Oct 1 2009 9:02 Oct 1 2009 68:57 P. O04 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, | CASE NO, 2007-09087 MICHAEL J. ZAPPA, M.D,, i RESPONDENT. INIST VE COMPL 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, Michael J. Zappa, MD, cand in support thereof alleges: | 1, Petitioner is the state department charged with reguiating the practice of medicine pursuant to Section 20.93, riorida Statutes; Chapter 456, Florida Statutes; and Chapter 458, Florida Statutes. : 2, At all times material to this Compizint, Respondent was a licensed physician within the State of Florida, having been issued license number ME 55435, SPB Singha Deo deel a MEE CORT 0005. SEs Oct 1 2009 «9:02 12009 8:57 P05 3. Respondent's address of record is 1800 Forest Hill Boulevard, Suite A-2, West Palm Beach, Florida 33406. 4, Respondent is board certified in Emergency Medicine. ! 5. On or about May 23, 2005, Patient DG, a forty-five (45) year- old male presented to the Emergency Room (ER) of Palms West Hospital (PWH) at approximately 7:00 a.m. with a rash and intense itching, 6. Patient DG had been exposed to chicken pox approximately two weeks earlier. 7. -Patient DG also complained of diffuse abdominal pain, ft was noted on the ER record that Patient DG had a history of crohn’s disease (a disease of the intestinal tract). 8. The ER records note that Patient DG medication: Tramadol, Zyrtec, and Purinethol. was taking the following 9. Tramadol, contained in Ultram, is an analgesic d arug which is not currently listed on ‘any Chapter 893, Florida Statutes schedule, 10, Purinethol is the trade name fo 1 Mercaptopurine, an | immunosuppressant, [lowers the body’s immune response (protection against disease)] anc balonas to the group of mecicines known as ft siggea! TP - feboeesgegs aan UE TE Oct 1 2009 9:02 Oct 1 2009 6:57 P. O06 antimetabolites which are generally used to treat acute feukemia and or some forms of cancer. 11. Zyrtec is used for allergies. 12, Immunocompromised patients (have reduced Immune response to combat disease) with chickenpox, as Patient |DG, tend to have more severe disease needing admission to the hospital for further treatment such as intravenous acyclovir (an antiviral medication), known to be ¢ffective against chickenpox. | | 13, The medical records for Patient DG do not contain any notes documenting Respondent recognized Patient DG was immunocompromised. 14, The medical records for Patient DG do not contain any notes mentioning or discussing the known effect of increasing the severity of an iliness an immunosuppressant such as Purinetho} wourd have and Patient DG's recent exposure to chicken pox. 15. The medical records for Patient DG do not contain any notes documenting a discussion between Responcent and Patient DG regarding the fact that he had contracted chickenpox whi¢ under the effects of an immunesuppressant drug. Oct 1 2009 «9:02 12009 6:58 P.O? 16. While in the ER, Patient DG was giver Benadryi and Vistaril and had a laboratory workup including @ complete b in essentially normal findings. 17, -Respondent suggested to Patient DG ood count which resuited that he should have a-CT scan of the abdomen, but Patient DG refused, pigning a form stating he had refused the CT scan. 18. After approximately six hours in the ER, having refused the CT scan, Respondent discharged Patient DG, with a diagnosis of Varicella (chickenpox) giving him a prescription for Atarax (to help with the itching). 19. Although Patient DG was on an immunosuppressive drug, there are no notes in the medical records indicating acknowledged that fact. Respondent addressed or 20. The medical records do not contain any notes indicating Respondent's justification or rezsoning for discharging Patient DG without any treatment for his diagnosis of varicella or chickenpox. 21. Respondent did not order any antiv iral medication to combat the chickenpox nor did he document his justification for giving Patient DGa prescription for Atar@y tc relieve the itching, pga Dae a Dhekocese: darn Cana Ee er ie without prescribing any Oct 1 2009 9:03 12009 6:58 P. 08 antiviral medication to combat the disease due to Patient DG being immunocompromised. 22. Patient DG's medical records do npt contain any follow-up instructions. 23. On or about May: 24, 2005, the day following Patient DG's presentation to the ER at PWH, Patient DG Regional Medical Center (WRMC) with simila presented to Wellington r symptorns as he had exhibited the previous day at the PWH emergency room. 24, While at WRMC, Patient DG consented to a CT scan of the abdomen which revealed a fistula between transverse colon. the terminal Keum and 25, An x-ray taken at WRMC on May 24, 2005, revealed Patient DG had bilateral pneumonia. 26. Soon thereafter, Patient DG developed progressive respiratory failure becoming hypoxic (insufficient oxygen reaching body tissues) and septic (the putrefaction or decay of body tissues) with multi-organ failure. 27, On or about May 26, 2005, Patient DG suffered cardiac arrest and expired, HMB Mgace! Dot Delbriggdiog: dient OTM om te Pape fet is Oct 1 2009 9:03 Oct 1 2009 6:58 P.09 COUNT I STANDARD OF CARE 28. Petitioner incorporates and realleges paragraphs one through twenty-seven (27) as if fully set forth herein. 29. Section 458.331(1)(t), Florida Statutes (2004) provide 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 discipline by the Board of Medicine. 30, Respondent failed to practice medicime 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 or more of the following ways: | a) by failing to consider or address that Patient DG had contracted chickenpox and while under the effects of an immunosuppressant drug; | b) by failing to admit Patient DG to the hospital for treatment of the chicken oox; Pe Mgdhse Dev? -batempthid: Caan {IRE eof fu i i Oct c) by failing to assess the additiona 1 2009 «99:03 1 2009 8:58 P.10 | risks chicken pox posed for Patient DG due to his immungcompromised condition; d) by failing to determine the type of medication Patient DG was taking; and or e) by failing to discuss with Patient immunosuppressant drug, SUCH was taking, has on chickenpox, 31, Based on the foregoing, Responds 458. 331(1)(t), Florida Statutes (2003), by failing DG the known effects an as the one Patient DG nt has violated Section 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 IT EDICAL RECOR 32. Petitioner incorporates and realleges twenty-seven (27) as if fully set forth herein. paragraphs one through 33, Section 458.331/1\m), Florida Statutes (2004), provides that failing to keep legibie, < Gefinec by cepartment rule in consult tation with Oct 1 2009 9:03 Oct 1 2009 6:59 P.11 the board, medical records that, among other things, justify the course of treatment of the patient, inclucing, ‘put not limited £0, patient histories; examination results; test results; records of arugs prescribed, dispensed, or administered; and reports of consultations and Hospitalizations, is grounds for discipline by the Board of Medicine. 34. Respondent failed to keep legible medical records that justify the course of treatment of the. patient in one jor more of the following ways: a) by failing to document reaspning or justification for discharging Patient DG, in light of the increased risk chicken pox posed to him due his immunocompromised condition; b) by failing to adequately docurrent that chickenpox could sffect Patient DG with greater severity due to the immunosuppressant he was taking; c) by failing to document reasoning or justification for discharging Patient DG without adequately addressing the diagnosis of varicella or ChicKenpox. TPR Megiay Dat» Teter caper Lan SREP GD GS nr ! : fag § of fe Oct 1 2009 9:04 Oct 1 2009 6:59 P.12 3) by failing to cocument reasoning or justification for issuing a prescription to Patient/DG to relieve the itching without prescribing an antiviral to. combat the chickenpox; and/ or e) by failing to document any digcussion with Patient DG regarding the known effects an immunosuppressant Grug such as Purinethol would have on chickenpox. 35. . Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2004). 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, fssuance 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. Oct 1 2009 9:04 Oct 1 2009 6:59 P.13 Signed this 1s day of Maven nine 2007. Ana M. Viamonte Ros, M.D., M, Px, State Surgeon General Dorys H. Penton Assistant Gengral Counsel DOH Prosecution Services Unit - 4052 Bald Cypress Way, Bin C#6S Tallahassee, * 32399-3205 Florida Bar # 0540080 (850) 245-4640 (850) 245-4681 Fax DHP/tih PCP: Nov. Ik, 2607 PCP Members: £(- Bah, Chizaxe Oct 1 2009 9:04 Oct NOTICE OF RIGHTS 12009 8:59 P14 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 quatified representative, to present evidence and argument, to ca i} and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. Ce NOTICE REGARDING ASSESSMENT OF COSTS i t i Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.0172(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours ahd costs, on the Respondent in addition any other discipline imposed. fo PB Umignte! def -Inbmeoebedt enpe TE EDP ae

Docket for Case No: 09-005338PL