STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. | CASE NO. 2007-16072 CRAIG E. AMSHEL, M.D., RESPONDENT. . t / i ADMINISTRATIVE COMPLAINT Petitioner, the Department of Health, by and through its undersigned counsel, files this Administrative Complaint before the Board of Medicine against the Respondent, Craig E. Amshel, M.D., and in support thereof states: 1. | _ Petitioner is the state department charged with regulating the Practice of medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, ov 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 ME 90042. J\PSU\Medical\Robert Milne\Cases\amshel 2007-16072\AC 458.331 (1)(t33.doe 1 pO’d = GEFLL LOZ LL une Se:TT aloz TT unc APG 3. The Respondent's address of racord is 1901 Haverford Plaza, #105, Sun City Center, Florida 33573, 4, : Respondent is certified by the American Board of Surgery. 5. : On or about April 14, 2006, Patient S.A. a forty-five (45) year-old female, was admitted to the Emergency Room of South Bay Hospital, Tampa Florida, with a pulse of 126, normotensive, with cramps, abdominal pain, nausea and vomiting. 6. i Abdominal x-rays were consistent with small bowel obstruction. 7, Patient S.A, was admitted by Respondent at 1345 on April 14, 2006, for hydration, correction of electrolytes, decompression of the intestinal tract by nasal gastric tube and observation. She was placed on antibiotics, morphine for pain, Phenergan for nausea and Zantac to decrease he production of stomach acid. 8, | At 2050 on April 14, 2006, Respondent was called because Patient SA. had 4 pulse of 136; blood pressure of 78/57; Patient S.A, was anxious and agitated; and had a pain score of 10. Respondent ordered by telephone a bolus of normal saline and increased the morphine dosage for pain relief, but did not come to the hospital to re-examine or re-evaluate _ Patient S.A. i} 1APSU\Medicl\Ropert Milne\Cases\Amshel 2007-16072\AC 458.331(1)(t)3.doc 2 SO‘d BE tkk OlO@ bE une SF:TT ode TT unc 9, At 0350 on April 15, 2006, Respondent was called again because Patient S.A.'s pulse was 130 and her blood pressure was now 90/58. Respondent ordered another bolus of normal. saline, a Foley catheter. and Ativan for sedation, Respondent did not return to the hospital to re- evaluat Patient S.A, nor did he take her to surgery to explore her abdomen and ‘her bowel obstruction. 10. At.0625 on April 15, 2006, Respondent was called a third time because Patient S.A.'s tachycardia (heart rate in excess of 100 beats per minute) temained unabated. She now had shortness of breath and her arterial blood gases showed Patient S.A. was acidotic, despite the correction of her dehydration and electrolyte imbalance. 11, Respondent arrived at South Bay Hospital at 0720 on April 15, 2006, and ordered additional intravenous fluids and sodium bicarbonate. Respondent also ordered an EKG and had consultations with a cardiologist | and an anesthesiologist. 12. At 0745 Patient S.A. experienced respiratory arrest while a central line was being placed and she was resuscitated. 13. | At 0805 Patient S.A. was taken to the operating room where JAPSU\Madical\Robert Milne\Cases\Amshel 2007-16072\AC 458,331(1)(t)3.doc 3 90 ‘d BetLL OlO@ bb une SF:TT ode TT unc Respondent performed an ileocolectomy (removal of a section of the intestine at the end of the ileum and beginning of the colon) because there Was a distended small bowel with obstruction in the distal ileum secondary to adhesions. 14, times and eventually expired at 1934 on April 15, 2006, Postoperatively Patient S.A. went into cardiac arrest several 15. The Final Pathology Report showed multifocal ischemia (restriction of blood supply at several sections of the intestines) and pseudomembranous enterocolitis (infection of the colon) with focal perforation with acute, sub acute and chronic serositis {inflammation of the inner lining of the abdomen). 16, Section 458.331(1)(t), Florida Statutes (2005), provides that committing medical malpractice constitutes grounds for disciplinary action ; by the Board of Medicine. Medical malpractice is defined in Section 456. 50, Florida Statutes to mean the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related: to health care licensure, For purposes of Section 458,331(1)(t), Florida Statutes, te Board shall give great weight to the provisions of Section 766.102, Florida Statutes, which provide that the prevailing professional 2:\PSU\Medical\Robert Milne\Cases\Amshel 2007-16072\AC 458.331(1)(t)3.doe 4 L0‘d estlL olog LL unr Se:TT aloz TT unc standard of care for a given health care provider shall be that level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers, 17, | Respondent failed to practice medicine with that level of care, skill and treatment which is recognized by a reasonably prudent similar physician under similar conditions and circumstances, in one or more of the foliowing ways: | a) By failing to recognize that the initial conservative treatment plan to observe Patient S.A’s small bowel obstruction should have been revaluated at 2050 on April 14, 2006, when S.A’s vital signs began to deteriorate in that despite hydration, Patient S.A.’s blood pressure was dropping, her pulse was becoming more rapid, and her pain had increased; | b) By failing to consider that the changes in S.A.'s vital signs suggested @ worsening of her condition, probably secondary to ischemic bowel or perforation and possible toxemia; ¢) By failing to timely return to the hospital to re-examine and re-evaluate $.A.’s condition; | J:\PSU\Medical\Robert Milne\Cases\Amshe! 2007-16072\AC 458.331 (1)()3.doc 5 80 ‘d . BetLL OlOe LE unr 9e:TT ode TT unc d) By failing to timely explore S.A’s abdomen on an emergent basis. 18. Based on the foregoing, Respondent violated Section 498.331(1)(0), Florida Statutes (2005), by failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being reasonable under similar conditions and circumstances. WHEREFORE, the Petitioner respectfully requests that the Board of Medicine | enter an order imposing one or more of the following penalties: imposition of an administrative fine, issuance of a reprimand, corrective action, remedial education and/or any other relief that the Board deems appropriate. | | | ! | UAPSU\Medical \Robert Milne\Cases\Amshel 2007-16072\AC 458.331(1){(t)3.dac 6 6O'd PESLL OlOe Lb une 9e:TT ode TT unc SIGNED this_S_ day of Mae , 2009. Ana M. Viamonte Ros, M.D., M.P.H, State Surgeon General, Department of Health tyr Robert A. Milne Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar No.: 622338 | (850)245-4640 (850) 245-4681 Facsimile PCP: Naw y, LL5 PCP Members: Cin Linn ra BEPARTMENT OF HEALTH | mares a DEPUTY CLERK fee SLERK: | DATE _.5-//-0 F | Craig E. Amshel, M.D., Case No, 2007-16072 | J:\PSU\Medical\Robert Milne\Cases\Amshel 2007-16072\AC 458,331(1)(t)3.doc 7 Old . PEtLL OlOe Le une 9¢:TT oOTde TT unc

Docket for Case No: 10-003184PL