STATE OF FLORIDA BOARD OF CHIROPRACTIC MEDICINE RECEIVED NOV 1 9 2003 ADMINIST, DEPARTMENT OF HEALTH, RATIVE LAW Petiticner, o wt SO one vs. Case No. CH 2003-23494 “| en KATHY ANNE RAGONE, D.C., Oe 2. ae % Respondent. oo Ea / ADMINISTRATIVE COMPLAINT COMES NOW Petitioner, Department of Health, (hereinafter “Petitioner’) by and through its undersigned counsel and files its Administrative Complaint against Respondent, Kathy Anne Ragone, D.C. (hereinafter “Respondent”) and alleges: NATURE OF THE ACTION 1. This is an action to impose administrative penalties and assess costs related to the investigation and prosecution of the allegations against Respondent pursuant to Sections 456.072 and 460.413, Florida Statutes and incorporates by reference that certain Emergency Suspension Order, Case Number 2003-23494, dated October 23, 2003 as it fully set forth herein (Exhibit A). JURISDICTION AND VENUE 2. This tribunal has jurisdiction pursuant to Sections 120.569 and 120.57, Florida Statutes. 3. Venue shall be determined pursuant to Rule 28-106.207, Florida Administrative Code. PARTIES 4. Effective July 1, 1997, Petitioner is the state agency charged with regulating the practice of chiropractic medicine pursuant to Section 20.43, Florida Statutes, and Chapters 456 and 460, Florida Statutes. 5. At all times material hereto Respondent has been licensed as a chiropractic physician having been issued license number CH 7953 on July 13, 2000. 6. Respondent's address of record is 3296 N.W. 9" Avenue, Oakland Park, Florida 33309, and she resides at 2748 N.E. 10" Street, Pompano Beach, Florida 33062. FACTS 7. In, or during, April 2003, the Broward County Sheriff's Office (“BCSO”) received information from a confidential informant (“Cl”) that a certain Dr. J. (a medical physician licensed under Chapter 458, Florida Statutes) was selling prescriptions for controlled substances to various patients without any medical justification for doing so. According to the Cl, on approximately twenty-five (25) occasions between July 2001 and April 2003, Dr. J. sold prescriptions for hydrocodone and diazepam to him without ever performing a physical examination of him. Based on that information, in or about May 2003, BCSO, in coordination with the Hollywood Police Department, the Florida Department of Law Enforcement, and the Federal Bureau of Investigations commenced an undercover investigation of Dr. J.’s medical practice. During the investigation it was discovered that Dr. Ragone was an active participant in the fraudulent scheme to sell controlled substances without medical examination or justification, acting in her capacity as a licensed chiropractic physician operating out of the “Tender Loving Pain Center” that is the address of record shared by Dr. Ragone and Dr. J. As part of this investigation, Cl and an undercover BCSO officer ("UCO”) embarked on a series of undercover attempts to purchase controlled substances and prescriptions for controlled substances from Dr. J. and Dr. Ragone. During these undercover operations, Cl and UCO were accompanied by several law enforcement officers, who electronically monitored the meetings with Dr. Ragone and Dr. J. 8. Hydrocodone is a schedule Ill controlled substance listed in Chapter 893, Florida Statutes (2003), which is indicated for the relief of moderate to moderately severe pain. - The abuse of hydrocodone can lead to physical and psychological dependence. 9. On or about May 12, 2003, Cl presented to Dr. J.’s medical office located in Boca Raton, Florida. At the inception of this meeting, Cl requested that Dr. J. provide him with a medication that was stronger than hydrocodone, the medication that Dr. J. normally prescribed to Cl. In response, Dr. J. offered to prescribe methadone to Cl, but Ci declined and stated that he preferred hydrocodone. When Dr. J asked Cl how many hydrocodone tablets he wanted, C! replied that he wanted one hundred. At the conclusion of this meeting, Dr. J. prescribed 100 hydrocodone 10/650 mg tablets and 30 Diazepam 10 mg tablets to Cl in return for payment of one hundred dollars ($100.00). Dr. J. then admonished Cl to have his prescriptions filled only by the “Boca Pharmacy” because, according to Dr. J., that pharmacy would not cause Cl any trouble or call him (Dr. J.) to check on the validity of the prescriptions. During the course of this visit, Dr. J. did not perform a physical examination of Ct or review Cl’s medical records. At no time during this visit did Cl complain to Dr. J. that he was suffering from any pain. 3 10. On or about June 2, 2003, Cl and UCO met with Dr. J. at Dr. J.’s office in Boca Raton, at which time Cl introduced UCO to Dr. J. At the beginning of this meeting, UCO complained to Dr. J. of pain to his neck and back areas. UCO explained to Dr. J. that he had previously relieved his neck and back pain by taking several of Cl’s pain medications. UCO presented Dr. J. with a fictitious MRI (magnetic resonance imaging) report that depicted a back and neck with no abnormalities. Dr. J. reviewed UCO’s MRI and remarked that his neck and back appeared normal. Dr. J. explained to UCO that he could not prescribe pain medications to him without some justification for doing so and suggested that UCO see a chiropractor friend of his (Dr. Ragone) who would perform an examination of UCO and provide Dr. J. with a report that would justify prescribing pain medications to UCO. Dr. J. then asked UCO several questions regarding UCO’s pain while he briefly examined UCO’s back and neck areas by having UCO perform several range-of-motion exercises. After some insistence by UCO, Dr. J. agreed to provide UCO with a prescription for 100 hydrocodone 10/650 mg. Once again, Dr. J. asked Cl and UCO to fill their prescriptions at the “Boca pharmacy” only. At the conclusion of this visit, Dr. J. provided UCO with three prescriptions, one for 10 vials of injectable Deca Durabolin 200 mg, a second for 100 Lorcet (hydrocodone) 10/650 mg, and a third for 30 Zanaflex 4mg in return for payment of one hundred fifty dollars ($150.00). During the course of this visit, Dr. J. did not perform any physical examination of Ci or review Cl’s medical records. in addition, Dr. J. did not perform a physical examination of UCO beyond the limited range-of-motion examination referenced above. 41. On or about June 5, 2003, UCO and Cl presented to Tender Loving Pain Center, located at 3296 N.W. 9" Avenue in Oakland Park, Florida. After completing several patient information forms, UCO met with Dr. Ragone, who then escorted UCO into an x-ray room. UCO explained to Dr. Ragone that in October 2002, he was involved in an automobile accident that caused him to suffer pain to his neck and back, which was ongoing. Dr. Ragone then took several x-rays of UCO's neck and back areas. 12. Subsequently, Dr. J. met with both UCO and Cl in an examination room. At the beginning of this meeting, UCO reminded Dr. J., who apparently did not have UCO's medical records with him at the time, that he (Dr. J.) had previously prescribed hydrocodone and Zanaflex to him for his neck and back pain. Moments later, Dr. J. reviewed UCO’s x-rays and explained to UCO that the x-rays did not show any signs of severe trauma, but indicated that UCO had a “reverse curvature” of his neck, which, according to Dr. J., could have been caused by an automobile accident. Dr. J. then instructed both UCO and CI to return to his office in two weeks time in order to have their prescriptions renewed, and he advised UCO not to lift any heavy objects over his head. 43. On or about June 17, 2003, UCO again presented to Dr. J’s Tender Loving Pain Center. At the beginning of this meeting, UCO advised Dr. J. that Cl was unable to meet with Dr. J. on that date. Despite this, Dr. J. agreed to provide UCO with Cl’'s medications, which UCO agreed to deliver to Cl. As the conversation continued, UCO mentioned to Dr. J. that Cl wanted to try oxycodone and that he (UCO) wanted to try Percocet. At the conclusion of this meeting, Dr. J. provided UCO with two prescription 5 bottles issued to Cl containing 100 Endocet (oxycodone) 5 mg each, one prescription bottle issued to Cl containing 50 Valium (diazepam) 10 mg, two prescription bottles issued to UCO containing 100 oxycodone 5 mg each, one prescription bottle issued to UCO containing 50 Soma 350 mg, one prescription bottle issued to UCO containing 30 Xanax 2 mg, and one prescription for Winstrol issued to UCO. In return, UCO paid four hundred fourteen dollars ($414.00) to Dr. J. for his visit and Cl’s visit (despite the fact that Cl was not present) and for the medication. 14. On or about July 28, 2003, UCO contacted Dr. J. by telephone in order to schedule an appointment to meet with him. Dr. J. advised UCO that he would not be able to meet with him and recommended that UCO go to Dr. Ragone in order to obtain refills of his and Cl’s medications. Dr. J. then informed UCO that he would personally call Dr. Ragone’s office and instruct her to refill his and Cl’s medications. 15. On or about July 29, 2003, UCO again presented to Tender Loving Pain Center in order to meet with Dr. Ragone. Upon entering the office, a receptionist asked UCO to complete a patient profile form. After UCO completed the form, Dr. Ragone escorted UCO into an examination room. Once there, UCO told Dr. Ragone that his purpose in visiting her was to obtain a refill of the medications that Dr. J. had previously prescribed to him and Cl. Dr. Ragone then took UCO’s weight and blood pressure while asking UCO some brief questions about his health. At one point during the conversation, Dr. Ragone asked UCO whether he was able to function without his pain medications. When UCO hesitated in answering the question, Dr. Ragone stated “[wlell if you can function without them then we can’t give them to you.” To which, UCO responded “[t]hen, of course, | can’t function without them.” 6 16. Dr. Ragone next produced a patient record for Cl and asked UCO several questions regarding Cl’s health, including how Cl was feeling that day and Cl’s age and weight. UCO advised Dr. Ragone that he did not know how Cl was feeling since he had not spoken with him in some time. UCO also told Dr. Ragone Cl’s approximate age and weight, which Dr. Ragone documented in Cl’s patient records. Subsequently, Dr. Ragone stated that Cl had no fever, a blood pressure of 120 over 80, and good color — despite the fact that Cl was not present. As Dr. Ragone documented this information in Cl’'s patient records, she asked UCO if he knew the source of Cl’s pain. UCO advised her that he thought that it was Cl’s neck or lower back, after which Dr. Ragone stated “[wle’ll give him neck and low back pain.” 17. At the end of UCO’s July 28, 2003, visit to Tender Loving Pain Center, Dr. Ragone dispensed 100 Endocet (oxycodone) 5 mg, and 50 Valium (diazepam) 10 mg, prescribed to Ci by Dr. J. and gave Cl’s medications to UCO. Dr. Ragone then dispensed and provided UCO with 200 Roxicet (oxycodone) 5 mg, 50 Soma 350 mg, and 30 Xanax 2 mg prescribed by Dr. J. for UCO. Aside from getting UCO’s weight and blood pressure, Dr. Ragone provided no chiropractic services or treatment to UCO. Dr. Ragone collected four-hundred and fourteen dollars for Cl and UCO’s “treatment,” even though Cli didn’t go there that day. 18. Diazepam is a schedule IV controlled substance listed in Chapter 893, Florida Statutes (2003) which is indicated for the management of anxiety disorder. The abuse of diazepam can lead to physical or psychological dependence. 19. Oxycodone is a schedule II controlled substance listed in Chapter 893, Florida Statutes (2003) which is indicated for the management of moderate to severe pain when a continuous, around-the-clock analgesic is needed for an extended period of time. Oxycodone has a high potential for abuse and has a currently accepted, but severely restricted, medical use in treatment in the United States. Abuse of oxycodone may lead to severe physical and psychological dependence. 20. Soma contains carisoprodol, a muscle relaxant that is indicated for the relief of discomfort associated with acute, painful musculoskeletal conditions. 21. Xanax contains alprazolam, a schedule IV controlled substance listed in . Chapter 893, Florida Statutes, which is indicated for the short-term relief of symptoms of anxiety. The abuse of alprazolam can lead to physical and psychological dependence. 22. UCO next presented to Tender Loving Pain Center on or about August 28, 2003. Upon arriving at the office, UCO was informed that Dr. J. was not in the office but that he could see Dr. Ragone instead. An employee of the office then instructed UCO to complete patient information forms for both himself and for Cl. As Dr. Ragone watched, UCO completed both his and Cl’s patient information forms. Moments later, Dr. Ragone escorted UCO into an examination room and asked UCO what he weighed, but did not weigh him, though the office had a weight scale. When UCO informed Dr. Ragone that he did not want to have his blood pressure taken, Dr. Ragone told UCO that she would just give him “all the normal vital signs,” and she did not take UCO’s blood pressure. Dr. Ragone documented UCO’s false weight and blood pressure information in UCO’s patient record and then asked UCO what Cl weighed. When UCO told Dr. Ragone CI's estimated weight, Dr. Ragone documented this in Cl's 8 patient record. Dr. Ragone went on to document other false information in Cl’s patient record, including Cl’s blood pressure, medical problems that Cl was experiencing, and the symptoms that Cl was demonstrating. 23. At the end of UCO’s August 28, 2003, visit to Tender Loving Care Pain Center, Dr. Ragone dispensed 100 Oxycodone 5 mg and 50 mg Valium (diazepam) 10 mg that Dr. J. prescribed for Cl, to UCO. She then dispensed 2 bottles containing 100 oxycodone 5 mg to Soma 350 mg an 40 Xanax 2 mg, prescribed to UCO by dr. J. and gave those medications to UCO. Cl was not present. No examination, chiropractic services or treatment were rendered to Cl or UCO on August 28, 2003. 24. At the conclusion of the August 28, 2003, visit, Dr. Ragone gave UCO the following medications that Dr. J. had prescribed for Cl.: two bottles containing 100 oxycodone, 5 mg each; one bottle containing 50 Valium (diazepam), 10 mg. During the course of this visit, Cl was never seen or examined by either Dr. Ragone, or Dr. J. Dr. Ragone gave UCO two prescription bottles issued to UCO by Dr. J. containing 100 oxycodone 5 mg each, one prescription bottle issued to UCO by Dr. J. containing 50 Soma 350 mg, and one prescription bottle issued to UCO by Dr. J. containing 40 Xanax 2mg. No physical examination of either Cl, or UCO was conducted. 25. Dr. Ragone is the president of 3296 Enterprises, Inc. and Powerline Medical Rehab Assoc., Inc. located at located at 3296 N.W. 9" Avenue in Oakland Park, Florida, and on September 17, 2003, Dr. Ragone filed articles of incorporation for an entity called A Heaven’s Touch Pharmacy, Inc., at the same address as Tender Loving Pain Center and Dr. Ragone’s address of record listed on her license to practice chiropractic medicine. None of the above entities have been issued permits to operate 9 a pharmacy, or registered with the Department as is required of such business establishments, pursuant to Sections 465.015 and 456.037, Florida Statutes, respectively. 26. Dr. Ragone is not a licensed pharmacist. 27. On or about September 30, 2003, BCSO arrested Dr. J. and Dr. Ragone and charged each of them with various criminal violations, including trafficking in oxycodone in violation of Section 893.135, Florida Statutes (2003), conspiracy to traffic oxycodone in violation of Section 893.13, Florida Statutes (2003), issuing prescriptions for monetary gain in violation of Section 893.13, Florida Statutes (2003), conspiracy to deliver a controlled substance in violation of Section 777.04, Florida Statutes (2003), and delivering a controlled substance in violation of Section 893.13, Florida Statutes (2003). COUNT I 28. Petitioner re-alleges and incorporates by reference paragraphs 1 through 27 as if fully set forth herein. 29. Section 456.057(5)(a), Florida Statutes (2003) a licensee to discipline for discussing a patient’s medical condition with anyone other than the patient or legal representative, or with a health care practitioner providing services to th patient. 30. Dr. Ragone discussed Cl’s medical condition with UCO, breaching patient confidentiality in violation of Section 456.057(5)(a), Florida Statutes. 10 COUNT II 31. Petitioner re-alleges and incorporates by reference paragraphs 4 through 30 as if fully set forth herein. 32. Section 460.413(1)(r), Florida Statutes (2003), subjects a licensee to discipline, including suspension, for gross or repeated malpractice or the failure to practice medicine with that level of care, skill, and treatment which is recognized bya reasonably prudent similar chiropractic physician as being acceptable under similar conditions and circumstances. 33. Dr. Ragone failed to practice chiropractic medicine with an acceptable level of care, skill, and treatment in violation of Section 460.413(1)(n), Florida Statutes (2003), by failing to perform adequate initial and follow-up physical examinations of UCO and Cl; by dispensing controlled substances to UCO and Cl; by failing to document an adequate treatment plan or evaluation of the appropriateness of the continued treatment by controlled substances; by failing to maintain an adequate medical history for UCO and CI; and by failing to obtain adequate previous physician records and study results to document the accuracy of the medical and physical histories that UCO and Cl reported; and, by making false entries in patient records, and; dispensing controlled substances without a pharmacist’s license from an unlicensed pharmacy. 34. Dr. Ragone’s practice of chiropractic medicine constitutes either 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 chiropractic physician as being acceptable under similar conditions and circumstances and constitutes grounds 1 for the imposition of discipline pursuant to Sections 460.413(1) (nr), (ff), and 456.072(1)(cc), Florida Statutes. COUNT Ill 35. Petitioner re-alleges and incorporates by reference paragraphs 1 through 3 as if fully set forth herein. 36. Dispensing controlled substances is not within the scope of professional responsibilities Dr. Ragone is either competent, or permitted, to perform as a chiropractic physician licensed in the State of Florida. 37. Dr. Ragone practiced beyond the scope of her licensure as a chiropractic physician when she dispensed controlled substances for UCO and Cl and is subject to discipline pursuant to Sections 460.413(1)(t), (ff), 456.072(1)(0),(cc), Florida Statutes. COUNT IV 38. Petitioner re-alleges and incorporates by reference paragraphs 1 through 37 as if fully set forth herein. 39, Dr. Ragone failed to keep written chiropractic medical records to justify a course of treatment for either UCO, or Ci, including, but not limited to, patient histories; examination results; test results; X-rays, diagnosis of a disease, condition, or injury, as required by Rule 64B2-17.0065, Fla. Admin. Code. 40. Dr. Ragone failed to keep written chiropractic medical records to justify a course of treatment for either UCO, or Cl, and is subject to discipline pursuant to Sections 460.413(1)(m), (ff), 456.072(1)(cc), Florida Statutes. 12 COUNT V 41. Petitioner re-alleges and incorporates by reference paragraphs 1 through 40 " as if fully set forth herein. 42. Dr. Ragone exercised influence over UCO and billed for chiropractic services that could not be justified by any actual, authentic, documented condition for the sole purpose of financial gain, constituting overutilization and exploitation as defined by Board Rule 64B2-17.005, Fla. Admin. Code. 43. Dr. Ragone’s exploitation of patients for financial gain constitutes grounds for discipline pursuant to Sections 456.072(1)(n), (cc), 460.413(1)(n), (ff), Florida Statutes. COUNT VI 44. Petitioner re-alleges and incorporates by reference paragraphs 1 through 43 as if fully set forth herein. 45. Dr. Ragone entered false information into UCO and Cl’s medical records in her capacity as a licensed chiropractor. 46. A chiropractic medical record is a report by the chiropractor of the patient's medical condition that becomes a permanent part of the patient's medical record. 47. Dr. Ragone made false reports in her capacity as a licensed chiropractic physician and is subject to discipline pursuant to Sections 460.413(1)(j),(ff), 456.072(1)(I), (cc), Florida Statutes. that were 13 COUNT Vii 48. Petitioner re-alleges and incorporates by reference paragraphs 1 through 47 as if fully set forth herein. 49. Dr. Ragone’s entry of false information into UCO and Cl’s medical record fraudulently represented that certain medical conditions were diagnosed and treated, when, in fact, they were not. 50. Dr.Ragone made fraudulent representations in the practice of chiropractic medicine and is subject to discipline pursuant to Sections 456.072(1)(a),(cc), 460.413(1)(k), (ff), Florida Statutes. COUNT VIII 51. Petitioner re-alleges and incorporates by reference paragraphs 1 through 50 as if fully set forth herein. 52. Sections 465.015 and 456.065, Florida Statutes subject a licensee to civil, criminal, and administrative penalties for the unlicensed practice of pharmacy. 53. Dr. Ragone intentionally engaged in the unlicensed practice of pharmacy by dispensing controlled substances to UCO without a valid pharmacist’s license to engage in the practice of pharmacy. 54. Dr. Ragone owns and operates a business establishment(s) engaged in the business of pharmacy that are required by Sections 456.037 and 465.015, Florida Statutes, to have pharmacy permits prior to providing pharmacy services. 55. Dr. Ragone’s unlicensed practice of pharmacy from a business establishment operating as a pharmacy without the requisite permit, constitutes 14 grounds for the imposition of discipline pursuant to Sections 465.015, 456.065, 456.072(1)(cc), 460.413(1)(f), Florida Statutes. CLAIM FOR RELIEF WHEREFORE, Petitioner respectfully requests the BOARD OF CHIROPRACTIC. MEDICINE to enter an order imposing one or more of the following penalties pursuant to Sections 456.072, 460.413, Florida Statutes, and Rule 64B2-16.003, Florida Administrative Code: a. Revocation or suspension of Respondent's license; b. Restriction of Respondent's practice: c. An administrative fine; d. A reprimand; e. Probation; and/or f. Any other penalty the Board deems appropriate. Dated this (4tnday of _ aut wey , 2003. Respectfully submitted, CHARLES J. CRIST, JR. Attorney General 1 OF caw . eines, cut A err ert e pre CHRISTINE M. THORSON ESQUIRE cer i al Assistant Attorney General one Department of Legal Affairs PL-01 The Capitol Tallahassee, Florida 32399-1050 (850) 414-3300 PCP: Barr/Glisson DATE: November 3, 2003 15 NOTICE OF HEARING RIGHTS AND ASSESSMENT OF COSTS RESPONDENT IS HEREBY NOTIFIED THAT HE/SHE HAS THE RIGHT TO ' REQUEST AN ADMINISTRATIVE HEARING PURSUANT TO SECTIONS 120.569 AND 120.57, FLORIDA STATUTES. SPECIFIC OPTIONS FOR ADMINISTRATIVE ACTION ARE SET OUT IN THE ATTACHED EXPLANATION OF RIGHTS. ALL REQUESTS FOR HEARING MUST BE MADE WITHIN 21 DAYS OF RECEIPT AND SENT TO CHRISTINE THORSON, ESQUIRE, ASSISTANT ATTORNEY GENERAL, DEPARTMENT OF LEGAL AFFAIRS, PL-01 THE CAPITOL, TALLAHASSEE, FLORIDA 32399-1050. 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. CERTIFICATE OF SERVICE | HEREBY CERTIFY that a true and correct copy has been served by certified mail this_Wenday of Nawnewlbeey, 2003 to Respondent: Kathy Anne Ragone, D.C., 2748 N.E. 10" Street, Pompano Beach, Florida 33062. CB AM F.:AUsers ADMIN\Cheistine Messanairagone revised ac.wpd 16

Docket for Case No: 04-000391PL