FILED 00 AUS -8 PM u: 0G 4 DIVISION] Gr STATE OF FLORIDA ADMINISTRATIVE DEPARTMENT OF HEALTH EARINGS DEPARTMENT OF HEALTH, ) PETITIONER 5 | 53 00-32 v. ) CASE NOS. 1998-18603 & 1999-52960 ) LEONARD WALKER, M.LD., ) 7 ) RESPONDENT. ) ee ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, Department of Health, hereinafterireferred to as “Petitioner,” and files this Administrative Complaint before the Board of Medicine against Leonard Walker, 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 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 0021417. Respondent's last known address is Ne] No) | 161 S. Camelia Ct., Vero Beach, Florida 32963. At all times relevant herein, Respondent was employed by and practiced at Lawnwood Regional Medical Center. FACTS PERTAINING TO PATIENT J.H. 3. On/or about December 18, 1997, Patient J.H. was treated at Lawnwood Regional Medical Center (Lawnwood) emergency room for complaints of shortness of breath and a productive cough of yellow sputum, fever and chills. | 4. Dr. Salehi's differential diagnosis indicated pneumonia, asthma or chronic obstructive pulmonary disease. Dr. Salehi recommended further evaluation and testing. 5. On or about December 22, 1997, while a patient at Lawnwodd, Patient J.H. underwenta \ bronchoscopy ordered by Dr. Lloyd which revealed bronchitis. Dr. Lloyd performed bronchial washings and a biopsy from Patient J.H.'s right middle lobe. 6. In his capacity as a pathologist, Respondent reviewed and interpreted | the specimens obtained by Dr. Lloyd and reached the following diagnosis: DIAGNOSIS: 1., 2., 3. BIOPSIES, LUNG WASHINGS CELL BLOCK AND CYTOLOGY SMEARS, LUNG BRUSHING CYTOLOG LARGE CELL (NON OAT-CELL) CARCINOMA. 7. Onor about January 26, 1998, Patient J.H. was readmitted to Lawnwood by Dr. Lioyd. | 8. During this admission, Patient J.H. came under the care of Dr. Ioannou who concurred with the diagnosis of large cell carcinoma by Respondent and performed a right middle lobectomy | and right upper lobectomy. 9. Intra-operatively, Dr. Ioannou did not find any cancer in either lung, but performed the bilateral lobectomies based on the Respondent's pathology report of large cell carcinoma. Caan ) 10. Subsequent pathology report by another pathologist states a diagnosis of metaplastic (abnormal) epithelial cells with atypicality and a few markedly atypical cells, but no malignancy. 11. Patient J.H. was discharged from Lawnwood after being ddvised that all of the cancer had been removed. Patient J.H. was never told that he in fact did not have cancer. 12. On or about February 12, 1998 a pathology report from the University of Miami regarding a right middle lobe biopsy of the tissue removed from Patient J.H. stated: Minute strips of highly dysplastic bronchial epithelium : present. Recommend further studies if clinically indicated. 13. Another outside review dated February 6, 1998, by an internationally known pathologist, Dr. Eugene Mark, at Massachusetts General Hospital indicated a diagnosis of: “Metaplastic epithelial cells with atypicality and a few markedly atypical cells.” 14. On or about June 3, 1999, the materials and slides rélating to Patient J.H.| were reviewed by another expert, a board certified pathologist acting at the request of the Agency. He specifically examined the bronchial biopsy diagnosed by Respondent as Large Cell Carcinoma. This expert found instead that "the very small amount of tissue on the slides reviewed is indeed atypical . . . but does not nearly reach the level warranting a diagnosis of carcinoma and probably represents an exaggerated inflammatory response. Unfortunately the patient underwent a bilobectomy on the basis of the diagnosis and no tumor was found." | 15. Respondent practiced medicine below the acceptable standard of care by diagnosing Patient J.H. with large cell carcinoma, resulting in unnecessary surgery; when he in fact had atypical epithelial cells, as confirmed by expert review. COUNT ONE 16. Petitioner realleges and incorporates paragraphs one (1) through fifteen (15), as if fully set forth herein this Count One. 17. Respondent practiced medicine below the acceptable jstandard of care, in Respondent misdiagnosed patient J.H. with large cell carcinoma of the lungs causing the patie undergo unnecessary surgery. |, Respondent failed to practice medi¢ine with at a level of recognized by a reasonably prudent physician as being acceptable under similar circumstances that nt to care 18. Based on the foregoing, Respondent violated Section 458.33 1(1)(t), Florida Statutes, by failing to practice medicine with that level of care, skill and treatment which is recognized by a reasonably prudent physician as being acceptable under similar circumstances. FACTS PERTAINING TO PATIENT RW, 19. On or about January 29, 1997, while a patient at Lawnwood, Patient R.W. underwent a biopsy of the colon with a preoperative diagnosis of multiple colon polyps. 20. Respondent examined the tissue and made a diagnosis of: 1) Ellipse of skin/subcutaneoussoft tissue, site unspecfed-od organized cutaneous scar 2) Segment of ¢olon with: Familial polyposis with numerous randomly distributed sysplat villoglandular/adenomatouscolonic polyps Focal intermurally infiltrating well differentiated adeno: cinomaarising from the base of the largest polyp with infiltration to, but not through, the underlying muscularis Large-bloc microsections of drainage area fat tissue negative for lymph nodes No mucosal polypoid structure noted closer than 10.0 om to either the proximaljor distal surgical plane of excision. UW VY 21. On or about June 3, 1999, the Agency’s expert submitted his opinion after reviewing the case. He opined that Respondent’s diagnosis of invasive carcinoma could not be sustained by the tissue reviewed. He expressed concer for the patient because the patient may be subjected to chemotherapy and given an incorrect diagnosis of cancer with a guarded prognosis. The expert also found this type of error to be particularly disturbing “since the pitfall of glandular pseudo- inclusions due to sectioning artifact should be well recognized by an experienced pathologist.” 22. Respondent practiced medicine below the acceptable standard of care by misdiagnosing Patient R.W. with adenocarcinoma. COUNT TWO 23. Petitionerrealleges and incorporates paragraphs one (1) through two (2) and paragraphs nineteen (19) through twenty-two (22), as if fully set forth herein this Count Two. 24. Respondent practiced medicine below the acceptable| standard of care, in |that Respondent misdiagnosed Patient R.W. with invasive carcinoma when no cancer was present. Respondent failed to practice medicine with at a level of care recognited by a reasonably prudent physician as being acceptable under similar circumstances. 25. Based on the foregoing, Respondent violated Section 458.33 1(1)(t), Florida Statutes, by failing to practice medicine with that level of care, skill and treatment which is recognized by a reasonably pnident physician as being acceptable under similar circumstances. 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, im dsition of an administrative ‘Pp P ipa UY fine, issuance of a reprimand, placement of the Respondent on probation, the assessment of casts. related to the investigation and prosecution of this case as provided fer in Section 455.624(4), or Florida Statutes, and/or ern other relief that the Board deems appropriate SIGNED this Loh day of _—y COUNSEL FOR DEPARTMENT: Kathryn L. Kasprzak Chief Medical Attorney Agency for Health Care Administration P. O. Box 14229 Tallahassee, Florida 3231 7-8229 Florida Bar # 937819 DKK/dk PCP: June 26, 2000 PCP Members: Cerda, Woods, Pardue lene , 2000. Robert G. Brooks, M.D., Secretary F LED OE ARTY cLERK CLERK ° DATE __telavloo

Docket for Case No: 00-003253PL