STATE OF FLORIDA Fon DEPARTMENT OF HEALTH G a Ny vO DEPARTMENT OF HEALTH, eS wn PETITIONER, 7 v. CASE NO. 2003-15497 ROBERT BRAUNER, M.D., BS dqu4Pe RESPONDENT. ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through undersigned counsel, files this Administrative Complaint before the Board of Medicine against Respondent, Robert Brauner, M.D. and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practice of medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 458, Florida Statutes. 2. At all times material to this Complaint, Respondent was a licensed physician within the state of Florida, having been issued license number ME39272. 3. Respondent's address of record is 13601 Bruce B. Downs Blvd., Suite 150, Tampa, Florida 33613-4609. 4, — Respondent is board certified in Obstetrics & Gynecology. 5. Patient J.H. a then 32-year old female was a patient of Respondent or Respondent's office throughout her pregnancy and delivery. 6. On or about January 11, 1999, in the early morning hours, Patient J.H. experienced a sudden “gush” of fluid from her vagina. Patient J.H. presented to Respondent later that day and was sent home as the test performed by Respondent used to determine if the amniotic membrane (the fluid-filled sac that surrounds the baby during pregnancy) had broken was “equivocal.” When a woman’s "water breaks", you are to notify your health care provider as labor may start immediately or within the next 24 hours. 7. On or about January 12, 1999, in the early morning hours, Patient J.H. again felt “gush” of fluid from her vagina. Patient J.H. presented to Respondent's office in mid afternoon and was examined by another physician who recorded Patient J.H. had green tinged mucous. Patient J.H. was thereafter admitted to University Community Hospital (Hospital) by another physician. 8. Green tinged mucous could possible be indicative of meconium mixed with amniotic fluid. Meconium is a baby's first stools, which sometimes is passed before the baby is born. Meconium in the amniotic fluid may be a sign of fetal distress. 9. Patient J.H. was started on pitocin to induce labor prior to Respondent's care. 10. Pitocin is a synthetic form of oxytocin, a hormone that is produced naturally by a female which is responsible for causing the uterus to contract during labor. 11. At or about 3:40 a.m. on January 13, 1999, Patient J.H.’s cervix was 4 cm dilated and she was 70% effaced. 12. The shortening and thinning of the cervix is called effacement. In a delivery, the cervix must stretch open to allow the baby’s head to emerge. Effacement is measured in percentages from 0% to 100%. When there is no change in the cervix, it is 0% effaced. When the cervix has thinned out completely it is said to be 100 % effaced. 13. Dilation is the actual stretching and opening of the cervix and is measured from 1 to 10 centimeters (cm). The larger the opening, the jarger the number of centimeters. 14. On or about January 13, 1999, Respondent assumed the care and treatment of Patient J.H., who was in the labor and delivery unit of University Community Hospital (Hospital). 15. Patient J.H. initially made excellent progress following the induction of !abor, progressing to 70% effaced and going from 1 cm to 8 cm dilated. 16. Patient J.H. had an electronic fetal heart monitor placed to observe the fetus’s heart rate and to monitor J.H.’s contractions. The monitor also helps to determine whether the stress of labor was threatening the baby. 16. A fetus’s normal heart rate ranges from 120 to 160 beats per minute. 17. Tachycardia is a fetal heart rate above 160 beats per minute. Reasons for fetal tachycardia include certain drugs; maternal fever, infection or hyperthyroidism; fetal anemia, heart failure, heart abnormalities, or hypoxia. 18. Bradycardia (decelerations or low heart rate) is a fetal heart rate below 110 beats per minute. Reasons for fetal bradycardia include, but are not limited to umbilical cord compression, fetal head compression, heart abnormalities, certain drugs, low temperature or low oxygen levels. 19. Respondent was present with Patient J.H. when she experienced seven (7) deep variable decelerations to the 60’s in the baby’s fetal heart tones at approximately 9:00 a.m. on January 13". The fetus experienced tachycardia in the range of 170 to 180, yet had persistent intermittent decelerations. 20. Patient J.H. was taken off the Pitocin at approximately 9:00 a.m. 21. Over the course of the morning of the 13", Patient J.H. experienced a fever and failure to progress in labor, and the fetus demonstrated more decelerations (i.e., the fetal heart rate went low) as evidenced by the fetal monitoring strips . 22. At approximately 1:00 p.m., Patient J.H. remained at 8 cm dilated and 90% effaced with tachycardia variability as reflected in her Hospital records. 23. At approximately 1:35 p.m., Patient J.H. was described as completely dilated by the nursing staff; however Hospital records do not reflect Respondent verified this information. 24. There was a lapse of physician notes from January 13, 1999 at 3:40 a.m. until the time of the C-section on January 13, 1999 at 4:30 p.m. 25. At approximately 4:30 p.m., Patient J.H. continued to experience a fever of 101°, she had made no additional labor progress, and Respondent recommended a Cesarean section (C-section) to Patient J.H. 26. A C- section is the surgical delivery of an infant through an incision in the mother's abdomen and uterus. 27. Respondent delivered Baby J.H. at 6:17 p.m. on January 13, 1999. 28. Baby J.H. was delivered with a diagnosis of cephalopelvic disproportion (a condition where the baby was too large to pass safely through the mother's pelvis during delivery), occiput-posterior presentation (a cephalic presentation of the fetus with the back of the head turned toward the sacrum) and chorioamnionitis (inflammation of the membrane surrounding the fetus). 29, Section 458.331(1)(t), Florida Statutes (1998), sets forth grounds for disciplinary action by the Board of Medicine and provides that a physician may be disciplined for gross or repeated malpractice or the 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. 30. Respondent fell below the acceptable standard of care in one or more of the following ways: a) By failing to recognize the seven (7) deep variable decelerations to the 60's in the baby’s fetal heart tones at approximately 9:00 a.m. on the 13" to warrant an immediate C-section of Patient 3.H.; b) By failing to recognize and or diagnose non-reassuring fetal heart tones in a timely manner; or ¢) By failing to timely perform (a delay of almost two hours from recommendation to performance) a Cesarean section on Patient J.H. following the continued fetal problems. 31. Based on the foregoing, Respondent has violated Section 458.331(1)(t), 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. WHEREFORE, Petitioner respectfully requests that the Board of Medicine enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. Kr SIGNED this _72 __ day of Uber , 2004. John O. Agwunobi, M.D., M.B.A., M.P.H. Secretary, Department of Health DEPARTMENT OF HEALTH Assistant General Counsel DEPUTY CLERK DOH Prosecution Services Unit - , Columa AA 4052 Bald Cypress Way, Bin C-65 cunx Nocti Tallahassee, FL 32399-3265 -20-0 oere__1a7B0-04 — Florida Bar # 0394572 850.410.0623 850.488.7723 FAX laqp Robert Brauner, M.D., DOH Case No.: 2003-15497 Reviewed and approved by: > _(initials) al isle (date) PCP:pecember 17, 2004 PCP Members: g1-pahri, Ondra, Long NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed. Robert Brauner, M.D., DOH Case No.: 2003-15497

Docket for Case No: 05-002949PL