STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO. 2004-19966 x Mathew J. Kachinas, M.D., S RESPONDENT. / 8 ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Medicine against the Respondent, Mathew J. Kachinas, M.D., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practice of medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 458, Florida Statutes. Respondent’s address of record is 1590 Harbor Cay Lane, 2. Longboat Key, Florida 34228. J:\pSU\medical\michael Milnes\ac Mike\Kachinas, Mathew J. AC.doc 3. At all times material to this Complaint, Respondent was a licensed physician within the State of Florida, having been issued license number ME 65595, 4. Respondent is not Board Certified. 5. On or about March 26, 2004, B.S. traveled from Jacksonville, Florida, and presented to Premier Institute for Women’s Health (PIWH) for an elective termination of pregnancy. 6. __ Respondent is the Obstetrician/Gynecologist who handled B.S.'s procedure at PIWH. . | 7. On or about March 26, 2004, Respondent determined B.S.'s pregnancy at approximately twenty-three and a half (2372) to twenty-four (24) weeks gestation, the last week of the second trimester. 8. On or about March 26, 2004, Respondent states he ordered and then reviewed a sonogram of B.S. and diagnosed the gestational age at twenty-four weeks. 9. On or about March 26, 2004, Respondent began the induction of labor procedure, by ordering the insertion of a Laminaria, an osmotic cervical dilator which causes the cervix to open and allows easier emptying of the uterus. The fetus was injected with Digoxin, which is injected J:\pSU\medical\michael Milnes\ac Mike\Kachinas, Mathew J. AC.doc 2 directly into the fetus to stop the fetal heartbeat, causing an Intrauterine Fetal Demise (IUFD). B.S. was then released from PIWH. 10. On or about March 27, 2004, Respondent continued with the induction procedure by administering Cytotec and high does Pitocin to B.S. to induce labor. 11. On or about March 27, 2004, at approximately 6:30pm, Respondent transferred and had B.S. admitted to Doctors Hospital of Sarasota (DHS) for failure to progress with the induction of labor procedure. 12. Respondent's principal admitting diagnosis was an IUFD at twenty-four (24) weeks, failure to dilate, and intolerance to the induction of labor. B.S. was admitted for an Exploratory Laparotomy, Hysterotomy, evacuation of the fetus, and Bilateral Tubal Ligation. 13. Respondent performed the above described procedures on patient B.S. 14. On or about March 28, 2004, following B.S. surgery, Respondent listed the post-operative diagnosis as a failure to induce labor, an intrauterine fetal demise (IUFD), a thin umbilical cord, and asymmetric intrauterine growth retardation (IUGR), a condition in which the fetus is smaller than expected for the number of weeks of pregnancy. J:\pSU\medical\michael Milnes\ac Mike\Kachinas, Mathew J. AC.doc 3 15. Respondent lists in the DHS medical records that a single non- viable male fetus was removed:from the uterine cavity. The condition of the fetus indicated an IUFD of at least forty eight hours. 16. On the fetal death certificate, Respondent listed the immediate Causes for the IUFD as a probable cord incident and multiple placental infarctions. The fetus died before labor and the clinical estimate of | gestation is twenty-four (24) weeks. 17. Placental infarctions are small deposits of a fibrous protein, caused by interference with the maternal circulation, which occur normally in the placenta as pregnancy progresses. Placental infarctions usually do not affect the fetus unless the process is extensive. 18. On the fetal death certificate, Respondent did not document the elective termination or the Digoxin injection. 19. There are no indications in the medical records or the autopsy report that suggests the fetus suffered a cord incident. This is in contradiction to Respondent's diagnoses. . 20. On or about April 26, 2004, the autopsy report from Sarasota Pathology reported a stillborn male with no obvious congenital anomaly, no intracranial hemorrhage and normal heart, lungs, and liver. The autopsy report does not indicate extensive placental infarctions or that the J:\pSU\medical\michael Milnes\ac Mike\Kachinas, Mathew J. AC.doc 4 infarctions caused any harm to the fetus. This is in contradiction to Respondent's diagnoses. 21. Respondent does not document an adequate patient history in the medical records. 22. Respondent does not document a physical examination prior to the insertion of the Laminaria in the medical records. 23. Respondent does not document the use of the Digoxin in the medical records. 24. Respondent does not document the time of the fetal demise in the medical records. 25. Respondent falsified the cause of death on the fetal death certificate. COUNT ONE 26. Petitioner realleges and incorporates paragraphs one (1) through twenty-five (25) as if fully set forth herein. 27. Section 456.072(1)(1), Florida Statutes (2003), provides making or filing a report which the licensee knows to be false, intentionally or negligently failing to file a report or record required by state or federal law, or willfully impeding or obstructing another person to do so constitutes grounds for disciplinary action by the Board of Medicine. J:\pSU\medical\michael Milnes\ac Mike\Kachinas, Mathew J. AC.doc 5 28. Respondent made or filed a report which the licensee knows to be false in one or more of the following ways: a. By listing the cause of death on the fetal death certificate as stillborn by a probable cord incident, when the actual cause of death was the Digoxin injection administered during the elective termination procedure; b. By failing to include the elective termination of pregnancy, by digoxin injection, on the fetal death certificate. 29. Based on the foregoing, Respondent violated Section 458.331(1)(I), Florida Statutes (2003), by making or filing a report which the licensee knows to be false, intentionally or negligently failing to file a report or record required by state or federal law, or willfully impeding or obstructing another person to do so. COUNT TWO 30. Petitioner realleges and incorporates paragraphs one (1) through twenty-five (25) as if fully set forth herein. | 31. Section 458.331(1)(m), Florida Statutes (2003), provides failing to keep legible, medical records, identifying the licensed physician by name and professional title, who is or are responsible for rendering, ordering, J:\pSU\medical\michael Milnes\ac Mike\Kachinas, Mathew J. AC.doc 6 supervising, or billing for each diagnostic or treatment procedure, and justifies the course of treatment of the Patient, including but not limited to, Patient histories; examination results; test results, records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations constitutes grounds for disciplinary action by the Board of Medicine. 32. Respondent failed to keep legible, medical records that document the justification for the course of treatment in one or more of the following ways: a. By failing to document an adequate patient history; b. By failing to document a physical examination prior to the insertion of the Laminaria; c. By failing to document the time of the fetal demise; od. By falsifying the fetal death certificate. 33. Based on the foregoing, Respondent violated Section . 458,331(1)(m), Florida Statutes: (2003), by failing to: keep legible, medical records that identify the licensed physician by name and professional title, who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure, and justifies the course of treatment of the Patient, including but not limited to, Patient histories; J:\pSU\medical\michael Milnes\ac Mike\Kachinas, Mathew J. AC.doc 7 examination results; test results, records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. COUNT THREE 34. Petitioner realleges and incorporates paragraphs one (1) | through twenty-five (25) as if fully set forth herein. 35. Section 458.331(1)(t), Florida Statutes (2003), provides that failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances constitutes grounds for disciplinary action by the Board of Medicine. 36. Respondent failed to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar circumstances, in one or more of the following ways: a. By failing to obtain an adequate patient history; b. By failing to perform a physical examination prior to the insertion of the Laminaria; c. By failing to document the time of the fetal demise. 37. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2003), by failing to practice medicine with J:\pSU\medical\michaet Milnes\ac Mike\Kachinas, Mathew J. AC.doc 8 that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. WHEREFORE, the Petitioner respectfully requests that the Board of Medicine 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 the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. J:\pSU\medical\michael Milnes\ac Mike\Kachinas, Mathew J. AC.doc 9 > ' r | SIGNED this _— day of - 2007. Ana M. Viamonte Ros, M.D., M.P.H. Secretary of Health lf (| Michael D. Milnes Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 DEPARTMENT OF HEALTH Tallahassee, FL 32399-3265 CLERK RCO KOCk Florida Bar # 0857491 paTe__