Feb 12 2009 $:23 Feb 12 2009 8:21 P.O5 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, ve - CASE NO. 2008-00506 LOWELL ANTHONY ADKINS, M.D., | | RESPONDENT, ce DMINIST I | COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Medicine against the Respondent, Lowell Anthony Adkins 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 seats 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 38661. Feb 12 2009 $:23 Feb 12 2009 8:21 P. O06 3. The Respondent's address of record is 3135 W. Atlantic Bivd. #14 and #15, Ft. Lauderdale, Florida 33069. | 4. The Respondent is not board certified in any American Medical Board specialties, 5. On or about September 19, 2007, Patient J.D., a twenty- -three (23) year-old male, presented to Respondent with complaints of pain from juvenile rheumatoid arthritis (JRA) and pain in his knee. 6. On or about September 19, 2007, through on or about February 11, 2008, Respondent prescribed oxycodone and carisoprodol for treatment of Patient J.D/s baln, 7. Oxycodone is commonly prescribed to treat pain. Oxycodone is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment i in the United States. Abuse of oxycodone may lead to severe psychological or physical dependence. | 8. Carisprodol, commonly known by the brand name Soma, isa muscle relaxant prescribed to treat muscular pain, According to Section 893.03(4), Florida Statutes, carisoprodol is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule IIT and has a currently accepted medical use in treatment in the J:\PSU\Madical\Bates Shirley\Adkins AC (t) overprescribing\Adkins (t) over prescribing,doc Feb 12 2009 $:23 Feb 12 2009 8:22 P.O? United States. Abuse of carisoprodol may lead to limited physica or psychological dependence relative to the substances in Schedule Il. 9. Rule 64B8-9.013(3)(a), Florida Administrative Code, provides standards for the use of controlled substances for pain control, Those standards require that a complete medical history and physical examination be conducted and documented in the medical record, The mecca record should document the nature and intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and history of substance abuse. The medical record also should document the presence of one or more recognized medical indications for the use of a. controled substance. | 10, On or about September 19, 2007, Respondent prescribe oxycodone, 15mg, 60 tablets for Patient J.D. | 11, Respondent failed to keep medical records which legibly record the rationale for prescribing oxycodone for Patient J.D. on or about September 19, 2007. ! 12, On or about October 19, 2007, Respondent prescribed oxycodone, 30mg, 90 tablets for Patient J.D. J:\PSU\Medical\ Bates Shirley\Adkins AC (t) overprescribing\Adkins (t) over prescribing.doc Feb 12 2009 $:23 Feb 12 2009 8:22 P. 08 13, Respondent failed to keep medical records which legibly record the rationale for prescribing oxycodone for Patient J.D. on or about October 19, 2007. | 14. On or about ‘November 16, 2007, Respondent ‘Prescribed oxycodone, 30mg, 120 tablets for Patient J.D, | 15, Respondent failed to keep medical records which legibly record the rationale for prescribing oxycodone for Patient J.D. on or about November 16, 2007. | 16. On or about December 14, 2007, Respondent prescribed oxycodone, 30mg, 120 tablets for Patient J.D. | 17, Respondent failed to keep medical records which legibly record the rationale for prescribing oxycodone for Patient J.D, on or about December 14, 2007, , 18. On or. about _ October 19, 2007, Respondent prescribed carisoprodol, 350mg, 60 tablets for Patient J.D. 19. Respondent failed to keep medical records which legibly record the rationale for prescribing Carisoprodol for Patient J.D, on ot about October 19, 2007. | 20. On or about October 31, 2007, Respondent prescribed carisoprodol, 350mg, 60 tablets for Patient J.D. J.\PSU\Medical\Bates Shirley\Adkins AC (t) overprescribing\Adking (t) over prescribing.doc Feb 12 2009 3:24 Feb 12 2009 8:22 P.09 21. Respondent failed to keep medical records which legibly record the rationale for prescribing carisoprodol for Patient J.D. on or about October 31, 2007, 22. On or about November 26, 2007, Respondent prescribed i | carisoprodol, 350mg, 60 tablets for Patient J.D, | 23, Respondent failed to keep medical records which lei record the rationale for prescribing carisoprodol for Patient J.D. on or about November 26, 2007, : 24. On or about December 14, 2007, Respondent prescribed carisoprodol, 350mg, 60 tablets for Patient J.D. 25. Respondent failed to keep medical records which lea record the rationale for prescribing carisoprodol for Patient J.D. on or about December 14, 2007. 26. On or about December 28, 2007, Respondent prescribed carisoprodol, 350mg, 60 tablets for Patient J.D. | 27. Respondent flled to keep medical records which legibly record the rationale for prescribing carisoprodol for Patient J.D, on or about December 28, 2007. | | 28. On or about February 11, 2008, Respondent prescribed carisoprodol, 350mg, 60 tablets for Patient J,D, J.\PSU\Medical\Bates Shirley\Adking AC {t) overprescribing\Adkins (t) over preseribing.doc | 5 Feb 12 2009 8:24 Feb 12 2009 8:22 P.10 29. Respondent failed to keep medical records which lei record the rationale for prescribing carisoprodo| for Patient J.D, on or about February 11, 2008, | 30. On or about December 14, 2007, T.R., Patient D's mother, reported to Respondent that she had walk in on her son sorting the meds Respondent was prescribing and that her son is addicted to those meds. 31. On or about December 14, 2007, T.R.,. Patient J, Dis mother, reported to Respondent that Patient had been arrested for drugs and was in a drug treatment program. 32. Respondent did not prescribe Patient 3.D. any non- steroidal anti-inflammatory drugs (NSAID) in an effort to manage J.D/s pain in his knee or any other pain, | 33, On ‘er about September 19, 2007, through on or about February 11, 2008, Patient J.D. was under the care of Respondent and Respondent did not refer. ‘Patient to a 2 Rheumatologist, an Orthopedic Specialist or to ar Addiction specialist. | | | COUNT. ONE | 34. Petitioner reallages and incorporates paragraphs ‘one (1) through thirty-three (33) as if fully set forth herein. J:\PSU\Medical\Bates Shirley\Adking AC {t) overprescribing\Adkins (t) over prescribing.doc ; 6 Feb 12 2009 3:24 Feb 12 2009 8:23 P.11 35. Section 458.331(1)(t), Florida Statutes (2007), subjects a doctor to discipline. for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2007), defines medical malpractice as the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure, 36. Level of care, skill, and treatment recognized -in general law related to health care licensure means the standard of care specified in Section 766.102. Section 766,102(1), Florida Statutes (2007), defines the standard of care to mean“... The prevailing professional standard of care for a given health care provider shall be that level of care, skill, and treatment which, in light; of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers. . . .” | 37, Respondent failed to meet the prevailing standard of care in regard to Patient J.D. in one or more of the following ways: a) by failing to refer Patient J.D. to a rheumatoid arthritis ‘Specialist and/or by failing to verify the complaints of pain from juvenile rheumatoid arthritis with blood tests: J:\PSu\Medical\Bates Shirley\Adkins AC (t) overprescribing\Adkins (t) over prescribing.doc 7 Feb 12 2009 3:24 Feb 12 2009 8:23 P.12 b) _ by failing to refer Patient J.D. to a Psychiatric-addiction specialist, especially after he was informed by Patient’s mother that he was, allegedly, an addict; | c) by failing 'to refer Patient J.D. to an orthopedic specialist to have the pain in his knee evaluated; | d) by prescribing excessive narcotics for Patient ID's alleged pain condition prior to exploring the effectiveness of other NSAIDs. | 38. Based on the foregoing, the Respondent has Violated Section 458,.331(1)(t), Florida Stattes (2007), by committing medica} malpractice COUNT TWO | 39, Petitioner realleges and incorporates paragraphs one (1) through thirty- three (33) S if fully set forth herein, | 40. Section 458.331(1)(a), Florida Statutes (2007, provides prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including eny controle substance, other than in the course of the physician's professional practice constitutes grounds for disciplinary action by the Board of Medicine. For the purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, TAPSU\Medical\Bates Shiriey\Adkins AC (t) overprescribing\Adkins (t) over preseribing.doc 8 [3 Feb 12 2009 3:25 Feb 12 2009 8:23 P.13 mixing, or otherwise preparing legend drugs, including al controlled substances, inappropriately or in excessive or inappropriate quanti 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 av 41. Respondent prescribed, dispensed, administered, otherwise prepared a legend drug, other than in the couse of his professional practice, from on or about September 19, 2007, through on or about February 11, 2008, in one or more of the following ways: — | a) By prescribing, dispensing, or administering a legend drug, to-wit: oxycodone, a controlled substance, to Patient J.D in excessive amounts, for an alleged pain conten prior to exploring the effectiveness of other NSAIDs; and/or | b) By prescribing, dispensing, or administering a legend drug, to-wit: oxycodone, a controlled substance to Patient J.D. without recording the rationale or justification for the narcotics he was prescribing for Patient J.D. ! 42. Based on the foregoing, the Respondent has vate Section 458.331(1)(q), Florida Statutes (2007), by prescribing, di spensing, administering, mixing, or otherwise preparing a legend drug, including any J:A\PSU\Medical\Bates Shirley\Adkins AC (t) overprescribing\Adkins (t) over prescribing.doc 9 Feb 12 2009 3:25 Feb 12 2009 8:23 P14 controlled substance, for Patient V.R. other than in the course of the physician's professional practice COUNT THREE 43. Petitioner realleges and incorporates paragraphs one a) through thirty-three (33) as if fully set forth herein. 44. Section 458.331(1)(m), Florida Statutes (2007), 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 disciplinary action by the Board of Medicine, | 49. Respondent failed to keep legible medical records justifying the course of treatment for Patient J. D. in one or more of the owing ways: a) By falling to keep legible medical. records recording the reasons for prescribing the aforementioned medications for Patient D.: and/or b) By failing to keep medical records which legibly recorded the patient history, examination results, test results, drugs prescribed, dispensed or administered for Patient J.D. J:\PSU\Medical\Bates Shirley\Adkins AC (t) overprescribing\Adkins (t) over prescribing.doc i 10 Feb 12 2009 3:25 Feb 12 2009 8:24 P.15 c) By fling t to keep medical records which justified the course of treatment for Patient J.D. | 46. Based on the foregoing, the Respondent has violated Section 458.331(1)(m), Florida Statutes (2007), by falling to keep legible medical records, that identify the censed physician or the physician extender and supervising physician by. name and professional title who is or are responsible for rendering, ordering, supervising, or bling for each diagnostic or treatment procedure and that justify the course of treatment of Patient V.R, | COUNT FOUR 47, Petitioner realleges and incorporates paragraphs, one (1) through thirty-three (33) as if fully set forth herein. | 48. Section 458, 331(1)(nn), Florida Statutes’ (2007), provides that violating any provision of chapters 456 or 458, Florida Statutes, or any rules adopted pursuant thereto, is grounds for discipline by the Board of Medicine. | 49. Respondent violated Rule 64B8-9.013(3)(a), FA. cy which outlines the standards for prescribing controlled substances for pain control in one or more of the following ways: | J.\PSU\Medical\ Bates Shirley\Adkins AC (t) overpreseribing\Adkins (t) over Prescribing.doc i 1 I iF ” | Pil | 50. Feb 12 2009 3:25 Feb 12 2009 8:24 PTB a) By prescriting, dispensing, or administering | controlled substances for pai control, to- -wit: oxycodone and carisprodol, to Patient J.D. without documenting the nature and intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and any history of substance abuse; and/or | b) By prescribing, dispensing, or administering controlled substances for pain control, to-wit: oxycodone and carisprodol, to Patient J.D, without documenting one or more recognized medical indcatons for the use of a controlled substance, Based on the forgoing, Respondent violated 458.331(1)(nn), | Florida Statutes (2007), by violating any provision of chapters 456 or 458, Florida Statutes, or any nies adopted pursuant thereto, spec ifically by violating Rule 6488-9. 01303), FA.C,, by failing to. document the nature and intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and history of substance abuse; and/or failing to | : document the presence of one or more recognized medical indications for the use of a controlled substance. J\PSU\Medical\Bates Shirley\Adkins AC (t) overprescribing\Adkins (t) over preseribing.doc = = 12 u Feb 12 2009 3:26 Feb 12 2009 8:24 PL? 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, rastriction 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_<3//_ day of 7 gem Jun _, 2008. Ana M. Viamonte Ros, M.D., M.P.H State Surgeon General DOH Prosecution Services Unit FILED 4052 Bald Cypress Way, Bin C-65 DEPAOEPUTY CLEGK Tallahassee, FL 32399-3265 CLERK Rachel Brooky Florida Bar # 0115320 DATE 11-24-08 (850) 245-4640 ext. 8244 — phone (850) 245-4681 — fax PCP Date: Hfaifox PCP Members: Zi “Bahe: and Beer son. DOH v. LOWELL ANTHONY ADKINS, M.D., Case #2008-00506 J:\PSU\Medical\Bates Shirley\Adkins AC (t) overprescribing\Adkins (t) over prescribing.doc . 13 / : i . i Feb 12 2009 3:26 Feb 12 2009 8:24 P.18 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.

Docket for Case No: 09-000727PL