Alarmed by how a Florida physician handled an abortion, a state licensing board has recommended that the doctor pay a fine that is more than three times what regulators had initially recommended.

The Florida Board of Medicine is recommending that physician Harvey Craig Roth pay a $10,000 fine and take additional courses because of performing a surgical abortion on a 35-year-old woman instead of a medication-induced abortion.

In making the recommendation, the board on Friday more than tripled a $3,000 fine sought by state health attorneys, who said that amount was “in line with board precedent” for the type of error involved. The board decision isn't final. Roth can agree to it or pursue a challenge.

The Board of Medicine, which consists largely of physicians selected by the governor, spent time during a meeting in Miami verbally sparring with Roth over whether he followed rules intended to cut down on mistakes.

One rule requires physicians to pause before surgery to ensure they have the right patient, the right site and are performing the right surgery. The pause must be performed again if physicians leave the room at any time during the procedure or surgery.

But Roth, who acknowledged he did not follow the pause rule, said Friday he didn't think that affected the work he was conducting at the abortion clinic, A Woman's Center of Hollywood. Roth works at the Broward County clinic between three and five hours a week, according to state records.

The board more than tripled the proposed fine after Roth's concession and after board members pressed him for details on how the mistake could have occurred.

According to state documents, the patient, identified by the initials K.N.M., went to the clinic seeking the so-called morning after pill, which first requires women to have a sonogram. After K.N.M. checked into the clinic in December 2017 and had her vital signs taken, a medical assistant walked her to a waiting room to wait her turn for a sonogram.

Roth told board members that before performing the procedure, he had a brief conversation with the woman and several times used the name “Ashley” instead of her actual name. She did not correct him about the name.

Board of Medicine Vice Chairman Hector Vila grilled Roth on details surrounding the procedure, asking Roth whether he followed the proper informed-consent requirements in the law.

“What position was the patient in when you were doing that?” Vila, a physician from Tampa, asked Roth about the informed-consent discussion.

“It was while I was doing the ultrasound,” Roth answered.

“In medical terms, what position was she in?” Vila asked again.

Roth, who is certified by the American Board of Obstetrics and Gynecology, answered, “supine.”

Roth continued, telling the board members he talked to the patient during the sonogram, asking her if she had questions.

“She said, 'no,' ” Roth said. “I told her that I was going to give her some medication. We started on IV. I gave her some sedation.”

Roth acknowledged he never specifically told the woman she was going to have a surgical abortion as opposed to a “medical” termination. Medical terminations can occur in the early stages of the first trimester and can be accomplished by ingesting medicine.

According to documents filed with the state, Roth learned of the mistake when the patient was taken to recovery. Roth's attorneys said the doctor immediately “apologized for the error and twice explained to her what had happened.”

Moreover, Roth's attorneys said he immediately documented the incident in the woman's medical records. His attorneys said that while Roth documented the incident in the patient's records, the clinic allegedly removed the information from her chart.

The records were reinserted into the patient's file, according to Roth's attorneys, after the doctor discovered they were removed. The clinic did not immediately comment.

Roth refused to say that the clinic was “sloppy” and said a similar mistake should never occur again under revised procedures.

Physician Steven Rosenberg, the chairman of the Board of Medicine, asked that the Agency for Health Care Administration be contacted about the facility.

The initial complaint into the incident was filed by the patient. In an interview with the state, she said she had not agreed to have to a surgical abortion but was told she must sign documents before she could leave.

“K.N.M. stated this was traumatic, and she felt a violation of her body,” the complaint said.

Roth told the board he has made changes to his personal practice to prevent such incidents from occurring again. He no longer addresses patients by their first names. His patients are required to identify themselves to him and say out loud the procedures they are having.

Vila, though, was not satisfied with Roth's answers.

“I think he's lacking any sense of responsibility for the true care of the patient in the facility,” Vila said. “Whether you just work in the facility or whatever, the conduct of the care of the patient is your responsibility. You can't just walk in and say, 'I'm just here to do a certain procedure,' ” adding, “That patient is your responsibility.”

Christine Sexton reports for the News Service of Florida.