Statutes, the Petitio ner h * vo U STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, ) ) PETITIONER, ) ) v. ) CASE NO. 1997-05502 ) FREDERICK L. REMARK, M_D., ) | | Ob- IGS RESPONDENT. _) 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 Frederick L. Remark, 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 provisions of Section 20. 43(3), Florida ‘ sted with nthe 2 Agency for Health Care Administration to provide consumer ¢ complai . “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 0014694. “ Respondent’ s last known address is 301 Sheridan Road, Melbourne, Florida 32901-3160. 3. Respondent is Board Certified in plastic surgery. Vv U 4, On or about November 2, 1982, Patient G.R., a fifty-two (52) year old female presented to the Respo ent’s office for breast augmentation mammoplasty surgery. 5, Thereafter, Patient G.R. presented back to Respondent for follow-up of the breast augmentation mammoplasty surgery. 6. In or about June 14, 1993, Patient G.R. was referred back to the Respondent with a complaint of a painful mass in her right breast. Respondent examined Patient G.R. and a. mammogram was performed, which was interpreted as negative. At this time, Respondent determined that the mass was not from a ruptured breast implant. Respondent did not perform a biopsy of the mass in Patient G.R.’s right breast. Respondent failed to perform a serial examination of the mass. Respondent’ s failed to appropriately document an adequate history and physical examination pertinent to Patient G.R.’s complaint of a painful lump in her right breast. 7. On or r about ‘August 4, 1995, ‘Patient G. R. retumed to the Respondent with complaints of enlargement of the mass i in the right breast. Respondent’ s examination revealed a very large mass at approximately 10 o’clock on the periphery of the right breast. Respondent’s medical records of Patient G.R. state that: “We will plan on excising this since it is tender, anytime at her convenience,” Respondent did not perform a biopsy of the mass on the right breast of Patient G.RY | 8. Inor about September 1995, Patient G.R. presented to the Respondent for biopsy of the mass on Patient G.R.’s right breast. The biopsy of the mass revealed invasive breast cancer. Respondent decided that the mass should be removed along with the right and left breast implants and the silicone gel implants be replaced with saline filled implants. hell oe ere la oe w) 7 Ss) 9. On or about October. 17, 1995, Patient G. R. presented to the Respondent for removal - of the mass on 1 the right breast and removal of the right and left breast implants for replacement with saline filled implants. 10. On or about October 17, 1995, Patient G.R. underwent the removal of the mass from the right breast and removal of the implants. Following surgery, the mass and implants were sent “to pathology for study, which revealed poorly differentiated adenocaréinoma with lymphatic invasion. 11. On or about November 1, 1995, Patient G.R. presented to Parrish Medical Center for completion of right modified radical mastectomy for clinical stage III breast cancer to include a re-excision of her axillary incision. 12. On or about November 3 1995, Patient G. R. was s discharged with instructions to return in one (1) week ‘for a ‘postoperative chemotherapy evaluation and an appointment with a a radiation oncologist for consideration of radiation therapy | to the chest wall due to the presence of poorly differentiated t tumor and lymphatic invasion, as well as axillary radiation. 13. A reasonably prudent physician under similar conditions and circumstances would have performed a biopsy or alternatively performed a fine needle aspiration of the mass on or about June 14, 1993, when Patient GR. was referred back to the Respondent with a complaint of a painful mass in her right breast to allow an earlier diagnosis of the cancer. 14, A 4 reasonably prudent physician under similar conditions and circumstances would soy wtdeccagaions De have pero: a sexial examination oft inen mass. soc 15. A reasonably prudent physician under similar conditions and circumstances would have referred Patient G.R. to the appropriate consultant upon discovering 1 the mass. i Nidal Sa ial Ee one -- DB ANLD ud. ls i al “conditions and circumstances, in that: Ww Wd . . 16. Respondent fell below the standard of care in that the diagnosis of Patient GR’s” condition was not appropriate, adequate, accurate, or timely. 17. Respondent fell below the standard of care in that she failed to refer Patient G. R. to the appropriate consultant to allow an earlier diagnosis of the cancer. 18. Respondent fell below the standard of care in that he failed to perform a biopsy or alternatively a fine needle aspiration of the mass to allow an earlier diagnosis of the cancer. 19. Respondent fell below the standard of care in that the history and physical examination pertinent to Patient G.R.’s complaints were inadequate.” . _ 20. Respondent failed to keep adequate medical records in that they do not contain a complete history and physical examination of Patient G.R. . 21. Respondent failed to keep adequate medical records in that they do not justify the course of treatment or the lack of a referral to the appropriate consultant to allow an earlier diagnosis of the cancer. COUNT ONE 22. Petitioner realleges and incorporates paragraphs one (1) through twenty-one cu), “as if fully set forth herein this ‘Count One. oe 3, Respondent failed to practice medicine with that level of care, skill, and treatment vo. Which is recognized by a reasonably prudent similar physician as being acceptable under similar . ”s condition was not appropriate, - b. Respondent failed t to refer Patient G. R. to the appropriate consultant to allow an le a BR Nt ae By i . ] earlier diagnosis of the cancer; _¢. c. Respondent failed t to > perform a biopsy or atematively a fine needle aspiration of the mass to allow | an earlier diagnosis of the cancer, and/or d. Respondent failed to perform an adequate history and physical examination pertinent to Patient G. R. °g complaints of a painful mass in her right breast. 24, Based on the foregoing, “Respondent has violated Section 458. 331(1N(0, 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. COUNT TWO 25. Petitioner realleges and incorporates paragraphs one (t) through twenty-one (21) and twenty-three (23), as if fully set forth herein this Count Two. 26. Respondent failed to keep adequate written medical records justifying the coursé of treatment of Patient G.R., in that Respondent failed to: a. adequately document a complete history and physical examination of Patient GReand a b. Justify ihe course of treatment and lack of referral to the appropriate consultant. : 27. “Based on the foregoing, Respondent violated ‘Section 458. 331(1)(m), Florida Statutes, failing to Keep written a medical records Justifying 1 the course of treatment of the ° patients, including, but not Timited to, ,, patient 1 tories; examination results; test results; ‘records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. rea sk ao am Sw) w) 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 Respondents 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 for in Section 455. 624(4), Florida Statutes, and/or any other relief that the Board deems appropriate. -.. SIGNED this /4 day of , 2000. Robert G. Brooks, M.D., Secretary Chief Medical Attorney COUNSEL FOR DEPARTMENT: Kathryn L. Kasprzak Chief Medical Attorney Agency for Health Care Administration DEPARTMENT OF HEALTH P. O. Box 14229 : DEPUTY CLERK " Tallahassee, Florida 32317-4229 crerk YWehi Ran Florida Bar # 937819 . j CALS . pate [14] 6° 7 PCP Members: Ashkar, Leon, Rodriguez =

Docket for Case No: 00-001631