Jul 9 200? 15:42 JUL-@9-2087 15:58 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, V. CASE NO. 2005-70754 MARI K. THOMAS, D.O., RESPONDENT. / ADMINISTRATIVE COMPLAINT Petitioner Department of Health, by and through its undersigned counsel, files this Administrative Complaint before the Board of Osteopathic Medicine against Respondent Mari K, Thomas, D.O., and states: 1. Petitioner is the state agency charged with regulating the practice of osteopathic medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statues; and Chapter 459, Florida Statutes. 2. At all times material to this Complaint, Respondent was an osteopathic physician licensed in the State of Florida. Respondent's license number is OS 8386. 3. Respondent's address of record is 4900 East 4th Street, Unit C, Panama City, Florida 32404. TAL#567263.1 P.a4-24 ind2 7% AV Jul 9 200? 15:43 JUL-@9-2087 15:58 P.@5/24 4. At all times material to this Complaint, Respondent was the medical director of the Calhoun County Health Department (“CCHD”) and of the Liberty County Health Department (“LCHD"). 5. | At all times material to this Complaint, Nurse D.G. practiced at CCHD as an Advanced Registered Nurse Practitioner CARNP”) pursuant to a protocol established between her and Respondent. 6. Asan ARNP, Nurse D.G. is not qualified nor licensed to prescribe controlled substances. 7. Inher role of medical director of CCHD, Respondent’s duties included supervising Nurse D.G. 8. As set forth below, over the course of the twenty-eight-month period during which Respondent supervised Nurse D.G. (July 2003 through December 2005), Nurse D.G. improperly prescribed controlled substances to at least five patients (S.C., B.S., A.R., L.G., and S.L.) on multiple occasions using Respondent’s DEA license. Facts Related to Patient S.C. 9. Onor about July 22, 2003, S.C. presented to CCHD. During this visit, Nurse D.G. prescribed Vicodin to $.C. The patient record does TAL#567263.1 2 Jul 9 200? 15:43 JUL-@9-2087 15:59 P.@6/24 not reflect any acknowledgement or co-signature by Respondent concerning the prescription issued by Nurse D.G, 10. Vicodin, also known as Hydrocodone, is a Schedule II controlled substance listed in Chapter 893, Florida Statutes. Hydrocodone has a high potential for abuse and has a currently accepted by severely restricted medical use in treatment in the United States. Abuse of the substance may lead to severe psychological or physical dependence. 11. On or about April 13, 2004, S.C. presented to CCHD. During this visit, Nurse D.G. prescribed Lortab to S.C. The patient record does not reflect any acknowledgement or co-signature by Respondent concerning the prescription issued by Nurse D.G, 12. Lortab, also known as Hydrocodone, is a Schedule IT controlled substance listed in Chapter 893, Florida Statutes. Hydrocodone has a high potential for abuse and has a currently accepted by severely restricted medical use in treatment in the United States. Abuse of the substance may lead to severe psychological or physical dependence. 13. Just three days later on April 16, 2004, S.C. was seen by Respondent. In her notations for this visit, Respondent specifically TAL#S67263.1 3 JUL-9-2687 15:59 TAT 8 200 18 Pare indicates S.C. should be continued on Lortab, which had previously been prescribed to S.C. by Nurse D.G. 14, On or about August 11, 2004, S.C. returned to CCHD and was seen by Nurse D.G., who again prescribed Lortab to $.C. The patient record does not reflect any acknowledgement or co-signature by Respondent concerning the prescription issued by Nurse D.G. 15, On or about October 25, 2004, S.C. presented to CCHD. During this visit, Nurse D.G. again prescribed Lortab to S.C. without any acknowledgement or co-signature by Respondent concerning the prescription. 16. Onor about December 14, 2004, Nurse D.G. renewed S.C.’s prescription for Lortab. Once again, the record is devoid of Respondent's acknowledgement or co-signature with respect to this prescription. 17, Onor about March 15, 2005, Nurse D.G. renewedS.C.'s prescription for Lortab without acknowledgement or co-signature by Respondent concerning the prescription issued by Nurse D.G, 18. On March 21, 2005, Nurse D.G. renewed $.C.’s prescription for Soma. The patient record does not reflect any acknowledgement or co- signature by Respondent concerning this prescription, TAL¥567263.1 4 Jul 9 200? 15:43 JUL-@9-2087 15:59 P.@8/24 19. Soma contains Carisoprodol, which is a Schedule IV controlled substance listed in Chapter 893, Florida Statutes. The effects of Carisoprodol and other central nervous system depressants may be additive. A substance in Schedule IV has a low potential for abuse and a currently accepted medical use in treatment. Abuse of this substance may lead to limited physical or psychological dependence. 20. Onor about March 30, 2005, S.C. presented to CCHD. 5.C. was seen by Respondent, who acknowledged in the patient record that S.C. was being maintained on Lortab and Soma, 21. On or about August 16, 2005, Nurse D.G. again renewed S.C.’s prescription for Lortab. Respondent's acknowledgement or co-signature concerning the prescription issued by Nurse D.G. does not appear in the record. 22. Onor about September 13, 2005, S.C. presented to the CCHD. At the end of this visit, Nurse D.G. prescribed Xanax to $.C. The patient record does not reflect any acknowledgement or co-signature by Respondent concerning this prescription. 23. Xanax contains Alprazolam, a Schedule IV controlled substance listed under Chapter 893, Florida Statutes. The effects of Alprazolam and TAL#567263.1 5 Jul 9 200? 15:44 JUL-@9-2087 15:59 P.@o/24 other central nervous system depressants may be additive, A substance in Schedule IV has a low potential for abuse and a currently accepted medical use in treatment. Abuse of this substance may lead to limited physical or psychological dependence. Facts Related to Patient L.G. 24. Onor about October 13, 2003, L.G. presented to CCHD. During this visit, Nurse D.G, prescribed Vicodin to P.G. The patient record does not reflect any acknowledgement or co-signature by Respondent concerning the prescription issued by Nurse D.G. 25. On or about October 31, 2003, Nurse D.G. prescribed Darvocet to P.G. The patient record does not reflect any acknowledgement or co- signature by Respondent concerning this prescription. 26. Darvocet contains Propoxyphene, a Schedule IV controlled substance listed under Chapter 893, Florida Statutes. The effects of Propoxyphene and other central nervous system depressants may be additive. A substance in Schedule IV has a low potential for abuse and a currently accepted medical use in treatment. Abuse of this substance may lead to limited physical or psychological dependence. TALH567263,1 6 Jul 9 200? 15:44 JUL-@9-2087 16:88 P.1a/24 27. On February 25, 2004, L.G. was seen by Respondent, who made no documentation in the patient record acknowledging that Nurse D.G. had prescribed Vicodin and Darvocet to L.G. during two prior visits. 28. On March 4, 2004, L.G. was seen again by Nurse D.G. This time, Nurse D.G. prescribed Lortab to L.G., again without any acknowledgement or co-signature by Respondent concerning this prescription. 29. On May 5, 2004, L.G. was seen by Respondent. Respondent made no documentation in the patient record that Nurse D.G. had earlier prescribed Lortab to L.G. Facts Related to Patient B.S. 30. On July 19, 2004, B.S. presented to CCHD. Nurse D.G. attended to B.S. and prescribed Xanax, among other medications, to B.S. The patient record does not reflect any acknowledgement or co-signature by Respondent concerning this prescription. 31. On August 18, 2004, B.S. returned and was seen by Respondent. Respondent prescribed Xanax to'B.S. There were no entries in the patient record for this visit regarding Nurse D.G.’s prior prescription for Xanax. TAL#567263.1 7 Jul 9 200? 15:44 JUL-@9-2087 16:68 P.iiv2d 32. On January 3, 2005, B.S. was again seen by Nurse D.G., who prescribed Soma to B.S. The patient record for this visit is devoid of any acknowledgement or co-signature by Respondent concerning this prescription, 33. When Respondent next sees B.S. on May 18, 2005, she prescribes Soma to B.S., but does not include any reference to Nurse D.G.’s prior prescription for the same medication. Facts Related to Patient A.R. 34. Onor about May 23, 2005, A.R. presented to CCHD and was seen by Nurse D.G. Among other medications, Nurse D.G. prescribed Soma to A.R. The patient record does not reflect any acknowledgement or co-signature by Respondent concerning this prescription. 35. Respondent next sees A.R. on July 15, 2005, at which time Respondent defers any refills of Soma, but fails to make any notation in the medical record to indicate that Nurse D.G. had previously prescribed Soma to AR. Facts Related to Patient S.L. 36. Onor about September 11, 2003, S.L. presents to CCHD. She is seen by Nurse D.G., who prescribes Soma to S.L., among other TAL#567263.1 8 JUL-89-2687 16'H TAN 9 20 188 P.ie/24 medications. The patient record does not reflect any acknowledgement or co-signature by Respondent concerning this prescription. 37, On or about October 7, 2003, S.L. is seen again by Nurse D.G. who prescribes Lortab to S.L. The record for this visit does not reflect any acknowledgment or co-signature by Respondent concerning this prescription. 38. On February 4, 2004, Nurse D.G. prescribed Lortab to S.L. The record for this visit does not reflect any acknowledgment or co-signature by Respondent concerning this prescription. 39. During visits by S.L. on March 29, 2004, and October 12, 2004, Nurse D.G. notes in the medical record that she will continue S.L. on the same medications, which include Lortab. 40. On or about December 18, 2004, S.L. is seen by Respondent, who notes in the medical record that S.L. is being maintained on Soma and Lortab, 41. During 5.L.’s next visit on or about December 20, 2004, Nurse D.G. notes that S.L.’s medications include Hydrocodone and Soma. 42. On or about December 27, 2004, Nurse D.G. again notes that S.L.‘s medications include Hydrocodone and Soma. TAL#567263.1 9 JUL-89-2687 16°@1 Jul 9 2000 Bea 43. Onor about January 12, 2005, Nurse D.G. renewed S.L.’s prescription for Lortab. The record for this visit does not reflect any acknowledgment or co-signature by Respondent concerning this prescription. 44, On or about February 2, 2005, S.L. is again seen by Respondent, who once more notes in the medical record that S.L. is being maintained on Soma and Lortab. 45. Onor about March 29, 2005, Nurse D.G. prescribes Lortab to S.L. The record for this visit does not reflect any acknowledgment or co- signature by Respondent concerning this prescription. 46. 5S,L. was next seen by Respondent on July 29, 2005. During this visit, Respondent again acknowledged that S.L.’s medications include Lortab and Soma, both of which had previously been prescribed by Nurse D.G. Facts Related to Pre-signed Prescriptions 47. Inor about January 2006, the Department commenced an investigation of Respondent. 48. During the course of its investigation, the Department discovered a total of nine blank prescription forms that had been pre- TALH567263,1 10 P.13/24 JUL-89-2687 16°@1 Fur 8 208 18 P.id-24 signed by Respondent. Six of these were written on LCHD forms and three on CCHD forms. 49, None of the pre-signed prescription forms denote a medication or a patient name. 50. Respondent left the pre-signed prescription forms with the nursing staff at CCHD and LCHD and instructed them to use the forms to prescribe medications to patients during her absence. Count I 51. Petitioner realleges and incorporates paragraphs one through fifty above as if fully set forth herein. 52, Section 459.015(1)(hh), Florida Statutes (2003 - 2005), provides the Board of Osteopathic Medicine may discipline an osteopathic physician for “failing to supervise adequately the activities of those... advanced registered nurse practitioners, or other persons acting under the supervision of the osteopathic physician.” 53. Respondent failed to adequately supervise the activities of Nurse D.G. as evidenced by the numerous controlled substances Nurse D.G. prescribed while under Respondent's supervision, TAL#567263.1 1] Jul 9 200? 15:45 JUL-@9-2087 16:81 P.15/24 54, Based on the foregoing, Respondent has violated Section 459,015(1)(hh), Florida Statutes (2003 - 2005). 55. The Department has retained the undersigned counsel to represent it in this case, and it has agreed to pay the undersigned counsel a reasonable attorney's fee. Respondent is obligated to pay to the Department its costs related to the prosecution of this case, including time spent by undersigned counsel working on the case, pursuant to sections 456.072(4), Florida Statutes. Count II 56. Petitioner realleges and incorporates paragraphs one through fifty above as if fully set forth herein. | 57. Section 459.015(1)(aa), Florida Statutes (2003 - 2005), provides the Board of Osteopathic Medicine may discipline an osteopathic physician for “delegating professional responsibilities to a person when the licensee delegating such responsibilities knows or has reason to know that such person is not qualified by training, experience or licensure to perform them.” 58. By instructing the nursing staff at CCHD and LCHD to prescribe medications to patients during her absence, Respondent delegated TAL#367263.1 12 Jul 9 200? 15:45 JUL-@9-2087 16:81 P.16/24 professional responsibilities to persons not qualified by training, experience, or licensure to perform them. 59. Based on the foregoing, Respondent violated Section 459.015(1)(aa) Florida Statutes (2003 - 2005). ‘60. The Department has retained the undersigned counsel to represent it in this case, and it has agreed to pay the undersigned counsel a reasonable attorney’s fee. Respondent is obligated to pay to the Department its costs related to the prosecution of this case, including time spent by undersigned counsel working on the case, pursuant to sections 456.072(4), Florida Statutes. Count III 61. Petitioner realleges and incorporates paragraphs one through fifty above as if fully set forth herein. 62. Section 459.015(1)(ee), Florida Statutes (2003 - 2005), provides the Board of Osteopathic Medicine may discipline an osteopathic physician for “presigning blank prescription forms.” 63. Respondent pre-signed blank prescription forms and left them with the nursing staff at CCHD and LCHD. TAL#567263.1 13 Jul 9 200? 15:45 JUL-@9-2087 16:82 P.iv/2d 64. Based on the foregoing, Respondent violated Section 459.015(1)(ee), Florida Statutes (2003 - 2005). 65. The Department has retained the undersigned counsel to represent it in this case, and it has agreed to pay the undersigned counsel a reasonable attorney's fee. Respondent is obligated to pay to the Department its costs related to the prosecution of this case, including time spent by undersigned counsel working on the case, pursuant to sections 456.072(4), Florida Statutes. Count IV 66. Petitioner realleges and incorporates paragraphs one through fifty above as if fully set forth herein. 67. Section 459.015(1)(0), Florida Statutes (2003 - 2005), provides the Board of Osteopathic Medicine may discipline an osteopathic physician for “[flailing 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 drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations,” TALA567263.1 14 Jul 9 200? 15:45 JUL-@9-2087 16:82 P. 18/24 68. Respondent failed to properly document medical records by acknowledging or co-signing for controlled medications prescribed by Nurse D.G. while under her supervision. | 69. Based on the foregoing, Respondent violated Section 459.015(1)(0), Florida Statutes (2003 - 2005). 70. The Department has retained the undersigned counsel to represent it in this case, and it has agreed to pay the undersigned counsel a reasonable attorney's fee, Respondent is obligated to pay to the Department its costs related to the prosecution of this case, including time spent by undersigned counsel working on the case, pursuant to sections 456.072(4), Florida Statutes. WHEREFORE, Petitioner respectfully requests the Board of Osteopathic Medicine enter an order imposing one or more of the following penalties upon Respondent: restriction of practice, imposition of an administrative fine, issuance of a reprimand, probation, corrective action, or remedial education, and assessing upon Respondent the costs and attorney’s fees incurred by the Department in the prosecution of this action. ave if SIGNED this | day of i 4 , 2007. TAL#567263,1 15 Jul 9 200? 15:47 JUL-@9-2087 16:82 P.19/24 Ana M. Viamonte Ros M.D., MPH Secretary, Department.of Health ¥ “oO y, eo wo a niel H Florida Bar No. 176834 CARLTON, FIELDS, P.A. 215 S. Monroe Street, Suite 540 Post office Drawer 190 Tallahassee, FL 32302 / Phone: 850-224-1585 eb LS Facsimile: 850-222-0398 ver Se ouenk Re nS IE pATE__ SS PCP Members: Rose + Swan 6/17 for Reviewed and approved by: (initials) (date) 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. TAL4567263.1 16 Jul 9 200? 15:47 JUL-@9-2087 16:83 P. 28/24 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. TALAS67263.1 17

Docket for Case No: 07-003069PL