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Manuscript Title:
Practitioner or Pretender? Unlicensed Activity Regulation in Florida
Word Count:
3,698
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Author(s):
Scott Flowers is Program Administrator for the Florida Department of Health, Unlicensed Activity (ULA)
program; Contribution: acquisition of data and critical revision of the manuscript for important
intellectual content
Jamie G. McNease, MSW, is a Strategy Manager for the Florida Department of Health, Division of
Medical Quality Assurance; Contribution: drafting of the manuscript, analysis and interpretation of data
and critical revision of the manuscript for important intellectual content
Nick Van Der Linden is a Strategy Manager for the Florida Department of Health, Division of Medical
Quality Assurance; Contribution: critical revision of the manuscript for important intellectual content
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ABSTRACT: The unlicensed practice of health care professions is becoming an increasingly popular topic
for media outlets nationwide. Unlicensed activity, or practicing medicine or other professions without a
license, is prohibited according to medical practice acts in most states. This places the task of protecting
consumers from the potentially harmful and unsafe practices of unauthorized practitioners on medical
and health care regulators. The Florida Legislature deemed the issue of unlicensed activity a state
priority and subsequently empowered the Florida Department of Health and health care regulators to
enforce vigorously the licensure regulations. As a result, Florida has developed a strategic program with
several initiatives to combat unlicensed activity. Through these initiatives, Florida is making positive
strides in protecting, promoting and improving the health of residents and visitors. This article outlines
program components, discusses lessons learned, and provides recommendations to states looking to
launch similar initiatives.
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Introduction
Unlicensed activity is generally defined as the provision of medical or health care services by an
individual whose professional education, training and other relevant qualifications have not been
approved through the issuance of a license by the appropriate regulatory authority.1 The overarching
purpose of professional licensure, and the statutes that regulate those licenses, is to protect and
promote the health, safety and general well-being of the public by ensuring that only individuals
qualified by education and experience are able to practice certain professions. Current regulations not
only set the professional standards for those who are licensed health care practitioners, but also give
consumers more confidence in knowing what licensed practitioners can and cannot do. State licensing
laws also protect the public by establishing penalties for practicing a health care profession without first
obtaining appropriate licensure.
The recognition of unlicensed activity as a problem in the United States dates back to 1760
when the city of New York enacted the first medical licensing laws. These laws were minimal and lacked
the capacity to fully protect the public from dangerous practitioners. As Kenneth De Ville explains, the
statutes “did not forbid unlicensed practice but merely provided certificates of legitimacy to ‘qualified’
doctors.”2 Over time, licensing laws were changed and developed into medical practice acts, which were
designed to “eliminate charlatans, incompetents or frauds”3 and better protect consumers from the
potentially injurious health care services delivered by unqualified providers.
Since most states do not maintain records of unlicensed health care providers, quantifying the
problem of unlicensed activity in the United States is a difficult task. Although there is limited data
available, the full size and scope of unlicensed activity remains unclear at this time. What is clear and
established as fact is that when an unlicensed and unregulated individual practices a health care
profession, the consequences of receiving health care services from these individuals can be grave. This
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article provides an overview of what is known about the problem of unlicensed activity in Florida and
throughout the United States, both past and present. It also describes Florida’s Unlicensed Activity (ULA)
program and outreach initiatives implemented in Florida to combat the unlicensed practice of health
care professions. Finally, the article summarizes the education initiatives implemented to address this
issue, emphasizing the important role health care practitioners and consumers play in eliminating
unlicensed activity.
Hurricane Andrew: The Straw that Broke the Camel’s Back
Although unlicensed activity has been around for many years, it has not necessarily been at the
forefront of professional regulation. In Florida, the problem of unlicensed activity was not fully
recognized or acknowledged until 1992—in the aftermath of Hurricane Andrew. On August 24, 1992,
Andrew, a Category 5 hurricane, barreled through South Florida, leaving hundreds of thousands of
individuals with devastating damage to person and property. During the days and weeks following the
hurricane, when vulnerable and desperate homeowners were beginning to pick up the pieces of their
broken lives and rebuild their homes, unlicensed contractors offered the allure of immediate assistance.
These individuals were not bound by the standards and regulations of licensure in Florida, and many
provided sub-standard work and/or received sizeable deposits from homeowners for repairs that were
never completed.
According to the Spring Term A.D. 1992 Final Report of the Dade County Grand Jury, there were
1,600 citizens’ complaints reviewed by Dade county investigators in November 1992 and 1,300 of those
complaints were related to unlicensed contractors.4 The number of complaints for one month alone
almost doubled the number of complaints involving unlicensed construction contractors in fiscal year
1990-1991.5 Annual report data shows that complaints against unlicensed construction contractors and
workers increased drastically from 890 in fiscal year 1991-1992, prior to Hurricane Andrew, to 1,307 in
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fiscal year 1992-1993.6 Although construction-related unlicensed activity complaints had the most
dramatic increase, other professions—electrical contractors, land surveyors, real estate agents and
architecture—also had a noticeable rise in unlicensed activity complaints.
The criminal actions of unlicensed contractors in 1992 brought attention to a broader problem—
the unlicensed practice of other occupations, including health care professions. Though complaints
against unlicensed health care practitioners were not nearly as prevalent as the construction industry, it
was recognized that the consequences of receiving health care services from unlicensed providers were
potentially more serious, even deadly. In 1992, the Florida Legislature began a series of targeted
activities aimed at reducing and preventing the unlicensed practice of a profession. In December 1998,
the Division of Medical Quality Assurance (MQA) opened its first ULA program office in Fort Lauderdale
with a staff of four.
Florida’s Unlicensed Activity Program
The Florida Legislature has made the vigorous enforcement of licensure requirements and
prevention of unlicensed activity a state priority. Section 456.065, Florida Statutes, states that the
unlicensed practice of a health care profession is strictly prohibited. This statute also gives the Florida
Department of Health the authority to investigate unlicensed activity allegations, issue and deliver
notices to cease and desist to violators, and impose citations and administrative penalties of up to
$5,000 per incident. The statute also details the civil and criminal penalties for unlicensed activity.
To implement the law and meet legislative intent, the Department of Health developed a
statewide program within MQA to combat unlicensed activity in Florida. The goal of the ULA program is
to pursue aggressively any and all allegations of unlicensed practice in the health care professions, and
to eradicate unlicensed activity. Currently, there are 18 ULA investigators working at 11 field offices
throughout the state. Maintaining such a vigorous program requires continuous funding sources to
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cover program expenditures. Expenses, such as personnel costs, enforcement activities and outreach
efforts, are approximately $1 million each year (see Table 1). In fiscal year 2014-2015, the annual
expenditures were over $1.2 million. The program is statutorily funded through a special fee of $5.00
per licensee upon initial licensure and at each renewal. In addition to the licensure fee, the ULA program
is also given statutory authority to collect fines and to recover the costs of investigations and
prosecutions. These funding sources allow the Department to maintain its unlicensed activity
enforcement and outreach initiatives throughout the year.
Enforcement
Practicing health care without a license is a crime in Florida that can result in misdemeanor or
felony penalties including fines and incarceration. Pursuant to section 456.065, Florida Statutes,
investigations involving the unlicensed practice of a health care profession are criminal in nature and
require a finding of probable cause to present to law enforcement or to file charges with the state
attorney in the county of occurrence. If the unlicensed activity allegations can be substantiated, the ULA
investigation will conclude with one or more of the following outcomes: (1) the arrest of the subject(s)
by law enforcement; (2) the issuance of a Uniform Unlicensed Activity Citation and; (3) a fine and/or the
issuance of a Cease and Desist Order. If the investigation results in the determination that the alleged
acts were lawful and proper or did not occur, the investigation is closed as unfounded. In the event that
the investigation determines that the allegation cannot be proved or disproved, the case is closed as
unsubstantiated.
In all cases, the ULA investigator prepares a detailed investigative report supporting the
conclusions reached by the investigation. Investigative records made or received by ULA investigators
are not exempt from public record laws; however, if the ULA investigative record involves a licensed
health care practitioner or licensure applicant, the record is protected under section 456.073, Florida
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Statutes. Certain documents within ULA investigative records may also be confidential, such as patient
medical records. The confidential portions of ULA investigative records must be redacted prior to public
inspection.
Outreach and Education
While enforcement remains a top priority, community outreach, marketing and education have
become critical components of the program’s efforts to eliminate current unlicensed activity and
prevent future occurrences. The ULA program’s prevention strategy includes a campaign to increase the
public’s awareness of unlicensed activity and promote prevention. To support the campaign, the
Department has a dedicated ULA hotline (1-877-HALT-ULA) where individuals can report suspected
unlicensed health care practice. Other avenues of reporting include a designated email address
([email protected]) and a complaint form that can be printed from the program’s website and
mailed. Key to the program is educating health care consumers of the importance of and how to verify
the license of their health care provider through the MQA License Verification website. The program
also has a designated Unlicensed Activity Liaison whose primary function is public outreach, law
enforcement collaboration and training.
Marketing of ULA resources is accomplished through various means, including public service
announcement movie trailers, online digital campaigns, billboards and bilingual gas pump toppers
located in specific regions of the state (see Figure 1). A digital video campaign during March and April of
2015 garnered nearly 930,000 impressions from movie goers in the Tallahassee, Jacksonville and
Panama City markets. Additionally, the ULA program partners with the Department’s Bureau of
Environmental Health, Migrant Farmworker Housing Program to conduct outreach within migrant
communities. Bilingual presentations are designed to educate migrant farmworkers about the dangers
of unlicensed health care providers and to share information on making informed health care decisions.
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Finally, the ULA program sends educational and training materials to law enforcement agencies and
private medical providers to increase awareness and recognition of unlicensed activity.
Collaboration
Florida law establishes that the unlicensed practice of a health care profession is a criminal
offense; however, the Department does not have jurisdiction to criminally prosecute unlicensed activity
cases.7 The statutory authority given to the Department allows for the issuance of civil citations and
orders to cease and desist all unlicensed activity. Collaboration with local law enforcement agencies and
state attorney offices is critical to the success of the ULA program. The program works in conjunction
with law enforcement and state attorneys to investigate, arrest and prosecute individuals practicing
health care professions without a license.
Although non-sworn, many ULA investigators have law enforcement experience from prior
careers as detectives or police officers. This experience allows investigators to develop strong
relationships within the law enforcement community and work cooperatively with local law
enforcement agencies on joint investigations of unlicensed activity in Florida. These collaborative
investigations have produced many notable successes in protecting the public.
Collaboration Success
In 2005, the ULA program produced a ten-minute educational video highlighting the positive
results from the program’s collaborative efforts with law enforcement agencies. The video showcased
high-profile arrests and operations along with the benefits of inter-agency cooperation. It was presented
at trade shows, conferences and inter-agency meetings to reinforce existing relationships and
encourage new partnerships.
A Collaborative Case
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Johnnie and Christine felt that they had nowhere else to turn. By early 2013, Johnnie was
diagnosed with stage-4 lung cancer and received a grim prognosis. Lynnette Blake—a wife, mother and
proclaimed survivor of cancer—pretended to be a licensed medical doctor who performed various
medical procedures, claiming she could cure terminally ill patients from cancer. At her clinic, Back To
Eden Wellness Center, Blake treated Johnnie, professing that she could cure his cancer through
alternative medicine.8
Christine watched as her husband of 15 years grew more and more ill. The alternative, unproven
treatments seemed to be doing more damage than good. Over the course of his eight treatments with
Blake, Johnnie was placed on a 21-day diet and received a series of unknown drugs through intravenous
injections. In June 2013, shortly after completing his treatments with Blake, Johnnie passed away.9
On August 6, 2013, Blake was arrested on 12 counts of criminal conduct: five for the unlicensed
practice of a health care profession, five for the unlicensed practice of naturopathy and two counts for
the unlicensed practice of dentistry. Interviews conducted with several patients revealed that Blake had
placed tooth bleaching substances into the patients’ mouths. Upon arrest, Blake told investigators that,
as a naturopathic doctor and member of the Pastoral Medical Association, she was exempt from Florida
laws requiring licensing for health care professions.10
After being convicted of all counts charged, Lynnette Blake appeared repentant at the
sentencing hearing on August 1, 2014. According to Blake, her intentions were “to help people, never
hurt.”11 The Martin County Judge allowed Blake to make her statements and apologies to the victims of
her admitted scheme. Witnesses and surviving family members of Blake’s victims gave emotional
accounts of their experiences and losses. The judge sentenced her to 15 years in prison.
During the joint operation between the West Palm Beach ULA unit and the Martin County
Sheriff’s Office (MCSO), it was discovered that Lynnette Blake had gone to great lengths to pose as a
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medical doctor at the Back To Eden Wellness Center. Many of her patients had terminal cancer
diagnoses and hoping to live beyond the scope of their disease, sought her alternative health care
services. In the investigation by ULA and MCSO, it was determined that Blake created fake transcripts
and medical school diplomas to deceive people.
The Program’s Impact
As is the case with other states, Florida does not have a mechanism for tracking the total
number of unlicensed health care practitioners that are still at-large. This makes it difficult to fully
measure the impact of the program on reducing unlicensed activity in Florida. To ensure that the
program is meeting its objectives and goals, the Department measures the program’s impact based on
certain metrics which are listed in the MQA annual report each year. The metrics include: complaints
received, complaints referred for investigations, completed inquiries, completed investigations, cease
and desists issued, and investigations referred to law enforcement. The data sets in the annual report
are also used to inform program administration of the geographic regions and specific professions with
high numbers of unlicensed activity cases so more targeted communication and marketing can be
implemented.
Florida is home to large immigrant and minority populations. According to the 2010 Census
data, minority groups make up almost half of Florida’s total population (see Table 2). Individuals from all
demographic categories can become victims of unlicensed activity; however, there are high instances of
unlicensed health care in areas with large minority and immigrant populations in Florida and other
states, such as Nevada and California.12,13 U.S. Census data indicates there are larger concentrations of
minority and immigrant populations in the south and central regions of Florida. Similarly, from fiscal
year 2011-2012 to fiscal year 2014-2015, there were greater numbers of unlicensed activity cases in
these regions than there were in north Florida (see Table 3).
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The prevalence of unlicensed activity in these population groups is influenced by many complex
factors, including sociocultural differences, communication barriers between physicians and patients,
high rates of poverty or unemployment and lack of access to services from licensed health care
practitioners. Cultural and linguistic barriers between patients and health care providers can have
negative effects on health outcomes and patients who experience such barriers are less likely than
others to have an established source of medical care.14,15 In certain regions of Florida, a large
percentage of the population over five years of age do not speak English (see Figure 2).16 To address
these factors and barriers, many of the public resources provided by the ULA program are strategically
designed to reach a broad range of demographic categories.
In addition to the prevalence of unlicensed activity within immigrant and minority populations
in Florida, certain professions have significantly greater numbers of unlicensed activity cases than others
(see Table 4). Massage therapy and medicine are professions that have consistently high numbers of
unlicensed activity cases. In fiscal year 2013-2014, unlicensed activity cases involving the practice of
massage therapy and medicine combined were almost half (48%) of the total number of cases (see
Figure 3). The professions of dentistry and opticianry, which include dental laboratories and optical
establishments, also attract unlicensed practice. In fiscal year 2014-2015, a majority (73%) of the
unlicensed activity cases involved the practice of massage therapy, medicine, dentistry or opticianry (see
Figure 4). Based on the demographic composition of Florida and the high number of unlicensed activity
cases in particular regions, the ULA program has created public service announcements and bilingual
educational materials to target these diverse groups.
Lessons Learned and Recommendations
Florida combats the enduring problem of unlicensed activity through its ULA program, which has
several key components:
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1. State legislation provides a critical backbone
Legislative activities over the years have allowed the program to grow and more effectively
enforce the law. Any state-run initiative requires a statutory basis on which to stand. As evidenced in the
history of the ULA program in Florida, legislative support and statutory authority to take action against
unlicensed practitioners is a foundational program component. Without the legislative authority to issue
cease and desist orders and citations, the ULA program would be less effective.
2. Secure a reliable funding source
Continuous funding is critical to initiating and maintaining a robust unlicensed activity program.
Florida’s ULA program is funded through both licensure/renewal fees and collection of fines and
investigative costs, which are credited to a specific ULA fund. The fees are collected from all initial health
care license applicants and licensees who are renewing a license. The fines are assessed from unlicensed
health care practitioners, who may also be required to pay the cost of the ULA investigation and any
further prosecution. The ULA program received approximately $2.5 million in licensure fees and
$150,000 in fines and investigative costs in fiscal year 2014-2015. Although the annual revenues
fluctuate slightly from year to year, the continual collection of these fees and fines provides consistent
funding to carry out investigations and enforcement operations.
3. Develop reliable data collection methods to assess performance
Reliable performance metrics are critical to assessing the program’s impact and progress toward
accomplishing goals and objectives. The ULA program has measures impacting its performance with a
clearly defined and consistent method for collecting data—something that has not always been in place.
One measure that has changed, for example, is the number of arrests resulting from unlicensed activity
cases. This data was listed in the MQA annual report until fiscal year 2013-2014. After evaluation, arrest
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data is no longer reported because arrests are made by law enforcement agencies and, therefore, are
not a direct reflection of the ULA program’s performance. Current measures, such as the number of
complaints received and cease and desists issued, are internal to the ULA program and can more
accurately reflect the performance of the program over time. In 2014-2015, the ULA program had a 72
percent increase in cease and desists issued compared to the previous fiscal year. The fluctuation in data
collection methods and measures of program performance over nearly 20 years of program operations
has resulted in some limitations in the assessment of the ULA program’s impact.
4. Develop strategic partnerships with law enforcement and state attorneys
Florida law grants the ULA program authority to issue civil citations and cease and desists to
violators. Because of this limited authority, collaborative relationships with law enforcement agencies
and state attorneys are essential to ensuring that violators are criminally prosecuted in accordance with
the law. Developing strategic partnerships with other state and local agencies, like law enforcement, is a
major component of any program of this nature.
5. Build strong investigations for criminal prosecution
In the early years of the ULA program, most cases were referred to state attorney offices for
further prosecution. Due to factors such as lack of resources, knowledge and legal sufficiency to pursue
the case in a criminal capacity, many of the unlicensed practitioners were never prosecuted once the
investigation was transferred to the state attorney. Over the years, investigators have been trained to
build complete investigative reports with legally sufficient information to present to the state attorneys.
Today, the ULA program’s investigative files are often the backbone of criminal investigations resulting
in misdemeanor and felony arrests. The program is constantly evaluating its investigative reporting
process.
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6. Take a preventative approach
Since the first program office opened in Fort Lauderdale in 1998, the ULA program has
continued to combine reactive efforts in investigating complaints received with proactive efforts to
prevent future unlicensed activity by educating the community through outreach and targeted
messaging. Over time, the program’s administration learned that consumers were unaware of the scope
and dangers of unlicensed practice. From this, the program developed its outreach campaign ensuring
educational materials were in English and Spanish. Various educational and outreach efforts include
profession-specific public service announcements, billboards, brochures and gas pump toppers.
Education has increased public awareness and provided a platform to find, investigate and prosecute
violators.
Conclusion
In the aftermath of Hurricane Andrew, unlicensed contractors preyed upon victims of the
devastation. This prompted state and local officials to begin taking steps to protect consumers from all
unlicensed activity. Today, Florida’s ULA program works diligently to enforce licensure regulations and
prevent unlicensed activity. Florida was the first state with a separate, designated program specifically
designed to combat unlicensed activity. Florida’s ULA program has been recognized for its unique and
proactive approach in addressing this national issue and due to its success, other states have used
Florida’s program model to fight against unlicensed activity.17
Although there are limitations to evaluating the scope of the problem nationally, most states
have enacted laws through medical and health care practice acts to prevent the unlicensed practice of a
health care profession. Both prevention and enforcement are important components in the fight against
unlicensed activity at a state and national level. Prevention requires a combination of outreach to
promote public awareness of the issue and encouraging licensed health care practitioners and
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consumers to report any and all suspected unlicensed activity. Enforcement requires statutory authority
to investigate and prosecute violators, and partnerships with state regulators and law enforcement
agencies.
After an analysis of program results and refinement of performance measures, the focus has
been shifted from a primary emphasis on enforcement to a broader prevention campaign that includes
outreach and education efforts. The results of this shift show an increase in unlicensed activity
reporting, allowing for the ULA program to conduct better investigations and issue more cease and
desist orders to violators. Initiatives like Florida’s ULA program are long-term and require continuous
evaluation to guide evidence-based strategies and direct program activities.
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References
1. This general definition was derived from a compilation of definitions listed in each state’s medical
practice act. Some states also include advertisement and the act of holding oneself out as a licensed
health care practitioner in the definition of unlicensed activity. For a list of medical practice acts by
state, see: Nevada Division of Public and Behavioral Health, Unlicensed Healthcare Task Force. Table
of Medical Practice Acts.
http://www.health.nv.gov/PDFs/unlicensedMedicalActivity/Table_of_Medical_Practice_Acts.pdf
Accessed June 2015.
2. De Ville KA. Medical Malpractice in Nineteenth-Century America: Origins and Legacy. New York, NY:
New York University Press; 1990.
3. Council of State Governments. Occupational Licensing Legislation in the States. Chicago, IL. Council
of State Governments; 1952.
4. The Circuit Court of the Eleventh Judicial Circuit of Florida in and for the County of Dade. Spring
Term A.D. 1992: Final Report Of The Dade County Grand Jury. Miami, FL; 1992.
5. Florida Department of Professional Regulation. Fiscal Year 1990-1991 Statistical Charts.
http://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/90-
91doh-ar.pdf. Accessed May 27, 2015.
6. Florida Department of Professional Regulation. Fiscal Year 1993-1994 Annual Report.
http://www.floridahealth.gov/licensing-and-regulation/reports-and-publications/_documents/93-
94mqa-ar.pdf. Accessed May 27, 2015.
7. FS (Florida Statutes) 456.065.
8. This story is based on the case of Johnnie Hughes who died in June 2013 of lung cancer that was
accelerated by alternative, unproven treatments prescribed by Lynette Blake. The story received
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media coverage in Florida, and both online newspaper articles and Florida Department of Health
press releases were used to assemble this fact pattern.
9. LaGrone K. Cases highlight problem in med spa industry. WPTV Contact 5. February 24, 2014.
http://www.wptv.com/news/local-news/investigations/cases-highlight-problem-in-med-spa-
industry. Accessed May 2015.
10. The Florida Department of Health, Office of Communications. Joint Investigation Leads to Arrest and
Conviction in Martin County, Press Release. August 4, 2014.
http://www.floridahealth.gov/newsroom/2014/08/080414-ula-actions-martin-county.html.
Accessed May 2015.
11. LaGrone K. Lynnette Blake: Woman sentenced to 15 years for posing as a doctor. WPTV Contact 5.
August 4, 2014. http://www.wptv.com/news/local-news/investigations/lynnette-blake-woman-
sentenced-to-15-years-for-posing-as-a-doctor. Accessed May 2015.
12. Latino Research Center. !NO A Los Médicos Clandestinos! – Public Awareness Campaign. University
of Nevada, Reno; 2012. Available at:
http://www.health.nv.gov/PDFs/unlicensedMedicalActivity/LatinoResearchCenterFinalReport.pdf.
Accessed June 4, 2015.
13. Medical Board of California. Operation Safe Medicine Returns July 2009. Medical Board of California
Newsletter--July 2009. Available at:
http://www.mbc.ca.gov/publications/newsletters/newsletter_2009_07.pdf. Accessed June 4, 2015.
14. The Sullivan Commission. Missing Persons: Minorities In The Health Professions, A Report Of The
Sullivan Commission On Diversity In The Healthcare Workforce. 2004. Available at: http://health-
equity.pitt.edu/40/1/Sullivan_Final_Report_000.pdf. Accessed June 19, 2015.
15. Flores G. Language Barriers to Health Care in the United States. N Engl J Med. 2006;355(3):229-231.
DOI:10.1056/nejmp058316.
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16. Floridacharts.com. Florida CHARTS Population Characteristics Data. 2015. Available at:
http://www.floridacharts.com/charts/PopulationCharacteristics/. Accessed June 24, 2015.
17. Del Papa FS. Responding to Unlicensed Health Care in Nevada: A Plan for Action.
http://www.health.nv.gov/PDFs/unlicensedMedicalActivity/RespondingToUnlicensedHealthCareNV-
ActionPlanFinal.pdf. Published June 2012. Accessed June 1, 2015.
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Tables:
Table 1. Annual Program Revenues and Expenditures from 2012-2015
Fiscal Year Total
Revenues1 License
Fees Fines Total
Expenditures2 Personnel
Costs Outreach
Costs3
2012-2013 $2,234,339 $2,125,122 $109,217 $1,043,930 $930,708 $113,222
2013-2014 $2,422,574 $2,314,458 $108,116 $956,216 $861,789 $94,427
2014-2015 $2,516,334 $2,361,686 $154,648 $1,258,581 $964,195 $294,386 1 Total revenues include monies received from both licensure/renewal fees collected and fines and investigative costs collected. 2 Total expenditures include expenses for personnel, outreach and enforcement. Both outreach and personnel expenses also include enforcement expenses since enforcement requires investigative personnel time and travel. 3 Outreach costs include expenses related to advertising, communications, travel, equipment and vehicle rentals, educational and training supplies, research services, printing and postage costs, and general outreach commodities (i.e. conference vendor booth registrations).
Table 2. Majority and Immigrant and Minority Populations in Florida and Selected Counties1
Place Total
Population Majority % of Total Population
Immigrant and Minority
% of Total Population
Florida 18,801,310 10,884,722 57.9% 7,916,588 42.1%
Miami-Dade County 2,496,435 383,551 15.4% 2,112,884 84.6%
Broward County 1,748,066 760,817 43.5% 987,249 56.5%
Palm Beach County 1,320,134 793,571 60.1% 526,563 39.9%
Hillsborough County 1,229,226 660,565 53.7% 568,661 46.3%
Orange County 1,145,856 526,754 46.0% 619,102 54.0%
Osceola County 268,685 108,292 40.3% 160,393 59.7% 1 Florida Legislative Office of Economic and Demographic Research, 2010 Census Redistricting Data (Public Law 94-171) Summary File, Generated on March 17, 2011.
Table 3. ULA Cases in Florida by Geographical Region from 2011-2015
Fiscal Year Total No. of
Cases1 No. of Cases in South
Florida2 No. of Cases in Central
Florida3 No. of Cases in North
Florida4
2011-2012 165 55 61 49
2012-2013 190 69 65 56
2013-2014 238 79 85 74
2014-2015 398 130 175 87 1 Total number of cases is based on legally sufficient investigations resulting in the issuance of a cease and desist order and/or a civil citation. 2 The counties in South Florida include Martin, Palm Beach, Broward, Miami-Dade, Monroe, Charlotte, Glades, Lee, Hendry and Collier. 3 The counties in Central Florida include Marion, Sumter, Lake, Seminole, Orange, Osceola, Polk, Hardee, Highlands, Volusia, Brevard, Indian River, Okeechobee, Saint Lucie, Citrus, Hernando, Pasco, Pinellas, Hillsborough, Manatee, Sarasota and DeSoto. 4 The counties in North Florida include Gadsden, Leon, Wakulla, Jefferson, Madison, Taylor, Hamilton, Suwannee, Lafayette, Dixie, Columbia, Union, Bradford, Gilchrist, Alachua, Levy, Baker, Nassau, Duval, Clay, Saint Johns, Putnam, Flagler, Escambia, Santa Rosa, Okaloosa, Walton, Holmes, Washington, Bay, Jackson, Calhoun, Liberty, Gulf and Franklin.
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Table 4. Most Represented Professions in Annual ULA Cases from 2011-2015
Fiscal Year Total Cases
Massage Therapy Medicine Dentistry Opticianry Other1
2011-2012 165 37 15 17 22 74
2012-2013 190 29 39 21 46 55
2013-2014 238 78 36 26 21 77
2014-2015 398 179 37 17 56 109 1 Other professions are listed in the Division of Medical Quality Assurance Annual Report for the fiscal years listed.
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Figures:
Figure 1. Location of ULA Program Bilingual Gas Pump Toppers as of December 2014
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Figure 2. Percentage of Individuals Over 5 That Do Not Speak English by Region1 as of 2010
Census2
1 Values for the Number of Persons Over 5 that Do Not Speak English are the sum of all counties in each region. Regional values for the Percent of Persons Over 5 that Do Not Speak English were calculated by dividing the Number of Persons Over 5 that Do Not Speak English by the regional total number of persons over 5 (from 2010 Census data), expressed as a percentage. 2 Data source: Florida Department of Health, Bureau of Vital Statistics. County-specific data can be retrieved from http://www.floridacharts.com/charts/OtherIndicators/NonVitalIndRateOnlyDataViewer.aspx?cid=0299.
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Figure 3. Percent of ULA Cases by Profession1 in Fiscal Year 2013-2014
1 Other professions are listed in the Division of Medical Quality Assurance Annual Report for the fiscal years listed.
Figure 4. Number of ULA Cases by Profession1 for Fiscal Year 2014-2015
1 Other professions are listed in the Division of Medical Quality Assurance Annual Report for the fiscal years listed.
33%
15%11%
9%
32%
Massage Therapy Medicine Dentistry Opticianry Other
Other27%
Massage Therapy, Medicine, Dentistry
and Opticianry73%
0 20 40 60 80 100 120 140 160