GMare STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, v. | CASE NO. 2006-27498 ALEXANDER C-JUNGREIS, M.D., RESPONDENT. | / a | . ADMINISTRATIVE COMPLAINT goog T a AYA Petitioner, Department of Health, by and through its undersigned counsel, files this Administrative Complaint before the Board of Medicine against Respondent, Alexander C, Jungreis, 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, and Chapters 456 and 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 ME 54328. 3. Respondent’s address of record is 951 Broken Sound Parkway, Suite 225, Boca Raton, Florida 33487. JAPSU\Medical\MarrGX\Cases\Vungreis, Alexander 2006-27498\AC doc 90d . 95°9 B800¢ FL +90 Bo:2 800¢ FT 4590 | i it poofE i yi 4. Respondent is certified in general neurology by the American Board of Psychiatry & Neurology. 5. At all times material hereto, Respondent practiced medicine at Florida Pain and Rehabilitation Institute, Inc., 1201 South Orlando Avenue, Suite 200, Winter Park, Florida’32789, 6. On or about March 15, 2004, Patient M.M., a then-sixty-four year old ! , female was initially seen by Respondent, upon referral, with one complaint, that of pain in the lower back. radiating into the right buttock and down the lateral aspect behind the knee, 7. Respondent recommended a series of stereotactic fluoroscopically guided facet and SI injections x3 together with physical therapy. 8, on or about March 30, 2004, Patient M.M. underwent bilateral lumbar facet joint injections at L1, L2, L3, L4 and L5 of icc of 1% Lidocaine and 20mg of Depo-Medrol at each joint. Patient M.M. also underwent a bilateral SI joint injection of 2c¢ of 1% Lidocaine and 40mg of Depo-Medrol. 9, on or about April 6, 2004, Patient M.M. underwent bilateral! lumbar facet joint injections at Li, L2, L3, L4 and L5 of icc of 1% Lidocaine and 20mg J:\PSU\Medical\MarrGx\Cases\Jungreis, Alexander 2006-27498\AC.doc 90 ‘d 95°9 B800¢ FL +90 69:4 8002 FT 450 4 | | of Depo-Medrol at each joint. Patient M.M. also underwent a bilateral SI joint injection of 2cc of 1% Lidocaine and 40mg of Depo-Medrol. 10. On or about April 20, 2004, Patient M.M. underwent bilateral lumbar facet joint Injections at Li, L2, L3, L4 and LS of tcc of 1% Lidocaine and 20mg of Depo-Medrol at each joint. Patient M.M, also underwent a bilateral SJ joint injection of 2cc of 1% Lidocaine and 40mg of Depo-Medrol. 11, on or about May 10, 2004, Patient M.M. returned to Respondent for a follow up vist. Respondent noted the series of facet and SI joint injections had significantly alleviated a lot of pain symptoms and the patient’s complaints of leg and low back pain were better. Respondent’s plan was to await physical therapy and re-evaluate the patient. , 412, On-orabouts une 1t,2004Patient-M-M.+eturned-for-afotlew-up visit with Respondent. It was noted that Patient M.M. had had a decrease of 80% of | her pain following the injections but prior to beginning physical therapy, Patient M.M. began experiencing pain again following the second physical therapy visit, Respondent that her pain had progressively returned and although not at its initial intensity, it was worse than after she had the injections. Patient M.M. | i 3 J:\PSU\Medical\MarrGx\Cases\Jungreis, Alexander 2006-27498\AC.doc é0‘d . 95°9 B800¢ FL +90 69:4 8002 FT 450 further stated she was continuing with physical therapy but had slowed down the pace. Patient M.M. had complaints of an electric current starting in the right side of her low back and radiating into the hip and anteriorly down the right lower extremity, with a knot of pain in the right side of her low back and in the right patellar area. - Patient M. M. was to continue physical therapy and return in one month. | 13. On or about March 1, 2006, Patient M.M. returned to Respondent having taken a fall in December, 2005, and developing increasing ‘pain and difficulty in the lumbar spine. Patient M.M. described her pain as at and below the belt line, radiating deep into the right buttock and down the right leg. She also had complaints of some weakness of the right leg with numbness and tingling ;-and-some tenderness-along-the-upper,-middie-ane-lower-right-Si-joint. Respondent ordered injection therapy for the right SI joint and physical therapy. a On ‘or about. March-27,.-2006, Patient-—M.M. - -Was—seen--again. by Respondent. Respondent record of this visit indicates the patient was under his care -for, sagt rere on eacsator-bE radiculopathy, or radiation of pain through the leg and foot from an underlying lumbar or lower back problem. Patient stated she was having severe pain 4 \PSU\MedicehMarr&X\Cases\iungrets, Alexander 2006-27498\AC.doc ald = 9589-—«-g0nz PL 390 00:8 800% rT 40 radiating from her low back area, above, at and below the belt line with radiculopathy deep into the right buttocks with pain radiating down into her right lower extremity down to the level of her knee. Patient stated the pain was severe in nature and she was having difficulties with activities of daily living as well as having a hard time ambulating, Patient was very tender at 13-4, L4-5 and L5-S1, and was extremely tender on the right side of the SI joint. Respondent recommended SI joint injections x3. 15, On oF about March 28, 2006;-Patient M.M. underwent a bilateral SI joint injection of 2cc of 1% Lidocaine and 40mg of Depo-Medrol. 16, On or about April 6, 2006, Patient M.M. underwent a bilateral SI joint injection of dec of 1% Lidocaine and 40mg of Depo-Medrol. -—47-~-On-or about April 13,-2006;-Patient M:Mcage inmunderwent-e bilateral SI joint injection of acc of 1% Lidocaine and 40mg of Depo-Medrol, nd Be _On-or about-April-20, 2006, Patient-M.M,-returned to-Respondent for @ follow up Vist Respondent’s record of this visit indicates the patient was ~condler-his-carefor;cemong other-neurological-conditions;"exacerbatiorcot-umbar ‘spine with radicular symptams in the right lower extremity. Patient reported having slipped on a wet floor on the day following her jast injection and had | 5 | PAPSU\Medical\MarrGX\Cases\Jungreis Alexander 2006-27498\AC. doc fd‘d 95°9 B800¢ FL +90 00:8 s800¢ FT 490 | pulled a muscle in her right groin. Respondent recommended, because of the recent slip and fall, patient should use ice, rest and have light physical therapy. 19, On or about July 25, 2006, Patient M.M. underwent a total right hip replacement due to avascular (or aseptic) necrosis, which is a disease resulting from the temporary or permanent loss.of the blood supply to the bones, which | can be caused by excessive steroid use, | COUNT ONE 20. Petitioner reallages— paragraphs one (1)~through=-nineteen (19), above, and incorporates them as if set out herein. 21, Section 458,331(1)(t), Florida Statutes (2003, 2004, 2005), subjects a licensee to discipline for gross or repeated malpractice or the failure to practice ——mecicine-ith-that level-of-care,—skill; and-treatment-which is-recogrized-by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances... -. .. .... ve we wt ste | 22. Respondent did not meet the applicable standard of care in his ~tendering-treatment-to Patient-MM=i F-ORe-OF-more-ofthefollowing-ways;. 0. a. | By failing. to. perform an adequate hip examination in 2004 before initiating injection therapy; | 6 | | ~ JAPSU\Medical\MarrGX\Cases\Jungreis, Alexander-2006-27498\AC.doc | Old . é$*9 8008 FL +90 00:8 s800¢ FT 490 b. By performing bilateral joint injections when the symptoms and diagnosis warranted only injections on the right; C By performing joint injections on the left thus unnecessarily doubling the quantity of steroid exposure to the patient; and, | d. By failing to perform an adequate hip examination in 2006 before.resuming injection therapy. 23. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes-(2003,-2004, 2005), by engaging-in gross-or repeated malpractice or by failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent. similar physician as being acceptable under similar conditions and circumstances, —— COUNT TWO 24, Petitioner realleges and incorporates paragraphs one (1) through nineteen {19),above,.as-if fully S@t-forth Herein —-—- mm a ee ee nee 25, Section 458.331(1)(q), Florida Statutes (2003, 2004, 2005), provides othat—presenibing;- dispensing —acministering,—-mixing:— or -othenwise- preparing. ‘a legend drug, including any controlled substance, other than in the course of the physician's professional practice constitutes grounds for disciplinary action by the 7 ] :\PSU\Medical\MarrGX\Cases\Jungreis, -Alexander..2006-27498\AC.dac Lk *d é$*9 8008 FL +90 00:8 8002 FT 450 Board of Medi icine. For the purposes of this paragraph, it shall be legally presumed that prescribing dispensing, administering, mixing, or otherwise preparing lege i} excessive or in nd drugs, including all controlled substances, inappropriately or in appropriate quantities is not in the best interest of the patient and is not in the course of the physician's professional practice, without regard to his or her intent. | 26. Depo-Medrol is the brand name for methylprednisolone acetate, a legend drug:-- - 27. On necrosis, | e adverse reaction for methylprednisolone acetate is aseptic | 28, Respondent administered excessive amounts of the legend drug ——Depe-Medrolin-ene-or more-of-the-following Way $$ a. --injections-at -L By performing, on March 30, 2004, bilateral lumbar facet joint 1, L2, L3, L4 and L5 of icc of 1% Lidocaine and 20mg of Depo- Medrol at each joint and a bilateral SI joint injection of 2cc of 1% Lidocaine and —=48mg-of ReposMedroton-Ratient-M.M.7 eer ve b. By performing, on April 6, 2004, a bilateral SI joint injection of 2cc of 1% Lidocaine and 40mg of Depo-Medrol as well as bilateral lumbar facet 8 ea ~A:\PSU\Medical\ MarrGx\Cases\ Jungreis, Alexander. 2006-27498\AC.doe él‘d é$*9 8008 FL +90 Ta:8 800¢ fT 450 yl 4 joint injections at U1, L2, L3, L4 and L5 of ice of 1% Lidocaine and 20mg of Depo-Medrol at each joint on Patient M.M.: om | By performing, on April. 20, 2004, a bilateral SI joint injection of 2cc of 1% Lidocaine and 40mg of Depo-Medrol as well as bilateral lumbar facet injections at ul, L2, L3, L4 and L5 of 1cc of 1% Lidocaine and. 20mg of Depo- Medrol at each Joint on Patient M.M.; d, | By performing, on March 28, 2006, a bilateral SI joint injection of: 2ec of 1%- Lidocaine: ‘and 40mg of Depe-Medrol on Patient M.M.;: e. | By performing, on April 6, 2006, a bilateral SI joint injection of 2cc of 1% Lidocaine and 40mg of Depo-Medro on Patient M.M.; and, f. : By performing, on April 13, 2006, a bilateral SI joint injection of 2cc of 1% Lidocaine and-40mg-ef Depe-Medrol on Patient M.M. 29, Based on the foregoing, Respondent has violated Section -458,331(1)(q),—Florida Statutes —(2003,--2004, 2005), by administering an excessive amount of a legend drug to a patient. NHEREFORE—Petitionerrespectfully-requests that the-Buard"of-Medicine enter an Order imposing one or more of the following penalties: permanent revocation or suspension: of Respondent’s license, restriction of practice, 9 woh! \PSU\Medical\MarrGX\Cases\Jung reis, Alexander -2006-27498\AC.doc Bhd é$*9 8008 FL +90 Ta:8 8002 fT 450 fei i : ’ 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 deems appropriate. Ath SIGNED this 22 __ day of April, 2008. Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar No.: 131369 (850) 245-4640 Ext. 8145 (850) 245-4681 Facsimile PCP: April 25, 2008 - PCP Members: Dr. El-Bahri, Dr. Bearison, Ms. Long tl od 85°9 B800¢ FL +90 Ta:8 8002 fT 450 Pookd H { q ‘Case Name: DOH v. Alexander C. Jungreis, M.D. Case No.: 2006-27498 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. | | oh \PSU\ Medica Mantax\Gases\yungreisAlexander-2006-27498\AC.doc . | | | | Gl ‘d 85°9 B800¢ FL +90 Ta:8 800¢ fT 450

Docket for Case No: 08-005070PL