Breesman v. Department of Professional Regulation, Bd. of Medicine, 89-2278
| Decision Date | 05 September 1990 |
| Docket Number | No. 89-2278,89-2278 |
| Parties | 15 Fla. L. Weekly D2249 William T. BREESMEN, M.D., Appellant, v. DEPARTMENT OF PROFESSIONAL REGULATION, BOARD OF MEDICINE, Appellee. |
| Court | Florida District Court of Appeals |
Rehearing Denied Oct. 26, 1990.
Susan W. Fox and William B. Taylor, IV, of MacFarlane, Ferguson, Allison & Kelly, Tampa, for appellant.
Lisa S. Nelson, Appellate Atty., Dept. of Professional Regulation, Tallahassee, for appellee.
William Breesmen, M.D., appeals a final order of the Board of Medicine, Department of Professional Regulation, that suspended his license to practice medicine in the state of Florida for 6 months for failing to keep medical records justifying his treatment of a patient in accordance with section 458.331(1)(m), Florida Statutes (1987). Because there was no showing that Dr. Breesmen violated section 458.331(1)(m), or any rule promulgated pursuant to this statute, we reverse.
Dr. Breesmen is a cardiologist who assumed care of B.R. when she was admitted to Oak Hill Community Hospital complaining of chest pain. B.R. told Dr. Breesmen that she had been having chest pain for the previous 24 hours, but was reluctant to go to the hospital. She had had several bad hospital experiences, and, as a result, refused to be placed on a respirator, be catheterized, undergo an echocardiogram, or submit to any type of radiation. Dr. Breesmen tried to persuade B.R. to allow him to conduct the necessary tests and treatment, but B.R. was steadfast in her refusal and told Dr. Breesmen not to tell anyone, especially her husband, that she was refusing such tests and treatment. She also instructed Dr. Breesmen not to record her refusal in the hospital chart because she knew, from her experience as a hospital nurse, that it would become common knowledge in the hospital. Dr. Breesmen told B.R. that since she was refusing treatment and restricting him in charting her refusal and communicating with others at the hospital, he should withdraw from the case. B.R. replied that she would leave the hospital if he withdrew, and she refused to be transferred to another hospital. She stated that she would check her hospital chart herself to determine whether he disobeyed her instructions. Because he hoped that he could build a rapport with her and convince her to submit to the necessary procedures, Dr. Breesmen agreed to abide by her requests. Four days after her admission, B.R. died of acute transmoral myocardial infarction.
The Department of Professional Regulation filed an administrative complaint against Dr. Breesmen alleging, inter alia, that he
violated Section 458.331(1)(t), Florida Statutes, by failing to practice medicine with that level of care, skill, and treatment recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances, [and]
* * * * * *
violated Section 458.331(1)(m) ... by failing to keep written medical records justifying the course of treatment of [B.R.], including, but not limited to, patient histories, examination results, and test results.
(R. 2-5).
At the subsequent administrative hearing, Dr. Breesmen testified to the above circumstances and stated that he maintained office notes explaining his reasons for not following his usual course of treatment. Dr. Laurence Dry testified for Dr. Breesmen as an expert in medical ethics. He stated that Dr. Breesmen's office notes provided adequate documentation of the course of treatment of B.R., and that he based his opinion on the national criteria for keeping hospital medical records published by the Joint Commission of Accreditation of Hospitals (JCAH).
The Department presented testimony of Dr. Jeffrey Ehrlich and Dr. Laurence Neufeld. Both of these doctors testified that a reasonably prudent physician whose patient refused to permit testing and treatment would thoroughly document such refusal on the patient's chart, even if the patient's instructions were that such refusal not be documented, because completeness of the medical record is necessary for other physicians to determine the appropriateness of medical care. Dr. James Menges also testified for the Department, and he stated that Dr. Breesmen's actions were not in keeping with the JCAH standards. He stated that while a patient clearly has the right to request that treatment be non-aggressive, she does not have the right to deny the physician his duty or responsibility to document those wishes in the hospital record.
The hearing officer entered a recommended order wherein he found that a...
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