STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, | v: CASE NO. 2003-19430 Earl B. Britt, M.D, RESPONDENT. — ii i ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health, by and through the undersigned counsel, and files this Administrative Complaint before the Board of Medicine against the Respondent, Earl B. Britt, 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 26016, 90d 65:8 é00¢ 86 4EW 6o:8 /00¢ te +e 3. Respondent's last known address is 1625 Physicians Drive Tallahassee, FL 32308. 4. Between August and September 2002, the health of Patient E.K. - a then eighty-two year old man with.a history of diabetes, coronary artery disease, congestive heart failure, coronary bypass and grafting, and a left-upper lobectomy for lung cancer - began to steadily deteriorate. 5. Respondent saw Patient EK, on or about August 20, 2002. While the documentation of E.K.’s chief complaints is largely illegible, a review of systems documented in the record of this visit indicates that Patient E.K. was suffering from a skin rash, shortness of breath (SOB), swelling in his legs, and weakness. The documentation of Respondent's treatment plan for this visit is essentially illegible; what can be made out, however, appears to involve ordering restriction of fluids and a follow-up echocardiogram (ultrasound of the heart). 6. The follow-up echocardiogram was performed the following day, on or about August 21, 2002. Respondent documents a (presumably left) ventricular ejection fraction of 63%, which is within normal limits. Ejection fraction is a measure of the volume of blood ejected from the 90 ‘d 65:8 é00¢ 86 4EW 6o:8 /00¢ te +e heart's ventricles during normal heart beats. Ejection fractions below 55% are typically considered unhealthy. 7, Respondent next saw Patient E.K, on or about August 28, 2002, While the documentation of E,K.’s chief complaints is largely illegible, a review of systems documented in the record of this visit indicates that Patient E.K,.was suffering from SOB, swelling in the legs and fatigue. Respondent's treatment plan for this visit is illegible as well. 8, Respondent next saw Patient E.K. on or about September 5, 2002. Patient E.K. presented complaining that he was suffering from confusion, that his shortness of breath was getting worse, and that he was experiencing visual hallucinations. Respondent's treatment plan to address “these symptoms is illegible; however off September. 16,2002 Patient E.K. “ -——-underwent-e-chest-x-ray_which apparently teveated-no-change-since the ~~ last tintié:Patiént_£.K.’s.chest.had been x-rayed and did not reveal evidence Of acute congestive heartfaMune.. cscs ee eae nie 9.. ..During the time period described above,-Respondent-had _ Sid ered Patient E.K, to use supplemental oxygen, however when oxygen treatment began is not legibly documented in the patient record: “During the period described above, Respondent did not admit Patient E.K. to a é0‘d 65:8 é00¢ 86 4EW 6o:8 400¢ ce 4b hospital, did not order laboratory testing and did not refer Patient E.K, to a cardiologist in order to determine why Patient E.K.‘s condition was deteriorating. | 10. Laboratory tests that could have been useful in diagnosing Patient E.K.’s condition include: * Complete blood count - a blood test that measures the quantities of white and red blood cells and platelets in a person’s blood. Abnormalities in these counts can be indicative or disease or internal bleeding. « Chem-7, or complete metabolic profile - a battery of blood chemistry tests that can reveal abnormalities indicative of disease. These include measures of sodium, potassium, chloride, carbon dioxide, nitrogen, creatinine and glucose, | * Thyroid function test: a series of tests that measure hormone levels in the blood in search of abnormalities that might indicate thyroid irregularity, 11. On or about September 24, 2002, Patient E.K. presented to another physician for a second opinion. He presented complaining of 80 ‘d 65:8 é00¢ 86 4EW 6o:8 /00¢ te +e abdominal distension, swelling in his lower extremities and SOB so severe that he had difficulty walking. 12. On or about September 24, 2002, the other physician examined Patient E.K. and observed that E.K.’s eyes and fingernails were markedly pale, causing him to suspect that E.K. was suffering from anemia (lack of oxygen in the blood). Listening to Patient E.K.’s heart led him to suspect that Patient E.K. was suffering from-heart failure. Based on this examination, the other physician immediately admitted Patient E.K. to Tallahassee Community Hospital (TCH) for monitoring, laboratory work, and additional testing. 13. Adiagnosis of acute congestive heart failure was confirmed ~ during the-approximatély-six (6) days that Patient £.K. was hospitalized at —“FEH:-Echocardiography {attrasound of the heart) performed during his. _ Stay. révéaled a left ventricular ejection fraction. of 40-45%, -with severe ... Mitral regurgitation. .Mitral.regurgitation is the abnormal leaking of blood through.the-mitral.valve,-from_the left-ventricle into. the-teft-atrium-of the ———T4. With reference to Patient €,K:’s disterided abdomen, endoscopy performed during his stay at TCH revealed that he was suffering from 60d O76 é008 &@ 4eW 00:6 400¢ se 4ey inflammation of the esophagus, stomach and intestine, with ulcers and bleeding. A diagnosis of anemia was also confirmed, possibly as.a result. of the abdominal bleeding, and Patient E.K. was transfused with six (6) units of packed red blood ceils. He tolerated these procedures well and was released from TCH on September 30, 2002, feeling much better and off of supplemental oxygen. Count I 15. Petitioner reincorporates and alleges paragraphs one (1) through fourteen (14) as if fully set forth herein. , 16, Section 458,.331(1)(t), Florida Statutes (2002), provides that the failure to practice medicine with that level of care, skill, and treatment . Which is recognized ‘by..a.téasonably. prudent. similar: physician as being ~~acceptable under —similar—conditions-and—circumstances—is~grounds for ~ -.discipline-by the. Board of Medicine. sa coe h7eeDuting. the-time-periods.described_in.paragraphs four (4). --»=through-ten-(1.0)-above, Respondent-violated-section-458.331(4)(m) Florida Stautes (2002) in one or more of the following ways: (a). “by hot ordering blood testing that could have assisted in diagnosing Patient E.K.'s deteriorating condition, including but not Ol‘d O76 é008 &@ 4eW oo:6 8 4o0¢ te +e limited to a complete blood count, a Chem-7, and a thyroid function test (b). by not referring Patient E.K. to specialists who could have assisted in diagnosing Patient E.K.'s deteriorating condition, including but not limited to a cardiologist (c). by not admitting Patient E.K. to a hospital in order to monitor his condition and conduct testing necessary to diagnose Patient E.K,'s deteriorating condition (d). by failing to diagnose and treat Patient E.K.’s acute congestive heart failure and mitral regurgitation (@). by failing to diagnose and treat Patient E.K.'s anemia (f). by failing to diagnose and treat Patient E.K.’s inflammation of the esophagus, stomach and intestine, with ulcers and bleeding 18. 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. Lk “d O76 é008 &@ 4eW oo:6 8 4o0¢ te +e Count IT 19. Section 458.331(1)(m), Florida Statutes (2002), requires that physicians keep legible medical records that, /nter aa, 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. 20. During the time periods described in paragraphs four (4) through ten (10) above, Respondent violated section 458.331(1)(m), Florida Statutes (2002), in one or more of the following ways: _ (a). by failing to keep legible medical records that justified not ordering blood testing that could have assisted in diagnosing Patient E.K’s deteriorating condition, including but not limited to a complete blood count, a Chem=7,and-a thyroid fonction test or if suctr testing occurred, by failing to legibly. document rr sue: (D),:=-by-failing-te-keep- legible-medical_records.that-justified.not --referring-Patient E,K.-te-specialists- who-could-have assisted i n-diagnesing cardiologist or, if such referrals were made, not legibly documenting them él‘d O76 é008 &@ 4eW 00:6 400¢ se 4ey (c). by failing to keep legible medical records that justified not admitting Patient E.K. to a hospital in order to monitor his condition and conduct testing necessary to diagnose Patient E.K.'s deteriorating condition (d). by failing to keep legible medical records documenting the August 20, 2002 office visit described above (@) by failing to keep legible medical records documenting the August 28, 2002 office visit described above (f) by failing to keep legible medical records documenting the September 5, 2002 office visit described above. 21. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2002), by not keeping legible medical records that 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. 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, Bld LO‘6 8 ¢00@ Ge 4eW oo:6 8 4o0¢ te +e 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. Ve SIGNED this _“6* ~ day of “222m ley” 2006. M. Rony Francois, M.D., M.S.P.H., Ph.D. Secretary, Department of Health _— Don Freeman Assistant General Counsel DOH-Prosecution Services Unit 4052 Bald Cypress Way-Bin C-65 DEPARTM! Pee yale Tallahassee, Florida 32399-3265 CLEAK: Florida Bar # 736171 DaTE_(Z Ul |» (850) 414-8126 (850) 414-1989 fax — PCP: December 8; 2006 PCP Members: Ashkar, Bearison, & Beebe 10 tl od LO‘6 8 ¢00@ Ge 4eW To:6 8 400¢ 2 Jey 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. il Gl ‘d LO‘6 8 ¢00@ Ge 4eW Ta:6 400¢ se +e

Docket for Case No: 07-001403PL