00-4669 FL STATE OF FLORIDA go NOY ta AM IG: 2 DEPARTMENT OF HEALTH pigs: Viola ie ADMIRISTRA. IVE HEARINGS DEPARTMENT OF HEALTH, ) ) PETITIONER, ) ) v. ) CASE NO. 1997-20938 ) JORGE H. PEREZ-PEREZ, 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 Jorge H. Perez-Perez, 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 456, 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 0019979. Respondent's last known address is 1822 East 4" Avenue, Hialeah, Florida 33010-3124. 3. Respondent is board certified in obstetrics and gynecology. 4. On September 2, 1995, Patient M.B., a female then age 25, presented to Hialeah Hospital with uterine contractions. She was in her thirty-seventh (37) week of pregnancy. 5. At approximately 9:35 a.m. on September 2, 1995, Respondent gave physician orders by telephone for Patient M.B., including an order for electronic fetal heart monitoring. Monitoring actually commenced at or about 11:03 a.m. that date. Patient M.B. was admitted to a labor room at approximately 11:50 a.m. The plan of care was for a vaginal delivery. 6. The tracing recorded by the electronic fetal heart monitor indicated virtually no beat-to-beat variability. Beat-to-beat variability is significant in the overall clinical evaluation of the fetus; absence of beat-to-beat variability can indicate fetal distress. At or about 11:50 a.m., a significant fetal heart deceleration (drop in fetal heart rate) occurred. At or about 11:55 a.m., Respondent gave further physician orders by telephone, including intravenous therapy. 7. The tracing continued to indicate virtually no beat-to-beat variability after 11:55 a.m. At or about 12:50 p.m., another significant fetal heart deceleration occurred. At or about 1:00 p.m., the tracing indicated both severe declerations and accelerations. At or about 1:10 p.m., Respondent performed a physical examination of Patient M.B., and an artificial rupture of the patient’s membranes to induce labor. The ‘plan of care remained for a vaginal delivery. 8. Severe decelerations were then recorded at approximately 1:15 p.m., 1:25 p.m., 1:45 p.m., 2:00 p.m., and 2:25 p.m. Respondent performed a physical examination of patient M.B. at 2:30 p.m. and again at 2:45 p.m. The plan of care remained for a vaginal delivery. 9. Further, severe decelerations were recorded at 2:50 pm., 3:15 p.m., and 3:20 p.m. At approximately 3:23 p.m., the patient was transferred to a delivery room. Patient M.B. gave birth by vaginal delivery at approximately 3:31 p.m. on September 2, 1995. 10. The infant was given an Apgar score of 7 at one minute. However, the infant suffered from seizures, and required mechanical ventilation. The infant was transferred to Miami Children’s Hospital on or about September 3, 1995, and was discharged September 18, 1995. The discharge summary from Miami Children’s Hospital indicates findings for the infant consistent with global brain injury. 11. Respondent failed to write progress notes in Patient M.B.’s hospital record for labor and delivery. Respondent further failed to write a narrative summary in Patient M.B.’s hospital record for labor and delivery. UNT ONE 12. Petitioner realleges and incorporates paragraphs one (1) through eleven (11), as if fully set forth herein this Count One. 13. Section 458.331(1)(t), Florida Statutes, provides that the Board of Medicine may take disciplinary action against a licensed medical doctor upon the medical doctor’s failure 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. 14. Respondent violated Section 458.331(1)(t) with regard to Patient M.B. on September 2, 1995, due to one or more of the following facts: a. Respondent failed to take the fetal heart tracings into account in his assessment and evaluation of Patient M.B. at approximately 1:10 p.m., when Respondent induced labor by artificial rupture of the membranes; b. Respondent failed to consider or to seek consultation for a Cesarian section for Patient M.B. at approximately 1:10 p.m., when Respondent induced labor by artificial rupture of the membranes; c. Respondent failed to take the fetal heart tracings into account in his assessment and evaluation of Patient M.B. at approximately 2:30 p.m., when he performed a physical examination of the patient and assessment for vaginal delivery; d. Respondent failed to consider or to seek consultation for a Cesarian section for Patient M.B. at approximately 2:30 p.m., when he performed a physical examination of the patient and assessment for vaginal delivery; e. Respondent failed to perform a Cesarian section or refer the patient for Cesarian section at approximately 2:30 p.m., and instead performed a physical examination of the patient and assessment for vaginal delivery; f. Respondent failed to take the fetal heart tracings into account in his assessment and evaluation of Patient M.B. at approximately 2:45 p.m., when he performed a physical examination of the patient and assessment for vaginal delivery; g. Respondent failed to consider or to seek consultation for a Cesarian section for Patient M.B. at approximately 2:45 p.m., when he performed a physical examination of the patient and assessment for vaginal delivery; h. Respondent failed to perform a Cesarian section or refer the patient for Cesarian section at approximately 2:45 p.m., and instead performed a_ physical examination of the patient and assessment for vaginal delivery; i, Respondent failed to further assess and evaluate the patient after 2:45 p.m., despite continued severe fetal heart decelerations and lack of beat-to-beat variability. COUNT TWO 15. Petitioner realleges and incorporates paragraphs one (1) through eleven (11), as if fully set forth herein this Count Two. 16. Section 458.331(1)(m), Florida Statutes, provides that the Board of Medicine may take disciplinary action against a licensed medical doctor for failing to keep medical records 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. 17. Respondent violated Section 458.331(1)(m) with regard to Patient M.B. on September 2, 1995, due to one or more of the following facts: a. Respondent failed to write progress notes in Patient M.B.’s hospital record for labor and delivery; b. Respondent failed to write a narrative summary in Patient M.B.’s hospital record for labor and delivery. c. Respondent otherwise failed to notate findings in Patient M.B.’s labor and delivery record to justify the plan of care for vaginal delivery in the presence of continued severe fetal heart decelerations and lack of beat-to-beat variability. 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 456.072(4), Florida Statutes, and/or any other relief that the Board deems appropriate. SIGNED this 27 Gay of Kolin be 2000. Robert G. Brooks, M.D., Secretary DEPARTMENT OF H DEPUTY CLEAR LY thryn L.asprzak CIERK Vehi R. Ln on Chief Medical Attorney DATE. Lae Le a 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 KLK/rme PCP: September 25, 2000 PCP Members: Cerda, McMillin, Varn

Docket for Case No: 00-004669PL