SUTIN REGULATION PRACTITIONER F & , = —— DEPARTMENT OF HER = = DEPARTMENT OF HEALTH, = PETITIONER, Vv. CASE NO. 2001-18196 James M. Snyder, M.D. RESPONDENT. j DMINISTRATIV MPLAINT 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, James M. Snyder, 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 69136. god peig 9002 82 #ny 26:6 9002 gz Bry 3. Respondent's last known address is 1300 Miccosukee Drive Tallahassee, Florida 32308. 4, Respondent is board certified in Emergency Medicine. 5, On or about May 26, 2000 Patient }.P,, a then thirty year old man, presented to the emergency room at Tallahassee Memorial Hospital complaining of recurrent episodes of sharp chest pain accompanied by sweating. He was treated by Respondent. 6. While treating Patient J.P. on or about May 26, 2000, Respondent ordered an electrocardiogram (“EKG”) and a chest X-ray, all of which were interpreted as normal. Respondent diagnosed Patient J.P. with “non-cardiac chest pain” and sent him home with instructions to take Tylenol or Motrin for pain, to use a heating pad, and to return if he had any difficulties. 7, There are a number of tests that are useful in diagnosing athero- or arterioslerosis “hardening” of the arteries, or restriction of blood flow due to plaque build up), including cardiac stress testing. There are also blood tests known as “cardiac enzymes” that are useful in detecting" the presence of proteins in the blood that are evidence a person has had a myocardial infarction (heart attack”). 2 J;\P5U\Medical\bon Flames Snyder AC.doc 90d peig 9002 82 #ny 26:6 9002 gz Bry 8, On May 26, 2000, Respondent did not order or schedule any diagnostic tests for Patient J.P. other than those described in paragraph six (6) above, nor did he refer Patient J.P, to any other physicians or specialists for additional testing or evaluation. . 9. There are a number of inherited or acquired risk factors whose presence or absence may signify increased risk for heart disease or heart attack, including but not limited to a family history of heart problems and the use of drugs. 10. There is no documentation in the records of Patient J.P’s May 26, 2000 hospital visit of his family history or history of drug use. 11. At approximately 1:30 p.m. on or about. July 1, 2000, Patient 1.P. again presented to the emergency room at Tallahassee Memorial Hospital complaining of recurrent chest pains, A nurse who saw him at the time noted that he was sweating and in obvious distress. He was again treated by Respondent. ) 12. In treating Patient J.P. on or about July 1, 2000, Respondent ordered lab work, including a Tronopin study, an EKG, placed Patient J.P. on oxygen, and had him transported to the radiology department for a chest X-ray, A Troponin study is one of the “cardiac enzyme” tests done to 3 }\P5U\Medical\Don Fares Snyder AC.dac é0-d g6i6 9002 82 =ny 26:6 9002 gz Bry determine whether there are elevated levels of proteins in the blood that could be indicative of a heart attack. 13. At approximately 2:30 p.m. on July 1, 2000, while waiting in the radiology department for a chest X-ray, Patient J.B. began to experience cardiac arrest. 14, Patient J.B’s was not being observed and his condition not being monitored at the time he went into cardiac arrest. 45. Over the course of the next three hours, Patient 1,P’s condition deteriorated, Attempts to stabilize his heart rhythm, and then to restart his heart when he went into asystole (no cadiac electrical activity), proved unsuccessful, He was pronounced dead at 5:31 p.m. the same day. 16. A subsequent autopsy revealed that the cause of Patient J.P’s death was “thrombosis of left anterior descending coronary artery” (i.e. a heart attack) brought on by “severe and extensive atherosclerosis [of] al coronary arteries.” Count I 17, Patient reincorporates and alleges paragraphs one (1) through sixteen (16) as if fully set forth herein. 4 3:\PSU\Medical\Don F\ames Snyder AC.doc god g6i6 9002 82 =ny eo:6 9o00z ez Bny 17. 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 a reasonably prudent similar physician as being acceptable under similar conditions and circumstances is grounds for discipline by the Board of Medicine. 18. Respondent failed to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician, in one or more of the following ways: a). by failing to order testing adequate to identity and diagnose Patient J.P’s heart disease, including but not limited to cardiac enzymes and/or a cardiac stress test on or after May 26, 2000, and/or b). by failing to refer Patient J.P. to a specialist for testing adequate to identify and diagnose Patient J.P’s heart disease, including but not limited to cardiac enzymes and/or a cardiac stress test on or after May 26, 2000 c). by not admitting Patient J.P. for observation on or after May 26, 2000 , d.) by not ordering a monitored, portable chest X-ray in the emergency room rather then sending Patient J.P to the radiology 5 2:\PSU\Medical\Don F\Jamas Snyder AC.doc 60"d g6i6 9002 82 =ny ecig 900% az Bry department and/or by not ordering someone to observe or monitor Patient 1.P. while he was in the radiology department on or about July 1, 2000. 19, Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (1999), 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 IT 20. Section 458,331(1)(m), Florida Statutes (1999), requires that physicians keep legible medical records that, inter alia, justify the course of treatment of the patient, including but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and results of consultations and hospitalizations. 21. During or after the May 26, 2000 visit, Respondent did not document Patient J.P’s farnily history or history of drug use, both relevant factors in diagnosing heart disease or heart attack. 22. Based on the foregoing, Respondent has violated Section. 458.331(1)(m), Florida Statutes (1999), by not keeping legible medical records that justify the course of treatment of the patient, including but not 6 3:\PSU\Medical\Don F\James Snyder AC.doc aob'd g6i6 9002 82 =ny eo:6 9o00z ez Bny limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and results of consultations and hospitalizations. 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. SIGNED this 772 day of __)one , 2006. M. Rony Francois, M.D., M.S.P.H., Ph.D. Secretary, Department of Health FILED Q 3 DEPARTMENT OF HEALTH DEPUTY CLERK Don Freeman CLERK te Treldawm Assistant General Counsel DATE (g-I ta DOH-Prosecution Services Unit 4052 Bald Cypress Way-Bin C-65 Tallahassee, Florida 32399-3265 Florida Bar # 736171 (850) 245-4640 (850) 245-4681 fax 7 3:\P5U\Medical\Den F\SnyderVames Snyder AC.doc LL'd g6'6 9002 82 ny ecig 900% az Bry PCP: June 9, 2006 PCP Members: Ashkar + Barray 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 shail 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. 8 2:\PSU\Medical\oon F\Snyder\James Snyder AC.doc Zk'd gi 9002 82 =ny ecig 900% az Bry

Docket for Case No: 06-003250PL