STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO. 2017-16968 ALEXANDER L. MENKES, P.A., RESPONDENT. / ADMINISTRATIVE COMPLAINT Petitioner Department of Health files this Administrative Complaint before the Board of Medicine against Respondent Alexander L. Meknes, P.A., and alleges: 1. Petitioner is the state agency 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 assistant within the state of Florida, having been issued license number PA 3135. 3. Respondent's address of record is 8771 Estero Blvd, PH-1, Fort Myers Beach, FL 33931. 4. Section 458.347(7)(g), Florida Statutes (2014-2015), provides that the Board of Medicine may impose penalties authorized under Sections 456.072 and 458.331(2), Florida Statutes, upon a physician assistant if the physician assistant has been found guilty of or is being investigated for any act that constitutes a violation of chapter 456 or chapter 458. 5. Dr. M.K., who resided in Lakeland, Florida, was Respondent's supervising physician from February 2013 through October of 2015 at Estero Medical Care LLC. Estero Medical Care was located in Estero, Florida, and Dr. M.K. only visited monthly. The majority of supervision was done via telecommunication. 6. Estero Medical Center LLC operated as a walk-in clinic that did not advertise or offer botox and/or filler treatments. 7. In or about December 2013, an account was opened with Merz North America using Dr. M.K.’s name and medical license for Estero Medical Care LLC. 8. Onor about December 12, 2013, an order of Asclera' 1.0% was placed through the Merz account and paid for with Respondent’s credit card. 9. Onor about January 13, 2015, a Merz representative presented to Estero for a marketing discussion and offered unsolicited samples of two ' Asclera is a sclerosing agent indicated to treat uncomplicated spider veins and uncomplicated reticular veins. DOH v. Alexander Menkes, M.D., Case Number 2017-16968 2 vials of Xeomin? 50 U vials, two syringes of Belotero Balance? 1cc, and two syringes of Radiesse* 0.8cc. According to Merz records, these samples were accepted and signed for by Dr. M.K. 10. On or about March 18, 2015, the same Merz representative presented to Estero for a marketing discussion and offered unsolicited samples of one vial of Xeomin 100 U and one syringe of Belotero Balance icc. These samples were accepted by and signed for by Respondent. 11. On the same day, Respondent ordered and paid for one order of Xeomin 100 U under the Merz account. 12. Onor about April 22, 2015, a representative from Merz presented to Estero to conduct injection training and provided samples of one vial of Xeomin 50 U, one syringe of Radiesse 0.8cc, and two syringes of Radiesse 1.5cc for training purposes. The training samples were signed for by Respondent. 13. In or about August 2015, Respondent ordered and paid for two orders of Xeomin 100 U and two orders of Asclera 1.0% using the Merz ? Xeomin is an acetylcholine release inhibitor and neuromuscular blocking agent indicated for the treatment of adults with chronic sialorrhea, upper limb spasticity, cervical dystonia, blepharospam with Botox prior treatment, and/or temporary improvement in the appearance of moderate to severe glabellar lines with corrugator and/or procerus muscle activity. 3 Beltero Balance is an injectable filler that is used to smooth moderate to severe etched-in lines and wrinkles on the face. 4 Radiesse is an injectable indicated for subdermal implantation for the correction of moderate to severe facial wrinkles and folds, and for restoration and/or correction of the signs of facial fat loss in people with human immunodeficiency virus. DOH v. Alexander Menkes, M.D., Case Number 2017-16968 3 account. Further, Respondent also requested and received one sample of Belotero 1.0, one sample of Radiesse 1.5, and two samples of Xeomin 100 U. 14. Dr. M.K., Respondent's supervising physician, was not qualified to perform derma filler or other injectable rejuvenation treatments on patients as he only practices emergency medicine. 15. In or about November 2015, Respondent changed his supervising physician to Dr. S.S. 16. Dr. S.S. did not authorize Respondent to administer or order derma fillers or other injectable rejuvenation treatments while under his supervision. , 17. On or about January 26, 2017, Respondent changed the Merz account from Estero Island Medical Care to Beach Medical. Due to Respondent's licensure status and having an active supervisory doctor, Merz allowed the change without any physician authorization. 18. On or about January 27, 2017, a Merz representative presented to Beach Medical for a marketing discussion and offered unsolicited samples of one vial of Xeomin 100 U, one syringe of Belotero Balance icc, and one syringe of Radiesse 1.5 cc. These samples were received and signed for by Respondent. DOH v. Alexander Menkes, M.D., Case Number 2017-16968 4 19. Onor about April 20, 2017, Respondent ordered and paid for one order of two syringes of Raidesse 1.5cc. 20. Respondent used the Xeomin, Belotero Balance, Radiesse, and Asclera to perform derma filler and/or other injectable treatments on himself and/or staff. 21. Respondent did not create or maintain any records related to the administration of the medications. Count I 22. Petitioner re-alleges and incorporates by reference paragraphs one (1) through twenty-one (21), as fully set forth herein. 23. Section 456.072(1)(0), Florida Statutes (2014-2015), provides that practicing or offering to practice beyond the scope permitted by law or accepting and performing professional responsibilities that the licensee knows, or has reason to know, the licensee is not competent to perform, constitutes grounds for disciplinary action by the Board of Medicine. 24. | Section 458.347(3), Florida Statutes (2014-2015), states that each physician or group of physicians supervising a licensed physician assistant must be qualified in the medical areas in which the physician assistant is to perform and shail be individually or collectively responsible DOH v. Alexander Menkes, M.D., Case Number 2017-16968 5 and liable for the performance and the acts and omissions of the physician assistant. 25. Rule 64B8-30.012(1), Florida Administrative Code, states that: A supervising physician shall delegate only tasks and procedures to the physician assistant which are within the supervising physician's scope of practice. The physician assistant may work in any setting that is within the scope of practice of the supervising physician's practice. The supervising physician's scope of practice shall be defined for the purpose of this section as "those tasks and procedures which the supervising physician is qualified by training or experience to perform." 26. Respondent practiced beyond the scope permitted by law and/or performed professional responsibilities that he knew, or had reason to know, he was not competent to perform by performing injectable and filler treatments on himself and/or staff members, a procedure for which his supervising physician, Dr. M.K., was not qualified to perform, and/or for which his supervising physician Dr. S.S. did not authorize him to perform. 27. Based on the foregoing, Respondent has violated Section 456.072(1)(0), Florida Statutes (2014-2015), by knowingly performing professional responsibilities beyond the scope permitted by law. Count II 28. Petitioner re-alleges and incorporates by reference paragraphs one (1) through twenty-one (21), as fully set forth herein. DOH v. Alexander Menkes, M.D., Case Number 2017-16968 6 29. Section 458.331(1)(m), Florida Statutes (2014-2015), provides that failing to 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 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 by not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultation and hospitalizations, constitutes grounds for disciplinary action by the Board of Medicine. 30. Rule 64B8-30.012(3), Florida Administrative Code, states that “all tasks and procedures performed by the physician assistant must be documented in the appropriate medical record.” 31. Respondent failed to create or maintain adequate, legible documentation of the administration of the Xeomin, Asclera, Belotero Balance, and/or Raidesse to himself and/or other staff members. 32. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2014-2015). WHEREFORE, the Petitioner respectfully requests that the Board of Medicine enter an order imposing one or more of the following penalties: DOH v. Alexander Menkes, M.D., Case Number 2017-16968 7 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. SIGNED this 16th_ day of November_, 2018. Celeste Philip, MD, MPH Surgeon General and Secretary Vinainia Ed | Virginia Edwards FILED Assistant General Counsel DEPARTMENT OF HEALTH Florida Bar Number 1003243 DEPUTY CLERK DOH-Prosecution Services Unit CLERK: Boral (Conte) 4052 Bald Cypress Way-Bin C-65 Tallahassee, Florida 32399-3265 .2.0\8 Telephone: (850) 558-9892 oxre || 4:20 Facsimile: (850) 245-4684 Email: Virginia.Edwards@flhealth.gov PCP Date: November 16, 2018 PCP Members: Georges El-Bahri; James W. Orr, Jr., M.D.; Brigitte Goersch; Richard Morales, P.A. DOH v. Alexander Menkes, M.D., Case Number 2017-16968 8 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. A request or petition for an administrative hearing must be in writing and must be received by the Department within 21 days from the day Respondent received the Administrative Complaint, pursuant to Rule 28-106.111(2), Florida Administrative Code. If Respondent fails to request a hearing within 21 days of receipt of this Administrative Complaint, Respondent waives the right to request a hearing on the facts alleged in this Administrative Complaint pursuant to Rule 28-106.111(4), Florida Administrative Code. Any request for an administrative proceeding to challenge or contest the material facts or charges contained in the Administrative Complaint must conform to Rule 28-106.2015(5), Florida Administrative Code. Mediation under Section 120.573, Florida Statutes, is not available to resolve this Administrative Complaint. 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. DOH v. Alexander Menkes, M.D., Case Number 2017-16968 9

Docket for Case No: 19-003155PL