STATE OF FLORIDA STE DEPARTMENT OF HEALTH inca, PL fy ‘9? DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO. 2004-01726 2004-12598 AY -YI0PL ROGER LEE GORDON, M.D., RESPONDENT. / ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through undersigned counsel, files this Administrative Complaint before the Board of Medicine against Respondent, Roger Lee Gordon, M.D., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practice of medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 458, Florida Statutes. 2. At all times material to this Complaint, Respondent was a licensed physician within the state of Florida, having been issued license number ME 82538. 3. Respondent is certified in plastic surgery by the American Board of Plastic Surgery. 4, Respondent's address of record is 1661 N.W. 100" Way, Plantation, Florida 33322. FACTS RELATED TO PATIENT “J. R.” 5. On or about December 10, 2003, J.R. presented to Respondent's office, the Florida Center for Cosmetic Surgery (‘FCCS”) for an initial consultation. J.R., a 45 year-old female, requested a tummy tuck and breast reduction. 6. JR. indicated on her intake form that she had (at the time of the consultation or previously) the following conditions: A. — A thyroid disorder (her thyroid had been removed), B. High blood pressure; C. — Bronchitis; D. Diabetes; and E. Sjogren's syndrome (a chronic, systemic inflammatory disorder, characterized by dryness of the mouth, eyes, and other mucous membranes and often associated with rheumatic disorders. tr 7, J.R. also indicated that she smoked cigarettes and was taking multiple prescribed medications. 8. On or about December 13, 2003, J.R. submitted pre-operative blood work at Holy Cross Hospital Clinical Laboratory. The laboratory report was prepared on December 14, 2003. The requesting physician was Dr. Alexander, another physician at FCCS. 9. On or about December 18, 2003, Margaret Starr, M.D., the primary care physician of J.R., faxed to FCCS a form “pre-operative history and physical” indicating that J.R. was medically cleared for a tummy tuck with liposuction. At such time, J.R. was 4'9” tall and weighed 186 pounds. Her blood pressure was 132/88. 10. On an undated form letter, Jeffrey C. Hamm, M.D. another physician at FCCS, requested clearance from J.R.s rheumatologist. On or about December 31, 2003, the rheumatologist responded that J.R. was cleared for surgery from a rheumatology point of view, but indicated that the patient needed medical clearance as well. 11. On or about January 7, 2004, Respondent performed surgery on J.R. for abdominoplasty and breast reduction. In his pre-operative notes, Respondent noted that J.R/s blood pressure was 120/64, and her lungs were clear. Anesthesia for the surgery was provided by Dr. Wicks. 12. Dr Wicks completed a form entitled “pre-surgical and anesthesia evaluation” on the morning of J.R.'s surgery. 13. J.R/s surgery began at 10:30 a.m. and was completed at 1:15 14, At approximately 1:35 p.m., J.R. was taken to the post- anesthesia care unit (‘PACU”) for recovery. While in PACU, the patient suffered a drop in blood pressure. 15, At 4:15 p.m., J.R. was dressed and assisted to a wheel chair, but she indicated, “I feel like I’m going to pass out.” Her blood pressure was noted to be 74/40 at which time she was administered smelling salts under her nose for inhalation. 16. At 4:20 p.m., J.R’s blood pressure had dropped to 78/38, but Dr. Wicks indicated the patient could go home. At 4:35 p.m, J.R. was discharged under Dr. Wick’s authority, and at that time J.R.’s blood pressure was noted to be 102/47. 17. On the PACU recovery notes that indicate the discharge criteria, J.R’s pre-operative blood pressure was indicated to have been 148/81, while her discharge blood pressure was indicated to have been 102/47. 18. Dr. Wicks signed a “Recovery Room Anesthesia Sign-Off Form” indicating that he had checked J.R’s vital signs and they were within normal limits; he had checked the patient, and the patient was stable; and that he had checked the patient, and the patient no longer required supervision. 19. On January 8, 2004, J.R. was seen by Dr. Hamm for a post- operative check up. Dr. Hamm's notes indicate that the patient “looks great.” He indicated the patient could resume showering, but should stop taking the prescribed narcotics. There was no indication that the patient's vital signs were taken during the post-operative examination, nor was there any mention of the PACU hypotensive incident in the post-operative visit. 20. On or about January 9, 2004, J.R. was acimitted to the emergency room at Florida Medical Center, Ft. Lauderdale, Florida, in respiratory distress and hypotensive shock. Upon admission, her initial blood pressure was 60/40. A chest x-ray showed bilateral infiltrates. She was also in renal failure. She had several cardiac arrests while in the emergency room and critical care unit. 21. J.R. died on January 10, 2004. The hospital listed her cause of death as septic shock, disseminated intravascular coagulation, and respiratory failure. 22. On or about January 11, 2004, an autopsy was performed on J.R/s body. The autopsy report indicates that the cause of death was community-acquired pneumonia and a contributory cause was diabetes mellitus. The report also states that the pneumonia pre-dated the surgery. 23. Following J.R’s surgery, Respondent prescribed an excessive amount of Lortab to J.R. The instructions were for one or two tablets of Lortab 7.5 mg, every 4 to 6 hours. If J.R. took the maximum dosage, the amount of medication would exceed the recommended dosage for this medication and would even be toxic. 24, Lortab, which contains hydrocodone, is a schedule II controlled substance under Chapter 893, Florida Statutes. A substance in schedule II has a high potential for abuse and has a currently accepted, but severely restricted medical use in treatment. Its maximum dosage should not exceed 6 tablets in a 24 hour period. 25. Prior to J.R’s surgery, Respondent failed to obtain an adequate preoperative evaluation, including adequate history and physical examination. Notwithstanding J.R’s medical clearances from other physicians, it was the responsibility of Respondent to determine if J.R. was an appropriate candidate for the surgical procedures performed. 26. J.R. was a poor candidate for the surgical procedures performed by Respondent. 27. Respondent failed to document that he discussed the risks, alternatives, and options associated with the procedures he performed on 1.R. 28. Respondent failed to provide to J.R. adequate post-operative and follow-up care. J.R’s case was handled as an itinerate surgery. Respondent did not attend the initial consultation, did not provide pre- operative care to J.R., did not supervise the post-operative PACU care to J.R., and did not see J.R. for follow up care. Each of these functions were performed by other physicians, if at all. FACTS RELATED TO PATIENT “M.S.” 29. On or about January 16, 2003, M.S. saw Respondent for an initial consultation. M.S. was a 58 year-old female who was 5’6” tall and weighed 197 pounds. 30. The family physician of M.S., Dr. Maurice Floreal, provided a pre-surgical examination and cleared M.S. for surgery. However, Dr. Floreal ordered an EKG that returned abnormal. 31. The results of the EKG were forwarded to Respondent with the medical clearance. 32. On or about January 24, 2003, Respondent performed surgery on M.S. for breast reduction, abdominoplasty and liposuction. The surgery was completed in approximately 3 hours and 15 minutes. 33. M.S. was seen by Respondent the day after surgery for a post- operative visit. Respondent's notes indicate that M.S. had no complaints. 34. M.S. died on January 26, 2003. The autopsy report indicates that M.S. died from drug toxicity, with hydrocodone in the toxic range and other drugs in the therapeutic range. 35, Respondent prescribed thirty (30) Lortab 7.5 mg, one or two tablets every 4 to 6 hours, as needed for pain. Respondent failed to include on M.S/s prescription, the maximum allowed dosage of six (6) tablets within a 24 hour period. 36. The Physician’s Desk Reference indicates that the maximum allowable dose for this medication would be one tablet every 4 to 6 hours, not to exceed 6 tablets in a 24 hour period. 37. Respondent did not document an adequate history and physical examination of M.S. 38. Although M.S. signed consent forms, the medical records do not indicate that Respondent actually discussed the benefits, options or risks of surgery. 39. The medical records do not indicate that Respondent actually advised the patient that the surgery could be performed in stages, lessening the morbidity or mortality associated with the surgical procedures performed on M.S. 40. M.S. was a poor candidate for outpatient procedures and a poor candidate for multiple procedures. M.S. was obese, had hypertension, and had an abnormal EKG. COUNT ONE AS TO PATIENT “J.R.” 41. Petitioner realleges and incorporates paragraphs one (1) through twenty-eight (28) as if fully set forth herein. 42. Section 458.331(1)(t), Florida Statutes (2003), provides that a physician may be subject to discipline by the Board of Medicine for 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. 43. Respondent failed to practice medicine with that leve! of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances, in one or more of the following ways: A. By failing to obtain an adequate preoperative evaluation, including an adequate history and physical examination; B. By failing to discuss and/or document the risks, alternatives, and options associated with the procedures performed on J.R.; C. By failing to provide to J.R. adequate post-operative and follow-up care; D. By prescribing an excessive amount of Lortab to J.R.; E. By performing one or more surgical procedures on J.R., who was a poor candidate for such procedures. 44, Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2003), by failing to practice medicine with that level of care, skill, and treatment which ts recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. COUNT TWO AS TO PATIENT “J.R.” 45. Petitioner realleges and incorporates paragraphs one (1) through twenty-eight (28) as if fully set forth herein. 46. Section 458.331(1)(q), Florida Statutes (2003), provides that a physician may be subject to discipline by the Board of Medicine for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. For the purposes of Section 458.331(1)(q), Florida Statutes (2003), it is legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and is not in the course of the physician’s professional practice, without regard to his or her intent. 47, Respondent prescribed an excessive amount of Lortab to J.R. by prescribing amounts that exceeded the maximum recommended dosage. 48. Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (2003), by prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, inappropriately and other than in the course of his professional practice. COUNT THREE AS TO PATIENT “M.S.” 49, Petitioner realleges and incorporates paragraphs one (1) through four (4) and twenty-nine (29) through forty (40) as if fully set forth herein. 50. Section 458.331(1)(t), Florida Statutes (2002), provides that a physician may be subject to discipline by the Board of Medicine for 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. 51. 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 one or more of the following ways: A. _ By failing to obtain an adequate preoperative evaluation, including an adequate history and physical examination, B. By failing to discuss and/or document the risks, alternatives, and options associated with the procedures performed on M.S.; C. By failing to advise M.S., or otherwise to document that he advised M.S., that the surgery could be performed in stages; D. By prescribing an excessive amount of Lortab to M.S.; E. By performing one or more surgical procedures on M.S., who was a poor candidate for such procedures. COUNT FOUR AS TO PATIENT “M.S.” 52. Petitioner realleges and incorporates paragraphs one (1) through four (4) and twenty-nine (29) through forty (40) as if fully set forth herein. 53. Section 458.331(1)(q), Florida Statutes (2002), provides that a physician may be subject to discipline by the Board of Medicine for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. For the purposes of Section 458.331(1)(q), Florida Statutes (2002), it is legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and is not in the course of the physician’s professional practice, without regard to his or her intent. 54, Respondent inappropriately prescribed Lortab to M.S. when he failed to include, on M.S.’s prescription, the maximum allowable dosage within a twenty-four (24) hour period. 55. Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (2002), by prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, inappropriately or in excessive or inappropriate quantities, and other than in the course of his professional practice. WHEREFORE, Petitioner respectfully requests that the Board of Medicine enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. SIGNED this JZ”. day of _Citoter , 2004. John O. Agwunobi, M.D., M.B.A. Secretary, Department of Health y FILED 4 aa DEPART GEak ula A. Wikis 03 99S72— cust uote Colman Assistant General Counsel ont 5 2 rosecution Services Uni pare_ vo i=l — 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar # 0746241 (850) 414-8126 (850) 414-1991 FAX PAW/sw Reviewed and approved by: DKL_(initials) Llefer (date) PCP: October $, AooYy PCP Members: Gustavo Leon,M D.(Qhairpersen), Krietomn Kent, M.D and Sohn Berke DOH v. Roger Lee Gordon, M.D.; DOH Case Nos. 2004-01726; 2004-12598 DOH v. Roger Lee Gordon, M.D.; DOH Case Nos. 2004-01726; 2004-12598 NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on Notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed.

Docket for Case No: 04-004320PL