Dr. John Lentz- Destin, FL

STATE OF FLORIDA

DEPARTMENT OF HEALTH

ADMINISTRATIVE COMPLAINT

Petitioner, Department of Health, by and through its undersigned counsel, files this Administrative Complaint before the Board of Medicine against Respondent, John Luther Lentz, Jr., M.D., and in support thereof alleges:

1. 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.

2. At all times material to this Complaint, Respondent was a licensed physician within the State of Florida, having been issued license number ME 82437.

3. Respondent's address of record is 15200 Emerald Coast Parkway, St. Maarten Unit 506, Destin, Florida 32541.

4. At all times material to this Complaint, Respondent was Board certified in Family Medicine.

5. During all time material to this Complaint, Respondent provided treatment to patients for Respondent's diagnoses of Lyme disease, Bartonellosis, and Babesiosis

6. Lyme disease is an infectious disease caused by the bacteria Borrelia burgdorferi.

7. Lyme disease is diagnosed by ERISA or Western blot immunoassay tests.

8. Bartonellosis is an infectious disease caused by bacteria of the genus Bartonella.

9. Bartonellosis is diagnosed by PCR amplification of Bartonella DNA, immunoassay, or a Western blot tests.

10. Babesiosis is a parasitic disease of the blood caused by infection with Babesia.

11. Babesiosis is diagnosed by a blood smear examination for Babesial parasites or PCR amplification for Babesial DNA.

12. The standard of care required Respondent to obtain an ERISA or a Western blot immunoassay test that provided objective laboratory test results confirming the presence of Borrelia burgdorferi antibodies to make an evidence based diagnosis of Lyme disease, and . obtain objective laboratory test results identifying Bartonella and/or Babesial parasites to make evidence based diagnoses of Bartonellosis and/or Babesiosis, refer patients to an infectious diseases specialist for evaluation and treatment of Lyme disease, Bartonellosis and/or Babesiosis, and to not prescribe the treatment provided by the Respondent.

FACTS SPECIFIC TO PT. D.H.

13. Respondent provided care and treatment to patient D.H. from on or about November 24, 2010, to on or about October 14, 2011.

14. Respondent did not refer patient D.H. to a specialist in the diagnosis and treatment of infectious diseases such as Lyme disease, Bartonellosis, and Babesiosis at any time during Respondent's care and treatment of patient D.H.

15. Beginning on or about November 24, 2010, Respondent prescribed patient D.H. CD57, C3a, C4a, and eosinophilic cationic protein laboratory blood tests, hair tests, and/or Fry Bartonella tests.

16. Respondent did not prescribe patient D.H. ERISA or Western blot immunoassay, PCR amplification of Bartonella or Babesial DNA, or blood smear tests at any time during Respondent's care and treatment of patient D.H.

17. Respondent did not obtain a complete medical history from D.H. at any time during Respondent's care and treatment of patient D.H.

18. Respondent did not perform an adequate physical examination of patient D.H. at any time during Respondent's care and treatment of patient D.H.

19. Respondent diagnosed patient D.H. as having Lyme disease and Babesiosis.

20. At all times material to this Complaint, Respondent did not have objective laboratory test results to support the diagnosis of Lyme disease for patient D.H.

21. At all times material to this Complaint, Respondent did not have objective laboratory test results to support the diagnosis of Babesiosis for patient D.H.

22. Respondent prescribed laboratory tests to patients D.H upon which he inappropriately relied for the diagnoses of Lyme disease and Babesiosis.

23. Respondent prescribed patient D.H. the antibiotics Omnicef, azithromycin, Cleocin, and Tindamax, and Interfase Plus Prothera (an enzyme supplement formulation), bolouke lumbrokinase (a fibrinolytic supplement), atenolol (a beta blocker used primarily in cardiovascular diseases), heparin injection (an anticoagulant), artemesinin (an antimalarial), Mepron (an antiparasitic), Plaquenil (an antimalarial), and Vermox (an antihelmentic).

24. Respondent prescribed antibiotics to patient D.H. without medical justification.

25. Respondent prescribed an anticoagulant medication to patient D.H. without medical justification.

26. Respondent prescribed supplements to patient D.H. without medical justification.

27. Respondent prescribed an antimalarial, an antiparasitic, and an antihelmentic to patient D.H. without medical justification.

28. Respondent prescribed a beta blocker to patient D.H. without medical justification.

29. The medications Respondent prescribed to patient D.H. were inappropriate and excessive.

30. Beginning on or about September 29, 2011, patient D.H. began care and treatment with P.A., D.O., a physician Board certified in Internal Medicine, with subspecialty Board certification in Infectious Disease. 31. On or about September 29, 2011, Dr. P.A. obtained Western blot immunoassay, PCR amplification, and peripheral blood smear tests of patient D.H. that were negative for Lyme disease and Babesiosis.

FACTS SPECFIC TO PT. J.L.

32. On or about September 22, 2010, patient J.L. contacted Respondent by e-mail requesting Respondent test her for Lyme disease.

33. Respondent did not refer patient J.L. to a specialist in the diagnosis and treatment of infectious diseases such as Lyme disease, Bartonellosis, and Babesiosis.

34. On or about September 22, 2010, Respondent prescribed patient J.L. CD57, C3a, C4a, and eosinophilic cationic protein laboratory blood tests.

35. Respondent did not prescribe patient J.L. ERISA or Western blot immunoassay, PCR amplification of Bartonella or Babesial DNA, or blood smear tests.

36. Respondent did not obtain a complete medical history from patient J.L.

37. Respondent did not perform a physical examination of patient J.L.

38. On or about September 22, 2010, Respondent documented his assessment of patient J.L. as Lyme disease.

39. Respondent prescribed laboratory tests to patients J.L. upon which he inappropriately relied for the diagnoses of Lyme disease and Babesiosis.

40. At all times material to this Complaint, Respondent did not have objective laboratory test results to support the diagnosis of Lyme disease for patient J.L.

41. On or about December 2, 2010, patient J.L. presented to P.A., D.O., a physician Board certified in Internal Medicine, with subspecialty Board certification in Infectious Disease.

42. On or about December 3, 2011, Dr. P.A. obtained Western blot immunoassay and PCR amplification tests of patient J.L. that were negative for Lyme disease, Bartonellosis and Babesiosis.

FACTS SPECIFIC TO W.L.

43. On or about September 22, 2010, patient J.L. contacted Respondent by e-mail requesting Respondent test her husband, patient W.L., for Lyme disease.

44. Respondent did not refer patient W.L. to a specialist in the diagnosis and treatment of infectious diseases such as Lyme disease, Bartonellosis, and Babesiosis.

45. On or about September 22, 2010, Respondent prescribed patient W.L. CD57, C3a, C4a, and eosinophilic cationic protein laboratory blood tests.

46. Respondent did not prescribe patient W.L. ERISA or Western blot immunoassay, PCR amplification of Bartonella or Babesial DNA, or blood smear tests.

47. Respondent did not obtain a complete history from patient W.L.

48. Respondent did not perform a physical examination of patient W.L.

49. On or about September 22, 2010, Respondent documented his assessment of patient W.L. as Lyme disease.

50. Respondent prescribed laboratory tests to patients W.L. upon which he inappropriately relied for the diagnosis of Lyme disease.

51. At all times material to this Complaint, Respondent did not have objective laboratory test results to support the diagnosis of Lyme disease for patient W.L.

52. On or about December 2, 2010, patient W.L. presented to P.A., D.O., a physician Board certified in Internal Medicine, with subspecialty Board certification in Infectious Disease.

53. On or about December 2, 2011, Dr. P.A. obtained Western blot immunoassay, PCR amplification, and peripheral blood smear tests of patient W.L. that were negative for Lyme disease, Bartonellosis and Babesiosis.

FACTS SPECIFIC TO D.D.

54. On or about September 22, 2010, patient J.L. contacted Respondent by e-mail requesting Respondent test her grandson, patient D.D., for Lyme disease.

55. Respondent did not refer patient D.D. to a specialist in the diagnosis and treatment of infectious diseases such as Lyme disease, Bartonellosis, and Babesiosis.

56. On or about September 22, 2010, Respondent prescribed patient D.D., and eight year old child, CD57, C3a, C4a, and eosinophilic cationic protein laboratory blood tests.

57. Respondent did not prescribe patient D.D. ERISA or Western blot immunoassay, PCR amplification of Bartonella or Babesial DNA, or blood smear tests.

58. Respondent did not obtain a complete medical history of patient D.D.

59. Respondent did not perform a physical examination of patient D.D.

60. On or about October 14, 2010, Respondent diagnosed patient D.D. as having Lyme disease.

61. Respondent prescribed laboratory tests to patients D.D. upon which he inappropriately relied for the diagnosis of Lyme disease.

62. At all times material to this Complaint, Respondent did not have objective laboratory test results to support the diagnosis of Lyme disease for patient D.D.

FACTS SPECIFIC TO S.L.

63. Respondent provided care and treatment to patient S.L. from on or about August 17, 2010, to on or about January 7, 2011.

64. Respondent did not refer patient S.L. to a specialist in the diagnosis and treatment of infectious diseases such as Lyme disease, Bartonellosis, and Babesiosis at any time during Respondent's care and treatment of patient S.L.

65. Beginning on or about August 17, 2010, Respondent prescribed patient S.L. CD57, C3a, C4a, and eosinophilic cationic protein laboratory blood tests, and/or Fry Bartonella tests.

66. Respondent did not prescribe patient S.L. PCR amplification of Bartonella or Babesial DNA, or Western blot immunoassay tests at any time during Respondent's care and treatment of patient S.L.

67. Respondent diagnosed patient S.L. as having Lyme disease, Bartonellosis, and Babesiosis.

68. Respondent prescribed laboratory tests to patients S.L. upon which he inappropriately relied for the diagnoses of Lyme disease, Bartonellosis, and Babesiosis.

69. At all times material to this Complaint, Respondent did not have objective laboratory test results to support the diagnosis of Lyme disease, Bartonellosis, or Babesiosis, for patient S.L.

70. On or about August 17, 2010, patient S.L. provided the Respondent a history of heavy rectal bleeding, which occurred every four to five days.

71. On or about August 17, 2010, patient S.L. informed the Respondent that in June a colonoscopy was recommended.

72. During all time material to this Complaint, Respondent did not obtain a report of a colonoscopy for patient S.L,

73. On or about October 5, 2010, Respondent prescribed patient S.L. Lovenox (heparin injection anticoagulant).

74. On or about October 19, 2010, patient S.L. reported to the Respondent that she had visited an Emergency Room for abdominal pain and hematuria (blood in urine) that was thought to be due to Lovenox.

75. On or about October 19, 2010, Respondent continued prescribing Lovenox to patient S.L.

76. Respondent also prescribed patient S.L. the antibiotics vancomycin, erythromycin, Omnicef, doxycycline, Flagyl, Cleocin, rifampicin, and Ceftin.

77. Respondent prescribed the anticoagulant heparin to patient S.L. without medical justification.

78. Respondent prescribed antibiotics to patient S.L. without medical justification.

79. The medications Respondent prescribed to patient S.L. were inappropriate and excessive.

COUNT I — PT. D.H.

80. Petitioner re-alleges paragraphs one (1) through thirty-three (33) as if fully set forth herein. 81. Section 458.331(1)(t), Florida Statutes (2010-2011), provides

that committing medical malpractice as defined in Section 456.50, Florida Statutes, constitutes grounds for disciplinary action by the Board of Medicine. The Board shall give great weight to the provisions of Section 766.102, Florida Statutes, when enforcing Section 458.331(1)(t), Florida Statutes. Medical Malpractice is defined in Section 456.50, Florida Statutes, 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. Section 766.102, Florida Statutes, provides that 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.

82. Respondent failed to practice medicine with 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 in violation of Section 458.331(1)(t), Florida Statutes (2010-2011), in the care and treatment of patient D.H. in one or more of the following ways:

a. By diagnosing Lyme disease without objective laboratory test results from ERISA or Western blot immunoassay tests;

b. By diagnosing Babesiosis without a pathologist's report of a positive blood smear examination for Babesial parasites or PCR amplification for Babesial DNA;

c. By prescribing inappropriate and excessive antibiotic therapy without medical justification;

d. By prescribing the anticoagulant heparin without medical justification.

e. By prescribing antimalarial medication without medical justification;

f. By prescribing antiparasitic medication without medical justification;

g. By prescribing antihelmentic medication without medical justification; h. By prescribing supplements without medical justification;

i. By prescribing a beta blocker without medical justification;

j. By failing to obtain a complete medical history;

k. By failing to perform adequate physical examinations;

I. By failing to order appropriate tests for the diagnosis of Lyme disease;

m. By failing to order appropriate tests for the diagnosis of Babesiosis; and/or

n. By failing to refer to a specialist in infectious disease.

83. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2010-2011)1 by committing medical malpractice.

COUNT II — PT. D.H.

84. Petitioner re-alleges and incorporates paragraphs one (1) through thirty-three (33) as if fully set forth herein.

85. Section 458.331(1)(m), Florida Statutes (2010-2011), subjects a licensee to discipline for 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.

86. On or about the date set forth above, Respondent failed to keep medical records that justified the course of treatment of patient D.H. in one or more of the following ways:

a. By failing to document a complete medical history;

b. By failing to document adequate physical examinations; and/or

c. By failing to document referrals to specialists.

87. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2010-2011), by failing to keep medical records that justified the course of treatment of patient D.H.

COUNT III —PT. J.L.

88. Petitioner re-alleges paragraphs one (1) through fourteen (14) and thirty-four (34) through forty-four (44) as if fully set forth herein.

89. Section 458.331(1)(t), Florida Statutes (2010-2011), provides that committing medical malpractice as defined in Section 456.50, Florida Statutes, constitutes grounds for disciplinary action by the Board of Medicine. The Board shall give great weight to the provisions of Section 766.102, Florida Statutes, when enforcing Section 458.331(1)(t), Florida Statutes. Medical Malpractice is defined in Section 456.50, Florida Statutes, 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. Section 766.102, Florida Statutes, provides that 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.

90. Respondent failed to practice medicine with 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 in violation of Section 458.331(1)(t), Florida Statutes (2010-2011), in the care and treatment of patient J.L. in one or more of the following ways:

a. By diagnosing Lyme disease without objective laboratorytest results from ERISA or Western blot immunoassay tests;

b. By failing to obtain a complete medical history;

c. By failing to perform a physical examination;

d. By failing to order appropriate tests for the diagnosis of Lyme disease; and/or

e. By failing to refer to a specialist in infectious disease. 91. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2010-2011), by committing medical malpractice.

COUNT IV — PT. J.L.

92. Petitioner re-alleges paragraphs one (1) through fourteen (14) and thirty-four (34) through forty-four (44) as if fully set forth herein.

93. Section 458.331(1)(m), Florida Statutes (2010-2011), subjects a licensee to discipline for 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.

94. On or about the date set forth above, Respondent failed to keep medical records that justified the course of treatment of patient J.L. in one or more of the following ways: a. By failing to document a complete medical history; b. By failing to document adequate physical examinations; and/or c. By failing to document referrals to specialists.

95. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2010-2011), by failing to keep medical records that justified the course of treatment of patient J.L.

COUNT V — PT. W.L.

96. Petitioner re-alleges paragraphs one (1) through fourteen (14) and thirty-four (34) through forty-four (44) as if fully set forth herein.

97. Section 458.331(1)(t), Florida Statutes (2010-2011), provides that committing medical malpractice as defined in Section 456.50, Florida Statutes, constitutes grounds for disciplinary action by the Board of Medicine. The Board shall give great weight to the provisions of Section 766.102, Florida Statutes, when enforcing Section 458.331(1)(t), Florida Statutes. Medical Malpractice is defined in Section 456.50, Florida Statutes, 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. Section 766.102, Florida Statutes, provides that 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.

98. Respondent failed to practice medicine with 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 in violation of Section 458.331(1)(t), Florida Statutes (2010-2011), in the care and treatment of patient W.L. in one or more of the following ways:

a. By diagnosing Lyme disease without objective laboratory test results from ERISA or Western blot immunoassay tests;

b. By failing to obtain a complete medical history;

c. By failing to perform a physical examination;

d. By failing to order appropriate tests for the diagnosis of Lyme disease; and/or

e. By failing to refer to a specialist in infectious disease.

99. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2010-2011), by committing medical malpractice.

COUNT VI — PT. W.L.

100. Petitioner re-alleges paragraphs one (1) through fourteen (14) and thirty-four (34) through forty-four (44) as if fully set forth herein.

101. Section 458.331(1)(m), Florida Statutes (2010-2011), subjects a licensee to discipline for 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.

102. On or about the date set forth above, Respondent failed to keep medical records that justified the course of treatment of patient W.L. in one or more of the following ways:

a. By failing to document a complete medical history;

b. By failing to document adequate physical examinations; and/or

c. By failing to document referrals to specialists.

103. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2010-2011), by failing to keep medical records that justified the course of treatment of patient W.L.

COUNT VII — PT. D.D.

104. Petitioner re-alleges paragraphs one (1) through fourteen (14) and fifty-six (56) through sixty-four (64) as if fully set forth herein.

105. Section 458.331(1)(t), Florida Statutes (2010-2011), provides that committing medical malpractice as defined in Section 456.50, Florida Statutes, constitutes grounds for disciplinary action by the Board of Medicine. The Board shall give great weight to the provisions of Section 766.102, Florida Statutes, when enforcing Section 458.331(1)(t), Florida Statutes. Medical Malpractice is defined in Section 456.50, Florida Statutes, 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. Section 766.102, Florida Statutes, provides that 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.

106. Respondent failed to practice medicine with 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 in violation of Section 458.331(1)(t), Florida Statutes (2010-2011), in the care and treatment of patient D.D. in one or more of the following ways:

a. By diagnosing Lyme disease without objective laboratory test results from ERISA or Western blot immunoassay tests;

b. By failing to obtain a complete medical history;

c. By failing to perform a physical examination;

d. By failing to order appropriate tests for the diagnosis of Lyme disease; and/or

e. By failing to refer to a specialist in infectious disease. 107. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2010-2011), by committing medical malpractice.

COUNT VIII — PT. D.D.

108. Petitioner re-alleges paragraphs one (1) through fourteen (14) and fifty-six (56) through sixty-four (64) as if fully set forth herein.

109. Section 458331(1)(m), Florida Statutes (2010-2011), subjects a licensee to discipline for 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.

110. On or about the date set forth above, Respondent failed to keep medical records that justified the course of treatment of patient D.D. in one or more of the following ways:

a. By failing to document a complete medical history;

b. By failing to document adequate physical examinations; and/or

c. By failing to document referrals to specialists. 111. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2010-2011), by failing to keep medical records that justified the course of treatment of patient D.D.

COUNT IX — PT. S.L.

112. Petitioner re-alleges paragraphs one (1) through fourteen (14) and sixty-five (65) through eighty-one (81) as if fully set forth herein.

113. Section 458.331(1)(t), Florida Statutes (2010-2011), provides that committing medical malpractice as defined in Section 456.50, Florida Statutes, constitutes grounds for disciplinary action by the Board of Medicine. The Board shall give great weight to the provisions of Section 766.102, Florida Statutes, when enforcing Section 458.331(1)(t), Florida Statutes. Medical Malpractice is defined in Section 456.50, Florida Statutes, 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. Section 766.102, Florida Statutes, provides that 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.

114. Respondent failed to practice medicine with 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 in violation of Section 458.331(1)(t), Florida Statutes (2010-2011)1 in the care and treatment of patient S.L. in one or more of the following ways:

a. By diagnosing Lyme disease without objective laboratory test results from ERISA or Western blot immunoassay tests;

b. By diagnosing Babesiosis without a pathologist's report of a positive blood smear examination for Babesial parasites or PCR amplification for Babesial DNA;

c. By prescribing inappropriate and excessive antibiotic therapy without medical justification;

d. By prescribing the anticoagulant heparin without medical justification.

e. By failing to obtain a complete medical history;

f. By failing to perform adequate physical examinations;

g. By failing to order appropriate tests for the diagnosis of Lyme disease;

h. By failing to order appropriate tests for the diagnosis of Bartonellosis;

i. By failing to order appropriate tests for the diagnosis of Babesiosis; and/or j. By failing to refer to a specialist in infectious disease.

115. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2010-2011), by committing medical malpractice.

COUNT X — PT. S.L.

116. Petitioner re-alleges and incorporates paragraphs one (1) through thirty-three (33) as if fully set forth herein.

117. Section 458.331(1)(m), Florida Statutes (2010-2011), subjects a licensee to discipline for 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.

118. On or about the date set forth above, Respondent failed to keep medical records that justified the course of treatment of patient S.L. in one or more of the following ways:

a. By failing to document a complete medical history;

b. By failing to document adequate physical examinations; and/or

c. By failing to document referrals to specialists. 119. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2010-2011), by failing to keep medical records that justified the course of treatment of patient S.L.

COUNT XI

120. Petitioner re-alleges and incorporates paragraphs one (1) through fourteen (14), twenty-one (21), forty (40), fifty-one (51), sixty-two (62), and sixty-nine (69) as if fully set forth herein.

121. Section 458.331(1)(g), Florida Statutes (2010-2011), provides that failing to perform any statutory or legal obligation placed upon a licensed physician licensed under Chapter 458 constitutes grounds for disciplinary action by the Board of Medicine.

122. Section 381.031(1), Florida Statutes (2010-2011), provides, in part, that any practitioner licensed in this state to practice medicine that diagnoses or suspects the existence of a disease of public health significance shall immediately report the fact to the Department of Health.

123. Rule 64D-3.029, Florida Administrative Code, provides, in part, that Lyme disease is a disease of public health significance that must be reported the next business day.

124. Respondent failed to timely report Respondent's diagnoses or suspicions of Lyme disease for patients D.H., W.L., D.D., and S.L. to the Department of Health.

125. Based on the foregoing, Respondent violated Section 458.331(1)(g), Florida Statutes (2010-2011), by violating Section 381.031(1), Florida Statutes (2010-2011), and Rule 64D-3.029, Florida Administrative Code.

WHEREFORE, Petitioner respectfully requests that the Board of Medicine enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate.

SIGNED this 8 day of November, 2013

__________________________

John H. Armstrong, MD, FACS

Surgeon General & Secretary

__________________________

John B. Fricke, Jr.

Assistant General Counsel

DOH Prosecution Services Unit

4052 Bald Cypress Way, Bin C-65

Tallahassee, FL 32399-3265

Florida Bar No.: 0901910

(850) 245-4444 Business

(850) 245-4684 Facsimile

john.frickejr@flhealth.gov

PCP Date: November 8, 2013

PCP Members: Dr. Avila, Dr. Orr, and Ms. Georsch

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 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.