STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO. 2010-24211 MANUEL DE JESUS GAINZA, M.D., RESPONDENT. / ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Medicine against the Respondent, Manuel De Jesus Gainza, 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 86679. DOH v. Manuel De Jesus Gainza, M.D., Case No, 2010-24211 Filed August 13, 2012 11:11 AM Division of Administrative Hearings 3. Respondent's address of record is 2692 Cooper Way, Wellington, Florida 33414. 4. Oxycodone is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes, oxycodone is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States, and abuse of oxycodone may lead to severe psychological or physical dependence. 5. Percocet is the brand name for a drug that contains oxycodone and is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, oxycodone is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States, and abuse of oxycodone may lead to severe psychological or physical dependence. 6. — Roxicodone contains oxycodone and is a Schedule II controlled substance, pursuant to Chapter 893, Florida Statutes. A substance in Schedule II has a high potential for abuse and has a currently accepted but severely restricted medical use for the relief of moderate to severe pain. Abuse of the substance may lead to severe psychological or physical dependence. Manuel De Jesus Gainza, M.D, 2 Case No, 2010-24211 7. Xanax is the brand name for alprazolam and is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, alprazolam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States. Abuse of alprazolam may lead to limited physical or psychological dependence relative to the substances in Schedule IIT. 8. | Soma is the brand name for carisoprodol, a muscle relaxant commonly prescribed to treat muscular pain. According to Section 893.03(4), Florida Statutes, carisoprodol is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States. Abuse of carisoprodol may lead to limited physical or psychological dependence relative to the substances in Schedule III. 9. Valium, which contains diazepam, is a schedule IV controlled substance under Chapter 893, Florida Statutes. A substance in schedule IV has a low potential for abuse, and a currently accepted medical use in treatment. Abuse of this substance may lead to limited physical or psychological dependence. 10. Endocet contains oxycodone and is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, oxycodone is a Schedule Manuel De Jesus Gainza, M.D. 3 Case No, 2010-24211 II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States. Abuse of oxycodone may lead to severe psychological or physical dependence. 11. Rule 64B8-9.013(3), Florida Administrative Code, provides as follows: The Board has adopted the following standards for the use of controlled substances for pain control: (a) Evaluation of the Patient. A complete medical history and physical examination must be conducted and documented in the medical record. The medical record should document the nature and intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and history of substance abuse. The medical record also should document the presence of one or more recognized medical indications for the use of a controlled substance. (b) Treatment Plan. The written treatment plan should state objectives that will be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and should indicate if any further diagnostic evaluations or other treatments are planned. After treatment begins, the physician should adjust drug therapy to the Patient medical needs of each patient. Other treatment modalities or a rehabilitation program may be necessary depending on the etiology of the pain and the extent to which the pain is associated with physical and psychosocial impairment. Manuel De Jesus Gainza, M.D. 4 Case No. 2010-24211 Facts Specific to ED 12. Respondent prescribed roxicodone, xanax and oxycodone for ED, on the dates and in the strengths and quantities described in the following table: Roxicodone | Xanax | Oxycodone | 30 Mg. 2 Mg. 15 Mg. 30 Mg. 1/19/2010 1/19/2010 30 Mg. 2 Mg. 100 Tablets | 30 Tablets | 2/2/2010 2/2/2010 30 Mg. 2 Mg. 200 Tablets | 30 Tablets 3/11/2010 3/11/2010 2 Mg. 30 Mg. 60 Tablets 200 Tablets 4/8/2010 4/8/2010 2 Mg. 30 Mg. 30 Tablets 200 Tablets 5/6/2010 30 Mg. 100 Tablets 6/1/2010 2 Mg. 30 Tablets 6/28/2010 2 Mg. 30 Mg. 200 Tablets 6/28/2010 30 Mg. 30 Tablets 200 Tablets 7/26/2010 | 7/26/2010 | 7/26/2010 2 Mg. 15 Mg. 30 Mg. 60 Tablets | 60 Tablets | 170 Tablets 8/23/2010 8/23/2010 2 Mg. 30 Mg. 60 Tablets 208 Tablets 9/22/2010 9/22/2010 2 Mg. 30 Mg. 60 Tablets 224 Tablets Manuel De Jesus Gainza, M.D, Case No. 2010-24211 Roxicodone 30 Mg. 30 Mg. 10/22/2010 10/22/2010 2 Mg. 30 Mg. 60 Tablets 224 Tablets 3/7/2011 3/7/2011 2 Mg. 30 Mg. 30 Tablets 180 Tablets 13. The strengths and quantities of roxicodone, xanax and 4/11/2011 4/11/2011 2 Mg. 30 Mg. 30 Tablets 180 Tablets oxycodone which Respondent prescribed were potentially lethal and were prescribed without justification or, without documenting justification in the medical record of patient ED. 14. Respondent did not refer or did not document a referral for ED to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist. 15. Respondent did not document or did not perform a complete medical history and physical exam on ED. 16. Respondent did not document or did not determine the following: a. The nature or intensity of ED’s pain; b. Current or past treatments of ED’s pain; Manuel De Jesus Gainza, M.D. Case No, 2010-24211 c. The effect of pain on ED’s physical or psychological function; d. Any history of substance abuse for ED; e. | Whether ED was taking the prescribed medications or whether ED was taking illicit drugs by performing any drug screens by outside laboratory during the course of treatment; f. obtain any diagnostic studies on ED; g. obtaining any consultations from other specialists on ED; h. Counsel ED on the potential danger of addiction and abuse of the medication being prescribed. i. Respondent did not develop or did not document a treatment plan for ED. Facts Specific to TL 17. Respondent prescribed oxycodone, xanax and percocet for TL, on the dates and in the strengths and quantities described in the following table: Manuel De Jesus Gainza, M.D, 7 Case No. 2010-24211 Oxycodone | Xanax Xanax Percocet 30 Mg. 1Mg. 2 Mg. 10/325 ml Mg. _ 12/31/2009 12/31/2009 30 Mg. 2 Mg. 84 Tablets 30 Tablets 1/21/2010 1/21/2010 30 Mg. 2 Mg. 200 Tablets 30 Tablets 2/20/2010 2/20/2010 30 Mg. 2 Mg. 200 Tablets 30 Tablets 3/22/2010 3/22/2010 30 Mg. 2 Mg. 200 Tablets 28 Tablets 4/19/2010 4/19/2010 30 Mg. 2 Mg. 224 Tablets 30 Tablets 5/17/2010 5/17/2010 30 Mg. 2 Mg. 224 Tablets 30 Tablets 6/14/2010 6/14/2010 30 Mg. 2 Mg. 224 Tablets 30 Tablets 8/12/2010 8/12/2010 30 Mg. 2 Mg. 224 Tablets 30 Tablets 9/9/2010 9/9/2010 9/9/2010 30 Mg. 1 Mg. 10/325 Mg. 210 Tablets | 60 Tablets 90 Tablets 10/19/2010 | 10/19/2010 | 10/19/2010 30 Mg. 1 Mg. 10/325 Mg. 210 Tablets | 60 Tablets | 90 Tablets 18. The strengths and quantities of oxycodone, xanax and percocet which Respondent prescribed were potentially lethal and were prescribed without justification or without documenting justification in the medical record of TL. Manuel De Jesus Galnza, M.O. 8 Case No. 2010-24211 19. Respondent did not refer or did not document a referral for TL to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist. 20. Respondent did not document or did not perform a complete medical history and physical exam on TL. 21. Respondent did not document or did not determine the following: a. | The nature or intensity of TL’s pain; b. | Current or past treatments of TL’s pain; c. The effect of pain on TL’s physical or psychological function; d. Any history of substance abuse for TL. 22. Respondent did not develop or did not document a treatment plan for TL. Facts Specific to HS 23. Respondent prescribed oxycodone, xanax and diazepam for HS on the dates and in the strengths and quantities described in the following table: Manuel De Jesus Gainza, M.D. 9 Case No, 2010-24211 Oxycodone | Oxycodone Xanax Xanax Diazepam 15 Mg. 30 Mg. 1 Mg. 2 Mg. 5 Mg. 6/18/2010 6/18/2010 30 Mg. 2 Mg. 100 Tablets __| 30 Tablets _| 6/30/2010 6/30/2010 30 Mg. 2 Mg. 180 Tablets 30 Tablets 7/30/2010 7/30/2010 30 Mg. 2 Mg. 180 Tablets 60 Tablets 8/30/2010 8/30/2010 8/30/2010 15 Mg. 30 Mg. 2 Mg. 60 Tablets | 180 Tablets | 60 Tablets | 9/27/2010 9/22/2010 30 Mg. 5 Mg. 172 Tablets 60 Tablets [10/28/2010 10/28/2010 10/28/2010 15 Mg. 30 Mg. 5 Mg. 6 Tablets 18 Tablets 60 Tablets 11/1/2010 11/1/2010 15 Mg. 30 Mg. 6 Tablets 18 Tablets aaj | 4/8011 | 30 Mg. 1 Mg. 180 Tablets | 30 Tablets _| 24. The quantities of oxycodone, xanax and diazepam which Respondent prescribed, were potentially lethal and were prescribed without justification or without documenting justification in the medical record of HS. 25. to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist. Manuel De Jesus Gainza, M.D. Case No. 2010-24211 Respondent did not refer or did not document a referral for HS 26. Respondent did not document or did not perform a complete medical history and physical exam on HS. 27. Respondent did not document or did not determine the following: a. The nature or intensity of HS’s pain; b. Current or past treatments of HS's pain; c. The effect of pain on HS’s physical or psychological function; d. Any history of substance abuse for HS. 28. Respondent did not develop or did not document a treatment plan for HS. Facts Specific to JB 29. Respondent prescribed oxycodone, soma, endocet and percocet to JB on the dates and in the strengths and quantities described in the following table: Percocet Oxycodone | Oxycodone Soma Endocet 15 Mg. 30 Mg. 350 Mg. 10/325 Mg. 12/29/2009 30 Mg. 100 Tablets 1/12/2010 1/12/2010 30 Mg. 350 Mg. 212 Tablets | 100 Tablets Manuel De Jesus Gainza, M.D. il Case No. 2010-24211 Oxycodone Oxycodone Soma Endocet Percocet 15 Mg. 30 Mg. 350Mg. | 10/325 10/325 Mg. Mg. ~~ | 2/10/2010 | 2/10/2010 30 Mg. 350 Mg. 224 Tablets | 100 Tablets 3/11/2010 | 3/11/2010 30 Mg. 350 Mg. 224 Tablets | 100 Tablets | 4/8/2010 | 4/8/2010 30 Mg. 350 Mg. i pect Tablets | 100 Tablets | 5/6/2010 5/6/2010 | 5/6/2010 15 Mg. 30 Mg. 350 Mg. 60 Tablets | 200 Tablets | 90 Tablets r 6/4/2010 | 6/4/2010 | 6/4/2010 15 Mg. 30 Mg. 350 Ma. 60 Tablets | 200 Tablets | 100 Tablets 7/1/2010 7/4/2010 | 7/1/2010 30 Mg. 350 Mg. | 10/325 Mg. L. 100 Tablets | 100 Tablets | 100 Tablets 7/29/2010 | 7/29/2010 | 7/29/2010 15 Mg. 30 Mg. 350 Mg. 60 Tablets 180 Tablets | 100 Tablets 8/26/2010 | 8/26/2010 | 8/26/2010 i” 15 Mg. 30 Mg. 350 Mg. 60 Table 180 Tablets | 100 Tablets 8/26/2010 | 8/26/2010 | 8/26/2010 15 Mg. 30 Mg. 350 Mg. 60 Tablets 180 Tablets | 100 Tablets 9/28/2010 | 9/28/2010 9/28/2010 30 Mg. 350 Mg. 10/325 Mg. | 180 Tablets | 90 Tablets 90 Tablets 3/4/2011 | 3/4/2011 30 Mg. 350 Mg. 180 Tablets | 90 Tablets 4/11/2011 | 4/11/2011 7 30 Mg. 350 Mg. | 30. The quantities of oxycodone, soma, endocet and percocet 170 Tablets | 90 Tablets | _ which Respondent prescribed, were potentially lethal and were prescribed 12 Manuel De Jesus Gainza, M.D. Case No. 2010-24211 without justification or without documenting justification in the medical record of JB. 31. Respondent did not refer or did not document a referral for JB to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist. 32. Respondent did not document or did not perform a complete medical history and physical exam on JB. 33. Respondent did not document or did not determine the following: a. The nature or intensity of JB’s pain; b. | Current or past treatments of JB’s pain; c. The effect of pain on JB’s physical or psychological function; d. Any history of substance abuse for JB. 34. Respondent did not develop did not document a treatment plan for JB. Facts Specific to KR 35. Respondent prescribed oxycodone and xanax to KR on the dates and in the strengths and quantities described in the following table: Manuet De Jesus Gainza, M.D. 13 Case No. 2010-24211 Manuel De Jesus Gainza, M.D. Case No. 2010-24211 Oxycodone 15 Mg. 11/12/2009 15 Mg. 56 Tablets a oe 30 Mg. ‘ 2/11/2010 15 Mg. 2/11/2010 30 Mg. 170 Tablets 60 Tablets | 200 Tablets 3/11/2010 | 3/11/2010 15 Mg. 30 Mg. 60 Tablets | 200 Tablets 4/8/2010 4/8/2010 15 Mg. 30 Mg. 60 Tablets | 200 Tablets 6/6/2010 6/6/2010 15 Mg. 30 Mg. 60 Tablets | 200 Tablets 9/15/2010 | 9/15/2010 15 Mg. 30 Mg. 60 Tablets | 180 Tablets 11/2/2010 | 11/2/2010 15 Mg. 30 Mg. 60 Tablets | 180 Tablets 2/10/2011 30 Mg. | 168 Tablets 3/11/2011 | 3/11/2011 30 Mg. 1 Mg. 180 Tablets 30 Tablets 4/11/2011 | 4/11/2011 30 Mg. ; Tablets 14 36. The quantities of oxycodone and xanax which Respondent prescribed, were potentially lethal and were prescribed without justification or without documenting justification in the medical record of KR. 37. Respondent did not refer or did not document a referral for KR to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist. 38. Respondent did not document or did not perform a complete medical history and physical exam on KR. 39. Respondent did not document or did not determine the following: a. | The nature or intensity of KR’s pain; b. Current or past treatments of KR’s pain; c. The effect of pain on KR’s physical or psychological function; d. Any history of substance abuse for KR. 40. Respondent did not develop or did not document a treatment plan for KR. Manuel De Jesus Gainza, M.D. 15 Case No. 2010-24211 COUNT ONE 41. Petitioner realleges and incorporates paragraphs 1 through 16 as if fully set forth herein. 42. Section 458.331(1)(q), Florida Statutes(2009)(2010), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician’s professional practice. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate 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 intent. 43. Respondent prescribed controlled substances inappropriately or in excessive or inappropriate quantities in one or more of the following ways: a. By prescribing the controlled substances, roxicodone, xanax and oxycodone without justification to ED, as outlined in paragraphs 1 through 16; Manuel De Jesus Gainza, M.D. 16 Case No. 2010-24211 b. By prescribing the controlled substances, roxicodone, xanax and oxycodone in potentially lethal doses to ED, as outlined in paragraphs 1 through 16. 44, Based on the forgoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2009)(2010) when he prescribed the controlled substances, roxicodone, xanax and oxycodone, without justification and in potentially lethal doses, to ED, as outlined in paragraphs 1 through 16. NT TW 45. Petitioner realleges and incorporates paragraphs 1 through 16 as if fully set forth herein. 46. Section 458.331(1)(m), Florida Statutes (2009)(2010), provides that failing to keep legible medical records that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations, constitutes grounds for disciplinary action by the Board of Medicine. Manuel De Jesus Gainza, M.D. 17 Case No. 2010-24211 47. Respondent failed to keep legible medical records justifying the course of treatment for ED in one or more of the following ways: a. Manuel! De Jesus Gainza, M.D. Case No. 2010-24211 By failing to document justification for prescribing roxicodone, xanax and oxycodone to ED; By failing to document referrals for ED to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; By failing to document performance of a complete medical history and physical exam on ED; By failing to document the nature or intensity of ED‘s pain; By failing to document current or past treatments of ED’s pain; By failing to document the effect of pain on ED’s physical or psychological function; | By failing to document any history of substance abuse for ED; By failing to document a treatment plan for ED; 18 i. By failing to document a medication management agreement on any visits but still prescribing controlled substances; j By failing to document a urine drug screen from an outside laboratory on ED; k. By failing to document any diagnostic studies on ED. 48. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2009)(2010), by failing to keep legible medical records that justify the course of treatment for ED. COUNT THREE 49. Petitioner realleges and incorporates paragraphs 1 through 16 as if fully set forth herein. 50. Section 458.331(1)(t), Florida Statutes (2009)(2010), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2009)(2010), defines medical malpractice as the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure. Manuel De Jesus Gainza, M.D. 19 Case No, 2010-24211 51. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in Section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean“. . . The prevailing professional 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. .. .” 52. Respondent failed to meet the required standard of care in one or more of the following ways: a. _ By prescribing roxicodone, xanax and oxycodone to ED without justification, as outlined in paragraphs 1 through 16; b. By prescribing roxicodone, xanax and oxycodone to ED in potentially lethal doses, as outlined in paragraphs 1 through 16; c. By failing to refer ED to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; Manuel De Jesus Gainza, M.D. 20 Case No. 2010-24211 d. By failing to obtain a complete medical history and perform a physical exam on ED; e. By failing to obtain the nature or intensity of ED’s pain; f. By failing to obtain the current or past treatments of ED‘s pain; g. _ By failing to obtain information on the effect of pain on ED’s physical or psychological function; h. By failing to obtain any history of substance abuse for ED; i. By failing to document a treatment plan for ED; j. By failing to document a urine drug screen from an outside laboratory on ED; k. By failing to document any diagnostic studies on ED. 53. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2009)(2010), by committing medical malpractice. Manuel De Jesus Gainza, M.D. . 21 Case No. 2010-24211 COUNT FOUR 54, Petitioner reincorporates and realleges paragraphs 1 through 16 as if fully set forth herein. 55. Section 458.331(1)(nn), Florida Statutes (2009)(2010), provides that violating any provision of chapters 456 or 458, Florida Statutes, or any rules adopted pursuant thereto, is grounds for discipline by the Board of Medicine. 56. Respondent violated Section 458.331(1)(nn), Florida Statutes (2009)(2010) when he violated Rule 64B8-9.013(3), FAC in one or more of the following ways: a. By failing to document justification for prescribing roxicodone, xanax and oxycodone to ED; b. By failing to document referrals for ED to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; c. By failing to document performance of a complete medical history and physical exam on ED; d. By failing to document the nature or intensity of ED's pain; Manuel De Jesus Gainza, M.D. 22 Case No. 2010-24211 e. By failing to document current or past treatments of ED’s pain; f. By failing to document the effect of pain on ED‘s physical or psychological function; g. By failing to document any history of substance abuse for ED; h. By failing to document a treatment plan for ED; i. By failing to document a medication management agreement on any visits but still prescribing controlled substances for ED; j. By failing to document a urine drug screen from an outside laboratory on ED; k. By failing to document any diagnostic studies on ED. 57, Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2009)(2010), by violating Rule 64B8- 9.013(3), FAC. COUNT FIVE 58. Petitioner realleges and incorporates paragraphs 1 through 11 and paragraphs 17 through 22 as if fully set forth herein. Manuel De Jesus Gainza, M.D. 23 Case No. 2010-24211 59. Section 458.331(1)(q), Florida Statutes (2009)(2010), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician’s professional practice. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate 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 intent. 60. Respondent prescribed controlled substances inappropriately or in excessive or inappropriate quantities in one or more of the following ways: a. By prescribing the controlled substances, oxycodone, xanax and percocet, without justification to patient TL, as outlined in paragraphs 17 through 22; b. By prescribing the controlled substances, oxycodone, xanax and percocet in potentially lethal Manuel De Jesus Gainza, M.D. 24 Case No. 2010-24211 doses to TL, as outlined in paragraphs 17 through 22. 61. Based on the forgoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2009)(2010) when he prescribed the controlled substances, oxycodone, xanax and percocet, without justification and in potentially lethal doses, to TL, as outlined in paragraphs 17 through 22. NT SI 62. Petitioner realleges and incorporates paragraphs 1 through 11 and paragraphs 17 through 22 as if fully set forth herein. 63. Section 458.331(1)(m), Florida Statutes (2009)(2010), provides that failing to keep legible medical records that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations, constitutes grounds for disciplinary action by the Board of Medicine. 64. Respondent falled to keep legible medical records justifying the course of treatment for TL in one or more of the following ways: Manuel De Jesus Gainza, M.D. 25 Case No. 2010-24211 Manuel! De Jesus Gainza, M.D. Case No. 2010-24211 By failing to document justification for prescribing oxycodone, xanax and percocet to TL; By failing to document referrals for TL to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; By failing to document performance of a complete medical history and physical exam on TL; By failing to document the nature or intensity of TL's pain; By failing to document current or past treatments of TL’s pain; By failing to document the effect of pain on TL’s physical or psychological function; By failing to document any history of substance abuse for TL; By failing to document a treatment plan for TL; By failing to document a medication management agreement on any visits but still prescribing controlled substances; 26 j. By failing to document a urine drug screen from an outside laboratory on TL; k. By failing to document any diagnostic studies on TL; 65. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2009)(2010), by failing to keep legible medical records that justify the course of treatment for patient TL. COUNT SEVEN 66. Petitioner realleges and incorporates paragraphs 1 through 11 and paragraphs 17 through 22 as if fully set forth herein. 67. Section 458.331(1)(t), Florida Statutes (2009)(2010), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2009)(2010), defines medical malpractice as the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure. 68. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in Section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean". . . The prevailing professional standard of care Manuel De Jesus Gainza, M.D. 27 Case No, 2010-24211 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. .. .” 69. Respondent failed to meet the required standard of care in one or more of the following ways: a. Manuel De Jesus Gainza, M.D. Case No. 2010-24211 By prescribing oxycodone, xanax and percocet to TL without justification, as outlined in paragraphs 17 through 22; By prescribing oxycodone, xanax and percocet to TL in potentially lethal doses, as outlined in paragraphs 17 through 22; By failing to refer TL to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; By failing to obtain a complete medical history and perform a physical exam on TL; By failing to obtain the nature or intensity of TL’s pain; 28 f. By failing to obtain the current or past treatments of TL’s pain; g. _ By failing to obtain information on the effect of pain on TL’s physical or psychological function; h. _ By failing to obtain any history of substance abuse for TL; i. By failing to document a treatment plan for TL; j. By failing to document a urine drug screen from an outside laboratory on TL; k. By failing to document any diagnostic studies on TL. 70. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2009)(2010), by committing medical malpractice. NT EIGHT 71. Petitioner reincorporates and realleges paragraphs 1 through 11 and 17 through 22 as if fully set forth herein. 72. Section 458.331(1)(nn), Florida Statutes (2009)(2010), provides that violating any provision of chapters 456 or 458, Florida Manuel De Jesus Gainza, M.D. 29 Case No. 2010-24211 Statutes, or any rules adopted pursuant thereto, is grounds for discipline by the Board of Medicine. 73. Respondent violated Section 458.331(1)(nn) Florida Statutes (2009)(2010) when he violated Rule 64B8-9.013(3), FAC in one or more of the following ways: a. Manuel De Jesus Gainza, M.D. Case No. 2010-24211 By failing to document justification for prescribing oxycodone, xanax and percocet to TL; By failing to document referrals for TL to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; By failing to document performance of a complete medical history and physical exam on TL; By failing to document the nature or intensity of TL's pain; By failing to document current or past treatments of TL's pain; By failing to document the effect of pain on TL's physical or psychological function; 30 g. By failing to document any history of substance abuse for TL; h. By failing to document a treatment plan for TL; i. By failing to document a medication management agreement on any visits but still prescribing controlled substances; j. By failing to document a urine drug screen from an outside laboratory on TL; k. By failing to document any diagnostic studies on TL. 74. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2009)(2010), by violating Rule 64B8- 9.013(3), FAC. COUNT NINE 75. Petitioner realleges and incorporates paragraphs 1 through 11 and paragraphs 23 through 28 as if fully set forth herein. 76. Section 458.331(1)(q), Florida Statutes (2009), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. For purposes of this paragraph, it shall be legally Manuel De Jesus Gainza, M.D. 31 Case No. 2010-24211 presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate 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 intent. 77. Respondent prescribed controlled substances inappropriately or in excessive or inappropriate quantities in one or more of the following ways: a. By prescribing the controlled | substances, oxycodone, xanax and diazepam without justification to patient HS, as outlined in paragraphs 23 through 28; b. By prescribing the controlled substances, oxycodone, xanax and diazepam in potentially lethal doses to patient HS, as outlined in paragraphs 23 through 28. 78. Based on the forgoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2010) when he prescribed the controlled substances without justification and in potentially lethal doses, to patient HS, as outlined in paragraphs 23 through 28. Manuel De Jesus Gainza, M.D. 32 Case No. 2010-24211 COUNT TEN 79. Petitioner realleges and incorporates paragraphs 1 through 11 and paragraphs 23 through 28 as if fully set forth herein. 80. Section 458.331(1)(m), Florida Statutes (2010), provides that failing to keep legible medical records that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations, constitutes grounds for disciplinary action by the Board of Medicine. 81. Respondent failed to keep legible medical records justifying the course of treatment for HS in one or more of the following ways: a. _ By failing to document justification for prescribing oxycodone, xanax and diazepam to HS; b. By failing to document referrals for HS to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; c. By failing to document performance of a complete medical history and physical exam on HS; Manuel De Jesus Gainza, M.D. 33 Case No. 2010-24211 d. By failing to document the nature or intensity of HS‘s pain; e. _ By failing to document current or past treatments of HS's pain; f. By failing to document the effect of pain on HS's physical or psychological function; g. By failing to document any history of substance abuse for HS; h. By failing to document a treatment plan for HS; i. By falling to document a medication management agreement on any visits but still prescribing controlled substances; j. By failing to document a urine drug screen from an outside laboratory on HS; k. By failing to document any diagnostic studies on HS. 82. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2010), by failing to keep legible medical records that justify the course of treatment for patient HS. Manuel De Jesus Gainza, M.D. 34 Case No, 2010-24211 COUNT ELEVEN 83. Petitioner realleges and incorporates paragraphs 1 through 121and paragraphs 23 through 28 as if fully set forth herein. 84. Section 458.331(1)(t), Florida Statutes (2009), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2009), defines medical malpractice as the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure. 85. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified In Section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean™. . . The prevailing professional 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... .” 86. Respondent failed to meet the required standard of care in one or more of the following ways: Manuel De Jesus Gainza, M.D. 35 Case No. 2010-24211 Manuel De Jesus Gainza, M.D. Case No. 2010-24211 By prescribing controlled substances oxycodone, xanax and diazepam to HS without justification, as outlined in paragraphs 23 through 28; By prescribing controlled substances oxycodone, xanax and diazepam to HS in potentially lethal doses, as outlined in paragraphs 23 through 28; By failing to refer HS to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; By failing to obtain a complete medical history and perform a physical exam on HS; By failing to obtain the nature or intensity of HS’s pain; By failing to obtain the current or past treatments of HS's pain; By failing to obtain information on the effect of pain on HS's physical or psychological function; By falling to obtain any history of substance abuse for HS; 36 i. By failing to document a treatment plan for HS; j. By failing to document a urine drug screen from an outside laboratory on HS; k. By failing to document any diagnostic studies on HS. 87. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2010), by committing medical malpractice. COUNT TWELVE 88. Petitioner reincorporates and realleges paragraphs 1 through 11 and paragraphs 23 through 28 as if fully set forth herein. 89. Section 458.331(1)(nn), Florida Statutes (2010), provides that violating any provision of chapters 456 or 458, Florida Statutes, or any rules adopted pursuant thereto, is grounds for discipline by the Board of Medicine. 90. Respondent violated Section 458.331(1)(nn), Florida Statutes (2010) when he violated Rule 64B8-9.013(3), FAC in one or more of the following ways: a. _ By failing to document justification for prescribing to HS; Manuel De Jesus Gainza, M.D. 37 Case No. 2010-24211 b. By failing to document referrals for HS to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; c. By failing to document performance of a complete medical history and physical exam on HS; d. By failing to document the nature or intensity of HS's pain; e. By failing to document current or past treatments of HS’s pain; f. By failing to document the effect of pain on HS‘s physical or psychological function; g. By failing to document any history of substance abuse for HS; h. By failing to document a treatment plan for HS; 1, By failing to document a medication management agreement on any visits but still prescribing controlled substances; j. By failing to document a urine drug screen from an outside laboratory on HS; Manuel De Jesus Gainza, M.D. 38 Case No. 2010-24211 k. By failing to document any diagnostic studies on HS. 91. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2010), by violating Rule 64B8-9.013(3), FAC. COUNT THIRTEEN 92. Petitioner realleges and incorporates paragraphs 1 through 11 and paragraphs 29 through 34 as if fully set forth herein. 93. Section 458.331(1)(q), Florida Statutes (2009)(2010), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician’s professional practice. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate 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 intent. 94. Respondent prescribed controlled substances, oxycodone, soma, endocet and _ percocet, inappropriately or in excessive or inappropriate quantities to JB in one or more of the following ways: Manuel De Jesus Gainza, M.D. 39 Case No, 2010-24211 a. By prescribing the controlled | substances, oxycodone, soma, endocet and percocet, without justification to patient JB, as outlined in paragraphs 29 through 34; b. By prescribing the controlled | substances, oxycodone, soma, endocet and percocet in potentially lethal doses to patient JB, as outlined in paragraphs 29 through 34. 95. Based on the forgoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2009)(2010) when he prescribed the controlled substances, oxycodone, soma, endocet and percocet without justification and in potentially lethal doses, to patient JB, as outlined in paragraphs 29 through 34. COUNT FOURTEEN 96. Petitioner realleges and incorporates paragraphs 1 through 11 and paragraphs 29 through 34 as if fully set forth herein. 97. Section 458.331(1)(m), Florida Statutes (2009)(2010), provides that failing to keep legible medical records that justify the course of treatment of the patient, including, but not limited to, patient histories; Manuel De Jesus Gainza, M.D. 40 Case No. 2010-24211 examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations, constitutes grounds for disciplinary action by the Board of Medicine. 98. Respondent failed to keep legible medical records justifying the course of treatment for JB in one or more of the following ways: a. _ By failing to document justification for prescribing oxycodone, soma, endocet and percocet to JB; b. By failing to document referrals for JB to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; c. By failing to document performance of a complete medical history and physical exam on JB; d. By failing to document the nature or intensity of JB's pain; e. _ By failing to document current or past treatments of JB’s pain; f. By failing to document the effect of pain on JB's physical or psychological function; Manuel De Jesus Gainza, M.D. 41 Case No. 2010-24211 k. 99. Based on the foregoing, 458.331(1)(m), Florida Statutes (2009)(2010), by failing to keep legible By failing to document any history of substance abuse for JB; By failing to document a treatment plan for JB; By failing to document a medication management agreement on any visits but still prescribing controlled substances to JB; By failing to document a urine drug screen from an outside laboratory on JB; By failing to document any diagnostic studies on JB. medical records that justify the course of treatment for patient JB. 100. Petitioner realleges and incorporates paragraphs 1 through 11 COUNT FIFTEEN and paragraphs 29 through 34 as if fully set forth herein. 101. Section 458.331(1)(t), Florida Statutes (2009)(2010), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2009)(2010), defines medical malpractice as the failure to practice medicine in accordance with Manuel De Jesus Gainza, M.D, Case No. 2010-24211 Respondent violated Section the level of care, skill, and treatment recognized in general law related to health care licensure. 102. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in Section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean™.. . The prevailing professional standard of care for a given health care provider shall be that level of care, skill, and treatment which, in fight of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers... .” 103. Respondent failed to meet the required standard of care in one or more of the following ways: a. By prescribing oxycodone, soma, endocet and percocet to JB without justification, as outlined in paragraphs 29 through 34; b. By prescribing oxycodone, soma, endocet and percocet to JB in potentially lethal doses, as outlined in paragraphs 29 through 34; Manuel De Jesus Gainza, M.D. 43 Case No. 2010-24211 Manuel De Jesus Gainza, M.D. Case No. 2010-24211 By failing to refer JB to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; By failing to obtain a complete medical history and perform a physical exam on JB; By failing to obtain the nature or intensity of JB’s pain; By failing to obtain the current or past treatments of JB's pain; By failing to obtain information on the effect of pain on JB's physical or psychological function; By failing to obtain any history of substance abuse for JB; By failing to document a treatment plan for JB; By failing to document a urine drug screen from an outside laboratory on JB; By failing to document any diagnostic studies on JB. 104. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2009)(2010), by committing medical malpractice. COUNT SIXTEEN 105. Petitioner reincorporates and realleges paragraphs 1 through 11 and paragraphs 29 through 34 as if fully set forth herein. 106. Section 458.331(1)(nn), Florida Statutes (2009)(2010), provides that violating any provision of chapters 456 or 458, Florida Statutes, or any rules adopted pursuant thereto, is grounds for discipline by the Board of Medicine. 107. Respondent violated Section 458.331(1)(nn), Florida Statutes (2009)(2010) when he violated Rule 64B8-9.013(3), FAC in one or more of the following ways: a. _ By failing to document justification for prescribing oxycodone, soma, endocet and percocet to JB; b. By failing to document referrals for JB to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; Manuel De Jesus Gainza, M.D. 45 Case No. 2010-24211 c. _ By failing to document performance of a complete medical history and physical exam on JB; d. By failing to document the nature or intensity of JB's pain; e. By failing to document current or past treatments of JB’s pain; f. By failing to document the effect of pain on JB's physical or psychological function; g. By failing to document any history of substance abuse for JB; h. By failing to document a treatment plan for JB; i. By failing to document a medication management agreement on any visits but still prescribing controlled substances; j. By failing to document a urine drug screen from an outside laboratory on JB; k. By failing to document any diagnostic studies on JB. Manuel De Jesus Gainza, M.D. 46 Case No. 2010-24211 108. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2009)(2010), by violating Rule 64B8- 9.013(3), FAC. COUNT SEVENTEEN 109. Petitioner realleges and incorporates paragraphs 1 through 11 and paragraphs 35 through 40 as if fully set forth herein. 110. Section 458.331(1)(q), Florida Statutes (2009)(2010), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate 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 intent. 111. Respondent prescribed controlled substances oxycodone and xanax inappropriately or in excessive or inappropriate quantities to KR in one or more of the following ways: Manuel De Jesus Gainza, M.D. 47 Case No. 2010-24211 a. _ By prescribing the controlled substances, oxycodone . and xanax without justification to patient KR, as outlined in paragraphs 35 through 40; b. By prescribing the controlled substances, oxycodone and xanax in potentially lethal doses to patient KR, as outlined in paragraphs 35 through 40. 112. Based on the forgoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2009)(2010) when he prescribed the controlled substances, oxycodone and xanax without justification and in potentially lethal doses, to patient KR, as outlined in paragraphs 35 through 40. COUNT EIGHTEEN 113. Petitioner realleges and incorporates paragraphs 1 through 11 and paragraphs 35 through 40 as if fully set forth herein. 114. Section 458.331(1)(m), Florida Statutes (2009)(2010), provides that failing to keep legible medical records that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or Manuel De Jesus Gainza, M.D. 48 Case No. 2010-24211 administered; and reports of consultations and hospitalizations, constitutes grounds for disciplinary action by the Board of Medicine. 115. Respondent failed to keep legible medical records justifying the course of treatment for KR in one or more of the following ways: a. Manuel De Jesus Gainza, M.D. Case No. 2010-24211 By failing to document justification for prescribing oxycodone and xanax to KR; By failing to document referrals for KR to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; By failing to document performance of a complete medical history and physical exam on KR; By failing to document the nature or intensity of KR’s pain; By failing to document current or past treatments of KR’s pain; By falling to document the effect of pain on KR's physical or psychological function; By failing to document any history of substance abuse for KR; 49 h. By failing to document a treatment plan for KR; i. By failing to document a medication management agreement on any visits but still prescribing controlled substances; and or, j. By failing to document a urine drug screen from an outside laboratory on KR; k. By failing to document any diagnostic studies on KR. 116. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2009)(2010), by failing to keep legible medical records that justify the course of treatment for patient KR. COUNT NINETEEN 117. Petitioner realleges and incorporates paragraphs 1 through 11 and paragraphs 35 through 40 as if fully set forth herein. 118. Section 458.331(1)(t), Florida Statutes (2009)(2010), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2009)(2010), defines medical malpractice as the failure to practice medicine In accordance with Manuel De Jesus Gainza, M.D. 50 Case No, 2010-24211 the level of care, skill, and treatment recognized in general law related to health care licensure. 119. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in Section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean“. . . The prevailing professional 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... .” 120. Respondent failed to meet the required standard of care in one or more of the following ways: a. _ By prescribing oxycodone and xanax to KR without justification, as outlined in paragraphs 35 through 40; b. By prescribing oxycodone and xanax to KR in potentially lethal doses, as outlined in paragraphs 35 through 40; Manuel De Jesus Gainza, M.D. 51 Case No. 2010-24211 Manuel De Jesus Gainza, M.D. Case No. 2010-24211 By failing to refer KR to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; By failing to obtain a complete medical history and perform a physical exam on KR; By failing to obtain the nature or intensity of KR’s pain; By failing to obtain the current or past treatments of KR’s pain; By failing to obtain information on the effect of pain on KR’s physical or psychological function, By failing to obtain any history of substance abuse for KR; By failing to document a treatment plan for KR; By failing to document a urine drug screen from an outside laboratory on KR; By failing to document any diagnostic studies on KR. 52 121. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2009)(2010), by committing medical malpractice. COUNT TWENTY 122. Petitioner reincorporates and realleges paragraphs 1 through 11 and paragraphs 35 through 40 as if fully set forth herein. 123. Section 458.331(1)(nn), Florida Statutes (2009)(2010), provides that violating any provision of chapters 456 or 458, Florida Statutes, or any rules adopted pursuant thereto, is grounds for discipline by the Board of Medicine. 124. Respondent violated Section 458.331(1)(nn), Florida Statutes (2009)(2010) when he violated Rule 64B8-9.013(3), FAC in one or more of the following ways: a. By failing to document justification for prescribing oxycodone and xanax to KR; b. By failing to document referrals for KR to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; Manuel De Jesus Gainza, M.D. 53 Case No. 2010-24211 Manuel De Jesus Gainza, M.D. Case No. 2010-24211 By failing to document performance of a complete medical history and physical exam on KR; By failing to document the nature or intensity of KR’s pain; By failing to document current or past treatments of KR’s pain; By failing to document the effect of pain on KR’s physical or psychological function; By failing to document any history of substance abuse for KR; By failing to document a treatment plan for KR; By failing to document a medication management agreement on any visits but still prescribing controlled substances oxycodone and xanax to KR; By failing to document a urine drug screen from an outside laboratory on KR; By falling to document any diagnostic studies on KR. 54 125. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2009)(2010), by violating Rule 64B8- 9.013(3), FAC. WHEREFORE, the 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 the Respondent on probation, corrective action, refund of fees billed or collected, remedial education any other relief that the Board deems appropriate. SIGNED this 227A day of __ 7Z ag , 2012. John H. Armstrong, MD State Surgeon General & Secretary of Health (eee Ian Brown Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, BIN C-65 Tallahassee, FL 32399-3265 FILED DEPARTMENT OF HEALTH DEPUTY aa Florida Bar #499048 CLERK Angel Sanders Telephone (850) 245-4640 pare WAY & 1 201 Fax (850) 245-4681 1B/jb PCP Date: May 25, 2012 PCP Members: Dr. Miguel, Dr. Stringer & Mr. Levine Manuel De Jesus Gainza, M.D. 55 Case No. 2010-24211 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. Manuel De Jesus Galnza, M.D. 56 Case No. 2010-24211

Docket for Case No: 12-002646PL