STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO. 2011-11189 PETER V. CHOY, M.D., RESPONDENT. / ADMINISTRATIVE COMPLAINT General Allegations The Department of Health (‘Department’) files this Administrative Complaint before the Board of Medicine against Respondent, Peter V. Choy, M.D., and in support thereof alleges: 1. The Department 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 74815. Bi Respondent's address of record is 3661 South Miami Avenue, Suite 606, Miami, Florida 33133. 4. Respondent is not certified in any specialty recognized by the Board of Medicine. 5. Patient TG had been a patient of Respondent since on or about 6. On or about May 13, 2008, TG, who was then seventy-nine (79) years old, saw Respondent with complaints of left lower quadrant pain and changes in bowel habits. Respondent scheduled TG for a CT scan of her abdomen and pelvis. 7. TG underwent the CT scan of her abdomen and pelvis on or about June 17, 2008. The report of the scan indicated stated that “[t]here is a large lobulated malignant tumor mass in the tail of the pancreas... .” This report was received in Respondent's office on or about June 19, 2008. 8. Respondent did not provide any further evaluation or referral for the tumor revealed by the CT scan. 9. Onor about June 24, 2010, TG was seen by Respondent for a follow-up appointment. TG complained of abdominal pain and abnormal weight loss. Respondent ordered another CT scan of TG’s abdomen and pelvis and did not make note of the June 17, 2008 CT scan. 10. This second CT scan was performed on or about July 15, 2010. A report of the results of this scan was drafted and delivered to Respondent's office on or about July 16, 2010. The report revealed that TG had a large mass at the level of the pancreatic tail. 11. On or about July 19, 2010, Respondent admitted TG to Mercy Hospital. TG underwent a liver biopsy and ultrasound-guided paracentesis, which revealed a metastatic tumor of pancreatic origin. 12. In or around July 2010, TG’s family obtained from Respondent copies of some of TG’s medical records. These records include office visit reports for January 19, 2009, February 11, 2010, and March 31, 2010. Upon information and belief, these reports were printed from Respondent's office computer system on or about July 27, 2010. 13. On or about August 6, 2010, TG died from complications of liver disease and acute renal failure. 14. In August 2011, the Department received a copy of TG's medical records via subpoena. The records include office visit reports for January 19, 2009, February 11, 2010, and March 31, 2010. Upon information and belief, these office visit reports were printed from Respondent's office computer system on or about July 27, 2011. 15. With respect to TG’s January 19, 2009 office visit, the report printed on or about July 27, 2011 contains an entry in the “Impression/Diagnosis” section stating “ . . . Weight Loss Abnormal — 783.21; Abdominal Pain Unknown ET — 78900 Possible ca of the Pancreas. . .” The report printed on or about July 27, 2010 for that same visit contains no such entry. 16. With respect to TG’s February 11, 2010 office visit, the report printed on or about July 27, 2010 contains an entry in the “Impression/Diagnosis” section stating that TG’s condition is “Medically Stable.” This statement does not appear in the report printed on or about July 27, 2011 for that same visit. 17. With respect to TG’s March 31, 2010 office visit, the report printed on or about July 27, 2010 contains an entry in the “Impression/Diagnosis” stating that TG’s condition is “Medically Stable.” This statement does not appear in the report printed on or about July 27, 2011 for that same visit. 18. In addition, the report of TG’s March 31, 2010 office visit that was printed on or about July 27, 2011 contains an entry in the “Impression/Diagnosis” section that states “Weight Loss Abnormal — 783.21 Again case was discuss [sic] with the Pt and she was advice [sic] of the abnormal finding.” This statement does not appear in the report printed on or about July 27, 2010 for that same visit. Count One (§ 458.331(1)(k)) 4 19. The Department realleges paragraphs one (1) through eighteen (18) above as if fully set forth herein. 20. Section 458.331(1)(k), Florida Statutes, provides that making deceptive, untrue, or fraudulent representations in or related to the practice of medicine or employing a trick or scheme in the practice of medicine is grounds for disciplinary action by the Board and/or Department. 21. Respondent made deceptive, untrue, or fraudulent representations in or related to the practice of medicine or employed a trick or scheme in the practice of medicine when he improperly altered the medical records of TG between on or about July 27, 2010, and July 27, 2011. At a minimum, Respondent altered the medical records covering the office visits of TG dated January 19, 2009, February 11, 2010 and March 31, 2010. 22. Respondent did not disclose that TG’s medical records had been altered until he was interviewed by the Department in connection with the investigation of this matter. 23. The medical records referenced in paragraph 14 above contain no self-evident indication that they have, in fact, been altered, nor the date or the justification for the alterations. 5 24. Based on the foregoing, Respondent has violated Section 458.331(1)(k), Florida Statutes (2008-2010), by making deceptive, untrue, or fraudulent representations in or related to the practice of medicine or employed a trick or scheme in the practice of medicine. | Count Two (§ 458.331(1)(m)) 25. The Department realleges and incorporates paragraphs one (1) through eighteen (18) above as if fully set forth herein. 26. Section 458.331(1)(m), Florida Statutes, provides that failing to keep legible, as defined by department 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, constitutes grounds for disciplinary action by the Board of Medicine. 27. Respondent failed to keep appropriate legible medical records justifying the course of treatment of TG in one or more of the following ways: a) _ by failing to document a referral to, and an appointment for, a gastroenterology appointment immediately following the June 17, 2008 CT scan; and b) by making improper and deceptive alterations in TG's medical chart without properly explaining when and why those record alterations were made. 28. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes, by failing to keep proper medical records which justify the course of his treatment of TG. Count Three (§ 458.331(1)(t)(1)) 29. The Department realleges paragraphs one (1) through eighteen (18) above as if fully set forth herein. 30. Section 458.331(1)(t)(1), Florida Statutes, subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50 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. 31. The level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in 7 Section 766.102, Florida Statutes. Section 766.102(1) defines the standard of care to mean “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.” 32. Respondent fell below the acceptable standard of care in one or more of the following ways: a) b) c) d) e) f) by failing to aggressively arrange a gastrointestinal (GI) consultation for TG’s pancreatic mass as soon as the results of the June 17, 2008 CT scan were available; by failing to clearly explain to TG the risks involved in not seeing a gastroenterologist; by failing to respond to the June 17, 2008 CT scan report with an appropriate plan of action; by inappropriately scheduling another CT scan for TG instead of immediately referring her to a gastroenterologist; by failing to adequately assess TG’s complaints and symptoms, including obtaining a complete history; by diagnosing TGs _ condition inappropriately, inadequately, inaccurately, and in an untimely manner in that Respondent should have made a timely diagnosis of pancreatic cancer. 33. Based on the foregoing, Respondent has violated Section 458.331(1)(t)(1), Florida Statutes, by committing medical malpractice. Count Four (§ 458.331(1)(nn)) 8 34. The Department realleges paragraphs one (1) through eighteen (18) above as if fully set forth herein. 35. Section 458.331(1)(nn), Florida Statutes, subjects a physician to discipline for violating any provision of chapters 456 or 458, Florida Statutes, or any rules adopted pursuant to those statutes. 36. Rule 64B8-9.003, Florida Administrative Code, provides standards for the accuracy of medical records. The rule states, /nter alia: (2) A licensed physician shall maintain patient medical records in English, in a legible manner and with sufficient detail to clearly demonstrate why the course of treatment was undertaken. (3) The medical record shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; reports of consultations and hospitalizations; and copies of records or reports or other documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient. (4) All entries made into the medical records shall be accurately dated and timed. Late entries are permitted, but must be clearly and accurately noted as late entries and dated and timed accurately when they are entered into the record. However, office records do not need to be timed, just dated. 37. Respondent failed to maintain the medical records of TG in accordance with Rule 64B8-9.003 in one or more of the following ways: a) — by failing to provide sufficient detail to demonstrate why Respondent did not immediately and appropriately address CT scan results indicating a malignant mass on TG’s pancreas; b) by failing to provide sufficient information to justify his treatment and to document the course and results of treatment; c) _ by failing to document any discussion with TG in which she said she did not want to seek treatment for possible pancreatic cancer; and d) _ by failing to document any timely referral to a specialist in connection with possible pancreatic cancer. 38. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes, by violating Rule 64B8-9.003 of the Florida Administrative Code. WHEREFORE, Petitioner, the Department of Health 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 Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. 10 th SIGNED this 4/5 ~__ day of June, 2012. JOHN H. ARMSTRONG, MD State Surgeon General Florida Department of Health JENNIFER TSCHETTER General Counsel Florida Department of Health VERONICA E. DONNELLY Attorney Supervisor Prosecution Services Unit WILLIAM H. STAFFORD III ‘ Assistant General Counsel Fla. Bar No. 70394 Florida Department of Health Office of the General Counsel 4052 Bald Cypress Way, Bin C-65 mond _— Tallahassee, Florida 32399-3265 OE TPUTY CLERK Telephone: (850) 245-4640 CLERK Ansg! Sa rs Facsimile: (850) 245-4681 pate JU Email: william_stafford@doh.state.fl.us PCP Date: June 22, 2012 PCP Members: Miguel, El Sanadi, Goersch 14,

Docket for Case No: 13-000527PL