17-003662N Michele Sanchez And Fidel Sanchez, On Behalf Of And As Parents And Natural Guardians Of Ailani Sanchez, A Minor vs. Florida Birth-Related Neurological Injury Compensation Association Status: Closed DOAH Final Order on Tuesday, January 15, 2019.

Summary: Child does not have a substantial and permanent mental and physical impairment. Therefore, she is not eligible for NICA benefits.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

MICHELE SANCHEZ AND FIDEL

SANCHEZ, on behalf of and as

parents and natural guardians of

AILANI SANCHEZ, a minor,

Petitioners,

vs. Case No. 17 - 3662N

FLORIDA BIRTH - RELATED

NEUROLOGICAL INJURY COMPENSATION

ASSOCIA TION,

Respondent,

and

CARL D. ZOLLICOFFER, M.D.,

Intervenor.

_______________________________/

FINAL ORDER OF DISMISSAL

This came before the undersigned upon a Joint Motion to

Submit Stipulated Factual Record in Li eu of a Contested Hearing ,

which was granted by the undersigned on September 21, 2018 ; a

Stipulated Record ; and written arguments/proposed f inal o rders

submitted by the parties.

STATEMENT OF THE ISSUES

The issue in this case is whether Ailani Sanchez suffe red a

birth - related injury as defined by section 766.302(2) , Florida

Statute s, for which compensation should be awarded under the

Florida Birth - Related Neurological Injury Compensation Plan (the

Plan).

PRELIMINARY STATEMENT

On June 14, 2017, Michele Sanche z and Fidel Sanchez

(Petitioners), on behalf of and as natural guardians of Ailani

Sanchez (Ailani), filed a Petition for Benefits (claim) with the

Division of Administrative Hearings (DOAH) alleging that Ailani

suffered brain damage as a result of a birth - related

neurological injury and requesting relief available under the

Plan.

The Petition na med Carl Zollicoffer, M.D.

(Dr. Zollicoffer) , as the physician who provided obstetrical

services for the birth of Ailani on October 29, 2015, at

Lakeland Regional M edical Center (Lakeland Regional) in

Lakeland, Florida.

On June 27, 2017, DOAH mailed a copy of the Petition to the

Florida Birth - Related Neurological Injury Compensation

Association ( NICA ) , with copies to Dr. Zollicoffer and Lakeland

Regional , by certifie d mail. The certified receipts indicate

that the same was received by NICA on June 30, 2017; by Dr.

Zollicoffer on June 29, 2017; and by Lakeland Regional on July

12, 2017. On July 24, 2017, the undersigned granted Lakeland

Regional's Petition to Interve ne. On October 11, 2017, the

undersigned granted Dr. Zollicoffer's Petit ion to Intervene. On

September 17, 2018, the undersigned granted Lakeland Regional's

Motion to Withdraw its Petition to Intervene.

On November 13, 2017, NICA responded to the Petitio n for

Benefits, suggesting that the subject claim was not compensable

because Ailani had not suffered a birth - related neurological

injury and requesting a final hearing to address said issue.

NICA filed a Motion for Summary Final Order on December 29,

2017 , which was denied by Order dated June 25, 2018 , because

Petitioners asserted both in their Petition and in their

Response to the undersigned's Order to Show Cause (as to why the

Motion for Summary Final Order should not be granted) that

Ailani suffered a birth - related neurological injury.

By Order dated September 21, 2018, this tribu nal granted

the parties' Joint Motion to Submit Stipulated Factual Record in

Lieu of a Contested Hearing. Dr. Zollicoffer takes no position

on the issue of compensability. Th e undersigned's Order of

September 21, 2018 , directed the parties to submit their

stipulated record no later than September 28, 2018 , and any

written arguments and/or proposed final orders no later than

October 5, 2018.

NICA and Dr. Zollicoffer filed a Joi nt Stipulation on

September 17, 2018 , establishing their agreement that at the

time of the birth of Ailani, Dr. Zollicoffer was a NICA

participating physician. The parties' Joint Stipulation

regarding Stipulated Record was filed on September 27, 2018.

Th e parties' Stipulated Record, consisting of Joint Exhibits A

through H, and NICA Ós Exhibits A through D, w ere timely filed on

September 28, 2018. The stipulated evidence includes, inter

alia , AilaniÓs medical records and the written reports of

two NICA co nsulting physician s, Dr. Donald G. Willis and

Dr. Laufey Sigurdardottir.

Each party timely filed written argument and/or a proposed

final order, which have been carefully considered in the

preparation of this Final Order.

FINDINGS OF FACT

1 . Ailani Sanche z was born a live infant at 5:46 a.m. , on

October 29, 2015 , at Lakeland Regional Medical Center.

2 . Ailani was a single gestation, weighing 2,950 grams at

birth.

3 . Ailani was delivered via cesarean section for suspected

abruption/velamentous insertion o f cord by Dr. Zollicoffer who

was a NICA participating physician on October 29, 2015.

4 . Ailani's Apgar scores were 2/4/4. Upon delivery , she

was floppy and pale and had no respiratory effort. Pulse

oximetry was within target saturations for age and her heart

rate remained 100 or greater. She was intubated at seven

minutes of age and transferred to the Neonatal Intensive Care

Unit ( NICU ) . No seizures were noted. Ailani had increasing

spontaneous respiratory effort and whole body cooling was

started pr ior to her transfer to St. Joseph's Hospital NICU on

October 29, 2015.

5 . Upon admission to St. Joseph's Hospital on October 29,

2015, Ailani was lethargic with decreased reactions to stimuli ,

but appeared pink and well perfused. Neurologically, she was

noted to be improving; she was breathing spontaneously and

moving all extremities to stimuli.

6 . After a complicated newborn hospital course , Ailani was

ultimately discharged from St. Joseph's Hospital on January 6,

2016. At the time of her discharge, sh e was noted to be feeding

by mouth and was overall gaining weight. Prior to her

discharge, an EEG on October 30, 2015 , showed seizures

predominantly on the right side of her brain and generalized

brain dysfunction. A brain MRI obtained on November 5, 201 5 ,

revealed restricted diffusion related to acute infarction in the

right temporal occipital region with laminar necrosis.

Additional laminar necrosis in the frontal lobes and insular

cortex bilaterally was noted. An EEG on November 16, 2015 , was

consist ent with nonspecific cerebral dysfunction with occasional

sharp waves in the temporal parietal regions bilaterally with no

evidence of seizures and irregular slow waves with slightly more

predominance to the right.

7 . Ailani was seen for a newborn visit b y her

pediatrician, Dr. Bou Salvador , on January 7, 2016.

Nutritionally, she was noted to be breast feeding adequately ,

with supplements with formula. Developmentally, she was noted

to have equal movements of all extremities and follow midline.

She resp onded to a bell and was able to lift her head while

lying on her stomach. Examination of her spine, extremities ,

and peripheral pulses were all normal. Neurologically, she was

reportedly normal , with normal strength, tone , and reflexes

reported.

8 . On J anuary 19, 2016, Ailani was evaluated at All

Children's Outpatient Care upon referral by St. Joseph's

Hospital secondary to hypoxic ischemia. The occupational

therapist's impression included decreased bilateral

coordination, decreased developmental milest ones, decreased

gross motor skills, decreased play skills, decreased strength,

and fine motor deficits. Skilled therapy was identified to have

the potential to improve her functional level in the areas of

manipulation. It was recommended that Ailani unde rgo 30 minutes

of occupational therapy once a week for six months. Her

prognosis for achieving goals established by her therapist was

noted to be excellent. On February 4, 2016, Ailani was

evaluated for participation in , and deemed eligible for , the

Earl y Steps Program.

9 . On February 18, 20 16, Ailani was evaluated by

Dr. Qureshi at Kids Neurology. Developmentally, she was noted

to smile and coo and focus. It was noted that Ailani had three

seizures at the age of one day old , b ut none since. At this

t ime, she was taking Keppra and Phenobarbital , from which she

was being weaned. A sleep deprived EEG , obtained since the last

visit , was normal. She was noted to be doing very well

neurologically. Her physical examination revealed she was

lifting her che st and head with her arms extended. Early head

control with bobbing motion was noted. She was noted to say

"aah , " smile, and follow pass midline. The plan noted at this

time was to continue to wean and discontinue Keppra and

Phenobarbital.

10 . Ailani w as again seen by Dr. Bou Salvador on March 4,

2016 , for her four - month well visit. Nutritionally, she was

noted to be feeding with formula adequately. She had been

started on solids for one to two feeds. Developmentally , she

was noted to squeal and lau g h. She was able to follow

180 degrees. She turned to void and was able to hold her head

up 90 degrees while lying on her stomach. She was able to sit

with support with her head up. She was able to pull to sit with

no head lag. She could bring her hand s together and had no

persistent fist clenching. Her physical examination was normal.

Her neurological examination was also normal , with normal

strength, tone , and reflexes reported.

11 . Ailani was again seen by Dr. Bou Salvador on May 4,

2016 , for her six - month well visit. Nutritionally, she was

noted to be breast feeding adequately. Developmentally , she was

noted to be social and smiling responsively. Adaptive equal

movements of all extremities and the ability to follow midline

were noted. She coul d respond to a bell and was able to lift

her head while lying on her stomach. A physical examination was

normal. A neurological examination was also normal , with normal

strength, tone , and reflexes reported.

12 . On May 24, 2016, Ailani returned to Dr. Qureshi at

Kids Neurology. It was noted that Ailani had been weaned from

her seizure medication and had had no seizures for the last

three month s . She was noted to be doing very well

neurologically. Physically and developmentally, she was noted

to have no head lag, to be rolling over, to have her chest up in

a prone position, to be trying to crawl, to be lifting her head ,

and to be sitting briefly unsupported. She was also noted to be

leaning forward on her hands, engaging in bounce activity,

supporting most of her weight, reaching out and grasping large

objects, transferring from hand to hand, babbling, enjoying

mirror, and using polysyllable sounds. She was noted to be

feeding herself. Dr. Qureshi reported that Ailani was in

occupation therapy but th at it was on hold since her evaluation

was "pretty unremarkable . " Ailani was noted to be progressing

well for her age and was receiving Early Steps intervention once

a week at home. She was given a prescription of Phenobarbital

for use only if a seizure occurred.

13 . On June 18, 2016, Ailani was seen by Dr. Frances

Arrillaga at Pediatric Cardiology Associates for a cardiology

consultation secondary to a history of pulmonary hypertension ,

and an echocardiogram that showed a patent foramen ova le ( PFO ) .

Ai lani's mother reported th at since her discharge from

St. Joseph's , she was doing well. Cyanosis, difficulty

breathing and unexplained diaphoresis and feeding problems , were

denied. An echocardiogram on this date showed a PFO , with

otherwise normal anatom y. There were normal right ventricular

( RV ) pressures, normal left ventricular ( LV ) size and function.

No cardiovascular restrictions were given and she was told to

return in one year for further follow up.

14 . Ailani was again seen by Dr. Bou Salvador on August 4,

2016 , for her nine - month well visit. Nutritionally, she was

reported to be feeding adequately. She was feeding 2 to 3

varieties of solid foods with no problems and was starting with

a cup for water and juice. Developmentally, she was report ed to

be playing pat - a - cake and looking for fallen objects. She could

bang two cubes in her hand with thumb - finger grasp. She could

say "dada" and "mama" and walk while holding on. She was also

noted to be crawling and standing momentarily. Her physica l and

neurological examinations were noted to be normal , with normal

strength, tone , and reflexes noted.

15 . An August 22, 2016 , a progress note from Early

Intervention reflects that Ailani was babbling two syllables

together, was happy, pulling to a stan d and cruising along

furniture , and was responding to her name. Attendance at Early

Intervention was noted to be consistent and once a week.

16 . Ailani was again seen by Dr. Bou Salvador on

November 3, 2016 , for her 12 - month well visit. Nutritionally,

s he was noted to be eating two to three varieties of solid foods

with no problems and was feeding herself finger foods.

Developmentally, she was reported to be playing pat - a - cake and

drinking from a cup. She was able to bang two cubes held in her

hands wi th thumb - finger grasp. She was saying "mama" and

"dada , " imitated speech sounds, could say three words other than

"mama" and "dada , " and understood "no . " She was able to walk

while holding on , and was reported to stand alone and walk well.

A physical ex amination revealed normal extremities. A

neurologic examination was also normal , with normal strength,

tone , and reflexes reported.

17 . On November 21, 2016, Ailani returned to Dr. Qureshi

at Kids Neurology. It was noted that Ailani had been weaned off

medications six months earlier and had no seizure activity

since. She was noted to be doing very well. It was noted that

no therapy was being provided at this time , although she was

evaluated for occupational therapy but did not qualify for it.

Develop mentally, she was noted to be walking with one hand held,

rising independently, taking several steps, getting to sitting,

pulling to stand, standing for two seconds, saying a few words

besides "mama" and "dada , " playing ball game, making postural

adjustmen t to dressing, waiving "bye bye , " and indicating what

she wants. She was noted to have pincer grasp, releasing

objects to others when grabbed , and banging two things.

Dr. Qureshi noted "she is doing amazing right now."

18 . A December 24, 2016 , emergency room record (for a

cough/choking episode after eating a piece of Dorito) from

Florida Hospital Tampa reflects that Ailani had not had seizures

since birth , and had been off Keppra and Phenobarbital for

almost a year. A physical examination revealed an ac tive, well -

developed , and well - nourished child. Neurologically, she was

noted to be awake, alert , and interacting with family and staff.

She was also noted to be active and playful.

19 . An Early Intervention progress note from February 15,

2017 , reflect s Ailani had age - level play skills, could

communicate using vocalizations and some single words, could

follow routine directions , and was independent with walking and

floor transfers. Good progress was noted to be made, many goals

were reported met , and t he parents decided to reduce services to

one time per month.

20 . On January 30, 2017 , Ailani was reevaluated for

participation in Early Steps. It was noted that Ailani's mother

had no concerns at this time. The report notes that Ailani

liked the slide, liked to kick the ball, liked to play with her

siblings and cousins , and that she is very curious. No hearing

or vision concerns were noted. It was reported that many of her

goals had been met , and that Ailani was using a variety of

vowels and consonants , identifying at least three family members

when named, that she was saying a variety of words , and was

using a sign for "more food . " Ailani was noted to still be

eligible for Early Steps secondary to her diagnosis of hypoxic

ischemic encephalopathy.

21 . Ailani was seen by Dr. Bou Salvador on March 28, 2017 ,

for her 16 - month well visit. She was noted to have good eating

habits and a good appetite. No mealtime problems were reported ,

and she was noted to be eating solid foods with no problems.

She was n oted to have socially appropriate behavior for her age.

She was talking well and was able to balance on one foot for

five second s , could throw a ball overhead , and pedal a tricycle.

Her orthopedic and neurologic examinations were normal , with

normal stre ngth, tone , and reflexes reported.

22 . At the request of NICA, Donald C. Willis, M.D. , who

specializes in obstetrics and gynecology and maternal - fetal

medicine, reviewed the medical records included in the

Stipulated Record as Joint Exhibits A through G. In his report

dated August 2, 2017, which was admitted into evidence without

objection, Dr. Willis noted in pertinent part that Ailani's

mother was cramping when she presented to the hospital , and was

three centimeters dilated with suspected amniotic memb ranes

ruptured. Contractions were noted to be occurring occasionally.

Medical records indicated the presence of late decelerations on

admission , which progressed to bradycardia , for which an

immediate Cesarean section was recommended. Dr. Willis observe d

that Ailani was depressed at birth with Apgar scores of 2/4/4,

and that cord blood gas was abnormal with a pH of only 6.97. He

further noted that Ailani was floppy, pale , and had poor

perfusion; that bag and mask ventilation was initiated , followed

by i ntubation for continued respiratory distress; that

hypotension was present and required IV fluids; that the initial

blood count was low; and that Ailani remained acidotic after

birth with a pH of 6.7 and a base excess of - 27 at 90 minutes

after birth. Dr. Willis further noted Ailani's hospital course

consistent with her medical records and ultimately opined that

Ðthere was an obstetrical event that resulted in loss of oxygen

to the baby's brain during labor, delivery and continuing into

the immediate post delivery period. The oxygen deprivation

resulted in brain injury.Ñ Dr. Willis was unable to comment

about the severity of the injury, however.

23. At the request of NICA, Laufey Y. Sigurdardottir,

M.D. , who is b oard c ertified in neurology and specializ ing in

pediatric neurology, reviewed the medical records included in

the Stipulated Record as Joint Exhibits A through G, and

performed a thorough examination of Ailani on October 18, 2017.

Dr. Sigurdardottir's summary of Ailani's medical history , along

w ith her findings upon a full physical and neurological

examination , is documented within her written report, which was

admitted into evidence without objection. Dr. Sigurdardottir

noted that Ailani was a non - dysmorphic, interactive toddler with

normal fac ial features and apparently intact vision. No

abnormalities in Ailani's extremities were noted other than

occasional toe walking. Neurologically, Ailani was noted to be

interactive, curious , and exhibiting normal joint attention.

Ailani exhibited preten d play with a stethoscope, said the word

"mom" a few times, pointed to her mouth when asked to do so,

enjoyed playing with a tablet computer, shook her head for "no , "

exhibited understandable words, and exhibited no autistic

features. Cranial nerves were intact, facial grimacing was

symmetric and normal , and hearing seemed intact. No drooling

was noted. Muscle tone was noted to be normal, strength was

full and symmetric and deep tendon reflexes were symmetric and

within normal limits. Gross and fine mot or skills were noted to

be within normal limits for age.

24 . Overall, Dr. Sigurdardottir determined that despite

her initial abnormal neurological examination , and delays in

early development, Ailani's current neurologic and developmental

functioning is a ge - appropriate. She went on to opine in

relevant part that,

Ailani is not found to have substantial

delays in motor and mental abilities at this

time . . . . In review of available

documents, there is evidence of impairment

consistent with a neurologic i njury to the

brain or spinal cord acquired due to oxygen

deprivation . . . . The prognosis for full

motor and mental recovery is excellent and

the life expectancy is full . . . . In

light of evidence presented I believe Ailani

does not fulfill criteria o f a substantial

mental and physical impairment at this time.

I do not feel that Ailani should be included

in the NICA program.

25 . Neither Petitioner nor Intervenor submitted or

introduced into evidence any expert reports rebutting the

opinions of Dr. W illis and/or Dr. Sigurdardottir.

CONCLUSIONS OF LAW

26 . The Division of Administrative Hearings has

jurisdiction over the parties to and the subject matter of these

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

27 . The Plan was established by the Legislat ure "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. Stat.

28 . The injured infant, her or his personal

representa tive, parents, dependents, and next of kin may seek

compensation under the Plan by filing a claim for compensation

with DOAH. §§ 766.302(3), 766.303(2), and 766.305(1), Fla.

Stat. NICA, 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.

29 . If NICA determines that the i njury alleged in a claim

is a compensable birth - related neurological injury, 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 .

30 . In discharging this responsibility, the administrative

law judge must 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 t he

satisfaction of the administrative law

judge, that the infant has sustained 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

im paired, a rebuttable presumption shall

arise that the injury is a birth - related

neuro logical 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

resuscitat ion in the immediate postdelivery

period in a hospital; or by a certified

nurse 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

administrative 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." § 76 6.31(1), Fla. Stat.

31 . The term "birth - related neurological injury" is

defined in section 766.302(2) as follows:

"Birth - related neurological injury" means

injury to the brain or spinal cord of a live

infant weighing at least 2,500 grams for a

single ges tation or, in the case of a

multiple gestation, a live infant weighing

at least 2,000 grams at birth caused by

oxygen deprivation or mechanical injury

occurring in the course of labor, delivery,

or resuscitation in the immediate

postdelivery period in a ho spital, which

renders the infant permanently and

substantially mentally and physically

impaired.

32 . To be compensable under the NICA Plan, there must have

been an obstetrical event which resulted in loss of oxygen to

the babyÓs brain during labor, deli very, or resuscitation in the

immediate post - delivery period resulting in a permanent and

substantial mental impairment and a permanent and substantial

physical impairment, inasmuch as both are required to establish

compensability. Fla. Birth - Related Neur ological Injury Comp.

AssÓn v. Div. of Admin. Hearings , 686 So. 2d 1349 (Fla. 1997).

33 . Dr. Willis' s unrebutted opinion that "there was an

apparent obstetrical event that resulted in loss of oxygen to

the baby's brain during labor, delivery and continuin g into the

immediate post - delivery period" is credited.

34 . Likewise, Dr. Sigurdardottir's unrebutted opinions

that "Ailani is not found to have substantial delays in motor

and mental abilities at this time" and that "the prognosis for

full motor and ment al recovery is excellent and the life

expectancy is full" are also credited.

35 . In his Order to Show Cause of February 5, 2018, the

undersigned included the following endnote:

2 / The undersigned notes that he is not

qualified to determine whether Ailani

Sanchez suffered a Ðbirth related

neurological injuryÑ based solely upon a

review of the medical records submitted to

NICA.

36 . Thereafter, on February 14, 2018, Petitioners filed a

response to the Order to Show Cause. In their response ,

Petitioners r eiterated their position that Ailani did suffer a

compensable neurological injury, and stating further

ÐPetitioners continue to rely upon the medical records submitted

to NICA with PetitionersÓ claim to support their position in

this case.Ñ Petitioners fu rther stated that Florida Statutes do

not require that Petitioners retain a medical expert in order to

obtain NICA benefits.

37 . While Petitioners are correct that nothing in the

statutes governing NICA requires them to retain a medical expert

to substan tiate their claim, they do bear the burden of proving,

by competent substantial evidence, that Ailani suffered a birth -

related neurological injury as defined by section 766.302(2).

38 . As noted in the cited endnote above, the undersigned

is not qualified to determine whether Ailani Sanchez suffered a

Ðbirth related neurological injuryÑ based solely upon a review

of the medical records submitted to NICA. See Worzalla v.

Barnhart , 311 F. Supp. 2d 782 (E.D. Wis. 2004) ( ÐALJs must not

succumb to the temptati on to play doctor and make their own

independent medical findings.Ñ ). As the party bearing the

burden of proof, it was incumbent upon Petitioners to present

expert medical opinion to rebut the expert medical opinions

expressed by NICAÓs retained experts. This, Petitioners failed

to do.

39 . The competent substantial evidence in this case

reveals that Ailani does not have a permanent and substantial

mental or physical impairment. Thus, Ailani has not suffered a

birth - related neurological injury as defined by section

766.302(2) and is not entitled to benefits under the Plan.

ORDER

Based on the foregoing Findings of Fact and Conclusions of

Law, it is ORDERED that the Petition filed by Michele Sanchez

and Fidel Sanchez , on behalf of and as parents and natural

guardians of Ailani Sanchez , is dismissed with prejudice.

DONE AND ORDERED this 15th day of January , 2019 , in

Tallahassee, Leon County, Florida.

S

W. DAVID WATKINS

Administrative Law Judge

Division of Administrative Hea rings

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 15th day of January , 2019 .

COPIES FURNIS HED:

(via certified mail)

Kenney Shipley, Executive Director

Florida Birth Related Neurological

Injury Compensation Association

Suite 1

2360 Christopher Place

Tallahassee, Florida 32308

(eServed)

(Certified Mail No. 7012 1640 0000 7869 7570)

Chafica A . Singha, Esquire

Singha Law Group

Post Office Box 56424

St. Petersburg, Florida 33732

(eServed)

(Certified Mail No. 7012 1640 0000 7869 7587)

Paula J. Lozano, Esquire

Walters Levine & Lozano

Sarasota City Center

1819 Main Street, Suite 1110

Saraso ta, Florida 34236

(eServed)

(Certified Mail No. 7012 1640 0000 7869 7594)

Michael R. D`Lugo, Esquire

Wicker, Smith, O`Hara, McCoy, Ford, P.A.

Suite 1000

390 North Orange Avenue

Orlando, Florida 32802

(eServed)

(Certified Mail No. 7012 1640 0000 7869 760 0)

Brooke M. Gaffney, Esquire

Smith, Stout, Bigman & Brock, P.A.

Suite 900

444 Seabreeze Boulevard

Daytona Beach, Florida 32118

(eServed)

(Certified Mail No. 7012 1640 0000 7869 7617)

Amie Rice, Investigation Manager

Consumer Services Unit

Department o f Health

4052 Bald Cypress Way, Bin C - 75

Tallahassee, Florida 32399 - 3275

(Certified Mail No. 7012 1640 0000 7869 7624)

Mary Mayhew , Secretary

Health Quality Assurance

Agency for Health Care Administration

2727 Mahan Drive, Mail Stop 1

Tallahassee, Florid a 32308

(Certified Mail No. 7012 1640 0000 7869 7730 )

NOTICE OF RIGHT TO JUDICIAL REVIEW

Review of a final order of an administrative law judge shall be

by appeal to the District Court of Appeal pursuant to section

766.311(1), Florida Statutes . Review proceedings are governed

by the Florida Rules of Appellate Procedure. Such proceedings

are commenced by filing the original notice of administrative

appeal with the a gency c lerk of the Division of Administrative

Hearings within 30 days of rendit ion of the order to be

reviewed, and a copy, accompanied by filing fees prescribed by

law, with the clerk of the appropriate District Court of Appeal.

See § 766.311(1), Fla. Stat., and Fla. Birth - Related

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

(Fla. 1st DCA 1992).