BRETT L. FELDMAN, M.D., RESPONDENT.
COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the
- 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.
DOH v. Brett L. Feldman, M.D., Case Number 2008-23135
Filed December 21, 2012 3:41 PM Division of Administrative Hearings
At all times material to this Complaint, Respondent was a licensed physician within the State of Florida, having been issued license number ME 68897.
Respondent's current address of record is 9077 South Federal
Highway, Port St. Lucie, Florida 34952.
Respondent is board-certified by the American Board of Orthopaedic Surgery.
On or about May 10, 2006, Patient S.W., an eleven (11) year
old female presented to her pediatrician and primary care doctor, Dr. D.W., with complaints of right hip and leg pain following a fall from playground equipment a week earlier.
Patient S.W.'s previous past medical history in regards to other health conditions was benign. S.W. had achieved her normal milestones regarding her healthcare, and was seen on a routine basis by her pediatrician.
On or about May 10, 2006, Dr. D.W. ordered an X-ray of S.W.'s
leg and hip. The results of the X-ray were believed to be consistent with an acetabular fracture or right hip fracture.
With this information, Dr. D.W., admitted S.W. to Lawnwood Regional Medical Center, in Fort Pierce, Florida (LRMC), in order to receive a consultation with an Orthopedic physician as soon as possible.
On or about May 10, 2006, another X-ray was ordered for Patient S.W. This X-ray showed again a right acetabular fracture. The radiologist who read the X-ray recommended a CT evaluation.
As requested by Dr. D.W., an orthopedic consultation was requested. Respondent performed a cursory physician examination of S.W., noting that she had discomfort involving her right lower extremity and that she had resistance to weight bearing.
Respondent also noted that S.W. had pain with gentle maneuvering of the right leg and that the patient did not have pain with impaction of the right leg.
Respondent ordered that S.W. have an X-ray of her right femur and that the results of that X-ray were to be called in to Respondent.
Patient S.W. had admitting lab work upon admission to LRMC. The results of this work showed S.W. to have a significantly elevated C reactive protein. A C-reactive protein test is a test which measures the
concentration in blood serum of a special type of protein produced in the liver that Is present during episodes of acute Inflammation or infection.
S.W.'s C-reactive protein was noted to be 67, with the range of normal from 0.0 to 3.0 mg/L.
Lab work also showed Patient S.W. had an elevated erythrocyte sedimentation rate of 40, with the normal range of 0-20. Erythrocyte Sedimentation is another test used to measure non-specific inflammation.
Respondent did not examine S.W. again after this initial visit and did not follow up on X-ray studies as he recorded intentions to do;
S.W. was examined on a daily basis as by Dr. D.W. The patient was noted to exhibit marked discomfort with weight bearing. She was also noted to have slight temperature elevation originating from the time of admission.
Per Respondent's orders, S.W. did receive Tylenol, Naprosyn, Morphine Sulfate, and Codeine for control of discomfort. The patient began physical therapy on crutches daily, in which she again exhibited significant pain during walking.
On or about May 13, 2006, Respondent discharged S.W. with orders to rest, apply ice and to elevate her right leg, and follow up on May 22, 2006, with her primary care doctor.
On or about May 16, 2006, S.W. presented to see Dr. D.W. with complaints of increased leg pain. Dr. D.W. suspected a possible hip fracture and scheduled S.W. for an appointment for May 24, 2006 with a second orthopedic specialist.
On or about May 23, 2006, S.W. again presented early to see Dr. D.W., with complaints of feeling weak and achy all over, a swollen right leg, and inability to fully lift her arm. S.W. had missed a week of school due to pain.
On or about May 23, 2006, blood work for S.W. showed several abnormalities including a billrubin of 14.6, an albumin of 1.1, and a differential of her white blood cells suggesting a mark shift to the left.
On or about May 23, 2006, Patient S.W. was admitted to Palms West Hospital (PWH) and placed under the care of a Pediatric intenslvist. Upon admission S.W. was noted to have a decreased urine output, altered mental state, lethargia and constipation, and increased fatigue. S.W. was diagnosed with shock and transferred to the Critical Care Unit.
On or about May 24, 2006, an X-ray taken of S.W.'s pelvis showed a non-displaced right acetabular fracture.
S.W. suffered several medical problems during her ten (10) week stay at PWH resulting from her initial Illness.
Patient S.W. underwent several parenteral infusions (the administration of liquid medication, nutrient, or other fluid through some other route than the alimentary canal, usually over minutes or hours, either by gravity flow or often by infusion pumping) and multiple surgical procedures.
On or about May 31, 2006, she had an MRI scan that was positive for a psoas abscess (a burrowing abscess formed by caries of the spine, and confined by the sheath of the psoas magnus muscle) involving the right hip. S.W. also underwent an incision and drainage of the right hip, right vastus medialis, and psoas muscle on this date.
On or about June 3, 2006, S.W. underwent a secondary procedure involving the right hip under the direction and care of Dr. M., an orthopedic specialist.
On or about June 6, 2006, a repeat washout procedure of S.W.'s right hip was done.
On or about June 10, 2006, S.W. was determined to have severe methicillin resistant staph aureus (MRSA) and pseudomonas involving both surgical areas. S.W. was cared for with a wound vac device in order to allow closure of all surgical areas.
S.W.'s final diagnoses were severe MRSA, MRSA septic shock, polymyositis (inflammation of many muscles) with right hip septic arthritis plus osteomyelitis (inflammation of bone and marrow), right femoral head avascular necrosis (cellular death necrosis of bone components due to interruption of the blood supply), right septic shoulder arthritis, cardiogenic shock, right heart failure, right tension pneumothorax, adult respiratory distress syndrome, pneumonia and a urinary tract infection.
Patient S.W.'s hospital stay was extended until on or about
August 6, 2006. The patient was discharged home and received physical therapy. She was noted to maintain an elevated sedimentation rate and c
reactive protein. At that time she was maintained on anti-depressant medication including Prozac, Zoloft, and initially also maintained on Zyvox.
On or about August 7, 2006, Patient S.W. continued to have complaints consistent with anxiety and ongoing right hip pain. The patient
DOH v. Brett L. Feldman, M.D., case Number 2008-23135 7
was carefully followed by Dr. M., in regards to her right hip. It was at this time she was noted to have avascular necrosis of the right femoral head.
On a follow up MRI scan, S.W. was noted to have marked abnormalities of both the right acetabulum, as well as the right proximal femur. The patient was noted to have complete loss of the capital physis involving the femoral head.
S.W. was also noted to have an increasing limb length discrepancy measured up to five (5) centimeters requiring prosthetic devices to be placed in her shoes. S.W. also suffers from an ongoing antalgic gait requiring the use of crutches or a walker at times.
On or about October 17, 2007, Patient S.W. was noted to have episodes of giving out of the right hip. Dr. M. recommended that S.W. will need total hip replacement upon reaching skeletal maturity.
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. "
Respondent failed to meet the prevailing standard of care in regard to patient S.W. in one or more of the following ways:
by failing to perform a detailed physical examination as to the character and/or nature of pain complained about by S.W.;
by failing to appropriately evaluate the lab work taken at admission of S.W.;
by failing to order additional and appropriate tests and studies in order to diagnose S.W.;
by failing to adequately recognize S.W.'s symptoms and/or the likely causes of those symptoms;
by ordering medications· for S.W. that masked her symptoms and/or were counterproductive as treatments for actual diagnosis;
by ordering physical therapy for S.W. without appropriately diagnosing the true nature of her pain;
Based on the foregoing, Respondent has violated Section
