STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, Petitioner, Vv. DOH CASE NO.: 2007-36742 JORGE OSCAR WEKSLER, 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 Respondent, George Oscar Weksler, M.D., (Respondent) 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. J:\PSU\Medical\Robert Milne\Cases\WEKSLER 2007-36742\Weksler AC 07-36742 doc Final Draft.doc 1 Filed November 14, 2012 12:27 PM Division of Administrative Hearings 2. At all times material to this Complaint, Respondent was board certified in Surgery and was a licensed physician within the State of Florida, having been issued license number ME 55145. 3. At all times material to this Complaint Respondent's address of record was 7315 Hudson Avenue, Hudson, Florida 34667-1158. 4, On or about November 16, 2004, Patient PO, a forty-four year- old male, presented to Gulf Coast orthopedic Center at the above mentioned address in Hudson, Florida complaining of lower back pain. His pain radiated across the lumbar area and down the back and sides of each leg with associated symptoms of numbness and tingling in both legs from the knee downwards, as well in both feet. 5. PO's past medical history included at least 5 lumbar spine surgeries including a laminectomy at L5/S1 and a posterolateral gutter fusion (spinal fusion involving the placing of bone graft on the outside of the spine) at L4/L5, 6. Subsequent evaluation at Gulf Coast Orthopedic Center by Respondent using diagnostic fluoroscopic guided nerve block injections of the facet joints on the right side at L3-4, L4-5, and L5-S1, provided PO with temporary relief from pain, iS) J:\PSU\Medical\Robert Milne\Cases\WEKSLER 2007-36742\Weksier AC 07-36742 doc Final Draft.doc 7. These diagnostic intra-articular injections into the joint space were performed to assess whether the source of PO's spinal pain was coming from inflamed osteoarthritic joints. 8. Facet Joint syndrome is a common cause of pain related to the spine. The facet joints are the articulations or connections between the vertebrae in the spine that enable the bending or twisting movements of the spine. The facet joints can get inflamed secondary to injury or arthritis and cause pain and stiffness. 9. If there is a favorable response to intra-articular injections, then more permanent techniques may be considered. Facet denervation (rhizolysis) is the interruption of spinal nerve roots by coagulation with radiofrequency waves, and is most commonly performed in the lumbar and cervical regions of the spine where a Radio-Frequency Lesion Generator produces an irreversible destructive lesion of the medial branch nerve, blocking the passage of painful messages from the affected facet joint to the rest of the central nervous system. i0. Based on the foregoing, even though Respondent had not performed diagnostic fluoroscopic guided nerve block injections of the facet J:\PSU\Medical\Robert Milne\Cases\WEKSLER 2007-36742\Weksler AC 07-36742 doc Final Draft.doc 3 joints on the left side at L3-4, L4-5, and L5-S1, Respondent diagnosed PO with bilateral facet joint syndrome at L3-4, L4-5, and L5-S1. 1i. On November 18, 2004, Respondent took PO to surgery at the Gulf Coast Orthopedic Center where he underwent bilateral microsurgical debridement with rhizolysis of the facet joints at L3-4,L4-5, and L5-S1 together with thermocoalgulation of the ‘dorsal rami innervating the facet joints at L3-4,L4-5, and L5-S1, where the use of heat produced by high- frequency electric current obtained the localized destruction of the posterior (or dorsal) branches (or divisions) of the spinal nerves, also referred to as the dorsal rami. 12. Section 458.331(1) (t), Florida Statutes (2004), provides that committing medical malpractice constitutes grounds for disciplinary action by the Board of Medicine. Count One 13. Paragraphs 1 through 12 are adopted and realleged as though fully set forth. 14. Medical Malpractice is defined in Section 456.50, Florida Statutes (2004), as the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to J:\PSU\Medical\Robert Milne\Cases\WEKSLER 2007-36742\Weksler AC 07-36742 doc Final Draft.doc 4 health care licensure. For purposes of Section 458.331(1)(t), Florida Statutes (2004), the Board shall give great weight to the provisions of Section 766.102, Florida Statutes (2004), which provide that 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. 15. On or about November 18, 2004, Respondent failed to practice with the 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 in one or more of the following ways: a) By failing to perform diagnostic fluoroscopic guided nerve block injections of the facet joints on the left side at L3-4, L4-5, and L5-Si prior to diagnosing bilateral facet joint syndrome at those levels; b) By failing to properly and completely evaluate PO in diagnosing bilateral facet joint syndrome at L3-4, L4-5, and L5-S1; ¢) By failing preoperatively to accurately examine and diagnose PO with bilateral facet joint syndrome at L3-4, L4-5, and L5-S1; J:\PSU\Medical\Robert Milne\Cases\WEKSLER 2007-3674 2\Weksler AC 07-36742 doc Final Draft.doc 5 d) By failing preoperatively to consider performing diagnostic fluoroscopic guided nerve block injections of the facet joints on the left side at L3-4, L4- 5, and L5-S1 before reaching a diagnosis of bilateral facet joint syndrome. e) By failing to appropriately advise his patient that he reached his diagnosis of bilateral facet joint syndrome at L3-4, L4-5, and L5-S1 without having accurately performed all the required testes to validate such a diagnosis; f) By failing to create a preoperative plan to correctly diagnose bilateral facet joint syndrome at L3-4, L4-5, and L5-S1; g) By performing rhizolysis of the left facet joints at L3-4, L4-5, and L5-S1 together with thermocoaigulation of the dorsal rami innervating the left facet joints at L3-4, L4-5, and L5-S1 without first having performed the necessary diagnostic tests that would have warranted such a procedure; 16. Based on the foregoing, Respondent has violated Section 458.331(1) (0), Florida Statutes (2004). Count Two 17. Paragraphs 1 through 12 are adopted and realleged as though fully set forth. J:\PSU\Medical\Robert Milne\Cases\WEKSLER 2007-36742\Weksler AC 07-36742 doc Final Draft.doc 6 18. Section 458.331(1)(m), Florida Statutes (2004), subjects a licensee to discipline for failing to keep legible, as defined by department rule in consultation with the board, medical records that identify the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for rendering, ordering, supervising, or 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; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. 19. Between November 16 and November 18, 2004, Respondent failed to keep medical records that justified the course of treatment of the patient, concerning the microsurgical debridement with rhizolysis of the left facet joints at L3-4, L4-5, and L5-S1 together with thermocoalgulation of the dorsal rami innervating the left facet joints at L3-4, L4-5, and L5-Si. 20. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2004). J:\PSU\Medical\Robert Milne\Cases\WEKSLER 2007-36742\Weksler AC 07-36742 doc Final Draft.doc 7 Count Three 21. Paragraphs 1 through 12 are adopted and realleged as though fully set forth. 22. Section 458.331(1)(p), Florida Statutes (2004), subjects a licensee to discipline for performing professional services which have not been duly authorized by the patient or client. 23. Informed consent requires that a physician sufficiently educate a patient as to the risks, benefits, and alternatives to a proposed treatment to allow a patient to consider the information prior to signing an “informed consent” form. | 24. On November 18, 2010 respondent failed to adequately explain to PO that he had failed to correctly and completely diagnose bilateral facet joint syndrome at L3-4, L4-5, and L5-S1 because he failed to adequately explain to PO that his diagnosis of bilateral facet joint syndrome at L3-4, L4-5, and L5-S1 was based on incomplete information in that he had not performed the required diagnostic fluoroscopic guided nerve block injections of the facet joints on the left side at L3-4, L4-5, and L5-S1 before reaching a diagnosis of bilateral facet joint syndrome. 25, By failing to make this disclosure and explain the J:\PSU\Medical\Robert Milne\Cases\WEKSLER 2007-36742\Weksler AC 07-36742 doc Final Draft.doc 8g consequences of failing to perform these diagnostic injections on the left side of L3-4, L4-5, and L5-Si, Respondent failed to obtain PO’s knowing and informed consent to the microsurgical debridement with rhizolysis of the left facet joints at L3-4, L4-5, and L5-S1 together with thermocoalgulation of the dorsal rami innervating the left facet joints at L3- 4, L4-5, and L5-S1. 26. Based on the foregoing, Respondent violated Section 458.331(1)(p), Florida Statutes (2004). 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 and/or any other relief that the Board deems appropriate. J:\PSU\Medical\Robert Milne\Cases\WEKSLER 2007-36742\Weksler AC 07-36742 doc Final Draft.doc 9 SIGNED this _/O day of October, 2010. Wha Ana M. ‘amonte Ros, M.D., M.P.H. State | ygeon General sa ath, FILED MLL [<~\ DEPARTMENT OFS | ourenCingela a one. {ps8 / 10 Sistant General Counsel orida Bar # 622338 DOH Prosecution Services Unit 4052 Bald Cypress Way-Bin C-65 Tallahassee, Florida 32399-3265 (850) 245-4640 Office (850) 245-4681 Facsimile PCP Members: K& A, Redrice HORSE? PCP: fiery 12, AGIO J:\PSU\Medical\Robert Milne\Cases\WEKSLER 2007-36742\Weksler AC 07-36742 doc Final Draft.doc 10 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 inciude attorney hours and costs, on the Respondent in addition to any other discipline imposed. J:\PSU\Medical\Robert Milne\Cases\WEKSLER 2007-36742\Weksler AC 07-36742 doc Final Draft.doc a]

Docket for Case No: 12-003658PL