Case Name: Ben COHN, Appellant, v. DEPARTMENT OF PROFESSIONAL REGULATION, Appellee
Court: Florida District Court of Appeal
Jurisdiction: Florida
Decision Date: 1985-10-22
Citations: 477 So. 2d 1039
Docket Number: No. 84-1217
Parties: Ben COHN, Appellant, v. DEPARTMENT OF PROFESSIONAL REGULATION, Appellee.
Judges: Before SCHWARTZ, C.J., and BASKIN and JORGENSON, JJ.
Reporter: Southern Reporter, Second Series
Volume: 477
Pages: 1039–1053

Head Matter:
Ben COHN, Appellant, v. DEPARTMENT OF PROFESSIONAL REGULATION, Appellee.
No. 84-1217.
District Court of Appeal of Florida, Third District.
Oct. 22, 1985.
Mark Krasnow, Miami, for appellant.
Bruce Lamb, Tallahassee, for appellee.
Before SCHWARTZ, C.J., and BASKIN and JORGENSON, JJ.

Opinion:
SCHWARTZ, Chief Judge.
This is an appeal from a final order of the Board of Pharmacy which, contrary to the recommendation of the hearing officer that the charges against him be dismissed, revoked Cohn's license to practice pharma cy. For the reasons which follow, we vacate the order and remand the cause initially for further proceedings before the hearing officer and for any appropriate review thereafter.
Facts and Proceedings Below
The case began when the Department of Professional Regulation filed an administrative complaint against Cohn charging him with dispensing a controlled substance, methaqualone — quaaludes—in such quantities as to demonstrate a lack of "good faith" and a departure from the "course of professional practice." The DPR claimed that this conduct violated sections 465.-016(l)(i) and 893.04(1), Florida Statutes (1981):
465.016 Disciplinary actions.—
(1) The following acts shall be grounds for disciplinary action set forth in this section:
(e) Violating any of the requirements of this chapter; chapter 500, known as the "Florida Food, Drug, and Cosmetic Law"; 21 U.S.C. ss. 301-392, known as the "Federal Food, Drug, and Cosmetic Act"; or chapter 893.
(i) Compounding, dispensing, or distributing a legend drug, including any controlled substance, other than in the course of professional practice of pharmacy. [e.s.].
893.04 Pharmacist and practitioner.—
(1) A pharmacist, in good faith and in the course of professional practice only, [e.s.] may dispense controlled substances upon a written or oral prescription of a practitioner, under the following conditions: .
The evidence at the hearing established that between August 4, 1981 and January 6, 1982, in the period just before the legal dispensing of methaqualone was barred in Florida — Cohn was employed as a pharmacist at Don's Discount Drugs in Dade County. During that time, the pharmacy, which was one of only ten in the county which would dispense the notorious drug at that time under any circumstances, filled 4,695 quaalude prescriptions for 202,404 300 mg. tablets. Of these, Cohn himself filled 2,724 prescriptions, 55% of the total, for 118,130 tablets. Cohn stated without contradiction that he kept an index file to assure that no one customer filled repeated prescriptions for the drug and that he individually verified the licensed status and the drug enforcement agency number of each physician whose quaalude prescriptions he filled. He acknowledged, however, that (a) quaaludes had a high potential for abuse and that their "street value" was higher for that reason, (b) as many as eighteen separate patients per day presented quaa-lude prescriptions written by the same doctor in the same quantity, and (c) he was aware that a number of physicians in the area were practicing in so-called "stress clinics" whose primary function seemed to be the indiscriminate prescribing of quaa-ludes. Notwithstanding all of this and although he recognized that individuals might be purchasing the drug for improper purposes, he justified his dispensing the quaaludes by stating that "not being able to buy it at the drug store was not going to stop them," and that "in some way I think it is more good than having them go out on the street and buy them."
Although there was no statute or rule that specifically precluded his activities, and Cohn met each of the particularized regulatory provisions of section 893.04, the DPR presented the testimony of an expert witness, Louis Fisher, who was both a licensed pharmacist and an investigator for the DEA. He opined that Cohn's dispensing of quaaludes in the quantities and under the circumstances involved was nonetheless not in "good faith" or "in the course of professional practice."
In the recommended order, the hearing officer found the undisputed, historical facts concerning the number and quantity of quaaludes Cohn dispensed during the relevant period. She concluded, however, that in the absence of any violation of a specific statute or rule, Cohn could not, as a matter of law, be subjected to discipline for the manner in which he filled apparently appropriate prescriptions written by duly licensed physicians; putting it another way, she held that a pharmacist necessarily acts in "good faith and in the course of professional practice" in filling prescriptions when, as Cohn did; he complies with the conditions in that regard contained in section 893.04. The officer specifically declined, on the ground that such a determination would be legally irrelevant, to make any finding as to whether Cohn violated, as Fisher testified, any generalized standard of "good faith" and "professional practice." Accordingly, she recommended dismissal of the charges.
On review, the Board of Pharmacy made two critical decisions — one of law and one of fact — which underlay the order of revocation now before us. In its legal determination — with which we concur — it concluded that, under the applicable statutes, a mere compliance with the terms of section 893.04 and any other existing rule does not insulate a pharmacist from appropriate discipline if his conduct otherwise lacks "good faith" or departs from the requirements of "professional practice." In this regard, it said:
Not only must a pharmacist be assured that the controlled substance in question meets the standards of Ch. 893 as regards to the former prescription, the manner in which the prescription is to be filled, the labeling requirements for the container in which the medication is dispensed and record keeping requirements for the pharmacist in filling the prescription but also such dispensing should be in the course of the professional practice whether or not the actual format of the prescription is met. In other words, a pharmacist must not be permitted under the guise of having received a prescription or many prescriptions from a licensed prescriber to fill such prescription(s) when based upon his training and experience and all of the facts surrounding the prescription(s) it is clear that such prescription or prescriptions taken as a whole have been written outside the course of professional practice of pharmacy and would do harm to the patient or public.
Upon this view of the law, the Board went on to conclude, as a matter of fact, as follows:
Based upon the expertise of the members of the Board of Pharmacy and the facts of this case it is determined that the practice of Respondent was not in the course of professional practice.
Discipline Permissible for Conduct Contrary to Good Faith and Professional Practice Although Not Violative of Specific Statute or Rule
Cohn's primary argument for reversal is essentially the same as the basis of the conclusion of the hearing officer. He contends that the demands both of due process and appropriate statutory construction preclude discipline when, as here, the professional's conduct contravenes no particularized statute or rule and is only subsequently claimed to have violated such amorphous standards as those requiring "good faith" or conduct "in the course of professional practice;" he says, in a word, that it is fundamentally unfair to punish him for something he had no reasonable way to know ahead of time was wrong. While the contention is certainly not unsubstantial, we cannot agree that the law of Florida permits its acceptance.
A prominent aspect of the appellant's argument, that, standing alone, nonspecific requirements of "good faith" and "professional practice," are unconstitutionally vague as inadequate to meet due process standards of prior fair notice — is plainly unsupportable in the light of State v. Weeks, 335 So.2d 274 (Fla.1976). In Weeks, the supreme court rejected the claim that a criminal statute, section 893.03(2)(e)(l), which forbids the delivering of a controlled substance by a physician through an order "not issued in good faith," was void for vagueness. The court said:
Applying "our own knowledge with which observation and experience have supplied us," we find that the language employed by the instant statute conveys [a] sufficiently definite meaning "that a person who may be liable to the penalties of the act may know that he is within its provisions or not." We note that many courts of other jurisdictions have reached the same result in cases involving the construction of virtually identical language.
* #
We are persuaded by the unanimous authority arrayed against the proposition that the term "good faith" is unconstitutionally vague.
335 So.2d at 277. Weeks presents an a fortiori situation to the administrative case before us. See also State, Department of Citrus v. Griffin, 239 So.2d 577 (Fla.1970); Solimena v. State, Department of Business Regulation, 402 So.2d 1240 (Fla. 3d DCA 1981), pet. for review denied, 412 So.2d 470 (Fla.1982). Indeed, numerous Florida decisions and those from other jurisdictions make clear that discipline may be imposed for violations of equally, if not even more facially uncertain standards than those contained in sections 465.016 and 893.04. E.g., Purvis v. Department of Professional Regulation, 461 So.2d 134 (Fla. 1st DCA 1984); Barker v. Board of Medical Examiners, 428 So.2d 720 (Fla. 1st DCA 1983); Bowling v. Department of Insurance, 394 So.2d 165 (Fla. 1st DCA 1981); Megdal v. Oregon State Board of Medical Examiners, 288 Or. 293, 605 P.2d 273, 275-76 (1980) ("Unprofessional conduct" adequate standard for discipline, even assuming insufficient for criminal prosecution, but see Weeks.); State ex rel. Lentine v. State Board of Health, 334 Mo. 220, 65 S.W.2d 943 (1933); In re Hawkins, 17 N.C.App. 378, 194 S.E.2d 540, 550-51 (1973), cert. denied, 283 N.C. 393, 196 S.E.2d 275 (1973), cert. denied, 414 U.S. 1001, 94 S.Ct. 355, 38 L.Ed.2d 237 (1973); Vivian v. Examining Board of Architects, 61 Wis.2d 627, 213 N.W.2d 359, 366-67 (1974). When such a violation is alleged, it is apparent that there need be no rule explicitly proscribing the allegedly improper conduct of the licensee. In Barker, the court specifically held:
The fact, however, that no rule was extant at the time Barker applied for licensure does not necessarily mean the Board's action was void. The time has long since past (if ever it existed) that agency action was mechanically invalidated simply because no rule was in effect.
428 So.2d at 722. See generally Astral Liquors, Inc. v. Department of Business Regulation, 463 So.2d 1130 (Fla.1985); Dickinson v. State, 227 So.2d 36, 37 (Fla.1969) ("The exigencies of modern government have increasingly dictated the use of general rather than minutely detailed standards in regulating enactments under the police power."); Department of Business Regulation v. Jones, 474 So.2d 359 (Fla. 1st DCA 1985), and cases cited; Burgess v. Florida Department of Commerce, 436 So.2d 356, 358 (Fla. 1st DCA 1983), pet. for review denied, 447 So.2d 885 (Fla.1984), and cases cited.
It also follows — addressing the precise situation involved in this case — that the licensee's compliance with any specific statutes or rules which do exist concerning the particular conduct involved, such as are arguably contained in section 893.04, does not prevent the imposition of discipline if the licensee otherwise violates the general requirements of the applicable statute. This conclusion is supported by the overwhelming weight of authority on the subject. Thus, in Lentine, supra, a doctor's license was revoked for having participated in a scheme to sell medical licenses. Relying upon a statute similar to section 465.-016, the State Board of Health deemed this activity "unprofessional and dishonorable" although the sale of medical licenses was not among the specifically enumerated acts of unprofessional conduct listed in the statute. The Supreme Court of Missouri upheld the Board, noting that by particularizing certain acts the legislature did not intend
to thereby exclude all other acts or conduct affecting the practice of medicine and the moral conduct of the physician, in that connection, which, by common opinion and fair judgment are bound to be in their very nature unprofessional and dishonorable, as grounds or cause for revocation of a license. Rather upon a showing of any of the things enumerated the Board of Health, and the court upon review, is not called upon in its sound discretion to determine whether such conduct is such as in common judgment is deemed unprofessional and dishonorable, for the statute has expressly declared it so to be. It would not be practicable to the carrying out of the wholesome purpose of the statute to undertake to catalog, list, or specify each and every act or course of conduct which would, or under what circumstances, constitute bad moral character or unprofessional and dishonorable conduct, and we do not think the Legislature intended to do so.
65 S.W.2d at 950.
Similarly, in Kansas State Board of Healing Arts v. Foote, 200 Kan. 447, 436 P.2d 828 (1968), the state board revoked a physician's license for "extreme incompetence" despite the fact that extreme incompetence was not one of 15 specific acts constituting "unprofessional conduct" under the governing statute. In affirming, the court said:
Considering the entire policy expressed in the act, we believe the legislature, by enumerating certain acts and classifying them as unprofessional conduct, did not thereby intend to exclude all other acts or conduct in the practice of the healing arts which by common understanding render the holder of a license unfit to practice. It would indeed be difficult, not to say impractical, in carrying out the purpose of the act, for the legislature to list each and every specific act or course of conduct which might constitute such unprofessional conduct of a disqualifying nature.
436 P.2d at 833.
To the same effect is the leading case of Matter of Heller, 73 N.J. 292, 374 A.2d 1191 (1977), in which the facts were uncannily similar to ours. Upon an extensive and well reasoned analysis, the court held that a pharmacist who dispensed an excessive quantity of codeine syrup was properly disciplined for "grossly unprofessional conduct" even though his action did not fall within any of the categories which were specifically defined as such in the applicable statute. Accord, Bell v. Board of Regents, 295 N.Y. 101, 65 N.E.2d 184, 187 (1946) ("It has never been necessary for the Legislature . to define with particularity acts which would constitute unprofessional conduct_"); see Talman v. Department of Registration and Education, 78 Ill.App.3d 450, 33 Ill.Dec. 818, 397 N.E.2d 151 (1979) (pharmacist filling excessive cough syrup prescriptions violated standard of "good faith"); see also Cotovsky v. Department of Registration and Edu cation, 110 Ill.App.3d 417, 66 Ill.Dec. 94, 442 N.E.2d 520 (1982); Vermont & 110th Medical Arts Pharmacy v. Board of Pharmacy, 125 Cal.App.3d 19, 177 Cal.Rptr. 807 (1981); cases collected Annot., Revocation or Suspension of License or Permit to Practice Pharmacy or Operate Drug Store Because of Improper Sale or Distribution of Narcotic or Stimulant Drugs, 17 A.L.R.3d 1408, 1419-20 (1968); contra, Pennsylvania State Board of Pharmacy v. Cohen, 448 Pa. 189, 292 A.2d 277 (1972).
Thus, we agree with the Board that it has the authority to discipline Cohn upon a proper finding that his activities were not in "good faith" or "in the course of professional practice."
Board's Independent Finding of Violation Improper
We most assuredly, however, cannot approve of the manner in which the Board reached that conclusion below. As has been seen, the hearing officer, based upon what we have concluded is an erroneous view of the law, made no finding at all concerning this issue. Notwithstanding, the Board invoked the asserted expertise of its members, presumably as pharmacists themselves, to determine that Cohn's actions were "not in the course of professional practice." This conclusion was totally unauthorized and improper.
In the first place, it is settled Florida doctrine that the rule which ascribes effect to an agency's determination of ultimate "facts" on a subject about which it may rightfully claim expert insight, which originated in McDonald v. Department of Banking and Finance, 346 So.2d 569, 579 (Fla. 1st DCA 1977), is not applicable to disciplinary proceedings in general, and to ones like this which are based upon an alleged breach of a broad standard of conduct in particular. In such an instance, the issue of whether the licensee's conduct was indeed in violation of a statutory standard is one of fact which not only must be established by "conventional" proof, but as to which the prosecuting agency bears a significantly enhanced burden. As' the first district recently made clear in Purvis:
McDonald involved an application for authority to organize and operate a bank. While we do not question the validity of the proposition quoted from McDonald, neither do we agree that it is applicable in this proceeding to discipline a professional for impermissibly deviating from accepted standards of conduct. In disciplinary proceedings of this nature, the Board has the burden of proving the applicable standard of conduct by competent substantial evidence, and there is a substantial difference between "evidence which 'substantially' supports conventional forms of regulatory action and evidence which is required to support 'substantially' a retrospective characterization of conduct requiring suspension or revocation of the actor's license." Bowling v. Department of Insurance, 394 So.2d 165, 171 (Fla. 1st DCA 1981). In Bowling, the court emphasized:
Rather, we glean a requirement for more substantial evidence from the very nature of licensee discipline proceedings: when the standards of conduct to be enforced are not explicitly fixed by statute or by rule, but depend on such debatable expressions as 'in the applicable regular course of business'; when the conduct to be assessed is past, beyond the actor's power to conform it to agency standards announced prospectively; and when the proceeding may result in the loss of a valuable business or professional li cense, the critical matters in issue must be shown by evidence which is indubitably as 'substantial' as the consequences. [Id. at 172].
461 So.2d at 137. Accord, Barker, supra.
On this basis, it is clear that an agency's reliance upon its own expertise to reverse a hearing officer's finding of no violation may not be sustained. Heifetz v. Department of Business Regulation, 475 So.2d 1277 (Fla. 1st DCA 1985); Purvis, supra; Johnston v. Department of Professional Regulation, 456 So.2d 939 (Fla. 1st DCA 1984); Sneij v. Department of Professional Regulation, 454 So.2d 795 (Fla. 3d DCA 1984). For the same reason, the Board's attempt below to make such a finding ab initio in the absence of any determination by the hearing officer on this point must likewise fall. Indeed, there is no authority for any agency to make an independent determination of disputed fact in a review proceeding like this under any circumstances; it may only consider whether findings actually made are sustained by the evidence; section 120.57(l)(b)(9), Florida Statutes (1983); and whether, if so, they support the recommended conclusions. When the entity charged with finding facts upon the evidence presented, the hearing officer, has, for whatever reason, failed to perform this function, the appropriate remedy is not for the agency (or the court of appeal) to reach its own conclusion, but rather to remand for the officer to do so. This was the holding in Gentile v. Department of Professional Regulation, 448 So.2d 1087 (Fla. 1st DCA 1984). There, an applicant had been denied a medical license by the Board of Medical Examiners. During a subsequent hearing, the hearing officer took testimony regarding his truthfulness during the application process, but failed to make a finding of fact on the subject because she was uncertain as to whether one was appropriate. Id. at 1089. Upon review, the Board accepted all the findings below but added one of its own that Gentile was in fact not truthful. Solely on this basis, the Board found that he was not of good moral character nor capable of safely engaging in the practice of medicine. Id. The first district vacated the Board's determination and remanded for further evidentiary hearing and resolution of the truthfulness issue by the hearing officer. Id. at 1090. We deem it appropriate to follow the same course here.
Conclusion
For the reasons stated, the order of revocation is vacated. The cause is remanded (a) for further administrative hearing, to be conducted in accordance with this opinion, on the issue of whether Cohn acted in good faith and in the course of professional practice; (b) for the hearing officer's entry of findings of fací; and conclusions of law thereon; and (c) for any further appropriate proceedings.
Vacated, remanded with directions.
BASKIN, J., concurs.
. Section 893.03, Florida Statutes (1981), was amended effective July 1, 1982 to delete metha-qualone from the list of Schedule II substances and to reclassify it as a Schedule I substance.
. As this fact clearly indicates, and as is indeed not disputed, no pharmacist is required to fill any prescription, no matter how regular in form, if he chooses not to do so.
. This court has recently affirmed the revocation of the medical license of one of these physicians. Apiau v. The Florida Board of Medical Examiners, 473 So.2d 775 (Fla. 3d DCA 1985).
. 893.04(1):
(a) Oral prescriptions must be promptly reduced to writing by the pharmacist.
(b) The written prescription must be dated and signed by the prescribing practitioner on the day when issued.
(c) There shall appear on the face of the prescription or written record thereof for the controlled substance the following information:
1. The full name and address of the person for whom, or the owner of the animal for which, the controlled substance is dispensed.
2. The full name and address of the prescribing practitioner and his federal controlled substance registry number shall be printed thereon.
3. If the prescription is for an animal, the species of animal for which the controlled substance is prescribed.
4. The name of the controlled substance prescribed and the strength, quantity, and directions for use thereof.
5. The number of the prescription, as recorded in the prescription files of the pharmacy in which it is filled.
6. The initials of the pharmacist filling the prescription and the date filled.
(d) The prescription shall be retained on file by the proprietor of the pharmacy in which it is filled for a period of 2 years.
(e) Affixed to the original container in which a controlled substance is delivered upon a prescription or authorized refill thereof, as hereinafter provided, there shall be a label bearing the following information:
1. The name and address of the pharmacy from which such controlled substance was dispensed.
2. The date on which the prescription for such controlled substance was filled.
3. The number of such prescription, as recorded in the prescription files of the pharmacy in which it is filled.
4. The name of the prescribing practitioner.
5. The name of the patient for whom, or of the owner and species of the animal for which, the controlled substance is prescribed.
6. The directions for the use of the controlled substance prescribed in the prescription.
7. A clear, concise warning that it is a crime to transfer the controlled substance to any person other than the patient for whom prescribed.
(f) A prescription for a controlled substance listed in Schedule II may be dispensed only upon a written prescription of a practitioner, except that in an emergency situation, as defined by regulation of the Department of Health and Rehabilitative Services, such controlled substance may be dispensed upon oral prescription. No prescription for a controlled substance listed in Schedule II may be refilled.
(g)No prescription for a controlled substance listed in Schedules III, IV, or V may be filled or refilled more than five times within a period of 6 months after the date on which the prescription was written unless the prescription is renewed by a practitioner.
. Specifically, Fisher testified before the hearing officer as follows:
I think there is a judgment factor that has to enter into this.
Number one, that a prescriber is prescribing larger quantities of one particular drug than another; is that prescriber prescribing larger quantities of one drug than other doctors in the area, are the people written these prescriptions of the type that are common to that particular community; are you suddenly getting an onslaught of one particular age group presenting this type of prescription; is he aware of the common knowledge in the community of the abuse of these substances. *
. it all comes under a judgment factor, which would be considered good faith.
. These findings were:
3. A drug diversion audit of all Schedule II prescriptions filled at Don's Discount Drugs was initiated by the Petitioner and covered a period from August 4, 1981, through January 6, 1982. The audit revealed that during that time period there were 202,404 methaqualone 300 mg. tablets (Quaaludes) dispensed on 4,695 prescriptions.
4. Respondent dispensed 118,130 of the noted methaqualone tablets on 2,724 prescriptions, or approximately 55 percent of the total methaqualone dispensed.
5. At the time, methaqualone was designated as a Schedule II substance.
. We agree that there was in fact no such violation. The only provision even suggested by the DPR in this respect is the portion of section 465.016(l)(i), which states that dispensing drugs "in excessive or inappropriate quantities is not in the best interest of the patient and is not in the course of the professional practice of pharmacy." It is apparent, however, that the clause refers to excessive quantities of drugs supplied to an individual patient, rather than, as in this instance, to an assertedly large amount of a particular drug distributed to multiple patients.
. In this regard, the order states:
One of Petitioner's witnesses essentially testified that Respondent's/Don's Discount Drugs' dispensing of large quantities of methaqual-one offended his personal ethical standards. That witness's personal ethical standards are no more relevant to this case than are those of the undersigned. The only thing that can be considered is whether Petitioner has proven by competent substantial evidence that Respondent violated a specific statutory prohibition. Petitioner has failed to do that.
. Pennsylvania State Board of Pharmacy v. Cohen, 448 Pa. 189, 292 A.2d 277 (1972), so holds. Moreover, as we point out infra, the considerations of fairness upon which the contention relies are the foundation of the heightened standard of proof which is imposed in passing upon a claimed violation of this kind.
. In common with each court which has been asked to follow Cohen, see Heller, Megdal, supra, we decline to do so.
. In this case, in which the issues are ones of constitutional magnitude and are otherwise so obviously within the competence of courts alone to decide, we consider that the rule which affords respect to an agency's interpretation of the statute it is charged with administering, e.g., Palm Beach Junior College v. United Faculty, 425 So.2d 133, 136 (Fla. 1st DCA 1982), is of little moment. Accordingly, we refer to the fact that the Board's view of the law is the same as ours as no more than a makeweight which may properly be relegated to this footnote.
. The concern reflected in these opinions of the ex post facto nature of a subsequent interpretation of a general statute resulting in punishment for previous activity are the same as those that compelled the Pennsylvania court in Cohen, supra, to take the further step of forbidding discipline entirely. See supra, note 9. While, as we have indicated, we do not agree with that extreme position, we wholeheartedly concur that the restrictions upon the process imposed by Bowling and Purvis are entirely appropriate.
. We reemphasize the requirements of Purvis and Bowling.