PARTMENT OF HEAL TEC V4 PH (47 DEPARTMENT OF HEALTH 06 Fe | DIVISs Bie ADMINIS TE “Ee. DEPARTMENT OF HEALTH, ) i ivy ) PETITIONER, ) OO- ug 24 0. ) v. ) CASE NO. 1998-22705 ) LUIZ KUNTZ, 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 Luiz Kuntz, 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 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 0021798. Respondent's last known address is 301 Health Park Blvd., #326, P.O. Box 299, St. Augustine, FL 32086-5778. 3. Respondent is board certified in surgery and thoracic surgery. 4. On or about July 31, 1998, Patient M.T., a seventy-eight (78) year old female, presented at Flagler Hospital in St. Augustine, FL, with chief complaint of shortness of breath, cough, and congestion. Patient M.T. had a history of probable pancreatic cancer, . based on an inconclusive biopsy performed on or about June 11, 1998, as well as a history of right-sided pneumonia. 5. The admitting physician diagnosed Patient M.T. with probable pancreatic carcinoma and bilateral pulmonary infiltrates consistent with bilateral pneumonia. The admitting physician's plan was to treat Patient M.T. with IV antibiotics and intensive respiratory therapy. The admitting physician ordered a chest x-ray, which revealed bilateral basilar infiltrates. 6. The admitting physician contacted Respondent concerning placement of a central line which Respondent subsequently performed on or about July 31, 1998. Respondent attempted both a right internal jugular and right subclavian approach with the line ultimately being placed in Patient M.T.'s right internal jugular. 7. On or about July 31, 1998, at approximately 4:25 p.m., Respondent obtained a chest x-ray, which revealed the right central line to be placed. However, there was a 10-15% right tension pneumothorax (accumulation of air or gas in the pleural cavity) and atelectasis (absence of gas from all or part of the lungs) of the right lung with a shift of the trachea and heart to the left. 8. Subsequently, Respondent placed a right chest tube in Patient M.T. A second chest x-ray was obtained on or about July 31, 1998, at approximately 4:50 p.m., which revealed the right tension pneumothorax to be evacuated with a small residual pneumothorax remaining. 9. On or about August 2, 1998, at approximately 2:00 a.m., hospital staff discovered that Patient M.T.'s chest tube had been pulled out by Patient M.T. Respondent was contacted and did not order a chest x-ray or a dressing to be placed over the chest tube insertion site. 10. On or about August 2, 1998, at approximately 4:00 a.m., Patient M.T. became acutely short of breath while walking to the bathroom. Respiratory therapy was called and a respiratory treatment was given. 11. On or about August 2, 1998, at approximately. 5:20 a.m., Patient M.T.’s heart rate dropped to 30 and a code was called. Patient M.T. was resuscitated with CPR and the emergency room (ER) physician intubated her. 12. On or about August 2, 1998, at approximately 5:30 a.m., the ER physician requested Respondent re-insert the chest tube. 13. Respondent did not present to re-insert the chest tube, but requested that the ER physician re-insert the chest tube. The ER physician was unable to comply with the request. 14. Subsequently, Respondent presented to re-insert the chest tube. Respondent left the room to obtain a chest tube tray and Patient M.T. became asystolic. A second code was then called. 15. Respondent returned to the room, performed closed chest heart massage and successfully resuscitated Patient M.T. Respondent inserted a Quinton catheter into Patient M.T.'s chest to relieve the tension pneumothorax. 16. Several minutes later, a chest tube tray was made available and Respondent inserted a chest tube. Subsequently, Patient M.T. was transferred to intensive care. 17. A few days later, on or about August 6, 1998, Patient M.T. died. The autopsy listed the cause of death as, "brain stem and cerebral dysfunction secondary to hypoxia, secondary to cardiac arrest, secondary to right tension pneumothorax." 18. A reasonably prudent similar physician under similar conditions and circumstances would have. ordered a dressing to be placed over Patient M.T.'s chest tube insertion site, on or about August 2, 1998. 19. A reasonably prudent similar physician under similar conditions and circumstances would have ordered an immediate chest x-ray after being notified that Patient M.T. had pulled her chest tube out, on or about August 2, 1998. 20. A reasonably prudent similar physician under similar conditions and circumstances would have presented to Patient MT immediately after being notified that Patient M.T. had pulled her chest tube out, in order to evaluate Patient M.T.'s condition, on or about August 2, 1998. 21. Respondent did not document a justification for not ordering a chest x-ray, not presenting to evaluate Patient M.T., not ordering a dressing to be placed over Patient M.T.'s chest tube insertion, and not timely re-inserting Patient M.T.'s chest tube on or about August 2, 1998. 22. An operative note written by Respondent on or about July 31, 1998, concerning central line placement is illegible. There is no dictated consultation note included in the medical records. 23. A second notation made by Respondent on or about August 2, 1998, concerning chest tube re-insertion is illegible. COUNT ONE 24. Petitioner realleges and incorporates paragraphs one (1) through twenty- three (23), as if fully set forth herein this Count One. 25. Respondent failed to perform the following: a) order a dressing to be placed over Patient M.T.'s chest tube insertion site after being notified that Patient M.T. had pulled her chest tube out; b) order a chest x-ray to rule out pneumothorax caused by the uncontrolled chest tube removal; c) timely, present to perform an evaluation of Patient M.T. after being notified that Patient M.T. had pulled her chest tube out; or d) re-insert the chest tube in a timely manner after being notified that Patient M.T. had coded. 26. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes, gross or repeated malpractice or the 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. COUNT TWO 27. Petitioner realleges and incorporates paragraphs one (1) through twenty- three (23) and paragraph twenty-five (25) as if fully set forth herein this Count Two. 28. Respondent failed to maintain legible medical records and failed to document a justification for the following: a) not ordering a dressing to be placed over Patient M.T.'s chest tube insertion site; b) not ordering a chest x-ray to rule out pneumothorax caused by the uncontrolled chest tube removal; c) not timely presenting to perform an evaluation of Patient M.T. after being notified that Patient M.T. had pulled her chest tube out; or d) not re-inserting Patient M.T.'s chest tube in a timely manner. 29. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes, failing to keep legible, as defined by department rule in consultation with the board, medical records that identify the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. 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_27 aay of L-pher - , 2000. Robert G. Brooks, M.D., Secretary ry Chief Medical Attorney COUNSEL FOR DEPARTMENT: DEPARTMENT OF HEALT: Kath L. Ka ak DEPUTY CLERK ryn L. Kasprz Lo gen Chief Medical Attorney CLERK Uehi R. k “ Agency for Health Care Administration DATE __jo/ 25/2092 P.O. Box 14229 Tallahassee, Florida 32317-4229 Florida Bar # 937819 CAL/cab PCP: October 21, 2000 PCP Members: Aahkar, Murray, Rodriguez

Docket for Case No: 00-004936PL