JD we ( ~f DCE) , O04 OAFO STATE OF FLORIDA TP DEPARTMENT OF HEALTH - Glos P DEPARTMENT OF HEALTH, BIVISIg4 © = A OMINIS TRAIT, ue PETITIONER, HEAD Ines | * Vv. CASE NO. 2002-00701 SERGE LEFEVRE ALEXANDRE, M.D., RESPONDENT. ADMINISTRATIVE COMPLAINT . COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Medicine against Respondent, Serge Lefevre Alexandre, M.D., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practice of medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 458, Florida Statutes. 2, At all times material to this Complaint, Respondent was a licensed physician within the state of Florida, having been issued license number ME 69471. 3. Respondent's address of record is 10969 Bal Harbor Drive, Boca Raton, Florida 33498. 4. Patient J.R. is an investigator with the Federation of State Medical Boards. 5. On or about November 6, 2001, Patient J.R., logged onto the website www.a247-drugstore.com (the website). 6. The website advertised various medications for sale. ( ~( 7. Patient J.R. selected thirty pills of Doxycycline (the Doxycycline) for a price of $125.00. : 8. Doxycycline is a legend drug (requires a prescription), broad-spectrum antibiotic which is indicated for treatment of various infections. 9. On the website Patient J.R. was presented with a “Consent Medical Care” statement for which he chose the option indicating agreement to it. 10. On the website Patient J.R. also completed a form regarding his billing address, shipping address, and a general medical questionnaire. 11. Patient J.R. indicated that his address was located in Texas and completed the medical questionnaire indicating that he did not have any current or past medical problems. 12. Patient J.R. completed his order for the Doxycycline by providing payment information consisting of his credit card number. 13. On or about Novmber 27, 2001, the Respondent prescribed the Doxycycline (30 pills, 100 mg) to Patient J.R. 14. Subsequently, Patient J.R. received from Lipton Square Pharmacy, Delray Beach, Florida, the Doxycycline he ordered and that the Respondent prescribed to him. 15. Prior to and subsequent to prescribing Patient J.R. the Doxycycline, the Respondent never personally interviewed and/or examined Patient J.R. nor did he rely upon any information provided by another qualified medical professional who personally interviewed and/or examined Patient J.R. ( ~ 16. Prior to and subsequent.to prescribing the Doxycycline to Patient LR, the Respondent had no communication in any form with Patient J.R. other tharr the information Patient J.R. provided via the above-referenced webpages. 17. At the time Respondent prescribed the Doxycycline to Patient J.R., the Respondent had entered into a contract with B and G Wholesale, Inc., (d.b.a. - Aprescribe.com) by which the Respondent agreed to authorize prescriptions derived from internet sales from the websites Aprescribe.com and A247prescriptions.com. 18. The Réspondent failed to establish a proper Patient/Physician relationship with Patient J.R. before prescribing the Doxycycline to Patient J.R. 19. A proper Patient/Physician relationship requires a personal interview by the physician via a mode of communication actively controlled by the physician or a qualified medical professional and an examination if necessary by the physician or qualified medical professional. This is of importance because the information obtained from the interview and any necessary examination is then assimilated with the patient's medical history to form a treatment plan that may or may not require prescription medicine. 20. A qualified medical professional consists of another licensed physician, nurse practitioner or physician’s assistant. 21. The standard of care for prescribing the Doxycycline requires all of the following: a. The physician develops a proper physician/patient relationship consisting of an adequate physical examination and personal interview where there is no prior established patient/physician relationship or, if ( xf there is a previously established patient-physician relationship with a appropriately recent physical examination and adequate information obtained by personal interview, the physician prescribes the Doxycycline with close follow-up during or after the prescription period; b. The physician obtains an adequate medical history; c. The physician makes a diagnosis; and, d. The physician develops an adequate treatment plan. 22. The Respondent's medical records for Patient J.R.. do not indicate that the Respondent made an adequate physical examination of Patient J.R prior to or after prescribing Patient J.R. the Doxycycline. 23. The Respondent's medical records for Patient J.R. do not indicate that the Respondent obtained an adequate medical history for Patient J.R. 24. The Respondent's medical records for Patient J.R. do not indicate that prior to or subsequent to prescribing Patient J.R. the Doxycycline, the Respondent made a diagnosis. 25. The Respondent's medical records for Patient J.R. do not indicate that the Respondent developed an appropriate treatment plan for Patient J.R. 26. A reasonably prudent similar physician under similar conditions and circumstances would not have prescribed the Doxycycline to Patient J.R. without establishing a proper Physician/Patient relationship, without obtaining an adequate medical history, without making a diagnosis and without developing a treatment plan. COUNT ONE — STANDARD OF CARE 7 27. ‘Petitioner realleges and incorporates paragraphs one (1) through twenty- six (26) as if fully set forth herein 28. Section 458.331(1)(t), Florida Statutes (2001), provides that failure by a physician 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 constitutes grounds for disciplinary action by the Board of Medicine. 29. 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 by doing one or more of the following: ao . Prescribing the Doxycycline to Patient 3.R. without establishing a Proper physician/patient relationship; b. Prescribing the Doxycycline to Patient J.R. without an adequate physical examination; c. Prescribing the Doxycycline to Patient J.R without obtaining an adequate medical history; d. Prescribing the Doxycycline to Patient J.R. without making an diagnosis; and/ or, e€. Prescribing the Doxycycline to Patient J.R. without developing an appropriate treatment plan. a 30. Based upon the foregoing, the Respondent has violated Section 458.331(1)(t), Florida Statutes (2001), by failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent physician as being acceptable under similar conditions and circumstances. COUNT TWO — ADMINISTERING MEDICINE IMPROPERLY 31. Petitioner realleges and incorporates paragraphs one (1) through twenty- six (26) as if fully set forth in this Count Two. 32. Section’ 458.331(1)(q), Florida Statutes (2001), provides that prescribing, dispensing, administering, mixing or otherwise Preparing a legend drug, including controlled substance, other than in the course of the physician's professional practice, constitutes grounds for disciplinary action by the Board of Medicine. 33. Respondent improperly prescribed Doxycycline, a legend drug, to Patient J.R. other than in the course of his professional practice by prescribing to Patient J.R. the Doxycycline without establishing a proper physician/patient relationship. 34. Based upon the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2001), by prescribing, dispensing, administering, mixing, or otherwise Preparing legend drugs, including all controlled substances, other than in his professional practice, COUNT THREE — MEDICAL RECORDS VIOLATION 35. Petitioner realleges and incorporates paragraphs one (1) through twenty- Six (26) as if fully set forth -herein this Count Three. 36. Section 458.331(1)(m), Florida Statutes (2001), provides that failing to keep legible medical records that justify the course of treatment of the patient, ( including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations, constitutes grounds for discipline by the Board of Medicine. 37. Rule 64B8-9.003(3), Florida Administrative Code, provides that the medical record shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course of and results of treatment accurately, by including, at a minimum, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; reports of consultations and hospitalizations; and copies of records or reports or other documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient. 38. The Respondent failed to maintain adequate medical records which justified his course of treatment of Patient J.R. by failing to document one or more of the following: a. A proper physician/patient relationship for prescribing Patient J.R. the ' Doxycycline; b. An adequate physical examination of Patient J.R. for prescribing Patient J.R. the Doxycycline; c. An adequate medical history for Patient J.R. for prescribing Patient J.R. the Doxycycline; d. An adequate diagnosis for prescribing Patient J.R. the Doxycylcine; and/ or, e. An appropriate treatment plan for Prescribing Patient JR. the Doxycycline. i. 39. Based upon the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2001), by failing to keep legible, as defined by department rule in consultation with the board, medical records that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drug prescribed, dispensed, or administered; and reports of consultations. 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 fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. SIGNED this_2/74 day of Lie a , 2003. John O. Agwunobi, M.D., M.B.A. Secretary, Department alth senat B AE NYT <1 HEALTH <~James W. Earl DEPUTY CLERK Assistant General Counsel! ouerk Neath Catena. DOH Prosecution Services Unit Hlanlys 4052 Bald Cypress Way, Bin C-65 oate__gl2znloe _ Tallahassee, FL 32399-3265 Florida Bar # 0139513 (850) 414-8126 (850) 414-1989 FAX JWE Roe oe and approved by: NICK (initials) (date) PCP: F/22/ 03 yf ue PCP Members: é/-B Baker Daves ; bony . 8 Bed : Fs i. rn Serge Lefevre Alexandre, M.D., 2002-00701 D A ee ue NOTICE OF RIGHTS Hea ve Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed.

Docket for Case No: 04-000280PL