May 13 2008 $:55 MAY-13-2088 HStS3 AHCA/LEGAL MEDICAL 856 414 1989 P.@8 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO, 2006-33942 DAVID J. NILES, D.O., RESPONDENT.. ! — ADMINISTRATIVE COMPLAINT = COMES NOW Petitioner, Department of Health, by and through its op undersigned counsel, and files this Administrative Complaint ‘before the Board of Osteopathic Medicine against Respondent, David J, Niles, D.0., "and in support thereof alleges: ) 1. Petitioner is the state department charged with regulating the practice of osteopathic medicine pursuant to Section 20.43, Florida Statutes; Chapter 156, Florida Statues; and Chapter 459, Florica Statutes. 2. At all times material to. this Complaint, Respondent was a licensed osteopathic physician within the State of Florida, having been - issued license number OS 5288. JAPSU\Medienl\Blake\Qateo\.CeiNilee, D,2006-3 3942 (x)(0).doe May 13 2008 $:55 MAY—13-2888 @e:54 AHCA/LEGAL MEDICAL 856 414 1989 P.@9 3. Respondent's address of record is 650 Richmond Close, Tarpon Springs, Florida 34688. 4. Respondent practiced. as an Emergency Rowm physician at - Community Hospital in New Port Richey, Morida. 5. On or about March 30, 2003, Patient R.O., a then eighty-two (82) year-old male, presented to the Emergency Room at Community Hospital with complaints of redness in his left foot. 6. Patient R.O. reporLed that he had a history of gout and he was taking the anti-coagulant drug, Coumadin. 7. After performing a physical examination and taking a medical history, -Resporident ordered the nurses to administer Toradol intramuscularly and Vicudin by mouth. 8. Toradol is a nonsteriodal anti-inflammary drug which is contraindicated in patients who are taking anticoagulants, such as Coumadin, wilhout following specific procedures to prevent adverse. reactions such as internal bleeding, 9, Respondent also ordered that the following lab tests be performed on Patient R.O.: sedimentation rate, uric acid, complete blood count, and prothrobin time. IAPSTUAMadica Blak orteo\ACaiNiles, D,2006-33942(x Ko). doc Z MAY-13-2088 BB:54 AHCA“LEGAL MEDICAL Mey Bs 28 fen aid 1989s 10. The results of the lab tests for Patient R.O. showed that Patient R.O. had an elevated INR at 3.32. 11. INR (International Normalized Ratio) i a laboratory Lest. which is used to monitor anticoagulation therapy. 12. Respondent failed to address Patient R.O.'s elevatect INR. 13, On ot about March 30, 2003, Patient R.O. was discharged from Community Hospital with prescriptions for Indocin and Vicodin. 14. Indocin is a nonsteriodal anti-inflammatory drug used to relieve pain, swelling, and joint stiffness caused by arthrilis, gout, bursitis, and tendonitis. 15. Following his discharge from Community Hospital, Patiant R.O, developed weakness, diarrhea, nausea, and vomiting. . 16. On or about April 7, 2003, Patient R.O, was adinilled to Community Hospital with a diagnosis of gastrointestinal hemorrhage. COUNT ONE 17, Petitioner realleges and incorporates paragraphs one (1) through sixteen (16) as fully set forth herein. . 18. Section 459.015(1)00, Florida Statutes (2002), provides thal the failure lo practice osteopathic medicine with that level of care, skill, JAPSU\Madical\ i lake\Csreo\ ACA E65. .2006=33 942(x Hu). doe 3 MAY-13-208 @8:54 AHCA/LEGAL MEDICAL Mey BS ane fen id 1989 Pld and treatment which is recognized by a reasonable prudent similar osteopathic ‘physician as being acceptable under similar conditions and Grcumstances, constitutes grounds for discipline by the Board of Osteopathic Medicine. 19. Respondent failed to practice osteopathic medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar osteopathic physician, in onc or more of the following ways: a) — by tailing to identify and address the abnormal lab results ordered during Patient R:0.’s visit at Community Hospital; b) by failing to identify and address the dangers of administering a non-steroidal anti-inflammatory medication to Palient R.O. while the patient was taking Coumadin; or c). by preseribing a nonsteriodal anti-inflammatory drug fo Paticnt R.O. for outpatient management. 20, Based on the foregoing, Respondent has violated Section _ 459.015(1)(x), Florida Statutes (2002), by failing to practice osteopathic medicine with that level of care, skill, and treatment which is recognized by | FAPSU\MedicahGlakc\Outeo\ ACA iles, 1).2006.-35 942(x)(0).doe 4 May ; May 13 2008 $:56 1 13-2688 BBIS4 _ AHCA“LEGAL MEDICAL SSA 414 1909 P.12 a reasonably prudent similar osteopathic physician as being acceptable - under similar conditions and circumstances. COUNT TWO 21. Petitioner realleges, and incorporates paragraphs one (1) _ through sixteen (16) as fully set forth herein. 29. Section 459.015(1)(0), Florida Statutes (2002), provides that failing to keep leyible, as defined by department rule in consullation with the board, medical records that idenitify the licensed osteopathic physician or the osteopathic physician extender or supervising osteopathic physician by name and professional title who is or are responsible for rendering, ordering, supervising, of billing for each diagnostic or treatment provedure _and that justify the course of treatment of the patient, including, but not fimited to, patient histories; examination results; test results: records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations, constitutes grounds for discipline by the Buard of Osteopathic Medicine. 23. Respondent failed to keep legible medical records that justify the course of treatment of Patient L.B. in one or more of the following ways: JAPS U\Medie ani lakesten\ a Cs\Niles 12006-3394 2{x a) duy § May 13 2008 $:57 MAY—13-2888 @e:55 AHCA/LEGAL MEDICAL 856 414 1989 P.13 a) _ by falling to document the adnormal INR; or b) by failing to document addressing the abnormal INR. 24, Based upon the foregoing, Respondent violated Section 459.015(1)(a), Florida Statutes (2002), by failing to kecp legible, as defined by department rule in consultation with Lhe beard, medical records that identify the licensed osteopathic physician or the osteopathic physician extender ar supervising osteopathic physician by name and professional title who is ar are responsible for rendering, ordering, supervising, of billing for each diagnostic or treatment procedure and that justify the course of , treatment of the patient, including, but not limited to, patient histories; examination results; tesl results; records of drugs prescribed, dispensed, or administered: and reports of consullalions and hospitalizations, WHEREFORE, Petitioner respectfully requests that the Board of Osteopathic Medicine enter an ofder impasing one af more of the following penaltics: permanent revocation or suspension of Respondent's license, restrictian of practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other . relief that the Board deers appropriate. TAPE U\Mepdical Blake ies ACe\Niles 2 203 19d2(29(0).doc 6 May 13 2008 $:57 MAY-13-2888 GSt55 AHCA/LEGAL MEDICAL 856 414 1989 P.14 sionepthis 15 day of — Mow abow 2007. Ana M, Viamonte Rgs, M-D., M.PII. State S i i ; 3/ Blake |unter sistant General Counsel ay j DOH Prosecution Services Unit ei Ere 4052 Bald Cypress Way, Bin C-65 eR SOO Tallahassee, FL 32399-3265 cent COB Florida Bar No, 0570788 ome (850) 245-4040, ext. 8114 0 Agi (850) 245-4682 FAX CPi NES 727 PCP Members: Ansuriele Stan JAPSLA\Medical\Blake\Ostec\ACs\Niles, D.2006-33 42(a }(u).doc 7 May 13 2008 $:57 MAY-13-2888 G8:55 AHCA/LEGAL MEDICAL 856 414 1989 P.is NOTICE OF RIGHTS Respondent has the right to request a hearing to he 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. JAPS UNM adteal\Hlakesten\ AC Niles D2006.33 949(xX9).doe & TOTAL P.15

Docket for Case No: 08-002276PL