19-001931PL Department Of Health, Board Of Medicine vs. John Carey Tomberlin, M.D.
 Status: Closed
Recommended Order on Tuesday, January 21, 2020.


View Dockets  
Summary: Petitioner did not establish by clear and convincing evidence that Respondent failed to meet the standard of care.

1STATE OF FLORIDA

4DIVISION OF ADMINISTRATIVE HEARINGS

8DEPARTMENT OF HEALTH,

11BOARD OF MEDICINE ,

14Petitioner , Case No. 19 - 1931PL

20vs.

21JOHN CAREY TOMBERLIN, M.D. ,

25Respondent .

27/

28RECOMMENDED ORDER

30On October 15 , 2019, Administrative Law Judge Yolonda Y.

39Green of the Division of Administrative Hearings (“DOAH”)

47conducted a duly - noticed hearing pursuant to section 120.57(1),

57Florida Statutes (2019), in Panama City Beach , Florida.

65APPEARANCES

66For Petitioner: Jasmine Green, Esquire

71Cynthia Nash - Early, Esquire

76Department of Health

794052 Bald Cypress Way , Bin C - 65

87Tallahassee, Florida 32399

90For Respondent: Brian Newman, Esquire 1/

96Kathryn Hood , Esquire

99Pennington, P.A.

101Suite 200

103215 South Monroe Street

107Post Office Box 10095

111Tallahassee, Florida 32301

114STATEMENT OF THE ISSUE S

119The issues to be determined are whether Respondent,

127John Carey Tomberlin, M.D. (“Respondent” or “Dr. Tomberlin”) ,

135violated section 458.331 (1) (t) 1. , Florida Statutes (2014) , by

145failing to identify a subdural hematoma on the left side of

156Patient J . A . ’s brain, as alleged in the Administrative

168Complaint; and if so, what penalty should be imposed.

177PRELIMINARY STATEMENT

179On June 22, 2018, the Department of Health, Board of

189Medicine ( “ Petitioner ” or “ the Department ” ), filed a two - count

205Administrat ive Complaint alleg ing Respondent violated

212section 458.331(1)(m) and (t)1. , in his interpretation of a CT

222scan of Patient J.A.’s head . On J uly 1 1, 2018, Respondent

235notified the Department that he disputed the allegations in the

245Administrative Complaint and requested a hearing involving

252disputed issues of material fact. On April 15, 2019, the

262Department referred this matter to DOAH for assignment of an

272administrative law j udge, which was assigned to the undersigned.

282On June 10, 2019, Petitioner filed a Notice of Dismissal of

293Count II, which dismissed the allegation of a violation of

303section 458.331(1)(m). The remaining count in the

310Administrative Complaint alleges that Respondent violated

316section 458.331(1)(t)1., by failing to identify a subdural

324hematoma on the left side of Patient J.A.’s brain.

333The undersigned issued a Notice of Hearing scheduling this

342case for June 20, 2019. On June 10, 2019, Respondent filed an

354Unopposed Motion to Continue , seeking a continuanc e based on a

365scheduling conflict , which the undersigned granted. The

372undersigned rescheduled this case for October 15 and 16, 2019 ,

382and it commenced as scheduled.

387The parties filed a n Amended Joint Pre - H earing Stipulation

399on October 8, 2019, containing f actual stipulations that h ave

410been incorporated into the Findings of F act below .

420At the hearing, Petitioner presented the expert testimony

428of Josep h Andriole, M.D . Petitioner’s Exhibit 1 was admitted

439over objection and Petitioner’s Exhibits 2 and 3 were admitted

449without objection. Respondent testified on his own behalf

457and presented the expert testimony of Katherine Lursen, M.D.,

466Respondent’s expert witness . Re spondent’s Exhibits 3, 4,

475and 6 were admitted without objection , and Respondent’s

483Exhibit 5 wa s proffered.

488The one - volume Transcript of th e proceeding was filed with

500DOAH on December 4, 2019 . On December 12, 2019, the undersigned

512considered and granted R espondent’s Unopposed Motion for

520E xtension of Time to F ile Proposed Recommended Orders . Thus ,

532the deadline for Proposed Recommended Orders ( “ PROs ” ) was

544December 20, 2019. The parties timely filed PROs , wh ich have

555been considered in preparation of this Recommended Order. 2 /

565This proceeding is gover ned by the law in effect at

576the time of the commission of the acts alleged to warrant

587discipline. See McCloskey v. Dep’t of Fin. Servs. , 115 So. 3d

598441 (Fla. 5th DCA 2013). Thus, references to statut es are to Florida Statutes (2014 ), unless otherwise noted.

617FINDING S OF FACT

621Based upon the testimony and documentary evidence presented

629at hearing, the demeanor and credibility of the witnesses, and

639the entire record of this proceeding, the following Findings of

649F act are made :

654Parties

6551 . Petitioner is the state agency charged with regulating

665the practice of med icine pursuant to section 20.43 and

675chapters 456 and 458, Florida Statutes.

6812. At all times material to this proceeding and

690Petitioner’s Administrative Complaint , Respondent was li censed

697to practice medicine in the sta te of Florida, havin g been issued

710license number ME 60438.

7143. Respondent’s practice address of record is

7212600 Hospital Drive, Bonifay , Florida 32425.

7274 . Respond ent, a board - certified radiologist , has been

738practicing since 1987. Respondent attended University of

745Alabama for medical school and is also licensed in that state.

756He has worked in rural areas in covering a variety of prac tice

769settings, including prisons, clinics , and hospitals. I n his

778practice as a radiologist, h e testified that he r eviews 100 to

791200 CT scans per week .

797Facts Related to Patient J.A. ’s CT S can

8065. On August 29, 2014, P atient J.A., a seventy - four year

819old male, presented to Doctor’s Memorial Hospital in Bonifay,

828Florida.

8296 . Patient J.A. presented with a history of suffering a

840physical attack including being struck over the head with a

850chair and being repeatedly punched in the head. The attack

860resulted in complaints of dizziness and a contusion on the left

871side of the head. T o fully assess the injury sustained during

883the attack , Patient J.A. underwent a CT scan of the head without

895contrast .

8977 . R espondent was tasked with interpreting the CT scan .

9098 . On August 29, 2014, Dr. Tomberlin dic tated a report of

922his findings as follows: “Bone and soft tissue windows are

932included. Soft tissue density can be seen within some of the

943paranasal sinuses. The calvarium is intact. The ventricles are

952symmetrical. Pineal calcifications are noted. There is no

960acute hemorrhage, midline shift, mass effect or extra - axial

970fluid collection.” H is opinion was as follows : “ (1) Negative

982CT brain scan ; and (2) M inimal sinusitis with bot h acute and

995chronic elements noted. ”

9999 . On August 29, 2 014, Respondent did not detect a

1011subdural hematoma in the CT scan images of Patient J.A .’s head.

102310 . A subdural hematoma is a collection of blood in the

1035head on the outside of the brain beneath the dura, a fibrous

1047lining of the brain.

105111 . Patient J. A . d ied on September 16, 2014 .

106412 . Dr. Tomberlin acknowledged that he did not perceive

1074the hematoma at the time of his initial review, despite

1084exercising due care in his review of the CT scan. He explained

1096that he missed the hematoma due to several factors: t here was

1108no indication of a midline shift ; hyperdensity was white and

1118dense in comparison to the rest of the brain tissue ; the brain

1130was very large ; and the size (described as small) of the

1141subdural hematoma. He noted that while elderly patients are at

1151a higher risk for subdural he matoma, P atient J.A. ha d a health y

1166and larger brain despite his age.

117213 . Dr. Tomberlin testified that after he learned that

1182Patient J.A. had died, he performed a post - mortem review of the

1195CT scan and discovered the subdural hematoma.

1202Expert Witnesses

1204D r. Andriole

12071 4 . T he Department presented the testimony of Joseph

1218Gerald Andriole, M.D . Dr. Andriole was accepted as an expert in

1230diagnostic radiology. Dr. Andriole is a board - certified

1239diagnostic radiologist with a subspecialty in interventional

1246radiology. He has been licensed to practice medicine in F lorida

1257since 1986. He attended Howard University S chool of M edicine

1268and completed his residency in diagnostic radiology at Case

1277Western Reserve University Hospital . Dr. Andriole is not

1286trained in and is not board certified in neuroradiology.

12951 5 . Since reducing his full - time practice to three to four

1309days per month in 2012, Dr. Andriole reviews approximately 15 CT

1320scans of the head per month in an outpatient setti ng.

1331Dr. Lursen

13331 6 . Respondent presen ted the testimony of Katherine

1343Perrien Lursen , M.D ., who was accepted as an expert in

1354diagnostic radiology. Dr. Lursen, a diagnostic radiologist , is

1362licensed to practice medicine in Alabama . Dr. Lursen is not

1373licensed to practice medicine in F lorida, but she maintains an

1384ex pert witness certificate , having been issued certificate

1392number MEEW6548 , which authorizes her to testify in Florida

1401cases. For the reasons set forth herein, she is also familiar

1412wit h the standards of reviewing CT scans.

14201 7 . Dr. Lursen earned her medical degree from the

1431University of Alabama at Birmingham and completed her residency

1440in radiology. She also completed a fel lowship in

1449neuroradiology. Dr. Lursen is board certified in diagnostic

1457radiology with a certification in the subspecialty of

1465neuroradiology.

146618 . Dr. Lursen has practiced diag nostic radiology for nine

1477years. In her full - time practice , she services three hospitals

1488as a neuroradiologist and reviews approximately 120 to 150 CT

1498scans of the head each month.

150419 . S he serves as the chair of the radiology department at

1517Mobile Infirmary, a 700 - bed hospital in Mobi le, Alabama, the

1529larges t hospital in Mobile. As the department chair , she helps

1540develop protocols for radiology at Mobile Infirmar y, including

1549the appropriate method to interpret radiology images.

1556Dr. Lursen also serves on a hospital peer - review committee and

1568reviews cases where the standard of care i s at issue.

15792 0 . In addition to h er practice related duties, Dr. Lursen

1592teaches at the Alabama College of Osteopathic Medicine and

1601instructs students during rotations.

1605Allegations Related to the Standard of Care

16122 1 . Dr. Andriole reviewed the hospital records for

1622Patient J.A. for August 29, 2014, including the admission record

1632that reflected Patient J.A. was “hit in the head” in the left

1644temple area and a contusion was noted on the left temple.

1655Dr. Andriole also reviewed t he CT scan of Patient J.A.’s h ead

1668and Respondent’s CT report . Based on his review of the CT scan ,

1681CT report, and hospital records, D r. Andriole opined that

1691Dr. Tomberlin departed from the standard of care by failing

1701to identify the subdural hematoma on the left side of

1711Patient J.A.’s brain.

17142 2 . When the standard of care is at issue , the individual

1727opinion of an expert witness does not establish the standard of

1738care. The standard of care is based on the level of care,

1750skill, and treatment which, in light of all relevant surrounding

1760circumstances, is recognized as acceptable and appropriate by

1768reasonably prudent similar health care providers . 3/

177623. Petitioner’s expert, D r. Andriole , was tasked with

1785establishing the actions a reasonably prudent radiologist would

1793exercise when interpreting a CT scan of the head. Dr. Andriole

1804testified that “ the standard of care states that a physician

1815would provide the type of interpretation that wou ld be expected

1826from a competent, prudent physician at the time under similar

1836circumstances. ” He also testified that th e standard of care

1847required Dr. Tomberlin to identify “expected abnormalities” that

1855result from the type of head injury or trauma suffered by

1866Patient J.A.

18682 4 . Based on the testimony at hearing, Dr. Andriole ’s

1880expert testimony fell short of establishing the standard of care

1890a reasonably prudent physician would exercise under the

1898circumstances to detect an abnormality.

19032 5 . W hen addre ssing the standard of care, Dr. Andriole’s

1916testimony was as follows:

1920Q. W hat is the standard of care for a

1930radiologist reviewing the CT scan of the

1937head or brain ?

1940A. [T] he standard of care states that a

1949physician would provide the type of

1955interpretatio n that would be expected from

1962a competent, prudent physician at the time

1969under the circumstances.

19722 6 . Dr. Andriole testified that a physician would provide

1983the type of interpretation that w ould be expected, but failed

1994to stat e standards upon which the undersigned could evaluate

2004Dr. Tomberlin’s interpretation of the CT scan.

20112 7 . Further, Dr. Andriole reached his opinion without

2021regard to the findings in the CT report , which reflected

2031Dr. Tomberlin’s assessment of the CT sc an. In considering

2041whether Dr. Tomberlin met the standard of care, Dr. Andriole

2051testified that a reasonably prudent physician would consider the

2060underlying cause of injury or trauma to aid in interpret ation of

2072the CT scan, which Dr. Tomberlin considered. Dr. Andriole

2081acknowledged that the abnormality was smaller than average for a

2091subdural hematoma. He also acknowledged that Dr. Tomberlin

2099carefully reviewed the CT scan because he identified small

2108abnormalities in the sinuses that were smaller than the subdural

2118hematoma.

21192 8 . Dr. Andriole agreed that the type of error in this

2132case, a perceptional error, may still meet the standa rd of care.

2144Dr. Andriole ack nowledged that a three to five percent error

2155rate can occur when reviewing radiology images.

216229 . Dr. Lursen , on the other hand, opined that

2172Dr. Tomberlin met the standard of care in his review of the CT

2185scan for Patient J.A. Dr. Lursen pointed to Respondent ’s

2195interpretation of the CT scan and highlighted that his reference

2205to absence of midline shift, absence of mass effect, and

2215calvarium (being) intact show Dr. Tomberlin was looking for a

2225subdural hematoma.

222730 . Dr. Lursen credibly testified that when interpreting a

2237CT scan of the head of a trauma patient, the standard of care

2250requires a physician to look at several factors to detect an

2261abnormality. Dr. Lursen testified that assessing whether there

2269is a midline shift and mass effect is important because those

2280are two signs of intracranial hemorrhage, including subdural

2288hematoma. The standard of care also requires that the

2297radiologist look for areas of hyperdensity because hyperdensity

2305is an indicator o f intracranial hemorrhage. Density refers to

2315the amount of gray versus the amount of black and white on an

2328image. If an image is hyperdense, then it is whiter than the

2340su rrounding or adjacent structure or tissue . The radiologist

2350should determine whether there is a skull fracture. Finally,

2359the radiologist should look for acute hemorrhage.

23663 1 . Dr. Lursen noted that Respondent’s CT report reflecte d

2378an appropriate assessment of care a reasonably prudent physician

2387would exercise to detect a subdural hematoma.

23943 2 . Despite the appropriate assessment, however, it is

2404undisputed that Respondent failed to identify the subdural

2412hematoma.

24133 3 . Dr. Lursen opined that failure to identify the

2424hematoma was not a departure from the sta ndard of care due to

2437its atypical appearance. Dr. Lursen considered the presentation

2445of the subdural hematoma to be atypical because of its “tiny”

2456size , and the absence of typical traits, “ including, mass

2466effect, midline shift, or inju ry to the skull in the CT images . ”

2481She testified that the density of the hematoma was closer to the

2493shade of the brain mass and there was no skull fracture.

25043 4 . Further, a classical subdural hematoma is C - shaped and

2517causes a midline shift of the brain , which was not apparent on

2529Patient J.A.’s CT scan.

25333 5 . Dr. Lursen provided testimony that Respondent’s

2542failure to identify the hematoma fell with an accepted three to

2553five percent error rate . That error rate includes the

2563presumption that the radiologist has conducted himself in a

2572manner in interpreting the film or image that is prudent under

2583the circ umstances. According to Dr. Lursen, a radiologist can

2593have a three to five percent error rate and still have met the

2606standard of care. In this case, Dr. Lursen credibly testified

2616that Respondent’s failure to identify the subdural hematoma f ell

2626within that three to five percent error rate, but he still met

2638the standard of care.

26423 6 . Dr. Lursen testified that Dr. Tomberlin’s error fell

2653with in the category of an observational or perceptual error. An

2664observational or perceptual error occurs when a radiologist

2672follows the appropriate method for reviewing images but does not

2682perceive the a bnormality upon initial review.

26893 7 . Dr. Lursen ’s opinion that Dr. Tomber l in’s failure to

2703identify the subdural hematoma wa s a perceptual error, which did

2714not fa ll outside the standard of care is credited.

2724Ultimate Findings of Fact

27283 8 . In determining whether Dr. Tomberlin met the standard

2739of care, the question is not whether either of the experts could

2751identify t he abnormality, but whether Dr. Tomberlin used the

2761degree of skill and care that a reasonably prudent physician in

2772the medical community would exercise to detect the abnormality.

278139 . To be convincing, the opinion ne eds to establish

2792clearly the existence of a standard of care in the profession

2803and explain how such standard ap plies to the facts of the case.

2816A n expert's opinion on the standard of care must result from a n

2830analysis of the facts to determine w hat a reason ably prudent

2842physician in the radiology community would do given the

2851circumstances.

285240 . T he undersigned finds in Dr. Lursen’s expert testimony

2863t hat Dr. Tomberlin met the standard of care in his

2874interpretation of Patient J.A.’s CT scan more persuasive than

2883D r. Andriole ’s testimony . 4 /

28914 1 . Thus, the Department did not establish by clear and

2903convincing evidence that Respondent violated the applicable

2910standard of care in his interpretation of the CT scan of

2921Patient J.A.’s head.

2924CONCLUSIONS OF LAW

29274 2 . The Division of Administrative Hearings has

2936jurisdiction over the parties to and the subject matter of this

2947proceeding pursuant to sections 120.569, 120.57(1), and

2954456. 073(5 ), Florida Statutes (2019 ).

29614 3 . The Department has authority to investigate and file

2972administrative complaints charging violations of the laws

2979governing the practice of nursing. § 456.073, Fla. Stat.

29884 4 . This is a proceeding in which the Department seeks to

3001discipline Respondent’s lice nse as a medical doctor. The

3010Department has the burden to prove the allegations in the

3020Administrative Complaint by clear and convincing evidence.

3027Dep’t of Banking & Fin. v. Osborne Stern & Co. , 670 So. 2d

3040932 (Fla. 1996); Ferris v. Turlington , 595 So. 2d 292 (Fla.

30511987). Fox v. Dep't of Health , 994 So. 2d 416 (Fla. 1st DCA

30642008); Pou v. Dep’t of Ins. & Treasurer , 707 So. 2d 941 (Fla. 3d

3078DCA 1998).

30804 5 . The clear and convincing evidence level of proof:

3091[E} ntails both a qualitative and

3097quantitative standard. The evidence must be

3103credible; the memories of the witnesses must

3110be clear and without confusion; and the sum

3118total of the evidence must be of sufficient

3126weight to convince the trier of fact without

3134hes itancy.

3136Clear and co nvincing evidence requires

3142that the evidence must be found to be

3150credible; the facts to which the witnesses

3157testify must be distinctly remembered; the

3163testimony must be precise and explicit and

3170the witnesses must be lacking in confus ion

3178as to the facts in issue. The evidence must

3187be of such weight that it produces in the

3196mind of the trier of fact a firm belief or

3206conviction, without hesitancy, as to the

3212truth of the allegations sought to be

3219established.

3220In re Henson , 913 So. 2d 579, 590 (Fla. 2005) (quoting

3231Slomowitz v. Walker , 429 So. 2d 797, 800 (Fla . 4th DCA 1983)).

3244While this burden of proof may be met where the evidence is in

3257conflict, it “seems to preclude evidence that is ambiguous.”

3266Westinghouse Elec. Corp. v. Shuler Bros. , 590 So. 2d 986,

3276988 (Fla. 1st DCA 1991).

32814 6 . Because this proceeding is considered penal in

3291nature, Respondent can only be found guilty of those allegations

3301specifically referenced in the Administrative Complaint.

3307Trevisani v. Dep’t of Health , 908 So. 2d 1108, 1109 (Fla. 1st

3319DCA 2005); see also Christian v. Dep’t of Health , 161 So. 3d

3331416, 417 (Fla. 2d DCA 2014); Ghani v. Dep’t of Health , 714 So.

33442d 1113, 1114 - 15 (Fla. 1st DCA 1998). Thus, only those allegations actually charged in the Admini strative Complaint are

3365considered in this Recommended Order. Moreover, charges in a

3374disciplinary proceeding must be strictly construed, with any

3382ambiguity construed in favor of the licensee. Elmariah v. Dep’t

3392of Prof’l Reg. , 574 So. 2d 164, 165 (Fla. 1st DCA 1990); Taylor

3405v. Dep’t of Prof’l Reg. , 534 So. 2d 782, 784 (Fla. 1st DCA

34181988). Charging statutes must be construed in terms of their literal meaning, and words used by the Legislature may not be

3439expanded to broaden their application. Beckett v. Dep ’t of Fin.

3450Servs. , 982 So. 2d 94, 99 - 100 (Fla. 1st DCA 2008); Dyer v. Dep’t

3465of Ins. & Treas. , 585 So. 2d 1009, 1013 (Fla. 1st DCA 1991).

34784 7 . The Administrative Complaint charges Respondent with

3487violating section 458.331(1)(t)1., which provided:

3492Notwithsta nding s. 456.072(2) but as

3498specified in s. 456.50(2):

35021. Committing medical malpractice as

3507defined in s. 456.50. The board shall give

3515great weight to the provisions of s. 766.102

3523when enforcing this paragraph. Medical

3528malpractice shall not be construed to

3534require more than one instance, event, or

3541act.

35424 8 . Section 456.50(1)(g) defined medical malpractice as

3551follows:

3552(g) “Medical malpractice” means the failure

3558to practice medicine in accordance with the

3565lev el of care, skill, and treatment

3572recognized in general law related to health

3579care licensure. Only for the purpose of

3586finding repeated medical malpractice

3590pursuant to this section, any similar

3596wrongful act, neglect, or default committed

3602in another state or country which, if

3609committed in this state, would have been

3616considered medical malpractice as defined in

3622this paragraph, shall be considered medical

3628malpractice if the standard of care and

3635burden of proof applied in the other state

3643or country equaled or ex ceeded that used in

3652this state.

365449 . S ection 766.102 provided in pertinent part:

3663(1) In any action for recovery of damages

3671based on the death or personal injury of any

3680person in which it is alleged that such

3688death or injury resulted from the negligence

3695of a health care provider as defined in

3703s. 766.202(4), the claimant shall have the

3710burden of proving by the greater weight of

3718evidence th at the alleged actions of the

3726health care p rovider represented a breach

3733of the prevailing professional standard of

3739care for that health care provider. The

3746prevailing professional standard of care for

3752a given health care provider shall be that

3760level of care, skill, and treatment which,

3767in light of all relevant surrounding

3773circums tances, is recognized as acceptable

3779and appropriate by reasonably prudent

3784similar health care providers.

378850 . The Admin istrative Complaint alleges Respondent failed

3797to meet the prevailing standard of care by failing to identify

3808the subdural hematoma on P atient J.A.’s CT scan. Both ex perts

3820agree d that the failure to perceive and identify an abnormalit y

3832that can be seen on an image does not always amount to a

3845depa rture from the standard of care , s uch is the case here ,

3858despite the outcome for the patient.

386451 . As set forth in the Findings of F act herein, the

3877evidence in this case was not clear and convincing that

3887Respondent violated an applicable standard of care by failing to

3897identify the subdural hematoma.

390152 . Based on the foregoin g , t he Department did not meet

3914its burden to prove , by clear and convincing evidence , that

3924Respondent committed a violation as alleged in the

3932Administrative Complaint.

3934RECOMMENDATION

3935Based on the foregoing Findings of Fact and Conclusions of

3945Law, it is RECOMMENDED that the Department of Health, Board of

3956Medicine enter a final order dismissing the Administrative

3964Complaint .

3966DONE AND ENTERED this 21st day of January, 2020 , in

3976Tallahassee, Leon County, Florida.

3980YOLONDA Y. GREEN

3983Administrative Law Judge

3986Division of Administrative Hearings

3990The DeSoto Building

39931230 Apalachee Parkway

3996Tallahassee, Florida 32399 - 3060

4001(850) 488 - 9675

4005Fax Filing (850) 921 - 6847

4011www.doah.state.fl.us

4012Filed with the Clerk of the

4018Division of Administrative Hearings

4022this 21st day of January , 202 0 .

4030ENDNOTE S

40321/ Mr. Newman serv ed as counsel of record for Dr. Tomberlin

4044during the final hearing. On December 12, 2019, Ms. Hood was

4055substituted as counsel for Dr. Tomberlin .

40622 / The undersigned granted the parties request for extension of

4073time to file PROs . Pursuant to F lorida Administrative Code

4084Rule 28 - 106.216(2 ) , the parties waived the timeline for this

4096Administrative Law J udge to issue this Recommended O rder within

410730 days after receiving the Transcr i pt.

41153/ See Section 766.102 Fla. Stat.

41214 / The undersigned had the opportunity to observe the live

4132testimony of both expert witnesses. Both physicians were

4140confident in their respective po sitions. However, Dr. Lursen’s

4149experience, both as a practitioner and as a professional

4158involved in both developing and implementing programs teaching

4166the appropriate approach for interpreting CT scans of the head ,

4176outweighed Dr. Andriole. Dr. Lursen was found to be more

4186credible as sh e outlined an analysis of all factors to determine

4198whether Respondent met the standard of care. Dr. Andr iole

4208appeared to understand what the standard of care typically

4217requires, but his testimony did not persuasively establish that

4226his approach represente d the appropria te standard of care. Much

4237of his testimony seemed directed toward what he deemed to be

4248prudent, as opposed to what the generally accepted standard of

4258practice would require. M cDonald v. Dep’t of Prof’l Reg. , Bd.

4269of Pilot Commrs. , 582. So. 2d 660 (Fla. 1st DCA 1992); Purvis v.

4282Dep’t of Prof’l Reg., Bd. of Veterinary Med. , 461 So. 2d 134,

4294136 (Fla. 1st DCA 1984).

4299COPIES FURNISHED:

4301Jasmine B. Green, Esquire

4305Department of Health

4308Prosecution Services Unit

43114052 Bald Cypress Way , Bin C - 65

4319Tallahassee, Florida 32399

4322(eServed)

4323Cynthia Elizabeth Nash - Early, Esquire

4329Department of Health

43324052 Bald Cypress Way , Bin C - 65

4340Tallahassee, Florida 32399 - 3265

4345(eServed)

4346Kathryn Hood, Esquire

4349Pennington, P.A.

4351Suite 200

4353215 South Monroe Street

4357Post Office Box 10095

4361Tallahassee, Florida 32301

4364(eServed)

4365Claudia Kemp, JD, Exec utive Director

4371Board of Nursing

4374Department of Health

43774052 Bald Cypress Way , Bin C - 03

4385Tallahassee, Florida 32399

4388(eServed)

4389Louise Wilhite - St. Laurent, General Counsel Department of Health

43994052 Bald Cypress Way , Bin C65

4405Tallahassee, Florida 32399

4408(eServed)

4409NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

4415All parties have the right to submit written exceptions within

442515 days from the date of this Recommended Order. Any exceptions

4436to this Recommended Order should be filed with the agency that

4447will issue the Final Order in this case.

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Date
Proceedings
PDF:
Date: 09/08/2020
Proceedings: Agency Final Order filed.
PDF:
Date: 09/04/2020
Proceedings: Agency Final Order
PDF:
Date: 01/27/2020
Proceedings: Amended Recommended Order cover letter identifying the hearing record referred to the Agency.
PDF:
Date: 01/21/2020
Proceedings: Recommended Order
PDF:
Date: 01/21/2020
Proceedings: Recommended Order cover letter identifying the hearing record referred to the Agency.
PDF:
Date: 01/21/2020
Proceedings: Recommended Order (hearing held October 15, 2019). CASE CLOSED.
PDF:
Date: 12/20/2019
Proceedings: Respondent's Proposed Recommended Order filed.
PDF:
Date: 12/20/2019
Proceedings: Petitioner's Proposed Recommended Order filed.
PDF:
Date: 12/12/2019
Proceedings: Order Granting Extension of Time.
PDF:
Date: 12/12/2019
Proceedings: Respondent's Unopposed Motion for Extension to Time to File Proposed Recommended Orders filed.
PDF:
Date: 12/12/2019
Proceedings: Notice of Appearance (Kathryn Hood) filed.
PDF:
Date: 12/04/2019
Proceedings: Notice of Filing Transcript.
PDF:
Date: 10/08/2019
Proceedings: Amended Joint Pre-Hearing Stipulation filed.
PDF:
Date: 10/08/2019
Proceedings: Notice of Filing of Petitioner's Exhibits filed.
PDF:
Date: 10/04/2019
Proceedings: Notice of Court Reporter filed.
PDF:
Date: 09/20/2019
Proceedings: Notice of Intent to Admit Medical Records filed.
PDF:
Date: 06/26/2019
Proceedings: Order Rescheduling Hearing (hearing set for October 15 and 16, 2019; 9:00 a.m., Central Time; Panama City Beach, FL).
PDF:
Date: 06/21/2019
Proceedings: Order on Notice of Dismissal of Count II.
PDF:
Date: 06/18/2019
Proceedings: Petitioner's Status of Availability for Final Hearing filed.
PDF:
Date: 06/18/2019
Proceedings: Respondent's Response to Order Granting Continuance filed.
PDF:
Date: 06/11/2019
Proceedings: Order Granting Continuance (parties to advise status by June 18, 2019).
PDF:
Date: 06/10/2019
Proceedings: Joint Pre-Hearing Stipulation filed.
PDF:
Date: 06/10/2019
Proceedings: Notice of Dismissal of Count II filed.
PDF:
Date: 06/10/2019
Proceedings: Respondent's Unopposed Motion to Continue filed.
PDF:
Date: 05/28/2019
Proceedings: Notice of Serving Petitioner's Response to Respondent's First Set of Interrogatories, First Request for Admission, and Request for Production filed.
PDF:
Date: 05/17/2019
Proceedings: Respondent's Response to Petitioner's First Request for Production filed.
PDF:
Date: 05/16/2019
Proceedings: Respondent's Response to Petitioner's First Requests for Admission filed.
PDF:
Date: 05/16/2019
Proceedings: Respondent's Notice of Service of Answers to Petitioner's First Interrogatories filed.
PDF:
Date: 05/08/2019
Proceedings: Petitioner's Notice of Taking Deposition filed.
PDF:
Date: 04/30/2019
Proceedings: Order of Pre-hearing Instructions.
PDF:
Date: 04/30/2019
Proceedings: Notice of Hearing (hearing set for June 20, 2019; 9:00 a.m., Central Time; Panama City, FL).
PDF:
Date: 04/29/2019
Proceedings: Respondent's First Requests for Admission Petitioner filed.
PDF:
Date: 04/29/2019
Proceedings: Respondent's Notice of Service of Answers to Petitioner's First Interrogatories filed.
PDF:
Date: 04/29/2019
Proceedings: Respondent's First Request for Production to Petitioner filed.
Date: 04/26/2019
Proceedings: CASE STATUS: Status Conference Held.
PDF:
Date: 04/23/2019
Proceedings: Notice of Telephonic Scheduling Conference (scheduling conference set for April 26, 2019; 10:00 a.m.).
PDF:
Date: 04/22/2019
Proceedings: Joint Response to Initial Order filed.
PDF:
Date: 04/16/2019
Proceedings: Notice of Serving Petitioner's First Request for Production, First Request for Interrogatories and First Request for Admissions to Respondent filed.
PDF:
Date: 04/16/2019
Proceedings: Initial Order.
PDF:
Date: 04/15/2019
Proceedings: Respondent's Request for Hearing Involving Disputed Issues of Material Fact and Waiver of the 45-Day Deadline filed.
PDF:
Date: 04/15/2019
Proceedings: Administrative Complaint filed.
PDF:
Date: 04/15/2019
Proceedings: Agency referral filed.

Case Information

Judge:
YOLONDA Y. GREEN
Date Filed:
04/15/2019
Date Assignment:
04/16/2019
Last Docket Entry:
09/08/2020
Location:
Panama City Beach, Florida
District:
Northern
Agency:
ADOPTED IN TOTO
Suffix:
PL
 

Counsels

Related Florida Statute(s) (9):