16-006136PL Department Of Health, Board Of Medicine vs. Ronald Evan Wheeler, M.D.
 Status: Closed
Recommended Order on Friday, February 24, 2017.


View Dockets  
Summary: Physician committed malpractice by diagnosing, recommending treatment, and treating prostate cancer without a tissue biopsy. Recommend license revocation and $30,000.00 fine.

1STATE OF FLORIDA

4DIVISION OF ADMINISTRATIVE HEARINGS

8DEPARTMENT OF HEALTH, BOARD OF

13MEDICINE,

14Petitioner,

15vs. Case Nos. 16 - 6136PL

2116 - 6148PL

24RONALD EVAN WHEELER, M.D., 16 - 6149PL

3116 - 6150PL

34Respondent.

35_______________________________/

36RECOMMENDED ORDER

38Pursuant to notice, a formal administrative hearing was

46conducted before Administrative Law Judge Mary Li Creasy by video

56teleconference with locations in Sarasota and Tallahassee ,

63Florida, on December 8 , 2016.

68APPEARANCES

69For Petitioner: Jack F. Wise, Esquire

75Department of Health

78Bin C - 65

824052 Bald Cypress Way

86Tallahassee, Florida 32399

89For Respondent: Christopher J. Schulte, Esquire

95Weekley Schulte Valdes, LLC

99Suite 100

1011635 North Tampa Street

105Tampa, Florida 33602

108STATEMENT OF THE ISSUE S

113Whether Respondent , a licensed physician, violated the

120applicable standard of care by diagnosing prostate cancer in four

130patients , and recommending and participating in a course of

139treatment for these patients , without confirming prostate cancer

147through tissue biopsy results ; and , if so, what is the

157appropriate penalty?

159PRELIMINARY STATEMENT

161On March 21 , 2016, Petitioner, Department of Health, Board

170of Medicine, referred the four above - captioned cases seeking

180disciplinary sanction of the medical license of Respondent,

188Ronald Evan Wheeler , M.D., to the Division of Administrative

197Heari ngs (DOAH). On the next day, DOAH assigned Administrative

207Law Judge J. Lawrence Johnston to conduct the proceeding. These

217four cases were consolidated on March 23, 2016 , and the matter

228was set for hearing for June 15 through 17, 2016.

238This matter was con tinued until August 17 and 18, 2016 , and

250was transferred to the undersigned on August 9 , 2016. On

260August 12, 2016, the parties reached a proposed resolution and

270filed a Joint Motion to Relinquish Jurisdiction Without

278Prejudice , which was granted.

282On Octo ber 14 , 2016, Petitioner filed a Motion to Re - Open

295Proce e ding because a final agreement was not reached . The m otion

309was granted and the matter was re - opened and re - set for

323December 8 and 9, 2016.

328The hearing was held as scheduled on December 8 , 2016 .

339Joint Exhibits 1 through 8 were admitted into evidence. At the

350hearing, Petitioner presented the testimony of Dennis Donahue,

358M.D., its expert witness. Petitioner's Exhibits 1 through 14

367were admitted into evidence.

371Included in Petitioner 's exhibits were the deposition

379transcripts of P atients G.P., J.W., K.S. , and V.P. , offered in

390lieu of live testimony. Petitioner also provided the transcripts

399of the Patients ' other physicians: Joel Gel man, M.D. (physician

410for Patient G.P.); M. Eric Brewer, M.D. (ph ysician for

420Patient J.W.); Jeffrey Jump, M.D. (physician for Patient K.S);

429and Vip ul Patel, M.D. (physician for Pa tient V.P.). Also

440i ncluded was the deposition transcript of Sarat Sabharwal, M.D.,

450a board - certified urologist , who was identified as an exp ert by

463Respondent.

464Respondent testified on his own behalf and presented the

473testimony of Stephen Leslie, M.D., as an expert witness.

482Respondent's Exhibits 1 through 6 and 8 through 20 were admitted

493into evidence.

495A two - volume Transcript of the proceeding was filed on

506January 9 , 2017 . Both parties filed timely proposed orders ,

516which were given due consideration in the preparation of this

526Recommended Order.

528Unless otherwise indicated, citations to the Florida

535Statutes or rules of the Florida Administrati ve Code refer to the

547versions in effect at the time of the alleged violations.

557FINDING S OF FACT

5611. Petitioner is responsible for the investigation and

569prosecution of complaints against medical doctors licensed in the

578state of Florida, who are accused of v iolating chapters 456 and

590458 of the Florida Statutes.

5952. Respondent is licensed as a medical doctor in Florida,

605having been issued license number ME 46625 .

6133. Respondent is not board - certified in any specialty

623recognized by the Florida Board of Medicin e.

6314. Respondent has never had disciplinary action against his

640license to practice medicine.

644Respondent's Practice

6465. Since his residency concluded in 1985 , Respondent has

655practiced urology. For more than 20 years, the focus of his

666practice has been pro state disease , its diagnosis , and treatment .

6776. In 2006, Respondent becam e the lead investigator for a

688General El ectric study regarding its 3 - T esla magnetic resonance

700spectroscopy imaging machine (3T MRI - s ) as part of an

712Institutional Review Board measuri ng the heat generated by the

722machine to ensure the safety of patients.

7297. B etween 2006 and 2010 , 1 , 600 prostates were scanned with

741a 3T MRI - s as part of the study . Respondent reviewed the results

756of each radiology report associated with these scans and c ompared

767them to the clinical data he had for each patient. Respondent

778also completed a double - blind study of 200 of these patients who

791had prostate biopsies during 2008 and 2009 , as well as the

8023T MRI - s , correlated the results of the biopsies and the sca ns,

816and became convinced that the 3T MRI - s technology alone is a

829positive predictor of prostate cancer 95 percent of the time.

8398. According to both parties' experts, as well as

848Respondent, t he standard of care in Florida and throughout the

859United States i s to use a needle tissue biopsy to identify

871prostate cancer. As admitted by Respondent, medical schools

879teach that needle biopsy is "the way" to diagnose prostate

889cancer. Absent a biopsy showing malignant tissue, it is not

899possible for a reasonably prude nt physician to diagnose or treat

910prostate cancer. Biopsies are usually performed to diagnose

918prostate cancer if a man has a combination of risk factors , such

930as family history, an abnormal digital rectal exam , a nd/or

940increasing levels of Prostate Specifi c Antigen (PSA) .

9499. However, needle biopsies for prostate cancer carry a

958fal se negative rate of 20 to 50 percent , which means that a

971standard 12 - point needle biopsy (where 12 samples of tissue from

983different locations in the prostate are sampled) often mi ss es

994cancerous tissue. Prostate needle biopsies are sometimes painful

1002and carry a risk of complications , including common complications

1011such as bleeding and i nfection , and the unlikely complications of

1022septic shock and death.

102610. Respondent is convinced that there is a significant

1035risk from a prostate needle biopsy to spread prostate cancer

1045cells outside the prostate capsule , which is referred to as

"1055seeding" or "needle tracking . " Respondent's belief is founded

1064upon a one - page 2002 article published in t he American Urological

1077Association , Inc.'s Journal of Urology (Journal) , which refers to

1086two cases in which a tumor was discovered in the rectal wall

1098after prostate biopsies and cryoblation. 1/ T he tumors were

1108suspected of being the result of needle tracki ng from prostate

1119cancer biopsies. Significantly, this article makes clear that

1127needle tracking resulting from prostate biopsies are rare and

" 1136exceedingly uncommon. "

113811. R espondent's concern , regarding prostate bi opsies

1146spreading prostate cancer, is also in part founded upon a

1156o ne - paragraph 1991 Journ al abstract reporting a John s Hopkins

1169University School of Medicine study of 350 patients in which

1179ne edle tracking was suspected in seven patients (two percent). 2/

1190According to Respondent, his belief that pr ostate biopsies spread

1200prostate cancer is "intuitive , " although he acknowledges this is

1209not the prevailing view in Florida. Respondent argues that

1218doctors do not want to believe needle tracking takes place with

1229prostate biopsies and suggests there is a fi nancial motivation

1239for doctors to require a positive bi o psy before definitively

1250diagnosing prostate cancer.

125312. Respondent is so convinced of the dangers of needle

1263biopsies for prostate cancer that he published a book, Men at

1274Risk : the Dirty Little Secret Î Prostate Biopsie s Really Do

1286Spread P rostate Cancer Cells , in 2012 , which he provides to all

1298his patients. In his book, Respondent states:

1305For me, a 3T MRI scan is the best objective

1315marker to a diagnosis of prostate cancer .

1323To summarize, patients must answer one

1329question. Should I agree to a prostate

1336biopsy procedure where it has been proven to

1344spread prostate cancer cells or do I keep my

1353fingers and toes crossed, hoping for the

1360best? In two words, . . . "absolutely not."

1369To me, the decision is easy Î the literature

1378validates avoiding random biopsies and

1383supports imaging with a 3 T magnet.

1390There is no other organ in the human body

1399where diagnosis is dependent on sticking

1405needles randomly and blindly into a delicate

1412organ in an attempt to find cancer . This

1421practice is archaic, patently barbaric,

1426unacceptable and preferentially favored by

1431virtually all urologists.

1434Beyond the obvious benefit to being able to

1442see a cancer and its pattern of invasion with

1451the 3.0 Tesla MRI scan, there is no other

1460exam o r scan that competes in terms of

1469diagnostic accuracy or predictability.

1473The discerning patient will soon recognize

1479that guessing where cancer is located,

1485through random biopsies, is for the less

1492informed. [ 3 ]

149613. Respondent refers to the use of 3T MRI - s as the "truth

1510serum" of prostate cancer diagnosis. During all times material

1519hereto, Respondent held himself out as a urologist who could

1529diagnose and treat prostate c ancer without a needle biopsy. In

1540fact , the four patients at issue in this case found Respond ent

1552through an I nternet search. Respondent defines his office, the

1562Diagnostic Center for Disease (DCD) as, "A comprehensive prostate

1571cancer diagnostic center in Sarasota, Florida specializing in

1579non - invasive diagnostics (MRI/MRIS) without bio psy as an integral

1590part of the diagnostic evaluation of prostate cancer. " 4/

159914. R espondent also advertised himself as "a world expert

1609in High Intensity Focused Ultrasound (HIFU), having diagnosed and

1618treat ed more patients for prostate c a n cer from mor e countries

1632than any other treating doctor in the world." 5 / HIFU is a

1645treatment alternative to brachytherapy ( the insertion of

1653radioactive seeds into the prostate) , radiation, and

1660prostatectomy (the surgical removal of the prostate gland) for

1669prostate can cer and uses highly focused ultrasound waves i n a

1681small area to create intense heat , which destroys prostate cancer

1691tissue. HIFU was not an approved treatment for prostate cancer

1701in the United States until October 9, 2015 , at which time the

1713F ood and Drug Administration (FDA) approved the use of the

1724Sonablate machine for prostate tissue ablation. Prior to that

1733time, Respondent referred his patients to treatment facilities in

1742Mexico and the Caribbean where he performed HIFU treatments.

175115. The standar d of care in Florida precludes treating

1761prostate cancer with HIFU in the absence of a tissue biopsy

1772confirming the presence of cancer. In order to be eligible for

1783HIFU treatment, in addition to a positive diagnosis, the

1792patient's prostate gland must be le ss than 40 grams. HIFU is not

1805appropriate on patients with multiple calcifications in their

1813prostate because they interfere with the treatment.

182016. Because a smaller prostate gland is easier to work

1830with, p rior to undergoing HIFU treatment, patients are often

1840prescribed Bicalutamide (also known by its brand name , Casodex)

1849and Trelstar. Bicalutamide suppresses the uptake of testosterone

1857and Trelstar suppresses the production of testosterone, with both

1866drugs having the effect of shrinking the prostate gland. Side

1876effects of these drugs include hot flashes, weakness, and a sense

1887of a loss of well - being.

1894Facts Related to Patient G.P.

189917. Patient G.P. , a 69 year - old retir ee , had a prostate

1912biopsy performed in December 2005 after a rise in his PSA l evel.

1925This biopsy was negative for prostate cancer , but Patient G.P.

1935was diagnosed with an enlarged prostate and benign prostate

1944hyperplasty (BPH).

194618. In M ay 2008, Patient G. P. learned through a physical

1958exam for a life insurance policy that his PS A level was elevated.

1971After anoth er check of his PSA level in November 2008, Patient

1983G.P. was advised to undergo another prostate biopsy. Because his

1993fi r st prostate biopsy was painful , Patient G.P. searched t he

2005Internet for alternatives to biopsy and lea rned of Respondent and

2016his use of the 3T MRI - s at the DCD in Sarasota for diagnosing

2031prost at e cancer.

203519. Patient G.P. traveled to Florida from Michigan to meet

2045with Respo nd e n t on January 5, 2009 . Patient G.P. underwent a 3T

2061MRI - s scan at Respondent 's office. Respondent told Patient G.P.

2073that he was unsure of the results because they were consistent

2084with BPH and not prostate cancer. However, Respondent advised

2093Patient G.P. was considered "high risk" because his father died

2103from prostate cancer in 2 002. Rather than undergoing any

2113treatment at that time, Patient G.P. was prescribed Avodart for

2123his BPH and agreed to active surveillance (A.S.) whereby he would

2134receive regular PSA screening .

213920. When Patient G.P.'s December 2009 PSA level went up

2149after being on Avodart for most of the year, he was concerned and

2162telephone d Responde n t's office. Respondent prescribed Casodex

2171based upon his telephone call with Patient G.P. on January 15,

21822010.

218321. By February 2010, G.P.'s PSA level decreased

2191sig nificantly , but not as much as he believed it should have

2203after taking Casodex for several weeks. Patient G.P. also

2212experienc ed urinary frequency problems and pain. He returned to

2222R e sp o ndent's office where Responde n t performed a n ultrasound and

2237digital r ectal exam . R e sponde n t told Patient G.P. it was likely

2253he had prostate cancer , b ut that he could not be sure wi t h ou t a

2271biopsy . However , Respondent's medical records reflect that

2279Respondent diagnosed Patient G.P. as having prostate cancer

2287without a tissue biopsy . 6/ Respondent offered to do a targeted

2299biopsy based on an MRI scan. Respondent also discusse d his

2310concerns regarding needle tracking from biopsies with

2317Patient G.P.

231922. Patient G.P. made it clear he did not want a biopsy ,

2331and he wanted t o proceed to HIFU . Respondent advised Patient

2343G.P. of the risk of erectile dysfunction following HIFU , but did

2354not discuss the possibility of urinary stricture problems.

236223 . In April 2010, Patient G.P. traveled to Mexico where

2373the HIFU procedure was performed by Respondent. In March 2011,

2383Patient G.P. saw a urologist in Michigan about his diminished

2393urinary stream and pain. The urologist used a reamer to open

2404Patient G.P's urethra , but on April 15, 2011, he went to the

2416emergency room because he was completely unable to urinate.

2425Patient G.P. was cath eterized and subsequently underwent

2433electro - vaporization on April 25, 2011, to relieve the urinary

2444stricture. In August 2011, Patient G . P . also underwent hydro -

2457dilating in an attempt to relieve the sym ptoms of his urinary

2469stricture.

247024 . In September 2011, Patient G.P. saw board - certified

2481urologist Dr. Joel Gelman , who specializes in urethral

2489reconstruction . At that time, Patient G.P. was advised that his

2500urinary stricture , caused by the HIFU trea tment , was a

2510significant problem because his urethra was closed off a l m ost to

2523the bladder neck. Dr. Gelman performed a trans urethral resection

2533of the prost ate (TURP) .

253925. As part of the TURP procedure, Dr. Gelman took samples

2550of Patient G.P.'s prost ate tissue and no evidence was found of

2562prostate cancer. Although Patient G.P. had no complaints

2570regarding his course of treatment from Respondent, Dr. Gelman

2579filed a complaint against Respondent because he was concerned

2588that Respondent prescribed medicat ions and performed HIFU on

2597Patient G.P. for prostate cancer without a tissue biopsy.

2606Facts Related to Patient J.W .

26122 6 . Patient J.W. , a 74 year - old retired dentist, had two

2626biopsies performed in 2005 and 2007 ordered by his urologist in

2637Alabama in res ponse to elevated PSA levels. No evidence of

2648malignancy was found.

265127. Patient J.W.'s PSA level was again elevated when tested

2661in March 2012. He was reluctant to have another biopsy because

2672the first two were painful. Patient J.W. was told about

2682R espondent by a friend , and he viewed Respondent's web site.

2693Patient J.W. was interested in consulting with Respondent because

2702Respondent advertised he had an MRI machine that could detect

2712cancer cells , and Respondent believed prostate biopsies spread

2720cance r.

272228. Patient J.W. traveled from Alabama to meet with

2731Respondent at the DCD on May 14 and 15, 2012. After a sonogram

2744and MRI, Respondent diagnosed Patient J.W. with prostate cancer.

2753Respondent discussed a trea tme nt plan which included what

2763Responde nt called "chemical castration" for a period of six

2773months , to be followed with a trip to Mexico for HIFU treatment

2785at the cost of $32,000.00 . Responde n t did not suggest any other

2800treatment options to Patient J.W. or recommend a tissue biopsy.

281029. T he idea of "chemical castration" scared Pat i e nt J.W. ,

2823who sought a second opinion in June 2012 from another urologist ,

2834Dr. M. Eric Brewer . Dr. Brewer told J.W. that HIFU was not an

2848accepted treatment in the United States for prostate can c er .

2860Patient J.W. declined to go forward with treatment by Respondent.

2870Dr. Brewer recommended A . S . and , as recommended by Dr. Brewer,

2883Patient J.W. ha s his PSA level checked every six months. Patient

2895J.W.'s PSA levels have decreased without any treatment.

290330. Dr. Br e wer discussed Patient J.W.'s case with his

2914partners , the tumor board, the president of the Southeastern

2923Urological Association , and the president of the American Board

2932of Urology , who unanimously advised Dr. Brewe r to file a

2943complaint with Petitioner agai nst Re sponde n t for cancer diagnosis

2955and recommending treatment in the absence of a pathologic

2964specimen.

2965Facts Related to Patient K . S.

297231. Patient K.S. is a 62 - year - old video producer and editor

2986from Tennessee. He has no family history of prostate ca ncer.

2997Patient K.S. had his PSA level tested in 2005 and 2009 , at which

3010time it was considered elevated.

301532. Patient K.S. was referred to a urologist by his primary

3026care physician. After again showing elevated PSA levels,

3034Patient K.S. underwent a p rostate biopsy in 2011 and 2012.

3045Neither biopsy was positive for prostate cancer. However,

3053Patient K.S. and his wife were concerned about his rising PSA

3064level and sought a second opinion.

307033. Patient K.S.' wife was concerned that if her husband

3080had prostate cancer, his local urologist would recommend removal

3089of the prostate. She researched alternative treatments on th e

3099Internet and found Responde n t's website.

310634. On Octobe r 15, 2012, Patient K.S. and his wif e traveled

3119to the DCD in Sarasota t o meet with Respondent. Respondent

3130initially performed an ultrasound on Patient K.S. and then told

3140Patient K.S. he was "concerned" Patient K.S. had prostate cancer.

3150He recommended HIFU treatment to Patient K.S.

315735. Respondent made it clear to Patie nt K.S. that

3167Responde n t would not perform a needle biopsy because it push es

3180cancer further into the prostate . Respondent told Patient K.S.

3190that the MRI would make it clear whether Patient K.S. had

3201prostate cancer. Later that same day, Patient K.S . had an MRI

3213performed at the D C D .

322036. Approximately a week later, Patient K.S. r eceived a

3230telephone call from Re sponde n t with the MRI results who told

3243Patient K.S. that based on the MRI, he had Gleason 7 prostate

3255cancer, a fairly aggressive form of prostate cancer that c ould be

3267treated with HIFU in Mexico the following month. This was

3277followed up with an e - mail from the DCD to Patient K.S. demanding

3291a payment of $32,000.00 within three days to schedule the HIFU

3303procedure in Mexico . Patient K.S.' wife immed iately secured a

3314bank loan for the $32,000.00

332037. Due to the seriousness of the diagnosis and the rush

3331for payment for HIFU, Patient K.S. visited his primary care

3341doctor for another opinion. Patient K.S' prima r y care doctor ,

3352Dr. Jeffrey Jump, told h im that no one can diagnose prostate

3364cancer as a Gleason 7 without a tissue biopsy. Further, it was a

" 3377red flag " to Dr. Jump that a cash payment of $32,000.00 was

3390expected in such a short time frame to schedule treatment.

340038. After speaking to Dr. Ju mp, Patient K.S. decided not to

3412have HIFU and instead opted for A . S. Subsequent PSA level tests

3425for Patient K.S. have shown a decrease in his PSA level . Patient

3438K.S.' wife filed a complaint with the Petitioner against

3447Respondent .

3449Facts Related to Patient V.P.

345439. Patient V.P. is a 63 - year - old construction worker and

3467guide from Alaska. He has no family history of prostate cancer.

347840. In August 2013, at age 60, Patient V.P. had his first

3490physical examination. As part of the exam, he took a PSA test ,

3502which showed an elevated PSA level of 6.3. As a result,

3513Patient V.P. was referred to a urologist who recommended a

3523biopsy .

352541. Patient V.P. heard from friends that prostate biopsies

3534are painful , so he looked on the I nternet for alternatives .

3546Patient V.P. found Respondent's website , which claimed Respondent

3554could diagnose prostate cancer without a biopsy by using new MRI

3565technology.

356642. Patient V.P. traveled to Sarasota to meet Respondent on

3576September 11, 2013. Respondent performed a d igital rectal exam

3586and told Patient V.P. that his prostate was much enlarged.

359643. Respondent next performed a prostate ultrasound on

3604Patient V.P. Immediately after the ultrasound, Responde n t told

3614Patient V.P., "I'm telling you right now you have pro state

3625cancer." Respondent provided Patient V.P. with a prescription

3633for Bicalutamide and T relstar , which Respondent said would wipe

3643out Patient V.P.'s testosterone and slow the growth of the

3653cancer.

365444. Respondent told P atient V.P. that prostate bio psies are

3665dangerous and metas t asize cancer c ells. Respondent said that

3676even though he knew Patient V.P. had cancer, he wanted an MRI to

3689see the amount of cancer. Respondent also offered Patient V.P.

3699the opportunity to participate in a private placement o ffering

3709for a HIFU company he was forming for a minimum investment of

3721$50,000.00.

372345. The following day, Patient V.P. had an MRI and then met

3735with Respondent to review the results. Respondent showed Patient

3744V.P. his MRI images and pointed to areas o f concern. Respondent

3756told Patient V.P. he had extensive prostate cancer and that

3766Patient V.P. did not have much time to decide whether to have

3778HIFU because the cancer was about to metastasize.

378646. Re sponde n t told Patient V.P. to take the B icalutami de

3800for ten days and then return for an injection of Trelstar to

3812atrophy his prostate and make him ready for HIFU in 90 days.

382447. At Respondent's direction, Patient V.P. began the

3832Bical utamide and then returned to the DCD on September 20 , 2013,

3844for a three - month injection of Trelstar. During this visit,

3855Patient V.P. questioned the cost if the HIFU was not successful

3866in getting all the cancer and he needed further treatment.

3876Respondent told Patient V.P. that he "doesn't miss , " but an

3886additional treatm ent of HIFU would cost another $10,000.00 to

3897$12,000.00, in addition to the $32,000.00 for the initial

3908treatment.

390948. C oncerned about these costs, Patient V.P. asked about

3919going to Loma Linda , California , for proton therapy as an

3929alternative. Respon dent told Patient V.P. that proton therapy

3938would cause bladder cancer and any alternative to HIFU would

3948require a needle biopsy first. Respondent actively discouraged

3956Patient V.P . from any non - HIFU treatment for prostate cancer.

396849. As soon as Patie nt V.P. questioned Respondent about

3978alternatives to HIFU, he was suddenly fast - tracked for HIFU

3989scheduled October 24 through 26, 2013. He was told he needed to

4001make a $10,000.00 deposit to hold the date and the total cost was

4015$32,000.00.

401750. Despite his concerns regarding the expedited scheduling

4025of his procedure and the cost of the HIFU treatment, Patient V.P.

4037returned to the office with a check for $10,000.00 to cover the

4050cost of the deposit to hold the October treatment d ate. While

4062w aiting to han d the check to Respondent's receptionist,

4072Patient V.P. overheard Respondent on a speakerphone arguing with

4081a radiologist concerning an MRI report. Respondent was insisting

4090the radiologist include the word "cancer" on MRI report s and the

4102radiologist insis ted it was not possible for him to make such a

4115diagnosis. After hearing this conversation, Patient V.P.

4122immediately left Respondent's office with his check.

412951. Patient V.P. subsequently discussed his experience with

4137a trusted friend who practiced a s a nurse in a cancer clinic.

4150She , too , expressed concerns about diagnosing and treating

4158prostate cancer without a biopsy. Patient V.P. was referred by

4168this friend to Dr. Vipul Patel, a physician specializing in

4178urologic cancer in Orlando.

418252. Pati ent V.P. met with Dr. Patel on October 18, 2013.

4194Dr. Patel advised Patient V.P. that it was not possible to

4205diagnose prostate cancer without a biopsy. Dr. Patel also

4214disputed that prostate biopsies can spread prostate cancer.

422253. Dr. Patel perfor med a digital rectal exam and found

4233Patient V.P.'s prostate to be slightly enlarged ( which is not

4244abnormal for a man of Patient V.P.'s age ) , normal , and smooth.

4256Dr. Patel told Patient V.P. that he doubted he had prostate

4267cancer. Patient V.P. then underw ent a prostate biopsy by

4277Dr. Patel , which was negative for prostate cancer. This was

4287surprising to Patient V.P. because Respondent led him to believe,

4297based on the MRI, that his prostate was full of cancer.

430854. Patient V.P. experienced significant side effects as a

4317result of taking the medications ordered by Respondent. The

4326Bicalutamide caused Patient V.P. to experience overwhelming

4333depression, shakes, hot flashes, tunnel vision , and headaches.

4341The Trelstar cause d erectile dy sfunction, increased f requency o f

4353hot flashes, night sweats , and made Patient V.P. so weak he was

4365unable to work for eight months.

4371Standard of Care

437455. As discussed above, t he experts who provided

4383deposition s o r live testimony in this case were unanimous in

4395their conclusi ons that the standard of care in Florida from 2008

4407through 2013 precluded diagnosis or treatment of prostate cancer

4416in the absence of a tissue biopsy. A reasonably prudent

4426physician would not tell a patient he had prostate cancer based

4437upon an ultrasound and/ or MRI. A reasonably prudent physician

4447would not prescribe medication, suggest treatment, or participate

4455in treating a patient for prostate cancer , based upon an

4465ultrasound or MRI.

446856. Respondent claims that in each of these cases, he

4478advised th e patient that a needle biopsy was the definitive test

4490for prostate cancer , but it was a method he did not favor due to

4504the pos sibility of needle tracking. Respondent's testimony in

4513this regard is not credible in light of the credible testimony of

4525the thr ee patients that Respondent made clear he would not

4536perform a needle biopsy and actively discouraged them from

4545anything other than diagnosis by MRI and subsequent HIFU

4554treatment. Respondent's suggestion, that he offered needle

4561biopsy as an option, is whol ly inconsistent with the title,

4572theme , and contents of his own book , an d the manner in which he

4586defined his method of diagnosing prostate cancer at the DCD in

4597his book and on his website .

460457 . It is self - evident that a patient ' s perceptions

4617regarding the safety and efficacy of needle biopsies for prostate

4627cancer detection are at least , in part , influenced by the

4637discussion with the physician. Respondent's active efforts to

4645dissuade these patients from having the one definitive test for

4655prostate cancer , by dramatically over - inflating the

4663infinitesimally small possibility of needle tracking, were wholly

4671inconsistent with the standard of care.

467758 . Respondent claims that these four patients insiste d

4687they did not want a needle biopsy, theref or e , it wa s appropriate

4701to diagnos e them on the basis of " a preponderance of the evidence

4714a nd concordance of data " and move forward with a treatment plan ,

4726including medications and HIFU.

473059 . The standard of care in Florida during 2008 through

47412013 , for a situa tion in which a patient suspected of having

4753prostate cancer refused a needle biopsy , was to prescribe a

4763course of A . S . , including regular and frequent PSA testing, and

4776to offer no other treatment. 7/

4782Ultimate Factual Determinations

478560. Petitioner esta blished by clear and convincing evidence

4794that Respondent commit t ed medical malpractice in his treatment of

4805Patients G.P., J.W., K.S., and V.P. by the following violations

4815of the standard of care:

4820a. f ailing to obtain and review prostate

4828biopsy results bef ore confirming the patient

4835had, or diagnosing the patient with , prostate

4842cancer ( Patients G.P., J.W., K.S., and V.P. );

4851b. p rescribing Bicalutamide/Casodex to a

4857patient without first confirming through a

4863prostate tissue biopsy that the patient has

4870prostat e cancer ( Pat i e nts G.P. and V.P);

4881c. p rescri b ing, injecting, or authorizing

4889the in j ection of Trelstar to a patient

4898without first confirming through biops y

4904results that the patient has pr ostate cancer

4912(Patient V.P);

4914d. r ecommending and/or attempting to

4920facilitate HIFU treatment without first

4925confirming through biops y results that the

4932patient has prostate cancer (Patients G.P.,

4938J.W., K.S., and V.P.); and

4943e. p articipating in, and/or assi s ting with

4952the performance of HIFU treatment for a

4959patient without f irst confirming through

4965biopsy results that the patient has prostate

4972cancer (Patient G.P.).

4975Accordingly, Respondent is guilty of the offense d efined in

4985section 458.331(1)(t) , Florida Statutes .

4990CONCLUSIONS OF LAW

499361 . DOAH has personal and subject matter j urisdiction in

5004this proceeding pursuant to sections 120.569 and 120.57(1),

5012Florida Statutes .

501562. A proceeding to suspend, revoke, or impose other

5024discipline upon a license is penal in nature. State ex rel.

5035Vining v. Fla. Real Estate Comm'n , 281 So. 2d 487, 491 (Fla.

50471973). Petitioner must theref ore prove the charges against

5056Respondent by clear and convincing evidence. Fox v. Dep't of

5066Health , 994 So. 2d 416, 418 (Fla. 1st DCA 2008)(citing Dep't of

5078Banking & Fin. v. Osborne Stern & Co. , 670 So. 2d 932 ( Fla.

50921996)).

509363. The clear and convincing standard of proof has been

5103described by the Florida Supreme Court:

5109Clear and convincing evidence requires that

5115the evidence must be found to be credible;

5123the facts to which the witnesses testify must

5131be distinctl y remembered; the testimony must

5138be precise and explicit and the witnesses

5145must be lacking in confusion as to the facts

5154in issue. The evidence must be of such

5162weight that it produces in the mind of the

5171trier of fact a firm belief or conviction,

5179without he sitancy, as to the truth of the

5188allegations sought to be established.

5193In re Davey , 645 So. 2d 398, 404 (Fla. 1994)(quoting Slomowitz v.

5205Walker , 429 So. 2d 797, 800 (Fla. 4th DCA 1983)).

521564. Disciplinary statutes and rules "must always be

5223construed s trictly in favor of the one against whom the penalty

5235would be imposed and are never to be extended by construction."

5246Griffis v. Fish & Wildlife Conserv. Comm'n , 57 So. 3d 929, 931

5258(Fla. 1st DCA 2011); Munch v. Dep't of Prof'l Reg., Div. of Real

5271Estate, 592 So. 2d 1136 (Fla. 1st DCA 1992).

528065. The grounds proving Petitioner's assertion that

5287Respondent's license should be disciplined must be those

5295spe cifically alleged in the Amended Administrative Complaint.

5303See e.g. , Trevisani v. Dep't of Health , 908 So. 2d 1108 (Fla. 1st

5316DCA 2005); Kinney v. Dep't of State , 501 So. 2d 129 (Fla. 5th DCA

53301987); and Hunter v. Dep't of Prof'l Reg. , 458 So. 2d 842 (Fla.

53432d DCA 1984).

5346Medical Malpractice

534866. Section 458.331(1)(t) provides that it is a violation

5357for a medical doctor to commit medical malpractice, as defined in

5368section 456.50. Section 456.50(1)(g) defines "medical

5374malpractice" as the failure to practice medicine in accordance

5383with the level of care, skill, and treatment recognized in

5393general law related to health care licensure.

540067. Petitioner proved by clear and convincing evidence that

5409Respondent violated section 458.331(1)(t) by falling below the

5417standard of care for doctors in the state of Florida and by

5429failing to obtain a tissue biopsy positi ve for prostate cancer

5440before : diagnosing prostate cancer; recommending treatment for

5448prostate cancer; commencing treatment to shrink prostates with

5456medications; recommending HIFU ; and performing HIFU.

546268. Respondent does not dispute that the existin g standard

5472of care is a tissue biopsy for the diagnosis and treatment of

5484prostate cancer. 8/ However, Respondent asserts that he is on the

5495cutting edge of medicine by diagnosi ng prostate can cer using

55063T MRI - s and treating prostate cancer with HIFU , and it is time

5520that the standard of care be modified in accordance with his

5531practice .

553369. In support of this contention, Respondent points to

5542several recent articles which support the efficacy of this

5551diagnosis and treatment protocol . 9 / Respondent also cites to

5562section 456.41 which permits physicians to offer complementary

5570and alternative health care treatments to patients .

557870. Significantly, the articles relied upon by Respondent

5586were published after the diagnosis and treatment of the patients

5596at issue in this action. Further, these articles do not advocate

5607for the use of MRI technology to diagnos e prostate cancer.

5618Rather, they suggest MRI has a developing role in guided prostate

5629biopsy procedures for diagnosis and treatment of prostate cancer

5638a nd emphasize that further study is needed. 10 /

564871. While section 456.41 a uthorizes a health care

5657practitioner to "recommend any mode of treatment that is, in his

5668or her judgment, in the best interests of the patient, including

5679complimentary or alterna tive health care treatments, in

5687accordance with the p rovisions of his or her license, " the

5698practitioner must inform the patient of the benefits and risks

5708associated with the treatment for the patient to make an informed

5719and prudent decision rega rding the t reatment option.

5728§ 456.41(3)(c) , Fla. Stat . This section does not " alter, in any

5740way the provis i ons of the individual practice acts for those

5752licensees, which require licensees to practice within their

5760respective standards of care. " § 456.41(5), Fla. S tat.

576972. Respondent gross ly exaggerated the risks of prostate

5778biopsy while shamelessly promoting MRI technology as the premier

5787diagnostic tool for prostate cancer. Respondent lured patients

5795from around the country to Florida with the false promise o f a

5808pain - free , accurate diagnostic procedure , and promoted an

5817unapproved, expensive treatment outside the United States.

582473. Respondent built his entire business model and

5832advertised his services of prostate cancer diagnosis and

5840treatment without a n eedle biopsy knowing this violated the

5850standard of care. At a minimum, the conversation between the

5860radiologi st and Respondent overheard by P atient V.P. demonstrates

5870that Respondent knew or should have known that prostate cancer

5880diagnosis is not possible w ith a 3T MRI - s. Respondent is well

5894aware that no other licensed physician in the United States is

5905purporting to diagnose and treat prostate cancer without a tissue

5915biopsy, other than in exceptional circumstances, which did not

5924exist for these four patien ts.

593074 . Whether Respondent was motivated by his sincere, but

5940misguided , belief that prostate biopsies spread cancer, or by

5949greed, is irrelevant to the determination of a violation .

5959Respondent violated the standard of care by telling patients they

5969ha d prostate cancer without a confirmatory prostate tissue

5978biopsy. Respondent not only failed to disclose to these patients

5988that 3T MRI - s technology cannot defini tively diagnose prostate

5999cancer but actively discouraged these patients from obtaining

6007biopsies that we now know would likely show no cancer.

6017Recommending a course of "chemical castration" and HIFU in the

6027absence of a positive tissue biopsy violates the standard of

6037care, constitutes malpractice , and is nothing less than barbaric .

6047Penalty Assessment

604975 . Respondent has no prior discipline against his medical

6059license.

606076 . Petitioner imposes penalties upon licensees consistent

6068with disciplinary guidelines prescribed by rule. See Parrot

6076Heads, Inc. v. Dep't of Bus. & Prof'l Reg. , 741 So. 2d 1231,

60891233 - 34 (Fla. 5th DCA 1999).

609677 . Penalties in a licensure discipline case may not exceed

6107those in effect at the time the violations were committed.

6117Willner v. Dep't of Prof'l Reg., Bd. of Med. , 563 So. 2d 805, 806

6131(Fla. 1st DCA 1990), rev. deni ed , 576 So. 2d 295 (Fla. 1991).

6144Id.

614578 . At the time of the incidents, Florida Administrative

6155Code Rule 64B8 - 8.001(2)(t) provided that for a first - time

6167offender committing medical malpractice, as described in section

6175458.331(1)(t), the prescribed pen alty range was from one year

6185probation to revocation or denial and an administrative fine from

6195$1,000.00 to $10,000.00. The recommended penalty for a second

6206violation of section 458.331(1)(t) ranged from two years of

6215probation to revocation and an adminis trative fine from $5,000.00

6226to $10,000.00.

622979 . Rule 64B8 - 8.001(3) provided that, in applying the

6240penalty guidelines, the following aggravating and mitigating

6247circumstances should also be taken into account:

6254(3) Aggravating and Mitigating

6258Circumstan ces. Based upon consideration of

6264aggravating and mitigating factors present in

6270an individual case, the Board may deviate

6277from the penalties recommended above. The

6283Board shall consider as aggravating or

6289mitigating factors the following:

6293(a) Exposure of patient or public to injury

6301or potential injury, physical or otherwise:

6307none, slight, severe, or death;

6312(b) Legal status at the time of the offense:

6321no restraints, or legal constraints;

6326(c) The number of counts or separate

6333offenses established;

6335(d ) The number of times the same offense or

6345offenses have previously been committed by

6351the licensee or applicant;

6355(e) The disciplinary history of the

6361applicant or licensee in any jurisdiction and

6368the length of practice;

6372(f) Pecuniary benefit or self - g ain inuring

6381to the applicant or licensee;

6386(g) The involvement in any violation of

6393Section 458.331, F.S., of the provision of

6400controlled substances for trade, barter or

6406sale, by a licensee. In such cases, the

6414Board will deviate from the penalties

6420recomm ended above and impose suspension or

6427revocation of licensure.

6430(h) Where a licensee has been charged with

6438violating the standard of care pursuant to

6445Section 458.331(1)(t), F.S., but the

6450licensee, who is also the records owner

6457pursuant to Section 456.057( 1), F.S., fails

6464to keep and/or produce the medical records.

6471(i) Any other relevant mitigating factors.

647780 . A significant aggravating factor is that Respondent's

6486actions exposed the public , and Pa tients J.W. and K.S. , to

6497potential severe physical injury , and treated Patients G.P. and

6506V.P. resulting in severe injury . Aggravating factor (c) applies

6516because Petitioner established four separate offenses commi tted

6524by Respondent.

652681. T his is mitigated by Respondent's prior discipline - free

6537history.

6538RECOMMENDATION

6539Based on the foregoing Findings of Fact and Conclusions of

6549Law, it is RECOMMENDED that the Board of Medicine enter a final

6561order finding that Respondent violated section 458.331(1)(t),

6568Florida Statutes, as charged in Amended Administrativ e

6576Complaint s ; imposing a fine of $ 30,000.00 ; revoking Respondent's

6587medical license ; and imposing costs of the investigation and

6596prosecution of this case.

6600DONE AND ENTERED this 2 4th day of February , 2017 , in

6611Tallahassee, Leon County, Florida.

6615S

6616MARY LI CREASY

6619Administrative Law Judge

6622Division of Administrative Hearings

6626The DeSoto Building

66291230 Apalachee Parkway

6632Tallahassee, Florida 32399 - 3060

6637(850) 488 - 9675

6641Fax Filing (850) 921 - 6847

6647www.doah.state.fl.us

6648Filed with the C lerk of the

6655Division of Administrative Hearings

6659this 24th day of February , 2017 .

6666ENDNOTE S

66681/ Responde n t's Exhibit 18, Theresa M. Koppie, Brian P. Grady,

6680and Katsuto Shinohara, Rectal Wall Recurrence of Prostate

6688Adenocarcinoma , 168 J. of Urology 2120 (N ov. 2002).

66972/ Respondent's Exhibit 19, S.S. Bastacky, P.C. Walsh, and

6706J.I. Epstein , Needle Biopsy Associated Tumor Tracking of

6714Adenocarcinoma of the Prostate , 145 J. of Urology 1003 ( May

67251991).

67263/ Ronald E. Wheeler, Men at Risk: the Dirty Little Secre t Î

6739Prostate Bio psies Really Do Spread P rostate Cancer Cells ,

6749pp. 50, 128, 145, 148, 149 (2012).

67564/ Id. at 269.

67605/ Id. at back cover.

67656/ Joint Exhibit 1, page 51, "HIFU Î Procedure Report f o r

6778Prostate Cancer."

67807/ Respondent's expert, Sarat Sabharw al, M.D., suggested that if

6790a patient has a particularly unique medical basis for refusing a

6801needle biopsy, it might be appropriate to trea t for suspected

6812prostate cancer. H owever, Dr. Sabharwal admitted that based upon

6822his review of the medical records o f each of these patients, none

6835of them had such a condition that would warrant treatment in the

6847absence of a confirmatory tissue biopsy . Further, Dr. Sabharwal

6857confirmed that "in the time period between 2008 and 2013, any

6868patient that he [Respondent] atte mpted to treat for prostate

6878cancer without a confirmatory biopsy would have resulted in a

6888deviation from the standard of care." Petitioner's Exhibit 10,

689754/25 - 55/9.

69008/ See Transcript of the final hearing, Vol. 2, 233/12 - 15 ;

6912241/6 - 22 ; 248/9 - 249/8 .

69199 / Respondent's Ex. 8, Thomas P, Frye, Amichai Kilchevsky, Arvin

6930K. George, and Peter Pinto, Multiparametric Magnetic Resonance

6938Imaging for Prostate Cancer , 35 AUA Update Series Lesson 14,

6948pp. 137 - 152 ( 2016); Respondent's Ex. 9, Baris Turkbey, Anna M.

6961Brown , Sandeep Sankineni, Bradford J. Wood, Peter Pinto, and

6970Peter Choyke, Mul t iparametric Prostate Magnetic Resonance Imaging

6979in the Evaluation of Prostate Cancer , 66 CA: A Cancer Journal for

6991Clinicians Issue 4, pp, 326 - 336 (July/Au g. 2016); Respondent's

7002Ex. 1 0, Robert K. Nam, Christopher J.D. Wallis, Jessica Stojcic -

7014Bendavid, Laurent Millot, Christopher Sherman, Linda Sugar, and

7022Ma so om A. Haider , A Pilot Study to Evaluate the Role of Magnetic

7036Resonance Imaging for Prostate Cancer Screening in the General

7045Popul ation , 196 J. of Urology Issue 2, pp. 361 - 366 (Aug. 2016).

705910 / Frye et al., supra note 9 , at 147 ( " The potential future use

7074of mpMRI is as a screening test in conjunction with PSA or novel

7087biomarkers to provide a filter to identify patients who may

7097benef it most from undergoing prostate biopsy. Of course,

7106determining the appropriate screening population will require

7113careful investigation until widespread adoption of this approach

7121can be implemented . ") ; Turkeby et al., supra note 9 , at 336

7134( " There are seve ral challenges facing prostate mpMRI. First, the

7145existing clinical data, although very compelling, cannot be

7153categorized as "Level 1" evidence, as it is largely derived from

7164single - institution studies. Larger, multi - ins t itutional studies

7175are needed befor e mpMRI becomes the standard of care. " ) ; Nam et

7188al., supra note 9 , at 364 (" This preliminary study suggests that

7200it may be reasonable to consider prostate MRI for prostate cancer

7211screening, although larger studies are required before

7218implementation . . . In this pilot study, we found that prostate

7230cancer screening using multiparametric prostate MRI is feasible

7238for use in the general population. We propose that prostate MRI

7249should be further evaluated in a prostate screening study . ").

7260COPIES FURNISHED:

7262Christopher J. Schulte, Esquire

7266Weekley Schulte Valdes, LLC

7270Suite 100

72721635 North Tampa Street

7276Tampa, Florida 33602

7279(eServed)

7280Jack F. Wise, Esquire

7284Department of Health

7287Bin C - 65

72914052 Bald Cypress Way

7295Tallahassee, Florida 32399

7298(eServed)

7299Nichole C. Gear y, General Counsel

7305Department of Health

73084052 Bald Cypress Way, Bin A02

7314Tallahassee, Florida 32399 - 1701

7319(eServed)

7320Claudia Kemp, JD, Executive Director

7325Board of Medicine

7328Department of Health

73314052 Bald Cypress Way, Bin C03

7337Tallahassee, Florida 32399 - 3253

7342( eServed)

7344NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

7350All parties have the right to submit written exceptions within

736015 days from the date of this Recommended Order. Any exceptions

7371to this Recommended Order should be filed with the agency that

7382will issue the F inal Order in this case.

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Date
Proceedings
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Date: 04/24/2017
Proceedings: Petitioner's Response to Respondent's Exceptions to Administrative Law Judge's Recommended Order filed.
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Date: 04/24/2017
Proceedings: Respondent's Exceptions to Administrative Law Judge's Recommended Order filed.
PDF:
Date: 04/24/2017
Proceedings: Agency Final Order filed.
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Date: 04/20/2017
Proceedings: Agency Final Order
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Date: 03/13/2017
Proceedings: Respondent's Exceptions to Administrative Law Judge's Recommended Order filed.
PDF:
Date: 02/24/2017
Proceedings: Recommended Order
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Date: 02/24/2017
Proceedings: Recommended Order (hearing held December 8, 2016). CASE CLOSED.
PDF:
Date: 02/24/2017
Proceedings: Recommended Order cover letter identifying the hearing record referred to the Agency.
PDF:
Date: 02/20/2017
Proceedings: Petitioner's Proposed Recommended Order filed.
PDF:
Date: 02/20/2017
Proceedings: Respondent's Proposed Recommended Order filed.
PDF:
Date: 02/06/2017
Proceedings: Order Granting Extension of Time.
PDF:
Date: 02/03/2017
Proceedings: Respondent's Motion for Extension of Time to File Proposed Recommended Orders filed.
Date: 01/09/2017
Proceedings: Transcript of Proceedings Volumes 1-2 (not available for viewing) filed.
PDF:
Date: 12/27/2016
Proceedings: Notice of Withdrawal filed.
Date: 12/08/2016
Proceedings: CASE STATUS: Hearing Held.
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Date: 12/01/2016
Proceedings: Notice of Re-Filing Petitioner's and Respondent's Proposed Exhibits filed.
PDF:
Date: 11/29/2016
Proceedings: Petitioner's Amended Notice of Court Reporter filed.
PDF:
Date: 11/28/2016
Proceedings: Joint Notice Regarding Joint Pre-hearing Stipulation filed.
PDF:
Date: 11/23/2016
Proceedings: Respondent's Notice of Hearing Scheduling and Unavailability filed.
PDF:
Date: 10/26/2016
Proceedings: Order Granting Motion to Incorporate/Consolidate Filings.
PDF:
Date: 10/25/2016
Proceedings: Petitioner's Unopposed Motion to Incorporate/Consolidate Filings filed.
PDF:
Date: 10/24/2016
Proceedings: Notice of Hearing by Video Teleconference (hearing set for December 8 and 9, 2016; 9:00 a.m.; Sarasota and Tallahassee, FL).
PDF:
Date: 10/24/2016
Proceedings: Order of Pre-hearing Instructions.
PDF:
Date: 10/21/2016
Proceedings: Order of Consolidation (DOAH Case Nos. 16-6136PL, 16-6148PL, 16-6149PL, 16-6150PL).
PDF:
Date: 10/21/2016
Proceedings: Order Granting Motion to Re-Open Proceeding.
PDF:
Date: 10/14/2016
Proceedings: Petitioner's Motion to Re-open Proceeding filed. (FORMERLY DOAH CASE NO. 16-1628PL)
PDF:
Date: 09/08/2016
Proceedings: Transmittal letter from Claudia Llado forwarding the Department's Proposed Exhibits to the agency filed.
PDF:
Date: 08/17/2016
Proceedings: Joint Motion to Relinquish Jurisdiction without Prejudice filed.
PDF:
Date: 08/15/2016
Proceedings: Transmittal letter from Claudia Llado forwarding the Department's four-volume Proposed Exhibits to the agency filed.
PDF:
Date: 08/15/2016
Proceedings: Order Closing File and Relinquishing Jurisdiction.
PDF:
Date: 08/12/2016
Proceedings: Petitioner's Proposed Exhibits (exhibits not available for viewing) filed.
PDF:
Date: 08/12/2016
Proceedings: Notice of Filing of Petitioner's Proposed Exhibits.
PDF:
Date: 08/12/2016
Proceedings: Joint Motion to Relinquish Jurisdiction without Prejudice filed.
PDF:
Date: 08/10/2016
Proceedings: Amended Notice of Hearing by Video Teleconference (hearing set for August 17 and 18, 2016; 9:00 a.m.; Sarasota and Tallahassee, FL; amended as to dates and location).
PDF:
Date: 08/09/2016
Proceedings: Notice of Transfer filed.
PDF:
Date: 08/08/2016
Proceedings: Joint Prehearing Stipulation filed.
PDF:
Date: 08/02/2016
Proceedings: Petitioner's Notice of Court Reporter filed.
PDF:
Date: 07/19/2016
Proceedings: Cross Notice of Taking Deposition by Skype (Dr. Stephen Leslie) filed.
PDF:
Date: 07/14/2016
Proceedings: Notice of Taking Deposition Duces Tecum (Dr. Sarat Sabharwal) filed.
PDF:
Date: 06/30/2016
Proceedings: Notice of Taking Deposition Duces Tecum (Dr. Stephen Leslie) filed.
PDF:
Date: 06/09/2016
Proceedings: Amended Notice of Taking Deposition Duces Tecum (Dennis Donahue) filed.
PDF:
Date: 05/26/2016
Proceedings: Order Granting Continuance and Re-scheduling Hearing (hearing set for August 17 through 19, 2016; 9:00 a.m.; Sarasota, FL).
PDF:
Date: 05/25/2016
Proceedings: Notice of Cancellation of Deposition filed.
PDF:
Date: 05/20/2016
Proceedings: Joint Motion for Continuance filed.
PDF:
Date: 05/17/2016
Proceedings: Subpoena Duces Tecum filed.
PDF:
Date: 05/16/2016
Proceedings: Amended Notice of Taking Telephonic Deposition in Lieu of Live Testimony (Dr. Vipul Patel) filed.
PDF:
Date: 05/05/2016
Proceedings: Amended Notice of Taking Telephonic Deposition in Lieu of Live Testimony (Patient G.P.) filed.
PDF:
Date: 05/03/2016
Proceedings: Notice of Serving Petitioner's Responses to Respondent's First Set of Interrogatories and First St of Requests for Production of Documents filed.
PDF:
Date: 04/29/2016
Proceedings: Notice of Taking Deposition Duces Tecum (Dr. Dennis Donahue) filed.
PDF:
Date: 04/29/2016
Proceedings: Notice of Serving Respondent, Ronald Evan Wheeler, M.D.'s Responses to Petitioner's First Set of Requests for Production of Documents filed.
PDF:
Date: 04/29/2016
Proceedings: Notice of Serving Respondent, Ronald Evan Wheeler, M.D.'s Answers to Petitioner's First Set of Interrogatories filed.
PDF:
Date: 04/29/2016
Proceedings: Notice of Serving Respondent, Ronald Evan Wheeler, M.D.'s Answers to Petitioner's First Set of Request for Admissions filed.
PDF:
Date: 04/26/2016
Proceedings: Notice of Taking Telephonic Deposition in Lieu of Live Testimony (Patient J.W.) filed.
PDF:
Date: 04/26/2016
Proceedings: Notice of Taking Telephonic Deposition in Lieu of Live Testimony (Dr. Eric Brewer) filed.
PDF:
Date: 04/21/2016
Proceedings: Amended Order on Request to Take Judicial Notice.
PDF:
Date: 04/20/2016
Proceedings: Joint Motion for Amended Order on Request to Take Judicial Notice filed.
PDF:
Date: 04/20/2016
Proceedings: Notice of Taking Telephonic Deposition in Lieu of Live Testimony (Dr. Joel Gelman) filed.
PDF:
Date: 04/20/2016
Proceedings: Notice of Taking Deposition in Lieu of Live Testimony (Patient V.P.) filed.
PDF:
Date: 04/19/2016
Proceedings: Notice of Taking Telephonic Deposition in Lieu of Live Testimony (Patient K.S.) filed.
PDF:
Date: 04/19/2016
Proceedings: Notice of Taking Telephonic Deposition in Lieu of Live Testimony (Patient G.P.) filed.
PDF:
Date: 04/19/2016
Proceedings: Notice of Taking Telephonic Deposition in Lieu of Live Testimony (Dr. Jeffrey Jump) filed.
PDF:
Date: 04/18/2016
Proceedings: Notice of Taking Telephonic Deposition in Lieu of Live Testimony (Dr. Vipul Patel) filed.
PDF:
Date: 04/18/2016
Proceedings: Order on Request to Take Judicial Notice.
PDF:
Date: 04/06/2016
Proceedings: Notice of Request to Take Judicial Notice filed.
PDF:
Date: 04/05/2016
Proceedings: Notice of Taking Deposition Duces Tecum (Respondent, Ronald Wheeler, M.D.) filed.
PDF:
Date: 03/31/2016
Proceedings: Notice of Serving Respondent's First Set of Interrogatories and First Set of Request for Poduction filed.
PDF:
Date: 03/30/2016
Proceedings: Order of Pre-hearing Instructions.
PDF:
Date: 03/30/2016
Proceedings: Notice of Hearing (hearing set for June 15 through 17, 2016; 9:00 a.m.; Sarasota, FL).
PDF:
Date: 03/29/2016
Proceedings: Notice of Serving Petitioner's First Set of Requests for Admission, First Set of Interrogatories, and First Set of Requests for Production of Documents filed.
PDF:
Date: 03/29/2016
Proceedings: Joint Response to Initial Order filed.
PDF:
Date: 03/23/2016
Proceedings: Order of Consolidation (DOAH Case Nos. 16-1628PL, 16-1629PL, 16-1630PL, and 16-1631PL).
PDF:
Date: 03/22/2016
Proceedings: Petitioner's Unopposed Motion to Consolidate filed.
PDF:
Date: 03/22/2016
Proceedings: Initial Order.
PDF:
Date: 03/21/2016
Proceedings: Notice of Appearance (Jack Wise and Geoffrey Christian).
PDF:
Date: 03/21/2016
Proceedings: Election of Rights filed.
PDF:
Date: 03/21/2016
Proceedings: Petition for Formal Hearing and Election of Rights filed.
PDF:
Date: 03/21/2016
Proceedings: Amended Administrative Complaint filed.
PDF:
Date: 03/21/2016
Proceedings: Agency referral filed.
PDF:
Date: 03/21/2016
Proceedings: Notice of Appearance (Jack Wise and Geoffrey Christian).
PDF:
Date: 03/21/2016
Proceedings: Election of Rights filed.
PDF:
Date: 03/21/2016
Proceedings: Petition for Formal Hearing and Election of Rights filed.
PDF:
Date: 03/21/2016
Proceedings: Amended Administrative Complaint filed.
PDF:
Date: 03/21/2016
Proceedings: Agency referral filed.

Case Information

Judge:
MARY LI CREASY
Date Filed:
10/19/2016
Date Assignment:
10/19/2016
Last Docket Entry:
04/24/2017
Location:
Sarasota, Florida
District:
Middle
Agency:
ADOPTED IN TOTO
Suffix:
PL
 

Counsels

Related Florida Statute(s) (6):

Related Florida Rule(s) (1):