DEPARTMENT OF HEALTH, 

BUREAU OF EMERGENCY MEDICAL SERVICES 

ORDER FACT SHEET 

(For use by Bureau Counsel and Staff) 

1) Petitioner's Name: Miami-Dade Fire Rescue 

Order# ()I - 241~ t::f::> 

Date Order Filed __ --+\~\_·_,_1 --"'[_)"_('-----

2) License Number: NIA 3) Profession Type: NI A 

4) Type of Order: 0 Discipline 0 Licensure Q'.l Declaratory Statement 

5) DOH Case Number: 2007-0102 6) DOAH Case Number: 

7) File Number: 

8) Statutory reference for Violations/Reasons for Denial: Ni A 

9) Violation Codes: 

10) Penalties Imposed: 

11) Closure Code: 

12) Exhibits to be Attached to Final Order: 

a) Admiuistrative Complaint D 

b) Consent Agreement/Stipulation D 

c) Recommended Order 0 

Exceptions: Petitioner's D Respondent's 0 

d) Motions (specify): 

e) Other (specify): Petition for Declaratory Statement 

12) Special Handling Instructions: 

13) Fact Sheet Prepared By: April A. Thornton 

14) Codes Added to Fact Sheet Bv: Donna Erlich 

15) Exhibits Attached to Order By: April A. Thornton 

EXHIBIT 1

Case 3:20-cv-04698-TKW-HTC Document 16-1 Filed 04/13/20 Page 1 of 7
STATE OF FLORIDA 

DEPARTMENT OF HEAL TH 

JN RE: Miami-Dade Fire Rescue 

Petition for Declaratory Statement. 

~~~~~~~~~~~~~~~~~ 

I 

FINAL ORDER GRANTING PETITION FOR DECLARATORY STATEMENT 

On July 27, 2007, Miami-Dade Fire Rescue ("MDFR") filed the attached Petition for 

Declaratory Statement ("Petition") pursuant to section 120 .565, Florida Statutes and 

chapter 28-105, Florida Administrative Code. Department deems the facts as asserted 

by MDFR in the Petition sufficient to trigger this Declaratory Statement. 

PRELIMINARY COMMENTS 

A. The answers here do not address the relationship between the Medical 

Director and the licensee. 

B. Though each question was limited to physicians licensed under Chapter 

458, such distinction is irrelevant to the answers. Therefore the questions are addressed 

below as solely regarding Medical Directors as defined in section 401.23(15), Florida 

Statutes. 

C. The questions use terms such as "medical practice privileges", "medical 

practice", "medical procedures", "medical supervisory authority", "competency" and 

"competency deficit." These are not terms present in either Part Ill, Chapter 401, Florida 

Statutes, or Chapter 64E-2, Florida Administrative Code. To avoid unintentionally 

creating new nomenclature, the answers avoid the use of these terms. 

Page 1 of 4 

Case 3:20-cv-04698-TKW-HTC Document 16-1 Filed 04/13/20 Page 2 of 7
FINDINGS OF FACT 

A. Petitioner is a licensee as defined in section 401.23(13), Florida Statutes. 

B. Petitioner seeks to understand the scope of authority a licensee's Medical 

Director has over Paramedics and Emergency Medical Technicians operating under the 

licensee (hereinafter "Certificate holders") by the questions stated in the attached 

petition. 

CONCLUSIONS OF LAW 

A. The Medical Director has direct responsibility for the medical performance 

of all Certificate holders operating for the licensee. §401.265(1}, F.S. 

B. The obligation of direct responsibility is accompanied by the supervisory 

authority necessary to require that the medical performance of the Certificate holders is 

of a quality and type for which the individual Medical Director is willing to take direct 

responsibility. Id. The exercise of this supervisory authority by the Medical Director is a 

mandatory part of the job. ]Q. Consistent with that supervisory authority, the Medical 

Director advises, consults, trains, counsels and oversees services. Id. The oversight of 

services includes, but is not limited to, appropriate quality assurance programs. ]Q. 

C. The Medical Director must develop medically correct standing orders and 

protocols. 64E-2.004(4 )(a), F.A.C. 

D. The Medical Director must assess the medical performance of the 

Certificate holders. 64E-2.004(4)(b), F.A.C. To gather data in aid of assessment and as 

part of general quality assurance, which includes the continuous improvement of 

performance for individuals, services and the industry, the Medical Director audits the 

performance of all system personnel. ]Q. This audit includes, but is not limited to, 

Page 2 of 4 

Case 3:20-cv-04698-TKW-HTC Document 16-1 Filed 04/13/20 Page 3 of 7
review of patient care records, direct observation, and comparison of performance 

standards for drugs, system protocols and procedures. ]Q. 

E. The Medical Director must supervise the medical performance of the 

Certificate holders operating for the licensee. §401.265(1 ), F.S. Supervisory authority 

enables the Medical Director to condition whether and how Certificate holders perform 

medically upon assessment of the Certificate holder's potential ability to comply with 

requirements, including standing orders and protocols, developed or adopted by the 

Medical Director, as well as the Certificate holder's actual compliance with such 

requirements. ]Q. 

Based upon the above, the questions are answered together as follows: 

The Medical Director has the authority to condition, limit, modify or suspend 

the Certificate holder's medical performance while operating for the licensee 

consistent with the Medical Director's direct responsibility for the medical 

performance of all Certificate holders operating for the licensee. 

Such conditioning, limitation, modification or suspension of a Certificate 

holder's medical performance while operating for the licensee can include 

requirement of completion of Medical Director identified training as a precondition 

for some or all parts of the Certificate holder's medical performance while 

operating for the licensee. 

DONE AND ORDERED this 30" day of Q c.- 0 l)=v:, 

L. Kline, R.N., B.S.N., M.P.H. 

puty Secretary for Health 

State Public Health Nursing Director 

Florida Women's Health Officer 

Page 3 of 4 

'2007. 

Case 3:20-cv-04698-TKW-HTC Document 16-1 Filed 04/13/20 Page 4 of 7
Attachment 

Copies to: 

Tarlesha W. Smith, Esq. 

Human Resources Division Manager 

Miami-Dade Fire Rescue 

9300 NW 41 Street 

Doral, FL 33178-2414 

Michael A. Greif, Senior Attorney 

Office of the General Counsel 

Department of Health 

4052 Bald Cypress Way, Bin A-02 

Tallahassee, FL 32399-1703 

NOTICE OF RIGHT TO JUDICIAL REVIEW 

A PARTY ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO 

JUDICIAL REVIEW PURSUANT TO SECTION 120.68, FLORIDA STATUTES. A 

REVIEW PROCEEDING IS GOVERNED BY THE FLORIDA RULES OF APPELLATE 

PROCEDURE. A PROCEEDING IS COMMENCED BY FILING A NOTICE OF 

APPEAL WITH THE CLERK OF THE DEPARTMENT OF HEAL TH AND A COPY 

ACCOMPANIED BY THE FILING FEE WITH THE DISTRICT COURT OF APPEAL 

IN THE APPELLATE DISTRICT WHERE THE PARTY RESIDES OR THE FIRST 

DISTRICT COURT OF APPEAL. A NOTICE OF APPEAL MUST BE FILED WITHIN 

30 DAYS OF THE FILING DATE OF THIS FINAL ORDER. 

CERTIFICATE OF SERVICE 

I CERTIFY that a copy of the foregoing FINAL ORDER has been sent by U.S. Mail, 

inter-office mail, or by hand delivery to each of the above-named persons this_)_ day of 

tooocx1J1:]_Qlci:J97 

Deputy Agency Clerk 

Department of Health 

Central Records 

4052 Bald Cypress Way, Bin CO! 

Tallahassee, Florida 32399-3251 

Phone (850) 245-4121 

Deputy Agency Cler~ 

Page 4 of 4 

Case 3:20-cv-04698-TKW-HTC Document 16-1 Filed 04/13/20 Page 5 of 7
Serving Unincorporated 

Dade Coun!y ~nd the 

Municip.:ililie$ of: 

Aventura 

f:l~I HJrhou< 

Say Hartm< lolands 

Dora! 

ti Porul 

FJorirlJ Cny 

Golden Beach 

Humesi<:ad 

lnd<an (reek 

Medley 

Moami Shure; 

North MiJmi 

Op.i·loc~.J 

f'Jlmeno A~y 

Sunny Isles 

Surfs.ide 

July 25, 2007 

R. Samuel Power 

Agency Clerk's Office 

Central Records Unit 

Department of Health 

4052 Bald Cypress Way, Bin COl 

Tallahassee, FL 32399-3251 

Re: Petition for Declaratory Statement 

Dear Mr. Power, 

.· .... 

rvtiami~Dade Fire Rescue Department 

9300 N.W. 4lst Street 

Doral, Florido 33178-2414 

T 786-331-5000 

miamidade.gov 

Enclosed please find a Petition for Declaratory Statement to the Bureau of 

Emergency Medical Services, 1 am respectfully requesting review by the 

aforementioned agency, Your prompt attention to this matter is greatly 

appreciated. Thank you in advance for your time and cooperation, 

Respectfully submitted, 

Tarlesha W, Smith, Esq. 

Human Resources Division Manager 

Miami-Dade Fire Rescue 

Case 3:20-cv-04698-TKW-HTC Document 16-1 Filed 04/13/20 Page 6 of 7
Always Ready, Proud To Serve 

Serving Unincorporated 

Dade County and the 

Municipalities of; 

Avcn!ur;;i 

B~I Haihour 

Bay Harbor 11!.inris 

El Pnn:iI 

Flnr;dJ Ci1y 

Gulden Reach 

Hornt'stead 

lndi~nCree~ 

MiJmi Sprin~s 

f'alme110 B.1y 

PcnecrC'!il 

Sunny l>ll"s 

SwN.>lwater 

F ~ ~. ::."; .M~~mi-Dade Fire Rescue Department ~· .•. ·.. 9300N.W.41st5treet 

IJFP<\RTMEk.N· :_"-;:::';"• ~. ,. Doral, Florida 33178-2414 

· I _' v;- "'"-~l; H T 786-331-5000 I.Ii..., '";LEH\.! 

CLERK. C 0 , ~- miamidade.gov 

DATE /") .;;;{] • Q/ 

Petition for Declaratory Statement Before the 

Department of Health, Bureau of Emergency Medical 

Services 

I, Human Resources Division Manager, Tarlesha W. Smith, Esq., of Miami-Dade 

Fire Rescue, am seeking a declaratory statement under Rules 28-105.001 and 

28-105.002, F.A.C, and Section 120.565, F.S., relating to the supervisory 

relationship between an emergency medical technician (EMT) or paramedic to a 

physician who is a medical director pursuant to 401.265 F.S. 

1. 

2. 

3. 

4. 

Does a physician licensed under chapter 458, F.S., who is serving as an 

emergency medical services (EMS) medical director pursuant to 401.265, 

F.S., have the authority to remove medical practice privileges from an 

EMT or paramedic (practicing under said physician) that the physician 

concludes has a deficiency in any area of medical practice? 

Does a physician licensed under chapter 458, F.S., who is serving as an 

EMS medical director pursuant to 401.265, F.S., have the authority to 

limit the medical procedures performed by an individual EMT or 

paramedic practicing under the medical supervisory authority of the 

physician? 

Does a physician licensed under chapter 458, F.S., who is serving as an 

EMS medical director pursuant to 401.265, F.S., have the authority to 

require specific training in protocols, proscribe and I or prescribe practice 

of procedures, or require medical training for an EMT or paramedic? 

Does a physician licensed under chapter 458, F.S., who is serving as an 

EMS medical director pursuant to 401.265, F.S., have the authority to 

require an EMT or paramedic demonstrate competency through a 

process defined by the physician, in any area of medical practice when 

the physician concludes the EMT or paramedic has a competency deficit? 

Should you require additional information, please do not hesitate to call me at 

786-331-4608. 

Respectfully submitted, 

Tarlesha W. Smith, Esq. 

Human Resources Division Manager 

Miami-Dade Fire Rescue 

July 25, 2007 

Case 3:20cv04698TKWHTC Document 161 Filed 04/13/20 Page 7 of 7