- Final Order No. DOH-02-0953- —S” FILED DATE - mM A Department of Health = PRACTITIONER REGULATIONSTATE OF FLORIDA LEGAL BOARD OF MEDICINE 2002 JUR 28 AKIO: 55— Why % DEPARTMENT OF HEALTH, Dy 7, 4 . RM, Fy Petitioner, Wp! oO : ly © S bin vs. _ CASE NO,: 1999-59542 LICENSE NO.: MEOO58051 O1- H900fL HLA- COS TRAVIS L. BOLTON, JR., M.D., Respondent. __/ FINAL ORDER THIS CAUSE came before the Board of Medicine (Board) pursuant to Sections 120.569 and 120.57(4), Florida Statutes, on June 7, 2002, in Tampa, Florida, for consideration of a Consent Agreement (attached hereto as Exhibit A) entered into between the parties in the above- styled cause. Upon consideration of the Consent Agreement, the documents submitted in support thereof, the arguments of the parties, and being otherwise advised in the premises, the Board rejected the Consent Agreement and offered to dismiss the Administrative Complaint in this matter provided Respondent waives the right to seek attorney's fees and costs. .Respondent agreed on the record to do so. IT IS HEREBY ORDERED AND ADJUDGED that the Consent Agreement as submitted be and is hereby REJECTED and the Administrative Complaint 3 filed in this cause is hereby DISMISSED. This Pinal Order shall take effect upon being filed with the Clerk of the Department of Health. DONE AND ORDERED this 2/ day of » 2002, BOARD OF MEDICINE * MCPHERSON, JR., DIRECTOR For GUSTRVO LEON, M.D. CHATIR-ELECT CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been provided by U.S. Mail to Travis L. Bolton, Jr., M.D., 990 Airport Road, Destin, Florida 32541; to Craig Dennis, Esquire, Dennis, Bowman, et. al., Post Office Box 15589, Tallahassee, Florida 32317-5589; and by interoffice delivery to Nancy M. Snurkowski, Chief - Practitioner Regulation, and Lisa Pease, Senior Attorney - Appeals, Agency for Health Care Administration, 2727 Mahan Drive, Tallahassee, Florida 32308-5403, on or before 5:00 p.m., this .. a day of 2ve 4’ STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, Petitioner, Vv. . DOH Case No. 1999-59542 TRAVIS L. BOLTON, M.D., Respondent, ne CONSENT AGREEMENT Travis L. Bolton, M.D., referred to as the "Respondent," and the Department of Health, referred to as "Department" stipulate and agree to the following Agreement and to the entry of a Final Order of the Board of Medicine, referred to as "Board," incorporating the Stipulated Facts and Stipulated Disposition in this matter. 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. STIPULATED FACTS 1. At all times material hereto, Respondent was a licensed physician in the State of Florida having been issued license number ME 0058051. 2. Respondent was charged by an Administrative Complaint filed by the Department and properly served upon Respondent with violations of Chapter 458, Florida Statutes, and the rules enacted pursuant thereto. 3. Respondent neither admits nor denies the allegations of fact contained in the Administrative Complaint for purposes of these proceedings only. STIPULATED CONCLUSIONS OF LAW 1. Respondent admits that, in his capacity as a licensed physician, he is subject to the provisions of Chapters 456 and 458, Florida Statutes, and the jurisdiction of the Department and the Board. 2. Respondent admits that the facts set forth in the Administrative Complaint, if proven, would constitute violations of Chapter 458, Florida Statutes, as alleged in the Administrative Complaint. 3. Respondent admits that the Stipulated Disposition in this case is fair, appropriate and acceptable to Respondent. STIPULATED DISPOSITION 1. FUTURE CONDUCT. Respondent shall not in the future violate Chapters 456, 458 and 893, Florida Statutes, or the rules promulgated pursuant thereto. Prior to signing this agreement, Respondent read Chapters 456, 458, and 893, Florida Statutes, and the Rules of the Board of Medicine, at Section 64B8, Florida Administrative Code. 2. FINE. The Board shall impose an administrative fine in the amount of Five Thousand Dollars ($5,000.00) against the Respondent. The fine shall be paid’ by the Respondent to the Board of Medicine within one year of its imposition by Final Order of the Board. THE RESPONDENT ACKNOWLEDGES THAT THE TIMELY PAYMENT OF THE FINE IS HIS LEGAL OBLIGATION AND RESPONSIBILITY AND THE RESPONDENT AGREES TO CEASE PRACTICING IF THE FINE IS NOT PAID AS AGREED TO IN THIS CONSENT AGREEMENT, SPECIFICALLY: IF THE RESPONDENT HAS NOT RECEIVED WRITTEN CONFIRMATION THAT THE FULL AMOUNT OF THE FINE HAS BEEN RECEIVED BY THE BOARD OFFICE WITHIN ONE YEAR OF THE FILING OF THIS FINAL ORDER, THE RESPONDENT AGREES TO CEASE PRACTICE UNTIL SUCH WRITTEN CONFIRMATION Is RECEIVED BY THE RESPONDENT FROM THE BOARD. (SEE EXHIBIT A, PARAGRAPH E OF THIS CONSENT AGREEMENT FOR BOARD ADDRESS AND STANDARD TERMS), | 3. REIMBURSEMENT OF COSTS. In addition to.the amount of any fine noted above, the Respondent agrees to reimburse the Department for any administrative costs incurred in the investigation and preparation of this case, including costs assessed by the Division of Administrative Hearings, if applicable, and by the Board of Medicine office. The agreed upon Agency costs to be reimbursed in this case is Two thousand, seven hundred eighty-eight dollars and seventy-one cents ($2,788.71).. The costs shall be paid by the Respondent to the Board of Medicine within six months of its imposition by Final Order of the Board. THE RESPONDENT ACKNOWLEDGES THAT THE TIMELY PAYMENT OF THE COSTS IS HIS LEGAL OBLIGATION AND RESPONSIBILITY AND RESPONDENT AGREES TO CEASE PRACTICING IF THE COSTS ARE NOT | PAID AS AGREED TO IN THIS CONSENT AGREEMENT, SPECIFICALLY: IF THE RESPONDENT HAS NOT RECEIVED WRITTEN CONFIRMATION THAT THE FULL AMOUNT OF THE COSTS NOTED ABOVE HAS BEEN RECEIVED BY THE BOARD OFFICE WITHIN 6 MONTHS OF THE FILING OF THIS FINAL ORDER, THE RESPONDENT AGREES TO CEASE PRACTICE UNTIL SUCH WRIITEN CONFIRMATION IS RECEIVED BY THE RESPONDENT FROM THE BOARD. (SEE EXHIBIT A, PARAGRAPH F OF THIS CONSENT AGREEMENT FOR BOARD ADDRESS AND STANDARD TERMS. 4. CONTINUING EDUCATION. Respondent shall complete 5 hours of continuing medical education in risk management. 5. QUALITY ASSURANCE REVIEW, An independent certified risk manager consultant (consultant) shall review Respondent's current practice for ordering diagnostic tests and supervising the physician's assistant. Specifically, the consultant shall review the office procedures employed at Respondent's practice that ensure appropriate ordering of diagnostic tests. The consultant will prepare a report addressing Respondent's practice of ordering diagnostic tests. Further, the consultant shall review the office procedures employed by Respondent that ensure appropriate supervision of the Physician's assistant. The consultant shall prepare a... report addressing Respondent's practice of supervising the physician’s assistant, The consultant's report shall include suggested improvements of the quality assurance of the practices referenced above. Respondent shall submit this report, as well as documentation that demonstrates his compliance with the suggestions enumerated in the report, to the Board for consideration. Respondent shall bear the cost of such consultation and any necessary or appropriate follow-up consultation. The report, together with Respondent’s documentation of compliance therewith, shall be submitted to the Board of Medicine within one year of entry of the final order. 6. It is expressly understood that this Agreement is subject to the approval of the Board and the Department. In this regard, the foregoing paragraphs (and only the foregoing paragraphs) shall have no force and effect unless a Final Order incorporating the terms of this Agreement Is entered by the Board, 7. Respondent shall appear before the Board at the meeting of the Board where this Agreement is considered. Respondent, in conjunction with the consideration of this Agreement by the Board, shall respond to questions under oath from the Board, Board Staff or Department Staff. Respondent shall be prepared to explain the circumstances involved in this matter and what measures ‘have been taken to prevent a recurrence. However, Respondent shall offer no evidence, testimony or argument that disputes or contravenes any stipulated fact or conclusion of law. 8. Should _ this Agreement be rejected, no statement made in furtherance of this Agreement by the Respondent may be used as direct evidence against the Respondent in any proceeding; however, such statements may be used by the Petitioner for impeachment purposes. 9. Respondent and the Department fully understand that this joint Agreement and subsequent Final Order incorporating same will in no way preclude additional proceedings by the Board and/or the Department against the Respondent for acts or omissions not specifically set forth in the Administrative Complaint. 10. Upon the Board's adoption of this Agreement, Respondent expressly waives all further procedural steps, and expressly waives all rights to seek judicial review of or to otherwise challenge or contest the validity of the Agreement and the Final Order of the Board incorporating said Agreement. FROM > Denni s&howman FAX NO. 3: 8584221325 Mar. 06 2202 12:21PM PS 11. Respondent walves the right to seek any attorney's fees or costs from the Department In connection with this matter. 12. This Agreement is executed by the Respondent for the purpose of avoiding further administrative action with respect to thts cause, In thls regard, Respondent authorizes the Board to review and examine all investigative file materials conceming Respondent prior to or in conjunction with consideration of the Agreement. Furthermore, should this joint Agreement not be accepted by the Board, it is agreed that presentation to and consideration of this Agreement and other documents and matters by the Board shall not unfairly or illegally prejudice ‘the Board or any of its members from further participation, consideration or resolution of these proceedings. grcnep this! day of LNG NE Travis Bolton, M.D. on Before me, personally appeared (Do l-4o0 Mb whose identity is known to me by Sona n (type of identification) and who, under oath, acknowledges that his/he¥ signature appears above. : Sworn and subscribed - before me this (pte day of “Peek 2002, , NOTARY PUBLIC My Commission Expires: af &, -/o 5 KATHLEEN A. LEEPER MY COMMISSION # CC 823226 EXPIRES: July 18, Bonded Thru rae Keenan APPROVED this 7 day of _(Y Yann 2002. John Agwunobi, M.D. Secretary, Department of Heal Attorney, Medical Section Exhibit A STANDARD TERMS APPLICABLE TO CONSENT AGREEMENTS The following are the standard terms applicable to all Consent Agreements. A. PAYMENT OF FINES. Unless otherwise directed by the Consent Agreement, all fines shall be paid by check or money order and sent to the Board address as set forth in paragraph E, below. The Board office does not have the authority to change terms of payment of any fine Imposed by the Board. B. COMMUNITY SERVICE AND CONTINUING EDUCATION UNITS. Unless other wise directed by the Consent Agreement, all community service requirements, continuing education units/courses must be completed, and documentation of such completion submitted to the Board of Medicine at the address set forth below in paragraph E, WITHIN ONE YEAR OF THE DATE OF THE FINAL ORDER. C. ADDRESSES. The Respondent must keep current residence and practice addresses on file with the Board. The Respondent shall notify the Board within ten (10) days of any changes of said addresses. Furthermore, if the Respondent's license is on probation, the Respondent shall notify the Board within ten (10) days in the event that the Respondent leaves the active practice of medicine in Florida. D. Costs. Pursuant to Section 458.331(2), Florida Statutes, the Respondent shall pay all costs necessary to comply with the terms of this Consent . Agreement. Such costs include, but are not limited to, the cost of preparation of Investigative Reports detailing compliance with the terms of the Consent Agreement, obtaining supervision or monitoring of the practice, the cost of quality assurance reviews, and the Board's administrative cost directly associated with the Respondent's probation. FE. ° BOARD ADDRESS, Unless otherwise directed by the Board office, all fines, and costs shall be sent to Departmént of. Health, HMQAMS/Client Services, P.O. Box 6320, Tallahassee, FL 32314 Att: Medical Compliance Officer. Any reports, correspondence, inquiries or communications other than for the payment of fines and costs shall be sent to: Board of Medicine, HMQAMS Client Services Unit/Bin C01, 4052 Bald Cypress Way, Tallahassee, Florida 32399-3251, Attn: Medical Compliance Officer, F. PROBATION TERMS, If probation was imposed by the Final Order of the Board, the following provisions are applicable. . 1. DEFINITIONS: a. INDIRECT SUPERVISION Is supervision by a monitoring physician (monitor) whose responsibilities are set by the Board. Indirect supervision does not require that the monitor practice on the same premises as the Respondent, however, the monitor shall practice within a reasonable geographic proximity to Respondent, which shall be within 20 miles unless otherwise provided by the Board and shall be readily available for consultation. The monitor shall be Board-certified in the Respondent's specialty area unless otherwise provided by the Board. b. DIRECT SUPERVISION is supervision by a supervising physician (supervisor) whose responsibilities are set by the Board. Direct supervision requires that the supervisor and Respondent work in the same office, The supervising physician shall be board-certified in the Respondent's specialty area unless otherwise provided by the Board. c. PROBATION COMMITTEE or “committee” is members of the Board of Medicine designated by the Chairman of the Board to serve as the Probation Committee, 2. REQUIRED SUPERVISION. a. If the terms of the consent agreement include indirect monitoring of the licensee’s practice (MONITORING) or direct monitoring of the licensee's practice (SUPERVISION), the Respondent shall not practice medicine without an approved monitor/supervisor, as specified by the Consent Agreement, unless otherwise ordered by the Board. b. The monitor/supervisor must be a licensee under Chapter 458, Florida Statutes, in good standing and without restriction or limitation on his license. In addition, the Board or Committee may reject any proposed monitor/supervisor on the basis that he has previously been subject to any. disciplinary action against his medical license in this or any other jurisdiction, is currently under investigation, or is the subject of a pending disciplinary action. The. monitor/supervisor must be.actively engaged in the same or similar specialty - area unless otherwise provided by the Board or Committee and ‘be practicing i within a reasonable distance of the Respondent's practice, a distance of no more than twenty (20) miles unless otherwise specifically provided for in the consent agreement. The Board or Committee may also reject any proposed monitor/supervisor for good cause shown. CG MECHANISM FOR APPROVAL OF MONITOR/SUPERVISOR: i. TEMPORARY APPROVAL. The Board confers authority on the Chairman of the Board's Probation Committee to temporarily approve Respondent's monitor/supervisor. To obtain this temporary approval, Respondent shall submit to the Chairman of the Probation Committee the name and curriculum vitae of the proposed monitor/supervisor at the time this agreement is considered by the Board. Once a Final Order adopting this Agreement is filed, Respondent shall not practice medicine without an approved monitor/supervisor. Temporary approval shall only remain in effect until the next meeting of the Probation Committee. ii. FORMAL APPROVAL. Respondent shall have the monitor/supervisor with him at his first probation appearance before the Probation Committee. Prior to consideration of the monitor/supervisor by the Committee, the Respondent shall provide to the monitor/supervisor a copy of the Administrative Complaint and Final Order in this case. Respondent shall submit a current curriculum vitae and a description of current practice from the proposed monitor/supervisor to the Board office no later than fourteen days before the. Respondent's first scheduled probation appearance. “Respondent's 12 monitor/supervisor shall also appear before the Probation Committee at such other times as directed by the Committee. It shall be Respondent's responsibility to ensure that the appearance of his monitor/supervisor as directed, Failure of the monitor/supervisor to appear as directed shall constitute a violation of the terms of this Stipulation and shall subject the Respondent to disciplinary action. d. CHANGE IN MONITOR/SUPERVISOR. In the event that Respondent's monitor/supervisor is unable or unwilling to fulfill his responsibilities as a monitor/supervisor. as described above; the Respondent shall immediately . advise the Board of this fact. Respondent shall immediately submit to the Chairman of the Board's Probation Committee the name of a temporary monitor/supervisor for consideration. Respondent shall not practice pending approval of this temporary monitor/supervisor by the Chairman of the Probation Committee. Furthermore, - Respondent shall make arrangements with his temporary monitor/supervisor to appear before the Probation Committee at its next regularly scheduled meeting for consideration of the monitor/supervisor by the Committee. Respondent shall only practice under the auspices of the temporary monitor/supervisor (approved by the Chairman) until the next regularly scheduled meeting of the Probation Committee whereat the. issue of the Committee's approval of the Respondent's new monitor/supervisor shall be addressed. . 3. - CONTINUITY OF PRACTICE 13 - 4 a. TOLLING PROVISIONS. In the event the Respondent leaves the State of Florida for a period of thirty days or more or otherwise does not engage in the active practice of medicine in the State of Florida, then certain provisions of Respondent's probation (and only those provisions of the probation) shall be tolléd as enumerated below and shall remain in a tolled status until Respondent returns to active practice in the State of Florida: i. The time period of probation shall be tolled, ii. The provisions regarding supervision whether direct or indirect by another physician and required reports from the monitor/supervisor shall be tolled. tii. The provisions regarding preparation of ‘investigative reports detailing compliance with this Stipulation shall be tolled. | iv. Any provisions regarding community service shall be tolled. b. ACTIVE PRACTICE, In the event that Respondent leaves the active practice of medicine for a period of one year or more, the Probation Committee may require Respondent to appear before the Probation Committee and demonstrate his ability to practice medicine with skill and safety to . patients prior to resuming the practice of medicine in this State, STATE OF FLORIDA. DEPARTMENT OF HEALTH ° . J DEPARTMENT OF HEALTH, PETITIONER, . ) ) } v. ) _ CASE NO, 1999-59542 ) CO TRAVIS L. BOLTON, JR., M.D, ) ) ) RESPONDENT. ADMINISTRATIVE COMPLAINT {COMES NOW the Petitioner, Department of Health, hereinafter referred toas “petitioner” and files this Adininistrative Complaint before the Board of Medicine against Travis L. Bolton, Jr, M.D., hereinafter referred to as “Respondent,” and alleges: i. Petitioner is the state agency with jurisdiction over the Respondent's license to practice medicine pursuant to Chapters 456, 458, and 120, Florida Statutes. 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 0058051. Respondent's last known address is 990 ‘Airport Road, Destin, Florida 32541-2808. ‘3. Respondent: Js Board Certified in Internal Medicine. ; , 4. On or about December 12, 1997, Patient RI, a 60 year-old male, : presented to Respondent's office complaining of stress and anmiety and sinus , congestion. Lo -5.° Respondent's Physician Assistant, Jonathan Farrar, acting under Respondent's supervision, examined Patient R.J. 6. Mk Farrar diagnosed stress-induced anxiety, and tobatco abuse, ‘and’ prescribed Atrovent, Z-pack, and Xanax. 7. Mr. Farrar ordered a chest xray for Patient R.., which revealed fibrotic changes secondary to tobacco abuse. 8. The Respondent also reviewed Patient R.J’s x-ray and concurred with Mr. Farrar’s diagnosis. . 9. The Radiologist’s report of Patient R.J’s chest x-ray, however, revealed - chronic obstructive pulmonary disease (COPD). oe 10. On or about January 8, 1998, Patient RJ. presented to Mr. Farrar. with complaints of insomnia and depression. | | 11. Mr. Farrar diagnosed Patient R.J. with insomnia, secondary to depression, ) anxiety and tobacco abuse. . 12. Mr. Farrar prescribed Ambien for the insomnia and Zoloft for the depression. _ 13. . .Respondent’s initials appear at the: bottom of Patient R.3s medical record for January 8, 1998, 14. On or about January 16, 1998, Patient R.J. presented to Mr. Farrar for a follow-up appointment. 15. Patient RJ. informed Mr. Farrer that he was sleeping four (4) to five (5) hours a night, and having anxiety symptoms wher he woke up. 16. - Mr Farrar again diagnosed Patient RJ. with insomhia, secondary 1 to depression, anxiety, and tobacco abuse. a7 Mr Farrar advised Patient R.J. to ‘seek counseling: for his depression and oy anxiety, and to continue taking the Zoloft, Ambien and Xanax. 18. Respondent's initials appear at the bottom of Patient R.J/s medical record - for January 16, 1998, 19, From, January 16 to January 20, 1998, Patient R.J. presented to Mike McNanus, a mental health counselor, who evaluated him for anxiety and depression..” 20. On or about January 20, 1998, Patient R.J. presented to Respondent with . lower extremity edema, insomnia and weight loss. 21, Respondent examined Patient R.J’s heart, which revealed a regular rate, regular rhythm and tachycardia with a systolic ejection murmur. - 22. Based upon weight loss, tachycardia, eye lid retraction and opthalmic: stare, Respondent diagnosed Patient R.J. with hyperthyroldism. 23. Respondent further diagnosed worsening anxiety and insomnia, secondary to stress, but possibly secondary to hyperthyroidism, and lower extremity edema. . ' 24, Laboratory studies revealed diminished Kidney function and abnormal liver _« enzymes, 25. Thyroid studies were normal. 26. Respondent prescribed Propranolol, Lasix, and Micro-k (a potassium _ Supplement for the lower extremity edema). 27, Columbia Fort Walton Beach ‘Medical Center with continuing anxiety and general "yrorsening physical status., ee 28. At the time of hospitalization, Respondent noted bilateral wheezing in Patient R.J/s lungs, and a heart murmur. . 29, . révealed that Patient R.J. had bilateral infiltrates, pleural effusion, and an enlarged heart, , , i 30. Respondent noted the abnormal chest x-ray In Patient R.J/s history and: , physical record. 31, Respondent further noted that Patient R.J. did not’show any evidence of, congestive heart failure. 32. On or about January 21, 1998, lab studies performed on Patient RJ, revealed alow sodium value of 135° (normal is 140 ~148), a high potassium value of 6.0 meq/a (notmal is 3.6-5.2),.a high BUN value of 48 (normal is 7-18), ‘and diminished blood pressure. 33. Respondent diagnosed diminished Kidney function and abnormal liver . enzymes, 34, Based upon the laboratory Studies performed on Patient R.J., Respondent - interpreted. the results to be more consistent: with. acute adrenal Insufficiency, Addisonian crists, and hypotension. On or about January 21, 1998, Respondent admitted Patient RJ. to we A chest x-ray taken on January 21, 1998, ‘at approximately 2:30 pam, 01. 35. During an Addisonian crisis, low blood pressure, low blood sugar, and high levels of potassium can be life threatening. “36. ‘Standard therapy. for Addisonian crisis includes ‘intravenous injections of” hydrocortisone, saline, and dextrose. 37. On or aboilt January 21, 1998, Respondent ordered an EKG to be performed on Patient RJ, enlargement, and left ventricular hypertrophy. 38. — Respondent noted in Patient R.3!s medical records that the EKG revealed a normal sinus rhythm. 39. On or about January 21, 1998, based upon Respondent's diagnosis of acute. adrenal Insufficiency, Addisonian crisis, and d hypotension, Respondent adniltied Patient R.J. to the Intensive Care Unit (1oU). 40. Respondent began treatment for Vv hydration, by administering IV saline at 200 ml. per hour, and IV hydrocortisone, 41, Respondent-also treated Patient R.J. for ARDS (adult respiratory distress syndrome) with Proventil, 42. Patient’ RIM blood pressure decreased to 105/60. ba 43. Respondent ordered three liters of IV saline to be administered wide open. 44, - Respondent ordered Dopamine to be administered to’ Patient -R.J.: to elevate his blood pressure. 45. Patient R.J. stopped breathing and CPR was started, Respondent then called a Code and resuscitation was started. . which: revealed a normal sinus rhythm, left atrial... 2° 46." On or about January 22, 1998, Patient RJ. expired, . 47, The Butopsy performed on Patient RJ, ‘listed the causes of death as pulmonary embolus, congestive heart fallure, left ventricular hypertrophy, ¢ cardiomegaly, developing -adutt respiratory distress syndrome, and adrenal hemorrhage, COUNT ONE STANDARD OF CARE VIOLATION 48. Petitioner realleges and incorporates paragraphs one (1) through forty- seven (47), as if fully set forth herein this Count One. a . 49. Respondent failed to practice medicine with that level of care, skill and - treatment which is tecognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances | In the treatment, oF. RJ. by one, or more of the following: — a. Diagnosing acute adrenal insufficiency based upon a single serum potassium level; b. Failing to recognize signs and Symptoms of congestive heart failure; c Administering large amounts of intravenous: fluids to Patient R.J,, which Is contraindicated in patients with congestivé heart failure; d, . Failing to order laboretory studies ‘on Patient’ RJ.” when :he - "presented to Respondent's office on December 12, 1997 « or January - "8, 1998; . e, Administering | Intravenous hydrocortisone to Patient R.J., whichis contraindicated In patients with congestive heart failure; f. Administering propanolol (Inderal) to Patient R.3., which is contraindicated in patients with ‘congestive heart fallure; ee 50.: Based, ‘on the foregoing, Respondent Violated Section 458, 855100, Florida Statutes, in that Respondent failed to practice medicine with that level Of care, skal and treatment which is recognized by a Teasonably prudent similar Physician as ) being acceptable under simitar ’ conditions and circumstances, COUNT Two FAILURE TO MAINTAIN ADEQUATE MEDICAL RECORDS wy oN Petitioner realleges and Incorporates paragraphs one (1) through forty- os / 51. seven (47), and paragraph forty-nine (49), as If fully set forth herein this Count Two, 52. Respondent failed’ to keep medical records that justify the course of _ treatment of Patient R.J., by failing to document in Patient RJ's medical records; . a, A complete history and physical exam for Patient Ry bb. OA diagnoses of acute adrenal insufficiericy based upona single serum potassium level;. Cc. | Adiagnosis of congestive heart failure based on the radiologist’s report of December 12, 1997; Administering large amounts Of intravenous fluids to patient suffering from congestive heart failure; e, Not ordering laboratory studies for Patient R.J, on December” 12, 1997 or January 8, 1998, : 53, Based’ on the foregoing, Respondent Violated Section 458 331(A)(m),- ; : Florida Statutes, by falling to keep legible, as defined by department rule in consultation 2 . 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 ’ Fesponsible for rendering, ordering, supervising, or billing for each diagnostic or _ treatment procedure and that justify the course of treatme but not limited to, Patient histories; examination results: test results: records of drugs prescribed, dispensed, : or: administered; . hospitalizations, FATLURE.TO SUPERVISE SOSA RE TO SUPERVISE 54, seven (47), and Paragraphs forty-nine (49) and fifty-two (52), and as if fully set forth herein this Count Three, 55, Respondent failed to responsibly supervise the activities of the Physician Assistant who was providing care and treatment to Patient R. J. by one or more of the following: a. Failing to ensure that the Physician Assistant performed a thorough history and physical on Patient RJ; b. Failing to ensure that the Physician Assistant ordered any laboratory Studies on Patient R.J, on December 12, 1997 or January 8,1998.. 56. Based on the foregoing, Respondent has Violated Section 458.331(1)(dd), Florida Statutes, by ‘falling to supervise adequately the activities of those physician: . "assistants; paramedics, emergency medical technicians, or advanced registered nurse . Practitioners acting under the supervision of the physian, ’ 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 Respondents license, restriction of the. Respondent's practice, ent of the patient, including, and ‘reports of consultations and. Petitioner Tealleges and Incorporates Paragraphs one (1) through forty- ‘imposition. of an administrative fine; issuance of a reprimand, placement of the Respondent on Probation, the assessment of costs rela prosecution of this case as provided for in Section 456.0 any other relief that the Board deems appropriate, SIGNED this. [BWheay of hiventloay- "2001. - John O. Agwunobi, M.D. M.BA.- " Secretary, Department of Health Nancy M. Snurkowski vv oe ‘Chief Attorney, Practitioner Regulation . CE pe AETV oy HEAL COUNSEL FOR DEPARTMENT: “AK ok . a DATE F "Keren “ te _. Robert C. Byerts Co . ~Wao/ or By Senlor Attorney, Practitioner Regulation - — a eo .. Agency for Health Care Administration P.O. Box 14229 : “Tallahassee, Florida 32317-4229 Florida Bar # 440817 SO RB/cs | PCP Date: Nov, 9, 2001 . PCP Members: Ashkar, Glotfelty, Rodriguez ted to the investigation and 72(4), Florida Statutes, and/oj ; teas

Docket for Case No: 01-004900PL