fol STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, ; PETITIONER, CASE NO. 2008-21684 JOHN E. NEES, M.D., RESPONDENT. / ; ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, the Florida Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Medicine against the Respondent, John E. Nees, M.D. In support thereof Petitioner alleges the following: 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, the Respondent was a licensed physician within the state of Florida, having been issued license number ME 36792. 35 Respondent’s address of record is 2901 Clint Moore Road, Suite 409, Boca Raton, Florida 33496. J:\PSU\Medical\Medical cases assigned to Allied Section\Nees, John E 2008-21684\AC_Nees-2_08-21684.doc S Filed November 16, 2012 10:01 AM Division of Administrative Hearings tie 4. Atall times material to this Complaint, Respondent engaged in the practice of medicine, specializing in plastic surgery. The Respondent is Board Certified by the American Board of Plastic Surgery. it On or about June 19, 2007, patient Y.D., a then fifty-two-year- old female, presented to Respondent at the Strax Rejuvenation & Aesthetics Institute for a “facelift,” “supplemental liposuction” (ie, a neck liposuction), and “upper and lower eyelid blepharochalasis” (i.e., a four quadrant blepharoplasty). 6. The Patient History and Physical Examination information recorded by Respondent prior to surgery is uninformative, inadequate and partially illegible. 7. Extreme pain is an expected consequence of multiple procedures such as those performed on Y.D. 8. Only local anesthesia was used and Y.D. was fully awake during the surgery. 9. YD. was in extreme pain during the procedure and complained to Respondent about the extreme pain. 10. Medical record progress notes recorded by Respondent regarding Y.D.’s surgery are uninformative, inadequate and partially illegible. J:\PSU\Medical\Medical cases assigned to Allied Section\Nees, John E 2008-21684\AC_Nees-2_08-21684.doc 2 ll. Medical record progress notes recorded by Respondent regarding Y.D.’s surgery do not justify the course of treatment. 12. Medical record progress notes of the surgery do not indicate that Respondent took any action to relieve Y.D.’s pain. 13. Post surgery, it was apparent that Y.D.’s left tragus, the small somewhat triangular-shaped protuberance at the front of the ear, was no longer intact. 14. Medical record progress notes for YD. do not document inadvertent or intentional amputation of Y.D.’s left tragus. 15. Silvadene® is the brand name for silver sulfadiazine, a sulfa antibiotic prescription drug that, according to the U.S. National Library of Medicine (USNLM), part of the National Institutes of Health, is used to prevent and treat infections, typically of second- and third-degree burns but also from other sources. According to the USNLM silver sulfadiazine kills a wide variety of bacteria. 16. Following the surgery, Y.D. suffered from wound dehiscence, ie., bursting: open of a wound along a surgical suture, a surgical complication that results from poor wound healing. 17. The extent of the dehiscence was not described in the medical records for Y.D. 18. Y.D. was started on Silvadene® for the open wounds. J:APSU\Medical\Medical cases assigned to Allied Section\Nees, John E 2008-21 684\AC_Nees-2_08-21684.doc 3 19. Medical record progress notes recorded by Respondent regarding Y.D.’s post operative progress are uninformative, inadequate and partially illegible. 20. Medical record progress notes recorded by Respondent regarding Y.D.’s post operative progress do not justify the course of treatment. COUNT I 21. Petitioner re-alleges and incorporates paragraphs one (1) through twenty (20) as if fully restated herein. 22. Section 458.331(1)()1, Florida Statutes (2008), 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, 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. For purposes of Section 458.331(1)(t), the Board shall give great weight to the provisions of Section 766.102, which provides 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. J:APSU\Medical\Medical cases assigned to Allied Section\Nees, John E 2008-21684\AC_Nees-2_08-21684.doc 4 23. Respondent committed medical malpractice in one or more of the following ways: (a) by inadvertently removing Patient Y.D.’s left tragus or by removing it without her consent; (b) by performing a facelift, four quadrant blepharoplasty and neck liposuction on Y.D. while she was entirely awake causing Y.D. significant and unnecessary pain; (c) by failing to recognize and attempt to remediate the extreme pain about which Y.D. complained during surgery. 24. Based on the foregoing, Respondent violated Section 458.331(1\(t), Florida Statutes (2008), by committing medical malpractice. COUNT II 25. Petitioner re-alleges and incorporates paragraphs one (1) through twenty (20) as if fully restated herein. 26. Section 458.331(1)(m), Florida Statutes (2008), provides that 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; J:\PSU\Medical\Medical cases assigned to Allied Section\Nees, John E 2008-21684\AC_Nees-2_08-21684.doc S 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. 27. Respondent failed to keep medical records that justify the course of treatment of Y.D. in one or more of the following ways: (a) by failing to include in the medical records an explanation of how the patient’s left tragus was amputated or destroyed; (b)by failing to include in the medical records a History and Physical examination report that was complete and informative; (c) by failing to maintain legible medical records that justify the course of treatment of the patient; (d)by failing to include an adequate description as to the need for Silvadene®. 28. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2008), by failing to keep medical records that justify the course of treatment of the patient. WHEREFORE, 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, J:\PSU\Medical\Medical cases assigned to Allied Section\Nees, John E 2008-21 684\AC_Nees-2_08-21684.doc 6 placement of Respondent on probation, corrective action and/or any other relief that the Board deems appropriate. SIGNED this_22_ day of December » 2011, H. Frank Farmer, Jr., M.D., Ph.D., F.A.C.P. State Surgeon General Adrienne/C. Rodgers Assistant General Counsel Department of Health Prosecution Services Unit Dp . DEPARTMENT OF HEALTH 4052 Bald Cypress Way, Bin C-65 DEPUTY CLERK Tallahassee, FL 32399-3265 Gree Angel Sanders Florida Bar # 0630071 ad DEC 27 201 (850) 245-4640 (telephone) (850) 245-4682 (facsimile) y ‘ PCP Members: Mul bias g singe PCP: 14-22-11 JAP SU\Medical\Medical cases assigned to Allied Section\Nees, John E 2008-21684\AC_Nees-2_08-21684.doc 7 John E. Nees, M.D. CASE No. 2008-21684 NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Sections 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 any other discipline imposed. J:APSU\Medical\Medical cases assigned to Allied Section\Nees, John € 2008-21684\AC_Nees-2_08-21684.doc 8

Docket for Case No: 12-003808PL