DEPARTMENT OF HEALTH,

Petitioner,

vs.

STATE OF FLORIDA BOARD qEt

tf, f

2015 JAN -9 AM II: 08

Oi\!{SiOi'"i

DM!NISTRAT!VE HEAR!NGS

Final Order No. DOH-15-0017-Fb -MQA

FILED DATE JAN O 8 2015

DOH CASE NO.: 2009-13497

2011-06111

2011-17799

DOAH CASE NO.: 13-0595PL

14-0514PL

14-0515PL LICENSE NO.: ME0059800

NEELAM TANEJA UPPAL, M.D.,

Respondent.

/

FINAL ORDER

THIS CAUSE came before the BOARD OF MEDICINE (Board) pursuant to Sections 120.569 and 120.57(1), Florida Statutes, on December 5, 2014, in St. Petersburg, Florida, for the purpose of considering the Administrative Law Judge's Recommended Order, Exceptions to the Recommended Order, and Response to Exceptions to the Recommended Order (copies of which are attached hereto as Exhibits A, B, and C, respectively) in the above-styled cause.

Petitioner was represented by Andre Ourso, Assistant General Counsel. Respondent was present but was not represented by counsel. Upon review of the Recommended Order, the argument of

the parties, and after a review of the complete record in this case, the Board makes the following findings and conclusions.

RULING ON EXCEPTIONS

The Board reviewed and considered the Respondent's Exceptions to the Recommended Order and ruled as follows:

1. Respondent's exception in the "Preliminary Statementn is rejected because Respondent failed to identify the legal basis for the exception and appropriate and specific citation to the record as required by Rule 28-106.217(1), Florida Administrative Code.

2. Respondent's exception 1 to paragraphs 8-13; 16-27; 59, 62, and 69 of the Recommended Order is denied because she failed to identify the legal basis for the exception and appropriate and specific citation to the record as required by Rule 28- 106.217(1), Florida Administrative Code. Additionally the Respondent's exception is denied based upon reasons stated orally by the Petitioner and based upon the written responses set forth by Petitioner. The Board is without substantive jurisdiction to overturn an evidentiary finding.

3. Respondent's exception 2 to paragraphs 28-35; 37; 40- 44, 59, and 65 of the Recommended Order is rejected because Respondent failed to identify the legal basis for the exception

   and appropriate and specific citation to the record as required

   by Rule 28-106.217(1), Florida Administrative Code. Additionally the Respondent's exceptions are denied based upon reasons stated orally by the Petitioner and based upon the written responses set forth by Petitioner. The Board is without substantive jurisdiction to overturn an evidentiary finding.

4. Respondent's exception 3 to paragraphs 46-48, and 65 of the Recommended Order is rejected because Respondent failed to comply with requirements of Rule 28-106.217, Florida Administrative Code. Additionally the Respondent's exception is denied based upon the reasons stated orally by the Petitioner and based upon the written responses set forth by Petitioner. The Board is without substantive jurisdiction to overturn an evidentiary finding.

5. Respondent's exception to the "Application of Law" is rejected because Respondent failed to identify the legal basis for the exception and appropriate and specific citation to the record as required by Rule 28-106.217(1), Florida Administrative Code. Additionally the Respondent's exception is denied based upon the reasons stated orally by the Petitioner and based upon discussion on the record. The Board is without jurisdiction to rule on constitutional challenges.

6. Respondent's exception to the "Findings of Fact for Case

   
   

   2009-13497" is rejected because Respondent failed to identify

   
   

   
   

   the legal basis for the exception and appropriate and specific citation to the record as required by Rule 28-106.217(1), Florida Administrative Code. Additionally the Respondent's exception is denied based upon the reasons stated orally by the Petitioner, the written responses set forth by Petitioner, and the discussion on the record.

7. Respondent's exception to the Findings of Fact for Case 2011-06111" is rejected because Respondent failed to identify the legal basis for the exception and appropriate and specific citation to the record as required by Rule 28- 106.217(1), Florida Administrative Code. Additionally the Respondent's exception is denied based upon the reasons stated orally by the Petitioner, the written responses set forth by Petitioner, and the discussion on the record.

8. Respondent's exception to the •Findings of Fact for Case 2011-17799" is rejected because Respondent failed to identify the legal basis for the exception and appropriate and specific citation to the record as required by Rule 28- 106.217(1), Florida Administrative Code. Additionally the Respondent's exception is denied based upon the reasons stated orally by the Petitioner, the written responses set forth by Petitioner, and the discussion on the record.

   
   

   
   

9. Respondent's exception to the "Findings of Violations by the Department" and "Argument" is rejected because Respondent failed to identify the legal basis for the exception and appropriate and specific citation to the record as required by Rule 28-106.217(1), Florida Administrative Code. Additionally the Respondent's exception is denied based upon the reasons stated orally by the Petitioner, the written responses set forth by Petitioner, and the discussion on the record.

FINDINGS OF FACT

1. The findings of fact set forth in the Recommended Order are approved and adopted and incorporated herein by reference.

2. There is competent substantial evidence to support the findings of fact.

CONCLUSIONS OF LAW

1. The Board has jurisdiction of this matter pursuant to Section 120.57(1), Florida Statutes, and Chapter 458, Florida Statutes.

2. The conclusions of law set forth in the Recommended Order are approved and adopted and incorporated herein by reference.

PENALTY

Upon a complete review of the record in this case, the Board determines that the penalty recommended by the

Administrative Law Judge be ACCEPTED. WHEREFORE, IT IS HEREBY ORDERED AND ADJUDGED:

1. Respondent shall pay an administrative fine in the amount of $10,000.00 to the Board within one year from the date the Respondent's license to practice medicine is reinstated. Said fine shall be paid by money order or cashier's check.

2. Respondent shall document completion of the medical records course sponsored by the Florida Medical Association (FMA) within one year from the date the Final Order is filed.

3. Respondent shall document the completion of five (5) hours of continuing medical education (CME) in the area of ethics within one year from the date the Final Order is filed. These hours shall be in addition to those hours required for biennial renewal of licensure. Respondent shall first submit a written request to the Probation Committee for approval prior to performance of said CME course(s). Unless otherwise approved by the Board or the Chairperson of the Probation Committee, said continuing education courses shall consist of a formal live lecture format.

4. Respondent's license to practice medicine in the State of Florida is hereby SUSPENDED for a period of six (6) months.

5. Following the period of suspension set forth in Paragraph 4 above, Respondent shall be placed on probation for a period of 2 years subject to the following terms and conditions:

   1. Respondent shall appear before the Board's Probation Committee at the first meeting after said probation commences, at the last meeting of the Probation Committee preceding termination of probation, triannually, and at such other times requested by the Committee. Respondent shall be noticed by Board staff of the date, time and place of the Board's Probation Committee whereat Respondent's appearance is required. Failure of the Respondent to appear as requested or directed shall be considered a violation of the terms of probation, and shall subject the Respondent to disciplinary action. Unless otherwise provided in the Final Order, appearances at the Probation Committee shall be made triannually.

   2. During the first year of the probationary period,

      
      

      Respondent shall not practice except under the direct supervision of a BOARD CERTIFIED physician fully licensed under Chapter 458 who has been approved by the Probation Committee.

      The supervisory physician shall work in the same office with the Respondent. Absent provision for and compliance with the terms regarding temporary approval of a supervising physician set

      forth below, Respondent shall cease practice and not practice

      until the Probation Committee approves a supervising physician. Respondent shall have the supervising physician appear at the first probation appearance before the Probation Committee.

      Prior to approval of the supervising physician by the Committee, the Respondent shall provide to the supervising physician a copy of the Administrative Complaint and Final Order filed in this case. A failure of the Respondent or the supervising physician to appear at the scheduled probation meeting shall constitute a violation of the Board's Final Order. Prior to the approval of the supervising physician by the committee, Respondent shall submit to the committee a current curriculum vitae and description of the current practice of the proposed supervising physician. Said materials shall be received in the Board office no later than fourteen days before the Respondent's first scheduled probation appearance. The attached definition of a supervising physician is incorporated herein. The responsibilities of a supervising physician shall include:

      1. Submit triannual reports, in affidavit form, which shall include:

         1. Brief statement of why physician is on probation.

            
            

         2. Description of probationer's practice.

         3. Brief statement of probationer's compliance with terms of probation.

            
            

         4. Brief description of probationer's relationship with supervising physician.

         5. Detail any problems which may have arisen with probationer.

      2. Review 25% percent of Respondent's patient records selected on a random basis at least once every month.

      3. Report to the Board any violation by the probationer of Chapter 456 and 458, Florida Statutes, and the rules promulgated pursuant thereto.

   3. During the second year of the probationary period, Respondent shall not practice except under the indirect supervision of a BOABD CERTIFIED physician fully licensed under Chapter 458 to be approved by the Board's Probation Committee. Absent provision for and compliance with the terms regarding temporary approval of a monitoring physician set forth below, Respondent shall cease practice and not practice until the Probationer's Committee approves a monitoring physician. Respondent shall have the monitoring physician present at the first probation appearance before the Probation Committee. Prior to approval of the monitoring physician by the committee, the Respondent shall provide to the monitoring physician a copy of the Administrative Complaint and Final Order filed in this

      case. A failure of the Respondent or the monitoring physician

      
      

      
      

      to appear at the scheduled probation meeting shall constitute a violation of the Board's Final Order. Prior to the approval of the monitoring physician by the Committee, Respondent shall submit to the committee a current curriculum vitae and description of the current practice of the proposed monitoring physician. Said materials shall be received in the Board office no later than fourteen days before the Respondent's first scheduled probation appearance. The attached definition of a monitoring physician is incorporated herein. The responsibilities of a monitoring physician shall include:

      1. Submit triannual reports, in affidavit form, which shall include:

         1. Brief statement of why physician is on probation.

            
            

         2. Description of probationer's practice.

            
            

         3. Brief statement of probationer's compliance with terms of probation.

         4. Brief description of probationer's relationship with monitoring physician.

         5. Detail any problems which may have arisen with probationer.

      2. Be available for consultation with Respondent whenever necessary, at a frequency of at least once per month.

      3. Review 25 percent of Respondent's patient records selected on a random basis at least once every month. In order to comply with this responsibility of random review, the monitoring physician shall go to Respondent's office once every month. At that time, the monitoring physician shall be responsible for making the random selection of the records to be reviewed by the monitoring physician.

      4. Report to the Board any violations by the probationer of Chapter 456 and 458, Florida Statutes, and the rules promulgated pursuant thereto.

   4. In view of the need for ongoing and continuous monitoring or supervision, Respondent shall also submit the curriculum vitae and name of an alternate supervising/monitoring physician who shall be approved by Probation Committee. Such physician shall be licensed pursuant to Chapter 458, Florida Statutes, and shall have the same duties and responsibilities as specified for Respondent's monitoring/supervising physician during those periods of time which Respondent's monitoring/supervising physician is temporarily unable to provide supervision. Prior to practicing under the indirect supervision of the alternate monitoring physician or the direct supervision of the alternate supervising physician, Respondent shall so advise the Board in writing. Respondent shall further

      
      

      
      

      advise the Board in writing of the period of time during which Respondent hall practice under the supervision of the alternate monitoring/supervising physician. Respondent shall not practice unless Respondent is under the supervision of either the approved supervising/monitoring physician or the approved alternate.

   5. CONTINUITY OF PRACTICE

   
   

   1. TOLLING PROVISIONS. In the event the Respondent leaves the State of Florida for a period of 30 days or more or otherwise does not or may not engage in the active practice of medicine in the State of Florida, then certain provisions of the requirements in the Final Order shall be tolled and shall remain in a tolled status until Respondent returns to the active practice of medicine in the State of Florida. Respondent shall notify the Compliance Officer 10 days prior to his/her return to practice in the State of Florida. Unless otherwise set forth in the Final Order,

      the following requirements and only the following

      
      

      requirements shall be tolled until the Respondent returns to active practice:

      1. The time period of probation shall be tolled.

      2. The provisions regarding supervision whether direct or indirect by the monitor/supervisor, and required reports from the monitor/supervisor shall be tolled.

   2. ACTIVE PRACTICE. In the event that Respondent leaves the active practice of medicine for a period of one year or more, the Respondent may be required to appear before the Board and demonstrate the ability to practice medicine with reasonable skill and safety to patients prior to resuming the practice of medicine in the State of Florida.

      RULING ON MOTION TO STAY PENALTY

      
      

      Respondent made an ore tenus motion to stay the penalty in this matter. The Board denied the Respondent's motion to stay the penalty.

      RULING ON MOTION TO ASSESS COSTS

      
      

      The Board reviewed the Petitioner's Motion to Assess Costs and the Respondent objected to these costs for the reasons stated orally. Following discussion, the Board imposed the costs associated with this case in the amount of $74,323.56. Said costs are to be paid within one (1) year of reinstatement of the Respondent's license to practice medicine.

      
      

      
      

      2015.

      DONE AND ORDERED this  .'1 ----

      AR L

      Chandra Prine, Acting Executive Director

      For Nabil El Sanadi, M.D., Chair

      
      

      NOTICE OF RIGHT TO JUDICIAL REVIEW

      
      

      A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO JUDICIAL REVIEW PURSUANT TO SECTION 120.68, FLORIDA STATUTES. REVIEW PROCEEDINGS ARE GOVERNED BY THE FLORIDA RULES OF APPELLATE PROCEDURE. SUCH PROCEEDINGS ARE COMMENCED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF THE DEPARTMENT OF HEALTH AND A SECOND COPY, ACCOMPANIED BY FILING FEES PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL, FIRST DISTRICT, OR WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE PARTY RESIDES. THE NOTICE OF APPEAL MUST BE FILED WITHIN THIRTY (30) DAYS OF RENDITION OF THE ORDER TO BE REVIEWED.

      
      

      NOTICE OF RIGHT TO HEARING REGARDING THE COSTS

      
      

      This notice constitutes final agency action if no request for a hearing is received by the Board on or before the twenty­ first day after the applicant's receipt of the notice. The applicant may request a hearing by filing an appropriate petition with the Executive Director of the Board at 4052 Bald Cypress Way, Bin #C-03, Tallahassee, Florida 32399-3253. The applicant may petition for a hearing involving disputed issues of material fact before an administrative law judge pursuant to Section 120.57 (1), Florida Statutes, or for a hearing not involving disputed issues of material fact pursuant to Section

      120.57 (2), Florida Statutes.

      A petition for a hearing involving disputed issues of material fact must contain information required by Rule 28- 106.201, Florida Administrative Code, inc1uding a statement 0£ a11 disputed issues 0£materia1 £act. The Board may refer a petition to the Division of Administrative Hearings for assignment of an administrative law judge only if the petition

      
      

      is in substantial compliance with the rule requirements. A petition for a proceeding not involving disputed issues of material fact must contain information required by Rule 28.106.301, Florida Administrative Code, including a concise statement of the ultimate facts alleged, as well as the rules and statutes which entitle petitioner to relief.

      
      

      CERTIFICATE OF SERVICE

      
      

      I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been provided by Certified Mail to NEELAM TANEJA UPPAL, M.D., P.O. Box 1002, Largo, Florida 33779;

      to Sean Ellsworth, Esquire, 420 Lincoln Road, Suite 601, Miami, Florida 33139; to Lynne Quimby-Pennock, Administrative Law Judge, Division of Administrative Hearings, The DeSoto Building, 1230 Apalachee Parkway, Tallahassee, Florida 32399-3060; and by interoffice delivery to Daniel Hernandez, Department of Health,

      4052 Bald

      Cypress

      Way, Bin #C-65, Tallahassee, Florida 32399-

      
      

      3253 this

      8ft)

      day of ]o_N..i.Clf'»/

      I

      
      

      , 2015.

      
      

      
      

      ,--------

          7014 2120 0004 1125 232-5 -- Deputy Agency Clerk

      
      

          7014 212□ □□□ 4 112r5 -2-3a32---

      
      

      STATE OF FLORIDA

      DEPARTMENT OF HEALTH

      
      

      DEPARTMl;NT OF HEALTH,

      PETITIONER,

      
      

      NEELAM T. UPPAL, M.D.,

      RESPONDENT.

      
      

      v. CASE NO. 2011-17799

      DOAH:14.00SISPL

      
      

      MOTION TO STRIKE AND DISMISS

      
      

      Neelam Uppal, M.D., Pro se.

      
      

      hereby moves the Court to dismiss Plaintiff's Complaint with prejudice.

      
      

      And states the grounds as follows for the DOH Exceeding its authority

      and jurisdiction; acted erroneously; failed to use proper procedure; acted arbitrarily or capriciously; failed to

      act as required by law or rule , and refened the case without

      meeting the Burden 01 i'rco··requirement as narrated below:

      
      

      1 Patient PA filed a complaint against her primary doctor.

      · American Family and Geriatrics. Respondent was the Infectious

      disease consultant on the case, The respondent's record were requested as a witness. The complaint against Dr. Neelam Shah was dismissed and the DOH ls filing a senseless complaint against the respondent • (See attached letter by the Patient)

      The complaint is being filed in bad faith es per Florida Statute

      2· 456.073 (I l)

      The complaint is filed and investigation started with 'legally

      J · insufficient' complaint in violation of Florida statute 456.073

      (2).

      
      

      Complaint is med s nn act of harassment. rctaliution and

      .4 tortuous interference of business.

      5·

      The complaint is filed as an act ofMalice.F.S 456.073 (II)

      The expert has filed a report against the primary care of the

6. Patient PA and the DOH is etTOneously applying it to the Infectious disease consultant on the case in violation of PL statute HB 499 as 'false deceiving and misleading expert opinion.'

The plaintiff is now wanting to do discovery which is required

7· to be done prior to staring an investigation and the probable.

cause hearing. F.S Ch.456.073 (1X2).

The case is violation of statute oftimitati.on as the initial 8· incident was more that 6 years ago. ·

9

The case is in violation of Florida statute 456.073 (1) as the

· probable cause was not found within 6 months of the complaint on the contrary Ms. Elana Jones dismissed the case in June of 2012 as not finding any evidence of any violation.(see attached). However, the PSU is re-- filing the complaint as exploitation and Double Jeopardy.

0

i Hence. I quest Your honor to not waste the time of the court

on this continuing malicious prosecution, harassment and tortuous interference with business

Hence, the respondent prays to strike the complaint

11'I'he plaintiff has failed to state a factual or statutary basis for 12claim. Hence, the case be dismissed for failure to state a claim.

The patient never filed a complaint against the respondent.

13Hence, the complaint should be dismissed for lack of standing.

The complaint was processed insufficiently #dnce, this case should be dismissed with prejudice.

Respectfully submitted,

Neelam Uppal, M.D,. Prose

PO Box 1002,

Largo, FL-33779

email: nneelu123@aol.com

' .·.•.· ,,...,...,... ,.....

STATE OF FLORIDA

r--ci:,_,1,

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-..

-

DEPARTMENT O.F HEALm

DEPARTMENT OFHEALTII,

PETmONER,

v.

NEELAM T. UPPAL► M.D.,

RESPONDENT.

MOTION TO STRIKE AND DISMISS

Neelam Uppal, M.D., Pro se.

CASE NO. !Hl-06111

DOAH l4-000514PL

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hereby moves the Court to dismiss Plaintiff's Complaint with prejudice.

And states the grounds as follows for the DOH Exceeding its authority

and jurisdiction; acted erroneously; failed to use proper procedure; acted arbitrarily or capriciously; failed to

act as required by law or rule , and referred the case without

meeting the; hrrdcn of Proof requirement as natTated below:

1 Patient CB filed a complaint stating that she went to the

· respondent as it was only the respondents's treatment that

helped her. Patient CB wrote in her complaint because her Allergy specialist told her to do so against the Respondent, who was the Infectious disease consultant on the case.

The complaint is being filed in bad faith as per Florida Statute

2. 456.073 (11)

The complaint is filed and investigation started with 'legally

3· insufficient' complaint in violation of Florida statute 456.073

(I).

4

The allegations are untrue and nopreliminary inquiry prior to Initiating

· investigation was done by the local DOH pursuant to F.S 456(2) -

Complaint is filed as an act of harassment, Defamation,

5· retaliation and tortuous interference of business and livlihood.

The complaint is filed as an act ofMalice.456.073(11)

The expert has filed a report against the Infectious disease

r.i, consultant on the case in violation of FL statute HB 499 as 'false deceiving and misleading expert opinion.'

The plaintiff is now wanting to do discovery which is required

B. to be done prior to the probable cause hearing.

The case is violation of statute of limitation as the initial 9• incident was more that 6 years ago.

The case is in violation of Florida statute 456.073 (I ) as the

10probable cause was not found within 6 months of the complaint

on the contrary Ms. Elana Jones dismissed the case in June of 2012 as not finding any evidence of any violation.(see attached). However, the PSU is re- tiling the complaint as exploitation and double Jeopardy.

Hence, I request Your honor to not waste the time of the court

l l on this continuing malicious prosecution, harassment and tortuous interference with business and livelihood.

The respondent prays to strike the complaint.

: iThe plaintiff has failed to state a factual or statutary basis for claim and hence it should be dismissed for failure to state a claim.

The complaint to bedismissed for lack of standing.

14The complaint was insufficiently processed.

·; fie DOH is not working in the interest of the public by supporting Drug addicts and criminals who are filing false and frivolous complaints against doctors as black-mail.

17 ence, this case should be dismissed WITH PREJUDICE.

Respectfully submitted,

M .D1 • Prose

nneelu123@aol.com

Neelam Uppal,

PO Box 1002, Largo, FL-33779

727-403-0022

ett1ail:

STATE OF FLORIDA

DEPARTMENT OFHEALTII

DEPARTMENT OF HEALTH,

PETITIONEU,

1. CASE NO. 1JJIIC\-2 f4!i(j

   2006-38111

     1>/1.23667

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   NE.ELAM TANEJA UPP-AL, M,D,.

   
   

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   srnI,fiMENJ AGREEMENT

   Noelam. Uppal, MD .• refet:red to as lhe "Respondent,• mid the Department of Health, refun'ed to 11!1 "Department" stil)lllate 111\d agree to lhe following Agreement and to the entry of a Final Order of the Boord of Medicine, referred to as "Board." incorporating die Stipulated Pacts 1111d Stipulated Disposition in this matter.

   Petitioner is the slate agt11111y charged with regulatins the practice of medicine pursuant to Section 20.43, Florida Statutes. and Chapter 456, Florida Stotutes, and Chapter 458, Florida Stututes.

   81]PUJ-,ATED fACJS

   l. Al all times material hereto, Respondent WIIS a llc:emeif physician in the State of

   Florida having bccQ issued license number MB «I..10enseNm,,

   2. 'Die Depamnent charged Respondenl wilh n Administmivc Complaint that wm fil d and properly served upon Rll&pondent with viobitions ofClulpler 458, Florida Statutes, and the rules adopted pursuant thercco. A_ b-uc and tXJrrect ClOp)' of the Ad1alnlstralive Comploint is attached hereto as Exhibit A.

   1. Respondent neither admits nor deoiea the allegadons of fact contained in the Administmlive ComplRial for purpoaes of these{l""C""dings nruy, ·

      
      

      STIPULATED CQNCl,JJSIONS Of LAW

      
      

      1. Respondent mimics !hut, in bis capocily 115 a licensed physician, be is subject lo Ibo provlsio1111 of Chapters 456 und 458, Florida S1a1t1tcs, and the jurisdiction nf the Department and lhe Boarcl

   2. ·Respondent admits lhlll the fiicts alloged in the A'dminislrotive Complaint, if proven, would conslitule violalions of Chapter 458, Florida Statutes, as alleged in the Administratiw Complnint,

   
   

   APPROVED Ibis _day of                   2012.

   
   

   H. FINlk Faoner, Jr., MD., Ph.D., F.A.C.P.

   State Surgeon oancnil

   
   

   By: BlanaJ.1ones

   Shirley L. Bates

   Assislant Genentl Counsel Departmettt of Heallh

   10

   J:IPSUIM<dicallBl1111aJ. J0J1el\C111e1\Uppal06-21456\SettlementAplllllCIII3-1-12.doo

   
   

   
   

   
   

   
   

   
   

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   . ' .

   STATE.OF FLORIDA

   DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH,

   Petitioner,

   
   

   FILED DEPARTMENT OF HEALTH

   DEPUTY CLERK CLERK A U..w,en DATE I l ij i!UI..

   
   

   1. DOH CASE NOS. 2009-13497 2011-06111 2011-17799

      DOAH CASE NOS. 13-059SPL

      14·0514PL

      14-0515PL

      
      

                                I

      MOTION JO ASSESS COSTS

      IN ACCORDANCE WITH SECTION 45§.072(41

      The Department of Health, by and through counsel, moves the Board of Medicine for entry of a Anal Order assessing costs against Respondent for the_ Investigation and prosecution of this case In _accordant'e with . Section 456.072(4), Florida Statutes (2014). As grounds therefore, the Petitioner states the following:

      1. At its next regularly scheduled meeting, the· BQard of Medicine

         will take up for consideration the above-styled disciplinary action and will enter a Final Order.

      2. Section 456.072(4), Florida Statutes (2014), states, in pertinent

         part, as follows:

         
         

         In addition to any other discipline imposed through final order, or clt.ation, entered on or after July 1, 2001, under this section or discipline Imposed through final order, or citation, entered on or after July 1, 2001, for a vlolation of any practice act, the board, or the department when there is no board, shall assess costs related to the Investigation and prosecution of the case. The costs related to the investigation and prosecution include, but are not limited to, salaries and benefits of personnel, costs related to the time spent by the attorney and other personnel working on the case, and any other expenses lnrurred by the department for the case. The board, or the department when there ls no board, shall determine the amount of costs to be assessed after its consideration of an affidavit of Itemized costs and any written objections thereto....

      3. As evidenced 1n the attached affidavit (Exhibit A), the

         
         

         investigation and prosecution of this c.ase has resulted in costs·tn the total amount of $74,702.75 based on the following Itemized statement of costs:

         1. Total costs for Complaints $326.49

         2. Total costs for Investigations $7,780.32 ·

            c·. Total costs for Legal $61,358.63

            d. · Total costs for expenses $5,237.30

      4. The attached affidavit from an outside attorney (Exhibit B) reflects, from a review of the file, a finding that the Department's attorney time in this case Is reasonable and justifiable In the amount of $60,979.45.

         
         

      5. Upon review of the file, the Department contends that the costs associated with attorney time spent on this case are reasonable and justifiable.

      6. Should Respondent file written objections to the assessment of

         costs, within ten {10) days of the da of this motion, specifying the grounds for the objections and the specific elements of the costs to which objections are made, Petitioner requests that the Board determine the amount of costs to be assessed based upon Its consideration of the affidavit attached as Exhibit A and any timely-flied written objections.

      7. Petitioner requests that the Board grant this motion and assess costs In the amount of $74,323.56 as supported by competent, substantial evidence. This assessment of costs Is In addition to any other dlsdpllne Imposed by the Board and Is in accordance with Section 456.072(4), Florida Statutes (2014). ·

WHEREFORE,• the Department of Health requests that the Boan:! of Medicine enter a Anal Order a lng costs against Respondent In the amount of $74,323.56.

[signatures appear on the folbWing page]

Respectfully submitted,

An re Ourso, Esquire

Assistant General Counsel

DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar # 91570

(850) 245-4444 Phone

(850) 245-4681 FAX

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing

Motion to Assess Costs has been provided to ·Neelam Uppal, M.D., via electronlc mall (nneelu123@aol.com), this I +t.... day of C>s.:,.b'P.e r:: , 2014,

Andre Ourso

Assistant General Counsel

·$TATE Of Fl.OIIPA

PE,A1lTMEffT QFIIIIALTR

D!IAftTMelt OF HEALTl1!

PErx1.IONl:li,

. V:a

NEEUJ4 TANElA UPPAL, M.Q.,

RESPOHOENf,..

ADMINISTRAJJYECQMpw:«[

PetlloReJi Department of Health, ay and through undersigned

counsel, flies, thts Admfn!$ttative -Complaint - tta Board of Medtcine

against Responc;IE!nt, N 1am 'nlneja tJppat, '1..0.t .$ld In suJiport tbereof

alleges:·

· 1. Petitioner Ts the state department d:larged: -with re.gulatirtg the practice of medidne nt to Section 20i43r FIPrida statq• -Ch.apll!r 456, Fl$rlda s wites; ® Ol ter 4S8t Florltur - •:

.1. At .au uma.s mat:erlal t<:> tl'1iS Complaint, i'les):)()nclent was ·a

licensed :physl¢lan Wltbtn the state of frorida, .havtns been- tssued ncense

number ME. 59800.

l:\PSt.i\Mcd '.!!hlr \tli:tpal';Lll4'AAC--(tl(q}(ffl't.dbll

3. R,espondent'!J . pf record I& Post Office Box 60351, St

Petersburg, Flmlda 33.111.

4, -WQad nt ts boara ®If.tad bv t.ile Am rtcan Board· pf

intetnal Medfame wit.ti tei11ficatfon in Infecll>us orase.

1. On at abo.tJt r ·g, 2Q.t Patient A.Mv :a sixteen (16} year

   . old,female:, fkeSefited:tb Respondentwlfh fati.h.rathes,·atid fewrs.

2. . On or :amut. October 9,. 2- ]lesponqent diagnosed .Patient A,:r,4 wlth s in bs' on butted<$ :af'ld: •10-'WQr' extrernltiw ang wJtb met rnn: reslG:mt,stapfl ,.nreus,(JtRMl,

3. On or about •Ottober 9, 2008 through Qctober ,1., ZStll,

   ResPOnde ) plan of -t:reatm.ent for Patient M. wat lntmmtlU.5.

   va-rttomyql1 arm oecastonanvzwox.

4. Wtlmm,dn IS a ,Q.l e8ffliblotie used ·In ttta.Prophl!Bfs

   and treatmehtJaf TnfectloM- caused t,.y:&am-positive: bacteria -

5. Zyvox is the trade rwnt far llnezolkl wb.Wh Jt ,a s

antlbtQtf : for the tre.a.tm or a;Jous in S'.- mi.a. by $

1n"n1"5.ft. .jye.t._..,......,_ tb..at.::ate 1-·,'1t1-.!;.D.,J-;n»Qt<.11' MW

ry-;s'"-".1: . Q·,tl I,' l-lltllf.l\l.WLf.lQMU\.il:J,,

J.(i. · On· cJt l.fttut •O<ltabet ·9>-, 2008 •fbm@ O®bet ·t1,. 2.0M, Resptmdent failed to document what we of lesions Pa t A.Ftt wa·, suffenn9 from; wtn _tJ;rer :tflW' · o,-a, bfnf"9 ;Or lf thtte we$ ·any.-

l

I

i

ce!t.;djtls (Q>mmon skin tnfectlen caused bye badaia} sottoundihQ the

leSlmlS.

;

11. nd,ent filJled to lnc'JSe and drain t A.M.i lesions Gr

failed to doe.uttten.t lnclsing and dra:lriirig·tnedeslmt..-

12, '0:n or'' o.ut:Qctt$er :9; • tt1.rougJr : n -or t- 0d:Qbir·.ii, 200, Re pondent failed :to; ,<Jocumerit thE! specific;stap liilfjttton · wf.tkh··had' In :Patient A,M,.

· 13. On{)f bOut bet t 20.0I .th(®ghw1 qr , r .

tma,, ReSJX)ndent failed » detem,Jn!, the speelfft «.aphyl tafeol&lt

wtlrdl had Infected :Patient AM.

14.. Q.n or allout O ber 9, - tttrouQh: QOJ·or abQyt ber ,

.Q 1- .•.-- , 1:;:,, i u• .v r-w...-. ·•' . w,...... n1g:: .,:w ·•a•. t• J1i4'-''. u

201l.a D i't,o n""' ·t..,;...,,.._..,.nt·' 4, t,,fi.t-.i, A'· ·u. ..,. f. *' ........,,.,.r;'ffirilli. · at: ;

.doses 'ilid 1n :the 1tneMts md1cmed m: ReSpOttdetit's medlcal records. for

Patient A.M.f was ,Inappropriate due to-Pat fltu. age•.

15... on or .al\101,1t O r ·t.,, .:200$' ·rtJrQllfh- r;m or '. ut·oc:tot>er 31, 200'$, RespQno nfs; tteat.ment of Pa•A-'.M. With N zvYo)( .ath d ­ a_od In e afS lo.dltated In nderit'$. 1 -re® ft)t Pattefit':

A. t, wa·s 1na fdate t'lue: to.PatlentA.M.- ,being l)Vert zt,Ox

16. Oti or. about October 9., 2008 through on at abOut October 31J! 2Qtm,, Responden nt.- of tfent A.M, Wltll if Va,rin;qQ'lyCIO,· WP

3

h18PPl'Qpr,lij d -to nrs faJJure to determlne the specific

Jilll:,r.lWWcca Jl;;W,l', .. _IW,Jl'J ,1::11',llf.' J QII .. ). ,--

...,;,,.-,.&1i,, 1"'1\'ft ·· f':ln •onw·•·1;.i..t.s- ln-. ... Patl--tA M.

l,7, On or '3bout - 8' 2NS thro119h on«·about. Ottaber ll

1008'J·

ResPonII..i.:-..;U;i{i.i

. '(-C"llle·.d ·.1l'U¥UrG.U;-.. r,u'.Q..IK..:.U.t.,..

MA·.tu'I..,. J,J...n·-I.I QPl.l.11.'!::i. .

*w"'-'itb•

Soap was1111trated.

CQltNTOR§

1. Petttton,r re-a11w-. and 'l Pl"9QI* '.mt {,U

   threu9h se&Fenteert. (17l asilfitdb' set'fbrth f! i

2. _ Section 45.8.33l{1)(t}l, flooda statotes .( ,provides -that

   .commtttlrng. ,mec11:91 malpra-cttc;:s const;tute& 9ro1,JO(l$ •ft.Jr d.kfplbmtf I

   by the • ·t)f JltlJtdoe, Med!Ciil Malpra ce. It d 11:1; Sfad:lrm: Gi.50,

   19bfida ;d.,.l\i'wl!eS :M_ Aho} to .·.· n ...,.. n,;.... M, li!!:tlil+t,;A; m. ec1---n ,• li'i

   . . . . lia\,J,11; ,. \/4,WPJ.r . m"'-'3} I um J.\:111!- w Pu:n,M . JU. 8

   accordant! with the level ofure1 sklll,i and treatment gnlzed In·general

   •tes

   law related · to healtb 'CiiBl'e. ncensure. for purposes . of 'Se.clfoti 4$8. l[lJffit,-:Plorida Ci tt1' 8Qar(J -s11,11_ give 9, it ­

   b.'J: the, PrtJ\ti'Slons Qf Sec.tterr 7tG 10i. f.toitda W-hlth p$¥Jde that·

   the prevailing protata1.mrm.atd o,ear.e·for a g1ver.t -(ltjtff-lY1dtat

   shau be that:level:bf sre,_ skill,. and treatment wh1ch,, Jn Ught of all relevant

   
   

   -

   i

   i

   
   

   \\ ..,,.J: iffl!lilll - ,.l;J!A •.u 4

   :J ....,, .,..:_......·:. ,._·..·. C111'1mMI"'""' ,,,,,,,,.._,._,._.:Ml..,_

   
   

   surrounding circu .IS 11.-J as'.a.cc:eptable and a propriate hr·

   reasonably, p:radent :slrttnar health' care prt,viderS.

3. Re$p(>nclent failed tGlmeet the reqUll'E!d. od-.1f 1c;Jre by bi:

   ine or more of the fallcwtng WllJS!

   1. By f pfU'opriatelY. treatl Patient A1 wftb1V Vatemydnj·:at,

      tbe. doses ml in the i l5:lnd , d to Pat'lent ;l.-ffl;l ge, oo qr ilbOut ·t>, iOOi'tht,QtJgb 31, :J00if' and/or

   2. s, falttng to Initiate b.o nt with. mlCf'QbllJl $0il.P Oil

   Patient A.M:;andfor

   c:) By falllng to:Incise .and draln l>al;lent.AJll!s leslo ; andJor

   1. :By fa1Ung" :on or about Qctdber 9, 260, through' Ql1 •Qr fbQu.t

      •Ot:tE)ber 31, lOOlt, to detetmtne 1he: ·spocffic: ;stapbyl000ccat Jn:f on wbtdl.had Infected Pattertf. A..M; artdtor'

   2. By tnapprepnMV treating .MM A wlth: Pl Vslc?ei1'Yffl\,

   ;W'J_JH.uiou.t

   ! 1'11.!.',.! l M

   tnQHJ1Ji:, the •Sf.).e(!itk,·.·.·' .U....i.l.f""'''-lfiul.i,. . .ul i1.1Jnl•;U,,Jn:1·. """M·

   . ..

   , rl]9\s.JW;b,f_'·I·t A: ,.l,.L.,

   .:.

4. Based on the·· fure{:JolrtQ,. l\espoltdent h VfQ1 1'd Settk>.o

45.8. l(l){t)l;,.Florf(fa :statl!teS. (2008), .cqmmfffln.J oo ical:rNJtrna t

l)y 1a1nn to t$tl m®l.id 'IP. ,wltbb:

'lev J o.f tar.er $kB\

,U,.H.,.U..4I . 1,11n., t \.',J& x.!'h.lr

i.n JIlig ··ht: VAf.J: ..:811 1 . -

,1H,S··I:Jr1-'1,tY.wUM..Wii.}:11111 .oU.1·r..cU;i .l.l.l.I-..Cil.Hl.-t ts.

recegnt:zed as:. ptable and c1ppropriate, by ·reaSQn bly ·Prudent lmJfa:r

health care prov,,.rs.

5

EOQRJTWQ

22 Petit:iOJ'.ier ·!'$'-al anti rnO!)rpote pa gmP.bs ·orti Cl}

thro.1$fT n' {17) 1ai,1; f \I IIJ •·1'Qr,t\11 ne,rreil.

1. Section 458.331{1)0t'-i florid& St&tttes· { state& that

   . . . -H . . . -t" .... 1&:11e, Q;:,' Q:H:lnQ'.l ,u.7. l,l J,W.-1. d;J.e IJ.!I.' l' f!,,9. ffl\(1

   failfn'1.' 'to k IQl'i1 1..1· -.ii!l.,,;i..1}1oSo,.,;1 ... ir.:1· · hii. "-'l!l-uf i14 .-- .t._

   the bo rJt rn.e.dittat ,t, ds that. td.enfJJv 'the lf - Jbf$i¢1ijO r tne.· ph n ender ind SiJ,etV1srn9 idan bf·r1a nd p.t0fesstenat ll who is or are resr,tmslble. for rendering, orderil19.t supeivi!lltg, or baling for eadl· lagnostlc QI" ealment proeedu and that· justrfJ the co r:I

   m i at tfle' patient,. 10.atldin.9.r. bot not n tQ; patient h1SJDrle$;

   aamb1atibn result:St test results; 1'8,fflrds of drugs be61 .dtSpetiSed, or edmii1istered; and r:epOrts of crinsLiitatlons and:hQSpitaUzattons comStitutes groan¢1s for disl;lpqr,cQY 8\tfo.n ,b.y the·aoar4 of'Met,lfc;fn .

2. nder,t fall ·to keep uate: 1 1. dsJu$.DfY.lttt

   the CIU1Se' 'Of tre.atmentd lttdent. A-.M-. tn ooe (11' mm-a of the 'fGlmwlr.t.g ways:

   aJ, B;y 'fialOng to: document the treatment- wHhanttmlcroblal 9'8P.

   ··was fflltiatecl; atidfnr-

   b'.t\.. a·Y

   1- -,itl••h-=n.,_

   +1,,.Q• Y ,: A

   •..,,.,,. . lk1;;;; ·SP•-\;.IUCuJ(:. 1t'l1,o, 'Pfk•.,.1,I,,!\l-!-llltlc.e--a1t.

   ;iftrlf-.W- ,:,:

   PatreotA.M. had;artd/et

   
   

   6

   
   

   e) By failing re document lndstng and dralnim, eatiettt AtM!$ .

   lesions;. and/or

   d) By mntn.9 t:Q, do 1:nnent type of t :Patient A;M. wa,

   saffer1A. g hI.fI .tl"u.•-·'1. Wh.Q..li.-t"ler t11.•··flt · V• ile't"'e .·0,.M..,.r,\''(, AJ'.-C"IlI.'Iil.r.•-l!rIiI

   WaS.any ceflulJtls surtotiitdlng tMe'lesk!itts.

   .Qt

   .rt +"h''i!-'tre

3. Based on the toregorns, Resf>O.ndm.t .has ¥lolated Setth.i>n

458'..lil:Cl*mJ, :Florida (2Q08), by faOing ·to ke P adequal;e

.medleai retordsJust1fJJng the·toOrse:df ti'eiffllenlef11Mefd:AM.

CQUNTTHREE

26 Pet:Jtlooer r:e,,-allegE$ at'd ln®rp011 WIP Qne ('.)

tttrou:gh seveoteffi,{f7):as4f·fu_lly set-fblth h.etetn.

27. Sectron ,45&. 1(1){<f)i, RQdda: St;atutes {2 i, · · a Dte.nsee w: :r;Jl !plltll, .tnclbdto; Qn, for 9, tf. na admrn1s-rlntr m ng, or ether-wise pmgartng a tegend cttu.St. t.nerudtns aQy

controlled nee, other than· kt the course of the _r>hv.sltianfs

rt' i ienat ·y".1',gM'"'i-.p-.;·g·

crU;.t.,. p.u-rt-- ur U11;1I,,;,L,l.

paragraP;._J'i,,t *ll,, S1;a1.;C_;J:,...ll iUi.C..._ le ·du-

pr.esumed that lng,.dispensing, edmlh'istering,. milfi:19. or otherwise preparlng l tallOdrugs; fl1Qu4rll9 all lfecl·SUfnappropr t­ or ln exGeSSJve. or rnapproprJate quantities ts not'ln·fbe btst:'tn of tile patient and not In the ·cou;se of >the, pbysidari's· pm lo.naJ !l , without:regamto:nis.intent.

I 11901

.zs, R pdent prescribed, dispensed,. adr.tllnlstafe4 Jfiiled; bl' o.ttierwtse pr.epatred ,a 1$,3.MCI dtug; 1&trter dl;tt ln ffli .u• tf b p JJrtal: pia .frtJJ:i:· t tnrm;igh:on r 1,be.1;1t r

31 ZODB1 ft\·mte, Or o.f'ffie fiallowmg w

1. By. jn_ap_r, '1atel\t ltf9r ()j- l :al;jmtnlsMtlrltr

rrtlxlA9t r «rerwrse ptepar.11\Qr wrmrnydff, a l•ttct drll, ta

Pa. A.d m Pcltfi!fltA.M.'Sage;: attd/Uf'

1,;is:; IJ••"li"H •M.u.YH•1nO. -Dli1!

ti) 81' f: Jjpr,OJ.lf:latllf.}:tt lbtn91 t.yvox,,,a hagend dt:Ug, ttt PatR!it

>,.1KJ-A"I, :w"-'

r0Q..M.i'..;1<,;rli.\'fi,A M•·

.t·n"" kh< -1'n.n r i ·u..J -,: due to Patfent

. -ft..lt. "10i,9ltaJ. Qrf\lV; anr#tr _

cJ ¥ 'ftlm,pr-apt:ia Jy pms,qrb,mg, d ng, :-,trlftilltlrf11ft.

rro g, or·Q\berwl$e prefJitT a lepni dNI:m

ij ­

tf nt A.J4. P..rl'Qr tQ P•rnitmll9. Qtl _.flt stl:J>tr,f--1

rn ctron. wfltch· ha lu nt ANJ ll'IMlr·

d): - lnap.pmpnately prescrlbing, tftspenstng,

Oin.fr-• :othetwiprepari - qvox.,a legend drJJg1 t& tfent:

. A,J:,11,, .'Prtor to !tetffltni mt I llh- mt lGfiialon

tl!ll. 'll'll!!lilir.,ii;,;..\,I ,a.tl•;;:11 t1.,1"t. ,

. Wrls.al"l;Hli'nt.,; h.....:i .,..'f;,o, ! .,,. ,.. ;jM.

29 h Gl 9n ·fQ,:goi pqn.ftnt; rv.llJfttt.ed Mnn,

Jil. . JU •·-.:ti· f

4WJa tll(q)t flt.md.a - - W J,t191bl1/J, Sid"

a.d. mt. U1 .W..,l..=......P,;tt Jilll..mi l\l.lIir .!,..I..Lt.O-..P.M. te=.6.-

t',NE!!i;J;,",;P,uUt

. Ja1!itA,..-i11: d lii'I· lntllldtn,. ,an-

Medicine enter an·order- 'lmpostng. one or more of tile foft0Wln9 penalties:

J nt rev.etait>Ji or '$Q. . iDll of R.

e t'S Oran$1a,; ;..,i ll•Of

'

pratti i lfflJ!tQSlti<Jl of a.n. adminlstmive, flne, lMance .d a m:antt placement -of Respondent <m pi:obatton1 • coiie:llve adim,,. refund 9.f fees bflled or collected, remecffal edur:attoA ..aoo/or any o relief that tbe Board- deerri's appropriate.

SIG.NEQthl-uPday-:Qf .:20l.O. .

Ana:M•. \llaffl0nte 'Ros1 M.:D., '.M.Pitl

SeQ!retary,. Department of Health;

. $LB/

PCP: September 10, 2010

PCP Members: l on,Thomas,. L-evtne:

11904

STATE O.F FLORIDA DEPARTMENT OF HEALTH.

DEPARTMENT OF HEALTH,

FILED

DEPARTMENT OF HEALTH DEPUTY CLERK

CLERK o'hupJ, cFa.nd.ah.4.

_EA! ,J\JI 1 4 2014

PETITIONER,·

v.

y

8

CASE .NO, 2011-0 11

(l') -:r,-11

_y:::- ;;c --·

NEELAM T. UPPAL, M,D,,

RESPONDENT.

-----------'

AMENDED ADMINISTRATIVE COMPLAINT

::.::::" .·:::- 1 ,,.,..- :*

\.0 ;

-..

u,

I.D

The Petitioner, Department of Health, by and through the undersigned counsel, and files this Administrative Complaint before the Board of Medicine againstthe Respondent, Neelam T. Uppal, M.D., and in support thereof aUeges:

1. The etitioner 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 materfal to this Administrative Complalnt, the Respondent was a licensed physician within the State of Florida, having been Issued license number ME 59800.

   
   

   EXHIBIT

   l B

3. The Respondent's address of record is P.O. Box 60357, St.

   
   

   Petersburg, Florida 33784.

   
   

4. The Respondent is board certified in Internal Medicine with a subspeclalty In Infectious Disease by the American Board of Internal Medicine.

5. On or about February 28, 20111 Patient C.B., a forty-three (43)

   
   

   year-old female, presented to the Respondent with complaints of food

   . .

   allergies and a request to check her immune system.

   
   

6. On or about March 7, 2011, the Respondent saw the patient for a follow up visit to review the patient's blood test and·conducted a physical examination. The Respondent diagnosed the patient with a hyper immune system, a systemic Candida infection, and multip_le food allergles.

7. Patient C.B,'s symptoms, blood test results and physical

examination did not substantiate a diagnosis of systemic Candida Infection, hyper Immune dysfunction, combined immunodeficiency or decreased immune response.

. 8. The laboratory studies ordered by the Respondent did not support the Respondent's findings of systemic Candida Infection or Immune function combined immunodeficiency or decreased immune response.

1. The Respondent failed to meet.the standard.of care In that she arrived at one or more diagnoses for which there was insufficient evidence,

2. On or about March 7, 2011, the Respondent's medical records indicate that the patient wanted to be treated intravenously (IV) and that the patient stated that Diflucan did not work on her previously,.·

3. Diflucan Is the trade name for an antifungal antibiotic.

4. On or about March 7, 2011, the medical records Indicate that the Respondent treated the patient with Vfend 100 mg tablets or with Dlflucan.. _The Respondent's records are not clear if she was treating the

   patient with Diflucan or Vfend.

5. Vfend is the trade name for an antlfungal medication.

6. On or about March 14, 2011, the Respondent started the patient on IV immunoglobulln.

15, IV immunoglobulln Is a blood product used· to treat Immune deficiencies.

1. On or about March 22, 2011, through March 28, 2011, the

   
   

   . Respondent treated the patient with IV AmBlsome.

   
   

2. AmBisome is an antibiotic antlfungal drug used to treat serious fungal Infections.

3. After receiving the AmBisome treatment on or about March 24, 2011, Patient C.B. developed a rash on her left arm. ·

4. The patient informed the Respondent about the rash at her next visit, which was on or about March 25, 2011.

5. On or about March 25, 2011, the Respondent informed Patient

   
   

   .C.B. that the rash on her arm was most likely a result of Candida.

   
   

6. The medical records for ori or about March 25, ·2011, indicate that patient had no rashes.

7. The rash could have beeri a side effect of AmBisome or immunoglobulin. The standard of care was to discontinue both drugs.

8. The Respondent failed to meet the standa·rd of care by

   
   

   continuing the patient on AmBlsome or lmmunoglobulln (or both).

   
   

9. On or about March 28, 2011, the patient informed the Respondent that she had a rash. Toe Respondent stated she would treat the patient. with Benadryl in addition to the IV AmBlsome, but the patient' refused treatment.

10. Benadryl is an antihistamine.

26; There are two records for on or about March 28, 2011. One record states that the Respondent's treatment plan was IV AmBlsome and IV immunoglobulin but also states that the patient walked out.

1. · Another record dated March 28, 2011 states that the patient did not show. up at her appointment and .that the patient went to a

   .hospital.

2. On or bout March 29, 2011, the medical records Indicate that the patient had a /Jllster on her abdomen. The records also indicate that

   I .

   the patient did not show up for treatment but also states that the

   
   

   Respondent had a discussion with the patient.

   
   

3. On or about March 29, 2011, Patient C.B. presented to the Respondent's offlc and was given a prescription for Vfend.

4. Vfend Ip an antifungal medication used to treat serious, invasive fungal infectlons.

5. On or about April 4, 2011, Patient C.B presented to the Respondent. The rnedlcal records Indicate the patient had a papule on her abdomen. The Respondent treated the patient with IV immunoglobulin.

6. C.B.'s $ymptoms and medical condition did not substantiate treatment with Diflucan, IV lmmunoglobulln, Vfend or AmBisome.

   
   

7. The Respondent used medical records with pre-printed findings for an examination on them. The Respondent's use of preprinted physical . · examination results do not specify if examinations actually occurred.

8. The hand written portions of the Respondent's medical records appeared vague, contradictory or incomplete.

9. Respondent failed to maintain and/or keep complete, legible medlcal records for patient C.B.

   
   

10. The Petitioner realleges and Incorporates paragraphs one (1)

    . .

    through thirty-five (35) as if fully set forth herein.

    
    

11. Section 458.331(1)(t)(1}, Florlda Statutes (2010), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section . 456.50, Florida Statutes, 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.

12. The level of care, skill, and treatment recognized In general _law related to health care llcensure means the standard of care specified in Sectlon 766.102. Section 766.102(1), Florida Statutes, defines the

    
    

    standard of care as the prevailing professional standard of care for a given health care provider shall be that level of care, skill, and treatment which, ln light of all relevant surrounding circumstances, · is recognized as acceptable and appropriate by reasonably prudent similar health· care providers.

13. The Resp<:>ndent fell below the acceptable standard of care In one or more of the Following ways:

    1. The Respondent's examination and evaluation of Patient C.B.

       was inadequate and inappropriate in that the examination did not

       support a diagnosis of one of the following conditions: systemic Candida Infection, hyperlmmune dysfunction,· immunodeficiency or decreased immune response;

    2. The Respondent's Inappropriately treated the patient w_ith or,e· or more of th following drugs: AmBlsome, lmmunoglobulin, Vfend or Dlflucan although the patient did not have any conditions which would lndicat their use.

    3. The Respondent failed to discontinue treatment with AmBlsome or immunoglobulin despite the patient having signs of negative side . effects.

14. Based on the foregoing, the Respondent has violated Section 458.331(1)(t), Florida Statutes (2010); by committing medical malpractice.

    COUNT II

15. The Petitioner realleges and Incorporates paragraphs one (1) through thirty-five (35) as if fully set forth herein.

16. Section 458.331(1)(m), Florida Statutes (2010), 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, indudlng; but not limited to, patient histories;

      
      

      examlna lon 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.

      
      

17. The Respondent failed to keep appropriate medical records in· one or more of the following ways:

1. The medical records did not justify one or more of the following diagnoses: systemic Candida infection, hyper immune dysfunction, combined lr:nmunodeflclency or decreased immune response.

2. The medical records did not justify the Respondent's treatment of the patient.

3. The medical records had conflicting accounts of the patient's treatment.

4. By falling to keep and/or maintain C.B.'s complete medical records.

.44. Based on the foregoing, the Respondent has violated Section 458.331(1)(m), Florida Statutes (2010), by faillng to keep medical records which justify the course of her treatment of Patient C.B.

WHEREFORE, the Petitioner respectfully requests that the Board of Medicine enter an order Imposing one or more of the followlng penalties:· permanent revocation or suspension of the Respondent's license, restriction of practice, imposition of an administrative fine, Issuance of a reprimand, placement of the Re$pOndent on probc,tlon, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the

• Board deems appropriate.

  -/+. '

  SIGNED this tjj' day of (f_,._l-+y

    ,, 2014.

  
  

  John H. Armstrong, MD, FACS Surgeon General & Secretary of Health

  
  

  atrick Reynolds lstant General Counsel

  Florida Bar No. 95291

  Florida Department of Health . Office of the General Counsel 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265

  Telephone: (850) 245-4444

  Facsimile: (850) 245-4684

  Email: Patrick. Reynolds@flhealth.gov

  
  

  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 subpoena and subpoena duces tecum 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 B.oard 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.

  
  

  STATE OF FLORIDA DEPARTMENT OF HEALTH

  
  

  DEPARTMENT OF HEALTH,

  FILED DEPARTMENT OF HEALT

  DEPUTY CLERK

  CLERK ,/h..g.o.l cl". dah.4.

  DATE JUL 1 4 2014

  
  

  PETITIONER,

  
  

  . NEELAM T. UPPAL, M.D.,

  
  

  CASE NO. 2011:i:l.7799

  
  

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  RESPONDENT.

  
  

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  . SECOND AMENDED ADMINISTRATIVE COMPLAINT 0

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  The Petitioner,· Department of Health, by and through the undersigned counsel, files this Second Amended Administrative Complaint (''Complaint'') before the Board of Medicine·. ("Board") against the Respondent, Neelam T. Uppal, M.D., and alleges:

  1. 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.

     EXHIBIT

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  2. At all times material to this Complaint, the Respondent was a . licensed physician within the State of Florida, having been issued license number ME 59800.

     
     

  3. · The Respondent is bo13rd certified in Infectious Disease by the American Board of Internal Medicine.

  4. The Respondent's address of .record Is P.O. Box 1002, Largo, Florida 33779.

  5. At all times material to this Complaint, the Respondent's primary practice address was 5840 Park Boulevard, Pinellas Park, FL 33781.

  · 6. 'The Respondent treated patient P.A. from on or about February 22, 200·8, through on or about December 3, 2011.

  1. On or about February 22, 2008, P.A., a 35 year old woman at the time, presented to the Respondent with complaints of itching. The Respondent planned to rule out parasites and order lab .work. ·

  2. On. or about February 23, 2008, P.A. returned to the Respondent with complaints of exhaust.ion.

  3. · CML stands for chronic myeloid leukemia.

     
     

  4. From on or about February 23, 2008, through December 3, 2011, the patient. complained of pain, insomnia, vomiting, nausea, an inability to eat, arid symptoms of upper respiratory Infections.

  5. From on or about February 23, 2908, through December 3,

     
     

     2011, the patient had blood tests which Indicated abnormally high readings

     
     

     for one or more of the following: white blood cells, red blood cells, hemoglobin and hematocrit.

  6. On or about March 27, 2008, the patient presented to Respondent with CML and an upper respiratory infection. The Respondent referred the patient to Moffitt.

  7. On or about May 18, 2010, the Respondent assessed the patient wlth a possible diagnosis of flbromyalgia without documented medical justification.·

  8. On or about September 13, 2010, the patient complained of vaginal · bleeding after her hysterectomy.. The Respondent planned to discuss P.A.'s condition with her gynecologist.

  9. On or about January 21, 2011,· the patient present d with complaints of fatigue and continuing cough.. The Respondent diagnosed. the patient with pneumonia and possible chronic obstructive pulmonary disease. The Respondent treated the patient with an injection.

  10. On _or about January 21, 2011, the name of the person who administered the injection was not documented.

      
      

  11. On or about February 28, _2011, the Respondent diagnosed the patient with polycythemia vera (PV). The Respondent failed to document justification for this diagnosis..

  12. On or about December 3, 2011, the Respondent diagnosed the patient with pneumonia or· bro"nchitis, but did not keep_ a copy of the X-ray or the X-ray report justifying this diagnosis.

  13. From on or about February 23, 2008, through on or about December 3, 2011, the Respondent failed to keep adequate records of physical examinations.

  14. The Respondent failed to adequately document a physical examination and medical history.

  15. The Respondent failed to document following up with the patient's physiclan(s) at Moffitt and she failed to keep medical records · provided by those physicians.

  16. · The Respondent failed to document following _up with the patient's oncologist and she failed to keep medical .-records provided by those physicians.

  17. . Respond nt failed to keep and maintain the complete medical recor9s for patient P.A.

      
      

  18. Section 458.331(1)(ni), Florida Statutes (2007-2011), 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 discipllnary action by the Board of Medicine.

  1. . Florida Administrative Code Rule 6488-9.003, Standards for

     ..•

     · Adequacy of Medical Records, further defines the the paramaters of adequate medical records.

  2. Florida Administrative Code Rule 64B8-9.003, titled standards

     
     

     for Adequacy of Medical Records, provides 1n part that:

     
     

     1. 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.

        
        

     2. 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.

     3. 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.

  3. The Respondent failed to keep medical records in one or more

     
     

     of the following ways:

     
     

     1. The medical records dld not contain adequate documentation of physical examinations.

        
        

     2. The medical record did not contain sufficient documentation of the course and results of treatment accurately.

     3. The medical records do not contain documentation of consultations and follow-ups.

     4. The Respondent failed to keep and maintain the complete

     
     

     · medical records for patient P.A.

     
     

  4. Based on the foregoing, th.e Respondent has violated Section

  
  

  458.331(1)(m), Florida Statutes (2007-2011), by failing to keep and maintain medical records.

  WHEREFORE, the Petitioner respectfully requests that the Board of

  
  

  Medicine enter an order imposing one or more ofthe following penalties: permanent revocation or suspension of the 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 collected, remedial education and/or any other relief that the Board deems appropriate.

PCP: April 19, 2013.

John: H,, Armstrong, MD, FACS­

An!Jd:!  

Surgeon Gen: al & Secre ry

·""'-Is.'ta.n. t·Gene. r..a. f c.·o..un' r;l':,1

Florida ear Number:; 1S70

. J=loride Department of Health Office of the (;enetaf Counsel 4052 Bald Cypress,·way, Btn C-65 Tallahassee,. Florida 323.99-326-5

Telephone;, (8'50) 245-4444, :x814;l

· FacsJmHe: (850) Z45-4684

. a.H: Andr -.OllrSO@flheafth.gov

PCP Members: _Dt•. Avlla, Dr.. Thomas, Mr-. 'Dyches

DOH v. NEELAM T. UPPAL, M.D., CASE NO. 2011-17799

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 subpoena and . subpoena duces tecum

issued on his or her behalf if a hearing is requested..

NOTICE REGARDING ASSESSMENT OF COSTS

Respondent is placed on notice that Petitiorier has Incurred costs relate to the investigation and prosecution. of this matter. Pursuant to Section 456.072(4), Florida 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.

Docket for Case No: 14-000515PL

Orders for Case No: 14-000515PL