_ ceived Event (Event Succeeded) Time: 2:21 PM ate: 12/3/2004 ages: 12 Duration: 3 min 11 sec ander: 850 414 1989 Company: ax Number: Subject: ype: Fax asa 414 1989 P.@3 peECc-a3-2884 14:26 AHCA/LEGAL MEDICAL STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO. 2004-10747 GUSTAVO ARROIO, M.D. ‘a Y Lt ans iL RESPONDENT. ADM & COMPLAIN COMES NOW Petitioner, Department of Health, by and through fts and files this Administrative Complaint before the undersigned counsel, Board of Medicine against Respondent, Gustavo Arrojo, M.D., and in support thereof alleges: ating the artment charged with regul 1. Petitioner ts the state dep Florida Statutes; Chapter ine pursuant to Section 20.43, © 458, Florida Statutes. plaint, Respondent was @ practice of medici 456, Florida Statutes; and Chapte >. At all times material to this Com ate of Florida, having been issued license licensed physician within the St number ME 0071298. Received Event (Event Succeeded) ———$—<————————$—— Date: 12/3/2004 Time: 2:21 PM Pages: 12 Duration: 3 min 11 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax $$$ PEC as 20e4 14:28 AHCA/LEGAL MEDICAL 85a 414 1989 P.@4 - sé 3. Respondent's address of record is P.O. Box 14056, Bradenton, , Florida 34280. 4, - Respondent is not board certified in any specialty. 5, Onor about October 13, 4999, Patient D.D., a then 38 year-old male, was admitted to Manatee Memorial Hospital (MMH) in Bradenton, Florida, through the emergency room. Respondent was the admitting physictan. 6. The emergency room history on Patient D.D. included Patient D.D/s report of consuming one half-pint of liquor per week. 7. Patient D.D. was given a primary diagnosis of atrial fibrillation. 8. Beginning October 14, 1999, Patient D.D. became agitated and uncooperative throughout his admission at MMH. 9. On or about October 15, 1999, at approximately 5:15 a.m. Patient D.D. was found sitting on his bed bleeding from the mouth secondary to a tongue bite. 10, At approximately 5:15 a.m, D.D requested a transfer to the emergency room, stating that he was afraid he would be unable to breathe due to his severely swolicn tongue, noted to be filling approximately sixty DOH v. Gustave Arrojo, M.D. Case no, 1999-62707 Page 2 Received Event (Event Succeeded) (Event SuCCe Cee Date: 12/3/2004 Time: 2:21 PM Pages: 12 Duration: 3 min 11 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax I DEC-B3- 2004 14:28 AHCA’LEGAL MEDICAL 958 414 1989 P.@5 percent (60%) of Patient D.b/s mouth. Patient D.D. also expressed a desire to leave the hospilal. 11. On or about October i5, 1999, at approximately 6:35 a.m, Patient D.D, was found on the floor of his room presenting with symptoms from an apparent seizure with profuse bleeding from the tongue.. 12. Following the seizure, Patient D.D. refused to cooperate with nursing staff. 43. On or about October 15, 1999, at approximately 6:45 a.m, Respondent gave a telephone order for Patient D.D. for 50 mg Librium for agitation. 14. Librium is a brand name or a trademark for preparations of chlordiazepoxide, a tranquilizer. 45. Chlordiazepoxide is in a class of drugs called benzodiazepines, and it affects chemicals in the brain that may cause anxiety or symptoms of alcohol withdrawal. 16. The Respondent was informed of Patient D.D/s request for transfer to the emergency room. . 17, On or about October 15, 1999, at approximately 8:00 a.m. Respondent gave a telephone order for Patient DD. for 100 mg Librium DOH v, Gustavo Arroie, M.D. Case np. 1999-62707 Page 3 Received Event (Event Succeeded) Date: 42/3/2004 Time: 2:21 PM Pages: 12 Duration: 3 min 11 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax DEC-@3-2084 14:20 AHCA/LEGAL MEDICAL 858 414 1989 ——— a ee intravenously and four-point. leather restraints after the patient removed a telemetry monitor, refused treatment, and left his bed. 38. The Respondent did not perform a blood-alcohol test to determine if Patient D.D. was experiencing alcohol withdrawal. 19. On or about October 15, 1999, at approximately 8:30 a.m. Respondent examined Patient D.D. and ordered 100 mg Librium per hour intravenously PRN (as needed) for agitation, without limitation. 20, The recommended maximum dosage for Librium is 300 mg ina 24-hour period. 21, From on or about 2:30 p.m. on October 15, 1999, until on or about 4:00 a.m, on October 16, 1999, Patient D.D. received 1,700 mg of Librium (17 administrations at 100 mg each), pursuant to the prescription of Respondent. COUNT ONE 22. Petitioner realleges and incorporates paragraphs one (1) through twenty-one (21) as if fully set forth herein. 23, Section 458.331(1)(m), Florida Statutes (1999), provides that failing to keep legible medical records that identify the licensed physician by name and professional title who is responsible for rendering, ordering, DOI! v. Gustave Arroio, M.D. Case no. 1999-62707 vage 4 Received Event (Event Succeeded) Date: 12/3/2004 Time: 2:21 PM Pages: 12 Duration: 3 min 11 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax ve DEC-@3-2@04 14:21 AHCA/LEGAL MEDICAL 85@ 414 1989 supervising, or billing for each diagnostic or treatment procedure and that , justify the course of treatment of the patient constitutes grounds for disciplinary action by the Buard of Medicine. 24. Respondent violated Section 458.331(1)(m), Fla. Stat. (1999) by keeping written medical records that do not justify the course of treatment of Patient D.D. in one or more of the following ways: A. Respondent failed to document justification for the excessive dosage of Librium; B. Respondent failed to document re-examination of Patient. D.D. despite the lack of response to medication; C. Respondent failed to document consideration of whether Patient D.D’s agitation resulted from the drugs prescribed to sedate him; D. Respondent failed to document performing blood-alcohol test to determine if Patient D.D. was experiencing alcohol withdrawal; E. Respondent failed to document a physical examination of Patient D.D, to determine whether Patient D.D.'s breathing difficulty was a result of his swollen tongue; DOH v. Gustavo Arrajo, M.D. Case no. 1999-62707 Page 5 Received Event (Event Succeeded) pibetahebaebadaeenaeaae (Event Succeete) Date: 42/3/2004 Time: 2:21 PM Pages: 12 Duration: 3 min 11 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax DEC-@3-28¢4 14:21 AHCA/LEGAL MEDICAL 858 414 1989 P.88 F. _ Respondent failed to document why treatment for other contributing factors to Patient D.D’s agitated condition was not undertaken; or G. Respondent failed to document the reason(s) for denying patient D.D, the opportunity to receive the emergency oy room treatment he requested for his swollen tongue. | 25, Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (1999), in that he failed to keep legible medical records that justify the course of treatment of Patient D.D. COUNT TWO 26. Petitioner realleges and incorporates paragraphs one (1) through twenty-one (21) as if fully set forth herein. 27. Section 458.331(4)(q), Florida Statutes (1999), provides that prescribing, dispensing, administering, mixing, or otherwise preparing 8 legend drug, induding any controlied substance, other than in the’ course of the physician's professional practice constitutes grounds for disciplinary action by the Board of Medicine. 28, Respondent violated Section 458.331(1)(q), Fla. Stat. (1999) by prescribing 1,700 mg Librium, administered intravenously to Patient DOH v. Gustavo Arroyo, M.D. Case no. 1999-62707 Page 6 Received Event (Event Succeeded) _ Date: 42/3/2004 Time: 2:21 PM ~ Pages: 12 Duration: 3 min 11 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax , DEC-83- 20804 14:21 AHCA/LEGAL MEDICAL e5B 414 1989 P.a9 D.D. from on or about October 15, 1999 at approximately 9:30 a.m. to on or about October 16, 4999 at approximately 4:00 a.m., more than five times the maximum allowable dose of Librium in a 24-hour period. 29. Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (1999), by prescribing, dispensing, of administering 4 legend drug, including a controlled substance, other than in the course of the his professional practice. COUNT THREE 30. Petitioner realleges and incorporates paragraphs one (1) through twenty-one (21) as if fully set forth herein. 31. Section 458.331(1)(t), Florida Statutes (1999), provides that the failure to practice medicine with that level of care, skill, and treatment which is recognized by 4 reasonably prudent similar physician as being acceptable under similar conditions and circumstances constitutes grounds for disciplinary action by the Board of Medicine. 32, Respondent failed to practice medicine with that level of care, skill, and treatment which is recognized by 4 reasonably prudent similar physician when he did one or more of the following: DOH! v, Gustave Arrojo, M.D. Case no. 1999-62707 Page 7 Received Event (Event Succeeded) Date: 42/3/2004 Pages: 12 Sender: 850 414 1989 Fax Number: Type: Fax _——$———$——————$ nn Time: 2:21 PM Duration: 3 min 11 sec Company: Subject: Type: FA DEC-@3-2084 14:21 AHCA/LEGAL MEDICAL 858 414 1989 Respondent pursued @ course of treatment and care of D.P. that was inappropriate and inaccurate; Respondent's prescription allowed the administration of 1,700 mg of Librium in less than 24-hours; Respondent falled to recognize that factors other than alcoho! withdrawal likely caused D.D. ‘s agitated state; Respondent failed to respond to D.D/s concerns that a severely bitten tongue impaired D.D/s breathing; Respondent falled to treat D.D. for causes of agitation other than alcohal withdrawal; or Respondent failed to obtain blood-alcohol level test to determine if D.D. was in fact experiencing alcohol withdrawal; 33, Based upon the foregoing, the Respondent has violated Section 458.334(1)(t), Florida Statutes (1999) by failing to practice meclicine with that level of care, skill, and treatment which is recognized by a reasonably prudent physician as belng acceptable under similar conditions and circumstances. DOK v, Gusteve Arroyo, M.D, Case na. 1995 62707 Page 8 10 Received Event (Event Succeeded) Date: 4213/2004 Time: 2:21 PM Pages: 12 Duration: 3 min 11 sec Sender: 850 414 1989 Company: Fax Number: Subject: Type: Fax DEC-83-2884 14:22 AHCA”’LEGAL MEDICAL 858 414 1989 P.1i4 WHEREFORE, the 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 the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. a> SIGNED this © ~ day of Sale, 2004. John ©. Agwunobi, M.D., M.B.A. Secrefary, Departmenyof Heatth FILED ba <—— nr DEPARTMENT OF HEALTH Ellen M. Simon a DEPUTY CLERK Assistant General Counsel a cork Woda Cohan DOH Prosecution Services Unit ‘ OATE a-2t—m 4052 Bald Cypress Way, Bin C-65 “ Tallahassee, FL 32399-3265 Florida Bar No. 0976792 (850) 414-8126 (850) 414-4989 FAX EMS/ems Reviewed and approved by: spc. (initials) tbalos (date) PCP: TiLly He, LOO ary ad Fi PCP Members: ies LO shar MD Cehaicperson), briston Henk, MiD,,oxe John Beebe DOH v, Gustave Arrojo, M.0. Case no. 1999-62707 Page 9 11 Received Event (Event Succeeded) [Event Succeee ee Date: 42/3/2004 Time: 2:21 PM ~ Pages: 12 Duration: 3 min 11 sec Sender: 850 414 1989 Company: F . DEC-@3-2484 14:22 AHCA/LEGAL MEDICAL e5¢ 414 1989 P.12 1 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. DOH v, Gustave Arrojo, M.D. Case no. 1999-62707 Page 10 TOTAL P.12

Docket for Case No: 04-004335PL