Feb 22 2008 14:07 Feb 22 2008 14:05 P.O5 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO, 2007-04535 FERNANDO JIMENEZ, M.D., RESPONDENT. ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through undersigned counsel, files this Administrative Complaint before the Board of Medicine against Respondent, Fernando Jimenez, 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 medical doctor within the state of Florida, having been issued license number ME 31545. Feb 22 2008 14:08 Feb 22 2008 14:05 P. O06 3. Respondent’s address of record is 75 Northeast 6" Avenue, Suite #104, Delray Beach, Florida 33483. 4. On or about January 4, 2006, Respondent submitted an application for reappointment for clinical privileges to University Hospital and Medical Center. As part of the application, Respondent attested to the accuracy and completeness of his application for reappointment. 5. Question number 1 on the application inquired as follows: SINCE YOUR LAST APPLICATION “1. Have your memberships or clinical privileges been voluntarily or involuntarily limited, reduced, or relinquished, or have your clinical privileges been terminated by any other health care entity (e.g., hospital, HMO, PPO)?” 6. Respondent answered NO to that question. 7. In fact, Respondent’s staff membership and clinical privileges at Imperial Point Medical Center, Broward General Medical Center, and North Broward Medical Center were suspended on April 13, 2005. Subsequently, by agreement, Respondent agreed that the suspension would remain in force six months from March 7, 2007, or until the end of his scheduled reappointment cycle. At time he was eligible to apply for reappointment, JAPSL Medical} DIANE Jimenev\Final AC 2007-04535 doc 2 Feb 22 2008 14:08 Feb 22 2008 14:06 P.O? @ @ but the Respondent acknowledged that he had received no promises or representations that he would be reappointed. 8. Section 456.039, Florida Statutes, requires that specified licensed health professionals provide information that is to be compiled into a practitioner profile. Section 456.041, Florida Statutes, describes the mechanism by which each practitioner is to review the initial profile and verify that it is accurate. Thereafter, pursuant to Section 456.042, Florida Statutes (2004), each covered practitioner “must submit updates of required information within 15 days after the final activity that renders such information a fact. The Department shall update each practitioner profile periodically. An updated profile is subject to the same requirements as an original profile.” 9. The practitioner profile contains specific questions related to actions against staff privileges which the practitioner is required to disclose. 10. On Respondent's practitioner profile downloaded on April 9, 2007, the profile reflected that: This practitioner has indicated the h/she has NEVER been asked to or allowed to resign from or had any medical staff privileges restricted or revoked within the previous 10 years by a health maintenance JnPSLaMedicai DIANE Jimenez Final AC 2007-04533 doc Feb 22 2008 14:08 Feb 22 2008 14:06 P. 08 organization, pre-paid health clinic, nursing home, hospital or ambulatory surgical center. 11. On Respondent’s practitioner profile downloaded on July 3, 2007, the profile reflected that disciplinary action had been taken by a hospital within the previous 10 years, related to delivery of services, but the profile now provided no information when Respondent was asked whether he has resigned from of had any medical staff privileges restricted or revoked with the previous 10 years. Respondent simply failed to provide this mandatory information. COUNT ONE 12. Petitioner realleges and incorporates paragraphs one (1) through twelve (12) as if fully set forth herein 13. Section 456.072(1)(a), Florida Statutes (2004), provides that making misleading, deceptive, or fraudulent representations in or related to the practice of the licensee's profession constitutes grounds for disciplinary action by the Board of Medicine. 14. Respondent made misleading or deceptive representations related to the practice of his profession in one or more of the following ways: JSPSU!Medicuh DIANE Jimenes:Final AC 2007-04 535. doe 4 Feb 22 2008 14:08 Feb 22 2008 14:06 P.09 a. By failing to disclose on his application for reappointment at University Hospital and Medical Center that Respondent's staff membership and clinical privileges at Imperial Point Medical Center, Broward General Medical Center, and North Broward Medical Center were suspended on April 13, 2005; b By failing to disclose on his application for reappointment at University Hospital and Medical Center that Respondent agreed with Imperial Point Medical Center, Broward General Medical Center, and North Broward Medical Center that the suspension would remain in force six months from March 7, 2007, or until the end of his scheduled reappointment cycle: C. By failing to disclose on his application for reappointment at University Hospital and Medical Center that his staff membership and clinical privileges at Westside Regional Medical Center were summarily suspended in 2005 and on January 27, 2006, he resigned from the staff at Westside Regional Medical Center during the pendency of peer review regarding that suspension. 15. Based on the foregoing, Respondent has violated Section 456.072(1)(a), Florida Statutes (2004), by making misleading, deceptive, JAPSU\MedicaiDIANE Jimena Final AC 2007-04334 doe fd Feb 22 2008 14:09 Feb 22 2008 14:06 P.10 ® @ or fraudulent representations in or related to the practice of the licensee's profession, COUNT TWO 16. Petitioner realleges and incorporates paragraphs one (1) through twelve (12) as if fully set forth in this count. 17, Section 456.072(1)(v), Florida Statutes (2004), provides that failing. to comply with the requirements for profiling and credentialing, including, but not limited to, failing to provide initial information, failing to timely provide updated information, or making misleading, untrue, deceptive, or fraudulent representations on a profile, credentialing, or initial or renewal licensure application constitutes grounds for disciplinary action by the Board of Medicine. 18. Respondent failed to comply with the requirements for profiling in one or more of the following ways: a. By failing to comply with Section 456.042, Florida Statutes (2004), which requires that each covered practitioner submit updates of required information within 15 days after the final activity that renders such information a fact; ISPSU\MedicaliDIANE Jimenez:F lnal AC 2007-04535. doe é Feb 22 2008 14:09 Feb 22 2008 14:07 P.11 b. By falsely stating on his April 9, 2007 profile that the he had NEVER been asked to or allowed to resign from or had any medical staff privileges restricted or revoked within the previous 10 years by a health maintenance organization, pre-paid health clinic, nursing home, hospital or ambulatory surgical center; c. By failing to disclose mandatory information on his July 3, 2007, profile as to whether he had resigned from of had any medical staff privileges restricted or revoked within the previous 10 years. 19. Based on the foregoing, Respondent has violated Section 456.072(1)(v), Florida Statutes (2004), by failing to comply with the requirements for profiling and credentialing, including, but not limited to, failing to provide initial information, failing to timely provide updated information, or making misleading, untrue, deceptive, or fraudulent representations on a profile, credentialing, or initial or renewal licensure application. 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, JSPSULM edical! DIANE Jimenez:Final AC 2007-04525 doc 7 Feb 22 2008 14:09 Feb 22 2008 14:07 P.12 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 2; 7 day of Seen. fe , 2007. Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General Assistant General Counsel ----— DOH-Prosecution Services Unit . 4052 Bald Cypress Way-Bin C-65 uc Tallahassee, Florida 32399-3265 “ Florida Bar # 233285 (850) 245-4640 (850) 245-4681 fax DKK PCP: December 21, 2007 PCP Members: El-Bahri & Farrner Fernando Jimenez, M.D. DOH Case No. 2007-04535 Feb 22 2008 14:09 Feb 22 2008 14:07 P.13 Fernando Jimenez, M.D. DOH Case No. 2007-04535 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. IJAPSU Medica \DIANEMimenes Final AC 200708834. doe y

Docket for Case No: 08-000978PL