Jul 6 2010 10:49 Jul 6 2010) 10:46 P. O04 S 7) STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO.: 2007-37618 WILLIAM M, HAMMESFARR , M.D., , RESPONDENT. / 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 Respondent, William ™. Hammesfahr, M.D., and in support thereof alleges: 1. Patitioner is the state department charged with regulating the practice of Medicine pursuant to Section 20.43, Florida Statutes, and Chapters 456 and 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 52212. Jul 6 2010 10:49 Jul 6 2010 10:46 P.O5 . 3.. Respondent's address of record is 7316 Central Avenue, St. Petersburg, Florida 33707. | 4. | From on or about August 6, 2007, through on or about August 10, 2007, P.A., and his mother, 1.4, were patients of and were examined and treated by Respondent. : 5. A dispute arose between the patients and Respondent over billing issues. . 6. Onor about December 18, 2007, PA. sent a certified mail request to Respondent, along with a durable power of attorney from LA. to PA., for the patient records of 1.A., and for his own patient records. 7. Respondent has not provided the requested patient records. : 8. On or about March 11, 2008, PA. sent a certified mail request to Respondent, along with a durable power of attorney from LA. to BA., for the itemized billing records of 1.A,, and for his own itemized billing records, 9. Respondent has not provided the requested billing records. JAPSU\Medical\ManGX\Cases\Hammesfahr, William 2007-3761 8\AC.dor 2 Jul 6 2010 10:49 Jul 6 2010) 10:46 P. 06 Newest naan! COUNT ONE 10. Petitioner realleges and ‘incorporates paragraphs one (1) through nine (9}, above, as if fully set forth herein. 11. Section 456.072(1)(k), Florida Statutes (2007), provides that failure to: perform any statutory or legal obligation placed upon a licensee constitutes grounds for disciplinary action by the Board of Medicine. | 12. Section 456.057(6), Florida Statutes (2007), provides that any health care practitioner licensed by the department or a board within the department who makes a physical or mental examination of, or administers treatment or dispenses legend drugs to, any person shall, upon request of such person or the person's legal representative, furnish, in a timely manner, without delays for legal review, copies of all reports and records relating to. such examination or treatment, including X rays and insurance information. 13. Respondent violated Section 456.057(6), Florida Statutes, by failing to furnish in a timely manner copies of all reports and records relating to the examination or treatment, including X rays and JAPSU\Medical\MarrGX\Cases\Hammiesfahr, William 2007-37618\AC doe 3 Jul 6 2010 10:49 Jul 6 2010 10:46 P.O? Ww Mail! insurance information, of Patient P.A. and Patient J.A., upon their request. | 14. Based on the foregoing, the Respondent has violated Section 456.072(1)(k), Florida Statutes, by violating Section 456.057(6), Florida Statutes. COUNT TWO 15. Petitioner realleges and incorporates paragraphs one (1) through nine (9), above, as if fully set forth herein. 16. Section 456.072(1)(k), Florida Statutes (2007), provides that failure to perform any statutory or legal obligation placed upon a licensee constitutes grounds for disciplinary action by the Board of Medicine. | 17. Section 458.323, Florida Statutes (2007), provides that whenever a physician licensed under this chapter renders : professional services to a patient, the physician is required, upon request, to submit to the patient, the patient's. insurer, of the administrative agency for any federal or state health program under which the patient is entitled to benefits an itemized statement of the specific services rendered and the charge for each, no later.than the J APSU\Medical\MarrGX\Cases\Hammesfahr, William 2007-3761 8\AC.dor 4 Jul 6 2010 10:49 ; Jul 6 2010) 10:47 P. 08 ed ad or physician's next regular billing cycle which follows the fifth day after the rendering of professional services. ! 18. Respondent violated Section 458.323, Florida Statutes, by failing to provide Patient PA. and Patient I.A., upon request, an itemized statement of the specific services rendered and the charge for each, 19. Basad on the foregoing, the Respondent has violated Section 456.072(1)(k), Florida Statutes, by violating Section 458.323, Florida Statutes. 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, placement of the Respondent on probation, corrective action, refund of fees billed or JAPSU\Madical\MarrGX\Casce\Hammesfahe, William 2007-3761 8\AC.doe 5 Jul 6 2010 10:50 Jul 6 2010) 10:47 P.09 Yue! \w we” collected, remedial education and/or any other relief that the Board deems appropriate. i # pP . : SIGNED this.2,7___ day of Aenik , 2010. Ana M. Viamonte Ros, M.D., M.RH State Surgeon General | maid RTMENT OF HEALTH DEPAREPUTY GLER Assistant General Counsel — CLERK: Ud _ DOH Prosecution Services Unit oare_el2@lLo. 4052 Bald Cypress Way, Bin C-65 ' Tallahassee, FL 32399-3265; Florida Bar No. 131369 . (850) 245-4640 - phone (850) 245-4681 - fax GSM/ PCP Date: April 23, 2010 PCP Members: Ashkar, Thomas, Levine JAPSU\Medical\ManrGX\Cases\Hammesfahr, William 2007-3761 8\AC.doc Jul 6 2010 10:50 Jul 6 2010 10:47 P.10 Newer” Nee tei” William M. Hammesfahr, M.D. DOH Case No. 2007-37618 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 chal a and subpoena duces tecum issued on his or her behalf if a hearing is requested. NOTICE REGARDING ASSESSMENT OF COSTS incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456:072(4), lorida 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. Respondent is placed on notice that Tone has i JAPBU\Medical\MarrGX\Cases\Hammesfahr, William 2007-376 18\AC.doc : 7

Docket for Case No: 10-004747PL