STATE OF FLORIDA DEPARTMENT OF HEALTH ADMINISTRATIVE COMPLAINT. COMES NOW, Petitioner, Department of Health, by and through its

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1 DEPARTMENT OF HEALTH, STATE OF FLORIDA DEPARTMENT OF HEALTH PETITIONER, ROBERT GUIRGUIS, D.O., RESPONDENT. CASE NOV: ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Osteop thic Medicine against the Respondent, Robert Guirguis, D.O., and in supp rt thereof alleges: 1. Petitioner is the state agency charged with regulating the practice of osteopathic medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 459, Florida Statutes. 2. At all times material to this Complaint, Respondent was a licensed osteopathic physician within the State of Florida, having been issued license number OS 9146.

2 3. Respondent's address of record is 2333 West Hillsborough Avenue, Suite 100, Tampa, Florida At all times relevant to this Complaint, Respondent at Tampa Pain Relief Center, Inc., in Tampa, Florida, and is board certified in physical medicine and rehabilitation. 5. On or about September 24, 2014, Patient J.R., presented to Respondent with complaints of low back pain. 6. From on or about October 14, 2014, until on or about April 3, 2015, Respondent administered a series of epidural steroid injections in Patient J.R.'s low back to treat Patient J.R.'s low back pain. 7. Epidural steroid injections are a minimally invasive procedure used to reduce back paid, but the steroids used temporarily reduce the body's immunity. 8. In December, 2014, Respondent ordered an MR1 scan of Patient J.R.'s lumbar spine. 9. On January 14, 2015, an MRI scan was performed on Patient J.R.'s lumbar spine. DOH V. Robert Guirguis, D.O. 2

3 10. The January 14, 2015 MRI scan performed on Patient J.R.'s lumbar spine revealed findings suggestive of osteomyelitis from L3 through L5 in Patient J.R.'s lumbar spine. 11. Osteomyelitis is a bone infection, 12. The report of Patient J.R.'s January 14, 2015 lumbar MRI scan was placed in Respondent's medical records for Patient J.R. 13. Respondent did not review Patient J.R.'s January 14, 2015 lumbar MRI scan. 14. Respondent did not document that he reviewed the January 14, lumbar MRI scan.report for Patient J.R. 15. Respondent did not develop an appropriate treatment plan for Patient J.R. following the January 14, 2015 lumbar MRI scan. 16. Respondent did not document an appropriate treatment plan for Patient J.R. following the January 14, 2015 lumbar MRI scan. 17. Respondent did not inform Patient J.R. of the results of her January 14, 2015 lumbar MRI scan. 18. Respondent did not diagnose Patient J.R. with osteomyelitis following the January 14, 2015 lumbar MRI scan. DOM V. Robert Guirguls, D.O.

4 18. Respondent did not refer Patient J.R. to an orthopedist or other physician specializing in wound treatment to treat Patient J.R.'s osteomyelitis following the January 14, 2015 lumbar MRI scan. 19. From January 14, 2015 until April 3, 2015, Respondent continued to administer epidural steroid injections to Patient J.R.'s low back, following the January 14, 2015 lumbar MRI scan. 20. On April 13, 2015, Patient J.R. was hospitalized and it was revealed that osteomyelitis caused collapse of the patient's vertebrae from L2 through L5. COUNT ONE 21. Petitioner realleges and incorporates paragraphs one (1) through twenty (20), as if fully set forth herein. 22. Section (1)(x), Florida Statutes (2014), allows the Board of Osteopathic Medicine to impose discipline for committing medical malpractice as defined in Section , Florida Statutes. 23. "Medical malpractice" is defined in Section (1)(e), Florida Statutes (2014), 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." DOH V. Robert Guirguis, D.O.

5 24. For purposes of Section (1)(x), Florida Statutes (2014), the Board shall give great weight to the provisions of Section , Florida Statutes (2014), which provides: The prevailing professional standard of care for a given health care provider shall be that level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers. 25. Respondent committed medical malpractice in his care of Patient F.H. in one or more of the following manners: a. By failing to review the January 14, 2015 lumbar MRI report; b. By failing to develop an appropriate treatment plan for Patient J.R. following the January 14, 2015 lumbar MRI report; c. By continuing to administer steroid injections to the patient following the January 14, 2015 lumbar MRI report; d. By failing to refer the patient to an orthopedic physician or other physician specializing in wound care to DOH v. Robert Guirguis, D.O. 5

6 treat the patient following the January 14, 2015 lumbar MRI report; e. By failing to diagnose the patient with osteomyelitis in a timely manner; and/or f. By filing to inform the patient of the results of the January 14, 2015 lumbar MRI scan. 26. Based on the foregoing, Respondent violated Section (1)(x), Florida Statutes (2014), by committing medical malpractice. COUNT TWO 27. Petitioner realleges and incorporates paragraphs one (1) through twenty (20), as if fully set forth herein. 28. Section (1)(o), Florida Statutes (2014), allows the Board of Osteopathic Medicine to impose discipline against an osteopathic physician for failing to keep legible, as defined by department rule in consultation with the board, medical records that identify the licensed osteopathic physician or the osteopathic physician extender and supervising osteopathic 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 DON V. Robert Guirguis, D.O. 6

7 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. 29. Rule 64B (1), Florida Administrative Code, provides that an osteopathic physician shall maintain written legible records for each patient including, at a minimum, patient histories; examination results; test results; records of drugs prescribed, dispensed or administered; reports of consultations; and hospitalizations. 30. Respondent failed to keep legible medical records for Patient F.H. in one or more of the following manners: a. By failing to document an appropriate treatment plan for the patient following the January 14, 2015 lumbar MRI scan; b. By failing to document he reviewed the January 14, 2015 lumbar MRI scan; and/or c. By failing to document any referrals to other physicians for appropriate treatment following the January 14, 2015 lumbar MRI scan. DOH V. Robert Guirguis, D.O. 7

8 31. Based on the foregoing, Respondent violated Section (1)(o), Florida Statutes (2014), as defined by Rule 64B (1), Florida Administrative Code, by failing to keep legible medical records. WHEREFORE, the Petitioner respectfully requests that the Board of Osteopathic 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 the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. DOH V. Robert Guirguis, D.O. 8

9 SIGNED this day of Celeste Philip, MD, MPH Surgeon General and Secretary FILED DEPARTMENT OF HEALTH DEPUTY CLERK CLERK Amber Greene DATE APR Mary S. Miller Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida Florida Bar Number Telephone (850) , ext Facsimile (850) Mary.Miller2@flhealth.gov /MSM PCP: April 14, 2017 PCP Members: Moran & Hayden DOH v. Robert Gulrguis, D.O.

10 NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section and , 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. A request or petition for an administrative hearing must be in writing and must be received by the Department within 21 days from the day Respondent received the Administrative Complaint, pursuant to Rule ,111(2), Florida Administrative Code. If Respondent fails to request a hearing within 21 days of receipt of this Administrative Complaint, Respondent waives the right to request a hearing on the facts alleged in this Administrative Complaint pursuant to Rule (4), Florida Administrative Code. Any request for an administrative proceeding to challenge or contest the material facts or charges contained in the Administrative Complaint must conform to Rule (5), Florida Administrative Code. Mediation under Section , Florida Statutes, is not available to resolve this Administrative Complaint. 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 (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. DON v. Robert Guirguis, D.O. 10