May 8 .906 10:44 MAY-GB-2@86 18:13 FL. DEPT OF HEALTH 8S6 Age 185° P.@2 om “™ S STATE OF FLORIDA & DEPARTMENT OF HEALTH nN DEPARTMENT OF HEALTH, mM ba PETITIONER, Ou-\ 004P Vv. CASE NO. 2004-27826 YUN TAE CHANG, M.D., RESPONDENT. a —— —/ ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Medicine against the Respondent, Yun Tae Chang, 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. Respondent's address of record is 13540 North Florida Avenue, Ste. 103-10, Tampa, Florida 33613. 3. Respondent is board certified in internal medicine. JAPSU\Medicai\trving Levine\AC\Chang, ac doc MAY-@8~-2086 16:14 May 3 2006 10:4) 3 Ba 185s P.@ FL DEPT OF HEALTH B50 488 f™ oo, 4. At all times material to this Complaint, Respondent was a licensed physician within the State of Florida, having been issued license number 73300 on June 18, 1997. 5. At approximately 10:07 p.m., on or about April 29, 2003, Patient J.S., a seventy-seven (77) year-old male, was admitted to Tampa General Hospital via Bay Flight following a motor vehicle accident. Patient J.S. had one episode of “coffee ground” emesis (vomiting) upon arrival to the emergency room (“ER”). Emesis can be a symptom of internal bleeding. 6. Patient J.S. was evaluated by the ER staff and found to have a fractured left femur. He had another episode of coffee ground emesis while being evaluated in the Radiology department and a nasogastric tube was placed. Patient J.S. also had an episode of hypotension (low blood pressure) which responded to a bolus of IV fluids, | 7. On or about April 30, 2003, Patient J3.S. was seen by an orthopedic consultant who noted that he had elevated blood sugars and a mildly elevated potassium level. 8. On or about April 30, 2003, Patient 1.5. underwent an open reduction, internal fixation of his left hip with a four hole plate and 110 JAPSU\Medical\irving Levine\AC\Chang, ac doc ha MAY-@8-2846 14:14 FL DEPT OF HEALTH May & .006 10:41 856 4196 1ast P04 oO ™ degree leg screw. Orthopedic orders post-operatively included Lovenox (an anti-coagularit used to prevent blood clots). 9. On or about May 1, 2003, the first post-operative day, Respondent conducted his first examination of Patient J.S. and noted that he had hyperkalemia (high potassium) and ordered Kayexelate. 10. On or about May 1, 2003, physical therapy was initiated for Patient 3.S. Between May 1* and discharge on May 6, 2003, the physical therapist documented that Patient J.S. had poor head and trunk contro! strength and had increased confusion from supine to sitting position. 11. On or about May 2, 2003, Respondent saw Patient JS, noted that the potassium level was improved and wrote that Patient J.S. iS “ok” to be transferred to a skilled nursing facility. On the same day, another physician ordered two units of packed red blood cells for transfusion. Patient J.S. was not discharged on May 24, 12. On-or about May: 3, 2003, Respondent saw Patient J.S. and made no mention in the record that he had received blood on the previous day and once again noted that Patient J.S. was Satisfactory to .be discharged to a nursing facility. JSAPSU\Maedical\ir ving Levinc\AC\Chang, ac. doc 3 MAY-@8-2086 14:14 May 8 .006 10:4; SB 1855 = PLS FL DEPT OF HEALTH 850 438 o~ ™ 13. On or about May 3, 2003, at approximately 10:25 a.m., Respondent telephonically entered orders for Social Services to transfer Patient JS. to a nursing facility. Respondent also ordered Protonix (a drug used for short-term treatment of erosive esophagitis associated with reflux disease), Patient J.S. was not discharged on May 3%. 14. On or about May 4, 2003, at approximately 1:40 a.m. and again at approximately 2:00 p.m., Patient J.S, had episodes of coffee ground emesis, one episode consisting of 200 cc. There are no notations of these episodes in Respondent's progress notes and yet Patient J.S. was still on Lovenox. On the same day, Respondent again ordered Patient J.S. to be discharged to a nursing facility. Patient J.S, was not discharged on May 4", 15. On or about May 5, 2003, there was a skilled nursing facility consultation indicating that Patient J.S. was not ready to be transferred due to somnolence and inability to participate in physical therapy. The consultant also indicated that Patient J.S. has some difficulty breathing, shortness of breath with exertion, and emesis of coffee ground material. 16. On or about May 6, 2003, a note was made by the respiratory service that Patient J.S.'s Oxygen saturation was 93% on 4 liters yet Respondent ordered Patient J.S. to be discharged to a community skilled JAPS U\MedicaNtrving Levine\aC\Chang, ac doc 4 May 8 2006 10:41 MAY-@8-28@6 16:15 FL DEPT OF HEALTH 85@ 486 1855 P.@6 oN ™ nursing facility. The last nurse’s note on that day indicated that Patient J.S, was weak and had swelling of all extremities. The physical therapy notes of this day indicated that Patient J.S. had poor head and trunk control strength and was confused. 17, In addition, Patient 3.S’s lab values for BUN (blood urea nitrogen) increased progressively from 15 on the day of admission to 37 on May 1%, 73 on May 3”, and 90 with 4 Creatinine level of 1.3 on May 4, 2003. Patient J.S’s blood sugar levels and white blood count were also elevated. Respondent never addresses these Issues in his progress notes. 18. Respondent's discharge orders included continuation of Protonix and Lovenox but did not include orders for blood sugar checks or therapy for Patient J.S.’s diabetic condition. 19. On May 6, 2003, Patient J.S. was transferred to Central Park Health and Rehabilitation Facility (“CPHRF”) on Respondent's orders. 20. -On of about May 9; 2003, Patient J-S.-was seen by the CPHRF attending rehabilitation physician who was advised by staff that Patient J.S. had bright red bleeding per rectum, was pale, lethargic, and had labored breathing. JAPSU\Medicaltirving Levine\AC\Chang, uc.doc 5 MAY-@8-2606 14:15 FL DEPT OF HEALTH May § 2006 10:41 850 488 1855 P.O? os ™~ 21. On or about May 9, 2003, Patient J.S. was transferred to University Community Hospital - Fowler. On admission, an ultrasound was performed which revealed that Patient J.S. was suffering from pancreatitis (inflamed pancreas), ascitis (excessive fluid between the membranes in the abdomen), steatosis of the liver (fatty degeneration), and gallbladder sludge. Patient J.S. was admitted to the Intensive Care Unit and given two _ units of packed red blood cells, - 22. On or about May 10, 2003, Patient J.S. underwent an Esophagogastroduodenoscopy (EGD) and was found to have erosive esophagitis, a small gastric ulcer and mild duodenitis. 23. On or about May 11, 2003, an IVD filter was inserted. There were consults with infectious disease, pulmonary, orthopedic, cardiac, and gastroenterology specialists. 24. Despite all efforts, Patient J.S’s condition continued — to deteriorate. intubation-and-mechanical-ventilation became necessary and Patient J.S. expired when his family discontinued life-support measures. 25. The discharge summary noted that Patient J.S’s death was most likely the result of multi-system failure in the Setting of sepsis. The death certificate fists the cause of death as cirrhosis of the liver. JAPSU\Medical\ieying Levine\aC\Chang, ac doc o MAY~@8-2086 18:15 FL DEPT OF HEALTH May 8 .006 10:4, 656 4868 1655. P.98 -—~ qi o™ COUNT I 26. Petitioner realleges and Incorporates paragraphs one (1) through twenty-five (25) as if fully set forth herein. 27. Section 458.331(1)(t), Florida Statutes (2002), provides that 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 constitutes grounds for disciplinary action by the Board of Medicine. 28. 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 rule out a gastrointestinal bleed in Patient J.S., who had several episodes of coffee ground emesis; b) by failing to recognize that Patient J.S.’s rising BUN was indicative of blood in Patient his gut and a cause of his altered mental Status; c) by failing to address the consultation by Social Services on or about May 5, 2003 regarding Patient J.S.’s lack of readiness to be placed in a skilled nursing facility; d) by discharging Patient J.S. to a nursing facility in an unstable condition; e) by continuing Patient 3.S. on Lovenox at the JAPSU\Medical\Urving Levine\AC\Chang, ov.doc 7 May 8 .006 10:4" MAY-@8-2686 18:15 FL DEPT OF HEALTH as 850 498 18s P.@9 —~ time of discharge even though Patient J.S. had not been evaluated for a gastrointestinal bleed; f) by failing to note Patient }.S.’s diabetes or order diabetic management on the transferal document to the nursing facility. 29. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2002), 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. COUNT II 30. Petitioner realleges and incorporates paragraphs one (1) through twenty-five (25) as if fully set forth herein. 31. Section 458.331(1)(m), Florida Statutes (2002), provides that failing to keep legible medical records that justify the course of treatment of the patient, including, but not limited to, patient histories: examination " o—Fesults; --test--results-—records of drugs -prescnibed; dispensed, or administered; and reports of consultations and hospitalizations, constitutes grounds for disciplinary action by the Board of Medicine. * 32. “Respondent failed to keep legible medical records justifying the course of treatment in one or more of the following ways: a) by failing to JAPSU\Medicalinaing Levine\aC\Chang, av.doc 8 May 8 .006 10:47 MAY-G8-2086 10:16 FL DEPT OF HEALTH 856 486 ies. on — P.1@ document any of Patient J.S/s laboratory abnormalities, Particularly the disproportionate rise in the BUN relative to the Creatinine; b) by failing to address in his progress notes the consultation by Social Services on or about May 5, 2003 regarding Patient J.S.'s lack of readiness to be placed in a skilled nursing facility; c) by failing to comment on the nursing notes which revealed that Patient J.S. had several episodes of coffee ground emesis; d) by failing to document a justification for transferring Patient J.S. to a nursing facility in an unstable condition; e) by failing to document a justification for continuing Patient J.S. on Lovenox at the time of discharge even though Patient J.S. had not been evaluated for a gastrointestinal bleed; f) by failing to document Patient J.S’s diabetes or order diabetic management on the transferal document to the nursing facility. 33. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2002), by failing to keep legible medical records that justify the course of treatment of the patient, including, but not limited to, patient histories; examination resuits; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. JAPSU\Medical\rving Levine\AC\Chang, ac doc 9 May o .0UB 1U:4" MAY-@8-2@86 16:16 Ft. DEPT OF HEALTH 850 484 ies. oN —™ P.il 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 Propet SIGNED this yt day of snag -_, 2006. M. Rony Francois, M.D., M.S.P.H., Ph.D, Secretary, Department of Health FI Ep oF z07EL Nea DEPARTMENT OF HEALTH UTY CLERK 7 - Ing Levine CLARK i cham for : man MH k fo ssistant General Counsel OAR a p-Oh DOH-Prosecution Services Unit 4052 Bald Cypress Way-Bin C-65 Tallahassee, Florida 32399-3265 Florida Bar # 0822957 wo eee ee ae ~~ €850)-245-4640,- ext 84128 : (850) 245-4680 fax PCP: January 13, 2006 “PCP Members: Leon and Barrau Yun Tae Chang, M..D,, DOH Case: 2004-27826 JAPSU\Medical\icving Levinc\AC\Chang, ac doc 10 Mdy & Ub Led MAY-@8-2446 10:16 FL DEPT OF HEALTH 850 4RE Labs P.12 oN —™ 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. Yun Tae Chang, M..D., OOH Case: 2004-27826 JAPSU\Medical\Irving Levine\AC\Chang, sc doc in

Docket for Case No: 06-001609PL