RESPONDENT.
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, Kambam R. Reddy M.D., and in support thereof alleges:
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.
At all times material to this Complaint, Respondent was a licensed physician within the State of Florida, having been issued license number ME 67382.
J:\PSU\Medical\christopher torres\cases\Reddy-07-15818\AC (t) gross malpractice.doc
Filed July 19, 2011 1:36 PM Division of Administrative Hearings
Respondent's current address of record is 1459 A Captain's Walk, Fort Pierce, Florida, 34950.
Respondent is board certified by the American Board of Anesthesiology.
On or about April 14, 2007, Patient B.R., a sixty-eight (68) year
.old female, was admitted to Lawnwood Regional Medical Center and Heart Institute (Lawnwood) due to altered mental status. Patient B.R. was transferred from Lawnwood's psychiatric unit to the hospital for medical follow-up for acute renal failure. Patient B.R. had a medical history of coronary artery disease, renal insufficiency, hypertension, congestive heart failure, chronic pain syndrome, anxiety, hyperlipidemia, osteoarthritis, alcohol abuse, major depression, and obesity.
Coronary artery disease (CAD), is a condition in which plaque, a substance composed of fat, cholesterol, calcium, and other substances builds up inside the coronary arteries, which supply the heart muscle with oxygen-rich blood.
Renal insufficiency is the partial failure of kidney function characterized by less than normal urine excretion of drugs and metabolites.
Hypertension (high blood pressure) is defined as a repeatedly elevated blood pressure exceeding 140 over 90 mmHg, a systolic pressure above 140 with a diastolic pressure above 90, which can cause blood vessel changes in the back of the eye (retina), abnormal thickening of the heart muscle, kidney failure, and brain damage.
Heart failure (HF) is a condition in which the heart's function as a pump to deliver oxygen rich blood to the body is inadequate to meet the body's needs. Heart failure can be caused by diseases that weaken the heart muscle, diseases that cause stiffening of the heart muscles, or diseases that increase oxygen demand by the body tissue beyond the capability of the heart to deliver.
Hyperlipidemia is an elevation of lipids (fats) in the bloodstream. These lipids include cholesterol, cholesterol esters (compounds), phospholipids, and triglycerides.
On or about April 30, 2007, Patient B.R. underwent a surgical insertion of a palindrome catheter placed in the right internal jugular vein and an arteriovenous graft placed as a loop from the left side of the brachi.al artery to the left cephalic vein at the elbow. This catheter was placed to permit dialysis after Patient B.R.'s kidneys began to fail. Dialysis
is a method of removing toxic substances (impurities or wastes) from the blood when the kidneys are unable to do so.
On or about May 3, 2007, Patient B.R.'s kidney function had improved. Because Patient B.R. was scheduled to return to Lawnwood's psychiatric ward, the catheter was removed. However, Patient B.R. had other medical problems and remained in Lawnwood's hospital.
On or between May 3, 2007 and May 18, 2007, Patient B.R.'s Blood Urea Nitrogen (BUN) and creatine had deteriorated enough that dialysis by catheter again appeared necessary. Additionally, increasing cyanosis of Patient B.R.'s left hand was present, particularly in the radial aspect with edema of the left arm.
Cyanosis is a blue coloration of the skin and mucous membranes due to the presence of > Sg/dl deoxygenated hemoglobin in blood vessels near the skin surface and is indicative of poor blood circulation.
On or about May 18, 2007, Patient B.R. was scheduled for removal of the original arteriovenous graft that was placed on her left arm on or about April 30, 2007, and the insertion of a new dialysis catheter in the right jugular vein. The anesthesia for this procedure was performed by
two separate Certified Registered Nurse Anesthetists (CRNA) supervised by the Respondent. A complete and thorough pre-anesthesia evaluation was not done.
The pre-anesthesia evaluation requires a written synopsis of the patient's chart, with pertinent anesthesia data including medical diagnosis, proposed surgery, anesthesia history, allergies, vital signs, an examination of the airway, condition of the teeth, medication history, pertinent lab work, Electrocardiogram, and chest plate results, if any.
On or about May 18, 2007, at approximately 3:15 P.M., the anesthesia for Patient B.R. was started. While still on the operating table, Patient B.R. was noted to be bleeding through the surgical dressing at the end of the surgical case.
On or about May 18, 2007, from approximately 3:15 P.M. until approximately 5:40 P.M., Patient B.R. received Ephedrine three (3) times during the surgical procedure.
Ephedrine is a "vasopressor." A vasopressor is any agent administered to produce an increase in systemic blood pressure.
On or about May 18, 2007, at approximately 5:50 P.M., Patient
B.R. received Neosynephrine drip during the surgical procedure and remained on the drip until she expired. Neosynephrine is a "vasopressor."
Patient B.R. was then transferred to the Post Anesthesia Recovery Room (PACU) at or about 6:39 P.M. CRNA St. Johns transferred Patient B.R. to the PACU nurse, Nurse Singh, with a vital sign of 84/54 mmHg and later 68/48 mmHg. This is severe hypotension in a hypertensive patient. A normal blood pressure· in a healthy adult ranges from 100/60 mmHg to 140/90 mmHg.
Hypotension is abnormally low blood pressure which can be life threatening. Despite the fact that Patient B.R. was known to be hypertensive and had never displayed hypotension before, CRNA St. John declared Patient B.R. stable and was sent home by the Respondent.
PACU Nurse Singh noted several times in his records that Patient B.R. had soaked, bloody dressings, bloody chest dressings, and low blood pressure. Patient B.R.'s hemoglobin had dropped from 11.0 grams pre-operative to only 7.3 grams post-operative.
Despite Patient B.R.'s low blood pressure, continued need for vasopressors, low hemoglobin, and perfuse bleeding from the surgical site,
the Respondent took no action to identify the cause of Patient B.R.'s hypotension.
On or about May 18, 2007, from approximately 3:15 P.M. to 6:20 P.M., Patient B.R. was under anesthesia provided by a CRNA supervised by the Respondent. From approximately 5:13 P.M. until 6:20 P.M., the Respondent personally provided anesthesia to another patient. For approximately one hour and eight minutes, the Respondent failed to supervise CRNA St. John as she provided anesthesia to Patient B.R.
On or about the evening of May 18, 2007, the Respondent was scheduled to fly out-of-state. The Respondent failed to transfer care of Patient B.R. to another anesthesiologist and/or obtain usual and complete anesthesia coverage prior to his departure.
On or about May 18, 2007, the Respondent left Lawnwood sometime between 6:00 P.M. and 8:00 P.M. Patient B.R. was in PACU at or near the time the Respondent left. Approximately one and a half hours after Patient B.R.'s admission to the PACU, a third vasopressor, Dopamine, was ordered over the telephone by the Respondent. Despite the Respondent's order, Patient B.R. remained severe_ly hypotensive.
On or about May 18, 2007, at approximately 8:40 P.M., Patient B.R. complained of pain and requested medication. At approximately 8:50 P.M., Patient B.R. arrested. Despite the efforts of another anesthesiologist, Patient B.R. remained unresponsive and was pronounced dead. The Respondent was not at Lawnwood when this occurred.
At all times material to this complaint, the Respondent failed to
execute a complete pre-anesthesia evaluation for Patient B.R.
At all times material to this complaint, the Respondent failed to adequately document in Patient B.R's medical records and/or address the cause or origin of Patient B.R.'s hypotension.
At all times material to this complaint, the Respondent failed to adequately document and/or identify a reasonable treatment plan for Patient B.R., particularly concerning the prescribing of medications to Patient B.R.
At all times material to this complaint, the Respondent failed to adequately supervise the CRNAs and PACU nurses providing treatment to Patient B.R.
Section 458.331(1)(t), Florida Statutes (2006), subjects a physician to discipline for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2006) defines medical malpractice as the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in Section 766.102. Section 766.102(1), Florida Statutes (2006) defines the standard of care to mean " .... The prevailing professional standard of care for a given health care provider shall be that level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers "
The Respondent committed medical malpractice as defined in Section 456.50 and/or failed to practice medicine in accordance with the level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers in one or more of the following ways:
By providing anesthesia to Patient B.R. on or about May 18, 2007, without completing a proper pre-
anesthesia evaluation. The evaluation requires a written synopsis of the patient's chart, with pertinent anesthesia data including medical diagnosis, proposed surgery, anesthesia history, allergies, an examination of the airway, condition of the teeth, medication history, pertinent lab work, Electrocardiogram, and chest plate results if any;
By leaving the hospital without securing usual and complete anesthesia coverage for Patient B.R. on or about May 18, 2007;
By failing to identify the source of Patient B.R.'s hypotension during and/or following surgery on or about May 18, 2007;
By failing to adequately supervise CRNA St. Johns during her treatment of Patient B.R. on or about May 18, 2007; and
By failing to adequately supervise PACU Nurse Singh during his treatment of Patient B.R. on or about May 18, 2007.
Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2006), by committing medical malpractice as defined in Section 456.50 and/or by failing to practice medicine in accordance with the level of care, skill, and treatment which, in light of all
