --

(1) In any acti on for recovery of damages

based on the death or personal injury of any

person in which it is alleged that such death

or injury resulted from the negligence of a

health care provider as defined in

s. 768.50(2)(b), the claimant shall have the

burden of pro ving by the greater weight of

evidence that the alleged actions of the

health care provider represented a breach of

the prevailing professional standard of care

for that health care provider. The

prevailing professional standard of care for

a given health care provider shall be that

level of care, skill, and treatment which, in

light of all relevant surrounding

circumstances, is recognized as acceptable

and appropriate by reasonably prudent similar

health care providers.

(2)(a) If the health care provid er whose

negligence is claimed to have created the

cause of action is not certified by the

appropriate American board as being a

specialist, is not trained and experienced in

a medical specialty, or does not hold himself

or herself out as a specialist, a " similar

health care provider" is one who:

1. Is licensed by the appropriate regulatory

agency of this state;

2. Is trained and experienced in the same

discipline or school of practice; and

3. Practices in the same or similar medical

community.

( b) If the health care provider whose

negligence is claimed to have created the

cause of action is certified by the

appropriate American board as a specialist,

is trained and experienced in a medical

specialty, or holds himself or herself out as

a speciali st, a "similar health care

provider" is one who:

1. Is trained and experienced in the same

specialty; and

2. Is certified by the appropriate American

board in the same specialty.

However, if any health care provider

described in this paragraph is p roviding

treatment or diagnosis for a condition which

is not within his or her specialty, a

specialist trained in the treatment or

diagnosis for that condition shall be

considered a "similar health care provider."

(c) The purpose of this subsection is t o

establish a relative standard of care for

various categories and classifications of

health care providers. Any health care

provider may testify as an expert in any

action if he or she:

1. Is a similar health care provider

pursuant to paragraph (a) or paragraph (b);

or

2. Is not a similar health care provider

pursuant to paragraph (a) or paragraph (b)

but, to the satisfaction of the court,

possesses sufficient training, experience,

and knowledge as a result of practice or

teaching in the specialty o f the defendant or

practice or teaching in a related field of

medicine, so as to be able to provide such

expert testimony as to the prevailing

professional standard of care in a given

field of medicine. Such training,

experience, or knowledge must be as a result

of the active involvement in the practice or

teaching of medicine within the 5 - year period

before the incident giving rise to the claim.

(3)(a) If the injury is claimed to have

resulted from the negligent affirmative

medical intervention of the health care

provider, the claimant must, in order to

prove a breach of the prevailing professional

standard of care, show that the injury was

not within the necessary or reasonably

foreseeable results of the surgical,

medicinal, or diagnostic procedure

con stituting the medical intervention, if the

intervention from which the injury is alleged

to have resulted was carried out in

accordance with the prevailing professional

standard of care by a reasonably prudent

similar health care provider.

(b) The provi sions of this subsection shall

apply only when the medical intervention was

undertaken with the informed consent of the

patient in compliance with the provisions of

s. 766.103.

(4) The existence of a medical injury shall

not create any inference or pres umption of

negligence against a health care provider,

and the claimant must maintain the burden of

proving that an injury was proximately caused

by a breach of the prevailing professional

standard of care by the health care provider.

However, the discovery of the presence of a

foreign body, such as a sponge, clamp,

forceps, surgical needle, or other

paraphernalia commonly used in surgical,

examination, or diagnostic procedures, shall

be prima facie evidence of negligence on the

part of the health care provi der.

(5) The Legislature is cognizant of the

changing trends and techniques for the

delivery of health care in this state and the

discretion that is inherent in the diagnosis,

care, and treatment of patients by different

health care providers. The fail ure of a

health care provider to order, perform, or

administer supplemental diagnostic tests

shall not be actionable if the health care

provider acted in good faith and with due

regard for the prevailing professional

standard of care.

(6)(a) In any acti on for damages involving a

claim of negligence against a physician

licensed under chapter 458, osteopathic

physician licensed under chapter 459,

podiatric physician licensed under chapter

461, or chiropractic physician licensed under

chapter 460 providing emergency medical

services in a hospital emergency department,

the court shall admit expert medical

testimony only from physicians, osteopathic

physicians, podiatric physicians, and

chiropractic physicians who have had

substantial professional experience w ithin

the preceding 5 years while assigned to

provide emergency medical services in a

hospital emergency department.

(b) For the purposes of this subsection:

1. The term "emergency medical services"

means those medical services required for the

immed iate diagnosis and treatment of medical

conditions which, if not immediately

diagnosed and treated, could lead to serious

physical or mental disability or death.

2. "Substantial professional experience"

shall be determined by the custom and

practice of the manner in which emergency

medical coverage is provided in hospital

emergency departments in the same or similar

localities where the alleged negligence

occurred.

56. The evidence establishes that the Respondent's taking

of photographs which had no s pecific diagnostic or therapeutic

value, and for which the patient had not specifically consented,

constitutes a failure to practice chiropractic medicine with

that level of care, skill, and treatment which is recognized as

being acceptable under similar c onditions and circumstances.

57. Count Two of the Administrative Complaint essentially

alleges that the Respondent induced or attempted to induce the

patient to engage in sexual activity outside the scope of

practice or the scope of generally accepted e xamination or

treatment of the patient by requiring the patient to disrobe and

pose for "biomechanical profile" photographs.

58. Section 460.412, Florida Statutes (2001), provides as

follows :

Sexual misconduct in the practice of

chiropractic medicine. -- Th e chiropractic

physician - patient relationship is founded on

mutual trust. Sexual misconduct in the

practice of chiropractic medicine means

violation of the chiropractic physician -

patient relationship through which the

chiropractic physician uses said

rela tionship to induce or attempt to induce

the patient to engage, or to engage or

attempt to engage the patient, in sexual

activity outside the scope of practice or

the scope of generally accepted examination

or treatment of the patient. Sexual

misconduct in the practice of chiropractic

medicine is prohibited.

59. Although the Petitioner's expert opined without

further elaboration that taking the photographs without the

patient's consent constituted sexual misconduct, the greater

weight of the evidence fail s to establish that the Respondent

attempted to induce the patient into sexual activity by the

taking of the photographs. Further, the Petitioner's assertion

that the photographs of the patient were taken while the patient

objected and was under duress, w ould appear to contradict an

alleged attempt to induce or engage a patient into a sexual

relationship.

60. The Respondent asserted that the expert witness

offered by the Petitioner was insufficiently qualified to render

a valid opinion as to whether the circumstances of the

photography completed in this case constitute a failure to

practice chiropractic medicine at an appropriate level.

61. While the Petitioner's expert has not received a

degree specifically related to "human biomechanical trauma," th e

evidence fails to establish that he was not sufficiently

qualified to render a valid opinion as to the therapeutic or

diagnostic value to photography such as was performed in this

case.

62. During the Respondent's testimony, the Respondent

referenced various texts he studied during his education about

biomechanics, and asserted that photographs taken from "oblique"

angles would be valuable in evaluating muscular atrophy and

asymmetry. However, in this case, the patient's condition had

already been dia gnosed, and treatment had been initiated, prior

to the photos being taken. The fact that the photography was

part of a "protocol" being developed by the Respondent and his

partner suggests that the Respondent' s methodology was not a

standard and routine p ractice, even among persons with post -

graduate training in biomechanical evaluations.

63. During his testimony, the Respondent referenced

chiropractic and medical texts wherein photographs of unclothed

persons appeared. There is no evidence whether or not such

photographic subjects had consented to the taking or publication

of the photographs.

64. The Respondent also offered evidence to establish that

the photos were securely stored on the Respondent's computer and

that any dissemination of the photog raphs was related to the

patient's decision to file complaints related to photos.

Whether the photographs were disseminated or not is immaterial

to this proceeding. The Administrative Complaint does not

allege that the Respondent disseminated the photogr aphs.

65. Florida Administrative Code Rule 64B2 - 16.003(1)(z)

sets forth disciplinary guidelines to be utilized in determining

the appropriate penalty to be assessed in this case. The

penalties applicable to a violation of S ubs ection 491.009(1)(r),

Flor ida Statutes (2001) , for failure to meet an acceptable level

of care, skill and treatment, range from a minimum fine of $1000

to a maximum fine of $10,000 and/or revocation.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of

Law, it is

RECOMMENDED that the Department of Health , Board of

Chiropractic Medicine, enter a final order finding that Scott

Drizin, D.C., is guilty of a failure to practice chiropractic

medicine with the level of care, skill, and treatment which is

recognized as being acceptable under similar conditions and

circumstances, and imposing a fine of $2,500.

DONE AND ENTER ED this 30th day of November , 2005 , in

Tallahassee, Leon County, Florida.

S

WILLIAM F. QUATTLEBAUM

Administra tive 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 Administ rative Hearings

this 30th day of November , 2005 .

COPIES FURNISHED :

Louis Kwall, Esquire

Kwall, Showers, Coleman & Barack, P.A.

133 North Fort Harrison Avenue

Clearwater, Florida 33755

Ephraim D. Livingston, Esquire

Department of Health

4052 Bald Cypre ss Way, Bin C - 65

Tallahassee, Florida 32399 - 3265

R. S. Power, Agency Clerk

Department of Health

4052 Bald Cypress Way, Bin A02

Tallahassee, Florida 32399 - 1701

Joe Baker, Jr., Executive Director

Board of Chiropractic Medicine

Department of Health

4052 B ald Cypress Way, Bin C07

Tallahassee, Florida 32399 - 1701

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

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

to this Recommended Order shou ld be filed with the agency that

will issue the Final Order in this case.