21-001137PL Department Of Health, Board Of Medicine vs. Edmond O. Alaka, M.D. Status: Closed Recommended Order on Monday, December 20, 2021.

Summary: Department of Health did not establish by clear and convincing evidence that Respondent violated section 458.331(1)(t). Recommend Dismissal.

S TATE OF F LORIDA

D IVISION OF A DMINISTRATIVE H EARINGS

D EPARTMENT OF H EALTH , B OARD OF

M EDICINE ,

Petitioner ,

vs. Case No. 21 - 1137PL

E DMOND O. A LAKA , M.D. ,

Respondent .

/

R ECOMMENDED O RDER

On October 19, 2021, Administrative Law Judge Lisa Shearer Nelson of

the Florida Division of Administrative Hearings (DOAH) conducted a duly -

noticed hearing by Zoom technology pursuant to sections 120.569 and

120.57(1), Florida Statutes (2021).

A PPEARANCES

For Petitioner: Hunter M. Pattison, Esquire

Michael Jovane Williams, Esquire

Department of Health

Prosecution Services Unit

Bin C - 65

4052 Bald Cypress Way

Tallahassee, Florida 32399 - 3265

For Respondent: Edmond Olatunde Alaka, M.D. , pro se

216 Elm Drive

Chattahoochee, Florida 32324

S TATEMENT OF T HE I SSUE S

The issues to be determined in this proceeding are whether Respondent

violated section 458.331(1)(t)1., Florida Statutes ( 2012), and if so, what

penalties should be imposed.

P RELIMINARY S TATEMENT

On June 22, 2018, Petitioner, Department of Health (DOH or the

Department), filed a one - count Administrative Complaint in DOH Case

No. 2015 - 30041, alleging that Respondent violated t he applicable standard of

care with respect to the care of patient R.G., whom he treated in 2013. On

July 25, 2018, Respondent signed an Election of Rights form disputing the

allegations in the Administrative Complaint and requesting a hearing

pursuant to section 120.57(1)(1). On March 25, 2021, the case was referred to

DOAH for assignment of an administrative law judge and docketed as DOAH

Case No. 21 - 1137PL.

The case was originally scheduled for hearing to take place on June 22

and 23, 2021. On June 7, 2021, the parties filed a Joint Motion for

Continuance citing the need to conduct more discovery, which was granted.

Shortly thereafter, RespondentÔs counsel moved to withdraw and requested

that Respondent be given time to secure other counsel. On June 16, 2021, an

Order was issued granting counselÔs motion to withdraw and directing the

parties to file a Joint Status Report on June 30, 2021, providing dates for

hearing and advising whether Respondent intended to secure counsel. A

timely filed Status Report indicated that Respondent was seeking new

counsel, but ultimately Respondent determined to proceed pro se. The case

was rescheduled for October 19 and 20, 2021, and the hearing commenced

and was completed on October 19. The parties filed a Joint Pre - Hearin g

Statement which contains several stipulated facts that the parties agree do

not require evidence at hearing. Where relevant, those facts have been

included in the Findings of Fact below.

At hearing, Joint Exhibits 1 through 4 and PetitionerÔs Exhibits 1

through 4 were admitted into evidence. Dr. David Libert, M.D., testified on

behalf of the Department, and Dr. Alaka testified on his own behalf.

The one - volume Transcript of the hearing was filed with DOAH on

November 18, 2021. Dr. Alaka filed a letter w hich is construed as his

Proposed Recommended Order on November 18, 2021, and Petitioner filed its

Proposed Recommended Order on November 29, 2021, both of which have

been considered in the preparation of this Recommended Order. Any

references to Florida S tatutes are to the 2012 codification, as that is the

version in effect at the time of the conduct alleged. McCloskey v. DepÔt of Fin.

Servs., 115 So. 3d 441 (Fla. 5th DCA 2003).

F INDINGS OF F ACT

Based upon the Stipulation of the parties and the evaluation of the

evidence presented at hearing, the following facts are found:

1. At all times material to the allegations in the Administrative

Complaint, Respondent was a licensed medical doctor within the State of

Florida and held license number ME 109501. Respo ndentÔs address of record

is 216 Elm Drive, Chattahoochee, Florida 32324. The Department presented

no evidence of prior discipline against his license.

2. In 2013, Respondent was under contract to furnish health care services

to inmates at Suwannee Correct ional Institution (SCI).

3. This case involves the care and treatment for hypertension that

Respondent provided to R.G. while R.G. was an inmate at SCI in June and

July 2013.

4. David Libert, M.D., who testified on behalf of the Department, is a

Board - cert ified family practice physician who has been licensed in Florida

since 1983. Dr. Libert sees patients in a clinical setting approximately three

days a week but has never practiced in a correctional institution setting.

5 . Dr. Libert testified that a Ñperf ectÒ blood pressure reading is 120/80. A

reading that is under 140/90 is considered acceptable, but blood pressure that

is consistently above 140/90 indicates hypertension.

6 . Malignant hypertension, or hypertensive emergency, is an acute

elevation of blo od pressure that is associated with end organ damage. End

organ damage is the affect that the high blood pressure has on certain parts

of the body, such as the brain, heart, and kidneys. The traditional benchmark

reading that signals malignant hypertension is 180/120, which Dr. Libert

testified is an arbitrary number but represents the ÑoldÒ definition of the

condition. According to Dr. Libert, newer studies define malignant

hypertension as an acute rise on the height in blood pressure associated with

end o rgan damage, even if the blood pressure reading does not go as high as

the 180/120 measure recognized in older literature. The record is not clear

when the change in definition took place , and if that change reflects the

standard of practice in June 2013. Dr. Libert did not describe what

constitutes an acute rise in blood pressure, either in terms of the length of

time by which it is measured, or how much of a change in blood pressure

constitutes an acute rise.

7 . The systolic reading is the top number in a blood pressure reading and

represents the maximum pressure that is exerted on the arteries with the

contraction of the heart. The diastolic reading represents the pressure after

the heart has relaxed from its beat and is the lower number in a blood

pressu re reading. While 180/140 is the traditional reading identified as a

signal for malignant hypertension in ÑolderÒ literature, there was no

testimony as to whether systolic and diastolic readings are equally important ,

or whether one is more important than the other when determining that a

patientÔs blood pressure is too high. In other words, no testimony was

presented to answer the question of whether, for example a blood pressure

reading of 185/96 or 170/133 would be considered a symptom of malignant

hyper tension. While there is no question both readings would indicat e

hypertension, the evidence did not indicate whether it is enough to have one

of the two pressure readings above the 180/ 12 0 level to signal the possibility

of malignant hypertension.

8 . The D epartment of Corrections has protocols for treatment of different

systems of the body. The form for the Hypertension Protocol, which is

included several times within R.G.Ôs medical records from Suwannee,

includes several categories of information to be add ressed by treating

personnel, such as Subjective (which includes the patientÔs chief complaint

and current symptoms); Objective (which requires notation of vital signs,

such as temperature, pulse, respiration, blood pressure, oxygen saturation

and weight); Findings Requiring Immediate Clinician Notification ; Plan ; and

Education.

9 . Under the heading ÑFindings Requiring Immediate Clinician

Notification,Ò there are several factors that a health care provider (typically

in this setting, a nurse) would check b efore the need to contact a physician

arises. Those factors are blood pressure greater than 160/100 (see PLAN

first); oxygen saturation less than 93 percent ; heart rate less than 60 or

greater than 110; wheezing (chest congestion); blurred vision; pedal ed ema

extending to above the knees; severe headache OR headache not relieved

after two hours of OTC pain med; or other.

10 . The PLAN portion of the protocol provides the following treatment

alternatives:

For mild to moderate headache give:

Acetaminophen 32 5mg two tablets every 4 - 6

hours as needed for pain, OR

Ibuprofen 200mg two tablets every 6 hours as

needed for pain

Put patient in a quiet environment; recheck blood

pressure in 15 minutes x2. Notify clinician if BP

remains greater than 160/100.

1 s t blood pressure recheck: / , at .

2 nd blood pressure recheck: / , at .

Bed rest lay - in x24 hours

Blood pressure recheck in 24 hours

Return to clinic for BP check

Pass

Other

11 . Respondent was responsible for patient R.G.Ôs medical care at SCI and

had access to all of R.G.Ôs medical records from SCIÔs medical clinic.

12 . R.G. was a 61 - year - old male inmate who presented to the clinic at SCI

for treatment.

13 . On or about June 7, 2013, R.G. presented to SCIÔs clinic with a blood

pressure reading o f 164/96 , and complaining of a headache. R.G. was given

10 mg Lisinopril to reduce his blood pressure, a pass for three days of

bedrest, and a follow - up appointment for June 10, 2013. The medical record

entitled Hypertension Protocol does not contain Respo ndentÔs name and he

did not see R.G. that day. However, from the PhysicianÔs Order Sheet , it

appears that he was consulted and approved the administration of Lisinopril,

and prescribed 10 mg of Lisinopril daily for three months.

14 . On June 9, 2013, R.G. p resented at the clinic complaining about his

blood pressure. The medical record notes that he had a headache. His blood

pressure reading was 151/90, and the section entitled Findings Requiring

Immediate Clinician Notification did not have any symptoms chec ked. The

medical record does not indicate that Respondent saw R.G. on June 9, 2013,

and he was not consulted about his care. The PLAN section of the

Hypertension Protocol says ÑNo treatment required.Ò

15 . On June 10, 2013, it appears that R.G. may have be en seen at the

clinic more than once. The initial entry in his medical records for that date,

which does not have a time recorded, indicates that his blood pressure was

158/98. The second entry, recorded at approximately 2:00 p.m., indicates that

R.G. pres ented to the clinic with a blood pressure reading of 173/98.

Respondent ordered a one - time do se of .2 mg Clonidine, and 10 mg of

Lisinopril and directed that his blood pressure be taken again in an hour.

Respondent tried to find the underlying cause for th e rise in R.G.Ôs blood

pressure by sending him for blood work, and a thyroid and cardiovascular

evaluation by the cardiac clinic. Respondent also directed that his blood

pressure be checked twice weekly for an indecipherable number of weeks.

When R.G.Ôs bl ood pressure was rechecked at approximately 4:00 p.m., it was

158/89. Respondent again ordered administration of 10 mg Lisinopril,

increased his prescription for Lisinopril to 20 mg for three months, and

ordered 600 mg of Ibuprofen to treat R.G.Ôs headache .

16 . R.G. next presented to the clinic on June 11, 2013, at 10:00 a.m. At

that time, his blood pressure was note d as 152/94. There is no indication in

the medical record that Respondent saw R.G. during that visit, and there is

no documentation in the Phys icianÔs Order Sheet to indicate that Respondent

ordered any prescriptions for him.

17 . On June 18, 2013, R.G. went to the clinic complaining of a headache

and vomiting. He listed his pain level at 6 out of 10. At his initial

presentation at noon, his blood pressure was 197/105 in the left arm, and

186/86 in the right.

18 . Under the PLAN heading, the medical record indicates R.G. was given

200mg Ibuprofen for his headache, and 0.2 mg of Conidine for blood pressure.

His blood pressure was rechecked at 1:00 p. m. and had lowered to 139/84.

19 . The medical record for June 18, 2013, does not indicate that Dr. Alaka

saw R.G. or that he was consulted about him. The Department of Corrections

Physician Order Sheet for R.G. has an entry dated June 18, 2013, but part o f

the record is indecipherable, and there is no doctor Signature/stamp

completed for the entry. In addition, the portion of the entry that is readable

refers to a Dr. Gonzalez, as opposed to Dr. Alaka.

20 . On June 20, 2013, R.G. returned to the clinic, thi s time complaining

that he was stumbling and had a headache. A protocol sheet for Neurological

Changes/Deficits was used in the medical records as opposed to the

Hypertension Protocol. At this visit, his blood pressure was 120/62. There is

no indication on the medical record for this date that Dr. Alaka saw R.G.

21 . R.G. returned to the clinic on June 25, 2013 , at 5:39 p.m. The medical

record indicates that he had a slight headache, a small amount of

pitting/extremity swelling, fatigue, and had vomited that morning. His blood

pressure was 165/94 in the left arm and 175/91 in the right . Pedal edema was

noted to stop at the mid to upper shins, and the records indicate that R.G.

had slept only three hours or less in the previous 24 - hour period.

22 . R.G. was gi ven acetaminophen for his headache, and his blood

pressure was rechecked at 5:59 p.m. and 6: 15 p.m. . His blood pressure at the

first recheck was 165/94, and at the second recheck was 164/93. The

Hypertension Protocol indicates that R.G. was administered 10 mg of

Lisinopril, was instructed to comply with all prescribed medications, and not

to sit with his legs crossed. The PhysicianÔs Order Sheet indicates that per

RespondentÔs discussion with the nurse who saw R.G., 1 the prescription for 20

mg of Lisinopril was discontinued and replaced with a prescription for the

same drug at 10 mg daily for three months.

23 . There was speculation throughout the hearing that R.G. did not

always take his medications as prescribed, and there are notations in the

medical recor ds that R.G. sometimes refused recommended medical

treatments, such as a referral for a urologist and a cardiac workup. There

was no clear and convincing evidence that R.G. was also failing to take his

blood pressure medications as required, although it is certainly a possibility.

24 . There is no indication in the medical records that R.G. went to the

clinic for treatment after June 25, 2013. 2 On July 2, 2013, R.G. was found

unresponsive on the floor. He was transferred to ShandsLiveOak Regional

Medical Cen ter, and from there, transferred to Jacksonville Memorial on

1 The Administrative Complaint alleges that R.G. was seen by an ARNP during this visit.

The signature of the health care provider indicate s that he or she was an SRN, not an ARNP.

The ARNP who reviewed the records and made what was referred to as an incidental entry

(one where the record is reviewed but the patient is not seen) the following day is a different

provider.

2 There is an entry for June 28, 2013, entitled Pre - Special Housing Health Assessment.

Dr. Alaka testified he did not know what that meant. It appears from the record that the

purpose of the assessment was to extend R.G.Ôs low bunk pass. At that time, his blood

pressure was r ecorded as 158/92. It is not clear who conducted the assessment.

July 3, 2013. R.G. died on July 5, 2013. The Medical ExaminerÔs Report lists

R.G.Ôs cause of death as hypertension.

25 . Dr. Libert reviewed the medical records related to R.G.Ôs treatment.

He o pined that Respondent did not meet the applicable standard of care in

his care and treatment of R.G. because he did not arrange for transportation

to the hospital on June 18, 2013. He also opined that Respondent should have

transferred R.G. on later dates prior to the transfer that occurred on July 2,

2013. He further opined that Respondent failed to recognize the signs and

symptoms of malignant hypertension and failed to diagnose it. Dr. Libert also

testified that Respondent failed to order basic blood tes ts that should have

been ordered for a patient with hypertension. However, as noted above,

Respondent did order blood work on June 10, 2013.

26 . There is no indication in the medical records that Dr. Alaka saw R.G.

on June 18, 2013. With respect to the Jun e 25 visit, Dr. Alaka would have

received a phone call from staff, but did not see R.G. in person.

27 . Dr. Alaka has no independent recollection of seeing R.G. , and had to

rely solely on his review of the medical records for his account of what

happened. T he treatment of this patient occurred over eight years prior to the

hearing in this case. Dr. Alaka did not believe that treatment in a prison

setting is the same as the treatment rendered in a typical outpatient setting,

and testified that in an outpatien t setting, physician groups are free to set

their own protocols. In a correctional setting, physicians were required to

follow the protocols established by the Department of Corrections. Dr. Alaka

testified that following the protocols was a condition of e mployment.

28 . Dr. Alaka testified that he did not create or maintain the medical

records for patients at the facility, but would have access to the records when

treating a patient. It is not clear, however, whether he had access to the

records when he wa s not at the facility but received a telephone call

regarding the treatment of a patient.

29 . Based upon the medical records in evidence, Dr. Alaka saw R.G. on

June 10; was consulted about R.G. on June 7 and June 25; and was neither

present nor consulted r egarding R.G. on June 9, June 11, June 18, and

June 20 , 2013 .

30 . The only time that the medical records indicate R.G.Ôs blood pressure

may have been above the standard of 180/120 for malignant hypertension

was June 18, 2013, and when rechecked, the pressu re went down to 139/84.

As noted above, the medical records do not indicate that Dr. Alaka either saw

R.G. or was consulted about his care on that day.

31 . On June 25, 2013, R.G.Ôs blood pressure, while still considered high,

was well below the standard id entified for consideration of malignant

hypertension.

32 . Dr. Alaka also testified that one must always consider the possibility

of malignant hypertension when taking a patientÔs blood pressure, but did

not believe R.G.Ôs blood pressure reached that level. He tried to prevent it

through the use of medication but did not believe that you needed to transfer

a patient because of swelling, vomiting, or headache combined with high

blood pressure, because those symptoms can occur with a variety of

conditions. In his view, there should be concrete blood pressure readings,

with indications of organ disturbance or stress. Organ damage would be

substantiated through blood work and treat ed with medication while waiting

for results. If the blood pressure is sustained, t hen he would call his

supervisor and report the blood pressure; that it is not coming down; what

medications were given ; and request a transfer. He testified he did not

request a transfer in this case because the blood pressure came down with

treatment. In addition, Dr. Alaka noted that blood pressure readings can

vary within the same hour, depending on who took the reading, the size of

the cuff used, operator error, etc.

33 . Dr. Alaka also testified, credibly, that transfers to facilities outside the

priso n setting required approval by the regional medical director, and that

was a condition for working at SCI. The Department did not provide any

evidence to rebut the statement that Respondent did not have the authority

to order transfer out of the facility, or that following the protocols reflected in

the medical records was not required for employment at the facility.

34 . Dr. AlakaÔs view of what blood pressure reading would have triggered

a diagnosis of malignant hypertension is higher than Dr. LibertÔs. B ased on

the evidence presented, Dr. LibertÔs definition appears to be more reasonable.

However, based on the totality of the evidence presented, the Department did

not present clear and convincing evidence to show that RespondentÔs care and

treatment of R. G. violated the prevailing standard of care as alleged in the

Administrative Complaint.

C ONCLUSIONS OF L AW

35 . DOAH has jurisdiction of the subject matter and the parties to this

action pursuant to sections 120.569 and 120.57(1), Florida Statutes (2021).

36 . This is a proceeding whereby the Department seeks to discipline

RespondentÔs license to practice medicine. The Department has the burden to

prove the allegations in the Administrative Complaint by clear and

convincing evidence. DepÔt of Banking & Fin . v. Osborne Stern and Co. , 670

So. 2d 932 (Fla. 1996); Ferris v. Turlington , 510 So. 2d 292 (Fla. 1987). As

stated by the Supreme Court of Florida,

Clear and convincing evidence requires that the

evidence must be found to be credible; the facts to

which the witnesses testify must be distinctly

remembered; the testimony must be precise and

lacking in confusion as to the facts at issue. The

evidence must be of such a weight that it produces

in the mind of the trier of fact a firm belief or

conviction, witho ut hesitancy, as to the truth of the

allegations sought to be established.

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

429 So. 2d 797, 800 (Fla. 4 th DCA 1983)). This burden of proof may be met

when the evidence is in confli ct, but seems to preclude evidence that is

ambiguous. Westinghouse Elec. Corp. v. Shuler Bros., 590 So. 2d 986, 988

(Fla. 1st DCA 1991).

37 . Moreover, in disciplinary proceedings, the statutes and rules must be

strictly construed in favor of the responde nt. Elmariah v. DepÔt of Prof .

Reg ul . , 574 So. 2d 164 (Fla. 1st DCA 1990); Taylor v. DepÔt of Prof . Reg ul . ,

534 So. 2d 782, 784 (Fla. 1st DCA 1988), and words used by the Legislature

cannot be interpreted to broaden their application. Beckett v. DepÔt of F in.

Servs. , 982 So. 2d 94, 99 - 100 (Fla. 1st DCA 2008); Dyer v. DepÔt of Ins. &

Treas. , 585 So. 2d 1009, 1013 (Fla. 1st DCA 1991). Not only are the statutes

and rules strictly construed, but the conduct alleged needs to be personal to

Respondent. Beshore v. DepÔt of Fin. Servs. , 928 So. 411, 413 (Fla. 1st DCA

2006); Pic NÔ Save Cent . Florida, Inc. v. DepÔt of Bus. Reg ul . , 601 So. 2d 245,

254 (Fla. 1st DCA 1992)(in the absence of evidence that licenseeÔs employees

acted in a persistent and practiced manner in making illegal sales of alcohol,

there is no factual basis for drawing an inference that the licensee has acted

negligently or with a lack of due diligence in the supervising and training of

its employees in order to subject the licensee to discipline).

38 . Finally, Respondent can only be found guilty of violations that are

actually alleged in the Administrative Complaint. Trevisani v. DepÔt of

Health , 908 So. 2d 1108, 1109 (Fla. 1st DCA 2005); see also Christian v. DepÔt

of Health , 161 So. 3d 416, 417 ( Fla. 2d DCA 2014); Ghani v. DepÔt of Health ,

714 So. 2d 1113, 1114 - 15 (Fla. 1st DCA 1998).

39 . In this case, the Administrative Complaint alleges the following:

13. At all times relevant to this Complaint, the

prevailing professional standard of care d ictated

that a physician assessing and/or treating a patient

with R.G.Ôs symptoms should:

a) diagnose the potential cause of causes of the

patientÔs signs and symptoms;

b) consider the possibility of malignant

hypertension and/or a hypertensive emergency,

and/or

c) transfer the patient to the emergency

department based on the combination of high blood

pressure and associated symptoms such as

swelling, vomiting, and headaches.

14. Respondent failed to meet the prevailing

professional standard of care in hi s treatment of

Patient R.G. in one or more of the following ways:

a) By failing to diagnose the potential cause or

causes of the patientÔs sign and symptoms;

b) By failing to consider the possibility of malignant

hypertension and/or a hypertensive emergen cy;

and/or

c) By failing to transfer the patient to the

emergency department due to his condition at that

time.

15. Section 458.331(1)(t)1., Florida Statutes (2012 -

2013), subject a licensee to discipline for

committing medical malpractice as defined in

Se ction 456.50(1)(g), Florida Statutes. Section

456.50(1)(g), Florida Statutes (2012) states that

medical malpractice means the failure to practice

medicine in accordance with the level of care, skill,

and treatment recognized in general law related to

healt h care licensure. Section 766.102, Florida

Statutes (2012), provides that the prevailing

standard of care for a given healthcare provider

shall be that level of care, skill, and treatment

which, in light of all relevant surrounding

circumstances, is recogn ized as acceptable and

appropriate by reasonably prudent similar health

care providers.

16. From on or about June 18, 2013, through on or

about June 25, 2013, Respondent fell below the

prevailing standard of care in his treatment of

Patient R.G. in one or more of the following ways:

a) by failing to diagnose potential cause or causes of

Patient R.G.Ôs signs and symptoms;

b) by failing to consider the possibility of malignant

hypertension and/or a hypertensive emergency;

and/or

c) by failing to transfer Pa tient R.G. to the

emergency room due to his condition at that time.

17. Based on the foregoing, Respondent committed

medical malpractice in violation of Section

458.331(1)(t)1., Florida Statutes (2012), by failing

to meet the standard of care in his treat ment and

diagnosis of Patient R.G.

40 . Respondent did not see R.G. on June 18, 2013 , and was not consulted

regarding his care on that date. He cannot be disciplined for the evaluation of

the patient by other staff. Beshore . supra ; Pic NÔSave , supra .

41 . While the Administrative Complaint alleges that from June 18

through June 24, 2018 [sic] R.G. presented to the clinic four times with

complaints of headache, nausea, vomiting, and stumbling, Respondent was

consulted with respect to only one of those visit s. For that visit, June 25,

Respondent was consulted by telephone, and it appears that R.G. was not

compliant with the instructions given on that date.

42 . The Administrative Complaint charges Respondent with violating the

applicable standard of care, whic h as noted above, is the Ñlevel of care, skill,

and treatment which, in light of all relevant surrounding circumstances , is

recognized as acceptable and appropriate by reasonably prudent similar

health care providers.Ò Dr. Libert testified that the standar d of care provided

in a prison setting is the same as that provided in a private clinical setting

but acknowledged that he has never practiced in a prison setting. While the

standard of care may indeed be the same, the evidence presented was not

sufficient to establish that it is. T his is a disciplinary proceeding . Therefore, a

finding that, in light of all relevant surrounding circumstances, the care

given by a private practitioner is the same or similar to a physician providing

care in a correctional inst itution setting must be based upon evidence more

substantial than a conclusory statement. For example, Dr. Libert was not

asked whether the protocols used by the health care providers working

within the Department of Corrections were consistent with the ap plicable

standard of practice. Moreover, he did not testify whether transfer to a

hospital setting for patients in a private clinic involve the same concerns that

are present with transfer of an inmate, or what measures should be in place

or what measures a physician must follow to address those concerns.

43 . In addition, the evidence was simply not clear and convincing that

Respondent erred in not ordering the transfer of patient R.G. for malignant

hypertension. The blood pressure readings, while high, di d not reach the

180/120 mark identified by Dr. Libert as the signal for malignant

hypertension in the older literature. He did not identify when the change in

standards took place, and did not identify under the more recent standard

what constitutes an acu te rise in blood pressure. Given the high burden of

proof in disciplinary proceedings and the number of questions left

unanswered regarding the expected standard of care, the Department simply

did not meet its burden of proof regarding the care and treatme nt of R.G.

R ECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of Law, it is

R ECOMMENDED that the Administrative Complaint against Respondent be

dismissed.

D ONE A ND E NTERED this 20th day of December , 2021 , in Tallahassee,

Leon County, Florida.

S

L ISA S HEARER N ELSON

Administrative Law Judge

1230 Apalachee Parkway

Tallahassee, Florida 32399 - 3060

(850) 488 - 9675

www.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 20th day of December , 2021 .

C OPIES F URNISHED :

Hunter M. Pattison, Esquire Michael Jovane Williams, Esquire

Department of Health Department of Health

Prosecution Services Unit Prosecution Services Unit

Bin C - 65 Bin C - 65

4052 Bald Cypress Way 4052 Bald Cypress Way

Tallahassee, Florida 32399 - 3265 Tallahassee, Florida 32399 - 3265

Edmond Olatunde Alaka, M.D. Louise St. La urent, General Counsel

216 Elm Drive Department of Health

Chattahoochee, Florida 32324 4052 Bald Cypress Way, Bin C - 65

Tallahassee, Florida 32399

Paul A. Vazquez, JD, Executive Director

Department of Health

4052 Bald Cypress Way, Bin C - 03

Tallahassee, Florida 32399 - 3253

N OTICE OF R IGHT T O S UBMIT E XCEPTIONS

All parties have the right to submit written exceptions within 15 days from

the date of this Recommended Order. A ny exceptions to this Recommended

Order should be filed with the agency that will issue the Final Order in this

case.