STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, _ PETITIONER, Ve CASE NO. 2004-03387 ANTHONY ROGERS, M.D., RESPONDENT. a ee D4 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, Anthony Rogers, M.D., and in support thereof alleges: 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 material to this Complaint, Respondent was a licensed physician within the State of Florida, having been issued license number ME 62034, 3. Respondent’ address of record is 900 North Olive Avenue, West Paim Beach, Florida 33401, | GO'd = s«9G2SL LOZ Laas oo:s— otoz T das 4. : Respondent is certified in Anesthesiology by the American Board of Anesthesiology 5. At all times. material to this complaint, Respondent practiced at Palm Beach Pain Management (“PBPM"), 6. on or about February 12, 2003, Patient H.W,, an 83-year-old male, presented to Respondent at PBPM complaining of post-shingles pain. 7, At the initial visit, Respondent examined Patient H.W, and found discomfort approximately the T7 through T12 nerve root and dermatome levels, with radicular origin around the abdominal cavity on the left side. 8, On or about February 12, 2003, Respondent diagnosed Patient , H.W. with postherpetic neuralgia (post-shingles pain), and prescribed Neurontin 100 mg, Lidoderm patches, and Darvocet N- 100, } 9. Neurontin iS. a prescription analgesic. Neurontin contains gabapentin, which is known to reduce neuropathic pain, Gabapentin is sometimes used as an anti-convulsant, 10, Ldodetm patches contain 5% lidocaine and are applied directly to the skin. _Lidacaine is a legend drug primarily used for anesthesia Purposes snd often included in injections indicated for production of local or regional anesthesia by infiltration techniques such as Percutaneous JAPSU\Medical\Patty\ACs\Rogers.(t)(m).2004-03387.doe DOH v. Anthony Ragers, M.D, : DOH Case No, 2004-03387 Page 2 a0 +d EGigL aloe - dag OO:9T oToz T das injection and intravenous regional anesthesia by peripheral nerve block techniques, 11, Darvocet N 100 contains Propoxyphene. Propoxyphene is indicated for the relief of mild to moderate pain. . Propoxyphene is a schedule WV controlled substance as defined in Chapter 893, Florida Statutes, and can produce drug dependence characterized by psychic dependence and, less frequently, physical dependence and tolerance, 12. at the February 12, 2003 office visit, Respondent instructed Patient H, w, to return in two weeks for re-evaluation and a determination - as to the use of a nerve block. 13. On or about March 18, 2003, Patient H.W, again presented to PBPM to see Respondent for a Thoracic Epidural Steroid Injection (ESI) with Flouro and Thoracic Epiduragram. 14. The epidural space is the space through which nerves travel before they form the nerves that travel down the arms, along the ribs and into the legs, Inflammation of these nerve roots May cause pain in the arms, chest or legs, An ESI places anti-inflammatory medicine over the root and into the epidural Space to decrease inflammation of the nerve roots, therefore reducing the pain. It may provide permanent relief or provide a 7:\PSU\Medical\Patty\ACs\Rogers.(t)(m).2004-03387.doc DOH v. Anthony Rogers, M.D, DOH Case No. 2004-03387 Pane . . dag L0"d £99. O10 L Ta:a1 oloz t das period of pain relief for several months while the injury/cause of pain 's : healing. 15, An €pidurogram is a method of directly visualizing and treating the inside of the spinal column using direct vision. A small flexible fiberoptic catheter is: inserted through a tiny incision and the areas of concern can be seen on a video monitor. Adhesions, or scar tissue, that 16. Performance of. procedures such as this that are in very close proximity to the spinal cord are safest when performed with local anesthetic and mild sedation so that the patient can report significant pain or paraesthesias if the epidural needle is placed inappropriately, 17, - Acconing to the “Conscious Sedation Record” within Patient H.W/s medical records from PBPM, Patient H. W, received 80 mg propofol prior to the eld injection. 18, Propo is an intravenous sedative-hypnotic agent used for the induction and: maintenance of’ anesthesia and/or sedation for surgery, During sedation with Propofol, patients have demonstrated hypotension, oryhemoglobin desaturation, apnea, airway obstruction, and oxygen . J:\PSU\Medical\Pa i Cs\Ror ers,(t (m),2004-03387.doc DOH v, Anthony Rogers, M.D. ain : 9 Xm) DOH Case No. 2004-03387 ; Page 4 £G'GL LOZ L dag Bd To:3T otoz T das oe desaturation, ‘specially following a rapid intravenous dose of a large volume of the drug, | 19, A patient who receives an 80 mg dose of Propofol is no longer able to verbalize or. otherwise indicate sensations such as pain and paraesthesias caused by the epidural injection, . «20, “After Patient H.W. was sedated with propofol, Respondent performed the epidural injection, | | 21. | In regard to Patient H.W’ condition after the Procedure, Patient H.Ws Conscious Sedation Record, signed by Respondent, indicates that: The patient tolerated the procedure well and withoy ¢ OF Cardiac sequiae. The patient was monitored for 15 minutes post procedure and ppeared neurologically and cognitively stable: before discharge, 22. Similarly, in his operative ‘note for Patient HLW’s Procedure, Which Respondent signed, Respondent Provided the the following post Operative details: | hypotension, weakness, numbness and dizziness before being discharges (sic), | + 7APSU\Mectcel\Petty\ACs\Rogets,()(m), 2004-03387 doc DOH v, Anthony: Rogers, M.D, / DOH Case No, 2004-03387 1 Pana < ‘ £G'SL OLOE boas 0'd 6 To:3T otoz T das | The patient and escort were instructed as to “normal Post block procedures, normal follow-up and _ what to do should an emergency arise in the immediate post block period. They were given written discharge instructions. No complications were seen, 23, In contrast to © Respondent’ Post operative notes, the nursing notes indicate that: ! a at 2:04 p.m. the procedure ended: : ES at 2:30 p.m. Patient H.W. had weakness in his legs and was unable to move his right leg; c. at 4:30 p.m., Patient H.W. was still having weakness in his legs; and , d. at 5:00 P.m., Respondent sent Patient H.W. to Bethesda Memorial Hospital (“Bethesda”) for further evaluation of the continued weakness, 24, a Bethesda, where Respondent was Patient H Ws admitting physician, Patent H. W. had an MRI of the brain and an MRI of the lumbar spine in addition to evaluation by a neurologist. Patient H.W’s evaluations did not reveal the cause of Patient H.W.s lower extremity weakness. 25. On or about March 20, 2003, Respondent discharged Patient H.W. with a ciagnosis of “right lower extremity weakness,” ay |\PSUWeekcalPaty\cs\Roges m) 2004 08567 a DOH v. Anthony Rogers, M.D, : . DOH Case No. 2004-03387 : Page 6 ' : das aL'd BS'SL OLoz | ZO:9~ oOloz T das ne : . , 26, Patient H.W, was discharged to a rehabilitation center for rehabilitation Of his lower extremity, COUNTI STANDARD OF CARE 27. Petitioner realleges and incorporates Paragraphs one (1) through twenty-five (25) as if fully set forth herein, 28, | Section 458.331(1)(t), Florida Statutes (2002), provides. that | gross or repeatied malpractice or the failure to Practice medicine with that level of care, ski 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, | : . 29, Respondent failed 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 when he administered 80 mg of Propofol to Patient H.W. before Performing a thoracic epidural injection, 30. Based | on the foregoing, Respondent has Violated Section 458,331( 1)(t), Florida Statutes (2002), by failing to practice medicine with that level of care, skill and treatment which iS recognized by a reasonably 7APSU\Medical\Patty\ACs\Rogers t)(m).2004-08387.doe DOH y, Anthony Rogers, M.D. i ' DOH Case No, 2004-03387 i Page 7 AG'GL OLOZ L dag Ld : ZO:9T O10Z T das Prudent smi physician as being acceptable under similar conditions and cumstances in Respondent's treatment of Patient H.W, COUNT I MEDICAL RECOR 31. | Petitioner realleges and incorporates paragraphs one (1) through twenty +five (25) as if fully set forth in this count, 32, Section 438.331(1)(m), Florida Statutes (2002), Provides. that : failing to ce sible, a defined by department rule in consultation with the board, _ medical records that identify the licensed physician or ‘the physician ertender and supervising physician by name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each dognsti or treatment procedure and 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 constitutes grounds for discipnary action by the Board of Medicine. 33, Respondent failed to justify the course of treatment of Patient H.W. in one or more of the following ways: 2 Falling to document Patient H.W.’s complications in his operative note and conscious sedation record; i: PSU aca cases (t)(m).2004-03387.doc DOH v. Anthony Rogers, M.D, DOH Case No, 2004-03387 H ‘ Pane 2 BS'SL Olo2 L das ‘d “ ZO:9T O10Z T das | D. Failing to docurnent a reason for administering such ! . @ large dose of Propofol prior to the ESI. 34, Based on. the foregoing, Respondent has violated Section 458. 331(3(m), Florida Statutes (2002), by failing to keep legible, as defined by depattment rule in consultation with the board, medical records that identify the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for rendering, ordering, Supervising, or billing for each diagnostic or treatment Procedure and 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, 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, imeston of an administrative fi Ine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or coleced remedial education and/or any other relief that the Board deems ; appropriate J\PSU\Medical\Patty\ACs\Rogers.(t)(m).2004-03387 doe DOH v. Anthony Rogers, M.D. / . DOH Case No. 2004-03387 ! Page 9 . : . das Bd BS'SL LOZ L Zo:at otoz T das - ) A , , ‘SIGNED this xin day of Muay | , 2007. Ana M. Viamonte Ros, M.D., M.P.H, reta Department of Health | 3 _ Patricia Nelson | | Assistant General Counsel DOH Prosecution Services Unit IMENT OF HEALTH 4052 Bald Cypress Way, Bin C-65 oer ene Tallahassee, FL 32399-3265 CLERKS Florida Bar No. 325790 nee 4 : ach fen (850) 245-4640 ——— (850) 245-4680. FAX | : /PN | PCP; January 26, 2007 PCP Member El ~Bahri, Winchester and Long J:\PSL\Madital\ Patty\ACs\Rogers.(t)(m).2004-03387.doc DOH v. Anthony Rogers, M.D, NPS Y a Roars DOH Case No, 2004-03387. : Page 10 pl’d ss BS2SL OLOZ Laas coral oloz 7 das _ NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida St tutes, to be represented by counsel or other. qualified representa ive, to present evidence and argument, to call and cross-examine witnesses and to have subpoena: and subpoena duces tecut 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 4SS€s8 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. i J:\PSU\Medical\Patty\ACs\Rogers.(t)(m).2004-0338%doc ‘DOH v, Anthony Rogers, M.D, P aoe) DOH Case No. 2004-03387 / Page 11 Ghd sBSEGL OLOZ Lag coral oloz 7 das

Docket for Case No: 10-008746PL