STATE OF FLORIDA | DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv ) CASE.NO: 2006-12633 ! . GABRIEL SANCHEZ, M.D., RESPONDENT. a / | . . | ADMINISTRATIVE 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, Gabriel Sanchez, M.D., and in support thereof alleges: 1. i 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 29931, J:\PSU\Medicall Matthew Casey\Cases\Sanchez 06-12633\(t) standard of care ac.doc ] 90d Bp tal B00 86 +90 oP:ST B800¢ 2 450 L-@ fatty 3. ‘Respondent's address of record is 2323 Curlew Road, Suite 6A, Dunedin, FL 34698. 4, ‘On or about March 30, 2006, Patient H.W. was a fifty-five (55) year old male whom presented to Respondent at the emergency room (hereinafter “ER”) at Town and Country Hospital (hereinafter “TCH”) in Tampa, Florida, with complaints of feeling very tired and of his legs feeling very heavy for the past week, Additionally, according to the nurse’s notes, Patient H.W, complained of having black, tarry stools for the three (3) days prior to his ER visit. 5, ‘On or about March 30, 2006, Patient H.W/s Visit Triage form noted he had a past medical history that included heart valve replacement, a bleeding ulcer, and a bloody nose for the past week. The form also indicated Patient H.W. was taking Warfarin (also known as Coumadin) as well as other medications at the time. Coumadin is a drug used to prevent and treat harmful blood clots by decreasing the amount of clotting proteins in the blood. 6. | On or about March 30, 2006, Respondent ordered Patient H.W. undergo some blood: tests, a chest x-ray, and an electrocardiogram | (hereinafter “EKG’). An electrocardiogram is a test that measures the | | J:\PSU\Medical\ Matthew Casey\Cases\Sanchez 06-12633\(t) standard of care ac.doc 2 90 ‘d Bp tal B00 86 +90 2ereT 800¢ 2 450 electrical signals that control the rhythm of your heartbeat. 7, on or about the same day Patient H.W. presented to the ER at TCH, the Respondent discharged him home after noting normal findings on the above-referenced tests with instructions to see his primary care physician in two (2) days, Respondent noted a possible viral syndrome as his clinical impression in Patient H.W,'s medical records, , 8. On or about March 30, 2006, Respondent failed to perform a rectal examination of Patient H.W. to look for a possible source of bleeding, and/or he failed to test Patient H.W.'s stool for the presence of blood. 9. On or about March 30, 2006, Respondent failed to order a test of Patient H.W’s prothrombin time (hereinafter “PT”) and/or the Respondent failed to check Patient H.W.s international normalized ratio (hereinafter “INR”) prior to discharging Patient H.W. Prothrombin time is a blood test that measures how long it takes blood to clot. INR is a method of standardizing PT test. results. 10. Onor about March 30, 2006, Respondent failed to consult with a gastroenterologist (a specialist in digestive diseases) and/or to refer Patient H.W. to a gastroenterologist. 11, On or about April 10, 2006, Patient H.W. presented to the ER at 3\PSU\Medical Matthew Casey\Cases\Sanchez 06-12633\(t) standard of care ac.doc 3 Lod Bp tal B00 86 +90 2ereT 800¢ 2 450 rt ii od University Community Hospital Carrollwood (hereinafter “UCHC”) with complaints! of dark stools for about three (3) weeks, which were ; worsening, and generalized weakness and fatigue. 12. On or about April 10, 2006, after conducting the appropriate tests, the ER physician treating Patient H.W. indicated his clinical impression was acute anemia secondary to upper gastrointestinal bleeding, likely due to non-steroidal anti-inflammatory drugs. Patient H.Ws treatment plan included withholding his Coumadin and transfusing ultimately six (6) units of packed red blood cells. 13. On or about April 11, 2006, Patient H.W. also underwent an upper gastrointestinal endoscopy, which is a procedure that allows a doctor ta look at the interior lining of the esophagus, stomach, and the first part of the small intestine (duodenum) through a thin, flexible. viewing instrument called an endoscope. 14, | On or about April 11, 2006, post-endoscopy, Patient H.W. was diagnosed | as having. a hiatal hernia, gastritis, and a pyloric channel (stomach) ulcer. A hiatal hernia occurs when part of the stomach bulges upward out of the abdomen and. into the chest cavity. Gastritis is the inflammation or irritation of the stomach lining. A stomach ulcer is a sore . J:\PSU\Medical\Matthew Casey\Cases\Sanchez 06-12633\(t) standard of care ac.doc 4 | | | 80 ‘d BP tél B00 86 +90 2hieT 800 Se 450 in the inner lining .of the stomach caused when the stomach’s digestive juices irritate and damage tissue. 15. | Respondent failed to document a reasonable justification prior to discharging Patient H.W. on or about March 30, 2006, for one or more of the following: for failing to perform a rectal examination of Patient H.W. to look for a possible source of bleeding; for failing to test Patient H.W.'s stool for the presence of blood; for failing to order a test of Patient H.W.’s prothrombin time; for. failing to check Patient H.W’s INR; for failing to consult with a gastroenterologist; and/or for failing to refer Patient H.W. to a gastroenterologist. COUNTI 16. Petitioner realleges and incorporates paragraphs one (1) through fifteen (15) as if fully set forth herein. 17. | 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. 18. | Respondent failed to practice medicine with that level of | | J:\PSU\Medical\Matthew Casey\Cases\Sanchez 06-12633\(t) standard of care ac.doc 5 60d priel 8008 86 +90 2ereT 800¢ 2 450 care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances in one or more of the following ways: by failing to perform a rectal examination of Patient H.W. to look for a possible source of bleeding; by failing to test Patient H.W’s stool for the presence of blood; by failing to order a test of Patient H.W.'s prothrombin time; by failing to check Patient H.W.'s INR; by failing to consult with a gastroenterologist; and/or by failing to refer Patient H.W. to a gastroenterologist. 19. ‘Based on the foregoing, Respondent has violated Section 458.331(1)(t), 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 20. Petitioner realleges and incorporates paragraphs one (1) through fifteen (15) as if fully set forth herein. al. | Section 458,331(1)(m), Florida Statutes (2005), provides that failing to keep legible medical records that justify the course of treatment of the patient, including, but not limited to, patient histories; examination J:\PSU\Medical\Matthew Casey\Cases\Sanchez 06-12633\(t) standard of care ac.doc 6 Ol'd priel 8008 86 +90 Br:eT 800 fe 450 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. 22, Respondent failed to keep legible medical records justifying the course of treatment prior to discharging Patient H.W. on or about March 30, 2006, in one or more of the following ways: regarding his failure to perform a rectal examination of Patient H.W. to look for a possible source of bleeding; regarding his failure to test Patient H.W.'s stool for the presence of blood; regarding his failure to order a test of Patient H.W/s prothrombin time; regarding his failure to check Patient H.W.'s INR; regarding his failure to. consult with a gastroenterologist; and/or regarding his failure to refer Patient H. W. to a gastroenterologist. 23, | Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2005), by failing to keep 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 reports of consultations and hospitalizations. | J:\PSU\Medical\Matthew Casey\Cases\Sanchez 06-12633\(t) standard of care ac.doc 7 Lk *d priel 8008 86 +90 Br:eT 800 fe 450 WHEREFORE, the Petitioner respectfully requests that the Board of Medicine enter an order imposing one or more of the following penaities: 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 that the Board deems appropriate. SIGNED this 12. day of bauer , 2007. Joseph J. Chiaro, M.D., FAAP Interim Secretary, Department of Health cena LED ousnn ee a ay “Wetton Coat bien heal Matthew Casey DATE, tft Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar # 0115320 | (850) 245-4640 ext, 8173 — phone (850) 245-4681 — fax PCP: 1/12/07 PCP Members: :Ashkar, Lage & Beebe J:\PSU\Medical\Matthew Casey\Cases\Sanchez 06-12633\(t) standard of care ac.doc 8 él‘d priel 8008 86 +90 Br:eT 800 fe 450 DOH vs. Gabriel Sanchez, M.D., Case No. 2006-12633 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 any other discipline imposed. J:\PSU)\Medical\Matthew Casey\Cases\Sanchez 06-12633\(t) standard of care ac.doc 9 | Bld Ghtel 8008 86 +90 Br:eT 800 fe 450

Docket for Case No: 08-005357PL