FILED - STATE OF FLORIDA “40 DEPARTMENT OF HEALT§) OCT 24 PH I2: & OWISIOR uN E | ADMINISTRAUYE HEARINGS 00-4387 a. DEPARTMENT OF HEALTH, PETITIONER, ) ) vs. ) CASE NO. 1999-50033 ). JERRY C. LINGLE, M.D., ) ) ) 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 Jerry C. Lingle, 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 456, 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 0066606. Respondent's last known address is 3075 East Commercial Boulevard, Fort Lauderdale, Tampa, Florida 33309. ) 3. Respondent is board-certified in cosmetic surgery. 4. On or about May 7, 1997, Patient G.C. presented to the Respondent for consultation regarding possible liposuction. Patient G.C. related to the Respondent that she had recently gained 30 pounds and was looking to “see immediate results”. An undated, unsigned physical examination report prepared by Respondent indicated that Patient G.C. had a previous liposuction in 1994. Respondent's physical examination of Patient G.C. on May 7, 1997, was documented as revealing one to 1 % inches of subcutaneous fat in the abdomen, approximately two inches of fat in the flank and lumbar areas, and an approximately one inch accumulation of fat on the inner and outer thighs. In addition, the Respondent noted “dimpling and cellulite” on the upper parts of Patient G.C.’s thighs. Respondent advised Patient G.C. that she was a candidate for “large volume liposuction”. The medical record does not contain notations regarding her height, weight, and whether she had made efforts to lose weight through other conventional weight loss and weight management programs. 5. According to a pre-operative note prepared by Respondent, Patient G.C. decided to have the surgery and was seen for pre-operative laboratory work on June 6, 1997. 6. On or about June 26, 1997, Patient G.C. returned to Respondent's Office. On that date, she signed the consent forms and executed a financial agreement, agreeing to pay $4,000.00 to Respondent for the following services: Fe Liposuction - stomach, flanks, thigh, inner & outer - knee; All operating room. expenses; Anesthesia; Surgeon's fees; Treatment of any complications that may occur; and Follow up care until satisfactorily healed. >opango 7. Patient G.C.'s medical records contain a hand-drawn diagram of the patient on a page titled Physician’s Report. The diagram is dated June 26, 1997, approximately a month and a half following Patient G.C.’s initial consultation and three weeks following her pre-operative lab work. The medical record does not contain any pre-surgery photographs of Patient G.C. or any detailed information demonstrating that she was an appropriate candidate for liposuction. 8. On or about October 10, 1997, Patient G.C. presented to Respondent's office for the scheduled surgery. The only pre-operative information contained in Patient G.C.'s medical record about her physical size was that she weighed 168 pounds on the day of the liposuction procedure. According to the hand-written operative report, the procedure began at 9:00 a.m. However, it is unclear what type of procedure was begun at that time as there were two different typed operative reports for Patient G.C.’s surgery. One report describes the surgical procedure as “Liposuction — Abdomen, Flanks, Thighs (inner and outer), Knees” and noted that the “standard Klein solution” was used. The other report described the surgical procedure as a “Suction Assisted Lipectomy” and noted that the “modified Hunstead Formula” was used. Both operative reports describe a procedure that was similar in nature, but different in technique, with one of the reports being more detailed than the other. 9. According to the hand-written operative report, which was dissimilar from either of the typed reports, a total of 12,000 cc of infiltrate (saline solution) was injected with an aspiration of 8,950 cc of fluid during the course of the one and a half hour surgery. This is an unusually large volume for a one and a half hour procedure. Patient G.C.'s medical record does not indicate that Respondent adequately monitored Patient G.C's blood pressure, pulse, and respirations intra-operatively. Following the procedure, Patient G.C. was taken to the recovery room.at approximately 11:00 a.m. She remained in the recovery room for a couple of hours and was discharged at 1:00 p.m. 10. On or about October 13, 1997, Patient G.C. returned for a follow-up appointment, complaining about the results of the procedure, which included "caves and dents" in her thighs and a scar. However, her concerns do not appear in the progress notes for that date. The medical records contain two different progress notes, one handwritten and one typed. For this date, the written progress notes show no entry. But the typed note indicates her weight and that there was “normal swelling, no significant bruising.” 11. Onor about October 17, 1997, Patient G.C. returned for another follow-up appointment, again complaining about the unsatisfactory. results. Again, those complaints do not appear in the progress notes. . The hand-written progress note reflects only that her weight was 164 pounds. The typed note reflects the weight and that “swelling starting to decrease”, that there were “no problems”, and that Patient G.C. was to return in one week. 12. On or about October 23, 1997, Patient G.C. returned for follow-up, at which time she indicated to Respondent that she was not happy with the results. Those concerns do not appear in the record. The hand-written progress notes show two different types of handwriting. One set of handwriting states “post op visit” and that Patient G.C.’s weight was 166 pounds. The other set of handwriting states “No prob. - Min Swelling + Bruising Pen VK for sm area of erythema @ umbilicus”. The typed note for that same date is significantly different and reads as follows: Patient is a [sic] healing without any problems. She is advised to watch her weight very carefully over the next few months in order to get the maximum benefit from the procedure that she has gone through. She will be seen in three months for the final evaluation, 13. On that date, Respondent advised Patient G.C. to wait six months to allow for the healing to complete and then return for a follow-up visit. Patient G.C. telephoned Respondent's office on May 25, 1998. At that time, Patient G.C. was advised that Respondent was unable to practice as his license had been suspended. Following repeated telephone calls by Patient G.C., Respondent did not make any effort to make arrangements for Patient G.C.'s "follow-up care until satisfactorily healed" as promised in the financial agreement. In addition, no effort was made to perform any revisional surgery to correct the "dents and rolls" on Patient G.C.'s thighs which resulted from the liposuction. 14. Rule 64B8-9.003, Florida Administrative Code, states in part that medical records shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately. In addition, all entries made into the medical records shall be accurately dated and timed. Late entries are permitted, but must be clearly and accurately noted as late entries and dated and timed accurately when they are entered into the record. However, office records do not need to be timed, just dated. NT ONE 15. Petitioner realleges and incorporates paragraphs one (1) through fourteen (14), as if fully set forth herein this Count One. 16. Respondent violated the standard for adequacy of medical records contained in Rule 64B8-9.003, Florida Administrative Code, in that Respondent failed to sign and date the history and physical examination; the medical record contains inconsistent handwritten and typed notes for the same dates of service; and there are two different typed operative reports for the procedure performed on October 10, 1997, which contain inconsistent information regarding the technique and fluid infiltration which was used. 17. Based on the foregoing, Respondent violated Section 458.331(1)(x), Florida Statutes, by violating any provision of Chapter 458, Florida. Statutes, a rule of the board or department, or a lawful order of the board or department previously entered in a disciplinary hearing or failing to comply with a lawfully issued subpoena of the department NT TWO 18. Petitioner realleges and incorporates paragraphs one (1) through fourteen (14), and sixteen (16), as if fully set forth herein this Count Two. 19. Respondent failed 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, in that Respondent failed to conduct a thorough assessment in order to determine whether Patient G.C. was an appropriate candidate for liposuction which should have included such as her height, weight, and whether she had made efforts to lose weight through other conventional weight loss and weight management programs; failed to adequately monitor Patient G.C's_ blood pressure, pulse, and respirations intra-operatively; failed to make arrangements for Patient G.C.'s follow-up care despite repeated telephone calls by Patient G.C.; and failed to perform revisiona! surgery to correct the "dents and rolls" on Patient G.C.'s thighs-which resulted from the liposuction. 20. 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 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 for in Section 456.072(4), Florida Statutes, and/or any other relief that the Board deems appropriate. SIGNED this_© day of eg Merler , 2000. Robert G. Brooks, M.D., Secretary COUNSEL FOR DEPARTMENT: Kathryn L. Kasprzak Chief Medical Attorney Agency for Health Care Administration P. O. Box 14229 Tallahassee, Florida 32317-4229 Florida Bar #0937819 KLK/kmk PCP: August 28, 2000 PCP Members: Cerda, El-Bahri, Varn Chief Medical Attorfiey FILED ’ DEPARTMENT OF HEALTH SPUTY CLERK CLERK fiona (i DATE

Docket for Case No: 00-004357PL