STATEOFFLORDA ne, ~ DEPARTMENT OF HEALTH ge DEPARTMENT OF HEALTH, (0-168 ) ) PETITIONER, ) ) v. ) CASE NO. 96-11304 ) ) ) ) RONALD STUART HOFFMAN, M.D., RESPONDENT. 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 Robert Stuart Hoffman, 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 Ageny for Health Care Administration to provide address t is 20 North ¥ Westmont Drive, Suite B, Altamonte Springs, Florida 32714-3392. 3. On or about September 25, 1995, J. P., a sixty- ‘six (66) year old male with a history of insulin de dependent diabetes, presented to > the Respondent’ s office with a complaint of inability to sleep and a dry cough. The patient also needed medical clearance for the performance of scheduled surgery on his hand. 4. On or about September 25, 1995, the Respondent’s Physician Assistant (hereinafter referred to as the P. A.) examined Patient J. P. 5. The P. A., after examining the patient, recorded in the medical records an abnormal EKG, stating that it showed a sinus rhythm, with poor R wave progression and there was some non-specific ST- T wave abnormalities. The PA, noted that he was ordering a stress test prior to - clearing the patient for surgery. 6. On or about September 27, 1995, Patient J. P. went to the hospital to take the cardiac stress test as ordered by the Respondent’s P. A. on September 25, 1995. 7. Upon arrival at the hospital, Patient J. P. was taken into the building in a wheel chair, as he was unable to walk. The nurse decided that the patient was in no condition to perform a stress test and called the Respondent’s office and informed them of the patient’s condition. 8. On or about September 27, 1995, Patient J. P. left the hospital and went to the Respondent’s office. . | — 9. Upon presentation to the Respondent’ s office, the patient was examined by the P.A., t retuned with a two 2 @) day history of i increasing shortness of 10. The PA. made a diagnosis of probable Congestive Heart Failure, which was es cfm bya a chest wera. ay discussed the cas Vg 11. The Respondent concurred and made a decision to treat Patient J. P. with “aggressive out-patient therapy”. 12. Under these circumstances, a reasonably prudent similar physician would have admitted the patient to a hospital, or consulted with a cardiologist to determine the etiology of the congestive heart failure. 13. Patient J. P., who had no prior history of cardiac problems, was given an ACE inhibitor, Digoxin, Potassium and Lasix twice daily. 14. On or about September 27, 1995, the P. A. informed Patient J. P. that the Respondent’s office would no longer be a provider for his insurance company and that he would need to follow up with his new PCP as soon as possible. Patient J. P. was also informed that he should go to hospital emergency room if his clinical condition worsened. 15. On or about September 27, 1995, at approximately 3:15 p. m., the Respondent’s office was contacted and informed that Patient J. P. was worsening. The P. A. told the family to take the patient to the hospital emergency room to be evaluated. 16. The Respondent notes in the medical record, dated September 27, 1995, that he had goneurred with the PAs diagnosis. The Respondent d does not indicate whether or not he examined the patient, but he does note several ° times that the ie patient and his wife were told to go the emergency room if his condition worsened. 17. Patient J. P. ‘died approximately 6: 45 p.m. on September 21, 1995. 18. The Respondent declined to admit Patient J. P., a sixty-six (66) year old insulin dependent diabetic, who was too feeble to perform the cardiac stress test, who had no history of cardiac problems, and whom the Respondent diagnosed as having Congestive Heart Failure , to Vw yg the © hospital for determination of the etiology of the heart’ failure, as any prudent physician i in the sartie or similar situation n would have done. COUNT ONE 19. Petitioner realleges and incorporates paragraphs one (1) through eighteen (18), as if fully set forth herein this Count One. - 20. Respondent failed to practice medicine within the acceptable standard of care in that he did not refer the patient to a cardiologist or have the patient admitted to a hospital upon his diagnosis of Patient J. P. as being in Congestive Heart Failure. ‘Respondent failed to independently examine and diagnose the patient on several occasions, relying solely on the observations of his PA. Also, Respondent referred the patient for a cardiac stress test when the patient was unable to perform the test because he was too weak and feeble. 21. Based on the foregoing allegations, the Respondent violated Section 458.331(1)(), Florida Statutes, by failure to practice medicine with that level of care, skill, and treatment which i is recognized by. a » reasonably prudent similar physician as s being acceptable under similar conditions and circ ; COUNT TWO ‘ alleges and incorporates paragraphs one ro) through eighteen (1s) and , veideranh twenty (20), as if fly set forth herein this Count Two. 23. Th Respondent's s medical ‘record for ‘the patient does not ‘document whether o or not he actually examined the Patient or whether he ever saw the Patient and talked with him and his a eee toa is lee opecesceeer eee Cee REE uv u 24. Based on the ¢ foregoing allegations, the Respondent i is in violation of Section 458.331 (1) (m), Florida Statutes by failing to keep legible, as defined by department rule in consultation with the board, medical records that identify the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and that justify 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. COUNT THREE 25. Petitioner realleges and incorporates paragraphs one (1) through eighteen 18), paragraphs twenty (20) and twenty - three (23), as if fully set forth herein this Count Three. 26. Respondent inappropriately prescribed ACE inhibitor, Digoxin, Potassium and Lasix twice daily for Patient J. P, knowing that the patient had Congestive Heart Failure, but not knowing the cause for Patient J. P.’s heart failure. 27. “Based ¢ on the foregoing allegations, the Respondent - is in violation of Section 458.331(1)(q), Florida ‘Statutes by Prescribing, dispensing, administering, mixing, or otherwise ” preparing a legend drug, including any controlled substance, other than in the course of the ’p ysician's professional practice. For the purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, , including all controlled ‘substances, inappropriately or in excessive © oF inappropriate q quantities i is not in the best interest of the patient and is not in ‘the course of the physician's professional * practice without regard to his or her intent,

Docket for Case No: 00-001168