STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, V. CASE NO. 2003-29078 DAVID W. WANG, 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, David W. Wang, 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 ME46620, aod gG'8L 002 2 #ny 2oreT 4o0z z= Bry 3. Respondent's address of record is 3827 Landlubber St. Orlando, FL 32812. 4. Respondent is board certified in Family Practice. 5. At all times relevant to this complaint, Respondent was employed as a physician at both the Cocoa Walk-in Clinic, 1119 King Street, Melbourne, Fl: 32922 and the Melbourne Walk-In Clinic, 316 Fast Strawbridge Avenue, Melbourne, FL 32901. General Allegations Pertaining to Controlled Substances 6. Under Section 893.03(3)(c), Florida Statutes, drugs containing limited quantities of hydrocodone are Schedule III controlled substances, meaning they have currently accepted medical uses in treatment in the United States and their abuse may lead to moderate or low physical dependence or high psychological dependence. Lortab and Lorcet are two ‘such drugs, | 7. Under subsection (3)1 of the same statute, any substance which contains any quantity of a derivative of barbituric acid, including butabarbital and butalbital, is also a Schedule III controlled substance. Phrenelin, Phrenelin-Forte and Fioricet are three such drugs. 60"d gG'eL 002 2 #ny 2S:¢T 42ooz z &ny 8. Under Section 893.03(4), Florida Statutes, the class of sedatives commonly called “benzodiazepines” are Schedule IV controlled substances, meaning they have currently accepted medical uses in treatment in the United States and their abuse may lead to limited physical or psychological dependence relative to the substances in Schedule III. Xanax (Alprazolam), Valium (Diazepam), Klonopin (Clonazepam), and Restoril (Temazepam) are four such drugs. | 9. Under the same statute, Darvon, an opioid containing propoxyphene, is also.a Schedule IV controlled substance. 10. Under the same statute, Soma, a “muscle relaxer’/central nervous depressant which contains carisoprodol, is also a Schedule IV controlled substance, 11. Flexeril is a muscle relaxer/central depressant and Ultram is an opioid painkiller but neither is a controlled substance. | Patient M.B. 12, On or about February 13, 2002, Patient M.B,, a then forty-one year old man, presented to Respondent complaining of increased tension secondary to a divorce, neck pain, recurrent headaches and possible hypertension. ab'd gG'eL 002 2 #ny 2oreT 4o0z z= Bry 13, Other than that Patient M.B.’s attitude was “happy” and “cooperative” (two conditions that do not require treatment with Xanax), on or about February 13, 2002, Respondent prescribed Patient M.B. thirty, one mg. Xanax without first completing and documenting an appropriate mental status exam, including but not limited to discussion of Patient M.B.'s; appearance, behavior, speech, thought processes, thought content, perceptions, cognition, consciousness, orientation, memory, judgment or insight. 14, On or about February 13, 2002, Respondent also prescribed - Patient M.B. thirty Phrenilin Forte for his pain without completing, or documenting findings from a physical exam adequate to validate Patient M.B.’s complaint of neck pain, or any other type of medical justification. 15. On or about March 18, 2002, Patient M.B. again presented to Respondent, this time complaining of back pain in addition to his neck pain. On or about March 18, 2002, Respondent discontinued Patient M.B.’s Phrenilin Forte and prescribed Lortab in its place, 16. On or about March 18, 2002, Respondent failed to document reasoning or justification for the switch in Patient M.B.’s medications, Respondent also failed to adequately document the history of Patient LL'd gG'8L 002 2 #ny 2oreT 4o0z z= Bry M.B.’s back pain, including but not limited to: the date of onset, whether it radiated into other areas of his body, whether anything made it better or worse and whether it was the result of trauma or some other kind of acute onset. . 17. On or about March 18, 2002, Respondent also prescribed Patient M.B. Flexeril without documenting justification for adding the drug to Patient M.B.’s medication regimen. 18. Respondent saw Patient M.B. on roughly a monthly basis between February 13, 2002 and August 19, 2002. During each of these visits, Patient M.B. complained of some combination of back or neck pain, anxiety and insomnia. During each of these visits, Respondent prescribed Patient M.B. some combination of Lortab, Flexeril and Xanax. 19, At no time during the approximately eight month period that Respondent treated Patient MB, did Respondent formulate or document a reasonable treatment plan appropriate to address the underlying causes of Patient M.B,’s complaints, including but not limited to referrals to a mental - health specialist, a physical therapist, an orthopedist, an orthopedic surgeon, or any other expert in back and neck problems; nor did zk'd qS'el 002 2 #ny 2oreT 4o0z z= Bry Respondent order diagnostic imaging studies adequate to diagnose. the underlying etiology of Patient M.B.’s back pain. 20. Patient M.B. was found dead on August 26, 2002. An autopsy conducted by the Brevard County Medical Examiner's Office revealed that Patient M.B. died with toxic levels of Xanax and hydrocodone in his blood. Patient S.B. 21. On or about May 3, 2002, Patient S.B., a then fifty year old woman, presented to Respondent complaining of unspecified pain. On this date, Respondent performed a physical examination of Patient S.B,’s extremities that he noted was “abnormal,” however he failed to legibly document which extremities this description applied to and in what ways they were abnormal. Respondent also noted that Patient S.B. had abnormal bowel movements, however he failed to legibly document the nature of the abnormality. 22. On or about May 3, 2003, Respondent prescribed Patient S.B. Lorcet, Soma, and Xanax, Other than documenting that Patient S.B.’s attitude was “happy” and “cooperative,” Respondent prescribed the Xanax without conducting or documenting an appropriate mental status exam, including but not limited to discussion of Patient §.B.’s: appearance, ek'd gG'eL ¢002 2 #ny ecreT goof 2 6ny behavior, speech, thought processes, thought content, perceptions, | cognition, consciousness, orientation, memory, judgment or insight. 23. On or about December 20, 2002, Patient S.B. again presented | to Respondent complaining of back pain, anxiety and insomnia and requesting refills of her previously prescribed medications, Respondent again prescribed thirty Xanax and also prescribed thirty Valium: double the number of: benzodiazepines he had prescribed during the earlier visit. On Or about December 20, 2002, Respondent failed to legibly document | justification for doubling the number of Patient S.B’s- prescribed benzodiazepines, atient M.L 24. On or about November 1, 1999, Patient M.L., a then fifty year old woman, presented to Respondent complaining of neck pain, back pain with spasm and epilepsy. Among other things, on or about November 1, 1999, Respondent prescribed Patient M.L. Lorcet, Phrenilin, Soma and Klonopin. | 25. Between November 1, 1999 and May 10, 2000, Respondent continued to see Patient M.L. on an approximately monthly basis. During each of these visits, Respondent prescribed Patient M.L. some combination Pled qS'el 002 2 #ny ecreT goof 2 6ny of Lorcet, Phrenilin, Soma and Klonopin. On three occasions he also prescribed a narcotic cough syrup that contains hydrocodone. 26, On or about May 10, 2000, Patient M.L.'s daughter called Respondent's office to report that her mother was addicted to and abusing her medications. The daughter requested that Respondent and the other | doctors at his practice exercise caution when prescribing her mother » ~aarcotics. The substance of this call was documented in Patient’M.E.’s medical record. | 27. On or about May 12, 2000, a Dr. Jenkins from Cape Canaveral Hospital called Respondent's clinic to report that Patient M.L. had been seen twice in the emergency room recently, secondary to a seizure and a fall. Dr. Jenkins reported that, on both occasions, Patient M.L. had toxic levels: of medications in her blood. The substance of this call was noted in Patient M.L.’s medical record. . 28. Respondent saw Patient M.L. again on or about May 31, 2000. Notwithstanding the concerns documented during the May 10 and May 12, 2000 phone calls, during this visit Respondent prescribed Patient M.L. (among other things), thirty Darvon, thirty Phrenilin, thirty Lorcet, sixty Soma and thirty Restoril. §k'd qS'el 002 2 #ny ecreT goof 2 6ny 29. On or about May 31, 2000, Respondent failed to discuss or legibly document discussing the reports he had received concerning Patient M.L.’s drug abuse with Patient M.L,, failed to refer or document referring Patient M.L. to a drug abuse counselor and/or detoxification/rehabilitation program, and failed to otherwise document justification for continuing to prescribe Patient M.L. significant quantities of controlled substances in light of the reports he had received on May 10 and 12, 2000. 30, Respondent saw Patient MLL. again on June 30, 2000. On or about June 30, 2000, Respondent again prescribed Patient M.L. Lorcet, Soma and Darvon without documenting or legibly documenting discussing the reports he had received concerning Patient M.L.’s drug abuse with Patient M.L., referring or documenting referring Patient M.L. to a drug abuse counselor and/or detoxification/rehabilitation program, or otherwise documenting justification for continuing to prescribe Patient M.L. significant Quantities of controlled substances light of the reports he had received on May 10 and 12, 2000, | 31. Respondent saw Patient MLL. again on July 28, 2000 and prescribed her more Restoril, Klonopin, hydrocodone and Soma. On or about July 28, 2000, Respondent failed to generate any notes or gL'd EGtel ¢o02 2 #ny ecreT goof 2 6ny documentation at all relating to this examination other than a receipt for. the payment received. 32. Patient M.L. was found dead on August 10, 2000. An autopsy conducted by the Brevard County Medical Examiner's Office revealed that Patient M.L. had a lethal concentration of hydrocodone in her blood when she died. wie Patient WLW, 33. On or about August 21, 2001, Patient W.W., a then forty-one year old man who claimed he was new to the Cocoa area, presented to Respondent complaining of anxiety and panic attacks. On or about August 21, 2001, Respondent prescribed Patient W.W. thirty Xanax without first receiving documentation of a previous diagnoses of Patient W.W.'s claimed psychological condition by a previous provider or without first completing and documenting an appropriate mental status exam (other than noting that Patient W.W. was “happy” and cooperative”), including but not limited to discussion of Patient W.W.’s: appearance, behavior, speech, thought processes, thought content, perceptions, cognition, consciousness, Orientation, memory, judgment or insight. Respondent did, however, recommend that Patient W.W., see a psychiatrist. 10 él'd EGtel ¢o02 2 #ny eoiel 4oo0z z= Bry 34. Respondent saw Patient W.W. again on September 18, 2001. During this visit, Respondent prescribed Klonopin to go along with Patient W.W.'s Xanax. Respondent failed to engage in or document discussion of whether or why Patient W.W. had failed to consult a psychiatrist in the preceding month as directed, 35. Respondent saw Patient W.W. again on October 18, 2001. During this visit, Patient W.W. complained of back pain’ so Respondent prescribed Ultram and Flexeril in addition to refilling Patient W.W.’s Xanax and Klonopin prescriptions. , 36. Onor about October 18, 2001, Respondent failed to adequately document the history of Patient W.W.’s back pain, including but not limited to: the date of onset, whether it radiated into other areas of his body, whether anything made it better or worse and whether it was the result of trauma or some other kind of acute onset. 37, Patient W.W. returned to see Respondent in November and December of 2001 and in January (twice), February, March, late April, early June, and July of 2002, During each of these visits, Respondent prescribed Patient W.W. some combination of Klonopin, Xanax, Flexeril, Fioricet, Lortab and Soma. 1i al'd EGtel ¢o02 2 #ny 6s:¢T 4ooz z &ny 38. During each of these visits, Patient W.W. always complained of the same things: hypertension, back pain with spasms, anxiety, panic attacks and insomnia. During the approximately eleven months that Respondent treated Patient W.W., Respondent failed to discuss or document discussion in Patient W.W.’s record of whether or why Patient W.W. had failed to see a psychiatrist for the underlying psychological problems that required him to take copious amounts of benzodiazepines. 39. At no time during the approximately eleven month period that Respondent treated Patient W.W. did Respondent formulate or document a reasonable treatment plan appropriate to address the underlying causes of Patient W.W.'s complaints, including but not limited to additional referrals to a mental health specialist, a physical therapist, an orthopedist, an orthopedic surgeon, or any other expert in back and neck problems; nor did Respondent order diagnostic imaging or other tests capable of assisting in diagnosing the underlying etiology of Patient W.W.’s back pain. 40. Despite persistently increasing the quantity of controlled substances he was prescribing Patient W.W. during the eleven months he treated him, Respondent failed to engage in or document discussion with Patient W.W. of addiction and dependence issues, condition receipt of his 12 Bl 'd EGtel ¢o02 2 #ny eoiel 4oo0z z= Bry prescriptions on completion of appropriate referrals or diagnostic testing, or otherwise refer him to a specialist in substance abuse issues. 41. Patient W.W, died of multiple drug intoxication July 21, 2002. An autopsy conducted by the Brevard County Medical Examiner's Office revealed that Patient W.W. had a lethal combination of opiates, | barbiturates, benzodiazepines and antidepressants in his blood when he died. =~. Count One 42. Petitioner incorporates and realleges paragraphs one through forty-one as if fully set forth herein. 43. Section 458.331(1)(t), Florida Statutes, provides that 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 physician as. being acceptable under similar conditions and circumstances is ground for discipline by the Board of medicine. 44. Respondent committed gross or repeated malpractice or failed to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable 13 az"d EGtel ¢o02 2 #ny eoiel 4oo0z z= Bry under similar conditions and circumstances in one or more of the following ways: a. On or about February 13, 2002, by prescribing Xanax to Patient M.B. without first completing an appropriate mental status exam (other than noting that Patient M.B.’s attitude was “happy” and “cooperative” -- two conditions that do not require treatment with Xanax), including but not limited: to discussion of Patient M.B.’s: appearance, behavior, speech, thought Processes, thought content, perceptions, cognition, consciousness, orientation, memory, judgment or insight. . b. On or about February 13, 2002, by prescribing Patient M.B. thirty Phrenilin Forte for pain without completing a physical exam adequate to validate Patient M.B.’s complaint of ~ neck pain, or any other type of exam which justified a_ prescription for controlled painkillers. c, On or about March 18, 2002, by failing to adequately elicit the history of Patient M.B.’s back pain, including but not limited to: the date of onset, whether it radiated into other areas of his body, whether anything made it lZ"d aiel ¢o02 2 #ny 6s:¢T 4ooz z &ny better or worse and whether it was the result of trauma or some other kind of acute onset, d. Between February 13, 2002 and August 19, 2002, by failing to formulate or implement a treatment plan adequate to address the underlying causes of Patient M.B,’s complaints, including but not limited to referrals to a mental health specialist, a physical therapist;: an orthopedist, an orthopedic surgeon, or any other expert in back and neck problems, and by failing to order diagnostic imaging or other tests adequate to diagnose the underlying etiology of Patient M.B,’s back pain. e. On or about May 3, 2002 by prescribing Patient S.B. Xanax without completing an appropriate mental status exam (other than documenting that Patient S.B.'s attitude was “happy” and “cooperative”), including but not limited to discussion ‘of Patient S.B.’s: appearance, behavior, speech, thought processes, thought content, perceptions, cognition, consciousness, orientation, memory, judgment or insight. f. On or about May 31 and June 30, 2000, by failing to discuss the reports he had received on May 10 and May 12, ze'd aiel ¢o02 2 #ny oa:rT 2ooz z &ny 2000, concerning Patient M.L.’s drug abuse, with Patient M.L., failing to refer Patient M.L. to a drug abuse counselor and/or detoxification/rehabilitation program, and failing to. otherwise document justification for continuing to prescribe Patient MLL. | significant quantities of controlled substances in light of the | reports he had received on May 10 and 12, 2000. g. Qn:orabout August 21, 2001, by prescribing Patient W.W. thirty Xanax without first consulting documentation of a previous diagnosis of Patient W.W.’s claimed psychological condition by a. previous provider and/or without first completing an appropriate mental status exam (other than noting that Patient W.W. was happy and cooperative), including but not limited to discussion of Patient W.W.’s: appearance, behavior, speech, thought processes, thought content, perceptions, cognition, consciousness, orientation, memory, judgment or insight. . h. On or about September 18, 2001, by not discussing with Patient W.W. why he had failed to consult a psychiatrist in 16 eed agiel ¢o02 2 #ny oo:rT 4o0z 2 6ny the preceding month, as directed, before prescribing Patient W.W. more controlled substances. i, On or about October 18, 2001, Respondent by failing to adequately inquire into the history of Patient W.W.’s back pain, including but not limited to: the date of onset, whether it radiated into other areas of his body, whether anything made it better or worse and whether it was the-rasult of trauma or some other kind of acute onset. | je During the approximately eleven months that he treated Patient Ww. by failing to formulate or implement a treatment plan adequate to address to the underlying causes of Patient W.W.’s complaints, including but not limited to additional referrals to a mental health specialist, a physical . therapist, an orthopedist, an orthopedic surgeon, or any other expert in back and neck problems; and by failing’ to order diagnostic imaging or other tests capable of assisting in diagnosing the underlying etiology of Patient W.W.'s back pain. . k. During the approximately eleven months that Respondent treated Patient W.W., by not discussing with Pe'd aiel ¢o02 2 #ny oo:rT 4o0z 2 6ny Patient W.W. why he had failed to see a psychiatrist for the underlying psychological problems that required him to take copious amounts of benzodiazepines and by not withholding Patient W.W.’s medications until he complied with this directive. I. Despite persistently increasing the quantity of controlled substances he was prescribing Patient W.W. during. the eleven months he treated him,:by failing to engage in discussion with Patient W.W. of addiction and dependence issues, to condition receipt of his prescriptions on completion of appropriate referrals or diagnostic testing, or otherwise refer him to a specialist in substance abuse issues. 45. Based on the foregoing, Respondent has violated Section 458,331(1)(t), Florida Statutes, Count Two 46. Petitioner incorporates and realleges paragraphs one through forty-one as if fully set forth herein. 47, Section 458.331(1)(q), Florida Statutes, provides that prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course gz"d BS'el ¢o02 2 #ny oo:rT 4o0z 2 6ny of the physician's professional practice is grounds for discipline by the Board of Medicine. For the purposes of this statute, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and is not in the course of the physician's professional practice, without regard. to-his or her intent. 48. Respondent prescribed, dispensed, administered, mixed, or otherwise prepared legend drugs, including controlled substances, other ; than in the course of his professional practice, in one or more of the following ways: , a. On or about February 13, 2002, by prescribing Xanax to Patient M.B. without first completing and documenting an appropriate mental status exam (other than noting that — Patient M.B.’s attitude was “happy” and “cooperative” -- two conditions that do not require treatment with Xanax), including but not limited to discussion of Patient M.B.’s: appearance, behavior, speech, thought processes, thought content, 19 qz"d BS'el ¢o02 2 #ny To:ft 2007 2 6ny perceptions, cognition, consciousness, orientation, memory, judgment or insight. b. On or about February 13, 2002, by prescribing Patient M,B, thirty Phrenilin Forte for his pain without completing or documenting findings from a physical exam consistent with Patient M.B.‘s complaint of neck pain, or any ~ » other type of medical justification. cn eal C Between February 13, 2002 and August 19, 2002, by continually prescribing Patient M.B. controlled substances in the absence of a treatment plan adequate to address the underlying causes of Patient M.B.’s complaints, including but not limited to referrals to a mental health specialist, a physical therapist, an orthopedist, an orthopedic surgeon, or any other expert in back and neck problems, and/or without ordering diagnostic imaging or other tests capable of assisting in diagnosing the underlying etiology of Patient M.B.’s back pain. d. On or about May 3, 2003, by prescribing Patient 5.B. Xanax. without conducting or documenting the results of an appropriate mental status exam (other than noting that 20 it'd BS'el ¢o02 2 #ny To:ft 2007 2 6ny Patient S.B.’s attitude was “happy” and “cooperative’), including but not limited to discussion of Patient S.B.’s: appearance, behavior, speech, thought processes, thought content, perceptions, cognition, consciousness, orientation, memory, judgment or insight. e. On or about May 31 and June 30, 2000, by continuing to prescribe Patient M.L::controlled substances in light of the reports he had received concerning her drug use on , May 10 and May 12, 2000 and/or without referring Patient M.L. to a drug abuse counselor and/or detoxification/rehabilitation program. f. On or about August 21, 2001, by prescribing Patient | W.W. thirty Xanax without first consulting documentation of a previous diagnosis of Patient W.W.’s claimed psychological condition by a previous provider and/or by prescribing Xanax without completing and documenting an appropriate mental status exam (other than noting that Patient W.W. was “happy” and cooperative”), including but not limited to discussion of Patient W.W.'s: appearance, behavior, speech, thought a1 az"d BS'el ¢o02 2 #ny To:ft 2007 2 6ny processes, thought content, perceptions, cognition, consciousness, orientation, memory, judgment or insight. g. Onor about September 18, 2001, by not discussing with Patient W.W. why he had failed to consult a psychiatrist in the preceding month, as directed, before prescribing Patient W.W. more controlled substances. h. During the approximately eleven months that he treated Patient W.W., by continuing to prescribe him significant quantities of controlled substances in the absence of a treatment. plan adequate to address the underlying causes of Patient W.W.’s back problems, including but not limited to referral to a physical therapist, an orthopedist, an orthopedic surgeon, or any other expert in back and neck problems. i. During the approximately eleven months that he treated Patient W.W., by continuing to prescribe him significant quantities of controlled substances without engaging in or documenting engaging in any discussion of whether or why Patient W.W. had failed to see a psychiatrist for the underlying psychological problems that required him to take copious 22 be"d BS'el ¢o02 2 #ny To:ft 2007 2 6ny amounts of benzodiazepines and for not making receipt of his prescriptions condition on Patient W.W.'s compliance with this directive. . j. During the eleven months that he treated Patient W.W., by continuing to prescribe him controlled substances without engage in or documenting discussion with Patient W.W. of addiction and “dependence issues, without coriditioning receipt of his _ prescriptions on completion of appropriate referrals or diagnostic testing, or otherwise referring him to a specialist in substance abuse Issues. 49. Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes. Count Three 50. Petitioner incorporates and realleges paragraphs one through forty-one as if fully set forth herein. 51. Section 458.331(1)(m), Florida Statutes, provides that failing to keep legible, as defined by department rule in consultation with the board, medical records that, among other things, justify the course of treatment of the patient, including, but‘not limited to, patient histories; examination . 23 ag"d aotpk gone 2 #ny To:rt 2oo0z z ny results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations, is grounds for discipline by the Board of Medicine. «52. Respondent failed to keep legible medical records that justify the course of treatment of the patient in one or more of the following ways: et a. On or about February 13, 2002, by prescribing Xanax to Patient M.B. without first documenting an appropriate mental status exam, including but not limited to discussion of Patient M.B.’s: appearance, behavior, speech, thought processes, thought /content, perceptions, cognition, consciousness, orientation, memory, judgment or insight. b. On or about February 13, 2002, by prescribing Patient M.B. thirty Phrenilin Forte for his pain without documenting findings from, a physical exam consistent with Patient M.B.’s complaint of neck pain, or any other type of medical justification, 24 Led aotpk gone 2 #ny ZO:pl 2o0z 2 6ny c. Onor about March 18, 2002, by failing to document reasoning or justification for the switch in Patient M.B.’s pain medication, failing to adequately document the history of ' Patient M.B.’s back pain, including but not limited to: the date of onset, whether it radiated into other areas of his body, | whether anything made it better or worse and whether it was the result: of trauma or some other kind of acute onset, and failing to document justification for prescribing Flexeril, d. | Between February 13, 2002 and August 19, 2002, by failing to document a reasonable treatment plan appropriate ' to address the underlying causes of Patient M.B.’s complaints, including but not limited to referrals to a mental health - specialist, a physical therapist, an orthopedist, an orthopedic ‘surgeon, or any other expert in back and neck problems and by failing to document ordering diagnostic imaging studies adequate to diagnose Patient M.B.’s underlying conditions. e, On or about May 3, 2002, by performing a physical examination of Patient S.B.’s extremities that he noted was 25 ze"d aotpl oe 2 #ny ZO:pl 2o0z 2 6ny “abnormal,” without legibly documenting which extremities this description applied to and in what ways they were abnormal. f. On or about May 3, 2002, by noting that Patient S.B. had abnormal bowel movements without legibly document the nature of the abnormality. — , g. On or about May 3, 2003, by prescribing Patient | 5.B. Xanax without documenting the results ‘Of an appropriate mental status exam, including but not limited to discussion of Patient , S.Bs: appearance, behavior, speech, thought processes, thought content, perceptions, cognition, consciousness, orientation, memory, judgment or insight. h. On or about December 20, 2002, by doubling the number of benzodiazepines he had prescribed Patient S.B. during an earlier visit without documenting justification for the change. i. On or about May 31 and June 30, 2000, by failing . to document discussing the reports he had received on May 10 and May 12, 2000 concerning Patient M.L’s drug abuse with Patient M.L., failing to document referring Patient M.L. to a 26 Bed aotpk gone 2 #ny ZO:rT 2ooz Zz &ny e ; r drug abuse counselor and/or detoxification/rehabilitation program, and failing to otherwise document justification for continuing to prescribe Patient M.L, significant quantities of controlled substances in light of the reports he had received on May 10 and 12, 2000. , j. On or about July 28, 2000, by seeing Patient M.L. during an office visit and prescribing. her more controlled substances without generating any record of the visit other than a receipt for payment received, k. On or about August 21, 2001, by prescribing Patient W.W. thirty Xanax without documenting an appropriate mental status exam, including but not limited to discussion of Patient W.W.’s: appearance, behavior, speech, thought processes, thought content, perceptions, cognition, consciousness, orientation, memory, judgment or insight. I, On or about October 18, 2001, by failing to adequately document the history of Patient W.W.'s back pain, including but not limited to: the date of onset, whether it radiated into other areas of his body, whether anything made it 27 Pe"d LOtpk 002 2 #ny ZO:rT 2ooz Zz &ny eo , @. better or worse ‘and whether it was. the result of trauma or some other kind of acute onset. m. During the approximately eleven month period that he treated Patient W.W., by failing to document a. reasonable treatment plan appropriate to address the underlying causes of . Patient W.W.’s complaints, including but not limited to additional referrals.to.a physical therapist, an orthopedist, an orthopedic surgeon, or any other expert in back and neck problems. | n. During the eleven months that he treated Patient W.W., by failing to document any discussion of whether or why Patient W.W. had failed to see a psychiatrist for the underlying psychological problems that required him to take copious amounts of benzodiazepines. 0. During the eleven months he treated him, by failing to document discussion with Patient W.W. of addiction and dependence issues, conditioning receipt of his prescriptions on completion of appropriate referrals or diagnostic testing, or 28 g8"d LOtpk 002 2 ny ca:rt 2ooz Zz &ny too! . eo eo otherwise referring him to a specialist in substance abuse issues, 53. Based on the foregoing, Respondent has violated Section 458,331(1)(m), Florida Statutes. 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. 29 96d LOtpk 002 2 ny co:ipl 2o0z 2 ny eo. e SIGNED this [3° day of___5 vlu , 2007. Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General (Q0D— Don Freeman DEPARTMENT OF HEALTH Assistant General Counsel PUTY At DOH-Prosecution Services Unit CLER 12 4052 Bald Cypress Way-Bin C-65 . DAI ; Tallahassee, Florida 32399-3265 Florida Bar # 736171 = (850) 245-4640 (850) 245-4681 fax PCP: July 13, 2007 PCP:Members: Leon, Rosenberg, & Beebe 30 fed LOtpk 002 2 ny co:ipl 2o0z 2 ny 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. 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. 31 ae "d LOtpk 002 2 ny ca:rt 2ooz Zz &ny

Docket for Case No: 07-003556PL