“4 STATE OF FLORIDA ig | 2 DEPARTMENT OF HEALTH “U~, © DEPARTMENT OF HEALTH, ) | PETITIONER, 5 00-01 a v. CASE NO. 1996-10365 . DAVID R. WEBB, M_D., , RESPONDENT. ee) ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, Department of Health, hereinafter referred to as “Petitioner,” and files this Administrative Complaint before the Board of Medicine against David R. Webb, M_D., hereinafter referred to as “Respondent,” and alleges: 1. Effective July 1, 1997, Petitioner is the state agency charged with regulating the practice of medicine pursuant to Section 20.43, Florida Statutes; Chapter 455, Florida Statutes, and Chapter 458, Florida Statutes. Pursuant to the provisions of Section 20.43(3), Florida . Statutes, the Petitioner has contracted with the Agency for Health Care Administration to provide consumer complaint, investigative, and prosecutorial services required by the Division of Medical Quality Assurance, councils, or boards, as appropriate. 2. Respondent is and has been at all times material hereto a licensed physician in the state of Florida, having been issued license number ME 0050512. Respondent’s last known address is 696 Harbor Is., Clearwater, FL 34630-1803. 3. Respondent practices in the area of emergency medicine and is board certified for that specialty. ‘ WU . WW 4, At all relevant times, Respondent was Medical Director for Pinellas County Jail through his employment with EMSA Correctional Care, Inphynet Medical Management, Plantation, Florida. 5. At all relevant times, Patient MB was a 24-year old female inmate at the Pinellas County Jail, with a history of cocaine abuse, obesity, non cardiogenic pulmonary edema, and ejection fraction of 30% by echocardiograpy. 6. Between February and late March, 1996, Patient MB had multiple contacts with health care providers at Pinellas County Jail for various complaints, including abdominal pain, chest pain, difficulty breathing, nausea, and vomiting. 7. On or about March 31, 1996, Patient MB developed weakness, vomiting, and difficulty walking. The nursing assessment on that date indicated tachypnea and lower extremity edema. 8. On or about April 1, 1996, Patient MB was evaluated by Mr. Caruso, a physician assistant who reported to Respondent. Mr. Caruso felt that Patient MB was depressed and requested psychiatric evaluation and lab studies. The ordered lab studies (CBC and Chem 7) were not obtained. 9. On or about April 2, 1996, upon observing Patient MB, the psychiatric evaluator noted psychomotor agitation with impoverished speech and recommended psychiatric evaluation. 10. | Onor about the evening of April 2, 1996, Patient MB was found face down in her cell, unresponsive, with hypotension. The nursing staff responded by administering oxygen, establishing IV access, and obtaining several electrocardiograms. Three EKGs were obtained One oS) which demonstrated evidence of lateral ischemia, which the attending nurses felt to be new and abnormal for this patient. _ 11. | When Respondent was advised on the evening of April 2, 1996, of Patient MB’s condition, Respondent requested that the attending nurses continue IV therapy, obtain more frequent vital signs, and monitor the patient. Respondent, however, did not come to the Pinellas County Jail that evening nor recommend that patient MB be transferred to a hospital emergency department. 12. Medical records indicate that later during the evening of April 2, 1996, attending nurses performed an Accucheck demonstrating hypoglycemia, and administered dextrose resulting in gradual improvement in Patient MB’s level of consciousness. According to nursing assessments that evening, patient MB remained hypotensive but eventually “‘stabilized.” 13. Respondent did not call back during the night of April 2 nor in the early morning hours of April 3, 1996, to check on the status of patient MB. In fact, upon his arrival at Pinellas County Jail at or about 7:00 a.m. on the moming of April 3, 1996, Respondent did not check on Patient MB. 14. Patient MB remained hypotensive and weak after 7:00 a.m., on the morning of April 3, 1999. 15. Upon being evaluated by physician assistant Caruso around 10:30 a.m. on April 3, 1996, Patient MB was found to be tachypneic and hypotensive. Mr. Caruso reported these observations to Respondent at about 11:30 am. that same morning and requested that Respondent evaluate Patient MB at once. Instead, Respondent asked that Mr. Caruso accompany him with his regular rounds with all patients of the day. 16. Thereafter, Patient MB became more profoundly hypotensive, and, around 12:10 p.m. on April 3, 1996, staff issued a page to Respondent, which was not returned. _ 17. Subsequently, staff issued an emergency page to Respondent, which was returned. Respondent arrived to see Patient MB around 12:40 p.m., at which time Respondent authorized that 911 be called for emergency transport of patient MB. 18. Paramedics arrived shortly thereafter and transported Patient MB to a local hospital, where she suffered a cardiopulmonary arrest shortly after her arrival, and was pronounced dead after resuscitation efforts failed. 19, An earlier evaluation and diagnosis of Patient MB’s condition would likely have resulted in earlier treatment that would have decreased the chances of her untimely death. 20. | Respondent failed to consider the seriousness and potential life threatening nature of Patient MB’s clinical presentation and course after the reports he received on the evening of April 2, 1996. 21. A reasonably prudent physician under similar conditions and circumstances would have come to the Pinellas County Jail to examine Patient MB and personally reviewed the . results of her tests and condition sooner than Respondent did in this case. 22. Respondent failed to meet the standard of care by failing recognize life threatening symptoms and failing to see and evaluate the patient in a timely manner. 23. Respondent also failed to direct appropriate management of the patient considering the nature of the presentation and lack of appropriate diagnostic modalities in the jail setting. 24. Patients in the condition presented by Patient MB require, at a minimum, continuous cardiac rhythm monitoring and rapid assessment of blood oxygenation and acid-base status through pulse oximetry and laboratory studies. Although these diagnostic modalities were not available in the jail setting, they were readily available at local emergency departments within driving distance of the jail. 25. A reasonably prudent physician under similar conditions and circumstances would have ordered transfer of Patient MB to a local hospital early in the morning of April 3, 1996, where proper diagnostic modalities were available for her care. 26. Respondent failed to meet the standard of care by failing to timely order a transfer of Patient MB to a local hospital. 27. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes, by 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. WHEREFORE, the Petitioner respectfully requests the Board of Medicine enter an order imposing one or more of the following penalties: permanent revocation or suspension of the . Respondent’s license, restriction of the Respondent’s practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, the assessment of costs related to the investigation and prosecution of this case as provided for in Section 455.624(4), Florida Statutes, and/or any other relief that the Board deems appropriate. SIGNED this £8 day of , 2000. Robert G. Brooks, M.D., Secretary FILED DEPARTMENT OF HEALTH LERK Caen, Chief Medical Attorney paTe__ |“25- COUNSEL FOR DEPARTMENT: Kathryn L. Kasprzak Chief Medical Attorney Agency for Health Care Administration P. O. Box 14229 Tallahassee, Florida 32317-4229 Florida Bar # 937819 CLG/clg PCP: January 22, 2000 PCP Members: Ashkar, Glotfelty, Rodriguez PATIENT INDEX DAVID R. WEBB, MD. Case No. 1996-10365 Patient MB... Melanie Bird Please refer to all patients by initials. Patient names and records are confidential.

Docket for Case No: 00-000764