How Disciplinary Actions are Initiated Against a Florida Nurse

There are many possible grounds for which disciplinary action may be initiated against a nurse in Florida.  It is important to be familiar with these so that you can avoid them.

You should review and be very familiar with all of the Florida laws and the Florida Board of Nursing’s Rules that appear in the Florida Administrative Code (F.A.C.).  These may all be accesses through the Florida Board of Nursing’s website:  www.doh.state.fl.us/mqa/nursing/.  Look for the menu item “Laws and Rules” and click on this.

The laws which set forth various grounds for discipline include:

Chapter 456, Florida Statutes (which applies to all licensed health professionals).

Chapter 464, Florida Statutes (the Nurse Practice Act).

Chapter 64B9, Florida Administrative Code (Rules adopted by the Board of Nursing).

Basically, a nurse may be disciplined for any violation of the Nurse Practice Act, for any violation of Chapter 456, Florida Statutes, for violation of any Rule of the Board of Nursing (Chapter 64B9, F.A.C.), for violation of any law applicable to nurses or nursing, or for violation of any final order of the Board of Nursing or Department of Health.  The most ambiguous of these tends to be actions of the nurse which fail to meet “minimal standards of acceptable and prevailing nursing practice” (sometimes called “falling below the standard of nursing practice” or “substandard performance”), as stated in Section 464.018, Florida Statutes.

Acts that Result in Disciplinary Action Against a Nursing License

Disciplinary action may be taken against the nurse’s license, through administrative proceedings, under the following circumstances, as provided by Section 464.018, Florida Statutes:

1. Procuring, attempting to procure, or renewing a license to practice nursing by bribery, by knowing misrepresentations, or through an error of the department or the board;

2. Having a license to practice nursing revoked, suspended, or otherwise acted against, including the denial of licensure, by the licensing authority of another state, territory, or country;

3. Being convicted or found guilty of, or entering a plea of nolo contendere to, regardless of adjudication, a crime in any jurisdiction which directly relates to the practice of nursing or to the ability to practice nursing;

4. Being found guilty, regardless of adjudication, of any of the following offenses:

  • A forcible felony as defined in Chapter 776, Florida Statutes;
  • A violation of Chapter 812, Florida Statutes, relating to theft, robbery, and related crimes;
  • A violation of Chapter 817, relating to fraudulent practices;
  • A violation of Chapter 800, relating to lewdness and indecent exposure;
  • A violation of Chapter 784, Florida Statutes, relating to assault, battery, and culpable negligence;
  • A violation of Chapter 827, Florida Statutes, relating to child abuse;
  • A violation of Chapter 415, Florida Statutes, relating to protection from abuse, neglect, and exploitation; and
  • A violation of Chapter 39, Florida Statutes, relating to child abuse, abandonment, and neglect.

5. Having been found guilty of, regardless of adjudication, or entered a plea of nolo contendere or guilty to, any offense prohibited under Section 435.03, Florida Statutes, or under any similar statute of another jurisdiction; or having committed an act which constitutes domestic violence as defined in Section 741.28, Florida Statutes;

6. Making or filing a false report or record, which the licensee knows to be false, intentionally or negligently failing to file a report or record required by state or federal law, willfully impeding or obstructing such filing or inducing another person to do so. Such reports or records shall include only those which are signed in the nurse’s capacity as a licensed nurse;

7. False, misleading, or deceptive advertising;

8. Unprofessional conduct, as defined by board rule;

9. Engaging or attempting to engage in the possession, sale, or distribution of controlled substances as set forth in chapter 893, for any other than legitimate purposes authorized by this part;

10. Being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, or chemicals or any other type of material or as a result of any mental or physical condition;

11. Failing to report to the department any person who the licensee knows is in violation of this part or of the rules of the department or the board; however, if the licensee verifies that such person is actively participating in a board-approved program for the treatment of a physical or mental condition, the licensee is required to report such person only to an impaired professionals consultant;

12. Knowingly violating any provision of this part, a rule of the board or the department, or a lawful order of the board or department previously entered in a disciplinary proceeding or failing to comply with a lawfully issued subpoena of the department;

13. Failing to report to the department any licensee under Chapter 458 or under Chapter 459, Florida Statutes, who the nurse knows has violated the grounds for disciplinary action set out in the law under which that person is licensed and who provides health care services in a facility licensed under Chapter 395, Florida Statutes, or a health maintenance organization certificated under part I of Chapter 641, Florida Statutes, in which the nurse also provides services;

14. Failing to meet minimal standards of acceptable and prevailing nursing practice, including engaging in acts for which the licensee is not qualified by training or experience; and

15. Violating any provision of this Chapter or Chapter 456, Florida Statutes, or any rules adopted pursuant thereto.

Section 456.072, Florida Statutes, which applies to nurses and all other licensed health professionals, also provides a list of grounds for disciplinary action against a nurse’s license. This information can be found here.

Contact an Experienced Health Attorney Familiar with Nursing Law Issues

The attorneys of The Health Law Firm have experience in representing nurses in both formal and informal administrative hearings and in representing nurses, nurse practitioners, and CRNAs in investigations and at Board of Nursing hearings.  Call us now at (407) 331-6620 or (850) 439-1001 or visit our website www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Preparing for an Informal Hearing Before the Florida Board of Dentistry

By George F. Indest III, J.D., M.P.A., LL.M. Board Certified by The Florida Bar in Health Law

If you are scheduled to appear for an informal hearing before the Florida Board of Dentistry, there are a number of facts that you will want to know in order to be properly prepared.  This article will cover many of them.

Limited Circumstances for Informal Administrative Hearing.

First, you should understand that you will only be at an informal hearing in which you appear before the Board of Denstistry itself for a very limited number of reasons.  These will include the following:

1.  If you completed an election of rights (EOR) form and agreed that you did not intend to dispute any material facts alleged against you from the administrative complaint (AC) in the case.

2.  If you entered into a settlement agreement (or “stipulation”) (similar to a plea bargain in a criminal case) in which you agreed to accept discipline against your license.

3.  You failed to submit any election of rights (EOR) form and failed to file a petition for a formal hearing in a timely manner, and, therefore, you have waived your right to a formal hearing.

There are a few other circumstances in which there may be an informal hearing before the Board, such as motions to modify a final order, motion to lift a suspension of a license, appearance in accordance with an earlier order, petition for a declaratory statement, or other administrative matters.  This article only discusses those directly relating to disciplinary action as indicated above.

What an Informal Administrative Hearing Is Not.

1.  An informal administrative hearing is not an opportunity for you to tell your side of the story.  You have agreed that there are no disputed material facts in the case or you would not be at an informal hearing.

2.  An informal administrative hearing is not an opportunity for you to prove that you are innocent of the charges.  You have agreed that there are no disputed material facts in the case or you would not be at an informal hearing.

3.  An informal administrative hearing is not an opportunity for you to introduce documents or evidence to show that someone else committed the offenses charged and you did not.  You have agreed that there are no disputed material facts in the case or you would not be at an informal hearing.

4.  An informal administrative hearing is not an opportunity for you to argue that you should not be in the board’s impaired practitioners program (either the Professionals Resource Network (PRN) or the intervention Project for Nurses (IPN)) because you have completed a different program or that you do not have a problem.  These are the only programs recognized and used and you have agreed that there are no disputed material facts in the case or you would not be at an informal hearing.

Formal Administrative Hearing vs. Informal Hearing.

If you desire to contest the facts alleged against you then you must state this in writing.  If the material facts in a case are challenged by you, then the Board or the Department of Health (DOH) (note:  all professional boards are under the Department of Health in Florida) must forward your case to the Division of Administrative Hearings (DOAH) where a neutral, objective administrative law judge (ALJ) will be appointed to hold a formal hearing in your case.  This is the only way that exists for you to prove that the facts alleged against you are incorrect or that you are not guilty of the charges made against you.  In fact, you do not even have to do anything in such a case.  The Department of Health has the burden of proof and it has to prove the charges against you and the material facts alleged against you by clear and convincing evidence.  Often, it is unable to do this at a formal administrative hearing.

However, because of the technicalities of evidentiary law and administrative law, we do not recommend that a nonlawyer attempt to represent himself or herself at such hearings.  You can make technical mistakes (such as answering requests for admissions incorrectly) that severely compromise any defense you may have.  We recommend that you always retain the services of an experienced health lawyer in any such matter.

What to Do If You Find That You Are at an Informal Hearing and That You Do Desire to Contest the Material Facts of the Case (And Your Guilt or Innocence).

If you have been scheduled for an informal administrative hearing and you decide that you do desire to challenge the material facts alleged against you in the administrative complaint (AC), file a written objection to proceeding at the informal hearing.  State that you have discovered that there are material facts that you do desire to challenge and that you desire that the proceedings be converted to a formal hearing.  File this with the Clerk of the administrative agency you are before (usually the department of health or the Agency for Health Care Administration (AHCA) and also send a copy to the opposing attorney and the executive director of the Board.  Do this as early as possible and keep proof that you have actually and filed the written request.

If you are already at the informal hearing when you discover this, object to the proceedings on the record and ask to have the informal hearing be converted to a formal hearing where you may contest the material facts.  State this as many times as reasonably possible.

Preparing for an Informal Hearing.

Since you are not contesting the facts alleged against you, if you are going to an informal hearing be sure you do the following:

1.  Be sure you know where the hearing is going to be held.  Try to stay the night before in the same hotel as the hearing will be held.  You will usually have to make these reservations early in order to get a room.

2.  Attend a Board meeting that occurs before the one at which your case is scheduled.  This will give you a feeling for the procedures that will be followed, will help to make you less nervous when you appear, and you can obtain continuing education units for doing so (be sure to sign in and sign out).  Be sure to attend one of the days when the disciplinary hearings are held.

3.  Dress professionally for the appearance.  This may be the most important event in your professional career.  For men, this means a suit and tie or, at least, a dark coat, dark slacks and a necktie.  For women, a professional business suit or the equivalent is in order.  Do not dress as if you are going to the park, the beach or out on a date.  Do not wear sexually provocative or revealing clothing.

4.  Check the agenda that is published on line a day or two before the scheduled hearing to make sure that your case is still scheduled for the date and time on the hearing notice.  Informal hearings may be moved around on the schedule.  Make sure you are there at the earliest time on the hearing notice or agenda.

5.  Listen to questions asked of you by Board members and attempt to answer them directly and succinctly.  You will be placed under oath for the proceeding and there will be a court reporter present as well as audio recording devices to take everything down.

6.  Do not argue with the Board members or lose your temper.  This is not the time or place to let this happen.  If you have such tendencies, then you should have an attorney there with you who can intercept some of the questions and can make defensive arguments (to the extent that they may be permitted) for you.

7.  You may introduce documents and evidence in mitigation.  However, you have agreed that the material facts alleged are true, so you may not contest these.  In effect, you have plead guilty and you are just arguing about how much punishment (discipline) and what kind of punishment you should receive.

8.  If you do intend to introduce documents and evidence in mitigation, be sure you know what the mitigating factors are (these are published in a separate board rule in the Florida Administrative Code for each professional board).  These may include, for example, the fact that there was no patient harm, that there was no monetary loss, that restitution has been made, the length of time the professional has been practicing, the absence of any prior discipline, etc.  You should submit these far ahead of time with a notice of filing, so that they are sent out to the board members with the other materials in your file.  This is another reason to have experienced counsel represent you at the informal hearing.

9.  Be prepared to take responsibility for your actions.  If you are not prepared to take responsibility, then this means you must believe you are innocent and you should be at a formal hearing, not an informal one.

10.  Be prepared to explain what went wrong, why it went wrong, and what remedial measures you have taken to prevent a recurrence of this type of event in the future.  Show that you have learned from this experience and that you are not going to make the same mistake again.

11.  It is our advice to always retain the services of an experienced attorney to represent you at such hearings.  Often your professional liability insurance will cover this.  If you have professional liability insurance, be sure that it contains a rider or addendum that provides coverage for professional license defense matters and administrative hearings.  You need at least $25,000 to $50,000 in coverage for this type of defense.  If necessary, you should contact your insurer or insurance agent and have the limits increased for a small additional premium.

Other Little Known Facts to Remember.

Professional licensing matters are considered to be “penal” or “quasi-criminal” in nature.  Therefore, you have your Fifth Amendment rights in relation to being required to give evidence against yourself.  You cannot be compelled to do this in such matters.  However, since it is an administrative proceeding and not a criminal proceeding, there is no requirement that the licensee be advised of this by a DOH investigator or attorney.

If you enter into a settlement agreement and attend the informal hearing to approve it, nothing you say or testify to at this hearing can later be used against you.  This is because you are involved in an attempt to negotiate and settle (or compromise) the claims being made against you.  It is a general rule of law that nothing the parties say in such settlement proceedings can later be used as evidence if the settlement agreement is not approved.  The law tries to promote settlements among parties to any dispute in this way.

It is true that on occasion the Board will examine a case on an informal hearing and will decide to dismiss it.  This is rare, but it does happen.  Sometimes, it will be a tactical decision on the part of you and your attorney to elect to go to an informal hearing with the hope that the Board may examine the case and decide to dismiss it.  However, you cannot count on this happening.

Don’t Wait Too Late;  Consult with an Experienced Health Law Attorney Early.

Do not wait until action has been taken against you to consult with an experienced attorney in these matters.  Few cases are won on appeal.  It is much easier to win your case when there is proper time to prepare and you have requested a formal hearing so that you may actually dispute the facts being alleged against you.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing dentists and dental hygienists  in investigations and at Board of Dentistry hearings.  Call now or visit our website www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Nurses: Don’t Work at an Illegal Health Care Clinic

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Despite the passage of Florida’s Health Care Clinic Act over nine years ago, there are still many health practices which are violating it. Unfortunately, the violation of the Health Care Clinic Act can have serious repercussions, including conviction of a felony, loss of all fees collected, and disciplinary/licensure action against any nurses or other licensed health professionals working there.

Over the past three years we have seen the following scenarios or ones similar to these (changed factually to ensure anonymity):

Scenario 1: A health care practitioner licensed in Florida decides to sell her practice and retire. Three non-licensed business people decide to form a corporation to purchase and operate the practice. The corporation purchases the medical practice’s assets, including patient records. The corporation has not applied for or received a health care clinic license.

Results: On the day of closing or the day the practice is transferred to the new corporation, the corporation is operating illegally, in violation of Florida law. Each day of operation is a separate felony.

Scenario 2: A health care professional practices medicine through a limited liability company (LLC) which the he owns with his non-licensed wife. The health care professional dies and his wife remains sole owner of the practice, hiring a locum tenens physician to come in and treat patients.

Results: As of the date of death of the health care professional, the practice is operating illegally, in violation of Florida law. Each day of operations is a separate felony offense.

Scenario 3: A health care professional licensed in Florida operates a medical practice as a sole proprietorship. The health care professional desires to reward her practice manager, a non-licensed business person, by making him a partner in her practice. The practice continues to operate as before without a health care clinic license.

Results: The practice is operating illegally as of the day the practice manager is made a partner.

Scenario 4: A health care professional has a medical practice which he owns and operates through a business corporation which does not need or have a health care clinic license. He decides to relocate to another state. He sells the shares of stock to a medical doctor who is licensed in Georgia, but is not licensed in Florida. The new physician owner hires a medical doctor licensed in Florida to deliver all medical services in the Florida practice.

Results: The corporation, its owner, and the physician employee are operating illegally as of the date the shares in the corporation are transferred. Each day of operation constitutes a new offense.

The consequences of such actions are severe. The act provides that violating it constitutes a felony of the third degree for each day of operation. Any licensed health professional having knowledge of the unlicensed status of the practice or clinic and who does not immediately report it can be disciplined by his or her professional board. Any fees of any kind collected from any source, Medicare, Medicaid, insurers, or cash from patients, are considered illegal as a matter of law and are subject to recoupment or refund.

If you are a nurse or other licensed health professional, be sure you know who the actual owners of the medical practice are. If any are not licensed in Florida, inquire as to the existence of a current, valid health care clinic license from the Agency for Health Care Administration. If any doubt or suspicion, consult with an experienced health care attorney.

Don’t Wait Too Late;  Consult with an Experienced Health Law Attorney At the Onset of Any Issue

Do not wait until action has been taken against you to consult with an experienced attorney in these matters. It is much easier to win your case when there is proper time to prepare.

The attorneys of The Health Law Firm are experienced in representing nurses, nurse practitioners, and CRNAs in investigations, IPN matters and at Board of Nursing hearings.  Call now or visit our website www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Florida Law Prohibits Control of a Dental Practice by a Nondentist

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Florida has long been a state that does not prohibit the corporate practice of medicine, unlike many other states. However, it does prohibit the corporate practice of dentistry.  The key provision in Florida law that establishes this is Section 466.028, Florida Statutes, but the Florida Board of Dentistry has also adopted administrative rules on this topic, as well.

What this means is that any corporation (or other type of business entity) that owns or operates a dental practice, under Florida law, must be one solely owned by and controlled by dentists. In this context, the term “dentists” means those licensed to practice dentistry in the state of Florida, with an active license.  Someone licensed in another state or who has a suspended or revoked license in Florida, would not meet that requirement.

Dentists Entering into Certain Types of Contracts Needs to Be Sure They Comply with the Law.

There may be certain types of contracts and agreements that a dentist or dental practice may legally enter into, especially ones that would provide administrative services or other types of non-professional services to the dentist.  These might include, for example, payroll services, staffing services (except for professional staff such as dental technicians), billing and collections services (provided the dentist retains final authority over such matters), marketing services, equipment leases (provided the dentists retains all control over the equipment), office leases, management services, or combinations of the above.  However, since any of these types of agreements may be worded so as to violate the law, a dentist should always have such an agreement reviewed in advance by his or her own experienced health attorney.  The dentist entering into any such contract must make sure he or she complies fully with the law.

Section 466.028(2), Florida Statutes, states that the purpose of the statute is to prevent any nondentists from attempting to influence or interfere with the professional judgment of the dentist.

Acts Prohibited by Law.

Acts specifically prohibited by the law include allowing a nondentist or business entity owned by a nondentist to:

1.    Employ a dentist or dental hygienist in the operation of a dental office;

2.    Control the use of any dental equipment or material while such equipment or material is being used for the provision of any dental services;

3.    Direct, control or interfere with a dentist’s clinical judgment;  and, specifically,

4.    Allowing any nondentist or organization owned by a nondentist to exercise control over:

a.    The selection of a course of treatment for a patient, the procedures or materials to be used as part of such course of treatment, and the manner in which such course of treatment is carried out by the dentist;

b.    The patient records of a dentist;

c.    Policies and decisions relating to pricing, credit, refunds, warranties and advertising; or

d.    Decisions relating to office personnel and hours of practice.

Violating Law is a Felony.

Any of these acts can result in disciplinary action against any licensed dental professional involved. More importantly, violation of this law is also a felony which may result in criminal prosecution for any person involved.  Contracts which violate the law are null and void.

Always have any contract relating to the operation of your dental practice reviewed by an experienced board certified health lawyer before signing it.

Contact Health Law Attorneys Experienced in Representing Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Board of Dentistry and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Did you know about this Florida Law that prohibits control of a dental practice by a nondentist? Please leave any thoughtful comments below.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

The 27 Biggest Mistakes Nurses Make in Department of Health Investigations

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Following are the 27 biggest mistakes that we have seen nurses make over and over again that cause them the worst trouble in DOH investigations.

1. Failing to keep a current, valid address on file with the DOH (as required by law), which may seriously delay the receipt of the Uniform Complaint (notice of investigation), letters, and other important correspondence related to the investigation.

2. Contacting the DOH investigator and providing him/her an oral statement or oral
interview. (Note: There is no legal requirement to do this.)

3. Making a written statement in response to the “invitation” extended by the DOH
investigator to do so. (Note: There is no legal requirement to do this.)

4. Failing to carefully review the complaint to make sure it has been sent to the correct nurse. (Note: Check name and license number).

5. Failing to ascertain whether or not the investigation is on the “fast track” which may then result in an emergency suspension order (ESO) suspending the physician’s license until all proceedings are concluded. (Note: This will usually be the case if there are allegations regarding drug abuse, alcohol abuse, sexual contact with a patient, mental health issues, or failure to comply with IPN instructions.)

6. Providing a copy of the nurse’s curriculum vitae (CV) or resume to the investigator
because the investigator requested her to do so. (Note: There is no legal requirement to do this.)

7. Believing that if they “just explain it,” the investigation will be closed and the case
dropped.

8. Failing to submit a timely objection to a DOH subpoena when there are valid grounds to do so.

9. Failing to forward a complete copy of the patient medical record when subpoenaed by the DOH investigator as part of the investigation, when no objection is going to be filed. Will usually not apply to nurses bu may apply to ARNPs and nurse midwives.

10. Failing to keep an exact copy of any medical records, documents, letters or statements provided to the investigator.

11. Failing to submit correspondence and documents via certified mail, return receipt
requested, so that you have proof of mailing and proof of receipt.

12. Believing that the investigator has knowledge or experience in hospital procedures, nursing procedures or the health care matters or procedures being investigated.

13. Believing that the investigator is merely attempting to ascertain the truth of the matter and this will result in the matter being dismissed.

14. Failing to check to see if your nursing malpractice insurance carrier will pay the legal fees to defend in this investigation.

15. Talking to DOH investigators, staff or attorneys, in the mistaken belief that they are capable of doing so without providing information that can and will be used against them.

16. Believing that because they haven’t heard anything for six months or more, that the matter has “gone away.” The matter does not ever just go away.

17. Failing to submit a written request to the investigator at the beginning of the investigation for a copy of the complete investigation report and file and then following up with additional requests until it is received.

18. Failing to wisely use the time while the investigation is proceeding to interview witnesses, obtain witness statements, conduct research, obtain experts, and perform other tasks that may assist defending the case.

19. Failing to exercise the right of submitting documents, statements, and expert opinions to rebut the findings made in the investigation report before the case is submitted to the Probable Cause Panel of the Board of Nursing for a decision.

20. Taking legal advice from their colleagues or employers regarding what they should do (or not do) in defending themselves in the investigation.

21. Retaining “consultants” or other non-lawyer personnel to represent them.

22. Retaining criminal defense attorneys, trial attorneys or other attorneys to represent them in such matters when that attorney does not have experience in appearing before the Board of Nursing in such cases (always ask the attorney how many time she or she has actually appeared before the Board of Nursing.)

23. Believing that the case is indefensible so there is no reason to even try to have it dismissed by the Probable Cause Panel. The case is usually defensible.

24. Attempting to defend themselves.

25. Believing that because they know someone on the Board of Nursing, with the Department of Health or a state legislator, that influence can be exerted to have the case dismissed.

25. Communicating with the Department of Health about the pending case.

27. Failing to immediately retain the services of a health care attorney who is experienced in such matters to represent them, to communicate with the DOH investigator for them, and to prepare and submit materials to the Probable Cause Panel.

About the Author:  George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Florida Board of Dentistry Warns About Responding to or Consulting with Individuals Over Internet About Dental Issues

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

At the Florida Board of Dentistry meeting held on November 15, 2013, one of the committee chairs discussed an issue that has arisen nationally that is causing dentists legal problems. The issue arises when individuals contact a dentist over the internet seeking “information” on a dental condition or problem, and possible treatment or procedures that can resolve these issues.

The concern is that the dentist may actually be diagnosing a dental condition or problem the individual has. The bigger concern arises if the individual contacting the dentist is in a different state from the one in which the dentist is licensed. Then the dentist is actually practicing dentistry in the state in which the individual is located.

In this blog I will discuss some of the issues a dentist can encounter when diagnosing a condition or problem over the internet. I will also talk about ways a dentist can reduce his or her risk.

Issues Dentists Can Face When Diagnosing a Condition Over the Web.

Diagnosing a non-patient over the internet can cause a myriad of different problems for the dentist involved, including these situations:

1. By diagnosing in a state in which the dentist is not licensed, he or she is engaging in the unlicensed practice of dentistry in that state. This can lead to criminal charges in that state and disciplinary actions in the state where the dentist is licensed.

2. Cases have arisen where incorrect diagnoses have been rendered because the individual failed to provide complete information, and the dentist failed to physically examine the individual or follow other procedures normally followed.

3. There have been instances where such individuals have filed complaints or claims against dentists for providing them information upon which they relied.

4. In most cases, a dentist’s professional liability (dental malpractice) insurance will not cover professional negligence in another state.

 

Recommendations to Reduce Risk.

I recommend that dentists take the following steps to help reduce risk if involved in providing information to non-patients over the internet or in the media (radio, television, newspaper, etc.):

1. Make sure that you have proper warnings and disclaimers that are included in every such e-mail communication or listserv communication you make.

A. Include the state in which the dentist is licensed/practicing and explain that the communication is not considered to be diagnosing, prescribing, treating or practicing any profession in any other state or jurisdiction.

B. Include a disclaimer or statement in every e-mail listserv or other communication with non-patients that you are providing general information for educational purposes only, and the individual must seek and follow the advice of a dentist in his or her geographic area to make any diagnoses.

C. Include that the person receiving the information cannot rely on it for treatment purposes since an actual physical examination must take place before any reliable information/recommendations can be made in any individual’s case.

2. Inquire with your professional liability insurer or agent to ask about “broad form coverage” and attempt to obtain coverage that includes educational activities, marketing activities and other similar activities. Make sure the “broad form coverage” also covers these activities in different states.

3. Make sure your professional liability insurance provides coverage for legal expenses involved in defending against administrative complaints and investigations initiated by any state or federal agency that could result in disciplinary action against you or your license. You probably need at least $25,000 in coverage for this. However, $50,000 or $75,000 in coverage for such matters is preferred. Buy this coverage separately if necessary. Lloyd’s of London provides such coverage separately.

4. Find out where the individual contacting you resides or is communicating from. Require complete information, including complete name, address and telephone numbers.

5. Be extremely reluctant to criticize care, services, procedures, materials or appliances used or prescribed by other dentists.

 

Contact Health Law Attorneys Experienced in Representing Dentists.

The attorneys of The Health Law Firm provide legal representation to dentists in Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Board of Dentistry and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

Have you ever been asked to consult with a patient over the internet? Did you know all of these issues could up? Please leave any thoughtful comments below.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

 

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Preparing for a Deposition for Nurses

George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

With the number of personal injury and healthcare-related lawsuits increasing each year, at some time in your professional career as a nurse, you will receive a subpoena requiring you to give an oral statement at a deposition. Having your deposition taken can be a stressful or even a scary experience. Following the few simple tips set forth in this chapter can make your deposition experience less stressful and hopefully relieve your feelings of anxiety.

Before the Deposition 

1. Be Prepared -You should prepare yourself for your deposition by familiarizing yourself with the chart or other medical records at issue in the lawsuit, unless your attorney instructs you otherwise. You should be prepared to answer general knowledge questions regarding the issues involved in the lawsuit. The examining attorney does not expect an in depth medical response; however, using some medical terminology may add to your credibility as a professional. Again, it is imperative that you realize your role in the case prior to deposition in order to assist in your preparation. If you have used certain medical terms in your nurse’s notes or medical record be sure you know exactly what they mean. If you used an abbreviation, be sure you know what it means.

2. Contact Your Attorney and Demand a Preparation Meeting – If you work in a hospital, you can probably expect the hospital’s attorney to conduct a predeposition conference to familiarize you with the plaintiff’s theory of the case when a hospital is being sued as an employer. Keep in mind that this attorney is not your attorney, but is your employer’s attorney; therefore, you may wish to retain a board certified healthcare attorney or a litigation attorney to be “on your side” for the deposition. If you are not contacted several weeks prior to your deposition regarding preparation for it, call your attorney and demand an appointment no later than one week prior to the deposition. This will give you time to meet with the attorney, learn about the issues involved in the suit, learn more about your role in the lawsuit, time to reschedule the meeting or have a follow-up meeting and time to relax before your deposition. Ask your attorney if he or she has a videotape of other depositions (from a different case) or a training videotape for you to watch. A training videotape can be particularly useful if you have never been deposed before. If your attorney does not conduct a pre-deposition conference with you, you are not receiving proper legal representation. Ask for a new attorney who has the time to properly prepare you for your deposition.

3. Ask If You Can Sit in on Other Depositions Before Yours – Although this may not be permitted in some cases, in many cases it will be. Consult with your attorney.

4. Do Not Discuss the Case With Others – Never discuss the case with others, unless your attorney is present or advises you it is ok to do this. If anyone tries to talk to you about the case, do not. If anyone asks you questions about the case, immediately advise them you have an attorney and that person should speak with your attorney.

5. Visit the Location of the Deposition – Unless the deposition will be held in your hospital or office, drive to the location where it will be held ahead of time and check out the parking situation. If you do this, you will not be rushed or late on the day of the deposition.

6. Pick Out Your Deposition Clothes – Pick out and prepare your deposition clothes prior to the deposition.

7. Obtain and Review Your Employer’s Medical Abbreviations List – If you work for a hospital, facility or group that has a “standard medical abbreviations list,” obtain it and review it. Check the records you wrote (after consulting with your attorney) to see if you used any incorrectly; if you did use an abbreviation incorrectly, be prepared to explain what you meant and why you used the abbreviation.

At the Deposition

1. Dress Professionally – As a general rule, unless your attorney advises you that it is okay to wear a nursing uniform, wear your best professional suit or “church clothes.” Regardless, be sure that your clothes are freshly cleaned and not in need of tailoring or repair. If in doubt, take what you plan to wear to your pre-deposition meeting with your attorney.

2. Do Not Be Intimidated – In some cases, an examining attorney will attempt to harass or intimidate a deponent during a deposition. If you have your own attorney present, she or he will attempt to curtail these types of tactics. If you begin to feel pressured, pause and take a breath before you begin your answer. Answers that are not thought out are the answers that the examining attorney will use to destroy your credibility as a witness.

3. Tell the Truth – When being deposed, you are under a sworn oath to tell the truth. Therefore, it is of the utmost importance that you give only truthful information to the deposing attorney. The truth is the easiest to remember and will help you deal with any psychological intimidation or other tactics that a hostile interrogating attorney might use. Harassment usually occurs when the attorney thinks that the witness is deliberately misstating or withholding relevant facts. Keeping your answers truthful may help reduce this type of behavior by the examining attorney.

4. Give Direct Answers – Give direct, straightforward responses without rambling or exaggerating and without volunteering information that was not requested. It is easy to be mislead into “telling all” by a friendly opposing attorney. Keep in mind that the deponent is only required to give knowledge that he or she personally has. If you do not know the answer to the question, you should state that you do not have personal knowledge of the information being asked. Remember, when an attorney for the other side is asking questions, the best answer is the shortest truthful answer. The best answer will usually be: “Yes,” “No,” “I don’t know,” or “I don’t recall.” If one of these answers applies, use it. Do not volunteer information. Additionally, do not guess the answer to the question. Similarly, do not state your opinion; give only facts of which you have personal knowledge. Keep your answers honest, straightforward and direct.

5. Listen Carefully – It is important that the deponent listen very carefully to the question asked by the attorney. Many times, attorneys do not prepare questions or rehearse questions in preparation for a deposition. As a result, some of the questions asked by the deposing attorney may be poorly worded, confusing or may be asked in many parts. Give only the answer to the question asked.

6. Ask the Attorney to Rephrase or Re-ask the Question – The questions asked should be completely understood. If you have listened carefully and you are asked a question that you do not understand, it is proper and appropriate to request that the attorney rephrase the question. You should not feel anxious or embarrassed to request that the question be rephrased.

7. Only Answer Questions Within Your Scope of Work – In some cases, you may be asked medical questions that are outside your knowledge or scope of practice. It is certainly appropriate for you to say that you do not know the answer to the question or that the information is beyond your knowledge as a nurse. You should not answer questions involving subjects about which you are not knowledgeable. It is also proper to state if you do not remember the answer to a question.

8. Stay Calm – While being deposed, attempt to stay calm, relaxed and composed throughout the deposition. This type of behavior will enhance your credibility as a witness. You should not be concerned with how your answers will affect others involved in the lawsuit. Be sure to take your time in answering the questions asked. You should not feel rushed to answer the questions; after all, the attorney deposing you subpoenaed you for the deposition.

9. Speak Clearly – Speaking clearly will also aid you in the deposition. A court reporter is recording everything you are saying. Therefore, you must orally answer every question. It will also assist to curtail rambling if you remember that a court reporter is recording every word you speak.

10. Be Polite – Being polite and cooperative can only help your position. Even though an attorney may attempt to intimidate you, being polite and cooperative will hinder his ability to make you feel uncomfortable.

11. Never Lose Your Temper – Never lose your temper or allow yourself to lose control. Some attorneys will try to get you to do this so you will say something without thinking.

12. No Joking – Do not laugh or joke around immediately before, during or after a deposition. This is a serious matter. Treat it seriously. Never relax your guard around the opposing attorney. He is not your friend.

13. Pause Before Answering – Pause two seconds before you answer each question. This will give you time to think. This will also give your attorney time to object if the question is improper.

14. Stop Immediately if Someone Else Speaks – If anyone else starts to speak, stop talking immediately. If your attorney objects, listen very carefully to the objection. Your attorney may be trying to tell you something.

After your Deposition 

After being deposed, if you made any mistakes in your deposition or later remember an answer, notify your attorney immediately. It is probably not too late to correct it.

You have the right to obtain a copy, check and change any errors or mistakes (even ones you made) in the typed transcript of the deposition. Never waive your right to obtain a copy and read the deposition transcript (unless your attorney has advised you of a good reason to do this before the deposition). Demand that you receive a copy of the transcript so you can review it prior to your later testimony at the trial (which may be years later). Always demand a copy of the transcript with all of the exhibits attached to it.

You have the right to review the entire transcript, correct any typographical errors or any erroneous statements you may have made and file these corrections with the transcript. You can only do this if you exercise your right as a deponent to “read and sign the transcript.” This is very important. Never agree to waive “reading and signing” unless you have discussed it with your attorney before the deposition and you have received a good reason you should do this.

If you will be called as a witness at the trial or in a related case, always review the transcript of your deposition twice, once approximately one week before and again the night before you testify.

Again, until the entire case is over and finalized (only your attorney can tell you when this is), do not discuss the case with anyone else.

Contact Health Law Attorneys Experienced in Representing Nurses at Depositions.

The Health Law Firm’s attorneys routinely represent nurses in depositions, Department of Health investigations, before the Board of Nursing, in appearances before the Board of Nursing in licensing matters, and in administrative hearings.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

Board of Dentistry Considers Adding Failure to Provide Dental Records to “Citation” Offenses

4 Indest-2009-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

At the Florida Board of Dentistry meeting held on November 21, 2014, it discussed a proposed change to Rule 64B5-13.0046, Florida Administrative Code. The amendment would add a provision for failing to timely produce dental records to patients. This addition should help dentists avoid receiving permanent discipline on their records for a minor technical violation.

Considered was the addition of the following language to the existing Rule, listing citation-approved offenses:

Violation of subsection 466.028(1)(n), F.S., failure to timely make available to a patient or client, or to his legal representative or to the Department, if authorized in writing by the patient, copies of documents in the possession or under control of the licensee, which relate to the patient or client. Timely means less than 30 days from the receipt of the written authorization. The subject of the citation has 10 days from the date the citation becomes a final order to release the patient records. Failure to comply will result in a $1,000.00 fine.


Citation vs. Charge
.

TIDCHAAn administrative citation such as those discussed is not considered to be discipline, but an alternative to discipline. The dentist can accept the citation and pay the fine; therefore the citation will not be recorded on his/her record as discipline. For more on this issue, read my blog on citations against physicians and other health professionals.

This is a good development for dentists as it allows the resolution of minor technical violations of statutes and rules without the very undesirable effect of creating a disciplinary record. We sometimes jokingly refer to these as “speeding tickets” since they carry a fine but are not considered to be permanent disciplinary action.

Carefully Review and Promptly Respond in Citation Cases.

Take immediately action on any proposed citation you receive from the Department of Health (DOH). Consult immediately with a health attorney who is experienced at representing dentists in Board of Dentistry matters. Click here for a previous blog on why you should speak with an attorney first.

In most cases, you will probably be advised to accept the citation and pay the fine. If so, be sure to submit the signed agreement, ending it by a method that documents sending and receipt (such as certified mail, return receipt requested), and keep a copy of all documents you submit. Make sure it is received (not sent) by the due date. Call to make sure it was received.

For additional information on citations in disciplinary cases, click here.

In Limited Circumstances, You May Not Want to Accept the Citation.

insurance policyIn limited circumstances, it may not be advisable to accept a citation. This may occur if there is pending litigation involving the subject of the citation. If the wrong person is named in the citation, this may be another reason for not accepting it. If you did not commit the offense and you are sure you can prove this, you may also desire to not accept the citation. This is especially true if you have dental liability insurance coverage which pays for a legal defense in such administrative disciplinary cases involving professional license defense.

For more information on dental license defense, read this previous blog.

If You Do Not Accept the Citation, Be Prepared for an Administrative Complaint.

If you do not accept the citation within the limited time given (usually 30 days), or if you send back a statement regarding why it is unfair or why you did not commit the violation, this will usually be treated as a statement disputing material facts. In this event, the case will be treated as though you were requesting a formal administrative hearing. You will be given a regular formal hearing (trial) with an administrative law judge from the Division of Administrative Hearings (DOAH). For information on hearings in dental cases, click here.

Be Sure Your Staff Knows How to Treat Record Requests.

Be sure that when your office receives a request for a patient’s dental chart that the request is promptly reviewed by someone in management. Management must make sure the authorization or subpoena is valid (remember HIPAA) and that the record is provided in a timely manner. Paying attention to such requests may allow you to detect and act on potential dental medical malpractice claims or DOH complaints. You should have a written office policy on this that every employee has signed.

Remember you are not authorized to withhold a patient’s dental record because the patient has not paid a bill. You are not authorized to withhold the chart because you are angry at the patient or the patient has threatened to sue you. Be sure to provide the patient (or his/her representative) a copy of the record within 30 days. Keep a copy of the letter transmitting the copy in the chart and annotate the HIPAA medical information disclosure form in the record.

Comments?

What do you think of a citation versus a charge in regard to promptly getting patients their dental records? Please leave any thoughtful comments below.

Consult With An Attorney Experienced in the Representation of Dentists.

We routinely provide deposition coverage to dentists, dental hygienists and other health professionals being deposed in criminal cases, negligence cases, civil cases or disciplinary cases involving other health professionals.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing dentists and dental hygienists and other health professionals in investigations and at Board of Dentistry hearings. Call now or visit our website http://www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.Copyright © 1999-2015 The Health Law Firm. All rights reserved.

 

How to Prepare for an Informal Hearing Before the Florida Board of Pharmacy

By George F. Indest III, J.D., M.P.A., LL.M. Board Certified by The Florida Bar in Health Law

If you are scheduled to appear for an informal hearing before the Florida Board of Pharmacy, there are a number of facts that you will want to know in order to be properly prepared.  This article will cover many of them.

Limited Circumstances for Informal Administrative Hearing.

First, you should understand that you will only be at an informal hearing in which you appear before the Board of Pharmacy itself for a very limited number of reasons.  These will include the following:

1.  If you completed an election of rights (EOR) form and agreed that you did not intend to dispute any material facts alleged against you from the administrative complaint (AC) in the case.

2.  If you entered into a settlement agreement (or “stipulation”) (similar to a plea bargain in a criminal case) in which you agreed to accept discipline against your license.

3.  You failed to submit any election of rights (EOR) form and failed to file a petition for a formal hearing in a timely manner, and, therefore, you have waived your right to a formal hearing.

There are a few other circumstances in which there may be an informal hearing before the Board, such as motions to modify a final order, motion to lift a suspension of a license, appearance in accordance with an earlier order, petition for a declaratory statement, or other administrative matters.  This article only discusses those directly relating to disciplinary action as indicated above.

What an Informal Administrative Hearing Is Not.

1.  An informal administrative hearing is not an opportunity for you to tell your side of the story.  You have agreed that there are no disputed material facts in the case or you would not be at an informal hearing.

2.  An informal administrative hearing is not an opportunity for you to prove that you are innocent of the charges.  You have agreed that there are no disputed material facts in the case or you would not be at an informal hearing.

3.  An informal administrative hearing is not an opportunity for you to introduce documents or evidence to show that someone else committed the offenses charged and you did not.  You have agreed that there are no disputed material facts in the case or you would not be at an informal hearing.

4.  An informal administrative hearing is not an opportunity for you to argue that you should not be in the board’s impaired practitioners program (either the Professionals Resource Network (PRN) or the intervention Project for Nurses (IPN)) because you have completed a different program or that you do not have a problem.  These are the only programs recognized and used and you have agreed that there are no disputed material facts in the case or you would not be at an informal hearing.

Formal Administrative Hearing vs. Informal Hearing.

If you desire to contest the facts alleged against you then you must state this in writing.  If the material facts in a case are challenged by you, then the Board or the Department of Health (DOH) (note:  all professional boards are under the Department of Health in Florida) must forward your case to the Division of Administrative Hearings (DOAH) where a neutral, objective administrative law judge (ALJ) will be appointed to hold a formal hearing in your case.  This is the only way that exists for you to prove that the facts alleged against you are incorrect or that you are not guilty of the charges made against you.  In fact, you do not even have to do anything in such a case.  The Department of Health has the burden of proof and it has to prove the charges against you and the material facts alleged against you by clear and convincing evidence.  Often, it is unable to do this at a formal administrative hearing.

However, because of the technicalities of evidentiary law and administrative law, we do not recommend that a nonlawyer attempt to represent himself or herself at such hearings.  You can make technical mistakes (such as answering requests for admissions incorrectly) that severely compromise any defense you may have.  We recommend that you always retain the services of an experienced health lawyer in any such matter.

What to Do If You Find That You Are at an Informal Hearing and That You Do Desire to Contest the Material Facts of the Case (And Your Guilt or Innocence).

If you have been scheduled for an informal administrative hearing and you decide that you do desire to challenge the material facts alleged against you in the administrative complaint (AC), file a written objection to proceeding at the informal hearing.  State that you have discovered that there are material facts that you do desire to challenge and that you desire that the proceedings be converted to a formal hearing.  File this with the Clerk of the administrative agency you are before (usually the department of health or the Agency for Health Care Administration (AHCA) and also send a copy to the opposing attorney and the executive director of the Board.  Do this as early as possible and keep proof that you have actually and filed the written request.

If you are already at the informal hearing when you discover this, object to the proceedings on the record and ask to have the informal hearing be converted to a formal hearing where you may contest the material facts.  State this as many times as reasonably possible.

Preparing for an Informal Hearing.

Since you are not contesting the facts alleged against you, if you are going to an informal hearing be sure you do the following:

1.  Be sure you know where the hearing is going to be held.  Try to stay the night before in the same hotel as the hearing will be held.  You will usually have to make these reservations early in order to get a room.

2.  Attend a Board meeting that occurs before the one at which your case is scheduled.  This will give you a feeling for the procedures that will be followed, will help to make you less nervous when you appear, and you can obtain continuing education units for doing so (be sure to sign in and sign out).  Be sure to attend one of the days when the disciplinary hearings are held.

3.  Dress professionally for the appearance.  This may be the most important event in your professional career.  For men, this means a suit and tie or, at least, a dark coat, dark slacks and a necktie.  For women, a professional business suit or the equivalent is in order.  Do not dress as if you are going to the park, the beach or out on a date.  Do not wear sexually provocative or revealing clothing.

4.  Check the agenda that is published on line a day or two before the scheduled hearing to make sure that your case is still scheduled for the date and time on the hearing notice.  Informal hearings may be moved around on the schedule.  Make sure you are there at the earliest time on the hearing notice or agenda.

5.  Listen to questions asked of you by Board members and attempt to answer them directly and succinctly.  You will be placed under oath for the proceeding and there will be a court reporter present as well as audio recording devices to take everything down.

6.  Do not argue with the Board members or lose your temper.  This is not the time or place to let this happen.  If you have such tendencies, then you should have an attorney there with you who can intercept some of the questions and can make defensive arguments (to the extent that they may be permitted) for you.

7.  You may introduce documents and evidence in mitigation.  However, you have agreed that the material facts alleged are true, so you may not contest these.  In effect, you have plead guilty and you are just arguing about how much punishment (discipline) and what kind of punishment you should receive.

8.  If you do intend to introduce documents and evidence in mitigation, be sure you know what the mitigating factors are (these are published in a separate board rule in the Florida Administrative Code for each professional board).  These may include, for example, the fact that there was no patient harm, that there was no monetary loss, that restitution has been made, the length of time the professional has been practicing, the absence of any prior discipline, etc.  You should submit these far ahead of time with a notice of filing, so that they are sent out to the board members with the other materials in your file.  This is another reason to have experienced counsel represent you at the informal hearing.

9.  Be prepared to take responsibility for your actions.  If you are not prepared to take responsibility, then this means you must believe you are innocent and you should be at a formal hearing, not an informal one.

10.  Be prepared to explain what went wrong, why it went wrong, and what remedial measures you have taken to prevent a recurrence of this type of event in the future.  Show that you have learned from this experience and that you are not going to make the same mistake again.

11.  It is our advice to always retain the services of an experienced attorney to represent you at such hearings.  Often your professional liability insurance will cover this.  If you have professional liability insurance, be sure that it contains a rider or addendum that provides coverage for professional license defense matters and administrative hearings.  You need at least $25,000 to $50,000 in coverage for this type of defense.  If necessary, you should contact your insurer or insurance agent and have the limits increased for a small additional premium.

Other Little Known Facts to Remember.

Professional licensing matters are considered to be “penal” or “quasi-criminal” in nature.  Therefore, you have your Fifth Amendment rights in relation to being required to give evidence against yourself.  You cannot be compelled to do this in such matters.  However, since it is an administrative proceeding and not a criminal proceeding, there is no requirement that the licensee be advised of this by a DOH investigator or attorney.

If you enter into a settlement agreement and attend the informal hearing to approve it, nothing you say or testify to at this hearing can later be used against you.  This is because you are involved in an attempt to negotiate and settle (or compromise) the claims being made against you.  It is a general rule of law that nothing the parties say in such settlement proceedings can later be used as evidence if the settlement agreement is not approved.  The law tries to promote settlements among parties to any dispute in this way.

It is true that on occasion the Board will examine a case on an informal hearing and will decide to dismiss it.  This is rare, but it does happen.  Sometimes, it will be a tactical decision on the part of you and your attorney to elect to go to an informal hearing with the hope that the Board may examine the case and decide to dismiss it.  However, you cannot count on this happening.

Don’t Wait Too Late;  Consult with an Experienced Health Law Attorney Early.

Do not wait until action has been taken against you to consult with an experienced attorney in these matters.  Few cases are won on appeal.  It is much easier to win your case when there is proper time to prepare and you have requested a formal hearing so that you may actually dispute the facts being alleged against you.

The lawyers of The Health Law Firm are experienced in both formal and informal administrative hearings and in representing pharmacists, pharmacies and pharmacy technicians in investigations and at Board of Pharmacy hearings.  Call now or visit our website www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

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