STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, CASE NO. 1998-22863 OO4796 PL Vv. JAMES D. FORBES, M.D., RESPONDENT. Ne ee ee ee ADMINISTRATIVE COMPLAINT a COMES NOW the Petitioner, Department of Health, hereinafter referred to as “Petitioner,” and files this Administrative Complaint before the Board of Medicine against James D. Forbes, 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 0008638. _Respondent’s last known address is P.O. Box 1085, Clewiston, Florida 33440-1085. _ 3. Respondent specializes in family practice, but is not board certified. 4. At all times material hereto, Respondent served as medical director of Clewiston Health Care Center, a nursing home in Clewiston, Florida. Patient A.W. 5. On April 14, 1998, Patient A.W., a 72-year-old female, was admitted to Clewiston Health Care Center with multiple diagnoses including pneumonia, residual . schizophrenia, and depression. Respondent was Patient A.W.’s attending physician. 6. On October 13, 1998, Patient A.W.’s family members expressed concern to facility staff over Patient A.W.’s complaints of, abdominal pain. Facility staff in turn notified Respondent. Respondent ordered an abdominal computerized tomography (CT) scan for Patient A.W. 7. On October 20, 1998, the CT scan was performed, and the radiologist’s impression was as follows: “Cholelithiasis is noted. No gross CT evidence of cholecystitis. The gallbladder is minimally indistinct. The findings should be correlated clinically.” Respondent was notified of the results on or about the same date. 8. Cholelithiasis refers to the presence of gallstones in the gallbladder. Symptoms of cholelithiasis include abdominal pain. A cholecystectomy (gallbladder removal) may be indicated in certain cases. 9. Following the results of the CT scan, Respondent next saw Patient A.W. in rounds on November, 3, 1998. Respondent's notation of his visit that date makes no “mention of the CT results or of Patient A.W.’s cholelithiasis. Respondent’s notation does mention that “She has had significant weight loss in the past several months.” 10. Respondent next saw Patient A.W. in rounds on December 4, 1998. Respondent's notation of that visit states the following in its entirety: “[A.W.], is up and about and doing well, lesion on her 5" toe on the right foot is still open but it is clean.” 11. On December 21, 1998, facility staff contacted Respondent concerning Patient A.W.’s continuing abdominal pain. Respondent suggested that A.W. be referred - toa specialist for a possible cholecystectomy. Facility staff planned for Patient A.W. to “see the specialist on January 13, 1999. _ ie A 12. Respondent next saw Patient A.W. in rounds on January 4, 1999. Respondent's notation of that visit states the following in its entirety: “[A.W.], is to get her gallbladder out in the very near future. She appears to be doing well otherwise. Her sugar has been satisfactory.” Patient R.A. 13. On March 16, 1998, Patient R.A., an 87-year-old female, was admitted to Clewiston Health Care Center with multiple diagnoses including arteriosclerosis and cerebral arterial insufficiency. Respondent was Patient A.W.’s attending physician. 14. Patient R.A.’s weight upon admission was one-hundred-and-forty-four (144) pounds. Patient R.A. was weighed by facility staff approximately every thirty (30) days following admission. . _ 15. On July 1, 1998, Patient R.A.’s documented weight was one-hundred-and- forty-three (143) pounds. Shortly thereafter, Patient R.A.’s weight began to decline significantly. 16. On July 13, 1998, facility staff documented a “stage III” pressure sore on Patient R.A.’s left buttock. The pressure sore was described in nursing notes as involving “yellow necrotic tissue”, and noted to be producing moderate drainage. 17. For compliance with health facility regulations, pressure sores are rated from . “stage I” to “stage IV”, with “stage I” being the least serious and “stage IV” the most “serious. : A 18. Respondent saw Patient R.A. in rounds on July 14, 1998. Respondent's notation of that visit states the following in its entirety: “[R.A.], 7/14/98, stable, resting well. Lesion on the nose appears somewhat smaller.” 19. On July 15, 1998, Patient R.A. was. given a Wound Evaluation by physical therapy staff of the facility. The evaluation confirmed Patient R.A.’s “stage III” pressure sore. 20. On July 29, 1998, Patient R.A.’s documented weight was one-hundred-and- seventeen (117) pounds, representing a loss of approximately twenty-three per cent (23%) of her body weight of July 1, 1998. 21. Respondent next saw Patient R.A. in rounds on August 17, 1998. Respondent's notation of that visit states the following in its entirety: “[R.A.], ulcer on the left hip and thigh.is worse. I will refer her to the wound care center. Continue wet to dry dressings.” COUNT ONE 22. Petitioner realleges and incorporates paragraphs one (1) through twenty- one (21), as if fully set forth herein this Count One. 23. Section 458.331(1)(t), Florida Statutes, provides that the Board of Medicine may take disciplinary action against a licensed physician upon the physician’s failure to practice medicine with that fevel of care, skill, and treatment which is recognized by a - reasonably prudent similar physician as being acceptable under similar conditions and ‘circumstances. ; 24. Respondent violated Section 458.331(1)(t), Florida Statutes, due to one or more of the following facts: a. Respondent failed to promptly evaluate and assess Patient A.W. for cholelithiasis, or to refer her to a specialist for such evaluation and assessment, following her diagnosis of same on October 20, 1998. Respondent did not refer Patient A.W. to a specialist for her cholelithiasis until December 21, 1998, and then only after being contacted by staff of Clewiston Health Care Center. b. Respondent failed to evaluate and assess Patient R.A. for weight loss, or to refer her to a specialist for such evaluation, on July 14, 1998, when Respondent knew or reasonably should have known that Patient R.A.’s nutritional requirements were not being met. c. Respondent failed to evaluate and assess Patient R.A. for weight loss, or to refer her to a specialist for such evaluation, on July 29, 1998, when Respondent knew or reasonably should have known that Patient R.A.’s nutritional requirements were not being met. COUNT TWO 25. Petitioner realleges and. incorporates paragraphs one (1) through twenty- one (21), as if fully set forth herein this Count Two. 26. 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 legible 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. 27. Respondent has violated Section 458.331(1)(m), Florida Statutes, due to one or more of the following facts: a. Respondent failed to document medical records to justify the course of Patient A.W.’s treatment for cholelithiasis. Patient A.W. was diagnosed with cholelithiasis on October 20, 1998. Respondent failed to document any plan of treatment for cholelithiasis until his notation of January 4, 1999. b. Respondent failed to document medical records to justify the course of Patient R.A.’s treatment for pressure sores. Patient R.A.was observed by facility staff to have a “stage III” pressure sore on July 13, 1998. Respondent made no mention of any pressure sore in his notation of the next day, July 14, 1998, and did not mention pressure sores until his notation of August 17, 1998. c. Respondent failed to document medical records to justify the course of Patient R.A.’s treatment for weight loss. Patient R.A.was documented by facility staff to have lost some twenty-three per cent (23%) of her body weight from July 1 to July 29, 1998. Respondent made no mention of weight loss or of Patient R.A.’s nutrition in his notation of July 14, 1998. Respondent made no mention of weight loss or of Patient . R.A.’s nutrition in his notation of August 17, 1998. i 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 LF day of Orble , 2000. Robert G. Brooks, M.D., Secretary FILED "EPARTMENT OF HEALTH DFPUTY CLERK “ERK teh R. Keron AATE lof2s j22eco. «(KaSp ief Medical Attorney 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: October 21, 2000 PCP Members: Ashkar, Murray, Rodriguez

Docket for Case No: 00-004796PL