Jan 1? 2008 11:30 Jan 17 2008 11:29 P. O04 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, V. CASE NO: 2006-24802 ARDESHIR KHADEMI-KERMANSHAHI, M.D., 002 9 T yay ‘RESPONDENT, _/ PLAINT ADMINISTRATIVE COM 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, Ardeshir Khademi- Kermanshahi, 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; Chaptet 456, Florida Statutes; and Chapter 458, Florida Statutes. — 2 At all times material to this Complaint, Respondent was a | . ae otida, having been issued license licensed physician within the State of F number ME 804 44, TARE Medical! latthew Caseviases\State 66 Cases\Khaceril-lermanshahi 06-248 02\(t) (a) standard of cats ec.dor Jan 1? 2008 11:30 Jan 17 2008 11:29 P.O5 3. Respondent's address of record is P.O. Box 2048, Clearwater, FL 33758-5048, | 4, Respondent is board certified in Neurology. by the American | Board of Psychiatry and Neurology, | 5. On or about October 9, 2001, Patient M.B. was a forty-nine (49) year old male whom presented to the Respondent for the First time at Bradenton Neurology, Inc., (hereinafter “BN") with the chief complaint of lower back pain worsening since the middle of July of 2001 and with a reported history of left knee replacement surgery, bilateral carpal tunnel surgery, ‘diabetes, hypertension, chest pain, and osteoarthritis., Patient M.B, provided the Respondent with a radiology report for a magnetic resonance imaging (hereinafter “MRI") scan performed on his lower back on or about September 25, 2001. A MRI is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body, | & On er about October 9, 2001, the Respondent noted chronic lower back pain, insomnia, and possible anxiety and depression as his clinical impressions for Patient M.B. The Respondent prescribed Patient MB, Nortriptyline, used to treat depression and to aid sleep, and advised! J:\PEU\Medical\ Matthew CaseyiCaser'Slatus 60 Cases\Khaceni-termanshall 06-24802\(1) (mi) standard on CRE Al 4icie Jan 1? 2008 11:31 Jan 17 2008 11:29 P. O06 him to return to the clinic in three (3) weeks for further evaluation and follow up. 7, OW or about October 30, 2001, Patient M.B. again presented to the Respondent at BN with the same complaint and. indicated pttle or no Improvernent since his prior visit. The Respondent again noted lower back ‘pain which was “not controlled at this time” as his clinical impression. The Respondent referred Patient M.B. for physical therapy, increased his dosage of Nortriptyline, prescribed him Zanaflex {a short-acting muscle relaxant), and advised him to return to the clinic in one (1) enn for further evaluation. | 8. On or about December 11, 2001, Patient M.B. again sented to the Respondent at BN with complaints that his lower back pain had been worsening since his last visit to the clinic. The Respondent noted as his clinical impression back pain, most likely due to lumbar radiculopathy, with some racliation to the bultocks. Radiculopathy refers to pain, and i other symptoms like numbness, tingling, and weakness in yout arms or legs that are caused by a problem with your nerve tools. The neive routs are branches ofthe spinal cord that carry signals to the rest of the bocly at each level along the spine. AAPSU\ Medical Matthew Casey\Cases\Stai lis 60 Cases Khadeni-lermansheah! N6-24802 00) (ni) standard ol Care acco Jan 1? 2008 11:31 Jan 17 2008 11:29 P.O? .9, Onor about December 11, 2001, the Respondent's treatment plan for Patient M.B. included continuing him on Nortriptyline and Zanaflex, starting him on Carbamazepine and Ibuprofen, and perfornling nerve conduction studies on both legs to evaluate for lumbar radiculopathy. Carbamazepine is used to prevent and control seizures and to relieve some types of nerve pain. Ibuprofen is used to relieve pain and welling. 10. On or about December 14, 2001, Patient M.B. returned to the clinic (BN) for the nerve conduction studies with complaints of increased lower back pain. The Respondent interpreted the studies to show Patient M.B. was suffering from mild sensorimotor peripheral polyneuropathy and chronic radiculopathy. Peripheral polyneuropathy is caused when many peripheral nerves throughout the body malfunction at the same time. 11. On or about December 14, 2001, the Respondent started Patient M.B, on Lortab, a pain reliever used for moderate to severe pain, | and suggested he return in two (2) weeks for a. possible MRI of the lower spine. | 12. On or about Decernber 19, 2001, Patient M.E, called the clinic | (BN) and spoke to a nurse whom noted in his meadical records that he ~ stated he got stuck on his knees and had to crawl into a chair. He also told \Khademi-herinanshali 6-24B002M) 110) standard JAPSU\Medical\Malthew Casey\Cases\Status 60 © in cae Jan 1? 2008 11:31 Jan 17 2008 11:30 P. 08 @ e the nurse that he went to the emergency room and received a shot of Demerol (used to treat moderate to severe pain), and ‘that he was unable to eat due to the pain. The Respondent recommended Patient MB. have a MRI and x-ray of his lower spine, increase his Lortab, and be referred to another doctor for an epidural steroid injection if he was interested, 13. Onor about December 23, 2001, Patient M.B. was taken to the emergency room at Manatee Memorial Hospital (hereinafter MMH" in Bradenton, Florida, after being discovered at home in severe pain and unable to get up. Patient M.B. was admitted with an upper gastrointestinal bleed, diagnosed with stomach and esophageal ulcers, and noted ta be paraplegic, ! 14. On or about December 29, 2001, Patient M.B. underwent MRI scans for his lumbar and thoracic spine, and he was subsequently diagnosed with discitis with an epidural abscess in the spinal cod causing cord compression most likely resulting in the weakness in his leas, Discitis is a low-grade infection that affects the disc space between two 2) vertebrae, An epidural abscess is an inflammation that includes a collection of infected material (pus) located between the outer membr ane — covering the spinal cord (the dura) and the bones of the spine. : | | JAPSU\Medical\Mattheve Casey \lases\Stntus 60 Cases necaimi-Fermanshehh O6-24802\(() (m) sanded of CBE at tie Jan 1? 2008 11:32 Jan 17 2008 11:30 P.09 15,. On or about December 29, 2001, Patient M.B. underwent emergency spinal decompression surgery which confirmed the presence of | | | 16, On or about January 7, 2002, Patient M.B, was discharged to a an epidural abscess and severe dciscitis. rehabilitation center with his discharge diagnoses including paraplegia | most likely caused by an epidural abscess. 17. During Patient M.B’s visits to the clinic, the Respondent failed to perform and/or document that he performed certain aspects of the physical exam of Patient M.B. including one or more of the following: an assessrnent of local tenderness and mobility in the lower spine, and/or an assessment of traction signs and/or straight leg raising and/or reverse straight leg raising. . | 18. Between October 9, 2001, and December 14, 2001, the Respondent failed lo proceed with more specific evaluation of Patient MB. when his sytnptoms and complaints progressed which should have included ordering and/or obtaining one. or more of the following: a complete blood count (hereinafter “CBC"); an erythrocyte sedimentation rate (hereinafter “sec rate) test; anc/or a repeat and/or more extensive | MRI scan and/or «ray of the affected area of Patient §.B,'s lower spine. JAPSU\Medical Matthew Casev\Cases\Sintus 40 Caces\KhadeniKermanshiahi 96-7480a\(iitny) sLancerd ab care feces Jan 1? 2008 11:32 Jan 17 2008 11:30 P.10 ~ 19. A CBC provides important information about the) kinds and numbers of cells in the blood, especially red blood cells, white blood! cells, and platelets. A CBC helps diagnose conditions such as anemia, infection, } and many other clisorders. A sed rate blood test measures how quickly. red blood cells (erythrocytes) settle in a test tube in one (1) hour. An elevated sed rate may help diagnose an infection, an autoimmune disease, or cancer, 20. The Respondent failed to refer Patient M,B. fora neurosurgical consult despite his worsening symptoms. , 21. Respondent failed to document a justification for one or more of the following: failing to perform and/or document that he performed ‘certain aspects of the physical exam of Patient M.B. including an assessment of local tenderness and mobility in the lower spine, an assessment of traction signs, and/or straight leg raising and/or reverse straight leg raising; failing to preceed with more specific evaluation of Patient M.B. when his symptoms. and complaints progressed which should | have included ordering and/or obtaining a complete blood count, a sed | rate test, and/or a repeat and/or more extensive MRI scan and/or x-ray of JA\PSi Medical Matthew Casey\Cases Status 60 0 ob cae | e\hedenth Kerman zat! (6-24802\01) (m) standard Cane A ‘ ; Jan 1? 2008 11:32 Jan 17 2008 11:91 P.11 | | the affected area of Patient M.B.’s. lower spine; and/or failing to refer Patient M.B. for a neurosurgical consult despite his worsening symptoms. COUNT I : 22. Petitioner.realleges and incorporates paragraphs one (1) ‘through twenty-one (21) as if fully set forth herein. 23, Section 458.331(1)(t), Florida Statutes (2005), 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, : 24. 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 ar more of the follawing ways: by failing to perform certain aspects of the physical exam cf Patient MB. induding an assessment of local tenderness and rnability in the lower spine, an assessmnent of traction signs, and/or straight leg raising and! r reverse straight leq raising: by failing to proceed with more specific evaluation of ; iota ech Patient PLE, when his symptoms and complaints progressed! which should PAPS|Whedical\Maithew nace ni-rermanshehi 06-24802\(1) (m) standard Jan 1? 2008 11:32 Jan 17 2008 11:91 P.12 have included ordering and/or obtaining a complete blood count, a sec rate test, and/or a repeat and/or more extensive MRI scan and the affected area of Patient M.B.’s lower spine: and/or by faili Patient M.B. for a neurosurgical consult despite his. worsening s or x-ray of ng to refer mptoms, 25. Based on the foregoing, Respondent ‘has. violated Section 458.331(1)(1), Florida Statutes (2005), 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 26, Petitioner realleges and incorporates paragraphs one through twenty-one (21) as if fully set forth herein. (1) 27. — Section 458.331(1)(m), Florida Statutes (2005), provides that failing to keep legible medical records that justify the course of | reatnient | of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or — administered; and reports of consultations and hospitalizations, constitutes grounds for disciplinary action by the Board of Medicine. JAPSU\Medical\Matthew Casey\Cages\Slalue 60 Cases ‘ of care & nedeml-Kermanshaht O6-24802\(t) (Mm) standard Jan 1? 2008 11:33 Jan 17 2008 11:91 P.13 . 28. Respondent failed to keep legible medical records justifying the course of treatment by failing to document that he performed certain aspects of the physical exam of Patient M.B, including an assessment of local tenderness and mobility in the lower spine, an assessment of traction signs, and/or straight leg raising and/or reverse straight leg raising, and/or by falling to document a justification for one or more of the following: failing to perform an assessment of local tenderness and mobility in the lower spine, an assessment of traction signs, and/or straight leg raising and/or reverse straight leg raising; failing to proceed with more specific evaluation of Patient M.B. when his symptoms and complaints progressed | which should have included ordering and/or obtaining a complete blooc! | ‘count, a sed rate test, and/or a repeat and/or more extensive MRI scan \ and/or x-ray of the affected area of Patient M.B.’s lower spine; and/or | failing to refer Patient M.B. for a neurosurgical consult despite his worsening symptoms. 29. “Based on the foregoing, Respondent violatec| Section 458.331(1)(m), Florida Statutes (2005), by failing to keep legible medical i records that justify the course of treatment of the patient, including, Lue ae not limited to, patient histories; examination results; test results; records J:APSU\Medical\ Matthew Cagey\Cases\Statue 60 Cases\Khaceni-fermanshali 06-24802\(1) (m) stendard Qf Aare ae.or , bo Jan 1? 2008 11:33 Jan 17 2008 11:91 P14 ‘WHEREFORE, the Fetitioner 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, rernedial education and/or any other relief that the Board deems appropriate. SIGNED this__|(= RPHETTMENT OF OF Gens aa GL BRI ct BATE PCP: April 13, 2007 PCP Members: Ashkar, Bearison & Beebe DOH vs. Ardeshir Khademi-Kermanshahi, M.D., Case No, 2006-24802 JAPSU\Medical\Malthew Casey\Casas\Slaiue 70 cases\Khaciami-Kermanshali 06-24802\(1) OE Cen ar chor ~_. day of Ana M. Viamonte Ros, M.D., MIP. Secr' etary, Department of Health Matthew Casey © Assistant General Counsel DOH Prosecution Services Unit fi. ped 2007, 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar # 0115320 (850) 245-4640 ext, 8173- phone (850) 245-4681 ~ fax i (m) standard Jan 1? 2008 11:33 Jan 17 2008 11:92 P.15 NOTICE OF RIGHTS f Respondent has the right to request a heari g to be conducted in accordance with Section 120.569 and Florida Statutes, to ba 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 any other discipline imposed. IAPSU\Medi¢al Matthews: Cage Cases \Status 60 Caser\ehecend kermenshahl 06-24802\(1) (in) slanciard mo Care Be

Docket for Case No: 08-000317PL