Florida Board of Medicine: Florida Board of Medicine: Disciplinary Action Case Disciplinary Action Case

StudiesStudies

Jason J. Rosenberg, M.D., FACSJason J. Rosenberg, M.D., FACS

DATEDATE

StatutesStatutes

http://www.leg.state.fl.us/statutes/index.cfhttp://www.leg.state.fl.us/statutes/index.cfmm

Chapter 456, Florida Statutes – General Chapter 456, Florida Statutes – General Provisions to all Health Care PractitionersProvisions to all Health Care Practitioners s. 456.072(1), FS – Grounds for Disciplinary s. 456.072(1), FS – Grounds for Disciplinary

ActionAction Chapter 458, Florida Statutes – Medical Chapter 458, Florida Statutes – Medical

Practice ActPractice Act s. 458.331(1)(, FS – Grounds for Disciplinary s. 458.331(1)(, FS – Grounds for Disciplinary

Action Action

RulesRules

https://www.flrules.org/https://www.flrules.org/

Rules 64B8, Florida Administrative Rules 64B8, Florida Administrative Code Code Rule 64B8-8.001, FAC – Disciplinary Rule 64B8-8.001, FAC – Disciplinary

GuidelinesGuidelines

Wrong Site, Procedure, Person Wrong Site, Procedure, Person Surgery CasesSurgery Cases

Violation: s. 456.072(1)(bb), FS (2010) – Violation: s. 456.072(1)(bb), FS (2010) – Performing or attempting to perform health Performing or attempting to perform health care services on the wrong patient, a wrong-care services on the wrong patient, a wrong-site procedure, a wrong procedure, or an site procedure, a wrong procedure, or an unauthorized procedure or a procedure that unauthorized procedure or a procedure that is medically unnecessary or otherwise is medically unnecessary or otherwise unrelated to the patient’s diagnosis or unrelated to the patient’s diagnosis or medical condition. For the purposes of this medical condition. For the purposes of this paragraph, performing or attempting to paragraph, performing or attempting to perform health care services includes the perform health care services includes the preparation of the patientpreparation of the patient

11stst Case Study Case Study

Summary: Performed vertebroplasty on Summary: Performed vertebroplasty on wrong vertebrae wrong vertebrae

Hearing: Accepted Settlement Hearing: Accepted Settlement AgreementAgreement

Penalty: letter of concern, $2,500 fine, Penalty: letter of concern, $2,500 fine, costs, 5 hours CME in risk management, costs, 5 hours CME in risk management, 1-hour lecture on wrong site surgery1-hour lecture on wrong site surgery

22ndnd Case Study Case Study

Summary: performed surgery on the Summary: performed surgery on the wrong finger; error was not discovered wrong finger; error was not discovered until the follow up visit at which time the until the follow up visit at which time the patient was scheduled for the correct patient was scheduled for the correct surgery surgery

Hearing: Settlement Agreement Hearing: Settlement Agreement Penalty: letter of concern, $5,000 fine, Penalty: letter of concern, $5,000 fine,

costs, 5 hours risk management CME, 1-costs, 5 hours risk management CME, 1-hour lecture on wrong site surgeryhour lecture on wrong site surgery

Prescribing CasesPrescribing Cases Violations: Violations: s. 458.331(1)(t), FS (2007-2009) – Notwithstanding s. 456.072(2) but as s. 458.331(1)(t), FS (2007-2009) – Notwithstanding s. 456.072(2) but as

specified in s. 456.50(2): 1.  Committing medical malpractice as defined in s. specified in s. 456.50(2): 1.  Committing medical malpractice as defined in s. 456.50. The board shall give great weight to the provisions of s. 766.102 when 456.50. The board shall give great weight to the provisions of s. 766.102 when enforcing this paragraph. Medical malpractice shall not be construed to require enforcing this paragraph. Medical malpractice shall not be construed to require more than one instance, event, or act. 2.  Committing gross medical more than one instance, event, or act. 2.  Committing gross medical malpractice. 3.  Committing repeated medical malpractice as defined in s. malpractice. 3.  Committing repeated medical malpractice as defined in s. 456.50. A person found by the board to have committed repeated medical 456.50. A person found by the board to have committed repeated medical malpractice based on s. 456.50 may not be licensed or continue to be licensed malpractice based on s. 456.50 may not be licensed or continue to be licensed by this state to provide health care services as a medical doctor in this state. by this state to provide health care services as a medical doctor in this state. Nothing in this paragraph shall be construed to require that a physician be Nothing in this paragraph shall be construed to require that a physician be incompetent to practice medicine in order to be disciplined pursuant to this incompetent to practice medicine in order to be disciplined pursuant to this paragraph. A recommended order by an administrative law judge or a final paragraph. A recommended order by an administrative law judge or a final order of the board finding a violation under this paragraph shall specify order of the board finding a violation under this paragraph shall specify whether the licensee was found to have committed "gross medical whether the licensee was found to have committed "gross medical malpractice," "repeated medical malpractice," or "medical malpractice," or any malpractice," "repeated medical malpractice," or "medical malpractice," or any combination thereof, and any publication by the board must so specify. combination thereof, and any publication by the board must so specify.

s. 458.331(1)(m), FS (2007-2008) – Failing to keep legible, as defined by s. 458.331(1)(m), FS (2007-2008) – Failing to keep legible, as defined by department rule in consultation with the board, medical records that identify department rule in consultation with the board, medical records that identify the licensed physician or the physician extender and supervising physician by the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for rendering, ordering, name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and that supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizationsdispensed, or administered; and reports of consultations and hospitalizations

11stst Case Study Case Study

Summary: prescribed Ativan, Klonopin, Summary: prescribed Ativan, Klonopin, Lortab and Ambien to patients, but failed to Lortab and Ambien to patients, but failed to maintain medical records to justify the maintain medical records to justify the treatment treatment

Hearing: Settlement AgreementHearing: Settlement Agreement Penalty: reprimand, $20,000 fine, costs, UF Penalty: reprimand, $20,000 fine, costs, UF

drug course, FMA records course, QA drug course, FMA records course, QA assessment, PRN evaluation and compliance assessment, PRN evaluation and compliance

Prescribing Cases ContinuedPrescribing Cases Continued Violations: Violations: s. 458.331(1)(t), FS (2009) – Notwithstanding s. 456.072(2) s. 458.331(1)(t), FS (2009) – Notwithstanding s. 456.072(2)

but as specified in s. 456.50(2): 1.  Committing medical but as specified in s. 456.50(2): 1.  Committing medical malpractice as defined in s. 456.50. The board shall give great malpractice as defined in s. 456.50. The board shall give great weight to the provisions of s. 766.102 when enforcing this weight to the provisions of s. 766.102 when enforcing this paragraph. Medical malpractice shall not be construed to paragraph. Medical malpractice shall not be construed to require more than one instance, event, or act. 2.  Committing require more than one instance, event, or act. 2.  Committing gross medical malpractice. 3.  Committing repeated medical gross medical malpractice. 3.  Committing repeated medical malpractice as defined in s. 456.50. A person found by the malpractice as defined in s. 456.50. A person found by the board to have committed repeated medical malpractice based board to have committed repeated medical malpractice based on s. 456.50 may not be licensed or continue to be licensed by on s. 456.50 may not be licensed or continue to be licensed by this state to provide health care services as a medical doctor this state to provide health care services as a medical doctor in this state. Nothing in this paragraph shall be construed to in this state. Nothing in this paragraph shall be construed to require that a physician be incompetent to practice medicine require that a physician be incompetent to practice medicine in order to be disciplined pursuant to this paragraph. A in order to be disciplined pursuant to this paragraph. A recommended order by an administrative law judge or a final recommended order by an administrative law judge or a final order of the board finding a violation under this paragraph order of the board finding a violation under this paragraph shall specify whether the licensee was found to have shall specify whether the licensee was found to have committed "gross medical malpractice," "repeated medical committed "gross medical malpractice," "repeated medical malpractice," or "medical malpractice," or any combination malpractice," or "medical malpractice," or any combination thereof, and any publication by the board must so specify. thereof, and any publication by the board must so specify.

Prescribing Cases ContinuedPrescribing Cases Continued

Violations Continued:Violations Continued: s. 458.331(1)(q), FS (2009) – Prescribing, s. 458.331(1)(q), FS (2009) – Prescribing,

dispensing, administering, mixing, or otherwise dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled preparing a legend drug, including any controlled substance, other than in the course of the substance, other than in the course of the physician's professional practice. For the purposes physician's professional practice. For the purposes of this paragraph, it shall be legally presumed that of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all otherwise preparing legend drugs, including all controlled substances, inappropriately or in controlled substances, inappropriately or in excessive or inappropriate quantities is not in the excessive or inappropriate quantities is not in the best interest of the patient and is not in the course best interest of the patient and is not in the course of the physician's professional practice, without of the physician's professional practice, without regard to his or her intentregard to his or her intent

Prescribing Cases ContinuedPrescribing Cases Continued Violations Continued:Violations Continued:

s. 458.331(1)(nn), FS (2009) – Violating any provision of this s. 458.331(1)(nn), FS (2009) – Violating any provision of this chapter or chapter 456, or any rules adopted pursuant chapter or chapter 456, or any rules adopted pursuant theretothereto

s. 458.331(1)(m), FS (2009) – Failing to keep legible, as s. 458.331(1)(m), FS (2009) – Failing to keep legible, as defined by department rule in consultation with the board, defined by department rule in consultation with the board, medical records that identify the licensed physician or the medical records that identify the licensed physician or the physician extender and supervising physician by name and physician extender and supervising physician by name and professional title who is or are responsible for rendering, professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or ordering, supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment procedure and that justify the course of treatment of the patient, including, but not limited to, treatment of the patient, including, but not limited to, patient histories; examination results; test results; records patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizationsreports of consultations and hospitalizations

22ndnd Case Study Case Study

Summary: dispensing physician in Pain-Management Summary: dispensing physician in Pain-Management Clinic; excessive prescribing for multiple patients; Clinic; excessive prescribing for multiple patients; failed to diagnose appropriately, maintain medical failed to diagnose appropriately, maintain medical records to justify course of treatment, failed to records to justify course of treatment, failed to complete History & Physicals, other tests, or refer the complete History & Physicals, other tests, or refer the patient to specialists, failed to tell patient about patient to specialists, failed to tell patient about alternative treatments available, refer the patient for alternative treatments available, refer the patient for addiction treatment, or follow up on positive drug addiction treatment, or follow up on positive drug screens screens

Hearing: Was originally under an Emergency Hearing: Was originally under an Emergency Suspension Order; Formal Hearing before the Division Suspension Order; Formal Hearing before the Division of Administrative Hearingsof Administrative Hearings

Penalty: RevocationPenalty: Revocation

Out of State Discipline Out of State Discipline CasesCases

Violations:Violations: s. 458.331(1)(b), FS (2008) – Having a license or the s. 458.331(1)(b), FS (2008) – Having a license or the

authority to practice medicine revoked, suspended, authority to practice medicine revoked, suspended, or otherwise acted against, including the denial of or otherwise acted against, including the denial of licensure, by the licensing authority of any licensure, by the licensing authority of any jurisdiction, including its agencies or subdivisionsjurisdiction, including its agencies or subdivisions

s. 458.331(1)(kk), FS (2008) – Failing to report to s. 458.331(1)(kk), FS (2008) – Failing to report to the board, in writing, within 30 days if action as the board, in writing, within 30 days if action as defined in paragraph (b) has been taken against defined in paragraph (b) has been taken against one’s license to practice medicine in another state, one’s license to practice medicine in another state, territory, or countryterritory, or country

11stst Case Study Case Study

Summary: failed to report action in NY for Summary: failed to report action in NY for standard of care issues; probation for standard of care issues; probation for three years, prohibited from performing three years, prohibited from performing breast imaging studies; failed to report breast imaging studies; failed to report action in PA based on the NY action; action in PA based on the NY action; probation in PA concurrent with NY probation in PA concurrent with NY probation probation

Hearing: Hearing not Involving Disputed Hearing: Hearing not Involving Disputed Issues of Material Fact Issues of Material Fact

Penalty: Revocation Penalty: Revocation

22ndnd Case Study Case Study

Summary: failed to report action in Summary: failed to report action in NC for physician/patient boundaries; NC for physician/patient boundaries; reprimanded and required to attend reprimanded and required to attend CME CME

Hearing: Voluntary Relinquishment Hearing: Voluntary Relinquishment Penalty: License relinquished Penalty: License relinquished

Standard of Care Cases Standard of Care Cases Violations: Violations: s. 458.331(1)(m), FS (2006) – – Failing to keep legible, as defined by s. 458.331(1)(m), FS (2006) – – Failing to keep legible, as defined by

department rule in consultation with the board, medical records that department rule in consultation with the board, medical records that identify the licensed physician or the physician extender and supervising identify the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for physician by name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment of the treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories; examination patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizationsadministered; and reports of consultations and hospitalizations

s. 458.331(1)(t), FS (2006) – Notwithstanding s. 456.072(2) but as s. 458.331(1)(t), FS (2006) – Notwithstanding s. 456.072(2) but as specified in s. 456.50(2): 1.  Committing medical malpractice as defined specified in s. 456.50(2): 1.  Committing medical malpractice as defined in s. 456.50. The board shall give great weight to the provisions of s. in s. 456.50. The board shall give great weight to the provisions of s. 766.102 when enforcing this paragraph. Medical malpractice shall not be 766.102 when enforcing this paragraph. Medical malpractice shall not be construed to require more than one instance, event, or act. construed to require more than one instance, event, or act. 2.  Committing gross medical malpractice. 3.  Committing repeated 2.  Committing gross medical malpractice. 3.  Committing repeated medical malpractice as defined in s. 456.50. A person found by the board medical malpractice as defined in s. 456.50. A person found by the board to have committed repeated medical malpractice based on s. 456.50 may to have committed repeated medical malpractice based on s. 456.50 may not be licensed or continue to be licensed by this state to provide health not be licensed or continue to be licensed by this state to provide health care services as a medical doctor in this state. Nothing in this paragraph care services as a medical doctor in this state. Nothing in this paragraph shall be construed to require that a physician be incompetent to practice shall be construed to require that a physician be incompetent to practice medicine in order to be disciplined pursuant to this paragraph. A medicine in order to be disciplined pursuant to this paragraph. A recommended order by an administrative law judge or a final order of the recommended order by an administrative law judge or a final order of the board finding a violation under this paragraph shall specify whether the board finding a violation under this paragraph shall specify whether the licensee was found to have committed "gross medical malpractice," licensee was found to have committed "gross medical malpractice," "repeated medical malpractice," or "medical malpractice," or any "repeated medical malpractice," or "medical malpractice," or any combination thereof, and any publication by the board must so specify. combination thereof, and any publication by the board must so specify.

11stst Case Study Case Study

Summary: thrombectomy performed on patient; no post-op Summary: thrombectomy performed on patient; no post-op antibiotics provided; failed to respond to repeated requests antibiotics provided; failed to respond to repeated requests from nurses that the patient was developing infection; no from nurses that the patient was developing infection; no follow up or referral; patient had leg amputated as a resultfollow up or referral; patient had leg amputated as a result

Hearing: Formal Hearing before the Division of Hearing: Formal Hearing before the Division of Administrative HearingsAdministrative Hearings

Penalty: $8,500 fine for count 1, $1,500 fine for count 2; Penalty: $8,500 fine for count 1, $1,500 fine for count 2; probation for 6 months, 5 hours CME in risk management, probation for 6 months, 5 hours CME in risk management, indirect supervision with 25% review of charts with monthly indirect supervision with 25% review of charts with monthly visits from the monitor, first and last reports and visits from the monitor, first and last reports and appearances along with the standard terms applicable to appearances along with the standard terms applicable to probation probation

22ndnd Case Study Case Study

Summary: failed to advise patient Summary: failed to advise patient about cancerous massabout cancerous mass

Hearing: Settlement Agreement Hearing: Settlement Agreement Penalty: letter of concern, $5,000 Penalty: letter of concern, $5,000

fine, costs, 5 hours risk management fine, costs, 5 hours risk management CME CME

33rdrd Case Study Case Study

Summary: failed to follow up to ensure Summary: failed to follow up to ensure patient had adequate airway before patient had adequate airway before discharging to rehab facility, failed to discharging to rehab facility, failed to assess the gravity of the patients assess the gravity of the patients condition, failed to provide immediate condition, failed to provide immediate treatment to the patient; patient ultimately treatment to the patient; patient ultimately died - suffered brain damage/death, acute died - suffered brain damage/death, acute respiratory failure and tachycardiarespiratory failure and tachycardia

Hearing: Settlement Agreement Hearing: Settlement Agreement Penalty: Dismissed Penalty: Dismissed