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DEPARTMENT OF PROFESSIONAL REGULATIONBOARD OF MEDlClNBIN RE: The PHitirm fork r a r n f o q Slaltment OFANTHONYNOWELS. M.D. ANDBARRY S. KAPLAN, M.D.d b l a D m O R S FAMILY CAREE'lflr.rrI.:*,- - : FINAL ORDERTHIS CAUSE cam Wore Ibe Board of Mcdicine (hminaner, Board). purmanr b Stetio.120.565. Florida Slaiutm. and Chnfiu 28-4. Rorida AdninisQnlivtC d e . on D s m b u 2 . 1 9 8 9 . Fthrusry 2, 19W. in M arru.Flonda. for the purpose o f cnrtsidering the Petition Tor D c c l a r d m Statemeol filed by Anlhnny N w l r , M.D. and Barry S. Kaplnn. M.D. dMa D ctorsFamily Oe(ht rnancrPetitioners). No pcwm or tntiry m g h r to i n t m t n e as a p n y .1Iavrng consided the Paitinn. h clglimony or the Pelrrioacrs. Ihc applicsblelmw, 8 n d l G aotherwise rully a d v i d in lhc prcrnists. the Board makes the following findings and conclusions.FINDINGS OF FACT1. The Pcritioncrs are cngngd in the prsdicc of medicine, w i a l i z i n g in psychialry, undsthc namc Doctma,Fsmily Cam. Bolh Pdilloncrs arc t i u tod praciicc medicim in Ihs Siatc orFImida pursuant to Chqter 458, Florrda Statues. slsd cumntly mainbin an omtics at Gmml C d aHmpilal, Dnde County, Florida.2. The Iscls as .M forth in t k wrillcn pdition (with orni-ion lo exhiblta t s t t c d ) ereloIloua:Fa Junc o f 1977, Dr. Nowcls baame M d i c a l Dimtor of GrsnlC m l e r Hospilal (a Fretslanding pychiatric hospibl Tor childrara d aclclcscmrs, localcd at 2 W i S.W. 157 Avenue. Miami.Ftmidn 33 187). and Dr. Ksplarr join& him st Frnnt Cmlcr inOclobcr. 1g77. At the lime there were very few privals hospilslpatienu;. m t cbildwi wce being c a r d fcr under a stale cnntractrosidcntiel rontmonlblsis, and L h c h p i t a l wasrclatiwly wknomrwith a qucs ionnhfcrqrutalim. Dr. N o m l s csm lo Granl Ccnkr .from rha Universily or Miami %hoof nr Mdicinc. Dyrartmnt ofPsychiatry where he ua the D i m l o r of the A d o l m l Programand had hacn the ace in Direclor o f Child and Adol-lPsychlatry. Dr. Kaplnn, v*ro hnd wrkd at Highlnnd ParkHmp lal.UIILS. s@ally I r n i d in ranlily lhcrapy and hwd b m inprivalapmct ce.Topcthcc. Dr. Nowcls nd.Dr.Kaplnn dwclopsdihc program at Granl Cmier m d pmmotsd those program in @he'.

A ffih of PA1.R. Iw. P.O. I b r 385.G*;navZir, FL 3 1 1 1W) 37s-WM12 FALR 1229I n a r f y 1981, as the hmpitnl becsrnt full sml was esscnliallyoperating wilh a wailing list, Dr.Iesnie G r s n t G m , the FmmnUrnnd owner o f the hospitsh, indieled she w l s h d to eslahlish aconlacl hmlw u l d ensurc the quahly or the programs and successof Ihe hospilaf hy formally havlng Dr. Nowelt and Dr. Kaplnn btrqxmsthle for the programs, to contrnue ro srvc as MedicalD i r a t o s , and io pmvide Ihe hiphesl qunlily medical services In allpatienls comlng i o l l eha pilalwho d dnot n l m d y have anattending physlcran. At lhai tirnc i t was very diflicull to disaoverany physiclnns who were routinely w l l l n pto frnwel uul to GrantCcntcr, whlch war perceivd as bcing 'far nut in thc Everglade ."Aficreegotraliohc. a format conlract was zigned on July 24. 1981.This initial contract contained the snmo right o f first rerusalprovision thnl is pr of the exisling contract, as d e w r i M i nthis Pel lion.Dr. Grsnt mid Granl Ccnltr Hospllal to FirN E x e u l i v c L i f eInsurance Company in 1982. with thocunlract cnnlinuing i n forceEach Pelil nneracquired a minorily slmk rnteresl (8 113%) i nGrant Ccnler Flnspitnl. The prlce p a d by Pcliliollerr Tor suchinteresl was lhc ssm p r share ralue ks puiJ by the majorilym r . First E X C F U LifeV B In%urancc. Pclilioners had nom e r s h i p i n r m l i n Grnnl Center Horpitut prior lo the purchsstof thrs interest.A five year, nnnsancolahle contract wasrenegolield a d s i g n d on March 5 . 1982. During thls t j m . Dr.Nowtls and Dr. Kaplan helped establish a sisler hwpilsl, GrantCenter Hosp ealst Nonh Florida (Ocaln), w l hsimilar programs.(At that Ilme Dr. Nowcls and Dr. Ksplan were praclicing hmdertht n a m of Psychialric Asrociates: PAPA.)Pctilioners Fulfilled their obligation undcr the annlracl with GranlCcntur Hospital and have confinuously s e d ms M u l c aDireelwlfor G m t Center Hospital from June. 1977 lo Ihe prcsent.Pelitioners have achuevcd a great degree of success i n enhancingthe rcputalion of Grant Center Howilal within the comrnunify andincreasing Ihe o c c u p x y rate. Petitioners also believe they wersinstrumental i n raising the quality o f a r c end lreatrnent at GrantCcnltr Hospilal.In Inle 1983, G m t CUlltr HnspilnI was pumhasbd by the ForumG w p . a hospital chain gernflng company. A s part of this sale.k l i t i n n w suld their a t i r e interest in Grant Center. The m n r n c tIn qlpcstlcm continued i n c f f l .bul was omended on Augud 31,

Petfrimtrs also k l i c v t i h a during this I h i n m (13) yeerperid o f 1 3.wzislionw i t h Grnnt Center Hospilnl, with olFiccs ntthe hospll.1, with uw 01 the -me telcphme ournher, s d 4 t halnrgc ponion o f nhcrr o u p t i u l cpreclicc k i n g a1 Grant CenlcrlIospilal, thst Ihc d i c n l cmnmunily has come lo co-arwistc Ihehospirol and Dr. Nowcls 88d Dr. Ksplen'd d t c n l praclicc. Dr.Nowcls' snd Dr. Knplnn's referral s o u r a s refer 0the hohpiul agi f t wrc the reme,# n referral to Ihcm. Indead. wtr h cyears.all w h inlcrnctions hy Dr. Nowcls, Dr. Krtplan and their g r w phave bccn l o piomole rhe asmintion u i t h the hospilnl. oncn wrthjointly sprmsoral m l i n g s , seminars, sndvis tsto r t f c m l agcnciband groups. The contract fieal ally c l l sfor this i n c n u m o lTharslntionship.In Oclohcr, t984. Grant Center Hospiial was p v r c h n d byHospital Corporation of America (HCA), which Ihm a w u d rhcobligalions and hcncrhq of the m n l r d Grant Center Hospital hadw l hIhc Pei tioncre. HCA Hcallh Scruiccs of Flodda,'lm. aFlonda Corporation, p m f l y rrmnins thc owner of Grant CcrrlcrHospital. I n March 1985 P c l i i i m m c n t d into zn ammdmcniof i h c conlrnclru11h Grant Ccnlcr Elospilat. I1 is clmr From ihcadded paragraphs of th sm l r n c t rwision thst i t WE HCA's intentto Ilrnii Dr. Nowels and Dr. Kaplm's Medical Dircctor dutimsolely to Grant Cenlcr Hospilal, lo further their c l m a wiat onl o the hmpital.H.C.A.hes no1 ind calsdany d i w t i s r a c t i a wilh Dr. Nowelst b Medicat Dirmtor hcrviccs beingprovided. In [act, HCA has spociFic;llly ind cattdits pllns rrcuilhthesc: services and has rcquesled lhare serv ccshe conlinued, menpInind i n I a l l t l l t r fmm the HCA Regional Vice Prcqidcnt.andtorIIIDr. KapTnn or any ofHCA has m t t y adviwd the Pctilirmcrs 1t crmsidcrs lhconlnclb c l w n the Pclilioncrs nnd HCA may be llegal andunmfmcable. at 1-1in prt. S t f i c n l l y zlnrler.pangraph t2(h)of Ihc coniracl i t Hales:'Thc hospilal a p m to provide PAPA with firstrefu.cal rights for sll new hmpilal prlicnlr whohave no artcnding psychialriqt. Said righl o r t i n trehrcal i c In be .daI upon hy PAPAirnmalintcly.a F n l nsuchp action by PAPA, IhcIlospiml rcrervcs the righl lo rerer any suchpalienr to other psychintrists.'

-.-. A -orFALR. Iw. P.O. ltar JBS.Cnhsak. VL. 31&Z [HI375.3'33612 FAX 1231r c l do provider6 o f hcalth care goods Md w i c a . ' Thatstatrnory scflicn also slates: 'Theprovisions orthis paragrpphshallnot lm c m s l r u d 10 p m c n l a physician from w i v i n g s t e Torpmfwionat mnsullalioo ssruiw."!I has been sllqed by HCA thnt the abme quoled clause in h sm n r m in queslion. giving the Paition- the righl o f Stst rerus llor naw patients who have m allending psychialrist, constituim akickback. Pet lioncrsbeIIcut that HCA is taking this posilion so'I b y may repudialc the right of first r c b l provision in thecontract and rerer the p l i c n t s in quealion lo r broader bax ofphysicians, during E l m cof dscllnlng hospilsl cmsus.Pctitioecrs w w l d point w t rhar under the contract b u w e n rhcmand Grant Center Hospital, all new hospital palitnls who ham noattending psych alnst r c m l n frsc to elact 8n attendingpsychtatria. The conlract in quwtion does jn no way restria apstiml's froedomofckoiecin clwingnna ! t d i n g physician. Therighf of first refusal givm to Ihe Ptlitioners by the contract inqueslion is rmly l f w l i v awhen the palitnt and the plient'sguardian or parent consent tonhe Ptl llonersacling ss thcstlcndingpsychiatrist tior guch a new hospital patient. Tkclaus. in questionis no m m lhnn a referral agmment, subject to !he consent o f thepm!icnls.7'k Petitioners believe thnt the c l s m i n question, above quoled.in no way ronnitules a kicktack or a fee splitting arrangementwith htmstlvcs.Grnnt Cmrcr Hwpitel, or any othea party. Thisclaute only eppgics to p c m s who want to bc patitnts of lhcHospital and who haw no attending pychiulrist. I t is n-rythnr cach such patient ba mferral l o an slltnding psychiatrist forthat permn no Ixcomo a p t f m t of Grant Curtcr HospilatThe Pciilioners M i w c ahat nhe m n l m t adqunrtty compensatestheir tffofisk5 r e d i d d i m t o r by asaIa ).of 140,000.00, and byp y m t of a salary o f M additional psychiatrisl to a s s i s inm i n g the r u m o f the conlract. Tk Pclitimcrs' righl of firstrefusal was established l o require them to continue Lo pmvidcorice scniess dircrtly on the gmunds or Grant Center Hospital(Perrrioncm h a maintained mch an olfiec since 1977). to momreadiIy be mvnilsblc to mi&immediate care for pariats (as isstipulated in theconlml), and to ensure the h ghcstquality of u r ep s s b l orhmugh the dtrmnstrnlorl w'- @am urd skills s h mover Ihc many ytprs of association with Grsnt Cenlcr Hospilal.ThL-tiglu of fiw r c k l clmra savad .s n induftmmt to thePctltiontrs to a t e r into Md lo continue a tnng-term arrangement. with Grant Cwter and is an i m p r i m 1pad of the entire contractup!-srranpemcnt k m n Ihe P a l t i o m and G m 1 Cmtcr.Tho