STATE OF FLORIDA BOARD OF PHYSICAL THERAPY PRACTICE. vs. Case No.: License No.: PTA FINAL ORDER

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1 Final Order No. DOH ft -MQA FILED DATE - Departm.;Ui STATE OF FLORIDA BOARD OF PHYSICAL THERAPY PRACTICE Deputy Agency Clerk DEPARTMENT OF HEALTH, Petitioner, vs. Case No.: License No.: PTA CARL JOSEPH PILACIK, P.T.A. Respondent. FINAL ORDER This matter appeared before the Board of Physical Therapy Practice (Board) pursuant to Sections and (2), Florida Statutes, at a duly-noticed public meeting on August 4, 2017, in Tampa, Florida, for a hearing not involving disputed issues of material fact. Petitioner was represented by Oaj Gilani, Assistant General Counsel, with the Department of Health. Respondent was not present and was not represented by counsel. The Administrative Complaint is attached as Exhibit A. Service of the Administrative Complaint was accomplished in accordance with the law. Respondent has not filed an Election of Rights or any other type of responsive pleading to the Administrative Complaint. Petitioner filed a Motion for Waiver of Rights and Final Order. Respondent has not filed a responsive pleading to the motion. At the Board Meeting the prosecuting attorney offered the investigative file into evidence to prove the facts as alleged in the Administrative Complaint and for the purposes of determining penalty. The investigative file was received into evidence and the Board finds that the facts adequately support the allegations. After a complete review of the record in this matter, including

2 consideration of the Administrative Complaint, any written evidence or testimony, and any mitigating or aggravating circumstances, the Board makes the following findings and conclusions: FINDINGS OF FACT The allegations of fact set forth in the Administrative Complaint are approved, adopted, and incorporated herein by reference as the findings of fact by the Board. The Board also finds there is competent, substantial evidence to support its findings and conclusions. CONCLUSIONS OF LAW Petitioner's Motion for Final Order for Hearing Not Involving Disputed Issues of Material Fact is granted. The conclusions of law alleged and set forth in the Administrative Complaint are approved, adopted, and incorporated herein by reference as the conclusions of law by the Board. Based upon the Findings of Fact, the Board concludes that the licensee violated Sections (1)(hh) and (1)(k), Florida Statutes. The violations warrant disciplinary action by the Board. Therefore, it is ORDERED and ADJUDGED: 1. Respondent's license is revoked. RULING ON MOTION TO ASSESS COSTS Costs of $ are assessed against Respondent and shall be paid within six months of the issuance date of this Final Order. Costs shall be paid to the Board of Physical Therapy Practice and mailed to: Department of Health, HMQAMS/Client Services, P.O. Box 6320, Tallahassee, FL , Attn: Physical Therapy Practice Compliance Officer. This Order shall become effective upon filing with the Clerk of the Department of Health.

3 DONE AND ORDERED this /6" day of AI-tit-LI-I, BOARD OF PHYSICAL THERAPY PRACTICE Allen Hall, Executive Director

4 NOTICE OF RIGHT TO JUDICIAL REVIEW A party who is adversely affected by this Final Order is entitled to judicial review pursuant to Section , Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings are commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health, and a second copy, accompanied by filing fees prescribed by law, with the District Court of Appeal, First District, or with the District Court of Appeal in the Florida appellate district where the party resides. The Notice of Appeal must be filed within thirty (30) days of rendition of the Order to be reviewed. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished by: CERTIFIED U.S. Mail to Mr. Carl Joseph Pilacik, 288 Woodland Ave., Daytona Beach, FL 32118; and by electronic mail to Lynette Norr, Assistant Attorney General, Office of the Attorney General, PL-01, The Capitol, Tallahassee, Florida and Oaj Gilani, Assistant General Counsel, Department of Health, 4052 Bald Cypress Way, Bin #C-65, Tallahassee, Florida , this 1 day of, Carl Joseph Pilacik 288 Woodland Ave Daytona Beach, FL ties Deputy Agency Clerk

5 918 DEPARTMENT OF HEALTH, STATE OF FLORIDA BOARD OF PHYSICAL THERAPY PRACTICE Petitioner, v. CASE NO CARL PILACIK, PTA Respondent. MOTION TO ASSESS COSTS IN ACCORDANCE WITH SECTION M The Department of Health, by and through counsel, moves the Board of Physical Therapy Practice for the entry of a Final Order assessing costs against the Respondent for the investigation and prosecution of this case in accordance with Section (4), Florida Statutes (2016). As grounds therefore, the Petitioner states the following: 1. At its next regularly scheduled meeting, the Board of Physical Therapy Practice will take up for consideration the above-styled disciplinary action and will enter a Final Order. 2. Section (4), Florida Statutes (2016), states, in pertinent part, as follows:

6 919 In addition to any other discipline imposed through final order, or citation, entered on or after July 1, 2001, under this section or discipline imposed through final order, or citation, entered on or after July 1, 2001, for a violation of any practice act, the board, or the department when there is no board, shall assess costs related to the investigation and prosecution of the case. The costs related to the investigation and prosecution include, but are not limited to, salaries and benefits of personnel, costs related to the time spent by the attorney and other personnel working on the case, and any other expenses incurred by the department for the case. The board, or the department when there is no board, shall determine the amount of costs to be assessed after its consideration of an affidavit of itemized costs and any written objections thereto As evidenced in the attached affidavit (Exhibit A), the investigation and prosecution of this case has resulted in costs in the total amount of $1,460.10, based on the following itemized statement of costs: a. Total costs for Complaints $38.27 b. Total costs for Investigations $1, c. Total costs for Legal $ d. Total costs for expenses $ The attached affidavit reflects the Department's costs for attorney time in this case as $ (Exhibit A). The cost of obtaining an affidavit from an outside attorney will exceed this amount. Therefore, the Department is not seeking costs for attorney time in this case.

7 5. Should Respondent file written objections to the assessment of costs for the complaints, investigations, compliance and expenses within ten (10) days of the date of this motion, specifying the grounds for the objections and the specific elements of the costs to which the objections are made, Petitioner requests that the Board determine the amount of costs to be assessed based upon its consideration of the affidavit attached as Exhibit A and any timely-filed written objections. 6. Petitioner requests that the Board grant this motion and assess costs in the amount of $1, as supported by competent, substantial evidence. This assessment of costs is in addition to any other discipline imposed by the Board and is in accordance with Section (4), Florida Statutes (2016). WHEREFORE, the Department of Health requests that the Board of Physical Therapy Practice enter a Final Order assessing costs against the Respondent in the amount of $1,

8 921 DATED this day of L--4pv.il, Respectfully submitted, Oaj Gila / Assista General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL Florida Bar # (850) ext (850) Fax CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Motion to Assess Costs has been provided by Certified Mail this 2.-S"`--- 1 day of (_ pv)i 2017, to: Carl Pilacik, PTA, at 288 Woodland Ave, Daytona Beach, FL OG/cg Oaj Gilani / Assistant General Counsel

9 908 STATE OF FLORIDA BOARD OF PHYSICAL THERAPY PRACTICE DEPARTMENT OF HEALTH, PETITION ER, V. CASE NO , CARL PILACIK, PTA, RESPONDENT. I ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through undersigned counsel, files this Administrative Complaint before the Board of Physical Therapy Practice (Board) against, Carl Pilacik, PTA, and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practice of physical therapy pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 486, Florida Statutes. 2. At all times material to this Complaint, Respondent was a licensed physical therapist assistant within the state of Florida, having been issued license number on or about July 26, 2012.

10 Respondent's address of record is 288 Woodland Avenue, Daytona Beach, Florida On or about December 8, 2014, Respondent entered into a five-year Concurrent Illness Monitoring Contract (Monitoring Contract) for psychiatric and boundary monitoring with the Professionals Resource Network (PRN). 5. PRN is a treatment and monitoring program for impaired practitioners in the state of Florida, 6, In September 2015, PRN representatives attempted several times to contact Respondent for his biannual check-up, but Respondent did not respond or contact PRN. 7, PRN continued to send Respondent warning letters and attempted to contact him several times in October 2015, January 2016, and June On or about June 24, 2016, PRN terminated Respondent from participation in the program due to his non-compliance and non-responsiveness. 9. In a letter dated June 24, 2016, PRN notified the Department that Respondent was non-compliant with the terms of D011 v. Carl Pllacik, PTA 2 Case No.:

11 910 his Monitoring Contract and PRN had terminated him from the program accordingly. 10. Respondent has not demonstrated good cause for his failure to comply with PRN's recommendations. 11. Section (1)(k), Florida Statutes (2015), provides that violating any provision of this Chapter or Chapter 456, or any rules adopted pursuant thereto, constitutes grounds for disciplinary action. 12. Section (1)(hh), Florida Statutes (2015), provides that being terminated from a treatment program for impaired practitioners for failure to comply, without good cause, with the terms of the monitoring or treatment contract entered into by the licensee, or for not successfully completing any drug treatment or alcohol treatment program constitutes grounds for disciplinary action. 13. Respondent was terminated from the PRN treatment program for impaired practitioners because he failed to comply with his monitoring contract without good cause. 14. Based on the foregoing, Respondent violated Section (1)(k), Florida Statutes (2015), through a violation of Section DOH v. Carl Pilacik, PTA 3 Case No,:

12 (1)(hh), Florida Statutes (2015). WHEREFORE, Petitioner respectfully requests that the Board of Physical Therapy Practice enter an order Imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. SIGNED this day of 04IoeY, Celeste Philip, MD, MPH Surgeon General d Secretary FILED DEPARTMENT OF HEALTH DEPUTY CLERK CLERK: AA SaNttUry DATE: OCT Oaj it Assistant GenF ral Counsel Florida Bar # Florida Department of Health Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida (850) , ext (850) (fax) PCP: 10/18/16 PCP Members: Dr. Pabian, Ms. Candela, and Mr. Kuhns DOH v. Cart Pliacik, PTA 4 Case No.:

13 912 NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section and , Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. A request or petition for an administrative hearing must be in writing and must be received by the Department within 21 days from the day Respondent received the Administrative Complaint, pursuant to Rule (2), Florida Administrative Code. If Respondent fails to request a hearing within 21 days of receipt of this Administrative Complaint, Respondent waives the right to request a hearing on the facts alleged in this Administrative Complaint pursuant to Rule (4), Florida Administrative Code. Any request for an administrative proceeding to challenge or contest the material facts or charges contained in the Administrative Complaint must conform to Rule (5), Florida Administrative Code. Mediation under Section , Florida Statutes, is not available to resolve this Administrative Complaint. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section (4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed. DOH v. Carl Pllaclk, PTA 5 Case No.:

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