ee “iy Wd ad STATE OF FLORIDA _ DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, ) - e PETITIONER, ) OO-1!17S ) v. ) CASE NO. 96-11006 ; ) DONALD L. MELLMAN, M.D., ) ) , RESPONDENT. +) a) ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, Department of Health, hereinafter referred to as “Petitioner,” and files this Administrative Complaint before the Board of Medicine against Donald L. Mellman, M.D., hereinafter referred to as “Respondent,” and alleges: 1 _ Effective July 1 1997 Petitioner i is s the state agency charged with regulating the : practice e of medicine pursuant to Section 20.4 43, Florida Statutes; Chapter 455, Florida Statutes, and Chapter 458 ida Statu S. Pursuant to the provisions of Section 20.43(3), Florida Statutes, the e Petitioner has contracted with the Agency for Health Care - Administration to provide - «esate complaint, investigative, and prosecutorial — services required by the Division of | Quality Assurance, councils, or boards, as appropriate. address is 25 3. ‘Respondent i is board certified in ‘Neurological Surgery. yw | ) 4. On or about September 23, 1993, at 12:25am, Patient K.M., a twenty-three (23) year old male, presented to the Emergency Room (hereinafter “ER’) of St Joseph’s Hospital, Tampa, with complaints of severe headaches over the past week accompanied by occasional nausea and vomiting. es open 5. On or about September 23, 1993, at 1:03am, Patient K.M. was seen by an ER physician who ordered a computer tomography (hereinafter “CT”) scan of the brain, which was performed at approximately 2:00am. The CT scan revealed a collection of fluid in the ventricles (open cavities within the brain) and swelling of the brain tissue. The CT scan results were provided to Respondent who then admitted Patient KM. to the hospital. 6. On or about September 23, 1993, at 3:44 AM, Respondent examined Patient K.M. _ and diagnosed acute hydrocephalus (collection of fluid in the brain), possibly caused by a benign mass or tumor. | 7. Collection of excessive fluid in the ventricles of the brain can cause a corresponding increase in pressure, which can lead to brain tissue damage and death. This dangerous pressure can be relieved by means of a ventriculostomy, or the creation of an artificial ~ © “opening through th the ‘skall ‘and into the brain ventricles with a tube or catheter, allowing excess “ fluid and pressure to escape, 9 then ordered an MRI 2 (magnetic resonance imaging) scan of _KM.’s brain, which was begun at + approximately 9:30am. 9, At approximately 10:30am, the radiologist called Respondent to report that ~~ Patient K.M. was moving too much and the MRI could not be taken. Respondent ordered that 2 pret + gee wv | ws the patient be administered intravenous Valium. At the time of this administration, Patient K.M. "was mildly hypotensive (had a low blood pressure) and bradycardic (had a slow heart rate). 10. Valium is a legend drug as defined by Section 465.003(7), Florida Statutes, and contains diazepam, a Schedule V controlled substance listed in Chapter 893, Florida Statutes. ‘Diazepam is a benzodiazepine sedative medication, and causes hypoventilation (decreased breathing), which in turn results in hypercarbia (and increase of carbon dioxide in the bloodstream). Hypercarbia can cause increased swelling of the brain in a patient with hydrocephalus, and thereby precipitate or exacerbate damage to brain tissue. 11. Respondent inappropriately prescribed a legend drug and controlled substance, i in that Respondent inappropriately prescribed intravenous ‘Valium to Patient K.M., where such prescription was contraindicated by KM? s medical condition. 12 A reasonably prudent similar physician would not have prescribed intravenous Valium to Patient K.M. under similar conditions and circumstances. 13. After the performance of the MRI, Patient KM. became restless and incontinent. ~ Respondent then contacted the operating room and scheduled a ventriculostomy for 1:30pm. 14. At spproximately 12:30pm, Patient K.M. became comatose and Respondent was oximately Ds Spm Respondent Performed emergency surgery, oS installing a ventric ostomy ina ventricle of Patient K. M. s ; brain. 15. Although Respondent secs installed the veticlsiomy, P Patient K.M. subsequently expired on or about September: 21, 1993. 16. A reasonably prudent similar physician would have installed a ventriculostomy in 7 Patient K. M? s ; brain sooner than Responde , given K. M? s deteriorating and serious ‘condition. weer or 2 gn a ee vu a w) In his medical records Respondent noted that in ‘retraspect he wished he had placed the ventriculostomy earlier. __SOUNTONE. 17. ~ Petitioner realleges and i incorporates paragraphs one (1) through sixteen (16) as of fully set forth herein this Count One. 18. Respondent inappropriately prescribed a legend drug and controlled substance, in - that Respondent inappropriately prescribed intravenous Valium to Patient K.M., when such — prescription was contraindicated by K.M.’s medical condition. 19. Based ¢ on the foregoing, Respondent violated Section 458. 33 10K), F lorida Statutes, by prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, ~ including ‘ any controlled substance, other than i in the course of the physician’ s professional - practice. For the purposes of this paragraph, it shall be legally. presumed that prescribing, - dispensing, administering, mixing, or otherwise preparing a legend drug, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of _ the patient and not in the course 1c of the , physician’s p ofessional pr: prac ce, without regard to his ‘ “inappropriately prescribed intravenous Valium to Patient KM, , where such prescription was ananae callliiaieiaumacaiteaoesitet rae tee seers ager . ; ww) ; . w) ; contraindicated by K.M.’s medical condition; failed to timely perform a ventriculostomy on Patient K.M., and delayed the performance of a necessary surgical procedure, the ventriculostomy, i in ‘order to obtain an MRI which was not necessary to the timely diagnosis and treatment of the patient. ~ ua 22. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes, by failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. _ WHEREFORE, the Petitioner respetflly requests the Board of Medicine enter an order imposing one or more ‘of the following penalties: permanent revocation or suspension of the “ Respondent's license, restriction of the Respondent's practic, imposition of an administrative : fine, i issuance eof a reprimand, Placement of the Respondent on probation, t the assessment of costs . ‘elated to thei investigation and prosecution of this case, other than costs associated with an : atomey’s s time, as 38 provided fori in n Section 455. 624@), Florida Stanstes, and/or any other relief 1999, Robert G. Brooks, M.D., ‘Secretary REPUTY CLERK Larry G. McPherson, Jr. R Wels Q. Duw Chief Medical Attorney - ~ pate_Q = 2229 SRF Sm Re Ww COUNSEL FOR DEPARTMENT: Larry G. McPherson, Jr. Chief Medical Attorney Agency for Health Care Administration P. O. Box 14229 Tallahassee, Florida 32317-4229 Florida Bar # 788643 RPC/hrb PCP: January 29, 1999 PCP Members: Slade, Winchester, Varn

Docket for Case No: 00-001175