FLORIDA DEPARTMENT OF he pe ny _, John 0. Agwunobi, M.D., M.B.A. dU YT PM 2: a5 Secretary July 16,2002, Jeb Bush Governor The Honorable Susan B. Kirkland Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 Sb C405 RE: DOH v. Moonasar Rampertaap, M.D. DOH Case Number: 2000-12859 DOAH Case Number: 2002-0314 PL Dear Judge Kirkland: Enclosed you will find a Final Order entered by the Board of Medicine in the above- referenced case. If you have any questions about this matter, please do not hesitate to contact our office at (850) 414-8126. Sincerely, Tiffany Underwood, CLA Paralegal to Bruce A. Campbell Senior Attorney TU/tu Enclosure 4052 Bald Cypress Way e Bin C-65 e Tallahassee, FL 32399-3265 Final Order No, DOH-02-0958. ~S" JOHER REGULATISHATE OF FLORIDA aa! ‘MND Pate @laz/oa PRACTITIO EGAL BOARD OF MEDICINE "£2. Department orAeaine~© = pp gunz’ RIO: 59 c2 IRF heron DEPARTMENT i HEALTH, cy Clerk rence rey re Petitioner, ue vs. . CASE NO.: 2000-12859 LICENSE NO.: ME0053985 MOONASAR PERSAD RAMPERTAAP, M.D., Respondent . / i 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 ahove- 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, IT IS HEREBY ORDERED AND ADJUDGED that the Consent Agreement as submitted be and is hereby approved and adopted in toto and incorporated by reference herein with the following stipulated clarification: The timeframe for completion of the presentation set forth in Paragraph 4 of the Stipulated Disposition shall be one (1) year from the date the Final Order is filed. Accordingly, the parties shall adhere to and abide by all the terms and conditions of the Consent Agreement as clarified above. This Final Order shall take effect upon being filed with the Clerk of the Department of Health. DONE AND ORDERED this Z/ day of Aue , 2002. BOARD OF MEDICINE ARRY G/ MCPHERSON, JR., BOARD DIRECTOR For _ GUSTAVO LEON, M.D. CHAIR-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 Moonasar Rampertaap, M.D., 4002 State Road 674, Suite A, Sun City Center, Florida 33573; to Bruce D. Lamb, Esquire, Ruden, McCloskey, et al., 2700 Suntrust Financial Centre, 401 East Jackson Street, Tampa, Florida 33602-5841; 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 Late f ot ran Me. , 2002. PRACTITIONER REGULATION" | Pa ore py STATE OF FLORIDAEGAL pie DEPARTMENT. “BRS ANE SOL 17 PH 295 DEPARTMENT OF HEALTH, Petitioner, v. AHCA Case No. 2000-12859 MOONASAR RAMPERTAAP, M.D. Respondent. CONSENT AGREEMENT Moonasar Rampertaap, 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. 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. STIPULATED FACTS 1, At all times material hereto, Respondent was a licensed physician in the State of Florida having been issued license number ME 0053985. 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. A true and correct copy of the Administrative Complaint is attached hereto as Exhibit A. 3, Respondent neither admits nor denies the allegations of fact contained in the Administrative Complaint. 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 6488, Florida Administrative Code. 2. FINE. The Board shall impose an administrative fine in the amount of five thousand dollars ($5,000) against the Respondent. Respondent shall pay this fine to the Board of Medicine within one (1) 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 (1) 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 B, PARAGRAPH F OF THIS CONSENT AGREEMENT FOR BOARD ADDRESS AND STANDARD TERMS). 3. REIMBURSEMENT OF COSTS. In addition to the amount of any fine noted above, 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 one thousand one hundred dollars ($1,100.00), Respondent shall pay these costs to the Board of Medicine within one (1) year 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 TOIN 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 ONE (1) 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 B, PARAGRAPH F OF THIS CONSENT AGREEMENT [FOR BOARD ADDRESS AND STANDARD TERMS. 4. PRESENTATION, Respondent shall present, to the hospital where he practices, a one hour presentation on the topic of medication errors. 5. LETTER OF CONCERN. Respondent shall receive a Letter of Concern from the Board of Medicine. 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 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 attached as Exhibit A herein. i0. | Upon the Board's adoption of this Agreement, Respondent expressly waives ail 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. 11. | Upon the Board's adoption of this Agreement, the parties hereby agree that with the exception of costs noted above, each party will bear his own attorney's fees and costs resulting from prosecution or defense of this matter. Respondent waives the right to seek any attorney's fees or costs from the Department in connection with this matter. 12. This Agreement is executed by Respondent for the purpose of avoiding further administrative action with respect to this cause. In this regard, Respondent authorizes the Board to review and examine all investigative file materials concerning Respondent prior to or in conjunction with consideration of the Agreement. Furthermore, should this 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. — SIGNED this Mal day of Wowk , 2002. Before me, personally appeared Moomasnr, Rampeenae MD whose identity is known to me by Resersnuy Valowon) (type of identification) and who, under oath, acknowledges that his/her signature appears above. Sworn to and subscribed before me this 71 day of 2000. Ky Katherine Fox Katfenrne PK My Commission DD021978 NOTARY PUBLIC ry Expires January 26 2004 . My Commission Expires: | 2ty 0% APPROVED this\St day offyat _. 2002. John W. Agwunobi, MD, MBA, Secretary Department of Health By: Nancy M. Snu Chief Attorney . EXHIBIT B : STANDARD TERMS APPLICABLE TO CONSENT AGREEMENTS The following are the standard terms applicable to all consent agreements, including supervision and monitoring provisions applicable to licensees on probation. 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 set forth in paragraph E, below. The Board office does not have the authority to change the terms of payment of any fine imposed by the Board. B. COMMUNITY SERVICE AND CONTINUING EDUCATION UNITS. Unless otherwise 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 F, WITHIN ONE YEAR OF THE DATE OF. THE FINAL ORDER. c. ADDRESSES. Respondent must keep current residence and practice addresses on file with the Board. 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 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 costs 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 costs directly associated with Respondent's probation. E. BOARD ADDRESS FOR PAYMENT OF FINES. All fines shall be sent to: Department of Health HMQAMS/Client Services, P.O. Box 6320, Tallahassee, FL 32314-6320, Attn: Medical Compliance Officer. F. BOARD ADDRESS FOR REPORTS. All reports, correspondence and inquiries shall be sent to the following address: Department of Health HMQAMS/Client Services/Bin C01, 4052 Bald Cypress Way, Tallahassee, FL 32399-3251, Attn: Medica! Compliance Officer. G. 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), physicians assistant, respiratory care practitioner, as set forth in the Consent Agreement, 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), physicians assistant, respiratory care practitioner, as set forth in the Consent Agreement, whose responsibilities are set by the Board. Direct supervision requires that the supervisor and Respondent work in the same office. The supervisor shall! be board-certified in the Respondent's specialty area unless otherwise provided by the Board. c. PROBATION COMMITTEE or "committee" are 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 licensees 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 10 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 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. c. MECHANISM FOR APPROVAL OF MONITOR/SUPERVISOR: (1) 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. (2) 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 11 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 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, then 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 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 or may 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 tolled as enumerated below and shall remain in a tolled status until Respondent returns to active practice in the State of Florida: (1) The time period of probation shall be tolled. (2) The provisions regarding supervision whether direct or indirect by the monitor/supervisor, and required reports from the monitor/supervisor shall be tolled. (3) The provisions regarding preparation of investigative reports detailing compliance with this Stipulation shall be tolled. (4) 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 practicé medicine with skill and safety to 13 patients prior to resuming the practice of medicine or respiratory therapy in this State. 14 STATE OF FLORIDA : DEPARTMENT OF HEALTH - DEPARTMENT OF HEALTH, ) " PETITIONER, , .i (Ov | } CASE NO. 2000-12859 MOONASAR PERSAD RAMPERTAAP, HD.) RESPONDENT. ) zm) 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 Moonasar Persad Rampertaap, 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 0053985. Respondent's last known address is 4002 State Road 674, Suite A, Sun City Center, Horida 33573. 3. Respondent is board certified in Internal Medicine. 4. On or about August 25, 2000, Patient J.V., a forty-seven (47) year old 7 male, presented to Blake Medical Center in Bradenton, Florida with a spontaneous pneumothorax (collapse of the lung). A chest tube was Inserted with good result and . Respondent, a pulmonologist, was consulted. 5. On or about August 27, 2000, Respondent ordered Talc 4 gm with 50 cc of 10% Lidocaine + 50 cc NS (normal saline solution) (total 100 cc) for a Pleurodesis procedure (seals the two layers of the pleura together obliterating the pleural space and preventing fluid re-accumulation to prevent recurrent spontaneous pneumothorax) scheduled for August 28, 2000. The appropriate concentration of Lidocaine for this procedure is 1%. 6. On or about August 28, 2000, the order was filled by the pharmacy as a vial of talc, five 10 ml bottles of Lidocaine and NS and was sent to the nursing floor. Maher Eter, M.D., another pulmonologist, sent the items back to the pharmacy to be mixed. Upon the retum of the mixed solution to the floor, Dr. Eter initiated the Pleurodesis procedure by administering the solution. 7. Within minutes following the administration the solution, Patient IN. experienced a Grand Mal seizure and coded, Following extensive resuscitation efforts, pulse and blood pressure were obtained but Patient J.V. remained unfesponsive. Patient J.V. was diagnosed with anoxic brain injury and expired on or about August 31, 2000, after withdraw of life-support. ~ 8. Respondent failed to render appropriate care and treatment to Patient J.V. - by inappropriately prescribing Lidocaine in that the usual dosage Is 50 cc of 1% 7 Lidocaine, but instead he prescribed 50 cc of 10% Lidocaine. COUNT ONE 9. Petitioner realleges and inco‘porates paragraphs one (1) through eight (8), as if fully set forth herein this Count One. 10. Respondent failed 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, in that Respondent inappropriately prescribed 50 cc of 10% Lidocaine to Patient 3.V,, instead of 50 cc of 1% Lidocaine. 11. Based on the foregoing, Respondent violated Section 458.331(1)(), 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. COUNT TWO 12. Petitioner realleges and incorporates paragraphs one (1) through eight (8) and ten (10), as if fully set forth herein this Count Two. 13. Respondent prescribed, dispensed, administered, mixed, or otherwise prepared a legend drug, including any controlled substance, other than in the course of the physician's professional practice, in that Respondent prescribed 50 cc of 10% Lidocaine to Patient J.V, instead of 50 cc of 1% Lidocaine. 14.° Based on the foregoing, Respondent violated 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: physician's professional practice. For the purposes of this paragraph, it shall be | legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including all controlled substances, inappropriately or in excessive or Inappropriate quantities is not in the best Interest of the patient and not in the course of the physician's professional practice, without regard to his intent. - 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. sienep this_L Ma day of Dvamber 2001. John O. Agwunobi, M.D., M.B.A,, . Secretary CLERK a ia No Nancy M. Snurkowski, wre. + (2 Chief Attorney ~ Practitioner Regulation D COUNSEL FOR DEPARTMENT: Britt Thomas, ; - Senior Attorney - Practitioner Regulation Agency for Health Care Administration ~ BO. Box 14229 ~ Tallahassee, Florida 32317-4229 .. Florida Bar # 0962899 BT/jwm ; CP: December 7, 2001 CP Members: Georges El-Bahri, M.D. Gaston Acosta-Rua, M.D. Monique Long

Docket for Case No: 02-000314PL