| STATE OF FLORIDA | A FILED O1 NOV 14 PM 3:05 AGENCY FOR HEALTH CARE ADMINISTRATION piyic ions pe JEB BUSH, GOVERNOR ADMIN ll fcro OEUHOLFPCE May 10, 1999 PERSONAL AND CONFIDENTIAL Larry Dee Thomas, M.D. 575 East Central Avenue Winter Haven, Florida 33881 Re: Case No. 1994-12341 Dear Dr. Thomas: Enclosed please find an Administrative Complaint which has been filed against you by the Department of Health. Also enclosed is an election of rights form and an Explanation of rights form. ; ; Please execute and return the Election of Rights form within 21 days from receipt of this letter. Your signature must be notarized. Failure to act within this 21-day period may result in the entry of a Default Judgement against your license or permit. As a result of the finding of probable cause, this file became a “public record” under state . law. A few lawyers in private practice regularly request copies of administrative complaints filed after a case becomes a “public record.” It is possible that you will receive a letter depicted as an “advertisement” from one or more of these lawyers seeking to represent you. These persons have no association with the Department or the Agency for Health Care Administration in any way. You may retain your own attomey or proceed with this matter in the way you desire. ; 2727 MAHAN DRIVE TALLAHASSEE, FL 32308 vr If you have any questions, please do not hesitate to contact me at (850) 414- at (850)414-1989, by TDD at 1-800-955-8771, or by mail at Office of the Gen Medical Section, P. O. Box 14229, Tallahassee, FL 32317-4229. LGMelg Enclosure ce: Donald Weidner, Esq. Alumni Way, Suite 201 Jacksonville, Fl 32246-6685 2727 MAHAN DRIVE Sincerely, Larry G. McPherson, Jr. Chief Medical Attorney Agency for Health Care Administration 8126, by fax eral Counsel, TALLAHASSEE, FL 32308 a oR me TNE ROTOR WR EE ore eco STATE OF FLORIDA FILED DEPARTMENT OF HEALTHg4 NOV 1&4 PM 3:05 DEPARTMENT OF HEALTH, ) ) PETITIONER, ) a pan! : ) ELE. “ v. ) CASE NO. 1994-1234; _ j , LARRY DEE THOMAS, M_D., ) ) RESPONDENT. +) a 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 Larry Dee Thomas, M. D. , teferred 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, F lorida 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 servicés 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 0036360. Respondent’s last known address is 575 East Central Avenue, Winter Haven, Florida 33881. 3. Respondent is board certified in surgery and thoracic surgery. 4, On February 1, 1994, Patient D.L.P., a fifty-four year old female with a history of liver disease, surgery for carcinoma, cirrhosis, and chronic ascitis (accumulation of large amount of fluid), presented to Respondent on referral of her primary care physician for evaluation for a possible peritoneal venous shunt. | 5. A peritoneal venous shunt is a tube inserted in the abdomen to drain the excess fluid from the abdomen and into the blood Stream to be reabsorbed. 6. Respondent advised Patient of an approximate 5% mortality rate from shunt insertion for ascites caused by coagulopathies (clotting problems). . 7. Onor about February 14, 1994, Patient D.J.P.,was admitted to Winter Haven Hospital for the insertion of a peritoneal venous shunt by Respondent. 8. A general anesthetic was administered to Patient D. J P. and Res central venous pressure (CVP) line to monitor her internal blood Pressure. He then conducted exploration of the right neck and found the internal jugular vein to be scarred and unusable from her previous surgeries. 9. Respondent chose to use the subclavian (chest area) approach to access the right subclavian vein for the venous shunt insertion. This approach does not allow direct visualization of the placement of the shunt. Several liters of fluid ‘were removed from the right chest with the insertion of the tube. 10. Respondent then entered the abdomen and removed approximately eight liters of clear straw-colored fluid. One liter of normal saline solution was placed in the abdominal cavity to help dilute any other ascitic fluid. When the fluid was removed the patient's central venous pressure (CVP) dropped to 2 and the patient was given albumin and Hespan. d nt inserted an. cop pens : r & ; i ' F E } 11. The peritoneal venous shunt was tunneled over the ribs and placed in the superior vena cava. The patient's CVP went from 2 to 14-15 indicating possible Pressure in the chest cavity. | . 12. Respondent completed the surgery and Postoperative chest x-ray and abdominal films were obtained. The chest x-ray showed the right chest filled with fluid. The patient was re-intubated and a chest tube was inserted, removing approximately 3 liters of serous pink-~ -tinged fluid. The fluid then became bloody and Patient D.J.P. 's condition deteriorated. Respondent re- _ opened the abdomen to clip the shunt to prevent further drainage of ascites into the venous system. D.J.P. continued to deteriorate until a blood Pressure was no longer discernable. Patient D.J.P. continued to deteriorate and she expired despite resuscitative efforts. 13. Respondent's records reflect that the cause of death was bleeding due to coagulopathy but no autopsy was performed. 14. A reasonably prudent similar physician would have Properly treated patient's preoperative coagulopathy and would have used an alternative vein that would have provided visualization of the shunt placement thereby reducing the risk of causing a hemorrhage given the patient's preoperative coagulopathy. 15. Respondent practiced medicine below the appropriate standard of care in that Respondent ‘failed to treat the patient's preoperative coagulopathy and he failed to use an alternative vein that would have allowed visualization of the shunt placement thereby reducing the risk of causing a hemorrhage given the patient's preoperative history. 16. Based on the foregoing, Respondent violated Section 45 8.331(1)(0), Florida Statutes, in that he failed to practice medicine with an acceptable level of care, skill, and treatment which - ree er ie ci cee ee ee 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 telated to the investigation and Prosecution of this case, other than costs associated with an attorney’s time, as provided for in Section 455.624(3), Florida Statutes, and/or any other relief that the Board deems appropriate. SIGNED this © day of YL , 1999, Robert G. Brooks, M.D., Secretary - Larry G. McPherson, r. Chief Medical Attorney COUNSEL FOR DEPARTMENT: Larry G. McPherson, Jr. . Chief Medical Attorney F | LE D Agency for Health Care Administration DEPARTMENT OF HEALTH P. O. Box 14229 EPUTY CLERK Tallahassee, Florida 32317-4229 oe cuencsptiphonued. em Florida Bar # 788643 Alloa — RPC/clg DATE__ U0 1 PCP: May 5, 1999 : - PCP Members: Skinner, Glotfelty, Cherney

Docket for Case No: 01-004406PL

Orders for Case No: 01-004406PL