STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, ) PETITIONER, ‘ v. 5 CASE NO. 1999-52514 WAGID GUIRGIS, 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 Wagid Guirgis, 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 0036072. Respondent’s last known address is 3953 South Nova Road, Port Orange, Florida 32127-4910. 3. On or about January 31, 1997, Patient P.C., a thirty two year old female, presented to Respondent due to complaints of palpitations, dizziness and loss of consciousness, which. started on or about December 25, 1996, and which were becoming more frequent and severe. Respondent examined Patient P.C., diagnosed her with heart “palpitations and tachycardia, rule out arrhythmia” and recommended that she wear a Holter Monitor (a device that records electrocardiographic signals on a magnetic tape). 4. Respondent's Patient Information notes that patient P.C.'s current medications are Dilantin 100 mg. and Mysoline 50 mg. Dilantin (phenytoin sodium) is an antiepileptic drug. Phenytoin sodium is related to the barbiturates in chemical structure. Mysoline (primidone) is an anticonvulsant drug, which alters seizure patterns.. Mysoline, used alone or concomitantly with other anticonvulsants, is indicated in the control of grand mal, psychomotor and focal epileptic seizures. 5. On or about February 5, 1997, Patient P.C. was to undergo an Electrocardiogram (hereinafter referred to as "EKG"). A handwritten note on the outpatient testing form states, “per HMC, they have no record, so it apparently was not done.” There is no notation in Respondent’s medical record that the EKG was performed nor is there any record Respondent contacted Patient P.C. about the original appointment, or attempted to contact Patient P.C. regarding this missed appointment and/or the rescheduling of another appointment. 6. On or about April 14, 1997, Patient P.C. experienced an episode of severe flushing of the face, palpitations and dizziness while at work. 7. On or about April 16, 1997, Patient P.C. again suffered a similar episode and was taken to the Urgent Care Center of Halifax Hospital where Lee Cate, M.D. evaluated her. Dr. Cate obtained a Dilantin level, an amoxicillin level, scheduled a glucose tolerance test, recommended that Patient P.C. get the Holter monitor and discharged her with recommendations that she follow-up with Respondent. 8. Subsequently, that same afternoon, while at Albertson’s picking up her medications, and Holter monitor, Patient P.C. experienced flushing in her face, tightness and fluttering in her chest, and again passed out, suffering a laceration to the head. 9. Patient P.C. was taken to the Emergency Room of Halifax Hospital where she received stitches. The emergency room report indicates that Patient P.C.’s husband observed the last episode and said there was no seizure activity. 10. — On or about April 17, 1997, following the head laceration and emergency room treatment, Patient P.C. was admitted to the hospital. Respondent's history and physical taken in the hospital noted that Patient P.C. began having dizziness and fainting spells since in or about December, 1996. It was noted that Patient P.C. felt fluttering and some tightness of the chest and felt very dizzy. A CT scan (computerized tomography) of the head was negative and SMA-7 (sodium, potassium, oxygen, chloride, glucose, BUN [blood urea nitrogen] and creatinine) and CBC (complete blood count) were within normal limits except for the potassium level. 11. Respondent’s plan was to admit Patient P.C. for monitoring; place Patient P.C. on a Holter monitor as well as perform an electroencephalogram (a graphic record of brain waves- hereinafter referred to as "EEG"), a thyroid profile, and a neurology consult was requested to assist in evaluations. No EKG was ordered, nor was a cardiac consultation ordered or performed. 12. On or about April 17, 1997, an EEG report revealed an abnormal electroencephalogram, which showed spontaneous spike/wave activity with hyperventilation as well as spontaneous paroxysmal EPD’s (equilibrium peritoneal dialysis) emanating from the right frontal parasagittal area. It was also noted that further interpretation required clinical correlation and perhaps imaging studies. .13. On or about April 18, 1997, at 9:30 a.m., approximately thirty-two (32) hours after Patient P.C. was admitted to the hospital under Respondent’s care, she was hooked up to the Holter monitor for approximately twenty-three (23) hours. . 14. On or about April 19, 1997, at approximately 8:15 a.m., upon a routine vital check, Patient P.C. was noted to be unresponsive and cold to the touch. Patient P.C. was noted to have mottling on her right upper leg and abdomen and the initial rhythm was asystole (cardiac standstill and/or no heartbeat). Code was called, resuscitation attempts were initiated and Respondent was notified. Respondent arrived and assisted in resuscitation attempts, however, Patient P.C. was pronounced dead at approximately 8:50 a.m. 15. On or about April 19, 1997, the Holter monitor report was interpreted and Patient P.C. was noted to have experienced frequent runs of sustained polymorphic ventricular tachycardia, possibly Torsade de Pointes (paroxysms of ventricular tachycardia or episodes of abnormal heart rhythm); one run of sustained or monomorphic ventricular tachycardia at approximately 3:05 a.m.; at approximately 4:39 a.m., Patient P.C. developed another sustained episode of polymorphic ventricular tachycardia degenerating into ventricular fibrillation and subsequent asystole. 16. The Holter monitor report reveals that Patient P.C. was noted to be in asystole for approximately four (4) hours prior to the onset of chest compressions during the Code 99. 17. Nurses’ notes revealed that on or about April 18, 1997, at approximately 3:05 p.m. and 11:00 p.m., Patient P.C. did experience and report a number of episodes of “heart beating fast,” “quick beats,” and at approximately 3:05 p.m., one episode of unresponsiveness . 4 and confusion. All of these episodes corresponded to polymorphic ventricular tachycardia on the Holter monitor. .18. Patient P.C. suffered cardiac arrest due to ventricular tarchycardia and fibrillation. A reasonably prudent physician in a similar situation would have placed the patient on telemetry (transmission of cardiac signals to a receiving station for monitoring) and/or cardiac monitoring with alarms that would have alerted the nurses or other medical staff of a life threatening problem, when the patient was admitted to the hospital instead of placing the patient on a Holter monitor. 19. A reasonably prudent physician in a similar situation would have called for specialized consultation. . 20. 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 do one or more of the following: (1) Respondent failed to place Patient P.C. on telemetry and/or cardiac monitoring with alarms. (2) Failed to call for specialized consultation with a cardiologist. (3) Failed to order an EKG. 21. 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 ae cater, an order imposing one or more of the following penalties: permanent cevocation&, pgtision of the Ys, Respgndent’s license, restriction of the Respondent’s practice, imposition of an idiMstrative 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_23'™ day of COUNSEL FOR DEPARTMENT: Kathryn L. Kasprzak Chief Medical Attorney Agency for Health Care Administration P. O. Box 14229 Tallahassee, Florida 32317-4229 Florida Bar # 937819 KLK/LFM PCP: May 19, 2000 PCP Members: Ashkar, Murray, Rodriguez , 2000. Robert G. Brooks, M.D., Secretary Pp hief Medical Attorney FIL DEPARTMENT OF HEALTH Bre Ri V4 CLER' DATE

Docket for Case No: 00-004968PL