11-001163N Natasha Hines And Alfonso Hines On Behalf Of And As Parents And Natural Guardians Of Akeelah Hines, A Minor vs. Florida Birth-Related Neurological Injury Compensation Association Status: Closed DOAH Final Order on Tuesday, October 18, 2011.

Summary: Infant's injury not caused by oxygen deprivation or mechanical injury; did not affect brain or spinal cord; and no permanent or substantial mental impairment. (SFO)

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

NATASHA HINES and ALFONSO HINES )

on behalf of and as parents and )

natural guardians of AKEELAH )

HINES, a minor , )

)

Petitioners , )

)

vs. ) Case No. 11 - 1163N

)

FLORIDA BIRTH - RELATED )

NEUROLOGICAL INJURY )

COMPENSATION ASSOCIATION , )

)

Respondent, )

)

and )

)

HOMESTEAD HOSPITAL, INC., d/b/a )

HOMESTEAD HOSPITAL, )

)

Intervenor . )

)

SUMMARY FINAL ORDER

This cause came on for consider ation upon Respondent's

Motion for Summary Final Order, served by U.S. Mail on

September 15, 2011, and filed with the Division of

Administrative Hearings (DOAH) the same date.

STATEMENT OF THE CASE

1. On March 4, 2011, Natasha Hines and Alfonso Hines, on

behalf of and as parents and natural guardians of Akeelah Hines,

a minor born March 12, 2006, filed a petition (claim) with DOAH

for compensation under the Florida Birth - Related Neurological

Injury Compensation Plan (Plan).

2. DOAH served the Florida Bir th - Related Neurological

Injury Compensation Association (NICA) with a copy of the claim

on March 9, 2011; s erved Mohama d Shamohamady, M.D. , on or about

March 14, 2011 ; and served Homestead Hospital on or about

June 27, 2011 . Only Homestead Hospital, Inc., d/b/a Homestead

Hospital , moved to intervene, and that motion was granted by an

Order entered July 13, 2011.

3. Following an extension of time in which to do so,

Respondent NICA served its response to the petition, which

response was filed May 23, 2011 , and gave notice that it was of

the view that Akeelah had not suffered a "birth - related

neurological injury" as defined in section 766.302(2), Florida

Statutes, which renders an infant "permanently and substantially

mentally and physically impaired," per section 766.302(2).

NICA's response requested that a hearing be scheduled to resolve

the issue of compensability. The case was subsequently

scheduled for a final hearing on October 7, 2011.

4. On September 15, 2011, NICA filed its Motion for

Summary Fin al Order. The predicate for NICA's motion was two -

fold: first, that although Akeelah had suffered an injury at

birth, that injury had not been caused by oxygen deprivation or

mechanical injury and did not affect Akeelah's brain or spinal

cord and second, that Akeelah is not permanent ly and

substantially mentally and physically impaired.

5. In support of its motion, NICA attached the affidavit

of Michael Duchowny, M.D., a pediatric neurologist, and the

affidavit of Donald Willis, M.D., a board - certified o bstetrician

with special competence in maternal - fetal medicine. 1/

6. Dr. Duchowny's affidavit rendered opinions within

reasonable medical probability, in pertinent part, as follows:

. . . The Florida Birth - Related Neurological

Injury Compensation Associat ion ("NICA")

retained me as its expert in pediatric

neurology to conduct an independent medical

evaluation of the minor child AKEELAH HINES

in this matter. As part of my evaluation I

reviewed the medical records of both the

child and her mother NATASHA HI NES. The

purpose of my review of the medical records

and evaluation of AKEELAH HINES and NATASHA

HINES was to determine whether she [Akeelah]

suffers from an injury which rendered her

permanently and substantially mentally and

physically impaired, and whe ther such injury

is consistent with an injury caused by

oxygen deprivation or a mechanical injury

occurring during the course of labor,

delivery, or the immediate post - delivery

period in the hospital.

. . . I evaluated AKEELAH HINES on May 11,

2011. A tr ue and accurate copy of my

independent medical evaluation is attached

hereto. All of the statements and opinions

expressed therein are true and correct based

upon my review of the records, the history

taken, and my opinions from the evaluation

of the chil d.

. . . In summary, AKEELAH HINES' neurologic

examination reveals evidence of immature,

impulsive behavioral style and speech

articulation deficit. She does not appear

to be autistic but her presentation likely

reflects underlying emotional issues. She

has no focal or lateralizing findings to

suggest a focal or structural brain damage.

I reviewed the medical records on Akeelah

which were sent on March 28, 2011. They

confirm the historical information provided

by Akeelah's mother. Of note, Akeelah's

A pgar scores were 9 and 9 at 1 and 5 minutes

and arterial blood gases drawn approximately

90 minutes after birth were entirely normal.

Akeelah never required intubation and her

only ventilatory assist was oxygen by mask.

She remained in the regular Newbor n Nursery

for nine days primarily for phototherapy of

her jaundice.

I also had an opportunity to review

Akeelah's MRI scans of the brain which were

performed at Miami Children's Hospital.

These studies demonstrate static lesions of

the white matter consi sting of punctuate

areas of increased signal primarily in the

frontal lobe. There is no mass effect and

the remainder of the MRI examination is

normal. There appears to be no evidence of

hypoxic or ischemic brain injury.

I, therefore, do not believe tha t Akeelah

has either a substantial or permanent

physical impairment and her problems are

primarily developmentally based and not the

result of a neurological injury to the brain

or spinal cord acquired due to oxygen

deprivation or mechanical injury. I,

th erefore, believe that Akeelah should not

be considered for compensation within the

NICA Program.

7. Dr. Duchowny's incorporated medical report also

provides the following assessment, among other views:

I had the pleasure of evaluating Akeelah

Hines on Ma y 11, 2011 . . . .

. . . MEDICAL HISTORY: Akeelah is a

5 - year - old girl who is developmentally

delayed. Her mother stated that she has

problems stemming from "brain damage in her

white matter" and that she "has global

developmental delay." Akeela h suffers from

speech articulation problems and learning

disabilities. . . . She is said to have

trouble learning new information and also

has problems paying attention. . . .

* * *

Akeelah has had intermittent problems with

leg pain going back at lea st one year. . .

. A possible diagnosis of childhood

arthritis is entertained b ut Akeelah has not

yet been evaluated by rheumatology.

Akeelah has suffered from gastroesophageal

reflux since infancy. . . .

Akeelah's activity level is high and she

often inadvertently "runs into things." A

helmet has been recommended to protect her

from craniofacial injury.

* * *

Akeelah's vision and hearing are stable.

She suffers from reactive airway disease and

takes Singulair and Flovent . Zyrtec and

Prilosec ar e prescribed for her

gastroesophageal reflux disease.

* * *

GROWTH AND DEVELOPMENT: Akeelah rolled over

at six months, sat at seven months, stood at

13 months, and walked at 13 - 14 months. She

did not say single words until age three

years and was t oilet trained at age three

but still has accidents at night.

* * *

PHYSICAL EXAMINATION today reveals an alert,

cooperative but impulsive, immature and

oppositional, well - developed and well -

nourished 5 - year - old girl who was clinging

to her mother and h ad difficulty separating

throughout the evaluation. The actual

physical examination was completed only with

difficulty as Akeelah essentially would not

cooperate and threw her arms around her

mother the whole time. Her attention span

is short and it is d ifficult to engage her

in meaningful conversation. She would

refuse to answer simple questions. At other

times, she asked questions with relatively

well - developed sentences. Her speech

articulation is poor for lingual, labial and

guttural consonants. S he did not drool.

Head circumference measured 49.3 cm and the

fontanels are closed. There are no cranial

or facial anomalies or asymmetries. There

is one pigmented nevus of the left arm but

no other neurocutaneous stigmata. There are

no dysmorphic fea t ures. The neck is supple

without masses, thyromegaly, or adenopathy.

The heart sounds are strong and there are no

murmurs, shocks or thrills. The lung fields

are clear. The abdomen is soft and

nontender. There are no audible

abnormalities. Peripheral pulses are 2 and

symmetric.

NEUROLOGICAL EXAMINATION reveals Akeelah to

be alert, _________ to the environment but

uncooperative with respect to verbal

commands. Her attention span is short and

she demonstrates an impulsive behavioral

style. Cranial n erve examination reveals

full visual fields to direct confrontation

testing. A brief funduscopic examination

disclosed no abnormalities. The pupils were

3 mm and react briskly to direct and

consensually presented light. There is no

nystagmus. The facia l muscles move

symmetrically. The uvula is midline. The

pharyngeal folds are symmetric. The tongue

is moist and papillated and moves well in

all directions. Motor examination reveals

symmetric muscle strength, bulk and tone.

There are no adventitious movements and no

focal weakness or atrophy. Finger - to - nose

maneuvers were accomplished briefly due to

poor cooperation. Her gait was stable

without lateralized asymmetry. Deep tendon

reflexes are 1 - 2 bilaterally with

flexor/plantar responses. Sensory

examination was intact to withdrawal of all

extremities to sti m ulation. The

neurovascular examination reveals no

cervical, cranial, or ocular bruits and no

temperature or pulse asymmetries. The spine

is straight without dysmorphism.

In SUMMARY, Akeelah' s neurologic examination

reveals evidence of immature, impulsive

behavioral style and speech articulation

deficit. She does not appear to be autistic

but her presentation likely reflects

underlying emotional issues. She has no

focal or lateralizing findi ngs to suggest a

focal or structural brain damage.

I reviewed the medical records on Akeelah

which were sent on March 28, 2011. They

confirm the historical information provided

by Akeelah's mother. Of note, Akeelah's

Apgar scores were 9 and 9 at 1 and 5 minutes

and arterial blood gases drawn approximately

90 minutes after birth were entirely normal.

Akeelah never required intubation and her

only ventilator assist was oxygen by mask.

She remained in the regular Newborn Nursery

for nine days primarily fo r phototherapy of

her jaundice.

I also had an opportunity to review

Akeelah's MRI scans of the brain which were

performed at Miami Children's Hospital.

These studies demonstrate static lesions of

the white matter consisting of punctuate

areas of increase d signal primarily in the

frontal lobe. There is no mass effect and

the remainder of the MRI examinations is

normal. There appears to be no evidence of

hypoxic or ischemic brain injury.

I, therefore, do not believe that Akeelah

has either a substantia l or permanent

physical impairment and her problems are

primarily developmentally based not the

result of a neurological injury to the brain

or spinal cord acquired due to oxygen

deprivation or mechanical injury. I,

therefore, believe that Akeelah should not

be considered for compensation within the

NICA Program. (emphasis added).

8. Dr. Willis' affidavit opines, within a reasonable

degree of medical probability that :

* * *

. . . The Florida Birth - Related Neurological

Injury Compensation Association retained me

as its expert in maternal - fetal medicine to

review the medical records of both the

child, AKEELAH HINES, and her mother

NATASHA HINES. The purpose of my review of

those medical records was to determine

whether an injury occurred in the course of

labor, delivery or resuscitation in the

immediate post - delivery period in the

hospital due to oxygen deprivation or

mechanical injury occurring in the course of

labor, delivery, or resuscitation in the

immediate post - delivery period in the

hospital.

. . . On April 12, 2011, I issued a Report

of my review. A true and accurate copy of

my Report is attached hereto. All of the

statements and opinions expressed there are

true and correct based upon my review of the

medical records.

. . . The baby was not depressed at birth.

Apgar scores were 9/9. Spontaneous cry and

respiratory effort were present at birth.

The newborn child was felt to be in no

distress and transferred to the normal

newborn nursery. Hospital course was

complicated by elevated bilirubi n levels due

to ABO blood type incompatibility. A small

atrial - septal defect of the heart was

identified by ECHO.

After hospital discharge, the baby was

evaluated for failure to thrive. Chromosome

studies, including microarray were negative.

Fee d ing ev aluation showed absent chewing

skills. By 21 months of age the child was

diagnosed with global developmental delay

and cerebral palsy. MRI was consistent with

static encephalopathy.

In summary, this child was delivery [sic] by

repeat Cesarean section pr ior to the onset

of labor. The baby was not depressed at

birth. Apgar scores were 9/9. Cerebral

palsy and global developmental delay were

diagnosed during early childhood. These

problems are not birth related.

The mother was not in labor at time of

repeat Cesarean section delivery. There was

no apparent obstetrical event that resulted

in loss of oxygen or mechanical trauma to

the baby's brain during delivery or the

immediate post delivery period.

. . . As such, it is my opinion that there

was no ox ygen deprivation or mechanical

injury occurring in the course of labor,

delivery or resuscitation in the immediate

post - delivery period in the hospital.

Further, in that there was no oxygen

deprivation or mechanical injury occurring

in the course of labor , delivery or

resuscitation in the immediate post - delivery

period in the hospital, then accordingly,

there was no causal event which could have

rendered AKEELAH HINES permanently and

substantially mentally and physically

impaired as a result of same. (emp hasis

added.)

9. Dr. Willis' attached and incorporated letter is

somewhat less precise in the summation but ultimately reaches

the same conclusion as follows :

* * *

Elective repeat Cesarean section delivery

was done at 39 weeks gestational age.

Hospi tal records indicate that she was not

in labor. Amniotic fluid was clear at

delivery. Birth weight was 2,886 grams or

6 lbs 9 oz's.

The baby was not depressed at birth. Apgar

scores were 9/9. Spontaneous cry and

respiratory effort were present at birt h.

The newborn child was felt to be in no

distress and transferred to the normal

newborn nursery. Hospital course was

complicated by elevated bilirubin levels due

to ABO blood type incompatibility. A small

atrial - septal defect of the heart was

identifie d by ECHO.

After hospital discharge, the baby was

evaluated for failure to thrive. Chromosome

studies, including microarray were negative.

Feeding evaluation showed absent chewing

skills. By 21 months of age the child was

diagnosed with global developm ental delay

and cerebral palsy. MRI was consistent with

static encephalopathy.

In summary, this child was delivered by

repeat Cesarean section prior to the onset

of labor. The baby was not depressed at

birth. Apgar scores were 9/9. Cerebral

palsy and global developmental delay were

diagnosed during early childhood. These

problems are not birth related.

The mother was not in labor at time of

repeat Cesarean section delivery. There was

no apparent obstetrical event that resulted

in loss of oxygen or m echanical trauma to

the baby's brain during delivery or the

immediate post delivery period. (emphasis

added).

10 . Neither Petitioners nor Intervenor filed a timely

response in opposition to the Motion for Summary Final Order 2/

alleging any facts in oppo sition to NICA's Motion for Summary

Final Order of D ismissal.

1 1 . An Order was entered on September 28, 2011, which

provided, in pertinent part:

On September 15, 2011, Respondent served a

Motion for Summary Final Order. To date,

neither Petitioners nor I ntervenor have

responded to the motion. Fla. Admin. Code

R. 28 - 106.103 and 28 - 106.204(4).

Nevertheless, and notwithstanding that they

have been accorded the opportunity to do so,

it is

ORDERED that by October 10, 2011,

Petitioners and Intervenor shall s how good

cause in writing, if any they can, why the

relief requested by Respondent should not be

granted, thereby disposing the case against

Petitioners.

1 2 . No timely response to the September 28, 2011 Order,

nor to the Motion for Summary Final Order ha s been filed.

Accordingly, nothing has been provided to refute the expert

medical opinions tendered by affidavits filed concurrent with

the motion. 3/

1 3 . It is of some concern that at one point Dr. Willis'

opinions are couched, in part, in terms of "no b rain injury,"

without ruling out a spinal cord injury. However, he is

otherwise clear in his affidavit , as is Dr. Duchowny .

14. Given the record, there is no dispute of material

fact. Specifically , there is no dispute that although

Akeelah Hines suffers some developmental deficits, possibly

originating at birth , she did not suffer an injury caused by

oxygen deprivation or mechanical injury that affected her brain

or spinal cord, and further, that although Akeelah has some

disabilities, she is not permane ntly and substantially

physically impaired.

CONCLUSIONS OF LAW

15. The Division of Administrative Hearings has

jurisdiction over the parties to, and the subject matter of,

these proceedings. §§ 766.301 - 766.316, Fla. Stat.

1 6 . The Florida Birth - Related N eurological Injury

Compensation Plan was established by the Legislature "for the

purpose of providing compensation, irrespective of fault, for

birth - related neurological injury claims" relating to births

occurring on or after January 1, 1989. § 766.303(1) , Fla. Sta t .

1 7 . The injured "infant, her or his personal

representative, parents, dependents, and next of kin," may seek

compensation under the Plan by filing a claim for compensation

with the Division of Administrative Hearings. §§ 766.302(3),

766.303 (2), 766.305(1), and 766.313, Fla. Stat. The Florida

Birth - Related Neurological Injury Compensation Association,

which administers the Plan, has "45 days from the date of

service of a complete claim . . . in which to file a response to

the petition and to submit relevant written information relating

to the issue of whether the injury is a birth - related

neurological injury." § 766.305(4), Fla. Stat.

1 8 . If NICA determines that the injury alleged in a claim

is a compensable birth - related neurological injur y, it may award

compensation to the claimant, provided that the award is

approved by the Administrative Law Judge to whom the claim has

been assigned. § 766.305(7), Fla. Stat. If, on the other hand,

NICA disputes the claim, as it has in the instant case, the

dispute must be resolved by the assigned Administrative Law

Judge in accordance with the provisions of chapter 120, Florida

Statutes. §§ 766.304, 766.309, and 766.31, Fla. Stat.

1 9 . In discharging this responsibi lity , the A dministrative

Law Judge mu st make the following determination based upon the

available evidence:

(a) Whether the injury claimed is a birth -

related neurological injury. If the

claimant has demonstrated, to the

satisfaction of the administrative law

judge, that the infant has susta ined a brain

or spinal cord injury caused by oxygen

deprivation or mechanical injury and that

the infant was thereby rendered permanently

and substantially mentally and physically

impaired, a rebuttable presumption shall

arise that the injury is a birth - re lated

neurological injury as defined in s.

766.303(2).

(b) Whether obstetrical services were

delivered by a participating physician in

the course of labor, delivery, or

resuscitation in the immediate postdelivery

period in a hospital; or by a certified

n urse midwife in a teaching hospital

supervised by a participating physician in

the course of labor, delivery, or

resuscitation in the immediate postdelivery

period in a hospital.

§ 766.309(1), Fla. Stat. An award may be sustained only if the

A dministrati ve Law Judge concludes that the "infant has

sustained a birth - related neurological injury and that

obstetrical services were delivered by a participating physician

at birth." § 766.31(1), Fla. Stat.

20 . Pertinent to this case, "birth - related neurological

injury" is defined by section 766.302(2), to mean:

Injury to the brain or spinal cord of a live

infant weighing at least 2,500 grams for a

single gestation or, in the case of a

multiple gestation, a live infant weighing

at least 2,000 grams at birth cause d by

oxygen deprivation or mechanical injury

occurring in the course of labor, delivery,

or resuscitation in the immediate

postdelivery period in a hospital, which

renders the infant permanently and

substantially mentally and physically

impaired . This def inition shall apply to

live births only and shall not include

disability or death caused by genetic or

congenital abnormality. (emphasis added ).

21 . Here, indisputably, A keelah Hines suffers from some

type of disability , probably developmental, but her injury

apparently did not occur during the statutory period for

compensability nor was it caused by oxygen deprivation or

mechanical injury . Finally, it does not affect her brain or

spinal cord. Further, although Akeelah has developmental and

physical di sabilities, she is not permanently and substantially

both physically and mentally impaired. Given the provisions of

section 766.302(2), A keelah does not qualify for coverage under

the Plan. See also Fl a. Birth - Related Neurological Injury Comp .

Ass 'n v. F l a. Div . of Admin . Hear ings , 686 So. 2d 1349 (Fla.

1997)(The Plan is written in the conjunctive and can only be

interpreted to require both substantial mental and physical

impairment.); Humana of Fl a. Inc. v. McKaughan , 652 So. 2d 852,

859 (Fla. 2d DCA 199 5)("[B]ecause the Plan . . . is a statutory

substitute for common law rights and liabilities, it should be

strictly construed to include only those subjects clearly

embraced within its terms."), approved , Fl a. Birth - Related

Neurological Injury Comp . Ass 'n v. McKaughan , 668 So. 2d 974,

979 (Fla. 1996).

CONCLUSION

Based upon the foregoing findings of fact and conclusions

of law, it is ORDERED:

1. NICA's Motion for Summary Final Order is granted.

2. The P etition for Benefits Pursuant to Florida Statute

Se ction 766.301, et seq . , filed by Natasha Hines and

Alfonso Hines, on behalf of and as parent s and natural guardian s

of A keelah Hines, a minor, be, and the same , is dismissed with

prejudice.

DONE AND ORDERED this 18th day of October , 2011 , in

Tallahassee, Leon County, Florida.

S

ELLA JANE P. DAVIS

Administrative Law Judge

Division of Administrative Hearings

The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675

Fax Filing (850) 921 - 6847

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 18th day of October , 2011 .

ENDNOTES

1/ See , e.g. , Vero Beach Care Ctr v. Ricks , 476 So. 2d 262, 264

(Fla. 1st DCA 1985)("Lay testimony is legally insufficient to

support a finding of causation where the medical condition

involved is not readily observable."); Ackley v. Gen. Parcel

Servs. , 646 So. 2d 242, 245 (Fla. 1st DCA 1994)("The

determination of the cause of a non - observable medical

condition, such as a psychi atric illness, is essentially a

medical question."); Wausau Ins. Co. v. Tillman , 765 So. 2d 123,

124 (Fla. 1st DCA 2000)("Because the medical conditions which

the claimant alleged had resulted from the workplace incident

were not readily observable, he was obligated to present expert

medical evidence establishing that causal connection.").

2 / Rule 28 - 106.103 provides:

In computing any period of time allowed by

this chapter, by order of a presiding

officer, or by any applicable statute, the

day of the act from which the period of time

begins to run shall not be included. The

last day of the period shall be included

unless it is a Saturday, Sunday, or legal

holiday, in which event the period shall run

until the end of the next day which is not a

Saturday, Sunday, or legal holiday. When

the period of time allowed is less than 7

days, intermediate Saturdays, Sundays, and

legal holidays shall be excluded in the

computation. As used in these rules, legal

holiday means those days designated in

Section 110.117, F.S. Except as provided in

Rule 28 - 106.217, F.A.C., five days shall be

added to the time limits when service has

been made by regular U.S. mail. One

business day shall be added when service is

made by overnight courier. No additional

time shall be adde d if service is made by

hand, facsimile transmission, or electronic

mail or when the period of time begins

pursuant to a type of notice described in

Rule 28 - 106.111, F.A.C.

Rule 28 - 106.204 provides:

(1) All requests for relief shall be by

motion. All m otions shall be in writing

unless made on the record during a hearing,

and shall fully state the action requested

and the grounds relied upon. The original

written motion shall be filed with the

presiding officer. When time allows, the

other parties may, within 7 days of service

of a written motion, file a response in

opposition. Written motions will normally

be disposed of after the response period has

expired, based on the motion, together with

any supporting or opposing memoranda. The

presiding offic er shall conduct such

proceedings and enter such orders as are

deemed necessary to dispose of issues raised

by the motion.

(2) Unless otherwise provided by law,

motions to dismiss the petition or request

for hearing shall be filed no later than 20

days after service.

(3) Motions, other than a motion to

dismiss, shall include a statement that the

movant has conferred with all other parties

of record and shall state as to each party

whether the party has any objection to the

motion.

(4) In cases in which the Division of

Administrative Hearings has final order

authority, any party may move for summary

final order whenever there is no genuine

issue as to any material fact. The motion

may be accompanied by supporting affidavits.

All other parties may, within seven days of

service, file a response in opposition, with

or without supporting affidavits. A party

moving for summary final order later than

twelve days before the final hearing waives

any objection to the continuance of the

final hearing.

( 5) In cases in which the Division of

Administrative Hearings has recommended

order authority, a party may file a motion

to relinquish jurisdiction whenever there is

no genuine issue as to material fact.

(6) Motions for extension of time shall be

filed prio r to the expiration of the

deadline sought to be extended and shall

state good cause for the request.

3/ When, as here, the "moving party presents evidence to

support the claimed non - existence of a material issue, he . . .

[is] entitled to a summary judg ment unless the opposing party

comes forward with some evidence which will change that result;

that is, evidence to generate an issue of a material fact. It

is not sufficient for an opposing party merely to assert that an

issue does exist." Turner Produc e Co., Inc. v. Lake Shore

Growers Coop. Ass'n , 217 So. 2d 856, 861 (Fla. 4th DCA 1969).

Accord , Roberts v. Stokley , 388 So. 2d 1267 (Fla. 2d DCA 1980);

Perry v. Langstaff , 383 So. 2d 1104 (Fla. 5th DCA 1980).

COPIES FURNISHED :

(Via Certified Mail)

Kenney Shipley, Executive Director

Florida Birth Related Neurological

Injury Compensation Association

2360 Christopher Place, Suite 1

Tallahassee, Florida 32308

(Certified Mail No. 7010 3090 0000 0717 1659)

Alfonso Hines

Natasha Hines

715 Northeast 35 Avenue

Homestead, Florida 33033

(Certified Mail No. 7010 3090 0000 0717 1666)

Martin P. McDonnell, Esquire

Rutledge, Ecenia, Purnell and Hoffman, P.A.

119 South Monroe Street, Suite 202

Tallahassee, Florida 32301

(Certified Mail No. 7010 3090 0000 0717 1673)

Scott E. Solomon, Esquire

Falk, Waas, Hernandez, Cortina,

Solomon & Bonner, P.A.

135 San Lorenzo Avenue Suite 500

Coral Gables, Florida 33146

(Certified Mail No. 7010 3090 0000 0717 1680)

Mohamad Shahmohamady, M.D.

975 Baptist Way, Suite 102

Homeste ad, Florida 33033

(Certified Mail No. 7010 3090 0000 0717 1697)

Am ie Rice, Investigation Manager

Consumer Services Unit

Department of Health

4052 Bald Cypress Way, Bin C - 75

Tallahassee, Florida 32399 - 3275

(Certified Mail No. 7010 3090 0000 0717 1703)

El izabeth Dudek, Secretary

Health Quality Assurance

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 3

Tallahassee, Florida 32308

(Certified Mail No. 7010 3090 0000 0717 1710)

NOTICE OF RIGHT TO JUDICIAL REVIEW

A party who is adversely af fected by this F inal O rder is entitled

to judicial review pursuant to s ections 120.68 and 766.311,

Florida Statutes. Review proceedings are governed by the Florida

Rules of Appellate Procedure. Such proceedings are commenced by

filing the original of a n otice of appeal with the Agency Clerk of

the Division of Administrative Hearings and a copy, accompanied by

filing fees prescribed by law, with the appropriate District Court

of Appeal. See § 766.311, F la. Stat. , and Fl a. Birth - Related

Neurological Injury Comp . Ass 'n v. Carreras , 598 So. 2d 299 (Fla.

1st DCA 1992). The notice of appeal must be filed within 30 days

of rendition of the order to be reviewed.