Hoping

There is no contract wherein you agree the doctor has the right to maim you. Hopefully any contract in which you waive the liability of the doctor for his own neglgence before the fact will be void. Just because you sign a form acknowledging the risks of surgical procedures does not allow the doctor to escape liability if his negligence caused the injury. And in my book, this is not negligence, but an intentional act almost certain to cause bodily injury. The doctor should be hung.

Just because a patient knows of the risks does not mean the doctor avoids malpractice. The issue is whether the doctors treatment fell below a minimal standard of care. In this case, it looks like it did. This is where the Coalition doctors could offer the most help, by willingly testifying as experts that the perpetrator of this crime gave medical care that was way below the standard of care. This is a case that could be worth into seven figures, so long as it is not in a state with tort reform that limits pain and suffering damages to a ridiculously small amount.

Wow, Customs, with all due respect, you could be the poster child for how to do it wrong. You ignored all of the advice from the good people here and tried to save money by going to Brazil when there are some very fine doctors here in Florida. I had my HT done by Epstein in Miami and could not be more pleased. He also does repair work. I would recommend your seeing him. Screw the dollars.

http://www.msnbc.msn.com/id/18703259/from/RS.2/

http://www.msnbc.msn.com/id/18703259/from/RS.2/

For relaxation I have read more of his posts. Here is a quote from one of them which I think is the gist of his argument: "I am educating everyone to the fact that Pat gets paid to promote doctors and says he is a "patient advocate". It is a conflict of interest in the worst way, and is probably illegal." The problem with the illogical arument by Perfectfew is that just because somebody makes a fee for giving advice does not necessarily mean their advice is not the best possible. Brokers make money being paid a fee for giving advice, as to life insurance salesmen, lawyers, even doctors who may or may not recommend a certain medical procedure, not to mention the sears appliance salesman and that guy at Circuit City. How perfectfew could conclude being paid to give advice is illegal is beyond me, but he obviously is not a very astute guy. The point is that people through their integrity and hard work develope certain reputations. Pat has been here a long time and I think deserves the reputation he has developed. Perfectfew simply could not understand that there is nothing inherently wrong with earning a fee to give advice. People certainly are free to give advice, as many do here, without giving advice, but everybody is entitled to earn a living. Its doubtful anybody would put the time and effort Pat does into researching the HT industry unless he could make a living at it. Anyway, I guess I am just offended by the lack of logic in Perfectfew's posts. I almost feel bad he can't respond to me to try to defend himself. Maybe he will respond on his board.

For relaxation I have read more of his posts. Here is a quote from one of them which I think is the gist of his argument: "I am educating everyone to the fact that Pat gets paid to promote doctors and says he is a "patient advocate". It is a conflict of interest in the worst way, and is probably illegal." The problem with the illogical arument by Perfectfew is that just because somebody makes a fee for giving advice does not necessarily mean their advice is not the best possible. Brokers make money being paid a fee for giving advice, as to life insurance salesmen, lawyers, even doctors who may or may not recommend a certain medical procedure, not to mention the sears appliance salesman and that guy at Circuit City. How perfectfew could conclude being paid to give advice is illegal is beyond me, but he obviously is not a very astute guy. The point is that people through their integrity and hard work develope certain reputations. Pat has been here a long time and I think deserves the reputation he has developed. Perfectfew simply could not understand that there is nothing inherently wrong with earning a fee to give advice. People certainly are free to give advice, as many do here, without giving advice, but everybody is entitled to earn a living. Its doubtful anybody would put the time and effort Pat does into researching the HT industry unless he could make a living at it. Anyway, I guess I am just offended by the lack of logic in Perfectfew's posts. I almost feel bad he can't respond to me to try to defend himself. Maybe he will respond on his board.

I have spent the last hour or so reading posts from and to Perfect Few. I believe he is now banned? I am all for free speech and freedom of expression, almost without limitation. I even believe in burning the American Flag to make a point(obviously I am not a Republican :-) However free speech has its limits when it is used to disrupt a community a community such as this one whose primary purpose is education. As the US Supreme Court ruled long ago, even students in public schools do not leave the First Amendment at home, however they cannot use speech that will unreasonably interfere with school functions of teaching students. One rotten apple can spoil it for all of us. If he is not yet gone, he should be. If he is, good riddance.

I have spent the last hour or so reading posts from and to Perfect Few. I believe he is now banned? I am all for free speech and freedom of expression, almost without limitation. I even believe in burning the American Flag to make a point(obviously I am not a Republican :-) However free speech has its limits when it is used to disrupt a community a community such as this one whose primary purpose is education. As the US Supreme Court ruled long ago, even students in public schools do not leave the First Amendment at home, however they cannot use speech that will unreasonably interfere with school functions of teaching students. One rotten apple can spoil it for all of us. If he is not yet gone, he should be. If he is, good riddance.

Sure, doctors always call on unlicensed medical personnel, who don't even work for their office, to come in and help out in surgical procedures. It happens all the time . . .in fantasy land.

One other thing, I am not certain that a medical assistant, under Florida Law, is qualified to actually insert the grafts into the holes made by the physician. I know that the techs do this all the time, but I wonder if they are either licensed as Physician's Assistants or if they are violating the law. Admittedly I have not done any indepth research in this area other than reading the above Statutes. Many I'll look a little deeper.

I think what is important in all this is that all of these "assistants" work under the supervision of physicians in Florida. Hair Tech seems to indicate that he is "independent". I have not studied this area of the law in depth, but Hairtech claims to work or have worked in Florida. If so, I don't see how he could legally operate independently of a licensed physician. Supervision by a physician is a requirement of the job.

Jessica, of course its right:-). You think I am going to fabricate a Statute? For completeness, here are the requirements for medical assistants: 458.3485 Medical assistant. - (1) DEFINITION. - As used in this section, "medical assistant" means a professional multiskilled person dedicated to assisting in all aspects of medical practice under the direct supervision and responsibility of a physician. This practitioner assists with patient care management, executes administrative and clinical procedures, and often performs managerial and supervisory functions. Competence in the field also requires that a medical assistant adhere to ethical and legal standards of professional practice, recognize and respond to emergencies, and demonstrate professional characteristics. (2) DUTIES. - Under the direct supervision and responsibility of a licensed physician, a medical assistant may undertake the following duties: (a) Performing clinical procedures, to include: 1. Performing aseptic procedures. 2. Taking vital signs. 3. Preparing patients for the physician's care. 4. Performing venipunctures and nonintravenous injections. 5. Observing and reporting patients' signs or symptoms. (b) Administering basic first aid. © Assisting with patient examinations or treatments. (d) Operating office medical equipment. (e) Collecting routine laboratory specimens as directed by the physician. (f) Administering medication as directed by the physician. (g) Performing basic laboratory procedures. (h) Performing office procedures including all general administrative duties required by the physician. (i) Performing dialysis procedures, including home dialysis. (3) CERTIFICATION. - Medical assistants may be certified by the American Association of Medical Assistants or as a Registered Medical Assistant by the American Society of Medical Technologists. History. - s. 7, ch. 84-543; s. 7, ch. 84-553; ss. 21, 26, ch. 86-245; s. 4, ch. 91-429; s. 28, ch. 97-264.

Hairtech, I'm not sure if you are here trying to advertise your services, but if you are you should be aware of the numerous Florida Administrative Code sections which regulate you, including your ability to advertise: 21M-17.005, 61F6-17.005, 59R-30.009, Amended 6-7-98, 3-28-99. 64B8-30.011 Advertising. (1) Advertising by physician assistants is permitted so long as such information is in no way false, deceptive, or misleading. (2) Physician assistant advertisements shall disclose the name of the primary supervising physician of the physician assistant advertising his or her services. (3) Physician assistants may not claim any type of specialty board certification. (4) Only physician assistants certified by the National Commission on Certification of Physician Assistants (NCCPA) may claim certification and employ the abbreviation "PA-C" next to his or her name. (5) Failure to abide by the provisions of this rule shall constitute a violation of Sections 458.331(1)(d) and (nn) and 456.072(1)(cc), F.S. Specific Authority 458.347(13) F.S. Law Implemented 458.331(1)(d) F.S. History - New 9-25-03. So who are you working for now?

Uh-OH. I can see I better keep my mouth quiet around here. Let me just respectfully say that we agree to disagree :-)

Hey Phil. I too am in Central Florida - Southeast of Orlando. Here is the Statute on PAs, in case you wanted it: 458.347 Physician assistants. - (1) LEGISLATIVE INTENT. - (a) The purpose of this section is to encourage more effective utilization of the skills of physicians or groups of physicians by enabling them to delegate health care tasks to qualified assistants when such delegation is consistent with the patient's health and welfare. (b) In order that maximum skills may be obtained within a minimum time period of education, a physician assistant shall be specialized to the extent that he or she can operate efficiently and effectively in the specialty areas in which he or she has been trained or is experienced. © The purpose of this section is to encourage the utilization of physician assistants by physicians and to allow for innovative development of programs for the education of physician assistants. (2) DEFINITIONS. - As used in this section: (a) "Approved program" means a program, formally approved by the boards, for the education of physician assistants. (b) "Boards" means the Board of Medicine and the Board of Osteopathic Medicine. © "Council" means the Council on Physician Assistants. (d) "Trainee" means a person who is currently enrolled in an approved program. (e) "Physician assistant" means a person who is a graduate of an approved program or its equivalent or meets standards approved by the boards and is licensed to perform medical services delegated by the supervising physician. (f) "Supervision" means responsible supervision and control. Except in cases of emergency, supervision requires the easy availability or physical presence of the licensed physician for consultation and direction of the actions of the physician assistant. For the purposes of this definition, the term "easy availability" includes the ability to communicate by way of telecommunication. The boards shall establish rules as to what constitutes responsible supervision of the physician assistant. (g) "Proficiency examination" means an entry-level examination approved by the boards, including, but not limited to, those examinations administered by the National Commission on Certification of Physician Assistants. (h) "Continuing medical education" means courses recognized and approved by the boards, the American Academy of Physician Assistants, the American Medical Association, the American Osteopathic Association, or the Accreditation Council on Continuing Medical Education. (3) PERFORMANCE OF SUPERVISING PHYSICIAN. - Each physician or group of physicians supervising a licensed physician assistant must be qualified in the medical areas in which the physician assistant is to perform and shall be individually or collectively responsible and liable for the performance and the acts and omissions of the physician assistant. A physician may not supervise more than four currently licensed physician assistants at any one time. (4) PERFORMANCE OF PHYSICIAN ASSISTANTS. - (a) The boards shall adopt, by rule, the general principles that supervising physicians must use in developing the scope of practice of a physician assistant under direct supervision and under indirect supervision. These principles shall recognize the diversity of both specialty and practice settings in which physician assistants are used. (b) This chapter does not prevent third-party payors from reimbursing employers of physician assistants for covered services rendered by licensed physician assistants. © Licensed physician assistants may not be denied clinical hospital privileges, except for cause, so long as the supervising physician is a staff member in good standing. (d) A supervisory physician may delegate to a licensed physician assistant, pursuant to a written protocol, the authority to act according to s. 154.04(1)©. Such delegated authority is limited to the supervising physician's practice in connection with a county health department as defined and established pursuant to chapter 154. The boards shall adopt rules governing the supervision of physician assistants by physicians in county health departments. (e) A supervisory physician may delegate to a fully licensed physician assistant the authority to prescribe any medication used in the supervisory physician's practice unless such medication is listed on the formulary created pursuant to paragraph (f). A fully licensed physician assistant may only prescribe such medication under the following circumstances: 1. A physician assistant must clearly identify to the patient that he or she is a physician assistant. Furthermore, the physician assistant must inform the patient that the patient has the right to see the physician prior to any prescription being prescribed by the physician assistant. 2. The supervisory physician must notify the department of his or her intent to delegate, on a department-approved form, before delegating such authority and notify the department of any change in prescriptive privileges of the physician assistant. 3. The physician assistant must file with the department, before commencing to prescribe, evidence that he or she has completed a continuing medical education course of at least 3 classroom hours in prescriptive practice, conducted by an accredited program approved by the boards, which course covers the limitations, responsibilities, and privileges involved in prescribing medicinal drugs, or evidence that he or she has received education comparable to the continuing education course as part of an accredited physician assistant training program. 4. The physician assistant must file with the department, before commencing to prescribe, evidence that the physician assistant has a minimum of 3 months of clinical experience in the specialty area of the supervising physician. 5. The physician assistant must file with the department a signed affidavit that he or she has completed a minimum of 10 continuing medical education hours in the specialty practice in which the physician assistant has prescriptive privileges with each licensure renewal application. 6. The department shall issue a license and a prescriber number to the physician assistant granting authority for the prescribing of medicinal drugs authorized within this paragraph upon completion of the foregoing requirements. 7. The prescription must be written in a form that complies with chapter 499 and must contain, in addition to the supervisory physician's name, address, and telephone number, the physician assistant's prescriber number. Unless it is a drug sample dispensed by the physician assistant, the prescription must be filled in a pharmacy permitted under chapter 465 and must be dispensed in that pharmacy by a pharmacist licensed under chapter 465. The appearance of the prescriber number creates a presumption that the physician assistant is authorized to prescribe the medicinal drug and the prescription is valid. 8. The physician assistant must note the prescription in the appropriate medical record, and the supervisory physician must review and sign each notation. For dispensing purposes only, the failure of the supervisory physician to comply with these requirements does not affect the validity of the prescription. 9. This paragraph does not prohibit a supervisory physician from delegating to a physician assistant the authority to order medication for a hospitalized patient of the supervisory physician. This paragraph does not apply to facilities licensed pursuant to chapter 395. (f)1. The council shall establish a formulary of medicinal drugs that a fully licensed physician assistant, licensed under this section or s. 459.022, may not prescribe. The formulary must include controlled substances as defined in chapter 893, antipsychotics, general anesthetics and radiographic contrast materials, and all parenteral preparations except insulin and epinephrine. 2. In establishing the formulary, the council shall consult with a pharmacist licensed under chapter 465, but not licensed under this chapter or chapter 459, who shall be selected by the Secretary of Health. 3. Only the council shall add to, delete from, or modify the formulary. Any person who requests an addition, deletion, or modification of a medicinal drug listed on such formulary has the burden of proof to show cause why such addition, deletion, or modification should be made. 4. The boards shall adopt the formulary required by this paragraph, and each addition, deletion, or modification to the formulary, by rule. Notwithstanding any provision of chapter 120 to the contrary, the formulary rule shall be effective 60 days after the date it is filed with the Secretary of State. Upon adoption of the formulary, the department shall mail a copy of such formulary to each fully licensed physician assistant, licensed under this section or s. 459.022, and to each pharmacy licensed by the state. The boards shall establish, by rule, a fee not to exceed $200 to fund the provisions of this paragraph and paragraph (e). (5) PERFORMANCE BY TRAINEES. - Notwithstanding any other law, a trainee may perform medical services when such services are rendered within the scope of an approved program. (6) PROGRAM APPROVAL. - (a) The boards shall approve programs, based on recommendations by the council, for the education and training of physician assistants which meet standards established by rule of the boards. The council may recommend only those physician assistant programs that hold full accreditation or provisional accreditation from the Commission on Accreditation of Allied Health Programs or its successor organization. Any educational institution offering a physician assistant program approved by the boards pursuant to this paragraph may also offer the physician assistant program authorized in paragraph © for unlicensed physicians. (b) The boards shall adopt and publish standards to ensure that such programs operate in a manner that does not endanger the health or welfare of the patients who receive services within the scope of the programs. The boards shall review the quality of the curricula, faculties, and facilities of such programs and take whatever other action is necessary to determine that the purposes of this section are being met. © Any community college with the approval of the State Board of Education may conduct a physician assistant program which shall apply for national accreditation through the American Medical Association's Committee on Allied Health, Education, and Accreditation, or its successor organization, and which may admit unlicensed physicians, as authorized in subsection (7), who are graduates of foreign medical schools listed with the World Health Organization. The unlicensed physician must have been a resident of this state for a minimum of 12 months immediately prior to admission to the program. An evaluation of knowledge base by examination shall be required to grant advanced academic credit and to fulfill the necessary requirements to graduate. A minimum of one 16-week semester of supervised clinical and didactic education, which may be completed simultaneously, shall be required before graduation from the program. All other provisions of this section shall remain in effect. (7) PHYSICIAN ASSISTANT LICENSURE. - (a) Any person desiring to be licensed as a physician assistant must apply to the department. The department shall issue a license to any person certified by the council as having met the following requirements: 1. Is at least 18 years of age. 2. Has satisfactorily passed a proficiency examination by an acceptable score established by the National Commission on Certification of Physician Assistants. If an applicant does not hold a current certificate issued by the National Commission on Certification of Physician Assistants and has not actively practiced as a physician assistant within the immediately preceding 4 years, the applicant must retake and successfully complete the entry-level examination of the National Commission on Certification of Physician Assistants to be eligible for licensure. 3. Has completed the application form and remitted an application fee not to exceed $300 as set by the boards. An application for licensure made by a physician assistant must include: a. A certificate of completion of a physician assistant training program specified in subsection (6). b. A sworn statement of any prior felony convictions. c. A sworn statement of any previous revocation or denial of licensure or certification in any state. d. Two letters of recommendation. (b)1. Notwithstanding subparagraph (a)2. and sub-subparagraph (a)3.a., the department shall examine each applicant who the Board of Medicine certifies: a. Has completed the application form and remitted a nonrefundable application fee not to exceed $500 and an examination fee not to exceed $300, plus the actual cost to the department to provide the examination. The examination fee is refundable if the applicant is found to be ineligible to take the examination. The department shall not require the applicant to pass a separate practical component of the examination. For examinations given after July 1, 1998, competencies measured through practical examinations shall be incorporated into the written examination through a multiple-choice format. The department shall translate the examination into the native language of any applicant who requests and agrees to pay all costs of such translation, provided that the translation request is filed with the board office no later than 9 months before the scheduled examination and the applicant remits translation fees as specified by the department no later than 6 months before the scheduled examination, and provided that the applicant demonstrates to the department the ability to communicate orally in basic English. If the applicant is unable to pay translation costs, the applicant may take the next available examination in English if the applicant submits a request in writing by the application deadline and if the applicant is otherwise eligible under this section. To demonstrate the ability to communicate orally in basic English, a passing score or grade is required, as determined by the department or organization that developed it, on the test for spoken English (TSE) by the Educational Testing Service (ETS), the test of English as a foreign language (TOEFL) by ETS, a high school or college level English course, or the English examination for citizenship, Bureau of Citizenship and Immigration Services. A notarized copy of an Educational Commission for Foreign Medical Graduates (ECFMG) certificate may also be used to demonstrate the ability to communicate in basic English; and b.(I) Is an unlicensed physician who graduated from a foreign medical school listed with the World Health Organization who has not previously taken and failed the examination of the National Commission on Certification of Physician Assistants and who has been certified by the Board of Medicine as having met the requirements for licensure as a medical doctor by examination as set forth in s. 458.311(1), (3), (4), and (5), with the exception that the applicant is not required to have completed an approved residency of at least 1 year and the applicant is not required to have passed the licensing examination specified under s. 458.311 or hold a valid, active certificate issued by the Educational Commission for Foreign Medical Graduates; was eligible and made initial application for certification as a physician assistant in this state between July 1, 1990, and June 30, 1991; and was a resident of this state on July 1, 1990, or was licensed or certified in any state in the United States as a physician assistant on July 1, 1990; or (II) Completed all coursework requirements of the Master of Medical Science Physician Assistant Program offered through the Florida College of Physician's Assistants prior to its closure in August of 1996. Prior to taking the examination, such applicant must successfully complete any clinical rotations that were not completed under such program prior to its termination and any additional clinical rotations with an appropriate physician assistant preceptor, not to exceed 6 months, that are determined necessary by the council. The boards shall determine, based on recommendations from the council, the facilities under which such incomplete or additional clinical rotations may be completed and shall also determine what constitutes successful completion thereof, provided such requirements are comparable to those established by accredited physician assistant programs. This sub-sub-subparagraph is repealed July 1, 2001. 2. The department may grant temporary licensure to an applicant who meets the requirements of subparagraph 1. Between meetings of the council, the department may grant temporary licensure to practice based on the completion of all temporary licensure requirements. All such administratively issued licenses shall be reviewed and acted on at the next regular meeting of the council. A temporary license expires 30 days after receipt and notice of scores to the licenseholder from the first available examination specified in subparagraph 1. following licensure by the department. An applicant who fails the proficiency examination is no longer temporarily licensed, but may apply for a one-time extension of temporary licensure after reapplying for the next available examination. Extended licensure shall expire upon failure of the licenseholder to sit for the next available examination or upon receipt and notice of scores to the licenseholder from such examination. 3. Notwithstanding any other provision of law, the examination specified pursuant to subparagraph 1. shall be administered by the department only five times. Applicants certified by the board for examination shall receive at least 6 months' notice of eligibility prior to the administration of the initial examination. Subsequent examinations shall be administered at 1-year intervals following the reporting of the scores of the first and subsequent examinations. For the purposes of this paragraph, the department may develop, contract for the development of, purchase, or approve an examination that adequately measures an applicant's ability to practice with reasonable skill and safety. The minimum passing score on the examination shall be established by the department, with the advice of the board. Those applicants failing to pass that examination or any subsequent examination shall receive notice of the administration of the next examination with the notice of scores following such examination. Any applicant who passes the examination and meets the requirements of this section shall be licensed as a physician assistant with all rights defined thereby. © The license must be renewed biennially. Each renewal must include: 1. A renewal fee not to exceed $500 as set by the boards. 2. A sworn statement of no felony convictions in the previous 2 years. (d) Each licensed physician assistant shall biennially complete 100 hours of continuing medical education or shall hold a current certificate issued by the National Commission on Certification of Physician Assistants. (e) Upon employment as a physician assistant, a licensed physician assistant must notify the department in writing within 30 days after such employment or after any subsequent changes in the supervising physician. The notification must include the full name, Florida medical license number, specialty, and address of the supervising physician. (f) Notwithstanding subparagraph (a)2., the department may grant to a recent graduate of an approved program, as specified in subsection (6), who expects to take the first examination administered by the National Commission on Certification of Physician Assistants available for registration after the applicant's graduation, a temporary license. The temporary license shall expire 30 days after receipt of scores of the proficiency examination administered by the National Commission on Certification of Physician Assistants. Between meetings of the council, the department may grant a temporary license to practice based on the completion of all temporary licensure requirements. All such administratively issued licenses shall be reviewed and acted on at the next regular meeting of the council. The recent graduate may be licensed prior to employment, but must comply with paragraph (e). An applicant who has passed the proficiency examination may be granted permanent licensure. An applicant failing the proficiency examination is no longer temporarily licensed, but may reapply for a 1-year extension of temporary licensure. An applicant may not be granted more than two temporary licenses and may not be licensed as a physician assistant until he or she passes the examination administered by the National Commission on Certification of Physician Assistants. As prescribed by board rule, the council may require an applicant who does not pass the licensing examination after five or more attempts to complete additional remedial education or training. The council shall prescribe the additional requirements in a manner that permits the applicant to complete the requirements and be reexamined within 2 years after the date the applicant petitions the council to retake the examination a sixth or subsequent time. (g) The Board of Medicine may impose any of the penalties authorized under ss. 456.072 and 458.331(2) upon a physician assistant if the physician assistant or the supervising physician has been found guilty of or is being investigated for any act that constitutes a violation of this chapter or chapter 456. (8) DELEGATION OF POWERS AND DUTIES. - The boards may delegate such powers and duties to the council as they may deem proper. (9) COUNCIL ON PHYSICIAN ASSISTANTS. - The Council on Physician Assistants is created within the department. (a) The council shall consist of five members appointed as follows: 1. The chairperson of the Board of Medicine shall appoint three members who are physicians and members of the Board of Medicine. One of the physicians must supervise a physician assistant in the physician's practice. 2. The chairperson of the Board of Osteopathic Medicine shall appoint one member who is a physician and a member of the Board of Osteopathic Medicine. 3. The secretary of the department or his or her designee shall appoint a fully licensed physician assistant licensed under this chapter or chapter 459. (b) Two of the members appointed to the council must be physicians who supervise physician assistants in their practice. Members shall be appointed to terms of 4 years, except that of the initial appointments, two members shall be appointed to terms of 2 years, two members shall be appointed to terms of 3 years, and one member shall be appointed to a term of 4 years, as established by rule of the boards. Council members may not serve more than two consecutive terms. The council shall annually elect a chairperson from among its members. © The council shall: 1. Recommend to the department the licensure of physician assistants. 2. Develop all rules regulating the use of physician assistants by physicians under this chapter and chapter 459, except for rules relating to the formulary developed under paragraph (4)(f). The council shall also develop rules to ensure that the continuity of supervision is maintained in each practice setting. The boards shall consider adopting a proposed rule developed by the council at the regularly scheduled meeting immediately following the submission of the proposed rule by the council. A proposed rule submitted by the council may not be adopted by either board unless both boards have accepted and approved the identical language contained in the proposed rule. The language of all proposed rules submitted by the council must be approved by both boards pursuant to each respective board's guidelines and standards regarding the adoption of proposed rules. If either board rejects the council's proposed rule, that board must specify its objection to the council with particularity and include any recommendations it may have for the modification of the proposed rule. 3. Make recommendations to the boards regarding all matters relating to physician assistants. 4. Address concerns and problems of practicing physician assistants in order to improve safety in the clinical practices of licensed physician assistants. (d) When the council finds that an applicant for licensure has failed to meet, to the council's satisfaction, each of the requirements for licensure set forth in this section, the council may enter an order to: 1. Refuse to certify the applicant for licensure; 2. Approve the applicant for licensure with restrictions on the scope of practice or license; or 3. Approve the applicant for conditional licensure. Such conditions may include placement of the licensee on probation for a period of time and subject to such conditions as the council may specify, including but not limited to, requiring the licensee to undergo treatment, to attend continuing education courses, to work under the direct supervision of a physician licensed in this state, or to take corrective action. (10) INACTIVE AND DELINQUENT STATUS. - A license on inactive or delinquent status may be reactivated only as provided in s. 456.036. (11) PENALTY. - Any person who has not been licensed by the council and approved by the department and who holds himself or herself out as a physician assistant or who uses any other term in indicating or implying that he or she is a physician assistant commits a felony of the third degree, punishable as provided in s. 775.082 or s. 775.084 or by a fine not exceeding $5,000. (12) DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE. - The boards may deny, suspend, or revoke a physician assistant license if a board determines that the physician assistant has violated this chapter. (13) RULES. - The boards shall adopt rules to implement this section, including rules detailing the contents of the application for licensure and notification pursuant to subsection (7) and rules to ensure both the continued competency of physician assistants and the proper utilization of them by physicians or groups of physicians. (14) EXISTING PROGRAMS. - This section does not eliminate or supersede existing laws relating to other paramedical professions or services and is supplemental to all such existing laws relating to the licensure and practice of paramedical professions. (15) LIABILITY. - Each supervising physician using a physician assistant is liable for any acts or omissions of the physician assistant acting under the physician's supervision and control. (16) LEGAL SERVICES. - Legal services shall be provided to the council pursuant to s. 456.009(1). (17) FEES. - The department shall allocate the fees collected under this section to the council. History. - ss. 1, 8, ch. 79-302; s. 301, ch. 81-259; ss. 2, 3, ch. 81-318; s. 8, ch. 84-543; s. 8, ch. 84-553; ss. 20, 25, 26, ch. 86-245; s. 29, ch. 88-1; s. 15, ch. 88-277; s. 3, ch. 88-361; s. 26, ch. 89-162; s. 2, ch. 90-60; ss. 33, 34, ch. 90-134; s. 2, ch. 91-22; s. 43, ch. 91-201; s. 4, ch. 91-429; s. 1, ch. 92-22; s. 108, ch. 94-218; s. 1, ch. 95-231; s. 1, ch. 96-197; s. 223, ch. 97-101; s. 1094, ch. 97-103; s. 27, ch. 97-264; s. 6, ch. 98-49; s. 49, ch. 98-166; s. 155, ch. 99-251; s. 1, ch. 99-370; s. 100, ch. 99-397; s. 107, ch. 2000-160; ss. 27, 42, ch. 2000-318; s. 1, ch. 2001-100; ss. 23, 55, ch. 2001-277; s. 75, ch. 2002-1; s. 76, ch. 2004-5; s. 15, ch. 2004-41.

Once we get rid of the war criminal occupying the White House, perhaps Stem Cell research in our country will roar ahead with all kinds of treatments and discoveries for various diseases and conditions.

How does the public do this Dr. Feller? What you suggest is virtually impossible. The public cannot submit products to blind studies and peer review to determine if a product is safe or not, effective or not. Only the government is well suited for that role, and the FDA has again and again let the public down. Not only does it approve medical devices which should never be approved (who knows how many people will waste their money on these lasers), but it approves drugs that actually kill - Vioxx comes to mind. Heck, the FDA has the public believing that generics are always the exact equivalent to the brand drug, and that is sometimes not true. Sometimes not even close. Just my two cents for the evening.

Let me pipe in and give my opinion here, and what I am saying I honestly and truly believe to the bottom of my heart. First, like a few of the other posters here, I am a trial lawyer practicing in Florida. In Florida we have some very good doctors and we have some very bad doctors, just like everywhere else. And just like everywhere else, doctors have attempted to close the court house doors to those injured by their malpractice. I believe something like 10% of the doctors out there cause 90% of the problems. But when they cause problems, they can be huge, ranging from death to disfigurement to paralysis to the wrong limbs being cut-off. Doctors and their insurance companies have done their very best to pollute the public mind-set by creating a fictitious liability problem in our State, in at attempt to convince state legislatures to pass tort reform (pretty easy when we had Jeb Bush as our governor), and in attempt to win over the public so that they find in favor of doctors if they actually sit on malpractice juries. Now it appears from our friend here that he is personally attempting to also prevent the free-flow of information through baseless threats so that the public does not know about those doctors who are substandard. I had my hair transplant by Dr. Jeffrey Epstein. He did a great job and I will always be grateful to him for his abilities and his expertise. If I however had been butchered by Dr. Epstein, I would be blasting him all over the internet and I would do my best to get his rear-end in court. It's a new world Doc. You may be able to close the court house doors but you will never be able to stop the free flow of information on the internet. If you are not good at what you do, if you can not do a decent Hair transplant, then get the hell out of the business. You have no right to butcher people for the benefit of your own enrichment. Screw you and your threats of retaliation. If it were me you were making the threats against, I would say bring it on. I've had my say :-)

Hairbanks, its called the First Amendment to the Constitution, prohibiting the government from limiting free speech. Yes there is a truth in advertising law, but it becomes a very slippery slope to allow the government to start regulating advertising to any great extent, imho. This is basically a buyer be ware society.

HI Dr. E. You did my transplant back on October 7, 2005. 2800 Front 1/3. I now have a full head of hair and could not be happier. It truly is undetectable and when I look at my photos, there is a huge difference between my bald look versus my current look. I met with you a few months ago to consider a second transplant to fill in the top of my head which is still thinning. You recommended maybe another 2200 But I am going to put that off as long as possible. I am now 52 but still have a large amount of donor hair available. Maybe I will see you in another year or so.

Bill, I'm at about 16 months now. I had the front 1/3 done. Just imagine a full head of hair in the front 1/3 and that's what I look like. Starting to thin behind though so sooner or later I will need HT number 2. I am 52 now, with still plenty of donor hair. I was about a Norwood 4 at the time of the HT, with almost no hair at the front 1/3.

Hey guys. 2800 grafts by Epstein in October 05. I could not have been more pleased with the results. My only regret is that I didn't do it sooner.

Let me give you a little free legal advice for your friend. Lets assume your friend lives in Ohio and this doctor practices in California. Lets assume doctor sent the contract to Ohio to be signed by your friend? Now the Ohio courts have jurisdiction over anything regarding this contract and your friend can march down to his local small claims court, file a suit against said doctor, have doctor served in California, and doctor either responds or shows up in court at the designated time, or hires an expensive lawyer to do so for him, or there is a default against him. Lets assume Doctor or his lawyer indeed shows up? Small claims court is the everyman court. A small claims court judge can do virtually anything he wants and if there is equity in your friend's cause, the Judge just might rule in his favor and simply ignore the contract. At any rate, can you imagine if people started suing this doctor in Small claims court on a regular basis? :-)

Hi Pat, I've sued a few people for defamation in the past (on behalf of my clients) and I've defended a few. I can't tell you whether this Doctor could win any kind of lawsuit against you, as "opinions" are generally protected where as defamatory facts are not. I can tell you a few things that are true in Florida however and probably most states. (1) It is always better to avoid a lawsuit if at all possible. No use looking for trouble. No matter how justified you are in your position nobody can predict how a lawsuit will turn out. (2) Even if you win, and even if you have an insurance company providing you a defense, lawsuits can still be draining of your time and energy (3) Truth is not an absolute defense to a defamation claim. For example, if you publish your neighbor has a loathsome disease and they do, that you published such fact maliciously may still result in your losing a case. (5) The results of any lawsuit very much depend on the randomness of the judge assigned to your case and the jury who hears the case. There are appellate courts if the Judge screws up, but they only bother, (in Florida at least) reversing a small percentage of all of the injustices inflicted on people in our courts and quite frankly, even if a Judge gets it completely wrong on the law the appellate courts often will not intervene. (5) The truth matters not at all in a courtroom. It is only the perception of truth. (6) Fairness is a foreign concept in a court of law. Fair has nothing to do with anything. There are always gray lines in defamation claims. After all, we should be able to give opinions about how good or bad we think a particular HT surgeon. On the other hand, there are laws on the books about defaming business people. You might find the case below interesting and somewhat informative. The bottom line is keep up the good fight and don't worry so much about offering opinions. On the other hand, if you can avoid a fight without compromising yourself or this websight you should do so. If you can do so without mentioning the name of this doctor, you should. Follow your attorney's advice. And make sure you have a policy of insurance that does not exclude claims for libel. Florida Case Law -------------------------------------------------------------------------------- BECKER v. HOOSHMAND, 841 So.2d 561 (Fla.App. 4 Dist. 2003) PATRICIA A. BECKER, Appellant, v. HOOSHANG HOOSHMAND, M.D., Appellee. Case No. 4D02-261. District Court of Appeal of Florida, Fourth District. Opinion filed March 12, 2003. Rehearing Denied April 24, 2003. Appeal of a non-final order from the Circuit Court for the Nineteenth Judicial Circuit, Indian River County; Scott M. Kenney, Judge; L.T. Case No. 01-415 CA11. Kevin S. Doty of Hatch & Doty, P.A., Vero Beach, for appellant. Janet M. Carney and Louis B. Vocelle, Jr., of Clem, Polackwich, Vocelle & Berg, L.L.P., Vero Beach, for appellee. POLEN, C.J. This appeal arises from a trial court's denial of a defendant's motion to dismiss based on alleged lack of personal jurisdiction. For the reasons explained below, we affirm the trial court's decision. Appellant, Patricia Becker, was named as the defendant in a multi-count civil action brought by Dr. Hooshmand. Becker is a resident of Chester County, Pennsylvania. Dr. Hooshmand is a licensed physician practicing in Indian River County, Florida. In Dr. Hooshmand's complaint, he alleged that Ms. Becker, through her activity on the internet, should be found liable for defamation, defamation per se, and tortious interference with a business relationship. Dr. Hooshmand further alleged that Ms. Becker is a moderator of an internet chat room and has posted numerous defamatory comments about him that were targeted to Florida residents, or people likely to seek medical care in the state of Florida, which resulted in injury to his reputation and business. Becker responded to the complaint with a motion to dismiss alleging that the court could not Page 562 properly exercise jurisdiction over her. The trial court disagreed, and so do we. The applicable standard of review is de novo. See Taylor v. City of Riviera Beach, 801 So.2d 259 (Fla. 4th DCA 2001). The Florida Supreme Court has held that determining the propriety of the exercise of long arm jurisdiction in Florida is a two-step inquiry. Venetian Salami Co. v. Parthenais, 554 So.2d 499 (Fla. 1989). The first step is to determine if the plaintiff has established sufficient jurisdictional facts to subject the defendant to Florida's long arm jurisdiction. Id. at 502. Once the first step has been satisfied, the second inquiry is whether the defendant possesses sufficient minimum contacts to satisfy the constitutional due process requirements. Id. at 500. The initial burden falls on the plaintiff to plead the basis for service under the long-arm statue. Id. at 502. The plaintiff may satisfy this initial burden either by alleging the language of the statute without pleading supporting facts, or by alleging specific facts that indicate that the defendant's actions fit within one of the sections of Florida's long arm statute, section 48.193. Id. Additionally, "a defendant wishing to contest the allegations of the complaint concerning jurisdiction or to raise a contention of minimum contacts must file affidavits in support of his position." Id. at 502. If a defendant submits such an affidavit, then the burden shifts back to plaintiff to submit affidavits establishing the basis for jurisdiction. Id. We conclude that the allegations of the complaint satisfy Dr. Hooshmand's initial burden. Florida's long arm statute provides in part: "Any person, whether or not a citizen or resident of this state, who personally or through an agent does any of the acts enumerated in this subsection thereby submits himself or herself and, if he or she is a natural person, his or her personal representative to the jurisdiction of the courts of this state for any cause of action arising from the doing of any of the following acts: . . . (b) Committing a tortious act within this state. . . . (f) Causing injury to persons or property within this state arising out of an act or omission by the defendant outside this state, if, at or about the time of the injury, either: 1. The defendant was engaged in solicitation or service activities within this state; . . . ?§ 48.193, Fla. Stat. The initial threshold was satisfied in the complaint by alleging facts that indicate that the defendant's actions fit within one of the sections of Florida's long arm statute, section 48.193. Specifically, facts were alleged that indicate that the defendant committed a tortious act within the state. Florida courts have long recognized that a cause of action in tort arises where the injury to the plaintiff first occurs. See, e.g., Williams v. Goldsmith, 619 So.2d 330 (Fla.3d DCA 1993) (tortious interference with contract claim accrued where plaintiff suffered injury by loss of clients); see also Walt Disney World Co. v. Leff, 323 So.2d 602 (Fla. 4th DCA 1975) (personal injury action accrued where injury occurred); Tucker v. Fianson, 484 So.2d 1370 (Fla.3d DCA 1986) (legal malpractice action accrued where asserted negligence impacted plaintiff's economic interest). The Florida Supreme Court recently clarified this issue and noted that: In order to commit a tortious act in Florida, a defendant's physical presence is not required. Second, committing a Page 563 tortious act in Florida under section 48.193(1)(b) can occur through the nonresident defendant's telephonic, electronic, or written communications into Florida. However, the cause of action must arise from the communications. Wendt v. Horowitz, 822 So.2d 1252 (Fla. 2002). Furthermore, this court has previously held that committing a tortious act under Florida's long arm statute does not require that a physical tort occur in this state. See, e.g, Carida v. Holy Cross Hosp., Inc., 424 So.2d 849 (Fla. 4th DCA 1982). (slanderous telephone conversations were sufficient.) Similarly, this court has concluded that mailing a letter into the State of Florida was sufficient to find that tortious conduct took place in the state. Silver v. Levinson, 648 So.2d 241 (Fla. 4th DCA 1994). Additionally, this court has held that making a defamatory statement over the telephone constitutes the commission of a tortious act for purposes of Florida's long arm statute. Achievers Unlimited, Inc. v. Nutri Herb, Inc., 710 So.2d 716 (Fla. 4th DCA 1998). We find that the communications that form the basis of the allegations in this case are analogous to cases previously decided by this court and certainly fit within the recent Supreme Court's discussion of electronic communications. As a result, we conclude that the initial burden required under Venetian Salami was satisfied. Next we turn to Becker's attempt to contest jurisdiction. Becker did submit an affidavit that contested the factual allegations of the complaint concerning jurisdiction. However, her affidavit was submitted ten days after the trial court ruled on the motion to dismiss. The trial court specifically commented on the lack of supporting affidavits in denying the motion based on the four corners of the complaint. Whether or not Becker's untimely affidavit challenges the allegations relating to jurisdiction pursuant to Venetian Salami, the affidavit was not filed in a timely manner. The trial court could not properly have considered it and was correct in ruling on the motion based on the four corners of the complaint. As a result, we affirm the decision of the trial court in all respects. AFFIRMED. GUNTHER and MAY, JJ., concur. .