Dec 13 200? 10:19 Dec 13 2007 11:19 P.O5 STATE OF FLORIDA DEPARTMENT OF HEALTH _ DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO. 2003-23325 MANUEL MIGUEL PENA, M.D,, RESPONDENT, I Tr PLAI Petitioner, Department of Health, by and through undersigned counsel, files this Administrative Complaint before the Board of Medicine against Respondent, Manuel Miguel Pena, 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 ficensed physician: within the state of Florida; having beer issued license number ME 42699. J:\pSU\medical\michael Milnes\ac Mike\Pena, Manuel M. AC.doe Dec 13 200? 10:19 Dec 13 2007 11:19 P. O06 @ e 3. Respondent's primary practice address of record is 6370 Pine Ridge Road, Suite 101, Naples, Florida 34119, | 4. Respondent is Board Certified by the American Board of Plastic Surgery. _ 5. On or about June 30, 2003, Patient L.G. (L.G.), a sixty-seven (67) year old female, presented to the Naples Day Surgery Center (NDSC), Respondent provided a consultation for a liposuction procedure of the trunk. 6. On or about July 17, 2003, Respondent recorded a history and physical of L.G. Respondent wrote that L.G. was a very healthy sixty-seven | (67) year old woman. | 7. The records from July 17, 2003, indicated L.G. had her kidney removed thirty years prior: 8. The records from July 17, 2003, indicated that L.G. did not smoke. 9. On or about July 22, 1998, Respondent performed a full face _laser resurfacing on L.G. J:\p8U\medical\michael Milnes\ae Mike\Pena, Manuel M, AC.doc Dec 13 200? 10:19 Dec 13 2007 11:19 P.O? 10. In the history and physical from the July 22, 1998 full face laser resurfacing procedure, Respondent noted L.G. smoked one half of a pack . Of cigarettes a day. 11. On or about July 22, 2003, L.G. presented to NDSC for the liposuction procedure. 12. The EKG in Respondent's medical records, taken in preparation for the procedure, listed a myocardial infarction (a heart attack) of indeterminate age. | | | | | 13. ‘The liposuction proceeded with no apparent complications. L.G. was sent to recovery Post procedure. 14, L.G. did not awaken after the procedure. The following timeline occurred in the recovery room, a 11:30 am - L.G. remains unresponsive; b. 12:00 pm -L.G. still no response to verbal commands; Cc. 12:30 pm - Ephedrine Sulfate 50 mg administered in L.G/'s left thigh to aid in extubation: d. 13:00 pm - Respondent called — ordered finger stick; oe ~7@: . 13:15 pm - L-G: not responding to verbal commands; J:\pSU\medical\michael Milnes\ac Mike\Pena, Manuel M. AC doc Dec 13 200? 10:19 Dec 13 2007 11:19 P. 08 f. 14:00 pm - LG. opening eyes to painful stimuli — will not turn head to right; g. 14:30pm - L.G, does not follow verbal commands; h. 14:50pm ~ Slight dropping noted to left side of L.G’s mouth. LG. not responding to verbal commands and not awakening to simple commands, such as hand squeezing. L.G, was admitted to Intensive Care Unit at Naples Community Hospital (NCH) for observation and neurological evaluation, 15. A CT scan and MRI were taken of L.G. while at NCH. The results were an infarction to multiple areas in the left hemisphere ~ total blockage of the left internal carotid artery, specifically an intra-operative stroke. 16. . The stroke was likely caused by a cerebral embolus. 17, A Trans Esophageal Echocardiograph (a diagnostic test that performs an ultrasound of the heart) revealed significant aortic disease with atherosclerosis. | 18. On or about August 01, 2003, L.G’s family decided to remove “LG's feeding tubes, 19. LG. was admitted to hospice and later expired. J:\pSU\medical\michaet Milnes\ac Mike\Pena, Manuel M. AC.doc } Dec 13 200? 10:19 Dec 13 2007 11:20 P.09 20. LG’s history from her past medical records indicated findings of obesity (Body Mass Index of 33), history of smoking for nine (9) years, . hyperlipidemia (the presence of excess fat or lipids in the blood), and adiposity (Loose connective tissue, the main role of which is to store energy in the form of fat, although it also cushions and insulates the body), , 21. Clinical and laboratory findings of L.G. indicated severe. atherosclerotic disease as evidenced by the history of an abdominal aortic aneurysm and an old myocardial infarction. 22, L.G. was not an appropriate candidate for any major elective surgery due to her severe atherosclerotic disease, history of smoking, obesity, and age, . 23. L.G’s atherosclerotic disease was evidenced by her abdominal aortic aneurysm and an old inferior myocardial infarction, as shown on the EKG. 24. The removal of three thousand eight hundred milliliters (3,800 mi) of fat is a traumatic event in a patient with L.G’s medical history of atherosclerotic disease, history of smoking, obesity, and age, 25.-—Section 458.331(1)(t), Florida Statutes (2003), provides that failure to practice medicine with that level of care, skill, and treatment 5 J:\pSU\medical\michael Milnes\ac Mike\Pena, Manuel M, AC.doc Dec 13 200? 10:20 Dec 13 2007 11:20 P.10 which is recognized by @ reasonably prudent similar physician as being acceptable under similar conditions and circumstances constitutes grounds for disciplinary action by the Board of Medicine. 26. Respondent fell below the standard of care recognized by'a reasonably prudent similar physician, in one or more of the following ways: a. By failing to take a proper history and physical; b. By failing to perform pre-operative testing; C. By failing to take into account L.G.'s severe atherosclerotic disease; , d. By failing to take into account L.G's history of an abdominal aortic aneurysm: e. By failing to take into account L.G’s history of an old myocardial infarction: f. —_ By failing to take into account L.G.s age of sixty seven years; g. _ By failing to take into account L.G.’s history of smoking; h, By failing to obtain pre-operative clearance from the _ ~~"—primary care physician; J:\pSU\medical\michael Milnes\ac Mike\Pena, Manuel M. AC.doc Dec 13 200? 10:20 Dec 13 2007 11:20 P.11 i. By failing to obtain pre-operative clearance from an internist; j. By failing to obtain pre-operative clearance from a cardiologist; k, By the removal of three thousand eight hundred milliliters (3,800ml) of fat in light of LG’s medical history of atherosclerotic disease, history of smoking, obesity, and age. Based on _the foregoing, Respondent has violated Section 458. 331(1)(t), Florida Statutes, (2003) 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: " pérmanent 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. J:\pSU\medical\michael Milnes\ac Mike\Pena, Manuel M. AC,doc Dec 13 200? 10:20 Dec 13 2007 11:20 P.12 SIGNED this__>. day of Vel nuues , 2007. Ana M. Viamonte Ros, M.D., M.P.H. Secretary of Health WE Michael BD. Milnes Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 DEPARTMENT OF HEALTH Tallahassee, FL 32399-3265 CLERK: Rac ee Florida Bar No.: 0857491 DATE Pt (850)245-4640 ext 8136 (850) 245-4680 Facsimile MDM/tgc PCP: January 26, 2007 PCP MEMBERS: El-Bahri, Winchester, Long | Case Name: MANUEL MIGUEL PENA Case No. 2003-23325 Ji\PSU\Medical\ Michael Miines\AC Mike\Pena, Manuel M. AC,doc | { Dec 13 200? 10:20 Dec 13 2007 11:21 P.13 Case Name: MANUEL MIGUEL PENA Case No. 2003-23325 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.

Docket for Case No: 07-005667PL