(ax | STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, ! PETITIONER, v. CASE NO, 2008-13126 KOZHIMALA JOHN, M.D,, | RESPONDENT. —— : ADMINISTRATIVE OMPLAINT | : Petitioner, the Department of Health, by and through its undersigned | counsel, files this Administrative Complaint before the Board of Medicine against the Respondent, Kozhimala John, M.D., and in support thereof states: 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 licensed physician within number ME 23148, J APSU\Medical\Robert Milne\Cases IOHN aod LPiSk BOOZ ¢ material to this Complaint, Respondent was a the State of Florida, having been issued license 4008-13126\Final AC.doc 1 420 oP: ST b6O0e 24 20 ~ Zephyrhills, Florida 33542, 3 The Respondent’s address of record is 6340 Fort King Road, 4, Respondent} is board-certified in internal medicine. 5, On or about! May 5, 2008, Patient S.R. a sixty-one (61) year-old i 1 female, presented to Respondent with orders for and a signed consent for a colonoscopy to be performed under sedation at Respondent's office, 6. The attending nurse had difficulty inserting and administering the sedation intravenously (LV). 7 Several attempts were made to obtain L.V sedation by inserting the needle into S.R.'s arms and then attempts were made to insert the LV. in S.R’s hands. 8. | The LV. infiltrated on several occasions, resulting in puffiness and redness in $.R.5 arm, | 9. | After these ineffectual attempts to obtain an LV. line Respondent removed the IV, from S)R’s hand and re-inserted it into S.R.'s tight inside elbow. 10. ! { | | i i Respondent then commenced the colonoscopy on S.R. without | | | having obtained adequate sedation, JAPSU\MedicalRobert Milne\CasesVIOHN 2008-13126\Final AC.doc 2 BO"d IpiSk 6002 £ 420 oP: :ST 600¢ 2 450 1 stop because of the pai 11. Shortly. afte 12, Respondent and Respondent then q | colonoscopy despite:S.R, of her pain. 13. Respondent the colonoscopy while k and that he was causing 14. 4 Respondent continue with the colon the severe pain that. Ss. down against her will, i5. | Respondent completed the scope due to S.R.' adhesions of her colon. 16. sedation, cesst S.R.5 fi ‘PSUMediahRoten Milne\Cases\OHN 20 Old LpeSk 600e the procedure Respondent co r starting the procedure S.R. asked Respondent to n she was experiencing, ignored S.R.’s instructions to halt the procedure ontinued to advance the scope and complete the S loud and repeated cries for him to stop because fontinued to advance the scope and continue with Nowing that he had obviously failed to sedate S.R. S.R. unnecessary and severe pain, was able to continue to advance the scope and oscopy without adequately sedating S.R., despite R. was suffering by having his nurses hold S.R. continued to advance the scope and then (lespite the difficulty he experienced in advancing § previous abdominal surgeries, and probable mpleted the Colonoscopy despite S.Rs lack of loud vocalization of her pain and unequivocal 8-13126\Final AC doc é 490 oF:ST B00e 4 30 i i ‘ rescission of her consent to Respondent continuing with the colonoscopy, and despite his knowledge that the difficulty that he was having in advancing the scope was causing S.R. severe additional and unnecessary pain. | 17, Respondent's medical notes fail to state that: a). obtaining an LY for S.R. was complicated by difficulty in obtaining a vein for LV. insertion; b), the LV infiltrated on multiple occasions; c). S.R was inadequately sedated: | d). S.R. demanded that Respondent stop her inadequately sedated | colonoscapy because of the severe pain that she was suffering; e€). Respondent continued to perform an un-sedated colonoscopy on the patient without her consent; f). Respondent Succeeded in completing the Procedure by having S.R. held down by his nurses against $.R.’s will; g). Respondent experienced difficulty in advancing the scope because of the patient’s prior abdominal surgeries and probable adhesions. | { | { | { JAPSUMedical Rabert Milne\Cases\VOHN 2008-13126\Final AC doc 4 i | i LLd LpiSl 6002 £ 320 or:ST 600Z 2 400 COUNT ONE 18, Paragraphs i through 17 are re-alleged and adopted as though fully set forth. ! 19, Section 456.072(1)(bb), Florida Statutes (2007), provides that performing or attempting to perform health care services on the wrong patient, a wrong-site procedure, a wrong procedure, or an Unauthorized procedure or a procedure that is medically unnecessary or otherwise unrelated to the patient's diagnosis or medical condition, constitutes grounds for discipline by|the Board of Medicine. 20.. Respondent performed a wrong procedure or an unauthorized procedure or a procedure that was medically unnecessary by one or more of the following ways: a). Performing a wrong procedure on Patient SR. on May 5, 2008, by performing @ colonoscopy without adequate sedation when consent was obtained for a colonoscopy with sedation; b). Performing an unauthorized procedure on Patient S.R. on May 5, 2008, by performing and completing a colonoscopy without adequate sedation when S.R.'s consent had been repeatedly withdrawn. J ‘APSU\Medical\Robert Milne\CasesUOHN 2008-13126\Final AC.doc 5 i zL‘d Beis. B00Z2 £ 320 épisl 600Z 4 400 i Vos : oo 21. Based -on | the foregoing, Respondent Violated Section 456.072(1)(bb), Florida Statutes (2007), by performing a wrong procedure, or an unauthorized procedure or a procedure that is medically unnecessary or otherwise unrelated to the patient's diagnosis or medical condition. | count two 22. Paragraphs 1/through 17 are re-alleged and adopted as though fully set forth. . 23. Section 458.331(1)(m), Florida Statutes (2007), provides that failing to keep legible medical records justifying 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 is grounds for discipline by the Board of Medicine. 24, | On May 5, 2008, Respondent failed to keep legible medical records justifying the: course of treatment of Patient S.R. by failing to document one or More ofthe following: a). that obtaining an IV for S.R, was complicated by difficulty in obtaining a vein for I.V, ingertion; b). that the I.V infiltrated on multiple occasions; JAPSU\Medical\Rabert Milne\Cases\VOHN 2008-13126\Final AC.doc 6 Bled ep Sk 6008 £ $90 2e:ST 600¢ 42 450 c). that S.R was inadequately sedated; d), that S.R. demanded that Respondent stop her inadequately i sedated colonoscopy betause of the extreme pain she was suffering; | @). that Respondent continued to perform an inadequately sedated colonoscopy on the patient without her consent; | f). that Respondent succeeded in completing the procedure by having S.R. held down by his nurses against S.R/s will; Net g 7 that Respondent experienced difficulty in advancing the scope because of the patient's prior abdominal surgeries and. probable adhesions. 25. Based on the foregoing, Respondent. has violated Section 458.331(1)(m), Florida Statutes (2007). 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 1 { practice, imposition of an administrative fine, issuance of a reprimand, Placement of the Respondent on probation, corrective action, refund of fees billed or collected, reémedial education and/or any other relief that the Board deems appropriate, | i | 1 JAPSU\Medical\Robert Milne\Cases\JOHN 2008-13126\Final AC.doe tl od . ep esl 600e é 490 2e:ST 600¢ 42 450 SIGNED this i, day of , 2009. Ana'M. Viamonte Ros, M.D., M.P.H. ssistant General Counsel ai ep Florida Bar No.: 622338 oerant jJENT OF HEALTH DOH Prosecution Services Unit DEPUTY ‘ Be Ae 4052 Bald Cypress Way, Bin C-65 GLEBK: ¢ Tallahassee, FL 32399-3265 aero ea (850)245-4640 (850) 245-4681 Facsimile POP: I Ape co PCP Mempers: Asher. scab v Barbe | | J ‘\PSU\Medical\Robert Milne\Cases\ JOHN |2008-13126\Final AC.doc 8 \ Ghd ep egt 600e £ +90 2F:oT 600¢ 42 450

Docket for Case No: 09-005487PL