Case Name: Osakatukei O. OMULEPU, M.D., Appellant, v. DEPARTMENT OF HEALTH, BOARD OF MEDICINE, Appellee.
Court: District Court of Appeal of Florida, First District
Jurisdiction: Florida
Decision Date: 2018-06-22
Citations: 249 So. 3d 1278
Docket Number: No. 1D17–1571
Parties: Osakatukei O. OMULEPU, M.D., Appellant,
v.
DEPARTMENT OF HEALTH, BOARD OF MEDICINE, Appellee.
Judges: 
Reporter: Southern Reporter, Third Series
Volume: 249
Pages: 1278–1284

Head Matter:
Osakatukei O. OMULEPU, M.D., Appellant,
v.
DEPARTMENT OF HEALTH, BOARD OF MEDICINE, Appellee.
No. 1D17-1571
District Court of Appeal of Florida, First District.
June 22, 2018
Monica L. Felder Rodriguez, Rodriguez & Perry, P.A., Coral Springs, for Appellant.
Sarah Young Hodges, Chief Appellate Counsel; Carrie B. McNamara, Katelyn R. Boswell, and Mari H. McCully, Assistant General Counsels, Florida Department of Health, Tallahassee, for Appellee.

Opinion:
Osterhaus, J.
Dr. Osakatukei Omulepu appeals a final order of the Board of Medicine revoking his license to practice medicine. Dr. Omulepu argues that the decision violated his Fifth Amendment rights by incorporating an adverse inference against him based on his decision to remain silent at his formal hearing in response to evidence of medical malpractice. He argues additionally that the administrative complaint failed to properly charge him and that the evidence did not support the charges filed by the Department of Health. We disagree with these arguments and affirm.
I.
In 2016, the Department filed an administrative complaint against Dr. Omulepu seeking disciplinary action against his medical license. The Department alleged in a nine-count complaint that Dr. Omulepu violated § 458.331(1), Florida Statutes (2014). According to the allegations, during a three-day period in May 2015, four of Dr. Omulepu's liposuction patients experienced severe post-surgery complications requiring hospitalization. The Department asserted that in all four cases, Dr. Omulepu deviated from the standard of care by using an improper concentration of epinephrine in a surgical solution that is used to reduce bleeding and failing to maintain accurate medical records of the concentration of epinephrine. See § 458.331(1)(m) & (t), Fla. Stat. It also alleged medical malpractice against Dr. Omulepu for puncturing the internal organs of two of the patients. See § 458.331(1)(t), Fla. Stat.
The complaint led to a formal hearing before an administrative law judge in October 2016. After the hearing, the ALJ issued recommended findings of fact and conclusions of law that Dr. Omulepu committed medical malpractice and violated the medical records law. Specifically, the ALJ found that Dr. Omulepu committed medical malpractice by puncturing the internal organs of two patients by an "improper angling of the cannula during the procedures." In reaching this conclusion, the ALJ relied partly upon an adverse evidentiary inference against Dr. Omulepu because he declined to testify or explain how the organ punctures occurred. In addition, the ALJ found in Dr. Omulepu's favor as to the charges of using an improper concentration of epinephrine to control bleeding in four patients, but found that he failed to create and keep medical records accurately reflecting the concentration of epinephrine given to them. The ALJ recommended that Dr. Omulepu be disciplined with a fine, probation, and costs.
The Board of Medicine then took up the recommended order, approving and incorporating almost all of it into its Final Order. The Board rejected, however, the discipline recommended by the ALJ. Due to the severity of the injuries to Dr. Omulepu's patients within the span of a single day, it decided to revoke his license to practice medicine. Dr. Omulepu timely appealed.
II.
A.
Dr. Omulepu contends first on appeal that the Board erred by accepting the ALJ's adverse inference because he remained silent about the medical malpractice charges at his formal hearing. He asserts that this adverse inference violated his right not to incriminate himself under the Fifth Amendment to the United States Constitution. We disagree.
The Fifth Amendment states that "[n]o person . shall be compelled in any criminal case to be a witness against himself." U.S. Const. amend. V. This privilege may be asserted in proceedings to protect "against any disclosures which the witness reasonably believes could be used in a criminal prosecution or could lead to other evidence that might be so used." Kastigar v. United States , 406 U.S. 441, 445, 92 S.Ct. 1653, 32 L.Ed.2d 212 (1972). In the criminal context, the defendant's silence may not be considered as evidence of guilt. Marston v. State , 136 So.3d 563, 569 (Fla. 2014) (quoting Griffin v. California , 380 U.S. 609, 615, 85 S.Ct. 1229, 14 L.Ed.2d 106 (1965) ).
The Florida Supreme Court has recognized the Fifth Amendment right against self-incrimination to apply in the context of professional license revocation cases because they are "penal" in nature. State ex rel. Vining v. Fla. Real Estate Comm'n. , 281 So.2d 487, 491 (Fla. 1973). Agreeing that Vining applies here, the Department asserts that the scope of the Fifth Amendment's protection is nevertheless circumscribed in civil cases like this one. It argues that, unlike the criminal context, the Fifth Amendment protection in civil cases allows fact-finders to consider a defendant's silence as evidence of guilt. The Department's argument is backed by the opinion of the United States Supreme Court in Baxter v. Palmigiano that "the Fifth Amendment does not forbid adverse inferences against parties to civil actions when they refuse to testify in response to probative evidence offered against them." 425 U.S. 308, 318, 96 S.Ct. 1551, 47 L.Ed.2d 810 (1976). Various federal courts have noted that Baxter applies "forcefully in medical discipline cases." Arthurs v. Stern , 560 F.2d 477, 478 (1st Cir. 1977) (agreeing with Baxter in a medical disciplinary proceeding that "the trier of fact [may] treat silence as evidence of guilt"); see also MacKay v. Drug Enf't Admin. , 664 F.3d 808, 820 (10th Cir. 2011) (citing Baxter and affirming the revocation of a medical doctor's registration to dispense controlled substances). Florida cases also echo the rule from Baxter . See, e.g., Vasquez v. State, 777 So.2d 1200, 1203 (Fla. 3d DCA 2001) ; Atlas v. Atlas , 708 So.2d 296, 299 (Fla. 4th DCA 1998). The Florida Supreme Court in Boedy v. Department of Professional Regulation, 463 So.2d 215, 218 (Fla. 1985) for example, found it constitutionally permissible to deny authority to practice medicine "to a physician who asserts the privilege against self-incrimination if his claim has prevented full assessment of his fitness and competency to practice." The Boedy opinion noted that
[w]hen a conflict arises between the right of a physician to pursue the medical profession and the right of the sovereignty to protect its citizenry, it follows that the rights of the physician must yield to the power of the state to prescribe reasonable rules and regulations which will protect the people from incompetent and unfit practitioners.
Id. at 217 ; cf. , Borrego v. Agency for Health Care Admin. , 675 So.2d 666, 668 (Fla. 1st DCA 1996) (affirming the revocation of a medical license against a Fifth Amendment double jeopardy claim because the sanction was "remedial rather than punitive," and noting that a medical license "is . a privilege granted by the sovereign, which may be withdrawn to 'preserve the public health, morals, comfort, safety and the good order of society' ") (quoting State ex rel. Munch v. Davis , 143 Fla. 236, 196 So. 491, 493-94 (1940) ).
In this case, the Department presented competent, substantial evidence that Dr. Omulepu committed malpractice by puncturing the organs of two patients during their cosmetic surgery procedures. In the face of this evidence, Dr. Omulepu exercised his Fifth Amendment right to remain silent. He wasn't forced to waive this right. In view of his silence, the ALJ applied an adverse inference, citing Baxter . The ALJ and Final Order did not, however, as a "consequence of [Dr. Omulepu's] silence automatically [find him] guilty of the infraction with which he has been charged." Baxter , 425 U.S. at 317, 96 S.Ct. 1551. Rather, the adverse inference combined with other probative evidence that advanced the Department's case-expert testimony identifying the improper angling of the cannula, multiple punctures of patient organs, and Dr. Omulepu's admission to a patient's mother that he'd "messed up" with a new cannula-supported the Board's ultimate decision. Under these circumstances, the adverse inference drawn by the ALJ, and accepted by the Board's Final Order, did not violate Dr. Omulepu's Fifth Amendment rights.
B.
We likewise affirm with respect to Dr. Omulepu's other claims involving the sufficiency of the evidence and alleged disparities between the administrative complaint and evidence deduced at the hearing. We recognize that a physician may not be "disciplined for an offense not charged in the complaint." Trevisani v. Dep't of Health , 908 So.2d 1108, 1109 (Fla. 1st DCA 2005) ; Ghani v. Dep't of Health , 714 So.2d 1113 (Fla. 1st DCA 1998). An administrative complaint must "afford 'reasonable notice to the licensee of facts or conduct which warrant' disciplinary action." Cottrill v. Dep't of Ins. , 685 So.2d 1371, 1372 (Fla. 1st DCA 1996) (quoting § 120.60(5), Fla. Stat.). Here, contrary to Dr. Omulepu's assertions, the administrative complaint did not fail to notice the charges against him. The violations found by the Board-medical malpractice in puncturing the internal organs of patients (see counts I and II of the Second Amended Complaint), and failing to create or maintain accurate records regarding the concentration of epinephrine used (see counts VI through IX)-were consistent with the allegations, which also were proven with competent, substantial evidence.
III.
For these reasons, we affirm the Board of Medicine's final order.
Lewis, J., concurs; Makar, J., concurs with opinion.