STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, HYD p U PETITIONER, . ve , - CASE NO.: | 2006-18698 FREDERICK L. HETHER, D.c., RESPONDENT |. ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through its undersigned counsel, files this Administrative Complaint before the Board of Chiropractic Medicine against Respondent, Frederick L.. Hether, D.C., and in support alleges: . a Petitioner is the. state department charged with regulating the practice of chiropractic medicine pursuant to Section 20.43, Florida Statutes; ‘Chapter 456, Florida Statutes; and Chapter 460, Florida Statutes. . 2. At all times material to this Complaint, Respondent was -a licensed chiropractic physician within the State of Florida, having been issued license number CH 4942 on or about . guly 26, 1990. 3. Respondent's address of record is 800 South Nova Road, Suite H, Ormond Beach, Florida 32174. 3:\PSU\Medical\Tobey\ -CAS€S\Hether, Frederick D:C\proposed A.C.-Hether.doc 1 1002 $ 2 d3$ On or about June 7,. 2004, patient JC presented ry the ‘seeking treatment for back and neck pain related to an autom ile accident. The initial history taken on June 7, 2004, lacks. any m in regard to the details of the motor vehicle accident: prior medical history, or the results. of any diagnost tests. ; “6. " Patient JC “returned to the Respondent's office for croctmaie related to the automobile accident on’ the following dates: Tygne 9, 11, 14, 16, 18, 21, 24, 25, 28, 390; guly 2, 5, 7, 9, 12, im, 16, 17, 19, 21, 23,° 26, 28, 30;. August 2, 9, 11, 13, 18, 20, bs, 30; September 1, 13, 15, 17, 20, 22, 24, 29, October 1, 6, 8, >11, 15, 18, 22, 25, 29; November 3, 8, 12, 15, 19, 22, 29; vecSber, 6, 10, 13, 20, 27, 31, 2004; January 3, IOV" 21, 24, February 7, 9, 21, 23, 2005. 7.@ The daily treatment notes for the above-mentioned dates aré generic and describe subjective complaints of neck. and back pain. The daily treatment notes for these dates ‘do not provide ean accurate, detailed and logical explanation of the clinicaI* findings and progress of patient JC that would he required to be minimally adequate. Moreover, the daily a treatmemt notes for the automobile accident do not justify the care pre@ided to patient Jc. a * J:\PSU\Medical\Tobey\_c ASE S\Hether, Frederick D.C\proposed A.C.-Hether.doc ; 2 soot m March 7, 2005, just 14 days after her last visit 8. ug related : the motor vehicle accident, patient JC. returned. to Responder to begin treatment ‘for carpal tunnel syndrome and xo disc with cold laser. The carpal tunnel is the passageway in the wrist. that is. made Wp of the arching carpal bones (eight bones. in the wrist) ! the ligament connecting the pillars of the arch - (the . transvers carpal ligament). The median nerve and the tendons that congect the fingers to the: muscles of the forearm pass through “@mhe tightly spaced tunnel. Carpal tunnel syndrome occurs: wien the median nerve becomes pinched due to swelling of the 1e nervy or tendons or both. 4 10. j Even though patient JC returned to _Respondent two weeks atger she stopped Her care for the motor vehicle accident, the tre%ment notes related to the automobile accident do not containgginy information indicating patient JC had significant orthopedéc or neurological findings. Respondent's notes for patient ™%7C do not indicate any serious spinal injury; nor do ry they contain: any information that might lead to a diagnosis of carpal pene? syndrome. il.y Patient Jc returned to the Réspondent and received additional cold laser treatments on the following dates: March J:\PSU\Medieal\Tobey\__C A S E S\Hether, Frederick D.C\proposed A.C.-Hether.doc 3 ae 9, 11, 14, 16, 18, 21, 23, 25, 28, 30; April 1, 4, 6, 8, 22, 27, 2005. 12. There are no exam findings indicating a diagnosis of carpal tunnel syndrome nor do the daily treatment notes from March 7, 2005, through April 27, 2005, remotely reference carpal tunnel syndrome. . 13. ; The daily “treatment: notes for the March 7, 2005 through April. 27,. 2005, time period are generic and describe " subjective complaints of neck and. back pain. The daily “treatment notes for these dates do not provide an accurate, detailed and logical explanation of the clinical findings ana progress of patient Ie. As such, the daily treatment notes for the March 7, 2005 through April 27, .2005 time period are not minimally adequate and do not justify the care provided to patient Jc. . 4a, JC's March 7, 2005 through April 27, 2005 treatment was pursuant to. her health care coverage with Volusia Health Network, a health maintenance organization. . 15. Respondent billed Volusia Health Network $110 per each cold laser treatment. Volusia Health Network refused | to pay that ‘amount and only reimbursed Respondent $10 for each treatment. 16. Respondent attempted to collect from patient JC the difference between what Volusia Health Network would pay and his J:\PSU\Medical\Tobey\___C AS E S\Hether, Frederick D.C\proposed A-C.-Hether-doc 4 ee the cold laser treatment ($100 for each ‘treatmént) . charge Attempti to obtain the difference between his actual -charges and the ount reimbursed by patient JC’s insurance company is. known as@#balance billing.” . . : 17. Balance billing is prohibited by Respondent's contract with Vol . ia Health Network. Respondent’s attempt to balance bill patient JC. for laser treatments constitutes a trick or scheme that fails % conform to the generally prevailing standards ‘Of treatmeniy in the chiropractic medical community. 2 . a * Count One » 19.9 Petitioner re-alleges and incorporates paragraphs one (1) chrofigh eighteen (18) as if fully set forth herein. 20.9 Section 460.413(1)(m), Florida Statutes (2003)-(2006), providess that failing to keep legibly written ‘chiropractic a a that identify clearly by name and credentials the li@ensed chiropractic physician rendering, ordering, v ; ; . superviging , ox billing for each examination or treatment procedume and that justify the course of treatment of the patient™ including, but not limited to, patient histories, eS examination results, X-rays, and Giagnosis of a disease, : ; condition, or injury is grounds for disciplinary action by the Board 6@™chiropractic Medicine. - 3 J:\PSU\Medieal\Tobey\___C A'S € S\Hether, Frederick D.C\proposed A.C.-Hether.doc 5 le espondent violated Section 460.413 (1)'(m), Florida 003)-(2006), in one or more of the following waysiis- (a) By failing to record an adequate examination “when patient JC presented on June 7, 2004, “for of injuries relate to a motor vehicle accident; ~ (b) By failing to maintain daily ‘treatment h justify the care provided to patient-JC. from June 7, 2004 a ugh February 23, 2005, related to the - automobile accident /-> which justify his diagnosis” that patient JC had carpal tunnel * mS syndroney * (ad) By failing to maintain daily treatment notes (c) By failing to maintain daily treatment notes = that .j cee his treatment provided to patient JC from March 7, us 4 until April 27, 2005 for carpal tunnel syndrome and back pain. a Based on the foregoing, Respondent violated Section 460.413 (¥%)(m), Florida Statutes (2003) - (2006), by failing to te keep legibly written chiropractic medical records for patient Jc that identify clearly by name and credentials the licensed chiroprd®tic physician rendering, ordering, supervising, or « . billing “for each examination or treatment procedure and that E justifywsthe. course of treatment of the patient, including, but not lined to, patient histories, examination results, X-rays, and diagnosis of a disease, condition. = J:\PSU\Medieal\Tobey\___C A'S £ S\Hether, Frederick D.C\proposed A:C.-Hether.doc 6 Count Two 23. Petitioner re-alleges and incorporates paragraphs one (1) through eighteen (18) as if fully set forth herein. 24. Séction 460.413(1) (f£), Florida Statutes (2003)- .(2006), provides that violating any provision of chapter 456.-or chapter 460, or any rules adopted pursuant thereto is grounds for disciplinary ‘action by the Board of Chiropractic Medicine. . 25. Rule 64B2-17.0065, Florida Administrative — Code (F.A.C.), sets forth the minimal recordkeeping standards as set forth below in pertinent part: a. Rule 64B2-17.0065(3), F.A.C. states that medical records shall be legibly maintained and shall contain sufficient information to identify the patient, support the .diagnosis, justify. the ‘treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; examination results;- test results; records of drugs ‘dispensed or administered; reports of consultations and hospitalizations; and copies of. records or reports or other: documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient. Initial and follow-up services (daily records) shall ‘consist of documentation to justify care. 3:\PSU\Medical\Tobey\___C A’S S\Hether, Frederick D.C\proposed A.C.-Hether.doc 7 b. Rule 64B2-17.0065(4), F.A.C., states that all patient records shall include a patient history; symptomatology and/or wellness care; examination finding(s), including X-rays when . medically or clinically indicated; a diagnosis; a prognosis; assessment(s); a treatment plan; and, treatments provided. 26. Respondent failed to comply with Rule 64B2-17.0065, F.A:C., in one or more of the following ways: (a) By failing to record an adequate examination and history when patient gC presented on June 7,. 2004 for treatment of injuries relate to a motor vehicle accident; (b) By failing to maintain daily treatment notes which justify the care provided to patient JC from June 7, - 2004 through February 23, 2005, related to the automobile - accident. (c) By failing to maintain daily treatment notes which justify his diagnosis that patient JC had carpal tunnel syndrome. (ad) By failing to maintain daily treatment notes that. justify his treatment provided to patient JC from March 7, until April 27, 2005 for carpal tunnel and back pain. J:\PSU\Medical\Tobey\___C A S E S\Hether, Frederick D.C\proposed A.C.-Hether.doc 8 Sem 27.% ‘Based on the foregoing, Respondent ‘has violated Section} 460.413(1) (ff), Florida Statutes (2003)-(2006), by violating Rule 64B2-17.0065, F.A.C., through a violation of : oe minimal “Standards for chiropractic record keeping. . - . aan Count Three _ of “at ; . Petitioner re-alleges and incorporates paragraphs one . (1) throygh eighteen (18) as if fully set forth herein. | 29 aw Section 460.413(1)(n), Florida Statutes (2003)-(2006), subjects~a chiropractic physician to discipline for exercising influence on the patient or client in such a.manner as to exploit the patient or client for financial gain of the licensee or of a. third party which shall include, but not be limited .to, the promotion or sale of services, goods or appliances, or raha drugs. -) - 30.3 Rule 64B2-17.005, F.A.C., states that overutilization of chiropractic services, goods, or testing, constitutes the Sh ; exploitation of a patient for financial gain. “> 31.8: According to Rule 64B2-17.005, F.A.C., overutilization occurs when, among other things, the written chiropractic records; required to be kept by subsection 460.413(1) (m), Florida’ Statutes, do not justify or substantiate the quantity or number “of chiropractic services, practices rendered, or goods or appliances sold by a chiropractic physician to a patient. J:\PSU\Medical\Tobey\__C A'S € S\Hether, Frederick D.C\proposed A.C.-Hether.doc 9 ~ 00)-(2006), through the following actions: (a) By treating patient JC ‘from June 7;°°2004 through *Mbruary 23, 2005, related. for injuries related to. the automobé: accident without sufficient records. to justify the (b) By treating patient JC from March 7 until April 27 2005 for injuries related to carpal tunnel and back a 2 ‘pain wigpout sufficient records to justify the necessity for care. . 335 Based on the Foregoing, Respondent has violated: Section $460.413(1)(n), Florida Statutes (2003)-(2005), by exploiting patient Jc for financial gain. lb : Count Four 34 ay Petitioner re-alleges and incorporates paragraphs one (1) trish eighteen (18) as if fully set forth herein. 35. Section 460.413 (1) (k), Florida Statutes (2003)- (2006) 1 subject#® a chiropractic physician to discipline for - making aad misleading, deceptive, untrue, or fraudulent representations in aie the pragtice of chiropractic medicine or employing a trick or te scheme in the practice of chiropractic medicine when such trick or scheme fails to conform to the generally prevailing standards ~—> of treatment in the chiropractic medical community. Saad ~ ad J:\PSU\Medical\Tobey\__-C ASE S\Hether, Frederick D.C\proposed A.C.-Hether.doc 10 36. Respondent’s attempt to balance bill patient JC for the cold laser treatments provided to her constitutes a trick or scheme that fails to conform to the generally prevailing standards of treatment in the chiropractic medical community. 37. ‘Based. on the foregoing, Respondent has violated Section 460.413(1) (k), Florida Statutes (2003)-(2006). . . WHEREFORE, Petitioner respectfully requests that the ‘Board of Chiropractic 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 eRe, that the Board deems appropriate. J:\PSU\Medical\Tobey\___C A S € S\Hether, Frederick D.C\proposed A.C.-Hether.doc jl stenep this 24” aay of _Sepleuber , 2007. Ana M. Viamonte Ros, M.D., M.P.H; Secretary of Health — u Tobey Schult Assistant Genéral Counsel , FILED DOH Prosecution Services Unit : 4052 Bald Cypress Way, Bin C-65 _ DEPARTMENT OF HEALTH Tallahassee, FL 32399-3265 EPUTY CLERK CLERK: EDN Florida Bar # 0542131 : : ‘Ol (850) 245-4640 ext. 8176 DATE (850). 245-4682 FAX tobey_schultz@doh.state.fl.us pce: Tl ao} o> kiebqa Wells J:\PSU\Medical\Tobey\___.C A S E’S\Hether, Frederick D.C\proposed A.C.-Hether.doc . NOTICE OF RIGHTS ‘ & a, ye hey Q conducted in accordance with Section 120.569 and 120.5774) Statutes, .to be represented by counsel or other qualseic representative, to present evidence and argument, to call ais cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. _ ; ; Respondent has the right to request a nearing/,to 2. by, oe e NOTICE REGARDING ASSESSMENT OF COSTS of : 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. : J:\PSU\Medical\Tobey\__C A S E S\Hether, Frederick D.C\proposed A.C.-Hether.doc . i

Docket for Case No: 08-003637PL