99-004377
Department Of Health, Board Of Medicine vs.
Agustin Carmona, M.D.
Status: Closed
Recommended Order on Thursday, June 15, 2000.
Recommended Order on Thursday, June 15, 2000.
1STATE OF FLORIDA
4DIVISION OF ADMINISTRATIVE HEARINGS
8DEPARTMENT OF HEALTH, )
12BOARD OF MEDICINE, )
16)
17Petitioner, )
19)
20vs. ) Case No. 99-4377
25)
26AGUSTIN CARMONA, M.D., )
30)
31Respondent. )
33_________________________________)
34DEPARTMENT OF HEALTH, )
38BOARD OF MEDICINE, )
42)
43Petitioner, )
45)
46vs. ) Case No. 99-4378
51)
52AGUSTIN CARMONA, M.D., )
56)
57Respondent. )
59_________________________________)
60RECOMMENDED ORDER
62This cause came on for a disputed-fact hearing on March 15,
732000, in Malone, Florida, before Ella Jane P. Davis, a duly-
84assigned Administrative Law Judge of the Division of
92Administrative Hearings.
94APPEARANCES
95For Petitioner: Carol A. Lanfri, Esquire
101Agency for Health Care Administration
106Post Office Box 14229
110Tallahassee, Florida 32317-4229
113For Respondent: Agustin Carmona, M.D., pro se
120DC# U03774
122Jackson Correctional Institute
1255563 Tenth Street
128Malone, Florida 32445-3144
131STATEMENT OF THE ISSUES
1351. The Administrative Complaint in DOAH Case No. 99-4377,
144charged Respondent with violating Section 458.331(1)(t), Florida
151Statutes (failure to practice medicine with care, skill and
160treatment); Section 458.331(1)(m), Florida Statutes (failure to
167keep written records justifying treatment); Section
173452.331(1)(x), Florida Statutes (violation of a rule of the Board
183or Department) by violating Rule 64B8-9.003(2), Florida
190Administrative Code, relating to legibility of medical records,
198in connection with Respondent's emergency room treatment of
206Patient B.W. on July 21, 1995.
2122. The Administrative Complaint in DOAH Case No. 99-4378,
221charges Respondent with violation of Section 458.331(1)(s),
228Florida Statutes (being unable to practice medicine with
236reasonable skill and safety to patients by reason of illness, use
247of any material, or as the result of any mental or physical
259condition).
260PRELIMINARY STATEMENT
262On or about October 20, 1999, these cases were referred to
273the Division of Administrative Hearings due to Respondent's
281request for hearing upon disputed issues of material fact.
290At all times material, Respondent has been incarcerated at
299Jackson Correctional Institute in Malone, Florida, because of his
308conviction for "driving under the influence" which is the focus
318of DOAH Case No. 99-4378.
323Upon information and belief that Respondent would not be
332released for several years, that his appeal had been concluded,
342and that no further criminal trials were anticipated, and
351balancing Respondent's right to remain silent against the
359Agency's right to reach finality of the prosecution herein, the
369undersigned consolidated these administrative cases and scheduled
376the disputed-fact hearing in the Jackson Correctional Institute
384with enough time prior to the hearing date to allow Respondent to
396obtain legal counsel and to allow both parties to engage in
407discovery under difficult circumstances.
411On December 13, 1999, Respondent filed a detailed response
420to the Administrative Complaints. No response is required at
429law.
430During a telephonic hearing concerning Petitioner's Motion
437in Limine, approximately a week before the scheduled disputed-
446fact hearing, the undersigned determined that Respondent had had
455the opportunity to be present by telephone at all depositions
465scheduled by Petitioner, and had, in fact, been present by
475telephone at all such depositions. The undersigned inquired
483whether a continuance was requested, and Respondent indicated in
492the negative.
494However, by the Pre-Hearing Stipulation and at the
502commencement of the disputed-fact hearing, on March 15, 2000,
511Respondent indicated for the first time that the incident which
521was the focus of DOAH Case No. 99-4378, was currently on appeal,
533that he was represented by an attorney on that appeal, and that
545he wanted a continuance until that appeal was concluded and until
556he could obtain some out-of-state medical records. At the
565commencement of the hearing, Respondent twice stated that he had
575never discussed the instant administrative cases with any lawyer
584and had not sought a lawyer to represent him herein, because he
596had insufficient funds. He stated that he preferred not to
606defend on DOAH Case No. 99-4378, for those reasons. 1 Respondent
617ultimately stated to the undersigned that he had everything he
627needed to defend.
630Petitioner presented a July 1, 1998, letter it had received
640from Respondent's original criminal attorney giving notice of
648termination of representation and requesting that all further
656administrative pleadings be sent directly to Respondent.
663Petitioner also effectively argued, with supporting exhibits,
670that Respondent's 1997 conviction for driving under the influence
679had already been affirmed and that a Rule 3.850 "Appeal" had
690likewise been decided against Respondent while he was represented
699by a different attorney than the one who withdrew. (Petitioner's
709Exhibits 1-4).
711Respondent had never been deposed by Petitioner with regard
720to either Administrative Complaint herein.
725Respondent voluntarily filed his December 13, 1999, Answer
733without consulting any attorney.
737Upon the foregoing, the undersigned determined that had
745Respondent elected to remain silent he could have done so, but he
757voluntarily filed his written response which waived any right
766against self-incrimination in these administrative cases; that he
774had five months to obtain legal counsel or obtain evidence for
785use at the disputed-fact hearing, but he did not do so; and that
798a continuance of the disputed-fact hearing on these
806administrative actions was not mandated by further collateral
814criminal appeals, even had it been established that such
823collateral appeals were in progress, which it was not.
832Accordingly, Respondent's oral motion for continuance to another
840date was denied.
843Nonetheless, prior to any evidence being prese nted on the
853merits, Respondent was twice offered a continuance until later
862the same day so that he could return to his living quarters in
875the same correctional facility in order to get copies of all
886proposed exhibits and depositions which had been provided to him
896by Petitioner as well as any exhibits Respondent might wish to
907offer. Respondent twice declined. 2 Petitioner's counsel
914provided Respondent with copies of all of Petitioner's exhibits
923for Respondent's use during hearing.
928Upon Petitioner's motion , official recognition was taken of
936Rules 64B8-8.001 and 64B8-9.003, Florida Administrative Code
943(1992 and currently). 3
947Petitioner presented the oral testimony of Raymond M. Pomm,
956M.D., and Lija G. Scherer. Petitioner's Exhibits 5-14 were
965admitted on the merits. They included depositions of Walter
974Muller, M.D.; Lt. Roger Chilton; Selena Bowers, Records Clerk of
984Kenneth Stark, M.D.; Dorothy Lee, Manager of Medical Records at
994Florida Hospital Waterman; Jennifer Louer, Records Clerk of Louis
1003Radnothy, D.O., and Robert Tober, M.D., 4 each with attachments.
1013Respondent testified on his own behalf and had no exhibits
1023admitted in evidence.
1026At the conclusion of the disputed-fact hearing on March 15,
10362000, Petitioner agreed to provide Respondent with a free copy of
1047the transcript and the undersigned explained to Respondent that,
1056pursuant to his oral agreement on the record with opposing
1066counsel, he would not have to file his proposed recommended order
1077until 35 days after the transcript was filed with the Division of
1089Administrative Hearings. One reason for granting 35 days in
1098which to file proposals was due to an anticipated delay between
1109the time the Transcript was mailed as "Legal Mail" and delivery
1120of the Transcript to Respondent by the correctional facility
1129where he is incarcerated.
1133On March 31, 2000, Respondent filed a letter of complaint
1143that he had not been provided with a copy of the Transcript.
1155On April 10, 2000, the original Transcript was filed with
1165the Division.
1167On April 13, 2000, Petitioner's couns el filed a notice of
1178service on Respondent of a copy of the Transcript.
1187On April 14, 2000, an Order was entered notifying Respondent
1197that the Transcript had been filed with the Division and
1207explaining how to prepare and file proposed recommended orders.
1216On April 20, 2000, Respondent filed his "Court Directed
1225Proposal" a/k/a Proposed Recommended Order, with a complaint that
1234he had not yet received his copy of the Transcript.
1244On May 1, 2000, Petitioner filed its Proposed Recommended
1253Order and a Motion to Strike Respondent's Proposed Recommended
1262Order.
1263By an Order entered May 12, 2000, only the exhibits attached
1274to Respondent's proposal were struck.
1279Thereafter, Respondent also filed various papers/pleadings
1285which have been addressed by sequential Orders in the file.
1295Both parties' proposals have been considered in preparation
1303of this Recommended Order. 5
1308FINDINGS OF FACT
13111. At all times material to the incidents alleged in the
1322Administrative Complaints, Respondent was a licensed medical
1329physician in the State of Florida, having been issued License No.
1340ME 0016828.
13422. Respondent specialized in internal medicine and
1349emergency medicine but has never been board certified in any
1359specialty.
13603. Respondent's license has been delinquent since January
136831, 2000, but because delinquent licenses may be subject to
1378renewal, the Petitioner has persisted in prosecuting these cases.
1387DOAH Case No. 99-4377
13914. On July 21, 1995, B.W., a 56-year-old female, presented
1401to Respondent in the emergency room of Florida Hospital Waterman,
1411with complaints of chest, epigastric, and left shoulder pain.
1420B.W. had a history of dermatomyositis, for which she had been
1431taking 100 mg of Prednisone for a month, along with other
1442medications. Prednisone in such large doses can cause
1450gastrointestinal irritation, ulceration, and bleeding. The day
1457before, B.W. had been prescribed Imuran by her rheumatologist for
1467immunologic problems.
14695. Dermatomyositis is a degenerative disease of skeletal
1477muscle that can lead to a multitude of complications, including
1487rheumatologic problems evidenced by abnormal laboratory results.
14946. The standard of care in the examination and treatment of
1505a patient with chest pain requires an emergency physician to
1515obtain a history including a complete medical history, family
1524history, and social history. Additionally, in order to meet the
1534standard of care, the emergency physician must perform a complete
1544physical examination, including a review of systems.
15517. The emergency room records for Respondent's treatment of
1560B.W. show the information contained above in Finding of Fact No.
15714.
15728. The emergency room records do not show that Respondent
1582obtained or documented a complete medical history, family
1590history, or social history of B.W. Respondent violated the
1599standard of care in that he failed to obtain or document a
1611complete medical history, family history, or social history of
1620B.W.
16219. Respondent also violated the standard of care in that he
1632failed to perform or document a complete physical examination,
1641including a review of systems.
164610. Respondent ordered an electrocardiogram (EKG), a chest
1654X-ray, a complete blood count (CBC), complete cardiac enzymes
1663testing (CPK and CKMB), and a metabolic profile or chemistry
1673panel (MPC). He also did a rectal exam which was negative for
1685blood. He did all appropriate tests. He did not fail to order
1697any appropriate tests.
170011. The EKG and the chest X-ray yielded normal results, but
1711B.W.'s blood count revealed several abnormal values, including a
1720decreased platelet of 21,000 and a markedly elevated white count
1731of 24,000. A platelet count of 21,000 is extremely low and
1744grounds for major concern, as is the elevated 24,000 white count.
1756Together, in the presence of the other symptoms and abnormal
1766blood values present, which included low RBC, anemic hemoglobin,
1775and low hemocrit, the standard of care requires that an emergency
1786physician obtain a consultation with a specialist, such as a
1796rheumatologist or a hematologist. In light of all the foregoing
1806results and normal corpuscular volume, which B.W. also had, the
1816emergency physician should have recognized that B.W. did not have
1826simple iron deficiency anemia.
183012. Under some circumstances, the emergency room
1837physician's consultation with B.W.'s primary care physician, who
1845in this case was also a rheumatologist, would have been
1855sufficient.
185613. Respondent maintained that he had obtained a history
1865from B.W. as set forth in Finding of Fact No. 4, and an oral
1879report from the hospital lab technician to the effect that a
1890blood test ordered by B.W.'s treating rheumatologist the
1898preceding day, July 20, 1995, had shown a platelet count of
190918,000, and that because Respondent presumed B.W.'s platelets
1918were increasing with the use of Imuran plus other factors,
1928Respondent did not admit B.W. to the hospital, but, instead,
1938discharged her without even consultation.
194314. Despite Respondent's foregoing explanation, it is clear
1951that Respondent did not record or document on B.W.'s chart his
1962oral conversation with the lab technician, if, in fact, such a
1973conversation occurred. This was below the acceptable standard of
1982medical care and record-keeping for an emergency room physician.
199115. Respondent stated that he felt that because the
2000treating rheumatologist had not admitted B.W. to the hospital or
2010transfused B.W. the previous day, she should not be admitted or
2021transfused on July 21, 1995. He stated that he also relied on a
2034medical text (Merck's Manual) which allegedly states that
2042platelet transfusions should not be given until the count falls
2052to 10,000.
205516. Respondent stated that he ruled out a myocardial
2064infarction on the basis that both the CKMB on B.W. and the CKMB
2077Index were not elevated and B.W.'s EKG was normal.
208617. However, Dr. Tober, who is certified in emergency
2095medicine, testified more credibly that he had never seen a CPK
2106test so high; that interpretation of CPK and CKMB in such a
2118patient as B.W. would be confounded by the co-existence of the
2129dermatomyositis, grossly throwing off these tests in an acute
2138cardiac setting, sometimes causing several EKGs to come back
2147normal in the course of a myocardial infarction; that B.W.'s
2157extremely low platelet count should cause great concern about the
2167hemologic system and clotting response if B.W. started to
2176hemorrhage; and that the suspiciously low lymphocytes and all
2185blood parameters should have caused Respondent not to discharge
2194B.W. prior to a consultation with a specialist.
220218. Respondent failed to meet the standard of care by the
2213treatment he rendered to B.W., in that he did not obtain a
2225consultation from either the primary care physician, another
2233rheumatologist, or a hematologist, before discharging her.
224019. That standard of care requires an emergency physician
2249to determine an appropriate diagnosis and treatment as related to
2259the patient's complaint and results of examinations.
226620. Respondent violated the standard of care in that he
2276merely wrote into B.W.'s chart a portion of her medical history,
"2287dermatomyositis," instead of a current diagnosis which addressed
2295her current abnormalities when she presented in the emergency
2304room. Thus, Respondent did not discern an appropriate diagnosis
2313while appropriately treating B.W. 6
231821. Respondent's chart on B.W. is illegible to the extent
2328that Dr. Tober was unable to read most of 23 lines of it.
234122. Because proper care of patients requires that medical
2350records be sufficiently legible for successive professionals to
2358discern what the writer has done and analyzed, I find that
2369Respondent is guilty of keeping written medical records that are
2379illegible and difficult to decipher. I do not consider Hospital
2389Waterman's failure to provide dictation or transcription
2396equipment and/or personnel to excuse this flaw.
2403DOAH Case No. 99-4378
240723. On or about July 14, 1995, Respondent was convicted of
2418driving under the influence and placed on probation for 12
2428months, and his driver's license was revoked for 12 months.
243824. About two years later, on July 12, 1997, Respondent's
2448vehicle collided with another vehicle. Respondent and the driver
2457of the other car were injured. Blood was drawn from Respondent
2468at the hospital. Laboratory studies performed by the Florida
2477Department of Law Enforcement revealed that Respondent's blood
2485alcohol level was 0.10 grams of ethyl alcohol per 100 ml. Under
2497Florida law, a driver is legally intoxicated when his blood
2507alcohol level is 0.08 grams of ethyl alcohol per 100 ml or
2519higher.
252025. On August 12, 1997, Respondent was arrested and charged
2530with one count of serious bodily injury while driving under the
2541influence, and two counts of property damage while driving under
2551the influence. On July 2, 1998, Respondent entered a plea of
2562guilty 7 to one count of serious bodily injury while driving under
2574the influence and was sentenced to imprisonment for a period of
2585seven years, one month, and eight days.
259226. On or about January 13, 1998, Walter J. Muller, M.D., a
2604board-certified psychiatrist, performed a psychiatric evaluation
2610of Respondent. Dr. Muller diagnosed Respondent with major
2618depression, dysthymic disorder, and alcohol abuse, pursuant to
2626The Diagnostic and Statistical Manual-IV. At that time, these
2635conditions were active and not in remission. The diagnosis of
2645major depression correlates with impaired social and occupational
2653functioning.
265427. A diagnosis of dysthymic disorder is an indication of
2664impairment and the inability to practice medicine with skill and
2674safety to patients.
267728. A diagnosis of alcohol abuse can be an indication of
2688inability to practice medicine with skill and safety to patients,
2698but would depend upon when the abuse is occurring and how long it
2711has been since the abuse occurred.
271729. In the expert opinion of Dr. Raymond Pomm, who is
2728board certified in adult psychiatry and general psychiatry, with
2737added qualifications in addiction psychiatry, and who relied on
2746Dr. Muller's evaluation, the combined three diagnoses of major
2755depression, dysthymic disorder, and alcohol abuse revealed that,
2763to a degree of reasonable medical certainty, Respondent was
2772unable to practice medicine with skill and safety to patients on
2783the date of Dr. Muller's report.
278930. Respondent was evaluated at Menninger Clinic in Kansas,
2798on or about May 26, 1998, and diagnosed with alcohol dependence.
280931. After six weeks of treatment at the Menninger Clinic,
2819Respondent was released as being "in early remission." The
2828treating physician made a number of recommendations for
2836rehabilitation of Respondent, including treating his alcohol
2843dependence by entering into a monitoring contract with the
2852Physician's Resource Network in Florida and requiring a further
2861evaluation by a neurologist of Respondent's apparently diminished
2869cognitive skills.
287132. Dr. Pomm did not have the opportunity to read the
2882entire evaluation by the Menninger Clinic, and did not rely upon
2893it in forming his opinion of Respondent's inability to practice
2903medicine with skill and safety to patients. However, according
2912to Dr. Pomm, there is no cure for alcohol dependence. It is a
2925life-long illness, which is incurable, and which at best, can
2935only be "in remission." In Dr. Pomm's opinion, one who is
2946alcohol-dependent cannot practice with skill and safety to
2954patients without undergoing a monitoring program.
296033. While I accept Respondent's testimony that he has
2969remained sober since approximately May 27, 1998, because he has
2979been in prison, I also note that Respondent has not entered into
2991a monitoring contract or been monitored in a recovery program
3001because he has been in prison.
300734. Accordingly, there is no evidence that Respondent's
3015circumstances have changed sufficiently since January 13, 1998,
3023so as to demonstrate that he is able to practice medicine with
3035skill and safety to patients in the real world.
3044CONCLUSIONS OF LAW
304735. The Division of Administrative Hearings has
3054jurisdiction over the parties and subject matter of this cause,
3064pursuant to Subsection 120.57(1), Florida Statutes.
307036. The Board of Medicine is empowered to discipline the
3080license of a medical physician, such as Respondent, for the
3090following violations of Section 458.331(1), Florida Statutes:
3097(m) Failing to keep written medical records,
3104justifying the course of treatment of the
3111patient. Including, but not limited to,
3117patient history; examination results; test
3122results; records of drugs prescribed,
3127dispensed, or administered; and reports of
3133consultations and hospitalizations.
3136(t) Failing to practice medicine with that
3143level of care, skill and treatment which is
3151recognized by reasonably prudent similar
3156physicians as being acceptable under similar
3162conditions and circumstances.
3165(s) By being able to practice medicine with
3173reasonable skill and safety to patients by
3180reason of illness or use of alcohol, drugs,
3188narcotics, chemicals, or any other type of
3195material or as a result of any mental or
3204physical condition.
3206(x) By violating a provision of Chapter 458,
3214a rule of the Board or Department, or a
3223lawful order of the Board or Department
3230previously entered in disciplinary hearing or
3236failing to comply with a lawfully issued
3243subpoena of the Department.
324737. Rule 64B8-9.003(2), provides as follows:
3253A licensed physician shall maintain patient
3259medical records in a legible manner and with
3267sufficient detail to clearly demonstrate why
3273the course of treatment was undertaken or why
3281an apparently indicated course of treatment
3287was not undertaken.
329038. The Board of Medicine may impose one or more of the
3302penalties as set out in Section 458.331(2), Florida Statutes.
331139. Herein, Petitioner must go forward and prove by clear
3321and convincing evidence the alleged violations. Department of
3329Banking and Finance v. Osborne Stern , 670 So. 2d 932 (Fla. 1996);
3341Ferris v. Turlington , 510 So. 2d 292 (Fla. 1st DCA 1987).
335240. Petitioner has proven by clear and convincing evidence
3361the allegations of Count I of the Administrative Complaint in
3371DOAH Case No. 99-4377, in that Respondent violated Section
3380458.331(1)(t), Florida Statutes, by practicing medicine below the
3388acceptable standard of care in that Respondent discharged B.W.
3397from the emergency room without implementing proper treatment,
3405making an appropriate diagnosis, or obtaining the necessary
3413consultation, despite the fact that B.W. had a dangerously low
3423platelet count and a significant history.
342941. Petitioner has proven by clear and convincing evidence
3438the allegations of Count II of the Administrative Complaint in
3448DOAH Case No. 99-4377, that Respondent violated Section
3456458.331(1)(m), Florida Statutes, in that Respondent failed to
3464keep written medical records justifying treatment. The evidence
3472proves this violation in that the history Respondent recorded in
3482the medical records was marginal, test results were not
3491documented, and an assessment was not recorded.
349842. Petitioner established by clear and convincing evidence
3506the allegations of Count III of the Administrative Complaint in
3516DOAH Case No. 99-4377, that Respondent violated Section
3524458.331(1)(x), Florida Statutes, in that Respondent is guilty of
3533violating Rule 64B8-9.003(2), Florida Administrative Code, by
3540failing to maintain patient medical records in a legible manner
3550and with sufficient detail to clearly demonstrate why a course of
3561treatment was undertaken, or why an apparently indicated course
3570of treatment was not undertaken.
357543. Petitioner established by clear and convincing evidence
3583the Administrative Complaint in DOAH Case No. 99-4378, to the
3593effect that Respondent violated Section 458.331(1)(s), Florida
3600Statutes, in that Respondent is unable to practice medicine with
3610reasonable skill and safety to patients because Respondent has
3619been diagnosed as suffering from major depression, dysthymic
3627disorder, and alcohol abuse.
363144. The disciplinary guidelines of the Board of Medicine,
3640set out at Rule 64B-8.001, Florida Administrative Code, provide a
3650range of penalties for violations of the provisions of Section
3660458.331, Florida Statutes, including suspension.
3665RECOMMENDATION
3666Upon the foregoing findings of fact and conclusions of law,
3676it is
3678RECOMMENDED that the Board of Medicine enter a final order
3688finding Respondent guilty of all violations charged, and as a
3698penalty therefore, suspending Respondent's license to practice
3705medicine in Florida until such time as Respondent presents to the
3716Board and proves that he can practice with skill and safety.
3727DONE AND ENTERED this 15th day of June, 2000, in
3737Tallahassee, Leon County, Florida.
3741___________________________________
3742ELLA JANE P. DAVIS
3746Administrative Law Judge
3749Division of Administrative Hearings
3753The De Soto Building
37571230 Apalachee Parkway
3760Tallahassee, Florida 32399-3060
3763(850) 488-9675 SUNCOM 278-9675
3767Fax Filing (850) 921-6847
3771www.doah.state.fl.us
3772Filed with the Clerk of the
3778Division of Administrative Hearings
3782this 15th day of June, 200 0.
3789ENDNOTES
37901 / The undersigned notes that during Dr. Muller's deposition,
3800page 24, Respondent told Petitioner's counsel that he was
3809represented by a lawyer in a collateral criminal case, was not
3820represented in these administrative cases, and had been advised
3829not to speak in these cases.
38352/ Much later in the proceedings, Petitioner requested to go
3845back to his dormitory to get another exhibit. This motion was
3856denied at that time on the basis of his two prior waivers before
3869evidence began to be presented.
38743/ Respondent did not object timely to the request for official
3885recognition. His objections contained in his Proposed
3892Recommended Order are late, without merit, and denied.
39004/ Dr. Tober is board certified in emergency medicine.
3909Respondent's Motion to Strike contained in his Proposed
3917Recommended Order is denied.
39215/ Petitioner's "challenges" of Section 458.331(1)(s) and
3928(1)(m), Florida Statutes, first contained in his Proposed
3936Recommended Order are untimely and are denied for that reason and
3947because determinations of constitutionality vel non are outside
3955the jurisdiction of the Division of Administrative Hearings.
3963Likewise, Respondent's attacks on the sufficiency of the
3971Administrative Complaint(s) first raised in his Proposed
3978Recommended Order, are untimely under Rule 28-106.204, Florida
3986Administrative Code, and the prayer to dismiss/strike based
3994thereon is denied. Respondent is not charged with "wrongful
4003death" under Chapter 766, Florida Statutes, or any other statute.
40136/ Respondent defended in part on the basis that four days after
4025B.W.'s emergency room visit with Respondent, another physician
4033also did not admit B.W. to the hospital and begin transfusions of
4045platelets. The evidence shows that ultimately B.W. was admitted
4054and transfused but that the source of her internal bleeding was
4065never definitively pinponted and B.W. died. Respondent is not
4074charged with allowing B.W. to die. However, Respondent's actions
4083or lack thereof also are not necessarily excusable due to actions
4094or inactions of other physicians at a later date, under different
4105circumstances. He is held to a standard of care for emergency
4116room physicians.
41187/ Despite Lt. Chilton's testimony that he testified at a
"4128trial," I have relied on other exhibits showing that Respondent
4138pled guilty. I can only assume that Lt. Chilton testified in
4149some proceeding prior to the entry of the guilty plea due to a
4162plea bargain.
4164COPIES FURNISHED:
4166Carol A. Lanfri, Esquire
4170Agency for Health Care Administration
4175Post Office Box 14229
4179Tallahassee, Florida 32399-4229
4182Agustin Carmona-Legal Mail
4185DC# U03774
4187Jackson County Correction Institution
41913563 Tenth Street
4194Malone, Florida 32445-3144
4197William Large, General Counsel
4201Department of Health
4204Bin A02
42062020 Capital Circle, Southeast
4210Tallahassee, Florida 32399-1701
4213Tanya Williams, Executive Director
4217Board of Medicine
4220Department of Health
42231940 North Monroe Street
4227Tallahassee, Florida 32399-0750
4230Dr. Robert G. Brooks, Secretary
4235Department of Health
4238Bin A00
42402020 Capital Circle, Southeast
4244Tallahassee, Florida 32399-1701
4247Angela T. Hall, Agency Clerk
4252Department of Health
4255Bin A02
42572020 Capital Circle, Southeast
4261Tallahassee, Florida 32399-1703
4264NOTICE OF RIGHT TO SUBMIT EXCEPTIONS
4270All parties have the right to submit written exceptions within 15
4281days from the date of this Recommended Order. Any exceptions to
4292this Recommended Order should be filed with the agency that will
4303issue the Final Order in this case.
- Date
- Proceedings
- Date: 09/13/2000
- Proceedings: Final Order filed.
- PDF:
- Date: 06/15/2000
- Proceedings: Recommended Order sent out. CASE CLOSED. Hearing held March 15, 2000.
- Date: 06/12/2000
- Proceedings: Order sent out. (respondent`s "objection to ex parte hearing and petitioner`s response to respondent`s motion to strike petitioner`s proposed recommended order contains no clear prayer for relief and requires no ruling)
- Date: 06/12/2000
- Proceedings: Order sent out. (respondent objection of lack of jurisdiction of subject matter; objection to attorney landfri`s harssment upon respondent through her client contains no clear prayer for relief and requires no ruling)
- Date: 06/06/2000
- Proceedings: Respondent`s Objection of Lack of Jurisdiction of Subject Matter; Objection to Attorney Lanfri`s Harassment Upon Respondent Through Her Client filed.
- Date: 06/01/2000
- Proceedings: Order sent out. (petitioner`s motion to strike, the pending motion is untimely, the order of May 11, 2000 stands, no reason sufficient at law or admin. practice has been shown to strike/dismiss DOAH Case No. 99-4377 and petitioner`s proposed recommended o
- Date: 05/31/2000
- Proceedings: Petitioner`s Response to Respondent`s Motion to Strike Petitioner`s Proposed Recommended Order and to Respondent`s Objection to Ex-Parte Hearing (filed via facsimile).
- Date: 05/30/2000
- Proceedings: Respondent`s Objection to Ex Parte Hearing Between Administrative Judge and Petitioner filed.
- Date: 05/18/2000
- Proceedings: Respondent`s Filed Objection and Motion to Strike; Counter Strike, in Answer to Petitioner`s Proposed Recommended Order and its Motion to Strike filed.
- Date: 05/12/2000
- Proceedings: Order sent out. (portions of respondent`s proposed recommended order which reference matters outside the record or beyond the jurisdiction of this cause will not be considered)
- Date: 05/01/2000
- Proceedings: Petitioner`s Proposed Recommended Order; Motion to Strike Respondent`s Proposed Recommended Order filed.
- Date: 04/20/2000
- Proceedings: Respondent`s Court Directed Proposal w/cover leter filed.
- Date: 04/14/2000
- Proceedings: Post-Hearing Order sent out.
- Date: 04/13/2000
- Proceedings: (Petitioner) Notice of Mailing Transcript of Formal Hearing (filed via facsimile).
- Date: 04/12/2000
- Proceedings: Letter to EJD from C. Lanfri Re: Response to Dr. Carmona`s letter dated 3/28/00 (filed via facsimile).
- Date: 04/10/2000
- Proceedings: Transcript filed.
- Date: 03/31/2000
- Proceedings: Letter to EJD from A. Carmona Re: Delay in receiving the transcript filed.
- Date: 03/15/2000
- Proceedings: CASE STATUS: Hearing Held.
- Date: 03/14/2000
- Proceedings: (Petitioner) Amended Notice of Attendance at Formal Hearing (filed via facsimile).
- Date: 03/13/2000
- Proceedings: (Petitioner) Notice of Attendance at Formal Hearing (filed via facsimile).
- Date: 03/08/2000
- Proceedings: Notice of Petitioner`s Attempt of Service (filed via facsimile).
- Date: 03/01/2000
- Proceedings: (Petitioner) Notice of Motion Hearing (filed via facsimile).
- Date: 02/24/2000
- Proceedings: Petitioner`s Motion in Limine w/cover letter (filed via facsimile).
- Date: 02/24/2000
- Proceedings: Joint Prehearing Stipulation (filed via facsimile).
- Date: 02/23/2000
- Proceedings: (Petitioner) (2) Notice of Taking Deposition Duces Tecum in Lieu of Live Testimony; (2) Subpoena Duces Tecum (filed via facsimile).
- Date: 02/23/2000
- Proceedings: (C. Lanfri) Notice of Taking Deposition in Lieu of Live Testimony (filed via facsimile).
- Date: 02/18/2000
- Proceedings: (Petitioner) (3) Notice of Taking Deposition Duces Tecum in Lieu of Live Testimony; (3) Subpoena Duces Tecum filed.
- Date: 02/17/2000
- Proceedings: Petitioner`s Motion to Take Official Recognition (filed via facsimile).
- Date: 12/16/1999
- Proceedings: Letter to C. Lanfri from Judge Davis sent out. (RE: enclosing copy of letter filed with the Division on 12/13/99)
- Date: 12/13/1999
- Proceedings: (Respondent) Response filed.
- Date: 12/06/1999
- Proceedings: Order of Consolidation sent out. (Consolidated cases are: 99-004377, 99-004378)
- Date: 12/06/1999
- Proceedings: Order of Pre-hearing Instructions sent out.
- Date: 12/06/1999
- Proceedings: Notice of Hearing sent out. (hearing set for March 15, 2000; 10:30 a.m.; Malone, FL)
- Date: 11/16/1999
- Proceedings: Order sent out. (respondent is granted 10 days from instant date to respond to initial order)
- Date: 11/12/1999
- Proceedings: Letter to EJD from C. Lanfri Re: Response to the 10/28/99 communication from the Respondent filed.
- Date: 11/04/1999
- Proceedings: Letter to SLS from A. Carmona Re: Response to C. Lanfri`s letter dated 7/15/99; Letter to A. Carmona from C. Lanfri Re: Cannot give additional time; Letter to C. Lanfri from A. Carona Re:Requesting additional time to respond filed.
- Date: 10/29/1999
- Proceedings: Unilateral Response to Initial Order and Request for Consolidation of Cases (filed via facsimile).
- Date: 10/20/1999
- Proceedings: Initial Order issued.
- Date: 10/14/1999
- Proceedings: Agency Referral Letter; Notice of Appearance; Administrative Complaint; Agency Letter To A. Carmona (re: Notification of Referral to DOAH) filed.