Apr 5 200? 10:18 Apr 5 2007 10:18 P. O04 STATE OF FLORIDA _ DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO. 2005-68548 ORLANDO VENANCIO ALMANZA, M.D., RESPONDENT. — NI TIVE 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, Orlando Venancio Almanza, M.D., and in support thereof alleges: 1. Petitioner is the state Gepartment 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 ficense number ME 72789, | od 34 f Pali a t Apr 5 200? 10:18 Apr 5 2007 10:18 P.O5 3... Respondent's last known address is 9193 Sunset Drive, Suite 210, Miami, Florida 33173. 4, Respondent is board certified in internal medicine by the American Board of Internal Medicine. , 5. Qn or about October 9, 2001, Patient N.G., a seventy-three (73) year-old female, was initially seen by Respondent on referral by her Primary physician. She presented with a history of hypertension, hyperlipidemia and GI symptoms. 6 N.G. was scheduled for a Gl endoscopy, but prior to the procedure, was referred to a cardiologist, Respondent. 7, Respondent recorded a history of chest pain with radiation .into the back associated with dyspnea which was not effort related. The history contained no note as to the duration of the symptoms. Pertinent physical findings were an atrial gallop and an apical systolic murmur. 8. The ECG showed T wave abnormality which could be inferior wall ischemia which was not present on previous ECGs, 9. Respondent ordered a nuclear stress test and echocardiogram to clarify N.G.'s condition,” ta J:\PSU\Medical\OIANE\Almanaa\AC 2005-68548 (t).doe Apr 5 200? 10:18 Apr 5 2007 10:18 P. O06 10, The stress portion of the nuclear stress test was done by Respondent on October 12, 2001, and he interpreted it. The nuclear images were interpreted by another physician, The echocardiogram was interpreted by the Respondent. | 11. The stress test showed unequivocal changes from the ECG of October 9, 2001, not only in the T wave in inferior leads, but also T wave changes in lateral leads plus subtle but definite ST changes that look like inferolateral injury and ischemia, 12. The Respondent interpreted these changes as “non-specific.” The stress portion of the ECG showed increasing QRS magnitude and 2 mm horizontal ST depression which was. interpreted as non-diagnostic in light of the abnormal resting pre study ECG, 13. While a nuclear stress test is an excellent way to compare N.G.'5 suspicious chest pain and non-diagnostic ECG changes, the pre- exercise ECG on October 12, 2001, clearly showed progression of ST-T changes not present on the ECG of October 9, 2001. 14. The ECG changes of October 9, 2001, were non specific, but the changes of October 12, 2001 were not. The ECG done on October 12, 2001, prior to the stress test, was consistent with inferolateral ischemia J.\PSU\Medical\DIANE\Almanza\Ac 2005-68548 (t).doc 3 Apr 5 200? 10:18 Apr 5 2007 10:18 P.O? and injury and provided firm evidence that an active unstable coronary syndrome was in Progress, 15. The proper course of action was then for Respondent to cancel the stress test, hospitaiize N.G., and move to cardiac catheterization as soon a feasible, 16, ‘tt was below the standard of care for Respondent to proceed with the nuclear stress test. 17. Respondent fell below the standard of care. by failing to correctly interpret the unequivocal changes in the ECG's that occurred from October 9, 2001, and October 12, 2001. 18. Patient N.G. had chest pain at home on October 16, 2001, and shortly thereafter suffered cardiac arrest. Fyen though resuscitated, she Suffered severe anoxic brain damage and ultimately suffered repeat fatal cardiac arrest on October 22,.2001. 19. Hospitalization and cardiac catheterization presented a good probability the N.G. would have had a good outcome. , 20. Section 458.331(1)(t), Florida Statutes (2001), 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 2:\P5U\Medical\DIANE\Almanga\AC 2005-68548 (t) doc 4 Apr 5 200? 10:18 Apr 5 2007 10:19 P. 08 acceptable under similar conditions and circumstances is grounds for discipline by the Board of Medicine, 21, 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 follow ways: , @) By failing to cancel the stress test, hospitalize N.G, and move to cardiac catheterization as soon a feasible after firm evidence that an active unstable coronary syndrome was in progress; \ b) By failing to correctly interpret the unequivocal changes in the ECG’s that occurred from October 9, 2001, and October 12, 2001 ; Cc) By inappropriately interpreting the patient's laboratory results. ' 22. Based on the foregoing, Respondent. has violated Section 458.331(1)(t), Florida Statutes (2001), 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. 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 2: \PSU\Medicel\DIANE\Almanza\aC 2005-68548 (t).doc 3 Apr 5 200? 10:19 Apr 5 2007 10:19 P.09 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 Zz DAY OF _ #eBesey 2007. Ana M, Viamonte Ros, M.D., M.P.H, Secretary of Health ; Take K. Kiesling C Assistant General Counsel : ILE DOH-Prosecution Services Unit _ DEPARTMENT oO 4052 Bald Cypress Way-Bin C-65 DEPUTY Glen STH Tallahassee, Florida 32399-3265 CLERK: Kee fe, Eten Florida Bar # 233285 ~ PATE 29-07 (850) 245-4640 (850) 245-4681 fax DKK/sdw PCP: January 26, 2007 PCP Members: El-Bahri, Davies, & Long * DOH v. Orlando Venancio Almanza, M.D,, Case No. 2005-68548 .\PSU\Medical\DIANE\Aimanza\AC 2005-68548 (t).doc 6 Apr 5 200? 10:19 Apr 5 2007 10:19 P.10 DOH v. Orlando Venancio Aimanza, M.D,, Case No. 2005-68548 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 piaced on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter, Pursuant to Section 456.072(4), Fiorida 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 discipiine imposed, 2:\PSU\Medical\DIANE\Almanza\ac 2005-68548 (t).doc

Docket for Case No: 07-001565PL