ence he, aaa all A tae li STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, ) PETITIONER, | ) v. ‘ CASE NO. 97-00688 - RONALDR. WILLEY, MD., 5 OOo 153 dy : 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 Ronald R. Willey, M_D., hereinafter referred to as “Respondent,” and alleges: 1. Effective July 1, 1997, Petitioner is the state agency charged with regulating the practice of medicine pursuant to Section 20.43, Florida Statutes; Chapter 455, Florida Statutes, and Chapter 458, Florida’ Statutes. Pursuant to the authority of Section 20.43(3), Florida Statutes, the Petitioner has contracted with the Agency for Health Care Administration to provide *~ Consumer complaint, investigative and prosecutorial services required by the Division of Medical Quality Assurance, councils, or boards, as appropriate. 2. Respondent is and has been at all times material hereto a licensed physician in the . state’ “of Florida, having been issued license number ME 0009631. Respondent’s last known address is 1521 Druid Road E., Clearwater, Florida 34616, 3. “Respondent \ was initially licensed as a physician in the State of Florida on or before a December 31, 1973. Upon information and belief, Respondent i is board-certified in pathology. a Vv an) 4. Patient L.P., born on or about April 2, 1925, presented to Sam Stieglitz, M.D. on September 21, 1994. She was noted to have an erythematous, shiny, pearly papule on the left side of the nose. Dr. Stieglitz’ impression was of basal cell carcinoma. He performed a biopsy. 5. The biopsied tissue was referred by Dr. Stieglitz to the Respondent. The Respondent - authored a Teport dated September 23, 1994. Under “Gross Description”, the report indicates / that “The specimen consists of an 0. 2 cm. portion of tissue from the left nose which i is carefully wrapped before being embedded.” Under “Microscopic Diagnosis” the report indicates in full as follows: “Tissue from left nose: Basal cell carcinoma.” 6. The tissue which was biopsied from Patient L.P. by Dr. Stieglitz on September 21, 1994 in fact did not demonstrate a simple basal cell carcinoma. Instead, the tissue should have raised suspicion of other possibilities, including melanoma and Merkel cell carcinoma. 7. Patient L.P. was seen again by Dr. Stieglitz on October 14, 1994. Dr. Stieglitz performed a fusiform excision of the suspected basal cell carcinoma, and again referred the specimen to the Respondent. 8. The Respondent authored a report dated October 18, 1994. Under “Gross Description”, the report indicates that “The specimen consists of an 0.3 cm. portion of tissue from the left nose which is embedded en toto.” Under “Microscopic Diagnosis” the report indicates in full as follows: “Tissue from left nose: Resection site of basal cell carcinoma without residual”. . 9. The tissue which was biopsied from Patient L.P. byD Dr. Stieglitz « on 11 October 14, 1994 in fact did not demonstrate a simple basal cell carcinoma. Instead, the tissue should have raised suspicion of other possibilities, including melanoma and Merkel cell carcinoma. 21, 19 v w) 10. Patient L.P. was seen again by Dr. Stieglitz on November 17, 1994. Dr. Stieglitz noted, “Follow up: healing well”, and that “Pathology indicated margins free.” 11. Patient L.P. was subsequently seen by Lewis Glass, M.D. On August 7, 1995, another biopsy was taken from the patient’s left nose, and the tissue was referred for pathological examination at the University of South Florida College of Medicine (USF). USF's Dermatopathology Report dated August 16, 1995 indicates under “Gross Description” the following: “Specimen received fixed in formalin consisting of a flat tissue measuring’ 9X3X3MM. Submitted entirely after sectioning.” Under “Microscopic Description”, the report indicates as follows: “In the dermis there is a proliferation of sheets and nests of pale-staining cells with a high mitotic rate. The nuclei are uniform and homogeneous. These are arranged in a trabecular pattern. Special histoimmunochemical stains for NSE and high molecular weight keratin are position.” The report concludes with a diagnosis of “Merkel Cell Carcinoma (cutaneous neuroendocrine carcinoma).” 12. Basal cell carcinoma is a relatively common form of skin cancer, and rarely metastasizes (spreads) to other parts of the body. It is to be distinguished from Merkel cell carcinoma, which is a less common form of skin cancer, and which frequently metastasizes to other parts of the body. 13. A reasonably prudent similar physician ‘would not have made an undifferentiated diagnosis of basal cell carcinoma for Patient L.P., concerning the tissue biopsied on September 4. A reasonably prudent similar physician would have made a differential diagnosis to include the possibility of melanoma and Merkel cell carcinoma, concerning the tissue biopsied on September 21, 1994. Ww ©) 15. A reasonably prudent similar physician would not have made an undifferentiated diagnosis of basal cell carcinoma for Patient L.P., concerning the tissue biopsied ¢ on October 14, . - 1994, - 16. A reasonably prudent similar physician would have made a differential diagnosis to include the possibility of melanoma and Merkel cell I carcinoma, ‘conceming the tissue biopsied on October 14, 1994. 17. Section 458.331(1)(t), Florida Statutes, provides that the Board of Medicine may take disciplinary ‘action against a licensed physician upon the physician’s failure 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. 18. Respondent violated Section 458.331(1)(0), Florida Statutes with respect to Patient LP., due to one or more of the following facts: | a. Respondent made an undifferentiated diagnosis of basal cell carcinoma for Patient LP., concerning the tissue biopsied on September 21, 1994 and reported September 23, 1994; b. Respondent failed to render a differential diagnosis to include the possibility of ‘melanoma and Merkel cell carcinoma, concerning the tissue biopsied on September 21, 1994 and reported September 23, 1994; wu CL Respondent made an undifferentiated diagnosis of basal cell carcinoma for Patient L. P., concerning the tissue biopsied on 1 October 14, 1994 and reported October 18, 1994; a. Respondent failed to render a differential diagnosis to include the possibility of melanoma ar and 1 Merkel ¢ cell. carcinoma, concerning the tissue biopsied on October 14, 1994 and __ reported October 18, 1994. U — WHEREFORE, the Petitioner respectfully 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 practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, the assessment of costs related to the investigation and prosecution of this case as provided fot in Section 455.624(4), Florida Statutes, and/or any other relief that the Board deems appropriate. SIGNED this _/ in of _ f72wth— , 2000. Robert G. Brooks, MD., Secretary hief Medical Attorney COUNSEL FOR DEPARTMENT: Kathryn L. Kasprzak Fl LE D Chief Medical Attorney “Agency for Health Care Administration -- - COON OOTY SF HEALTH P.O. Box 14229 Tallahassee, Florida 32317-4229 CLERK Sowwne (1 ght Def Florida Bar #937819 DATE Lila ch 24302 KLK/mme PCP: March 10, 2000 PCP Members: Ashkar, Miguel, Rodriguez

Docket for Case No: 00-001532