Final Order No. DOH-18-2186FILED DATE Departm

STATE OF FLORIDA
BOARD OF MEDICINE

ealth
•

ty Agency Clerk

DEPARTMENT OF HEALTH,
Petitioner,
VS.

DOH CASE NO.: 2016-24699
LICENSE NO.: ME0085650
RAMON VAZQUEZ, M.D.,
Respondent.

FINAL ORDER
THIS CAUSE came before the BOARD OF MEDICINE (Board)
pursuant to Sections 120.569 and 120.57(4), Florida Statutes, on
December 7, 2018, in Orlando, Florida, for the purpose of
considering a Settlement Agreement (attached hereto as Exhibit
A) entered into between the parties in this cause. Upon
consideration of the Settlement Agreement, the documents
submitted in support thereof, the arguments of the parties, and
being otherwise full advised in the premises, the Board rejected
the Settlement Agreement and offered a Counter Settlement
Agreement which Respondent was given 7 days to accept. By
correspondence dated December 24, 2018, Counsel for Respondent
timely accepted the Board's Counter Settlement Agreement on
behalf of Respondent. The Counter Settlement Agreement
incorporates the original Settlement Agreement with the
following amendments:

-MQA

DEC 2 7 2018

 1. The fine set forth in Paragraph 2 of the Stipulated
Disposition shall be increased to $3,000.00.
2. The costs set forth in Paragraph 3 of the Stipulated
Disposition shall be set at $4,817.90.
3. The continuing medical education (CME) set forth in
Paragraph 4 of the Stipulated Disposition shall be amended to
require the CME to be in the management of retroperitoneal
masses.
4. Respondent shall document the completion of 3 hours of
continuing medical education (CME) in the area of pre-operative
evaluation of surgical patients within one year from the date
the Final Order is filed. These hours shall be in addition to
those hours required for biennial renewal of licensure.
Respondent shall first submit a written request to the Probation
Committee for approval prior to performance of said CME
course(s).
5. Within six (6) months from the date the Final Order is
filed, Respondent shall present a one hour lecture to the entire
medical staff of the hospital at which the Respondent maintains
staff privileges or healthcare facility at which Respondent
performs surgical procedures. The lecture shall address the
subject of wrong site surgery. Respondent shall submit a
written plan to the Board's Probation Committee for approval
prior to the performance of said lecture. Documentation of

 completion of said lecture shall be provided to the Board's
Probation Committee.
6. The requirement for the risk management continuing
medical education set forth in Paragraph 5 of the Stipulated
Disposition shall be deleted.
IT IS HEREBY ORDERED AND ADJUDGED that the Settlement
Agreement as submitted is hereby accepted with the amendments
set forth above.
This Final Order shall take effect upon being filed with
the Clerk of the Department of Health.
DONE AND ORDERED this

/

day of

2018.
BOARD OF MEDICINE

Claudia Kemp, J.D., Executive Director
For Jorge J. Lopez, M.D., Chair

CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the
foregoing Final Order has been provided by U.S. Mail to RAMON
VAZQUEZ, M.D., 560 Village Boulevard, #200, West Palm Beach,
Florida 33409; to Michael D. Burt, Esquire, Sonneborn, Rutter,
et al., 1400 Centrepark Boulevard, Suite 400, West Palm Beach,
Florida 33401-7403; by email to Allison Dudley, Assistant

 General Counsel, Department of Health, at
Allison.Dudley@flhealth.gov; and by email to Edward A.
Tellechea, Chief Assistant Attorney General, at

-)-1-14
Ed.Tellechea@myfloridalegal.com this og
/ \

day of

cOe-Ce4,--k\j6-tA__. , 2018.

Deputy Agency Clerk

 Rick Scott
Governor

Mission:
To protect, promote & improve the health
of all people in Florida through integrated
state, county & community efforts.

Celeste Philip, MD, MPH
State Surgeon General and Secretary

Vision: To be the Healthiest State in the Nation

MEMORANDUM
DATE:

December 19, 2018

TO:

Mark Whitten, Bureau Chief

FROM:

Claudia Kemp, J.D., Executive Director
Board of Medicine

SUBJECT:

Delegation of Authority

This is to advise that while I am out of the office December 19-28, 2018, the following Executive
Directors will serve as Acting Executive Director for the Board of Medicine.
Jennifer Wenhold: December 19-21, 2018 - (850) 245-4460
Kama Monroe- December 26-28, 2018 — (850) 245-4162
CK/sl
Cc:

Sylvia Sanders
Staff, Board of Medicine
Board and Council Chairs

Florida Department of Health
Division of Medical Quality Assurance
4052 Bald Cypress Way, Bin C-03 • Tallahassee, FL 32399
PHONE: 850/245-4131 • FAX: 850/412-1268

Accredited Health Department
Public Health Accreditation Board

 STATE OF FLORIDA
DEPARTMENT OF HEALTH
DEPARTMENT OF HEALTH,
PETITIONER,
v.

CASE NO. 2016-24699

RAMON VAZQUEZ, M.D.,
RESPONDENT.

SETTLEMENT AGREEMENT
Ramon Vazquez, M.D., referred to as the "Respondent," and the Department of
Health, referred to as "Department," stipulate and agree to the following Agreement and
to the entry of a Final Order of the Board of Medicine, referred to as "Board,"
incorporating the Stipulated Facts and Stipulated Disposition in this matter.
Petitioner is the state agency charged with regulating the practice of medicine
pursuant to Section 20.43, Florida Statutes, and Chapter 456, Florida Statutes, and
Chapter 458, Florida Statutes.
STIPULATED FACTS
1.

At all times material hereto, Respondent was a licensed physician in the

State of Florida having been issued license number ME 85650.
2.

The Department charged Respondent with an Administrative Complaint that

was filed and properly served upon Respondent alleging violations of Chapter 458, Florida

 Statutes, and the rules adopted pursuant thereto. A true and correct copy of the
Administrative Complaint is attached hereto as Exhibit A.
3.

For purposes of these proceedings, Respondent neither admits nor denies

the allegations of fact contained in the Administrative Complaint.

STIPULATED CONCLUSIONS OF LAW
1.

Respondent admits that, in his/her capacity as a licensed physician, he/she

is subject to the provisions of Chapters 456 and 458, Florida Statutes, and the jurisdiction
of the Department and the Board.
2.

Respondent admits that the facts alleged in the Administrative Complaint,

if proven, would constitute violations of Chapter 458, Florida Statutes.
3.

Respondent agrees that the Stipulated Disposition in this case is fair,

appropriate and acceptable to Respondent.

STIPULATED DISPQSITION
1.

Letter of Concern — The Board shall issue a Letter of Concern against

Respondent's license.
2.

Fine - The Board shall impose an administrative fine of One Thousand

Five Hundred Dollars ($1,500.00) against Respondent's license which Respondent
shall pay to: Payments, Department of Health, Compliance Management Unit, Bin C-76,
P.O. Box 6320, Tallahassee, FL 32314-6320, within thirty (30) days from the date of filing
of the Final Order accepting this Agreement ("Final Order"). All fines shall be paid by

cashiers check or moncv (tEd. r, Any change in the terms of payment of any fine

DOH v. Ramon Vazquez, M.D., Case Number 2016-24699
Medical Settlement Agreement

2

 imposed by the Board must be approved in advance by the Probjtion Committee
of the Board.
RESPONDENT ACKNOWLEDGES THAT THE TIMELY PAYMENT OF THE
FINE IS HIS/HER LEGAL OBLIGATION AND RESPONSIBILITY AND
RESPONDENT AGREES TO CEASE PRACTICING IF THE FINE IS NOT PAID AS
AGREED IN THIS SETTLEMENT AGREEMENT. SPECIFICALLY, IF RESPONDENT
HAS NOT RECEIVED WRITTEN CONFIRMATION WITHIN 41 DAYS OF THE DATE
OF FILING OF THE FINAL ORDER THAT THE FULL AMOUNT OF THE FINE HAS
BEEN RECEIVED BY THE BOARD OFFICE, RESPONDENT AGREES TO CEASE
PRACTICE UNTIL RESPONDENT RECEIVES SUCH WRITTEN CONFIRMATION
FROM THE BOARD.
3.

Reimbursement of Costs - Pursuant to Section 456.072, Florida Statutes,

Respondent agrees to pay the Department for the Department's costs incurred in the
investigation and prosecution of this case ("Department costs"). Such costs exclude the
costs of obtaining supervision or monitoring of the practice, the cost of quality assurance
reviews, any other costs Respondent incurs to comply with the Final Order, and the
Board's administrative costs directly associated with Respondent's probation, if any.
Respondent agrees that the amount of Department costs to be paid in this case is Three

Thousand Two Hundred Twenty-Two Dollars and Twenty-Nine Cents
($3,222.29), but shall not exceed Five Thousand Two Hundred Twenty-Two
Dollars and Twenty--Nine Cents ($5,222.29) Respondent will pay such Department
costs to: Payments, Department of Health, Compliance Management Unit, Bin C-76, P.O.

DOH v. Ramon Vazquez, M.D., Case Number 2016-24699
Medical Settlement Agreement

3

 Box 6320, Tallahassee, FL 32314-6320, within thirty (30) days from the date of filing of
the Final Order. All costs shall :)e paid by cashier's check or money order. Any
change in the terms of payment of costs imposed by the Board must be approved in
advance by the Prokation Committee of the Board.
RESPONDENT ACKNOWLEDGES THAT THE TIMELY PAYMENT OF THE
COSTS IS HIS/HER LEGAL OBLIGATION AND RESPONSIBILITY AND
RESPONDENT AGREES TO CEASE PRACTICING IF THE COSTS ARE NOT PAID
AS AGREED IN THIS SETTLEMENT AGREEMENT. SPECIFICALLY, IF
RESPONDENT HAS NOT RECEIVED WRITTEN CONFIRMATION WITHIN 4
DAYS OF THE DATE OF FILING OF THE FINAL ORDER THAT THE FULL AMOUNT
OF THE COSTS NOTED ABOVE HAS BEEN RECEIVED BY THE BOARD OFFICE,
RESPONDENT AGREES TO CEASE PRACTICE UNTIL RESPONDENT RECEIVES
SUCH WRITTEN CONFIRMATION FROM THE BOARD.
4.

Continuing Medical Education - Respondent shall document completion

of three (3) hours of Continuing Medical Education (CME) in spine surgery within one (1)
year from the date the Final Order is filed.
5.

Continuing Medical Education — "Risk Management" — Respondent

shall complete this requirement and document such completion within one (1) year from
the date the Final Order is filed. Respondent shall satisfy this requirement in one
of the two following ways:
(a)

Respondent shall complete five (5) hours of CME in "Risk

Management" after first obtaining written advance approval from the Board's Probation

DOH v. Ramon Vazquez, M.D., Case Number 2016-24699
Medical Settlement Agreement

4

 Committee of such proposed course, and shall submit documentation of such completion,
in the form of certified copies of the receipts, vouchers, certificates, or other official proof
of completion, to the Board's Probation Committee; or
(b) Respondent shall complete (5) five hours of CME in risk management
by attending one full day or eight (8) hours, whichever is more, of disciplinary hearings
at a regular meeting of the Board of Medicine. In order to receive such credit, Respondent
must sign in with the Executive Director of the Board before the meeting day begins,
Respondent must remain in continuous attendance during the full day or eight (8) hours
of disciplinary hearings, whichever is more, and Respondent must sign out with the
Executive Director of the Board at the end of the meeting day or at such other earlier
time as affirmatively authorized by the Board. Respondent may not receive CME credit
in risk management for attending the disciplinary hearings portion of a Board meeting
unless the Respondent is attending the disciplinary hearings portion for the sole purpose
of obtaining the CME credit in risk management. In other words, Respondent may not
receive such credit if appearing at the Board meeting for any other purpose, such as
pending action against Respondent's medical license.
STANDARD PROVISIONS
1.

Appearance - Respondent is required to appear before the Board at the

meeting of the Board where this Agreement is considered.
2.

No Force or Effect until Final Order - It is expressly understood that

this Agreement is subject to the approval of the Board and the Department. In this
regard, the foregoing paragraphs (and only the foregoing paragraphs) shall have no force

00H- v. Ramon Vazquez, M.D., rage Number 2016-24699

Medical Settlement Agreement

 and effect unlesf. the Board enters a Final Order incorporating the terms of this
Agreement.
3.

Continuing Medic Education - Unless otherwise provided in this

Agreement Respondent shall first submit a written request to the Probation Committee
for approval prior to performance of said CME course(s). Respondent shall submit
documentation to the Board's Probation Committee of having completed a CME course in
the form of certified copies of the receipts, vouchers, certificates, or other papers, such
as physician's recognition awards, documenting completion of this medical course within
one (1) year of the filing of the Final Order in this matter. All such documentation shall
be sent to the Board's Probation Committee, regardless of whether some or any of such
documentation was provided previously during the course of any audit or discussion with
counsel for the Department. CME hours required by this Agreement shall be in addition
to those hours required for renewal of licensure. Unless otherwise approved by the
Board's Probation Committee, such CME course(s) shall consist of a formal, live lecture
format.

4.

magma -

Respondent must provide current residence and practice

addresses to the Board. Respondent shall notify the Board in writing within ten (10) days
of any changes of said addresses
5.

Future Conduct - In the future, Respondent shall not violate Chapter 456,

458 or 893, Florida Statutes, or the rules promulgated pursuant thereto, or any other
state or federal law, rule, or regulation relating to the practice or the ability to practice
medicine to include, but not limited to, all statutory requirements related to practitioner

DOH v. Ramon Vazquez, M.D., rag. Number 201E-24699
Medical Settlement Agreement

6

 profile and licensure renewal updates. Prior to signing this agreement, the Respondent
shall read Chapters 456, 458 and 893 and the Rules of the Board of Medidne, at Chapter
6488, Florida Administrative Code.
6.

Violation of Terms

- It is expressly understood that a violation of the

terms of this Agreement shall be considered a violation of a Final Order of the Board, for
which disciplinary action may be initiated pursuant to Chapters 456 and 458, Florida
Statutes.
7.

Purpose of Agreement - Respondent, for the purpose of avoiding further

administrative action with respect to this cause, executes this Agreement. In this regard,
Respondent authorizes the Board to review and examine all investigative file materials
concerning Respondent prior to or in conjunction with consideration of the Agreement.
Respondent agrees to support this Agreement at the time it is presented to the Board
and shall offer no evidence, testimony or argument that disputes or contravenes any
stipulated fact or conclusion of law. Furthermore, should this Agreement not be accepted
by the Board, it is agreed that presentation to and consideration of this Agreement and
other documents and matters by the Board shall not unfairly or illegally prejudice the
Board or any of its members from further participation, consideration or resolution of
these proceedings.
8.

No Preclusion Of Additional Proceedings

-

Respondent and the

Department fully understand that this Agreement and subsequent Final Order will in no
way preclude additional proceedings by the Board and/or the Department against

DOH v. Ramon Vazquez, M.D., Case Number 2016-24699
Medical Settlement Agreement

7

 Respondent for acts or omissions not specifically set forth in the Administrative Complaint
attached as Exhibit A.
9.

Waiver Of Attorney's Fees And Costs

- Upon the Board's adoption of

this Agreement, the parties hereby agree that with the exception of Department costs
noted above, the parties will bear their own attorney's fees and costs resulting from
prosecution or defense of this matter. Respondent waives the right to seek any attorney's
fees or costs from the Department and the Board in connection with this matter.
10.

Waiver of Fgrtber Procedural Steps - Upon the Board's adoption of this

Agreement, Respondent expressly waives all further procedural steps and expressly
waives all rights to seek judicial review of or to otherwise challenge or contest the validity
of the Agreement and the Final Order of the Board incorporating said Agreement.
[Signatures appear on the following page.]

DOH v. Ramon Vazquez, M.D., Case Number 2016-74699
Medical Settlement Agreement

8

 SIGNED this Pday of

bri (ALI

Ra on Vazquez, M.D.
STATE OF FLORIDA
COUNTY OF R

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BEFORE ME personally appeared -"RG W

Vci-zolu-rE

identity is known to me or who produced

, whose
(type of

identification) and who, under oath, acknowledges that his/her signature appears above.
SWORN TO and subscribld before me this 094+)1
day of
2018.
AO" NI.

NOVIPubbe State of Florio.

yr: Amanda

44/001
C
NOTARY PUBLIC

My Commission 00 1118395

ome Expires 03/2412022

My Commission Expires:
APPROVED this 1Sty of
Celeste Philip, M.D., M.P.H.
Surgeon General & Secretary

By:

Natalia S omas
Assistant General Counsel
Department of Health

DON V. Ramon Vazquez, MD., Case Number 2016-24699
Medical Settlement Agreement

9

 STATE OF FLORIDA
DEPARTMENT OF HEALTH
DEPARTMENT OF HEALTH,
PETITIONER,
CASE NO. 2016-24699

v.
RAMON VAZQUEZ, M.D.,
RESPONDENT.

ADM NISTRATIVE COMPLA,I,NT
Petitioner, Florida Department of Health, hereby files . this
Administrative Complaint before the Board of Medicine against Respondent,
Ramon Vazquez, M.D., and in support thereof alleges:
1.

Petitioner is the state agency charged with regulating the

practice of medicine in the state of Florida pursuant to section 20.43, Florida
Statutes, and chapters 456 and 458, Florida Statutes.
2.

At all times material to this Administrative Complaint,

Respondent was a licensed physician within the state of Florida, having been
issued license number ME 85650.
3.

Respondent's address of record is 560 Village Blvd., #200, West

Palm Beach, Florida 33409.

 4.

At all times material to this Administrative Complaint,

Respondent practiced as a surgeon at Wellington Regional Medical Center
(WRMC), located in Wellington, Florida.
5.

Respondent is board-certified in General Surgery by the

American Board of Surgery.
6.

On or about April 29, 2016, through on or about April 30, 2016,

M.P., a then fifty-one (51) year-old female was admitted to WRMC for an L5S1 instrumented anterior lumbar interbody fusion in which Respondent was
assigned to assist.
7.

During the surgical procedure, Respondent noted a pelvic mass

and provided a presumptive diagnosis of a gynecologic malignancy,
lymphoma, and/or other metastatic disease.
8.

Respondent determined that the surgical procedure would

continue and that a biopsy of the mass was not indicated given the potential
malignancy.
9.

The pelvic mass was clipped, transected, and removed in its

entirety.
10. On or about May 2, 2016, a pathologist at WRMC confirmed the
pelvic mass removed by Respondent was an intact pelvic kidney.
DOH v. Ramon Vazquez, M.D.
Case Number 2016-24699
Page 2 of 5

 11. Respondent's removal of the pelvic kidney was not related to
M.R's diagnosis and/or medical condition and was therefore a medically
unnecessary procedure.
12. Section 456.072(1)(bb), Florida Statutes (2015), subjects a
licensee to discipline for performing or attempting to perform health care
services on the wrong patient, a wrong-site procedure, a wrong procedure,
or an unauthorized procedure or a procedure that is medically unnecessary
or otherwise unrelated to the patient's diagnosis or medical condition. For
the purposes of this paragraph, performing or attempting to perform health
care services includes the preparation of the patient.
13. Respondent performed a medically unnecessary procedure on
M.P. by removing a pelvic kidney during a lumbar fusion.
14. Based on the foregoing, Respondent violated section
456.072(1)(bb), Florida Statutes (2015), by removing a pelvic kidney during
a lumbar fusion.
(Signature follows on the next page.)

DOH v. Ramon Vazquez, M.D.
Case Number 2016-24699
Page 3 of 5

 WHEREFORE, Petitioner respectfully requests the Board 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 Respondent on
probation, corrective action, refund of fees billed or collected, remedial
education, and/or any other relief the Board deems appropriate.
SIGNED this

day of f-DR Cf}rYI la6K. , 2017.
Celeste Philip, M.D., M.P.H.
Surgeon General and Secretary

th(ink
FILED

DEPARTMEK1 OF HEALTH
DEPUTY CLERK

Tio DEC
DA

15 2017

Natalia S. Thomas
Assistant General Counsel
Florida Bar No. 83826
Department of Health
Prosecution Services Unit
4052 Bald Cypress Way, Bin C-65
Tallahassee, Florida 32399-3265
Telephone (850) 558-9907
Facsimile (850) 245-4684
E-mail Natalla.Thomas@flhealth.gov

PCP: December 15, 2017
PCP Members: Dr. Georges El-Bahri, Dr. Hector Vila, Ms. Brigitte Goersch

DOH v. Ramon Vazquez, M.D.
Case Number 2016-24699

Page 4 of 5

 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.
A request or petition for an administrative hearing must be in
writing and must be received by the Department of Health within
twenty-one (21) days from the day Respondent received this
Administrative Complaint, pursuant to rule 28-106.111(2), Florida
Administrative Code. If Respondent fails to request a hearing
within twenty-one (21) days of receipt of this Administrative
Complaint, Respondent waives the right to request a hearing on the
facts alleged in this Administrative Complaint pursuant to rule 28106.111(4), Florida Administrative Code. Any request for an
administrative proceeding to challenge or contest the material
facts or charges contained In this Administrative Complaint must
conform to rule 28-106.2015(5), Florida Administrative Code.
Mediation under section 120.573, Florida Statutes, is not
available to resolve this Administrative Complaint
NOTICE REGARDING ASSESSMENT OF COSTS
Respondent is placed on notice that Petitioner has incurred
costs related to the investigation and prosecution of this matter.
Pursuant to section 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 Respondent in addition to any other discipline Imposed.

DON v. Ramon Vazquez, M.D.
Case Number 2016-24699
Page 5 015