08-001140N
Douglas Stalley, As Guardian Of The Property Of Inaaya Limone vs.
Florida Birth-Related Neurological Injury Compensation Association
Status: Closed
DOAH Final Order on Wednesday, March 11, 2009.
DOAH Final Order on Wednesday, March 11, 2009.
1STATE OF FLORIDA
4DIVISION OF ADMINISTRATIVE HEARINGS
8DOUGLAS STALLEY, AS GUARDIAN OF )
14THE PROPERTY OF INAAYA LIMONE, )
20)
21Petitioner, )
23)
24vs. ) Case No. 08-1140N
29)
30FLORIDA BIRTH-RELATED NEUROLOGICAL INJURY )
35COMPENSATION ASSOCIATION, )
38)
39)
40Respondent, )
42)
43and )
45)
46FLORIDA HEALTH SCIENCES CENTER, )
51INC., d/b/a TAMPA GENERAL )
56HOSPITAL, )
58)
59Intervenor. )
61)
62FINAL ORDER
64Pursuant to notice, the Division of Administrative
71Hearings, by Administrative Law Judge William J. Kendrick, held
80a hearing in the above-styled case on November 13 and 14, 2008,
92by video teleconference, with sites in Tallahassee and Tampa,
101Florida.
102APPEARANCES
103For Petitioner: William E. Hahn, Esquire
109William E. Hahn, P.A.
113310 South Fielding Avenue
117Tampa, Florida 33606-2225
120For Respondent: Robert J. Grace, Jr., Esquire
127Stiles, Taylor & Grace, P.A.
132Post Office Box 460
136Tampa, Florida 33606
139For Intervenor: Edward J. Carbone, Esquire
145Patricia S. Calhoun, Esquire
149Buchanan Ingersoll, P.A.
1522500 Suntrust Financial Centre
156401 East Jackson Street
160Tampa, Florida 33602
163STATEMENT OF THE ISSUE
167At issue is whether Inaaya Limone, a minor, qualifies for
177coverage under the Florida Birth-Related Neurological Injury
184Compensation Plan (Plan).
187PRELIMINARY STATEMENT
189On March 5, 2008, Douglas Stalley, as Guardian Ad Litem for
200Inaaya Limone (Inaaya), a minor, filed a petition with the
210Division of Administrative Hearings (DOAH) to resolve whether
218Inaaya qualified for coverage under the Plan. The petition
227included the following allegations:
2319. The Petitioners do not believe that
238Inaaya Limone suffered a "birth-related
243neurological injury["] which was caused by
250oxygen deprivation or mechanical injury
255occurring in course of labor, delivery or
262resuscitation in the immediate post-delivery
267period at Tampa General Hospital. While
273Petitioners do believe that Inaaya Limone
279has suffered permanent mental and physical
285impairments, it is our firm belief that this
293was a consequence of the failure to properly
301staff and prepare for the extubation which
308took place on March 31, 2004, more than two
317full days following the birth of Inaaya
324Limone.
32510. Petitioners, in good faith, have filed
332this Petition as a direct consequence of an
340Order entered by the Honorable James M.
347Barton, Tampa[,] Florida, abating a civil
354action which has been brought against Tampa
361General Hospital . . . . [Emphasis in
369original]
370DOAH served the Florida Birth-Related Neurological Injury
377Compensation Association (NICA) with a copy of the claim on
387March 6, 2008, and on August 21, 2008, following a number of
399extensions of time within which to do so, NICA responded to the
411petition and gave notice that it was of the view the claim was
424compensable, and offered to provide benefits as prescribed by
433the Plan. In the interim, Florida Health Sciences Center, Inc.,
443d/b/a Tampa General Hospital, was accorded leave to intervene.
452Given that Petitioner was of the view that Inaaya did not
463suffer a "birth-related neurological injury," a hearing was
471scheduled for November 13 and 14, 2008, to resolve whether the
482claim was compensable. Left to resolve in a subsequent
491proceeding were issues related to an award. § 766.309(4), Fla.
501Stat.
502At hearing, Joint Exhibits 1A, 1B, and 2-15 were received
512into evidence, and Petitioner called Paul Gatewood, M.D.,
520Enid Gilbert-Barness, M.D., William Spellacy, M.D., and
527Michael Duchowny, M.D., as witnesses. No other witnesses were
536called, and no further exhibits were offered.
543The transcript of the hearing was filed November 26, 2008,
553and the parties were initially accorded 10 days from that date
564to file proposed orders. However, at Respondent's request the
573time for filing proposed orders was extended to December 16,
5832008. The parties elected to file such proposals and they have
594been duly-considered.
596FINDINGS OF FACT
599Stipulated facts
6011. Douglas Stalley is the Guardian Ad Litem for
610Inaaya Limone, a minor, and Fatima El-Atriss is Inaaya's mother.
620Inaaya was born a live infant on March 29, 2004, at Florida
632Health Sciences Center, Inc., d/b/a Tampa General Hospital, a
641licensed hospital located in Tampa, Florida, and her birth
650weight exceeded 2,500 grams.
6552. Obstetrical services were delivered at Inaaya's birth
663by William Spellacy, M.D., who, at all times material hereto,
673was a "participating physician" in the Florida Birth-Related
681Neurological Injury Compensation Plan as defined by Section
689766.302(7), Florida Statutes.
6923. The participating physician (Dr. Spellacy) and the
700hospital (Tampa General Hospital) complied with the notice
708provisions of the Plan.
7124. Inaaya sustained a brain injury caused by oxygen
721deprivation and was thereby rendered permanently and
728substantially mentally and physically impaired.
733Coverage under the Plan
7375. Pertinent to this case, coverage is afforded by the
747Plan for infants who suffer a "birth-related neurological
755injury," defined as an "injury to the brain . . . caused by
768oxygen deprivation . . . occurring in the course of labor,
779delivery, or resuscitation in the immediate postdelivery period
787in a hospital, which renders the infant permanently and
796substantially mentally and physically impaired." § 766.302(2),
803Fla. Stat. See also §§ 766.309 and 766.31, Fla. Stat.
8136. Here, it is undisputed that Inaaya suffered a brain
823injury, caused by oxygen deprivation, which rendered her
831permanently and substantially mentally and physically impaired.
838What must be resolved is whether the record supports the
848conclusion that, more likely than not, such injury occurred "in
858the course of labor, delivery, or resuscitation in the immediate
868postdelivery period" in the hospital, as required for coverage
877under the Plan. § 766.302(2), Fla. Stat.; Nagy v. Florida
887Birth-Related Neurological Injury Compensation Association , 813
893So. 2d 155, 160 (Fla. 4th DCA 2002)("According to the plain
905meaning of the words as written, the oxygen deprivation or
915mechanical injury to the brain must take place during labor, or
926delivery, or immediately afterward."). As to that issue,
935Petitioner was of the view that Inaaya's brain injury was not
946birth-related (did not result from oxygen deprivation that
954occurred during labor, delivery, or resuscitation in the
962immediate postdelivery period), but followed Inaaya's extubation
969on March 31, 2004, when she stopped breathing, and efforts to
980re-intubate her were not successful for 7 to 8 minutes. In
991contrast, NICA was of the view that Inaaya's brain injury likely
1002resulted from oxygen deprivation that occurred during labor,
1010delivery, or resuscitation immediately thereafter. Intervenor
1016agreed with NICA's position, and further contended that the
1025oxygen deprivation caused Innaya to aspirate meconium, which
1033lead to meconium aspiration syndrome, with further injury to her
1043brain following delivery.
1046Inaaya's birth and immediate newborn course
10527. At or about 12:01 a.m., March 29, 2004, Fatima El-
1063Atriss, with an estimated delivery date of March 8, 2004, and
1074the fetus post-dates at 43 weeks' gestation by ultrasound (US),
1084presented to Tampa General Hospital complaining of the onset of
1094uterine contractions at 7:00 p.m., the previous evening. There,
1103physical examination revealed Ms. El Atriss to be morbidly obese
1113(5'5", 383 lbs.); external fetal monitoring (begun at
112112:11 a.m.) revealed an overall reassuring fetal heart rate in
1131the 160 beat per minute (BPM) range; and vaginal examination (at
114212:40 a.m.) revealed the cervix at 1 centimeter dilation,
1151effacement thick, and the fetus high.
11578. Ms. El-Atriss was admitted to labor and delivery at or
1168about 1:30 a.m., for induction of labor; was induced with
1178petocin; progressed to complete dilation by 2:07 p.m.; and at
11882:14 p.m., Inaaya was born by spontaneous vaginal delivery. In
1198the interim, at 7:50 a.m., Ms. El-Atriss' membranes were
1207artificially ruptured, with thick meconium noted, and the Labor
1216and Delivery Record documents recurrent moderate/severe variable
1223decelerations and prolonged decelerations. However, given
1229Ms. El-Atriss' obesity, at times monitoring was difficult. But,
1238as late as 1:40 p.m., the physicians' progress notes described
1248the fetal heart rate as overall reassuring.
12559. At delivery, Inaaya was described as pink and vigorous,
1265but with evidence of mild respiratory distress ("grunting") and
1276was provided blow-by oxygen for 1 minute and suctioned (by bulb
1287and catheter). Otherwise, Inaaya did not require resuscitation.
1295Apgar scores were good (8 and 9, at one and five minutes,
1307respectively). 1 Retractions were documented at 5 minutes of
1316life, with improvement at 15 minutes of life. (Joint Exhibit
13261A, Labor and Delivery Record, page 2).
133310. According to the medical records, Inaaya was
1341transferred to the newborn nursery at or about 2:25 p.m. (Joint
1352Exhibit 1A, Labor and Delivery Record, page 2). There,
1361admission examination was normal, except for skin (meconium
1369stained nails, skin and cord were noted), throat (secretions
1378were noted), and lungs (retractions, grunting, and tachypnea
1386were noted). Impression/Plan was noted as: (1) viable post-
1395term appropriate for gestational age female - routine care; (2)
1405tachypnea/respiratory distress (thick meconium) - required
1411blowby on delivery, now to keep oxygen saturation greater than
142190 percent, check chest x-ray. (Joint Exhibit 2, Newborn
1430History and Physical).
143311. Insofar as the record reveals, Inaaya did not require
1443intervention until 2:50 p.m., when her respiratory rate was
1452elevated at 84, her oxygen saturation level was low at 87, and
1464she was accorded blow-by oxygen. Thereafter, at 3:15 p.m.,
1473notwithstanding she was receiving blow-by oxygen, Inaaya's
1480respiratory rate was still elevated at 98, and her oxygen
1490saturations remained low at 81. (Joint Exhibit 2, Transition
1499Newborn Admission DataBase; Joint Exhibit 10, page 32).
1507Accordingly, Inaaya was immediately tranferred to the neonatal
1515intensive care unit (NICU) for further management.
152212. Upon arrival at NICU, the neonatalogist noted that
1531Inaaya was crying, pink, well-perfused, in mild to moderate
1540distress (tachypnea, grunting, and retracting), and on exam
1548breath sounds were described as coarse with rales bilaterally.
1557Neurological exam was described as "normal/nonfocal."
1563Assessment was full-term, appropriate for gestational age baby
1571girl with meconium aspiration syndrome. Respiration plan
1578included NCPAP (nasal continuous positive airway pressure),
1585chest x-ray (CXR), and arterial blood gases (ABGs).
1593Neurological plan noted "[no] issues."
159813. Following evaluation, Inaaya was placed on NCPAP, and
1607chest x-ray was obtained at 3:23 p.m., which showed marked
1617prominence of pulmonary vessels consistent with congestive heart
1625failure. However, an "emergency echocardiogram due to
1632[patient's] clinical deterioration to rule out congenital heart
1640disease," ordered at 4:56 p.m., showed normal intracardiac
1648anatomy, and revealed pulmonary hypertension with bi-directional
1655ductus. Initial arterial blood gases drawn at 4:07 p.m.,
1664indicated a pH of 7.43, PO 2 of 64, PCO 2 of 35, and a BE (base
1681excess) of 0, findings inconsistent with acidosis. (Joint
1689Exhibit 6, p. 15).
169314. At or about 6:15 p.m., with her respiratory status
1703deteriorating, Inaaya was sedated in preparation for intubation,
1711and at 6:40 p.m., she was intubated and placed on high frequency
1723oscillator ventilation (HFOV) until the early morning of
1731March 30, 2004, when she was switched to synchronized
1740intermittent mandatory ventilation (SIMV). In the interim, at
174811:00 p.m., March 29, 2004, Dopamine was added to Inaaya's
1758interventions to support her blood pressure, and when that
1767proved inadequate Dobutamine was added at 4:00 a.m., March 30,
17772004.
177815. At 3:10 p.m., March 31, 2004, Inaaya was extubated,
1788and immediately clamped down and became apnic, with bradycardia.
1797Code was initiated at 3:11 p.m., with chest compressions and
1807positive pressure ventilation (PPV), and four attempts were made
1816to re-intubate Inaaya, with the fourth attempt at 3:18 p.m.,
1826proving successful. Notably, during attempts to re-intubate
1833Inaaya copious secretions were visualized below the cords, and
1842they were suctioned following re-intubation. Following re-
1849intubation, Inaaya was placed on SIMV.
185516. According to the Code 19 Flow Sheet, from 3:11 p.m.,
1866when the code was called, through re-intubation at 3:18 p.m.,
"1876pulse ox[imeter] not reading," and saturations were noted as
1885zero. During the same period, heart rate was noted as 40 to 50
1898beats per minute. Thereafter, at 3:19 p.m., heart rate was
1908noted as 50, with saturations at 20 percent; at 3:20 p.m., heart
1920rate was noted as 51, with saturations at 80 percent; and at
19323:21 p.m., heart rate was noted at 117, with saturations at 77
1944percent. The Code ended at 3:25 p.m., and post-code heart rate
1955was documented as 210, with saturations at 99 percent.
196417. Of note, the last arterial blood gas before the Code
1975was called, was taken at 1:52 p.m., and indicated a pH of 7.39,
1988PO 2 of 83, PCO 2 of 37, and a BD (base deficit) of 2, which were
2005within the reference range. First arterial blood gas following
2014the Code, at 3:33 p.m., indicated a pH of 7.10, PO 2 of 205, PCO 2
2030of 72, and a BD of 8, which were all outside the reference
2043range, and consistent with metabolic acidosis. Arterial blood
2051gases were still abnormal at 4:16 p.m., but by 6:57 p.m., they
2063were within the reference range.
206818. Later on March 31, 2004, sedation (Versed and
2077Fentanyl) was decreased, and Inaaya was slowly weaned until
2086April 2, 2004, when Versed and Fentanyl were stopped. In the
2097interim, on April 1, 2004, the nurses note Inaaya's pupil
2107reaction as sluggish bilaterally. However, given Inaaya's
2114sedation, the reliability of such observation as clinical
2122evidence of neurologic injury is fairly debatable.
212919. On April 7, 2004, an MRI of the brain was done. The
2142radiologist's impression was "[a]bnormal basal ganglia signal
2149[symmetrically demonstrated bilaterally involving the globus
2155pallidus]. This may be seen with hypoxia or hypoperfusion."
2164Follow-up MRI was done on December 1, 2004, and reported by the
2176same radiologist, as follows:
2180CLINICAL INDICATION: Developmental delay.
2184Abnormal MRI of the brain 04/07/04 performed
2191at Tower Advanced MRI.
2195The previous examination was performed at a
2202time with the clinical history of hypoxic
2209event. April, 2004. Comparison is made.
2215* * *
2218IMPRESSION:
22191. SEQUELA ARE NOTED FROM HYPOXIC EVENT.
2226THE AREA OF THE BASAL GANGLIA PREVIOUSLY
2233NOTED AS ABNORMAL HAS EVOLVED INTO
2239ABNORMALLY DECREASED SIGNAL SUGGESTING THE
2244POSSIBILITY OF DYSTROPHIC CALCIFICATIONS....
2248Notably, while Inaaya's brain injury is consistent with a
2257hypoxic/ischemic event, it is not possible, based solely on the
2267MRIs, to time the onset of the injury ( i.e. , as birth-related or
2280as related to the Code event).
228620. A neurology consult was requested, and on April 9,
22962004, Inaaya was evaluated by Maria Gieron-Korthals, M.D., a
2305pediatric neurologist. Dr. Gieron-Korthals reported the results
2312of her evaluation, as follows:
2317REASON FOR CONSULTATION: Abnormal MRI and
2323poor sucking.
2325HISTORY OF PRESENT ILLNESS: This baby was
2332born on March 29th, so it is 12 days old by
2343normal vaginal delivery with meconium-
2348stained amniotic fluid and respiratory
2353distress, subsequently diagnosed with
2357meconium-aspiration syndrome . . . .
2363The baby was initially put on ventilator,
2370subsequently placed on CPAP and subsequently
2376on oxygen by a nasal cannula and now is on
2386room air. On day four of life, the infant
2395apparently coded and needed some pressors
2401for a couple of days. The present concern
2409is that the baby has a poor suck and does
2419not take a lot by mouth.
2425Regarding the feeding, the information I
2431gather is that the sucking ability is
2438inconsistent. At times the baby does suck
2445well, at some other time not. Nevertheless,
2452the baby is gaining weight and the feeding
2460is supplemented by NG. The MRI of the brain
2469was performed a couple of days ago and it
2478was abnormal showing bilateral basal ganglia
2484lesions ie decreased signal on diffusion-
2490weighted images of MRI. We reviewed the MRI
2498today.
2499PHYSICAL EXAMINATION: On physical
2503examination, the baby's behavior was
2508somewhat unusual. The baby had episodes of
2515very strong cry, inconsolable and then
2521suddenly would stop crying, become
2526motionless with eyes widely open and turned
2533down. This behavior occurred intermittently
2538throughout the entire period of evaluation.
2544The head was shaved for IV and all sutures
2553were somewhat overlapping anterior fontanel
2558can be covered with the tip of the fifth
2567finger. There was a swelling and redness of
2575the right lower eyelid more than the left.
2583The pupils seem equal and reactive to light
2591and eye's moved to doll's maneuver. The
2598facial expression was symmetrical and
2603movements were normal. The gag reflex,
2609however, is decreased and the sucking is
2616intermittent and not strong. The other
2622developmental reflexes, such as Moro, palmar
2628and plantar grasps were present, but rooting
2635was not elicited.
2638On motor system examination, even when the
2645baby was crying, there was a marked head lag
2654on pulling up to sitting position. The
2661posture of the rest of the body with flexion
2670at the elbows and knees was normal. In
2678ventral suspension, however, the head was
2684flexed and the back was curved, indicative
2691of mild hypotonia. Deep tendon reflexes
2697were about 1 biceps and patella and there
2705was no clonus at the ankle.
2711IMPRESSION: This is a 12 day-old baby with
2719meconium aspiration syndrome followed by an
2725episode during which the baby coded and with
2733abnormal MRI for basal ganglia involvement
2739which is most likely secondary to hypoxic
2746event that occurred during the above
2752episode. The baby's suck is indeed of
2759concern and so is the baby's behavior of
2767going from crying to motionless state. One
2774should consider the possibility of seizures
2780and the plan is to obtain one EEG today to
2790capture the episode of going from crying to
2798motionless state and determine whether or
2804not these are seizures . . . .
2812EEG was done and was interpreted as normal.
282021. On April 12, 2004, Inaaya was discharged from Tampa
2830General Hospital. The diagnoses at that time included:
28381) Meconium Aspiration Syndrome
28422) Hypotension, resolved
28453) Clinical Sepsis, resolved
28494) Respiratory distress syndrome with
2854tacypnea, resolved
28565) Poor po intake, resolved
2861Outpatient follow-up with pediatrics, neurology, and cardiology
2868was recommended.
287022. Currently, Inaaya presents with severe cerebral palsy,
2878with profound mental and physical disabilities, that
2885indisputably are related to the brain injury she suffered (to
2895the basal ganglia) because of oxygen deprivation. Left to
2904resolve is the likely timing of Inaaya's brain injury.
2913The statutory presumption
291623. When, as here, the proof demonstrates that the infant
2926suffered an injury to the brain caused by oxygen deprivation
2936that rendered her permanently and substantially mentally and
2944physically impaired, a rebuttable presumption arises that the
2952injury is a "birth-related neurological injury," as defined by
2961the Plan. § 766.309(1)(a), Fla. Stat. See also Orlando
2970Regional Healthcare System, Inc. v. Alexander , 909 So. 2d 582
2980(Fla. 5th DCA 2005). In this case, the presumptions is that
2991Inaaya's injury occurred "in the course of labor, delivery, or
3001resuscitation in the immediate postdelivery period in . . .
3011[the] hospital." Consequently, it must be resolved whether
3019there was credible evidence produced to support a contrary
3028conclusion and, if so, whether absent the aid of such
3038presumption the record demonstrates, more likely than not, that
3047Inaaya's injury "occurred in the course of labor, delivery, or
3057resuscitation in the immediate postdelivery period. 2 Here, there
3066should be no serious debate that credible evidence was produced
3076(through the medical records and the various experts and fact
3086witnesses who testified) to support a contrary conclusion.
3094The likely cause and timing of the brain injury that
3104rendered Inaaya profoundly, neurologically impaired
310924. To address the likely cause and timing of the brain
3120injury that rendered Inaaya profoundly, neurologically impaired,
3127the parties offered the medical records related to Ms. El-
3137Atriss' antepartal course, as well as those associated with
3146Inaaya's birth and subsequent development. Additionally, the
3153parties offered the testimony (by deposition or live) of many of
3164the health care providers who were involved with Ms. El-Atriss'
3174and Inaaya's care at Tampa General Hospital, including
3182William Spellacy, M.D., the participating physician who provided
3190obstetrical services at Inaaya's birth; Enid Gilbert-Barness,
3197M.D., a pediatric pathologist; Terri Ashmeade, M.D., a
3205neonatologist; Maria Gieron-Korthals, M.D., a pediatric
3211neurologist; and Edward Blum, III, a respiratory therapist.
3219Finally, between them, the parties offered the testimony (by
3228deposition or live) of eight experts retained by them to offer
3239opinions related to the likely cause and timing of Inaaya's
3249brain injury. Offered by Petitioner were Paul Gatewood, M.D.,
3258an obstetrician/gynecologist; Michael Duchowny, M.D., a
3264pediatric neurologist; William Rhine, M.D., a neonatologist; and
3272Elias Chalhub, M.D., a pediatric neurologist. Offered by
3280Respondent was Joseph Casadonte, M.D., a pediatric neurologist,
3288and offered by Intervenor were Barry Schifrin, M.D., an
3297obstetrician/gynecologist; Edwina Popek, M.D., a pediatric
3303pathologist; and Marcus Hermansen, M.D., a neonatologist.
331025. The medical records, as well as the testimony of the
3321various health care providers, have been thoroughly reviewed.
3329Having done so, it is apparent that Inaaya developed respiratory
3339dysfunction, caused by meconium aspiration in utero , induced by
3348the stresses of labor, that revealed itself following delivery
3357with evidence of grunting and retractions. However, the record
3366failed to demonstrate that, more likely than not, any oxygen
3376deprivation she may have suffered during labor, delivery, or
3385resuscitation in the immediate postdelivery period, as a result
3394of her respiratory dysfunction or otherwise, resulted in brain
3403injury. Rather, the likely cause of Inaaya's brain injury was
3413shown to be the oxygen deprivation she suffered during the Code
3424event.
342526. In so concluding, it is noted that, following delivery
3435at 2:14 p.m., March 29, 2004, Inaaya was described as pink and
3447vigorous, albeit with evidence of mild respiratory distress; she
3456required minimal resuscitation measures (blow-by oxygen for 1
3464minute and suctioning); her Apgar scores were good (8 and 9, at
3476one and five minutes, respectively); her initial arterial blood
3485gases at 4:07 p.m., did not reveal any acidosis; her
3495neurological evaluations before sedation at 6:40 p.m., were
3503normal; the first arterial blood gases following the Code event
3513of March 31, 2004, were consistent with metabolic acidosis;
3522there was evidence of neurologic dysfunction after, but not
3531before, sedation was stopped on April 2, 2004; and the MRI
3542results were consistent with an acute hypoxic ischemic event.
3551Given the proof, it is likely, as opined by the health care
3563providers offered by Petitioner, that the cause of Inaaya's
3572brain injury was the oxygen deprivation she suffered during the
3582Code event on March 31, 2004, and not any oxygen deprivation she
3594may have suffered during labor, delivery, or resuscitation in
3603the immediate postdelivery period in the hospital. 3
3611Consequently, Inaaya was not shown to have suffered a "birth-
3621related neurological injury" as defined by the Plan. §
3630766.302(2), Fla. Stat. See also Nagy v. Florida Birth-Related
3639Neurological Injury Compensation Association , 813 So. 2d 155,
3647160 (Fla. 4th DCA 2002)("According to the plain meaning of the
3659words as written, the oxygen deprivation or mechanical injury to
3669the brain must take place during labor, or delivery, or
3679immediately afterward.").
3682CONCLUSIONS OF LAW
368527. The Division of Administrative Hearings has
3692jurisdiction over the parties to, and the subject matter of,
3702these proceedings. § 766.301, et seq ., Fla. Stat.
371128. The Florida Birth-Related Neurological Injury
3717Compensation Plan was established by the Legislature "for the
3726purpose of providing compensation, irrespective of fault, for
3734birth-related neurological injury claims" relating to births
3741occurring on or after January 1, 1989. § 766.303(1), Fla. Stat.
375229. The injured "infant, her or his personal
3760representative, parents, dependents, and next of kin," may seek
3769compensation under the Plan by filing a claim for compensation
3779with the Division of Administrative Hearings within five years
3788and 766.313, Fla. Stat. The Florida Birth-Related Neurological
3796Injury Compensation Association, which administers the Plan, has
"380445 days from the date of service of a complete claim . . . in
3819which to file a response to the petition and to submit relevant
3831written information relating to the issue of whether the injury
3841is a birth-related neurological injury." § 766.305(3), Fla.
3849Stat.
385030. If NICA determines that the injury alleged in a claim
3861is a compensable birth-related neurological injury, it may award
3870compensation to the claimant, provided that the award is
3879approved by the administrative law judge to whom the claim has
3890been assigned. § 766.305(7), Fla. Stat. However, if a dispute
3900exists, as it does in the instant case, the dispute must be
3912resolved by the assigned administrative law judge in accordance
3921with the provisions of Chapter 120, Florida Statutes.
3929§§ 766.304, 766.309, and 766.31, Fla. Stat.
393631. In discharging this responsibility, the administrative
3943law judge must make the following determination based upon the
3953available evidence:
3955(a) Whether the injury claimed is a
3962birth-related neurological injury. If the
3967claimant has demonstrated, to the
3972satisfaction of the administrative law
3977judge, that the infant has sustained a brain
3985or spinal cord injury caused by oxygen
3992deprivation or mechanical injury and that
3998the infant was thereby rendered permanently
4004and substantially mentally and physically
4009impaired, a rebuttable presumption shall
4014arise that the injury is a birth-related
4021neurological injury as defined in s.
4027766.303(2).
4028(b) Whether obstetrical services were
4033delivered by a participating physician in
4039the course of labor, delivery, or
4045resuscitation in the immediate post-delivery
4050period in a hospital; or by a certified
4058nurse midwife in a teaching hospital
4064supervised by a participating physician in
4070the course of labor, delivery, or
4076resuscitation in the immediate post-delivery
4081period in a hospital.
4085§ 766.309(1), Fla. Stat. An award may be sustained only if the
4097administrative law judge concludes that the "infant has
4105sustained a birth-related neurological injury and that
4112obstetrical services were delivered by a participating physician
4120at birth." § 766.31(1), Fla. Stat.
412632. Pertinent to this case, "birth-related neurological
4133injury" is defined by Section 766.302(2), to mean:
4141injury to the brain or spinal cord of a live
4151infant weighing at least 2,500 grams for a
4160single gestation or, in the case of a
4168multiple gestation, a live infant weighing
4174at least 2,000 grams at birth caused by
4183oxygen deprivation or mechanical injury
4188occurring in the course of labor, delivery,
4195or resuscitation in the immediate
4200postdelivery period in a hospital, which
4206renders the infant permanently and
4211substantially mentally and physically
4215impaired. This definition shall apply to
4221live births only and shall not include
4228disability or death caused by genetic or
4235congenital abnormality.
423733. As the proponents of the issue, the burden rested on
4248Respondent and Intervenor to demonstrate that Inaaya suffered a
"4257birth-related neurological injury." See Balino v. Department
4264of Health and Rehabilitative Services , 348 So. 2d 349, 350 (Fla.
42751st DCA 1977)("[T]he burden of proof, apart from statute, is on
4287the party asserting the affirmative issue before an
4295administrative tribunal."); Galen of Florida, Inc. v. Braniff ,
4304696 So. 2d 308, 311 (Fla. 1997)("[T]he assertion of NICA
4315exclusivity is an affirmative defense."); Tabb v. Florida Birth-
4325Related Neurological Injury Compensation Association , 880 So. 2d
43331253, 1260 (Fla. 1st DCA 2004)("As the proponent of the issue,
4345the burden rested on the health care providers to demonstrate,
4355more likely than not, that the notice provisions of the Plan
4366were satisfied.").
436934. Here, the proof failed to demonstrate that Inaaya's
4378impairments were, more likely than not, caused by an "injury to
4389the brain or spinal cord . . . caused by oxygen deprivation or
4402mechanical injury occurring in the course of labor, delivery, or
4412resuscitation in the immediate postdelivery period in a
4420hospital." Indeed, the more compelling proof established that
4428the cause of Inaaya's neurologic impairments was most likely a
4438brain injury caused by oxygen deprivation that post-dated labor,
4447delivery, and resuscitation in the immediate postdelivery
4454period. Consequently, given the provisions of Section
4461766.302(2), Florida Statutes, Inaaya does not qualify for
4469coverage under the Plan. See also Humana of Florida, Inc. v.
4480McKaughan , 652 So. 2d 852, 859 (Fla. 2d DCA 1995)("[B]ecause the
4492Plan . . . is a statutory substitute for common law rights and
4505liabilities, it should be strictly construed to include only
4514those subjects clearly embraced within its terms."), approved ,
4523Florida Birth-Related Neurological Injury Compensation
4528Association v. McKaughan , 668 So. 2d 974, 979 (Fla. 1996).
453835. Where, as here, the administrative law judge
4546determines that ". . . the injury alleged is not a birth-related
4558neurological injury . . . he [is required to] enter an order [to
4571such effect] and . . . cause a copy of such order to be sent
4586immediately to the parties by registered or certified mail."
4595§ 766.309(2), Fla. Stat. Such an order constitutes final agency
4605action subject to appellate court review. § 766.311(1), Fla.
4614Stat.
4615CONCLUSION
4616Based on the foregoing Findings of Fact and Conclusions of
4626Law, it is
4629ORDERED that the claim for compensation filed by
4637Douglas Stalley, as Guardian Ad Litem for Inaaya Limone, a
4647minor, is dismissed with prejudice.
4652DONE AND ORDERED this 11th day of March, 2009, in
4662Tallahassee, Leon County, Florida.
4666WILLIAM J. KENDRICK
4669Administrative Law Judge
4672Division of Administrative Hearings
4676The DeSoto Building
46791230 Apalachee Parkway
4682Tallahassee, Florida 32399-3060
4685(850) 488-9675
4687Fax Filing (850) 921-6847
4691www.doah.state.fl.us
4692Filed with the Clerk of the
4698Division of Administrative Hearings
4702this 11th day of March, 2009.
4708ENDNOTES
47091/ An Apgar score is a numerical expression of the condition of
4721a newborn infant, and reflects the sum points gained on
4731assessment of heart rate, respiratory effort, muscle tone,
4739reflex irritability, and color, with each category being
4747assigned a score ranging from the lowest score of 0 to a maximum
4760of 2. (Dorland's Illustrated Medical Dictionary, 28th Edition,
47681994; Joint Exhibit 1A, Labor and Delivery Record). Here, at
4778one minute, Inaaya's Apgar score totaled 8, with heart rate,
4788respiratory effort, and reflex irritability being graded at 2
4797each, and muscle tone and color being graded at 1 each. At five
4810minutes, Inaaya's Apgar score totaled 9, with heart rate,
4819respiratory effort, muscle tone, and reflex irritability being
4827graded at 2 each, and color being graded at 1.
48372/ Where, as here, a presumption is "established primarily to
4847facilitate the determination of a particular action in which the
4857presumption is applied, rather than to implement public policy,
4866[it] is a presumption affecting the burden of producing
4875evidence." § 90.303, Fla. Stat. The nature and effect or
4885usefulness of such a presumption in assessing the quality of the
4896proof was addressed in Berwick v. Prudential Property and
4905Casualty Insurance, Co. , 436 So. 2d 239, 240 (Fla. 3d DCA 1983),
4917as follows:
4919Unless otherwise provided by statute, a
4925presumption established primarily to
4929facilitate the determination of an action,
4935as here, rather than to implement public
4942policy is a rebuttable "presumption
4947affecting the burden of producing evidence,"
4953see § 90.303, Fla. Stat. (1981), a "bursting
4961bubble" presumption, see C. Ehrhardt, supra,
4967at §§ 302.1, 303.1. Such a presumption
4974requires the trier of fact to assume the
4982existence of the presumed fact unless
4988credible evidence sufficient to sustain a
4994finding of the non-existence of the presumed
5001fact is introduced, in which event the
5008bubble bursts and the existence of the fact
5016is determined without regard to the
5022presumption. See § 90.302(1), Fla. Stat.
5028(1981); C. Ehrhardt, supra, at § 302.1; see
5036generally Ladd, Presumptions in Civil
5041Actions, 1977 Ariz.St.L.J. 275 (1977)
5046Accord Caldwell v. Division of Retirement , 372 So. 2d 438 (Fla.
50571979), Public Health Trust of Dade County v. Valcin , 507 So. 2d
5069596 (Fla. 1987), and Insurance Company of the State of
5079Pennsylvania v. Estate of Guzman , 421 So. 2d 597 (Fla. 4th DCA
50911982. See also Gulle v. Boggs , 174 So. 2d 26, 29 (Fla. 1965),
5104citing with approval Tyrrell v. Prudential Insurance Co. , 109
5113Vt. 6, 192 A. 184, 115 A.L.R. 392, wherein it was stated:
5125Presumptions disappear when facts appear;
5130and facts are deemed to appear when evidence
5138is introduced from which they may be found.
51463/ In enacting the Florida Birth-Related Neurological Injury
5154Compensation Plan, the Legislature expressed its intent, as
5162follows:
5163It is the intent of the Legislature to
5171provide compensation, on a no-fault basis,
5177for a limited class of catastrophic injuries
5184that result in unusually high costs for
5191custodial care and rehabilitation. This
5196plan shall apply only to birth-related
5202neurological injuries.
5204§ 766.302(2), Fla. Stat.
5208In defining "birth-related neurological injury," the Legislature
5215chose to limit coverage to brain injuries that occurred during
"5225labor, delivery, or resuscitation in the immediate postdelivery
5233period." § 766.302(2), Fla. Stat. However, the Legislature did
5242not define "resuscitation in the immediate postdelivery period."
5250When not defined, "the plain and ordinary meaning of words in a
5262statute can be ascertained by reference to a dictionary."
5271Seagrave v. State , 802 So. 2d 281, 286 (Fla. 2001).
"5281Resuscitate" is commonly understood to mean "[t]o return to
5290life or consciousness; revive." The American Heritage
5297Dictionary of the English Language, New College Edition, 1979.
5306Dorland's Illustrated Medical Dictionary, 28th Edition, 1994,
5313defines "resuscitation" as "the restoration to life or
5321consciousness of one apparently dead; it includes such measures
5330as artificial respiration and cardiac massage." "Immediate" is
5338commonly understood to mean "[n]ext in line or relation[;] . . .
5351[o]ccuring without delay[;] . . . [o]f or near the present
5363time[;] . . . [c]lose at hand; near." The American Heritage
5375Dictionary of the English Language, New College Edition, 1979.
5384Finally, "period" is commonly understood to mean "[a]n interval
5393of time characterized by the occurrence of certain conditions or
5403events." The American Heritage Dictionary of the English
5411Language, New College Edition, 1979.
5416Under the statutory scheme then, the brain injury must occur
5426during labor, delivery, or immediately thereafter. Nagy v.
5434Florida Birth-Related Neurological Injury Compensation
5439Association , 813 So. 2d 155, 160 (Fla. 4th DCA 2002)("According
5450to the plain meaning of the words as written, the oxygen
5461deprivation or mechanical injury to the brain must take place
5471during labor, or delivery, or immediately afterward."). Such
5480conclusion is also consistent with "the requirement that
5488statutes which are in derogation of the common law be strictly
5499construed and narrowly applied." Nagy , 813 So. 2d at 159;
5509Humana of Florida, Inc. v. McKaughn , 652 So. 2d 852, 859 (Fla.
55212d DCA 1995)("[B]ecause the Plan . . . is a statutory substitute
5534for common law rights and liabilities, it should be strictly
5544construed to include only those subjects clearly embraced within
5553its terms."), approved , Florida Birth-Related Neurological
5560Injury Compensation Association v. McKaughn , 668 So. 2d 974, 979
5570(Fla. 1996).
5572Under the facts of this case, resuscitation in the immediate
5582postdelivery period ended not later than the five-minute Apgar,
5591by which time Inaaya had been provided blow-by oxygen for 1
5602minute and suctioned. Thereafter, Inaaya required no further
5610respiratory support until after her transfer to the newborn
5619nursery, when at 2:50 p.m., she was again provided blow-by
5629oxygen. Inaaya's subsequent brain injury, post-dated her
"5636resuscitation in the immediate postdelivery period." (Joint
5643Exhibit 6, pp. 36-39, 43-46, 66 and 67). Compare , Orlando
5653Regional Health Care System, Inc. v. Florida Birth-Related
5661Neurological Injury Compensation Association , 33 Fla.L.Weekly
5667D2563 (Fla. 5th DCA 2008).
5672COPIES FURNISHED :
5675(Via Certified Mail)
5678Kenney Shipley, Executive Director
5682Florida Birth Related Neurological
5686Injury Compensation Association
56892360 Christopher Place, Suite 1
5694Tallahassee, Florida 32308
5697(Certified Mail No. 7099 3400 0010 4404 3664)
5705Edward J. Carbone, Esquire
5709Patricia S. Calhoun, Esquire
5713Buchanan Ingersoll, P.A.
57162500 Suntrust Financial Centre
5720401 East Jackson Street
5724Tampa, Florida 33602
5727(Certified Mail No. 7099 3400 0010 4404 3657)
5735Robert J. Grace, Jr., Esquire
5740Stiles, Taylor & Grace, P.A.
5745Post Office Box 460
5749Tampa, Florida 33606
5752(Certified Mail No. 7099 3400 0010 4404 3640)
5760William E. Hahn, Esquire
5764William E. Hahn, P.A.
5768310 South Fielding Avenue
5772Tampa, Florida 33606-2225
5775(Certified Mail No. 7099 3400 0010 4404 3633)
5783Charlene Willoughby, Director
5786Consumer Services Unit - Enforcement
5791Department of Health
57944052 Bald Cypress Way, Bin C-75
5800Tallahassee, Florida 32399-3275
5803(Certified Mail No. 7099 3400 0010 4404 3626)
5811William Spellacy, M.D.
5814University of South Florida
5818College of Medicine
582112901 Bruce B. Downs Boulevard, MDC 2
5828Tampa, Florida 33602
5831(Certified Mail No. 7099 3400 0010 4404 3619)
5839Tampa General Hospital
5842One Davis Boulevard
5845Tampa, Florida 33602
5848(Certified Mail No. 7099 3400 0010 4404 3602)
5856NOTICE OF RIGHT TO JUDICIAL REVIEW
5862A party who is adversely affected by this Final Order is entitled
5874to judicial review pursuant to Sections 120.68 and 766.311,
5883Florida Statutes. Review proceedings are governed by the Florida
5892Rules of Appellate Procedure. Such proceedings are commenced by
5901filing the original of a notice of appeal with the Agency Clerk
5913of the Division of Administrative Hearings and a copy,
5922accompanied by filing fees prescribed by law, with the
5931appropriate District Court of Appeal. See Section 766.311,
5939Florida Statutes, and Florida Birth-Related Neurological Injury
5946Compensation Association v. Carreras , 598 So. 2d 299 (Fla. 1st
5956DCA 1992). The notice of appeal must be filed within 30 days of
5969rendition of the order to be reviewed.
- Date
- Proceedings
- PDF:
- Date: 07/08/2009
- Proceedings: Index, Record, and Certificate of Record sent to the Second District Court of Appeal.
- PDF:
- Date: 06/03/2009
- Proceedings: Supplemental Index (of the Record) sent to the parties of record.
- PDF:
- Date: 04/03/2009
- Proceedings: Notice of Appeal filed and Certified copy sent to the Second District Court of Appeal this date.
- PDF:
- Date: 03/17/2009
- Proceedings: Certified Return Receipt received this date from the U.S. Postal Service.
- PDF:
- Date: 03/16/2009
- Proceedings: Certified Return Receipt received this date from the U.S. Postal Service.
- PDF:
- Date: 03/13/2009
- Proceedings: Certified Return Receipt received this date from the U.S. Postal Service.
- PDF:
- Date: 03/13/2009
- Proceedings: Certified Return Receipt received this date from the U.S. Postal Service.
- PDF:
- Date: 03/11/2009
- Proceedings: Certified Mail Receipts stamped this date by the U.S. Postal Service.
- PDF:
- Date: 03/11/2009
- Proceedings: Final Order (hearing held November 13 and 14, 2008). CASE CLOSED.
- PDF:
- Date: 02/25/2009
- Proceedings: Letter to parties of record from Judge Kendrick acknowledging receipt of your legal assistant`s letter of February 19, 2009, with enclosures.
- Date: 02/19/2009
- Proceedings: Letter to Judge Kendrick from H. O`Brien enclosing MRI reports of I. Limone filed (not available for viewing).
- PDF:
- Date: 02/19/2009
- Proceedings: Letter to parties of record from Judge Kendrick regarding the reports for inclusion in the record.
- PDF:
- Date: 01/26/2009
- Proceedings: Letter to parties of record from Judge Kendrick acknowledging receipt of your letter of January 15, 2009.
- PDF:
- Date: 01/21/2009
- Proceedings: Letter to Judge Kendrick from W. Hahn regarding Mr. Graces` non-objection to the page and line designation of Dr. Ashmead and Mr. Blum filed.
- Date: 01/06/2009
- Proceedings: Joint Exhibits 1A, 1B, 2-15 and Medical Records filed (not available for viewing).
- PDF:
- Date: 01/06/2009
- Proceedings: Letter to parties of record from Judge Kendrick acknowledging receipt of the Joint Exhibits (1A, 1B, ad 2-15).
- PDF:
- Date: 12/16/2008
- Proceedings: Petitioner`s Notice of Filing Proposed Final Order (with corrected Certificate of Service).
- PDF:
- Date: 12/04/2008
- Proceedings: Order (Motion for Extension of Time in which to File Proposed Orders is grantes, parties are accorded until December 16, 2008, to file proposed orders).
- PDF:
- Date: 12/03/2008
- Proceedings: Motion for Extension of Time in which to File Proposed Orders filed.
- Date: 11/26/2008
- Proceedings: Transcript filed (not available for viewing).
- PDF:
- Date: 11/25/2008
- Proceedings: Letter to Judge Kendrick from R. Grace enclosing Joint Exhibits (exhibits not available for viewing) filed.
- PDF:
- Date: 11/14/2008
- Proceedings: Petitioner`s Response to Intervenor Florida Health Sciences Center, Inc., d/b/a Tampa General Hospital`s Motion to Strike Witnesses or Alternative Motion for Enlargement of Time filed.
- Date: 11/13/2008
- Proceedings: CASE STATUS: Hearing Held.
- PDF:
- Date: 11/12/2008
- Proceedings: Order (denying Intervenor`s Motion to Strike Witnesses or Alternatively Motion for Enlargement of Time).
- Date: 11/10/2008
- Proceedings: CASE STATUS: Motion Hearing Held.
- PDF:
- Date: 11/10/2008
- Proceedings: Intervenor Florida Health Sciences Center, Inc. d/b/a Tampa General Hospital`s Motion to Strike Witnesses or Alternative Motion for Enlargement of Time filed.
- PDF:
- Date: 11/10/2008
- Proceedings: Petitioner Response to Intervenor Florida Health Sciences Center, Inc. d/b/a Tampa General Hospital`s Motion to Strike Witnesses or Alternative Motion for Enlargement of Time filed.
- PDF:
- Date: 11/07/2008
- Proceedings: Letter to Judge Kendrick from W. Hahn in response to Florida Health Sciences Center, Inc. d/b/a Tampa General Hospital`s Motion to Strike Witnesses or Alternative Motion for Enlargement of Time filed.
- PDF:
- Date: 11/06/2008
- Proceedings: Intervenor Florida Health Sciences Center, Inc. d/b/a Tampa General Hospital`s Motion to Strike Witnesses or Alternative Motion for Enlargement of Time filed.
- PDF:
- Date: 11/05/2008
- Proceedings: Petitioner Supplemental Answers to Defendant Neurological Injury Compensation Association Expert Interrogatories filed.
- PDF:
- Date: 11/03/2008
- Proceedings: Notice of Taking Videotaped Deposition Duces Tecum via Videoconference for Use at NICA Hearing on November 13 and 14, 2008 filed.
- PDF:
- Date: 11/03/2008
- Proceedings: Respondent, Florida Birth-related Neurological Injury Compensation Association`s, Amended Notice of Taking Deposition Duces Tecum filed.
- PDF:
- Date: 10/31/2008
- Proceedings: Respondent, Florida Birth-Related Neurological Injury Compensation`s Notice of Taking Deposition Duces Tecum filed.
- PDF:
- Date: 10/30/2008
- Proceedings: Defendant Florida Health Sciences Center, Inc. d/b/a Tampa General Hospital`s Univerified Answers to Petitioner`s Expert Interrogatories filed.
- PDF:
- Date: 10/30/2008
- Proceedings: Notice of Taking Videotaped Deposition for Use at NICA Hearing on November 12 and 14, 2008 (E. Chalhub) filed.
- PDF:
- Date: 10/29/2008
- Proceedings: Respondent, Florida Birth-related Neurological Injury Compensation Association`s, Notice of Filing Unexecuted Answers to Expert Interrogatories of Petitioner filed.
- PDF:
- Date: 09/29/2008
- Proceedings: Petitioner Answers to Defendant Neurological Injury Compensation Association Expert Interrogatories filed.
- PDF:
- Date: 09/29/2008
- Proceedings: Petitioner Interrogatories to Defendant Florida Health Sciences Center filed.
- PDF:
- Date: 09/29/2008
- Proceedings: Petitioner Interrogatories to Defendant Neurological Injury Compensation Association filed.
- PDF:
- Date: 08/20/2008
- Proceedings: Notice of Hearing by Video Teleconference (hearing set for November 13 and 14, 2008; 9:00 a.m.; Tampa and Tallahassee, FL).
- PDF:
- Date: 07/31/2008
- Proceedings: Order Granting Extension of Time (response to the petition to be filed by August 15, 2008).
- PDF:
- Date: 07/30/2008
- Proceedings: Motion for Extension of Time in which to Respond to Petition filed.
- PDF:
- Date: 06/02/2008
- Proceedings: Order Granting Extension of Time (response to the petition to be filed by July 30, 2008).
- PDF:
- Date: 05/30/2008
- Proceedings: Motion for Extension of Time in Which to Respond to Petition filed.
- PDF:
- Date: 05/06/2008
- Proceedings: Order Granting Extension of Time (response to the petition to be filed by May 30, 2008).
- PDF:
- Date: 04/24/2008
- Proceedings: Motion for Extension of Time in Which to Respond to Petition filed.
- PDF:
- Date: 04/10/2008
- Proceedings: Order (Florida Health Sciences Center, Inc., d/b/a Tampa General Hospital is granted Intervenor status).
- PDF:
- Date: 04/07/2008
- Proceedings: Order (Motion to accept K. Shipley as qualified representative granted).
- PDF:
- Date: 04/02/2008
- Proceedings: Motion to Intervene Filed by Florida Health Sciences Center, Inc. d/b/a Tampa General Hospital filed.
- PDF:
- Date: 03/31/2008
- Proceedings: Motion to Intervene filed by Florida Health Sciences Center, Inc., d/b/a Tampa General Hospital filed.
- PDF:
- Date: 03/24/2008
- Proceedings: Motion to Act as a Qualified Representative Before the Division of Administrative Hearings filed.
- PDF:
- Date: 03/13/2008
- Proceedings: Certified Return Receipt received this date from the U.S. Postal Service.
- PDF:
- Date: 03/10/2008
- Proceedings: Certified Return Receipt received this date from the U.S. Postal Service.
- PDF:
- Date: 03/06/2008
- Proceedings: Certified Mail Receipts stamped this date by the U.S. Postal Service.
- PDF:
- Date: 03/06/2008
- Proceedings: Letter to Kenney Shipley from Claudia Llado enclosing NICA claim for compensation.
- PDF:
- Date: 03/06/2008
- Proceedings: Notice sent out that this case is now before the Division of Administrative Hearings.
- Date: 03/05/2008
- Proceedings: NICA filing fee (Check No. 1052; $15.00) filed (not available for viewing).
- PDF:
- Date: 03/05/2008
- Proceedings: Defendant, Florida Health Sciences Center, Inc.`s, Answer and Affirmative Defenses filed.
Case Information
- Judge:
- WILLIAM J. KENDRICK
- Date Filed:
- 03/05/2008
- Last Docket Entry:
- 05/17/2012
- Location:
- Tampa, Florida
- District:
- Middle
- Agency:
- Florida Birth-Related Neurological Injury Compensation Associati
- Suffix:
- N
Counsels
-
Edward J. Carbone, Esquire
Address of Record -
Robert J. Grace, Esquire
Address of Record -
William E Hahn, Esquire
Address of Record -
Kenney Shipley, Executive Director
Address of Record