Final Order No. . FILED DATE - 29 cut of Health OF FLORIDA. "m BOARD OF MEDICINE BF \?Deputy Agency Clerk DEPARTMENT OF HEALTH, Petitioner, vs. DOH CASE NO.: 2002-14154 2002-15913 2002?18969\/ 2002-26203?? 2002-15687 2002?18966 LICENSE NO.: MEOO47340 IGNACIO A. MAGANA, M.D., Respondent. FINAL ORDER THIS CAUSE came before the BOARD OF MEDICINE (Board) on August 5, 2005, in Jacksonville, Florida, for the purpose of considering Respondent?s offer to voluntarily relinquish his license to practice medicine in the State of Florida. (Attached hereto as Exhibit A.) Said written offer of relinquishment specifically provides that Respondent agrees never again to apply for licensure as a physician in the State of Florida. Upon consideration of the written offer of voluntary relinquishment, the Charges, and the other documents of record, and being otherwise fully advised in the premises, IT IS HEREBY ORDERED that Respondent?s Voluntary Relinquishment of his license to practice medicine in the State of Florida is hereby ACCEPTED, and shall constitute discipline upon Respondent?s license. This Final Order shall take effect upon being filed with the Clerk of the Department of Health. DONE AND ORDERED this day of . - 2005. BOARD OF MEDI INE Larry Mc erson, Jr., Exec?five Director for Lau ie K. Davies, M.D., Chair CERTI FI CATE OF SERVI CE I HEREBY CERTIFY that a true and correct copy of the foregoing Final Order has been provided by U.S. Mail to IGNACIO A. MAGANA, M.D., 3370 Burns Road, Suite 200, Palm Beach Gardens, Florida 33410; to Roy Watson, Esquire, Wachovia Tower, Suite 1600, 1555 Palm Beach Lakes Boulevard, West Palm Beach, Florida 33401; and by interoffice delivery to Denise O'Brien and Dana Baird, Department of Health, 4052 Bald Cypress Way, Bin Tallahassee, Florida 32399?3265 this ZQLJ day of 2005. F: 2005 \MaganaVR .wpd Vb - Deputy Agency Clerk STATE OF FLORIDA DEPARTMENT OF HEALTH v_ mam, i vs. 3 CASE No. 2002-13350 . IGNACIO MAGANA, N0, . RESPONDENT - ADMINISTRATIVE COMES NOW Petitioner Department of Health (?Petitioner?) and files this: Administrative Complaint'before the Board of Medicine against Respondent Ignacio 'Magana, and allegesf I 1. The Board of Medicine has jurisdiction over this matter pursuant to Section 450.307 of the Florida Statutes. - Earties 2. . medicine pursuant to section 20.43, Florida Statutes, Chapter 456, Florida Statutes, and 7934 . Chapter 458, Florida Statutes Pursuant'to the provisions or Section 2028(3), From; .. Statutes, the Petitioner has contracted with the Agency for Health Care Administration to I I provide consumer complaint, investigative, and 'prosecutorial services required by the Division of.'Medicai Quality Assorance, councils, or boards, as appropriate. 3. . Respondent is,'and'has been at all times relevant to this matter, a'duly' iicensed physician pursuant to Chapter 458, Florida -- Petitioner,is: the state agency charged .with'regulating the practice of Jul-T Iladln - "Ill Cal - Factual Allegations 4. .On or about August 6, '2001,'ReSpondent performed back surgeryz'on? I. Patient T.W. secondary to a work-related injury_'IW suffered in June 2000'. Prior to performing the surgery, Respondent examined 1W during several office visits without I. incident. . 5. On or about October 4, 2001, presented to Respondent's of?ce as a follow?up to her surgery. . 6. During this visit, TW was accompanied by a female worker's compensation case manager. Respondent askedjW?s; case manager to remain in the waiting room while he examined No 'omeruperson was present during the examination. 7. Once in the examination room, TW expressed some concern to . Respondent about the viability of her worker's compensation claim. 8. Respondent then drew 1W closer to him and whispered to TW that he could help her retain her medical benefits by reporting to ,?lW's insurance carrier that I she had not reached her maximum medical improvement. As he ?did so, Respondent attempted to kiss i 9. TW pushed'Respondent away and left the office. 10. . On or about November '27, 2001, TW returned to Respondent?s office for another follow?up visit. 7936 11. TW was accompanied by her female worker's compensation case manager, who Was again asked by Respondent to remain ,in the waiting room while he examined No other person present during the examination. '12. Upon entering the examination room, Respondent locked the door and instructed lower her pants so that he could examine her longer back. 13. During the Course of the examination, Respondent put his hands inside of underpants-and began fondling her vaginal area while whispering to TW that?he could help her with her worker?s compensation claim. 14. Undeterred by demands that he stop his sexual advances, Respondent attempted to remove underpants. 15'. PS the two of-them struggled, Respondent exposed hispenisito TW and." tried to force her to have sexual intercourse with him. - TW was ultimately able to push Respondent away. 16. As Tw gathered her clothing to leave the examination room, Respondent gave 1W his personal pager number, asked if he could see_her socially outside of the. of?ce, and attempted to kiss her. 18. On or about January 29, 2062, reluctantly presented to Respondent?s of?ce for another follow?up consultation' This time?le arranged tic?have her mother meet her at Respondent's office to accompany her into ih?'?x?hiiha?reported this incident to the Palm Beach Gardens Police-Deparhnent . . . . I . amou- ulrgi-Il-?lluwll . I I I I 7937 19. TW's mother was late to arrive; and .TW was called into the examination room alone; I Betore mother could arrixre, Respondent brie?y examined neck and back and then asked to remove her pants and shoes and put on a gown. I 21. Respondent left the examination room brie?y, and when he retumed; he locked the room's door and braced a chair against it. 22. Respondent proceeded to pull W's underpants off and to dnzip his own I pants. 23. Undaunted by pleas for him to stop, Respondent proceeded to force to have sexual intercourse with him. 124'. . After leaving Respondent?s-office, reported this incident to 25. subsequently collected underpants for forensic testing. 2 - I 26. TW's next scheduled appointment with Respondent was. on Cir-about March 26, 2002. TW agreed to attend this appointment in order to assist with. their investigation of Respondent. 27. Several hours before her appointment, met with fiW and eguipped her with Video and voice recording equipment . I 28?. female worker?s compensation'case manager was present during. this visit and accompanied into/ the examination ?rais'm, Respondent subseqpently entered the examination room and instructed TW's caSe?manager to wait outside while . he examined -'Respondent and room ddrin?gmthe examination. 7938 I 29. Respondent next asked to change into a gown, which TW did; 30.. After some conversation. Respondent attempted to kiss but 31; Respondent then ordered x?rays for TW and instructed her to return to. .- see him that same day without'her. case manager; 32. When ?rw returned later that day, she was taken-to an examination room __to be seen by Respondent. No other person was present in the examination rOom. 33' Respondent SUbsequenUv entered the examination room alone and" immediately warned to" be careful about letting her case manager into the examination room. I 34.. A After. brie?y 'counsellng'rw about physical therapy, asked . . if she was upset at him and whether they could continue to be friends. Ashe asked" these questions, Respondent put his hands up shirt and fondled her breasts. 35. TW stopped Respondent and told him that she was concerned that he might have ejaculated inside of her during her January 29,. 2002 visit. Respondent; replied that he had not ejaculated and assured TW that he would noted in that manner again; 36.? On Aprilz, 2002' and April 4, 2092, spoke with Respondent by telephone while monitored their conversations. 37. - Dunno these .conxiersations, Respondent?"admitted to making sexual advances on for his behavior andreassured Tw that he -: would not act in the .. . . 38. On May 9, 2002, attested Respondent and charged him. with one count of first?degree felony sexual batteran violation of Section 794.011, Florida. ._Statutes. Count SW 39. Petitioner realleges and incorporates paragraphs 1 through 38 as if fully set forth herein. 40. Section 458.329, Florida Statutes, states as foilows: The physician?patient relationship is founded on mutual trust. Sexual misconduct in the practice of medicine means violation of the physician- patient relationship through which the physician uses said relationship to - induce or attempt to induce the patient to engage, or to engage or - attempt to engage the patient, in seixualactivity outside the scope of the _j . - practice 'or the scopebf generally accepted examination or treatment of- . the patient. Sexual misconduct in the practice of medicine is prohibited: 41. ReSpondent engaged in sexual misconduct contrary to the prohibition _.contained in Section 458.329, Florida Statutes, by touching and fondling breasts and vagina and havingzsexual intercourse with-Tw during?the course 'of a physical". examination without any legitimate medical. purpose. I. i . 242'. Based the - Statutes. - Count .II. ?ExerciSino in?uenceto En a a 'Pat'ient'inSetkuai actiui I . 43. Petitioner.reallegesand incorporates paragraphs 1 through as if'fully? set forth herein.'- 4 I 7940 patient in seanl actiuityifi 44. Section Piorida Statutes, subjects a licensee to discipiine for ?[ejxercising in?uence withina patient?physician relationship for purposes of engaging a 45; ReSpondent used his-in?uence. as a physician to engage TW in sexual: activity'that included touching and fondling .?iW's breasts and vagina and having sexual A intercourse with TW. 46. Based on? the foregoing, Respondent yioiated Section FioridaStatutes. .., .. 47. Petitioner has incurred costs reiated to the investigation and prosecution of this matter._ . 48'. Pursuant to?Section Fio'rida. Statutes, the Board of?edicine . shaii assess cosis related to the investigation and prosecution of alidisciplinary?matter on a respondent in addition to any other-discipiine imposed. I WHEREFORE, Petitioner respectfuiiy requesis the Board of Medicine enter an order against Respondent imposing one or more of the foiiowing penalties: permanent. revocation or-suspension of Respondent's license, restriction of Re5pondent's practice, . imposition of an administratiue ?ne, issuance'of a reprimand, piecement of Respondent on probation; the assessment of costs reiated to the investigation and prosecution of this case as provided for-in Section 45697280, Florida Statutes; and any other reiief that the Board deems appropriate. 7941 Daniel Hernandez 176834 SIGNED this; day of 8114qu 2002 John Secretary,-Department of Health Elana; M. . Chief Attorney - Practitioner Regulation Senior Attorney 4 Practitioner Regulation . Agency for Health Care Administration P. O. Box 14229 .- Tallahassee, Florida 32317?4229 DEP?g?grazgiAL-m PCP: JUNE 14 2002 - - I PCP ASHKAR AND BEEBE 9W -. mg) 29 loa? 7932 DEPARTMENT OFHEALTH, Petitioner, V. STATE OF FLORIDA DEPARTMENT OF HEALTH ni- .- ~u 3: DOH Case Non 2002-13350, .2002- 14154, 2002-15913, 2002-18969, 2002- 26205, 2002-25870, 2002-15687, 2002-? 18966 MD. Respondent: VOLUNTARY RELINQUISHMENT OF LICENSE lgnacio A. License No. ME 41340, hereby voluntarily relinquishes Respondent?s license to practice medicine in the State of Florida and states as follows: 1. Respondent?s purpose in executing this Voluntary Relinquishment is to avoid further administrative action with respect to this cause. Respondent . understands that acceptanceby the Board of Medicine (hereinafter the Board) of this Voluntary Relinquishment shall be construed as disciplinary action against Respondent?s license pursuant to section 45B.072, Florida Statutes. Respondent agrees to never reapply for licensor as a physician in the State of Florida. Respondent has not practiced since his suspension. Respondent further agrees to refrain from the practice of medicine until such time as this Votuntary Relinquishment is presented to the Board and the Board issues a written Finai Order in this matter. 7933 Upon the Board?s acceptance of this Voluntary Relinquishment, Respondent agrees to waive all rights to seekjudicial review of, or to otherwise challenge or contest validity of this Voluntary Relinquishment and of the Final Order of the Board?incorporating this Voluntary Relinquishment; Petitioner and Respondent hereby agree that upon the Board?s acceptance .of- this Voluntary Relinquishment, each party shall bear its own attorney's fees and costs related to the prosecution or defense of this matter. Respondent authorizes the Board to review and examine all investigative file materials concerning Respondent in connection with the Board?s consideration of this Voluntary Relinquishment. Respondent agrees that consideration of this Voluntary Relinquishment and other related materials by the Board shall not prejudice or preclude the Board, or any of its members, from further participation, consideration, or resolution?of these proceedings if the terms of this Voluntary Relinquishment are not accepted by the Board. this 25 day of .2005. - mew Before me personally appeared lgnacio Magana, whose identity is known to be by and Who acknowledges that his signature appears above. Sworn to and subscribed before me this 615 day of {35% ,2005. Notary Public 6 Commission Expires: Deborah L. Maynard 5.3 ?ameran am jag Expires Dec 2005 1-, 9 7952 STATE OF FLORIDA DEPARTMENT or HEALTH DEPARTMENT or HEALTH, I PETITIONER, 3 vs. i CASE NO. 2002?15913 A. MAGANA, M.D., 3 RESPONDENT. )3 ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, Department of Health, hereinafter referred to as ?Petitionerf? and ?les this Administrative Complaint before the Board of Medicine - against Ignacio A. Magana, M.D., hereina?er referred to as alleges: 1. Effective July 1, 1997, Petitioner is the state agency charged with regulating the practice of medicine porsuant to Section 2043, Florida Statutes, Chapter 456, Florida Statutes, and Chapter 453, Florida Statutes. 2. Respondent is and has been at all times material hereto a licensed physidan in the state of Florida, having been issued license number ME 0047340. Respondent's last known address is 3370 ,Bums Rd., Suite 200, Palm Beach Gardens, Florida 33410. 3. her about October of 1998, Patient JR injured her back at work. She was referred to the Respondent through worker?s compensation. 4. On or about April 20, 1999, Patient 1R. presented to the Respondent for a neurosurgicai evaluation. Patient complained of low back pain radiating down 7953 into her legs. The Respondent conducted a physical examination which revealed a severely limited lumbar range of motion and tenderness in her lower back. The Respondent diagnosed her with mechanical low back pain and lumbar radiculopathy. . 5. On or about May 18, 1999, Patient J.R. presented to the Respondent for follow up at which time she complained of increased back pain. The Respondent recommended that Patient 1R. undergo a lumbar iaminectomy, diskectomy and posterior lumbar interbody fusion. I 6. On or about August 2, 1999, the Respondent performed the laminectomy, . diskectomy, and posterior lumbar interbody fusion on Patient JR. 7. On or about August 24, 1999, Patient J.R. returned to the ReSpondent?s _of?ce for follow up. During her visit with the Respondent, he'commented on how Patient hair looked nice, how she must have lost weight, and that he liked-her lipstick. I - 8. On or about September 21, 1999, Patient. SLR. returned to the Respondent's of?ce for follow up. On that date, the Respondent again commented that he liked Patient J..R.'s lipstick and further stated that he just liked her lips. 9. On or about January 25, 2000, Patient J.R. presented to the Respondent for. follow up complaining of bilateral hip pain and'knee pain. He ordered a repeat 10. - On or about February 22, 2000, Patient J.R. presented to the Respondent for follow up regarding her neck and low back pain. When the Respondent entered the A examination room where Patient 1R. was waiting for him, he locked the door behind him. He then proceeded to physically examine her. He stood behind her and began to 7954 rub her neck, stating that she had spasms in her neck. Patient J.R. then felt the ReSpondent press his erect penis against her leg and begin rubbing his erection on her leg. While doing so, the Respondent stated that he could be persuaded to make house- calls. Patient rejectedthe Respondent?s advances and stepped away from him. He responded by telling 'her that he was going to put her at maximum medical improvement. Patient 1R. left his of?ce and did not return again. 11. Respondent inappropriately exercised in?uence within a patient-physician relationship for the purpose of engaging a patient in sexual activity in that Respondent perpetrated an act upon Patient 1R. which was sexual in nature and which was not performed for any legitimate medical purpose. 12. Section 458.329, Florida Statutes, states that the physician-patient relationship is founded on mutual trust. Sexual misconduct in the practice of medicine means violation. of the physician-patient relationship through which the physician uses said relationship to induce the patient to engage, or to engage or attempt to engage the patient, in sexual activity outside the scope of the practice or the scope of generally accepted examination or treatment of the patient. Sexual misconduct in the practice of medicine is prohibited. 13. Rule 648-9008, Florida Administrative: Code, states in part that sexual contaCt with a patient is sexual misconduct, which includes, but is not limited to, verbal or physical behavior which may reasonably be interpreted as romantic involvement with a patient regardless of whether such involvement occurs in the professional setting or outside of it; may reasonably be interpreted as intended for the sexual arousal or 7955 - grati?cation of the physician, the patient or any third party; or may be reasonably interpreted as being sexual. EXERCISING INFLUENCE IN PATIENT - PHYSICIAN . RELATIONSHIP I 14. Petitioner realleges and incorporates paragraphs one (1) through thirteen (13), as if fully set forth herein this Count One. 15. Respondent exercised in?uence within a patient-physician relationship for purposes of engaging a patient in sexual activity, in that Respondent rubbed his erect penis against Patient leg during a physical examination at his office. 15. Based on the foregoing, Respondent violated Section Florida Statutes, by exercising in?uence within a patient-physician relationship for purposes of engaging a patient in sexual activity. A patient shall be presumed to be incapable of giving free, full, and informed consent to sexual activity with his or her physician. gouuT Two- SEXUAL MISCONDUCT 17. Petitioner realleges and incorporates paragraphs one (1) through thirteen (13), as if fully set forth herein this Count Two. .18. Respondent violated the express prohibition against sexual? misconduct stated in Section 458.329, Florida Statutes, and Rule 648-9008, Florida Administrative Code in that Respondent rubbed his erect penis against Patient leg during a physical examination at his office. 19. Based on the foregoing, Respondent violated Section Florida Statutes, by violating any provision ?of Chapter 458, Florida Statutes, a ruleof the board or department, or a lawful order of the board or department previously entered in a disciplinary hearing or failing to comply with a lawfully issued subpoena of the department. COUNT THREE -- STANDARD OF CARE VIOLATION 20. Petitioner realleges and incorporates paragraphs one (1) through thirteen (13), as if fully set forth herein this Count Three. A 21. . Respondent failed to practice medicine with that level of care, skill, and treatment, which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances, in that the Respondent rubbed . his erect penis against Patient leg during a physical examination at his office. 22. Based on the foregoing, Respondent has violated Section Florida Statutes, by failing to practice medicine with that level of care, skill, and .treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. 99.515. 23. Petitioner has incurred costs related to the investigation and prosecution of this matter. 24. Pursuant to Section Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter on a respondent in addition to any other discipline imposed. 7956 WHEREFORE, the Petitioner respectfully requests that the Board of Medicine enter an . Order assessing administrative costs. related to the investigation and prosecution of this case as provided for in Section Florida Statutes, in addition to or as wellas imposing one or more of the following penalties: permanent revocation or suspension of Respondent?s license, restriction of practice, imposition of an administrative ?ne, issuance of a reprimand, placement of the Respondent on probation, corrective action and/or any other relief that the Board deems appropriate. SIGNED this and day of Wm rC 200,213 John O. Agwunobi, M.D., M.B.A. Secretary, Department of Health - oEPAnmem or HEALTH Kim M. Kluck PUTY CLERK Assistant General Counsel CLERK Km Fla. Bar 0040957 DATE 31% 4? DOH, Prosecution Services Unit I 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 323998250 Phone (850)488-4518 Fax (850)414-1989 Reviewed and approved L7 (s KMK PCP: Q\ai\c>3 PCP Members: gom judk WY 3 7957 7958 STATE OF FLORIDA DEPARTMENT or HEALTH DEPARTMENT or HEALTH, .) PETITIDNER, - i - vs. CASE No. 2002-26205 A. MAGANA, M.D., RESPONDENT. ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, Department of Health, by and through undersigned counsel, and ?les this Administrative Complaint before the Board of Medicine against Respondent, Ignacio A. Magana, M.D., and 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. I 2. At, ali times material to this Complaint, Respondent was a licensed physician within the state of Florida, having been issued license number ME 0047340. 3. . Respondent?s address of record is 3370 Burns Rd., Suite 200, Palm Beach Gardens, Florida 33410. 4. Respondent is?board certified in neurological surgery. 5. On or. about June 15, 1996, Patient T.E.C. was involved in a motor vehicle accident and taken to the-Palm Beach Gardens Medical Center emergency room for treatment. At that time, the emergenqr room physician referred her to the Respondent for a neurological consultation. 7959 6. On or about July 2, 1996, Patient T.E.C. presented to the Respondent with complaints of neck pain and shoulder pain. The Respondent conducted a physical examination, a neurologic examination, and a review of Patient imaging studies. 'He diagnosed her with a cervical sprain. The Respondent recommended physical therapy and muscle relaxants. 7. From July 2, 1996, to March 25, 1997, Patient T.E.C.?con?nued to treat with-the Respondent. On each occasion that she went to his office, the Respondent would make suggestive comments to Patient T.E.C. and try to kiss her. 8. On or about March 25, 1997, Patient T.E.C. presented to the Respondent and advised that she was experiencing worsening neck and arm pain. The Respondent discussed with Patient T.E.C. the possibility of surgery to preserve neurologic function and reduce pain. Patient T.E.C. decided to proceed with back surgery. 9. On or about April 28, 1997, Patient T.E.C. presented to the ReSpondent at the St. Mary?s Hospital where he performed an anterior cervical diskectomy and arthrodesis with a strut graft atithe (IS-ti level. Patient tolerated the procedure well and was discharged from the h05pital two days later. ReSpondent prescribed pain medications and instructed her to follow up with him at his of?ce in two weeks. 10. From May 13, 1997, to June 30, 1993, Patient T.E.C. followed up with the Respondent for her back problems. The Respondent routinely locked the door to the examination room, whispered in her ear to ask how she was doing, told her that she was beautiful, hugged her, and tried to kiss her. On those occasions when the Respondent hugged her, Patient T.C. could feel that he had an erection. And on I Several occasions, the Respondent would take Patient T.E.C.'s hand and place it on his 7960 penis. 11. In August of 2001, Patient T.E.C. was involved in another automobile accident and returned to the Respondent tor treatment. During her appointments on August 30, 2001, September 27, 2001, and December 4, '2001, the Respondent continued to make sexual advances on Patient T.E.C. by trying to kiss her. 12. On or about January 22, 2002, Patient T.E.C. presented to the Respondent for follow up. The Respondent entered the room, locked the door behind him, and tried to kiss Patient T.E.C. Patient T.E.C. leaned away from the Respondent. He' then instructed Patient T.E.C. to stand up and face away from him. The Respondent checked Patient range of motion in her neck, lifted up her skirt, moved her undenlvear to the side, and tried to put 'his penis into her vagina. She immediately turned around and told him The Respondent had his erect penis out of his pants and there was what appeared to be semenlon the tip of his penis. 13. Respondent inappropriately exercised in?uence within a patient-physician I relationship for the purpose of engaging a patient in sexual activity in that Respondent perpetrated acts upon Patient T.E.C. which were sexual in nature and which were not performed for any legitimate medical purpose. 14. Section 453.329, Florida Statutes, states that the physician-patient relationship is founded on mutual trust. Sexual misconduct in the practice of medicine means violation of the physician-patient relationship through which the physician uses said relationship to induce the patient to engage, or to engage or attempt to engage the patient, in sexual activity outside the scope of-the practice or the scope of generally accepted examination or treatment of the patient.- Sexual misconduct in the practice of 7961 medicine is prohibited. 15. Rule 648-9008, Flon'da Administrative Code, states in part that sexual contact with a patient is sexual misconduct, which includes, but is not limited to, verbal or physical behavior which may reasonably be interpreted as romantic involvement with a patient regardless of whether such involvement occurs in the professional setting or outside of it; may reasonably be interpreted as intended for the sexual arousal or grati?cation of the physician, the patient or any third party; or may be reasonably interpreted as being sexual. . COUNT one EXERCISING INFLQENCE IN PATENT - 16. Petitioner realleges and incorporates paragraphs one (1) through fifteen (15), as if fully set forth herein this Count One. 17. Section Fiorida Statutes, sets form grounds for disciplinary action by the Board. of Medicine and provides that a physician may be subject to discipline for exercising in?uence within a patient-physician relationship for purposes of engaging a patient in sexual activity. It further provides that a patient shall be presumed to be incapable of giving free, fuli, and informed consent to sexual activity with his or her physician. 18. Respondent exercised in?uence within a'patient-physician relationship for purposes of engaging a patient in sexual activity, in that Respondent hugged Patient T.E.C. while he had an erection, tried to kiss Patient T.E.C., placed Patient hand on his penis, and/or attempted to penetrate Patient vagina with his erect penis. 7962 19. Based on the foregoing, Respondent violated Section Florida Statutes, by exercising in?uence within a patient-physician relationship for pUrposes of engaging a patient in sexual activity. 20. Petitioner realleges and incorporates paragraphs one (1) through fifteen (15) as if fully set forth herein this Count Two. 21. Section Florida Statutes, sets forth grounds for disciplinary action by the Board of Medicine and provides that a physician may be subject to discipline for violating any provision of Chapter 458, Florida Statutes, Chapter 455, Florida Statutes, orany 'ruies adOpted pursuant thereto. 22. Respondent violated the express prohibition against sexual misconduct stated in Section 458.329, FloridaIStatutes, and Rule 648-91308, Florida Administrative Code, in that Respondent hugged Patient T.E.C. while he had an erection, tried to kiss Patient T.E.C., placed Patient T.E.C.'s hand on his penis, and/or attempted to penetrate Patient vagina with his erect penis. 23. Based on the?foregoing, Respondent violated Section Florida Statutes, by violating Chapter 458.329, Florida Statutes, and Rule 648-9308, Florida Administrative Code. - 24. Petitioner realleges and incorporates paragraphs one (1) through ?fteen (15) as if fully set forth herein this Count Three. 25. Section Florida Statutes (2001), sets forth grounds for ?1?"disciplinary action by the Board of Medicine and provides that a physician may be 7963 subject to discipline for gross or repeated malpractice or the failure to practice medicine with that level of care, 'skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. 26. ReSpondent failed to practice medicine With that level of care, skill, and treatment, which is recognized by a reasonably prudent similar-physician as being acceptable under similar conditions and circumstances, in that the ReSpondent hugged Patient T.E.C. while he had an erection, tried to kiss Patient T.E.C., placed Patient hand on his penis, and/or attempted to penetrate Patient vagina with his erect penis. . 27. Based on the foregoing, Respondent has violated Section Florida Statutes, by failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and. circumstances. WHEREFORE, the 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 ?ne, 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. 31,;er SIGNED this 2395? day of . 2003. John O. Agwunobi, M.D., M.B.A. Secretary, Department of Health 53% Kim M. Ki?ck- Assistant General Counsel Florida Bar No.: 0040967 - . DOH Prosecution Services Unit . ?Ema 4052 Bald Cypress Way, Bin C-65 ?gment gm? Tallahassee, FL 32399-3265 P. - ?rst? (850) 488-4451 CLERK. ?k 2; ?3 I (850) 414-1989 FAX 0m: Reviewed and approved byM?nitials) 9- (date) pCp;June 20, 2003 Members: El-Bahri, Long, McMillin Magana, 00H Case No. 2002-26205 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 quali?ed 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 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. 7964 7965 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT or HEALTH, . PETITIDNER, vs. 3 CASE NO. 2002-18966 IGNACIO A. MAGANA, M.D., 3 I RESPONDENT. )3 COMES NOW the Petitioner, Department of Health, by and through undersigned counsel, and ?les this Administra?ve Complaint before the Board of Medicine against Respondent, Ignacio A. Magana, M.D., and 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 0047340. 3. Respondent's address of record is 3370 Burns Rd., Suite 200, Palm Beach Gardens, Florida 33410. 4. Re5pondent is board certified in neurological surgery. 5. On or about April 20, 1999, Patient L.H. presented to the Respondent for a second neurosurgical opinion regarding her chronic-low back pain. The Respondent conducted a physical examination, a neurologic examination, and a review of Patient -L.H.'s imaging studies. He diagnosed her with continuing mechanical low back and 1 .7966 lumbar radiculopathy. The Respondent recommended a number of 'diagnostics tests including a lumbar myelogram, a CT scan, an EMG and nerve conduction study, and a hip x?ray. 6. Onor about May 18, 1999, Patient L.H. returned to the Respondent for foliow~up at which time she continued to complain of low back pain. The diagnostic tests revealed bulging discs at L1-2, L2-3, L3-4 and The Respondent ordered a SPECT bone scan to determine whether Patient L.H. had some facet disease. 7. On or about June 8, 1999, Patient L.H. returned to the ReSpondent to review the results of the bone scan. The scan revealed pathology at the right L- 4 facet. The Respondent recommended facet injections. 8. On or about August 10, 1999, Patient L.H. returned to the Respondent after receiving several facet injections in the right lower lumbosacral region. Patient LW. reported that the injections did not relieve her lower back pain. The Respondent ordered lumbar ?exion and extension views to determine whether any occult instability was present. 9. On or about August 24, 1999, Patient L.H. returned for follow Up to the Respondent. During the appointment, the Respondent began touching Patient L.H. on her arm and complimenting her on how good she looked. As Patient L.H. was standing at the end of the exam table, the Respondent pressed himself against her and kissed her. Patient LH. could feel that the Respondent had an erection at the time. She pushed away and he tried to kiss her again. She again pushed the Respondent away to which he stated ?we?re being bad aren't we?? The Respondent again tried to kiss Patient L.H., at which time she pushed him away and headed for the door. The 7967 o?r' Respondent made Patient L.H. kiss him on the cheek before he would let her leave the exam room. In Patient medical records, the Respondent noted that Patient L.H. continued to have pain in her right middle back region and that he wanted to pursue conservative measures. He noted no other plan of treatment. Patient L.H. did not return to the Respondent's of?ce for another eight months. 10. In or about April 25, 2000, Patient L.H. returned to the Respondent in follow up. In the examination room, the Respondent forced Patient LH. into the a comer and kissed Patient L.H. while he pressed his erect penis against her. Patient L.H. tried to back away from him, but the Respondent pinned her against the exam table and kissed her again as he rubbed his erection against her. She pushed him off again and tried to leave,-but the Respondent stood between her and the door, refusing to let her leave until she gave him a kiss. Patient L.H. kissed the Respondent on the :cheek and he allowed her to leave. 11. On or about August 1, 2000, Patient L.H. presented to the Respondent for foildw up. Patient L.H. complained of continuing low back pain and the Respondent advised her that she was a candidate for a new procedure, but that she would have to wait another six months until all the procedure was approved by the American Medical Association. While looking at one of Patient scars from a previous surgery, the Respondent shoved his hand down her pantyhose and grabbed her in her vaginal area. She pulled his hand out and tried to leave the room at which time the Respondent blocked the door and insisted that she kiss him before she could leave. Patient L.H. refused and left, never to return again. i 12. Respondent inappropriately exercised in?uence within a patient-physician 7968 relationship for the purpose of engaging a patient in sexual activity in that Respondent perpetrated acts upon Patient LH. which were sexual in nature and which Were not performed for any legitimate medical purpose. . 13. Section 458.329, Florida Statutes, states that the physician-patient relationship is founded on mutual trust. Sexual misconduct in the practice of medicine means violation of the physician~patient relationship through which the physician uses said relationship to induce the patient to engage, or to engage or attempt to engage the patient, in sexual activity outside the scope of the practice or the scope of generally accepted examination or treatment of the patient. Sexual misconduct in the practice of medicine is prohibited. 7 14. Rule 6488.003, Florida Administrative Code, states in part that sexual contact with a patient is sexual misconduct, which includes, but is not limited to, verbal or physical behavior which may reasonably be interpreted as romantic involvement with _a patient regardless of whether such involvement occurs in the professional setting or outside of it; may reasonably be interpreted as intended for the sexual arousal or grati?ca?on of the physician, the patient or any third party; or may be reasonably interpreted as being sexual. COUNT ONE - EXERCIQNG INFLUENCE IN PATIENT - RELATIONSHIP 15. Petitioner realleges and incorporates paragraphs one (1) through fourteen (14) as if fully set forth herein this Count One. 16. Section Florida Statutes, sets forth grounds for disciplinary action by the Board of Medicine and provides that a physician may be subject to discipline for exercising influence within a patient-physician relationship for purposes of 4 7969 engaging a patient in sexual activity. It further provides that a patient shall be presumed to be incapable of giving free, full, and informed consent tosexual activity with his or her physician. 17. Respondent exercised in?uence within a patient-physician relationship for purposes of engaging a patient in sexual activity, in that Respondent kissed Patient L.H. while he had an erection and grabbed Patient L.H.'s vaginal area. 18. Based- on the foregoing, Respondent violated Section Florida Statutes, by exercising in?uence within "a patient-physician relationship for purposes of engaging a patient in sexual activity. COUNT MISCON DUCT 19. Petitioner reaileges and incoi'porates paragraphs one (1) through fourteen (14) as if fully set forth herein this Count Two. 20. Section Florida Statutes, sets forth grounds for. disciplinary action by the Board of Medicine and provides that a physician may be subject to discipline for violating any provision of Chapter 458, Florida Statutes, Chapter 456, Florida Statutes, or any rules adopted pursuant thereto. 21. Respondent violated the express prohibition against sexual misconduct stated in Section 453.329, Florida Statutes, and Rule mas-9.008, Florida Administrative Code, in that Respondent kissed Patient L.H. while he had an erection and grabbed Patient vaginal area. - 22. Based on the foregoing, Respondent violated Section Florida Statutes, by violating Chapter 458.329,, Florida Statutes, and Rule 6488-9008, Fibrida Administrative Code. 7970 MT - OF CARE VIOLATION 23. Petitioner realleges and incorporates paragraphs one (1) through fourteen (14) as if fully set forth herein this Count Three. 24. Section Florida Statutes (2001), sets forth grounds for disciplinary action by the Board of Medicine and provides that a physician may be I subject to discipline for gross or repeated malpractice or the failure to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. 25. Respondent failed to practice medicine with that level of care, skill, and treatment, which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances, in that the Respondent kissed Patient L.H. while he had an erection and grabbed Patient L.H.'s vaginal area. 26. Based on the foregoing, Respondent has violated Section Florida Statutes, by failing to prach?ce medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. I WHEREFORE, the 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 ?ne, 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 apprOprlate. ea SIGNED this 93 day of quea- ,2003. 7971 John D. Agwunobi, M.D., M.B.A. Secretary, Department of Health ED 1? Kim M. Kluck ?$13,251 7, Assistant General Counsel DE 059m . Florida Bar No.: 0040967 GEEK. L): 93> DOH Prosecution Services Unit TE 4052 Bald Cypress Way, Bin C-65 0? Tallahassee, FL 32399?3265 (850) 483-4451 (850) 414-1989 FAX Reviewed and approved by: bg??nitials) 5,532.42 (date) PCP: June 20, 2003 PCP Members: El-Bahri, Long, McMillin Magana, DOH Case No. 2002?18966 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 quali?ed representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena ducestecum 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 Florida Statutes, the Board shall assess costs related to the investigation and prosecution ofa disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any?other discipline imposed. . 7972 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, vs. 3 CASE No. 2002-18969 IGNACIO A. MAGANA, M.D., RESPONDENT. i 12E. COMES NOW the Petitioner, Department of Health, by and through undersigned counsel, and ?lesthis Administrative Complaint before the Board of Medicine against Respondent, Ignacio A. Magana, M.D., and 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 0047340. 3. Respondent's address of record is 3370 Burns Rd., Suite 200, Palm-Beach Gardens, Florida 33410. 4. Respondent is board certi?ed in neurological?surgery. 5. On or about February 22, 2000, Patient C.S. presented to the Respondent for a Second neurosurgical opinion and independent medical examination regarding neck pain and left arm pain related to an injury that she suffered while working as a paramedic. The Respondent conducted a physical examination, a neurologic 1 examination, and a review of Patient imaging studies. His impression was that Patient C.S. suffered from mechanical neck pain and cervical radiculopathy. He advised Patient C5. of the possible bene?ts of surgery, which she declined at that time. 6. On or about June 27, 2000, Patient (25. returned to the Respondent for follow-up at which time she complained of arm numbness and neck pain. The Re5pondent again discussed the anterior cervical discectomy and fusion procedures with her. Patient C.S. decided to undergo the procedures, which were scheduled for August 21, 2000. I On or about August. 21, 2000, Patient?C.S. presented to the Palm Beach Gardens Medical Center where the Respondent performed an anterior cervical discectomy and fusion at C5-6 and C6-7, with autograft and titanium plate. 8. On or about September?lz, 2000, Patient C.S. returned to the Respondent for post-operative follow up at his of?ce. At that time, Patient CS. was experiencing. some post-operative stiffness. The Respondent noted that she would be able to begin physical therapy in approximately four weeks. 9. On' or about May 8, 2001, Patient returned for follow up to the Respondent following the completion of her physical therapy. Patient complained of recurrent neck and arm pain. The Respondent recommended a cervical myelogram and CT scan. During the appointment, the ReSpondent began touching Patient C.S.'s arm and shoulders while telling her that she was pretty, sexy, and was turning him on. He stared ether breasts while making these suggestive comments. 10. On or about-July 21, 2001, Patient CS. went to Palm Beach Gardens Medical Center to visit her husband who had been hospitalized and was being treated 7974 by the Respondent, While sitting in her husband's hospital room, the Respondent came in to discuss his condition with Patient C5. The Rspondent took Patlent (2.5. to his office at the hospital under the guise of talking to her about her husband's condition. Once alone Patient C5. In his ofi'ice, the Respondent grabbed her and kissed her. He then smrted to grape her all over her body and threw her against the desk in his office, He removed his pants and attempted to penetrate her with his penis from behind. The Respondent then flipped Patient over and penetrated her his penis frontally and told her that he was '-her now." He also grabbed her breast and sucked on it. 11. Respondent lnappropriately exercised influence within a patient-physician relationship for the purpose of engaging a patient in sexual activity in that Respondent perpetrated acts upon Patient LH. which were mual in nature and which were not performed for any legitimate medial purpose. 12. Section 458.329, Florida Statutes, states that the physician-patient relationship is founded on mutual mist. Sexual miscondua in the practice of medicine meats violation of the physician-patient relationship through which the physician uss said relationship to induce the patient to engage, or to engage or attempt to engage the patient, in sexual activity outside the scope of the practice or the scope of genelally accepted examination or treatment of the patient. Sexual misoondua In the practice of medicine ls prohibited. 13, Rule 648-9008, Florida Administrative Code, states in part that sexual contact with a patient ls sexual misconduct, which include, but is not limited to, verbal or physical behavlor which may reasonably be interpreted as romantic involvement with a patient regardless of whether such involvement occurs in the professional setting or outside of it; may reasonany be interpreted as intended for the sexual arousal or grati?cation of the physician, the patient or any third partyi or may be reasonably interpreted as being sexual. COUNT ONE EXERCISING INFLUENCE IN PATIENT - PHYSICIAN RELATIONS IP 14. Petitioner realleges and incorporates paragraphs one (1) through thirteen (13) as if fully set forth herein this Count One. 15. Section Florida Statutes, sew forth grounds for disciplinary action by the Board of, Medicine and provides that a physician may be subject to discipline for exercising influence within alpatient-physician relationship for purposes of engaging a patient in sexual activity. It further provides that a patient shall be presumed to be incapable of giving free, full, and informed consent to sexual activity with his or her physician. 16. Respondent exercised in?uence within a patient-physician relationship for purposes of engaging a patient in sexual activity, in that Respondent made sexually suggestive comments to Patient C.S., kissed Patient C.S., forcibly had sexual intercourse with patient and grabbed and sucked on Patient breast. 17. Based on the foregoing, Respondent violated Section Florida Statutes, by exercising in?uence within a patient-physician relationship for purposes of engaging a patient in sexual activity. COUNT TWO- SEXUAL MISCONDUCT 18. Petitioner reaileges and incorpoiates paragraphs one (1) through thirteen 7 (13) as if fully set forth herein this Count Two. 4 7975 7976 19. Section Florida Statutes, sets forth grounds for disciplinary action by the Board of Medicine and provides that a physician may be subject to discipline for vioiating any provision of Chapter 458, Florida Statutes, Chapter 456, Florida Statutes, or any rules adopted pursuant thereto. A Respondent violated the express prohibition against sexual misconduct stated in Section 458.329, Fiorida Statutes, and Rule Administrative Code, in that Respondent made sexually suggestive comments to Patient C.S., kissed Patient 9.5., forcibly had sexual intercourse with Patient (2.5., and grabbed and sucked on Patient breast. 21. Based on the foregoing, Respondent violated Section Florida Statutes, by'violating Chapter 458329, Florida Statutes, and Rule 6413-9308, Florida Administrative Code. A COUET THREE - ST ANDARQOF CARE VIOLATION 22. Petitioner realleges and incorporates paragraphs one (1) through thirteen (13) as if fully set forth herein this Count Three. 23. Section Florida Statutes (2001), sets forth grounds for disciplinary action by the Board of Medicine and provides that a physician may be subject to discipline for gross or repeated malpractice or the failure to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. 7977 24. Respondent failed to practice medicine with that level of care, skill, and treatment, which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances, in that the Respondent made sexually suggestive comments to Patient C.S., kissed Patient C.S., forcibly had sexual intercourse with Patient C.S., and grabbed and sucked on Patient breast. 25. Based on the foregoing, Respondent has violated Section Florida Statutes, by failing to practice medicine that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. WHEREFORE, the 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 ?ne, issuance of a reprimand, placement of the Re5pondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. rd xen- SIGNED this 3" day of \l 2003. John 0. Agwunobi, Secretary, Department of Health 0? WE a p. oeragepw (Earl- ?1020? o0? DATE Kim M. Kiuck Assistant General Counsel Florida Bar No.: 0040967 DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 (850) 488?4451 (850) 414-1989 FAX 7978 Reviewed and approved by: ML, (initials) ?5:30! 0 3 (date) PCP: June 20, 2003 Members: El-Bahri, Long, McMillin Magana, 00H Case No. 2002-18959 NOTICE or 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 quali?ed 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 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. 7979 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, VS. CASE NO. 2002-25870 IGNACIO A. MAGANA, M.D., RESPONDENT. COMES NOW the Petitioner, Department of Health, by and through its undersigned counsel, and ?les this Administrative Complaint before the Board of Medicine against Ignacio A. Magana, M.D., and alleges: 1. Petitioner is the state agency charged with regulating"the practice of medicine pursuant to Section 20.43, Florida Statutes, Chapter 456, Florida Statutes, and Chapter 458, Florida Statutes. 2. ReSpondent is and has been at all times material hereto a licensed physician In the state of Florida, having been issued license number ME 0047340. Respondent?s last known address is 3370 Burns Rd., Suite 200, Palm Beach Gardens, Florida 33410. 3. Respondent is board certi?ed in neurological surgery. 4. On or about January 22, 2002, Patient J.B. presented to the Respondent for'a complaint of back pain dating back to a motor vehicle accident in 1995. 5. on or about January 22, 2002, the Respondent conducted a physical 7980 examination, a neurologic eXamination, and a review of Patient imaging studies. He diagnosed her with a disrupted and herniated disk with an extruding disk fragment at The Respondent recommended that Patient J.B. undergo an anterior lumbar interbody fusion procedure at the LS-SI level, to which Patient J.B. agreed. During the course of the of?ce visit the Respondent told Patient J.B. that she was attractive and was her ?special patient." 6. On or about January 30, 2002, Patient J.B. presented to the Respondent at the Palm Beach Gardens Medical Center where he performed the interbody fusion. Patient J.B. tolerated the procedure well and remained at the medical center for three days to recover. I . 7. On or about February 2, 2002, me Respondent discharged Patient 3.8. with pain medication and a plan to have a home health care nurse administer subcutaneous injections of Lovenex (for prevention of deep vein thrombosis and pulmonary?embolism) every day for a week. Patient J.B. was scheduled for follow up with the Respondent at his of?ce in two weeks. 7 8. On or about February 14, 2002, Patient J.B. presented to the Respondent for post?operative follow up. Patient J.B. was taken to an exam room by one of the nurses where she waited for the Respondent. When the Respondent entered the room, he locked the door behind him. He asked Patient J.B. how she was by whispering it in her ear. The Respondent then instructed Patient J.B. to remove the back brace and lay. down on the examination table so that he could look at her incisionf Patient J.B. unzipped her pants and moved them down to just above her thighs. The Respondent 7981 felt the scar on her lower back and then slid his hand down her pants and penetrated her vagina with his ?nger. While doing so, he asked ?Don't you like it?" Patient 18. immediately pulled his hand out and told him that she would have none?of that. Patient 1.8. then let: and scheduled a follow up appointment for four weeks. 9. Prior to Patient J.B.'s next appointment, the Respondent telephoned her at home several times to ask how ?special patient? was. on one occasion, the ReSpondent called and asked Patient 3.3. if she wanted to go out to dinner with him and go out on his boat. 10. Qn or about March 5, 2002, Patient J.B. returned to thevRespondent's of?ce for follow up. On that date, the Respondent again locked the door to the exam room. During the visit, the Respondent grabbed Patient 3.8. by the buttocks and kissed her. When he pulled her against his body, Patient 1.8. felt that the Respondent hadan erection. Patient J.B. pushed the Respondent away and told him that she was married and reminded him that he-was, too. 11. On or about April 12, 2002, Patient 13. presented to the Respondent for follow up. During this appointment, the Respondent grabbed Patient 3.8. again and kissed her. She pulled away from him and told him The Respondent then asked Patient 3.3. if she was going to get him into trouble. He also told her that she was a very beautiful person and that she shouldn?t let a man take advantage of her. 12. Respondent inappropriately exercised in?uence within a patient-physician? relationship for the purpose of engaging a patient in sexual activity in that Respondent perpetrated acts upon Patient 3.8. which were sexual in nature and which were not 7982 performed for any legitimate medical purpose. 13. Section. 458.329, Florida Statutes, states that the physician-patient relationship is founded on mutual trust. Sexual misconduct in the practice of medicine means violation of the physician?patient relationship through which the physician uses said relationship to induce the patient to engage, or to engage or attempt to engage the patient, in sexual activity outside the scope of the practice or the scope of generally accepted examination or treatment of the patient. Sexual misconduct in the practice of medicine is prohibited. 14. Rule 643-9008, Florida. Administrative Code, states in part that sexual contact with a patient is sexual misconduct, which includes, but is not limited to, verbal or physical behavior which may reasonably be interpreted as romantic involvement with a patient regardless of whether such involvement occurs in the professional setting or outside of it; may reasonably be interpreted as intended for the sexual arousal or grati?cation of the physician, the patient or any third party; or may be reasonably interpreted as being sexual. COUNT ONE EXERCISING INFLUENCE IN PATIENT - RELATIONSHIP 15. Petitioner realleges and incorporates paragraphs one (1) through fourteen (14) as if fully set ?rth herein this Count One. 15. Section Florida statutes, sets forth grounds for disciplinary action by the Board of Medicine and provides that a physician may be subject to discipline for exercising influence within a patient-physician relationship for purposes of ?xengaging a patient in sexual activity. It further provides that a patient shall be 4 7983 presumed to be incapable of giving free, full, and informed consent to sexual activity with his or her physician. 17. Respondent exercised in?uence within a patient-physician relationship for purposes of engaging a patient in sexual activity, in that Respondent penetrated Patient vagina with his finger, kissed her, and/or grabbed her buttocks. 18. Based on the foregoing, Respondent violated Section Florida Statutes, by exercising influence within a patient?physician relationship for purposes of engaging a patient in sexual activity. A patient shall be presumed to be incapable of giving free, full, and informed consent to sexual activity with his or her physician 19. Petitioner realleges and incorporates paragraphs one (1) through fourteen (14) as if fully set forth herein this Count Two. 20. Section Florida Statutes, sets forth grounds for disciplinary action by the Board of Medicine and provides that a physician may be subject to discipline for violating any provision of Chapter 458, Florida Statutes, Chapter 456, Florida Statutes, or any rules adopted pursuant thereto. 21. Respondent violated the express prohibition against sexual misconduct stated in Section 458.329, Florida Statutes, and Rule 648-9008, Florida Administrative Code, in that Respondent penetrated Patient vagina with his finger, kissed her, and/or grabbed her buttocks. 7984 22. Based on the foregoing, Respondent violated Section Florida Statutes, by violating any provision of Chapter 458, Florida Statutes, a rule of the board or department, or a lanul order of the board or department previously entered in a disciplinary hearing or failing to comply with a lawfully issued subpoena of the department. COUNT THREE - STANDARD OF CARE VIOLATION 23, Petitioner realleges and incorporates paragraphs one (1) through fourteen (14) as if fully set'forth herein this Count Three. 24. Section Florida Statutes (2001), sets forth grounds for disciplinary action by the Board of Medicine and provides that a physician may be subject to discipline for gross or repeated malpractice or the failure to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. 25. Respondent failed to practice medicine with that level of care, skill, and treatment, which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances, in that the Respondent penetrated Patient J.B.'s vagina with his finger, kissed her, and/or grabbed her buttocks. 26. Based on the foregoing, Respondent has violated Section Florida Statutes, by failing to practice medicine with that level of care, skill, and treatment-which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. 7 985 WHEREFORE, the 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 ?ne, 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. i SIGNED this 93? day of . 2003. John 0. Agwunobi, Mo, M.B.A. Secretary, Department of Health Ki?m Assistant General Counsel Florida Bar No.: 0040967 DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 (850) 488-4451 (850) 414?1989 FAX avast? whim? oat 925%; ll 05 stat otUna Reviewed and approved t3mi (initials) 03> (date) PCP: June 20, 2003 PCP Members: El-Bahri, Long, MoMillin Magana, 00H Case No. 200225870 7986 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 quali?ed 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 Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 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. 7987 STATE OF FLORIDA DEPARTMENT or: HEALTH - DEPARTMENT or HEALTH, PETITIONER, vs. CASE No. 2002-15687 M.D., 3 RESPONDENT. 3 COMPLAINT COMES now thePetitioner, Department of Health, hereinafter referred to as ?Petitioner,? and ?les this Administrative Complaint before the Board of Medicine against Ignacio A. Magana, M.D., hereinafter referred to as ?Respondent,? and alleges: 1. Effective July 1, 1997?, Petitioner is the state agency charged with regulating'the practice of medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 458, Florida Statutes. . 2. Respondent is and has been at'all times material hereto a licensed physician in the state of Florida, having been issued license number ME 0047340. Respondent?s last knoiivn address is 3370 Burns Rd., Suite 200, Palm Beach Gardens, Florida 33410. 3. On or about February 11, 1996, Patient 3.2. injured her back on an escalator at the mall. 4. On or about January 27, 1998, Patient 3.2. presented to the Respondent at his of?ce in Palm Beach Gardens for an independent medical examination. At that 7988 time, Patient J.Z. complained of neck and back pain. The Respondent conducted'a physical examination which revealed limited cervical and lumbar range of motion and tenderness inI-her. neck, upper back and lower back. The Respondent's impression was that Patient 3.2. had developed mechanical neck and back pain and cervical and lumbar radiculopathy. The Respondent recommended physician follow up, pain medications, physical therapy and diagnostic tests. 5. On or about August 16, 2001, Patient J.Z. presented to the Respondent at his of?ce for her?continued complaints of low back and neck pain with occasional neck, shoulder, and arm pain. The Respondent conducted" a physical examination which revealed a limited cervical and lumbar range of motion, no atrophy or fasciculation (involuntary contraction of groups of muscle ?bers) of the extremities, and tenderness of the lumbosacral iunction. The Respondent diagnosed Patient 3.2. with mechanical back pain and lumbar radiculopathy. 6. The Respondent advised Patient 3.2. that her condition was very severe and that he did not know if he could help, but that he would try. Patient 12. revealed to him that she was currently going through a divorce and custody'battle which was I causing her a lot of sbess. The Respondent left the exam room brie?y. When he returned, he locked the door behind him and proceeded to discuss Patient personal dif?culties until Patient 31. became emotionally upset. The Respondent then hugged Patient 3.2. and looked at Patient 3.2. with what she perceived to a longing stare. The Respondent gave Patient-3.2. his personal pager number. He prescribed Vicodin for her pain, recommended a lumbar discography, and scheduled her for follow 7989 7. At approximately 6:30 pm. that same day, the Respondent telephoned Patient 3.2. at her home and asked her how she was doing. Patient 3.2. advised that she- was hurting. 1The ReSpondent advised that he was in the area and asked if he could stop by and answer any other questions that Patientlz. might have. Patient 3.2. was experiencing a lot of pain and agreed to allow the Respondent to stop by so that she could discuss her condition with him further. 8. When the Respondent arrived at her apartment, Patient 3.2. invited him to sit down in the living room. After a brief discussion about her back problems, the Respondent left the living room and entered Patient 3.2.?5 bedroom where he proceeded to sit down on her bed. The Respondent then pulled Patient 3.2. on the bed and began to grope her breasts and vaginal area. He forcefully kissed-Patientlz. She pleaded with him to stop and began her and her back was really hurting. Patient 3.2. then screamed and yelled "at the Respondent. because he said he was going to help her and was actually hurling her. The ReSpondent ?nally got up from on top of her and Patient 3.2. noticed a wet stain on the front of his pants. The Respondent tried to hug Patient 3.2. and told her that things were okay and that he was going to take care of her. The Respondent then left her house. - 9. On. or about November 13, 2001, Patient 3.2. presented to the Respondent for follow up. During the appointment, the Respondent locked the door of the examining room and told Patient 3.2. that she looked sexy and beautiful. 'He then pushed her up against a wall and put his hands up her dress to feel her buttocks. The Respondent tried to kiss Patient J.Z. As he pressed himself against her, she could feel that he had an erection. Patient 3.2. was able to leave after there was a knock at the door and the Respondent let go of her. 10. On or about November 21, 2001, the Reapondent presented at Patient J.Z.'s home uninvited. ?He pushed his way into her apartment and kicked the door closed behind him. The Respondent then attempted to remove Patient J.Z.'s clothes, but was unable to do so. He removed his penis from his pants and tried'to force Patient 3.2. to masturbate him. Soon thereafter, the Respondent ejaculated on Patient J.Z.'s clothes and hand. Patient warned the ReSpondent that her ex-husband would be arriving any minute, prompting the Respondent to leave. 11. On or about January 3, 2002, Patient 3.2. returned to the Respondent?s of?ce. for follow up. She complained" of an increase in neck and back pain and indicated that she had been using a cane. Physical examination revealed iimited cervical and lumbar range of motion. 'l?he. Respondent renewed her pain medication and ordered electric stimulation therapy. I 12. Patient 12. did not return to the Respondent?s of?ce again. . 13. Respondent inappropriately exercised in?uence within a patient-physician relationship for the purpose of engaging a patient in sexual activity in that Respondent perpetrated acts upon Patient 12. which were sexual in nature and which were not performed for any legitimate medical purpose. 14. Section 458.329, Florida Statutes, states that the - physician-patient relationship is founded on mutual trust. Sexual misconduct in the practice of medicine 7990 7991 means violation of the physician~patient relationship through which the physician uses said relationship to induce the patient to engage, or to engage or attempt to engage the patient, in sexual activity outside the scope of the practice or the scope of generally accepted examination or treatment of the patient. Sexual misconduct in the practice of medicine is prohibited. . .15. Rule (MB-9.008, Florida Administrative Code, states in part that sexual contact with a patient is sexual misconduct, which includes, but is not limited to, verbal or physical behavior which may reasonably be interpreted as romantic involvement with a patient regardless of whether such involvement occurs in the professional setting or outside of it; may reasonably be interpreted as intended for the sexual arousal 'or grati?cation of the physician, the patient or any third party; or may be reasonably interpreted as being sexual. COUNT ONE -- EXERCISINQ INFLUENCE IN PATIENT PHYSICIAN RELATI NSHIP 16. Petitioner realleges and incorporates paragraphs one (1) through fifteen - (15), as if fully set forth herein this Count One. 17. Respondent exercised in?uence within a patient-physician relationship for purposes of engaging a patient in sexual adtivity, in that Respondent did one or more of the following: a. - Sexually assaulted Patient b. Grabbed Patient breasts; c. Grabbed Patient J.Z.'s vaginal area; d. Kissed Patient e. Attempted to force her to masturbate him; f. Tried to remove her clothing forcibly; 9. Put his hands up her dress to grab her buttocks; h. Pressed his body against hers while he was in an aroused state; and/or i. Ejaculated on her clothing and hand. 18. Based on the foregoing, ?Respondent violated Section Florida Statutes, by exercising in?uence within a patient-physician relationship for purposes of engaging a patient in sexual activity. A patient shall be presumed to be incapable of giving free, full, and informed consent to sexual activity with his or her physician I court: mo- SEXUAL MISCONDUCT 19. Petitioner realleges and incorporates paragraphs one (1) through fifteen (15), as if fully set forth herein this Count Two. 20. Respondent violated the express prohibition against sexual misconduct stated in Section 458.329, Florida Statutes, and Rule 648-9008, Florida Administrative Code, in that Respondent did one or more of the following: I a. Sexually assaulted Patient b. Grabbed Patient breasts; c. Grabbed Patient vaginal area; d. Kissed Patient 7993 e. Attempted to force her to masturbate him; - f. Tried to remove her clothing forcibly; 9. Put his hands up her dress to grab her buttocks; hi. Pressed his body against hers while he was in an aroused state; and/or I i. Ejaculated on her clothing and hand. I 21. Based on the foregoing, Respondent violated Section Florida Statutes, by violating any provision of Chapter 458, Florida Statutes, a rule of the board or department, or a lawful order of the board or department previoust entered in a disciplinary hearing or failing to comply with a lawfully issued subpoena of the department. COUNT THREE STANDARD OF CARE VIOLATION 22. Petitioner realleges and incorporates paragraphs one (1) through ?fteen (15), as if fully set form herein this Count Three. . 23. Respondent failed to practice medicine with that level of care, skill, and treatment, which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances, in that the Respondent did one or more of the following for no legitimate medical purpose: a. Sexually assaulted Patient b. Grabbed Patient breasts; c. Grabbed Patient vaginal area; d. Kissed Patient 7994 e. Attempted to force her to masturbate him; f. Tried to remove her clothing forcibly; 9. Put his hands up her dress to grab her buttocks; h. Pressed his body against hers'while he was. in an aroused state; and/or i. Ejaculated on her clothing and hand. 24: Based on the foregoing, Respondent has violated Section _Florida Statutes, by failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as- being acceptable under similar conditions and circumstances. COSTS 25. Petitioner has incurred costs related to the investigation and prosecution of this matter. 25. Pursuant to Section Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter on a respondent in addition to any other discipline imposed. WHEREFORE, the Petitioner respectfully requests. that the Board of Medicine enter an order assessing administrative costs related to the investigation and prosecution of this case as provided for in Section Florida Statutes, in addition to or as well as imposing one or more of the following penalties: permanent revocation or su5pension of Respondent?s license, restriction of practice, imposition of 7995 an administrative ?ne, issuance of a reprimand, placement of the Respondent on probation, corrective action and/or any other relief that the Board deems appropriate. SIGNED. this i ELL day of KMK Merci? - .2002 John 0. Agwunobi, M.D., M.B.A. Secretary, Department of Health Kim' M. Kluck Assistant General Counsel Fla. Bar 0040967 DOH, Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3250 Phone (850)488-4518 Fax (850)414-1989 Reviewed and approved byMUni?alsV?/ez" z?(date) PCP: ab?o?b PCP Members: El (balm!- Lujx Ignacio A. Magana, M.D., DOH Case No. 2002-15687 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 qyali?ed representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena dunes tecum issued on his or her behalf if a hearing is reg nested. 10 7996 7997 SF ATE OF FLORIDA DEPARTMENT or HEALTH DEPARTMENT or HEALTH, PETITIONER, i vs. i CASE NO. 2002-14154 IGNACIO A. MAGANA, M.D., i RESPONDENT. i ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, Department of Health, hereinafter referred to?as ?Petitioner,? and ?les this Administrative Complaint before the Board of Medicine against Ignacio A. Magana, M.D., hereinafter referred to as ?Respondent,? and alleges: 1. Effective July 1, .1997, Petitioner is the state agency charged with regulating the practice of medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Honda Statutes; and Chapter 458, Plorida Statutes. 2. Respondent is and has been at all times material hereto a licensed physician in the state of Florida, having been issued license number ME 004734. Respondent?s IaSt known address is Burns Rd., Suite 200, Palm Beach Gardens, Florida 33410. 3. In or around January 1999, Patient L.W. was in an automobile accident. Patient attorney recommended that Patient L.W. seek treatment at the neurology practice of Fernando Miranda, M.D., and Respondent in Port St. Lucie. - 4. On or about February 2, 1999, Patient L.W. presented to Dr. Miranda with 7998 complaints of neck pain, headaches, and low baCk pain. 5. Dr. Miranda performed a neurological examination, a cranial nerve examination, a motor examination, deep tendon re?ex tests and sensory tests. His impression was radiculopathy at C5-6 and on the leit side. Dr. Miranda scheduled Patient L.W. for an MRI scan of the neck and low back to rule out the possibility of a herniated disk. 6. The results of the MRI scan of the cervical spine showed a bulging disc- with osteOphytes at and (26-7. The MRI of the lumbar spine showed slight facet hypertrophy at L4-5 and LS-SI, thickened iigamentum flavum at a dehydrated disc at L4-5 and LS-SI, and a central herniated disc at 15-51. 7. On or about February 26, 1999, Patient L.W. presented to Respondent for her follow-up appointment. Respondent conducted a physical examination, neurological examination, and reviewed the results of the MRI. He diagnosed Patient L.W. with herniated disc L5-51 and mechanical low back pain, and lumbar radiculopathy. The Respondent recommended continued conservative treatment, epidural steroid injections, continued physical therapy and medications and that Patient L.W. consider the possibility of surgery in the future. She was scheduled to follow up with him in six weeks. 8. From February 1999 through January 2001, Respondent treated Patient L.W. for continued back pain and general discomfort. 9. In or about January 2001, Respondent recommended an anterior lumbar interbody fusion for Patient L.W., which was performed on or about January 29, 2001. Following the surgery, Patient L.W. wore a brace for eight weeks and continued to see Respondent for follow-up appointments and check-ups. Patient L.W. attended these appointments with her husband. 10. In or around August 2001, Patient L.W. presented to the Respondent for foliow up at which time he began rubbing her back and asking Patient L.W. where it hurt. Alter Respondent stopped rubbing her back, he began asking her personal questions and told her she was pretty. 11. Respondent then put his hands on Patient pulled her towards him and kissed her, putting his tongue in her mouth. When Patient L.W. pushed away, Respondent apologized, told Patient ILW. she was blushing and then asked her if they were still friends. 12. In or around November 2001, Patient returned to Respondent for her '?nal visit. During this visit Respondent began to rub her back as before. Respondent then grabbed Patient shoulders and kissed her with his tongue while simultaneously pushing her backward into a counter. When she turned her face away, Respondent grabbed her right hand and pulled it down putting it on his erect penis. Patient L.W. said something and Respondent stopped. 13. Patient L.W. never returned to Respondent?s of?ce. 14. On or about May 15, 2002, Patient L.W. reported Respondent's behavior to the Vero Beach Police Department. 15. The Respondent's actions of kissing Patient L.W., puth'ng his tongue in her mouth, and pressing her hand against his erect penis during the course of an of?ce visit 8000 constitute sexual activity. A reasonable and prudent physician under similar conditions and circumstances would not have engaged in sexual activity with a patient. 16. Respondent inappropriately exercised influence within a patient-physician relationship for the purpose of engaging a patient in sexual activity in that Respondent performed acts upon Patient Lw. which were sexual in nature and which were not performed for any legitimate medical purpose. 17. Section 458.329, Florida Statutes, states that the physician-patient relationship is founded on mutual trust. Sexual misconduct in the practice of medicine means violation of the physician-patient relationship through which the physician uses said relationship to induce the patient to engage, or to engage or attempt to engage the patient, in sexual activity outside the scope of the practice or- the scope of generally accepted examination or treatment of the patient. Sexual misconduct in the practice of medicine is prohibited. 18. Rule magma, Florida Administrative cede, states in part that sexual contact with a patient is sexual misconduct, which includes, but is not limited to, verbal or physical behavior which may reasonably be interpreted as romantic involvement with a patient regardless of whether such involvement occurs in the professional setting or outside of it; may reasonably be interpreted as intended for the sexual arousal or grati?cation of the physician, the patient or any third party; or may be reasonably interpreted as being sexual. 19. Petitioner realleges and incorporates paragraphs one (1) through eighteen (18), as if fully set forth herein this Count One. 20. Respondent exercised influence within a patient-physician relationship for purposes of engaging a patient in sexual activity, In that Respondent kissed Patient L.W. inserting his tongue into her mouth, and placed Patient L.w.?s hand on his penis. 21. Based on the foregoing, Respondent violated Secb'on Florida Statutes, by exercising influence within a patient-physician relationship for purposes of engaging a patient in sexual activity. A patient shall be presumed to be incapable of giving free, full, and informed consent to sexual activity with his or her physician COUNT TWO 22. Petitioner realleges and incorporates paragraphs one (1i through eighteen (18), as if fully set forth herein this Count Two. 23. Respondent violated the express prohibition against sexual misconduct stated in Section 453.329, Florida Statutes, and Rule CAB-9.008, Florida Administrative Code, in that he engaged in sexual activity with Patient L.W. 24. Based on the foregoing, Respondent violated Section Florida Statutes, by violating any provision of Chapter 458, Florida Statutes, a rule of the board or department, or a lawful order of the board'or department previously entered in a disciplinary hearing or failing to comply with a lawfully issued subpoena of the department. 8002 COUNT THREE 25. Petitioner realleges and incorporates paragraphs one (1) through eighteen (18), as if fully set forth herein this Count Three. 26. Respondent failed'to practice medicine with that level of care, skill, and is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances, in that Respondent engaged in sexual activity with Patient LW. for no legitimate medical purpose. 27. Based on the foregoing, Respondent has violated Section Florida Statutes, by failing to practice medicine with that level of care, skill, and ?treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. WHEREFORE, the 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, resb'iction of practice, imposition of an administrative ?ne, 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 theBoard deems appropriate. 8003 SIGNED this c9521? day of . 2003. John O. Agwunobi, M.D., M.B.A. Secretary, Department of Health ?25 . 1? Kim M. Kluck Assistant General Counsel . DOH ProsecutionServices Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar #0040967 (850) 488-4518 (850) 488-7723 FAX KLK/amp Reviewed and approved by: M?nitials) >7 0) (date) PCP: HM 15: PCP Members: (1?an was we Ignacio Antonio Magana, M.D. 2002-14154 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 quali?ed 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 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.