Apr 22 2009 13:34 Apr 22 2009 12:33 p.0g STATE OF FLORIDA | DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, | PETITIONER, v. CASE NO. 2008-13844 JEFFREY ROBERT PERELMAN, M.D., RESPONDENT, ee DMINIS I INT COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Medicine against Respondent, Jeffrey Robert Perelman, 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 medical doctor within the state of Florida, having been issued license number ME 51866. J.APSU\Medical\Bates Shirley\Perelman 08-13844 AC (gtm)\PersimanAC 2008-13844) (nn).doc i Apr 22 2009 13:35 Apr 22 2009 12:99 P.03 3, Respondent's address of record is 98 S. Federal Highway, Boca Raton, Florida 33432. ; | 4. At all times material to this complaint, Respondent was the Medical Director of The Health and Rejuvenation Center (THRC). 5, The Health and Rejuvenation Center's mailing address and physical location is Gardens Medical Park, 3345 Burns Road, Suite 204 Palm Beach Gardens, Florida 33410. 6. The Health and Rejuvenation Center operates as an On-Line . Clinic.’ 7. Beginning in or about February 2007, Patient G.D. first contacted THRC through an internet advertisement. | 8. Patient G.D. spoke with an employee of THRC, Mike Faller, who informed Patient G.D. that THRC would send a testing company to his residence to take blood samples for testing and evaluation by THRC's medical director. Mike Faller named the Respondent as the medical _ director. 9. Patient G.D. did not speak to or meet with Respondent at that time or any time thereafter. JAPSU\Medicai\Bates Shirley\Perelman 08-13844 AC (qtm)\PerelmanAC 2008-13844 fon).dos : 2 Apr 22 2009 13:35 Apr 22 2009 12:99 10. On or about May 23, 2007, THRC sent someone to Patient GDS home to take blood. 11. On or about May 30, 2007, Respondent sent, via fax, prescriptions to APS Pharmacy: for testosterone and Isotropin for Patient G.D. 12. ‘Testosterone is a schedule IV drug that is the principal male sex hormone and an anabolic steroid. It is sometimes used to loss, loss of bone density, fatigue, and low sex drive, treat weight 13. Tsotrepin-is-a-brand- name-for-human-growth hormone. Human growth hormone is normally produced in a person's pituitary gland, According to the Food and Drug Administration (FDA), human growth hormone is legal for only two (2) conditions; wasting syndrome of AIDS and Growth Hormone Deficiency (GHD). 14. There is no documentation indicating that Respondent met with | Patient G.D. prior to prescribing testosterone for Patient G.D. 15, There is no documentation indicating that Respondent met with Patient G.D. prior to prescribing Isotropin for Patient G.D. 16. There is no documentation indicating that conducted a patient evaluation, including history and physical JAPSU\Medical\Bates Shiriey\Perelman 08- 13844 AC (qtm)\PerelmanAG 2008-13844 /(jn).doc i 3 q y Respondent examination Apr 22 2009 13:35 Apr 22 2009 12:34 G.D. testosterone. 17, There is no documentation indicating _ that P.O5 to establish a diagnosis for the condition for which he prescribed Patient Respondent conducted a patient evaluation, including history and physical examination to establish a diagnosis for the condition for which he prescribed Patient G.D. Isotropin. 18. There is no documentation that there was 4 between Respondent or his physician assistant and Patient G.D. discussion concerning treatment options and’ the risks and benefits of treatment with testosterone. 19. There is no documentation that there was a ‘between Respondent or his physician assistant and Patient G.D. treatment options and the risks and benefits of treatment with COUNT ONE | discussion concerning Isotropin. 20. Petitioner realleges and incorporates paragraphs one (1) through nineteen (19) as if fully set forth herein. 21, Section 458.331(1)(t), Florida Statutes (2007), doctor: to discipline for committing medical malpractice as subjects a defined in Section 456.50. Section 456.50, Florida Statutes (2007), defines medical ) . t ; ; JAPSU\Medical\Bates Shirley\Pereiman 08-13844 AC (qim)\PerelmanAC 2008- va i(nn).doe . 1 i 4 1 Apr 22 2009 13:35 Apr 22 2009 12:34 P. O06 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. 52. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care Section 766.102. Section 766.102(1), Florida Statutes (2007), standard of care to mean“... The prevailing professional specified in defines the standard of care for a given health care provider shall be that level of care, skill, and treatment-—whieh;—in—light-of -all-relevant_surteunding circumstances, is - recognized as acceptable and appropriate by reasonably prudent similar health care providers. .. .” 23. Rule 64B8-9.014, Florida Administrative Code, provides that prescribing medications based solely on an electronic medical questionnaire constitutes the failure to practice medicine with that level of care, skill, and treatment which is recognized. by reasonably prudent physician. The Rule further provides that the physician shall not. provide treatment recommendations, including issuing a prescription, via electronic or other means, unless the following elements have been met: i | i i i i | ' 1; J A\PSU\Medicai\Bates Shirley\Perelman 08-13844 AC (qim)\PerelmanAC 7008-135 (nn).doe: rf : Apr 22 2009 13:36 Apr 22 2009 12:34 P.O? a) Documented patient evaluation, including history and physical examination to establish the diagnosis for which any legend drug is prescribed; b) Discussion between the physician or the physician assistant and the patient regarding treatment options and the risks and benefits of treatment; c) Maintenance of contemporaneous medical records meeting the requirements of Rule 64B8-9.003, FA.C. v= 24, Respondent failed to practice medicine: with that-level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances, — in one or more.of the following ways: a). By failing to conduct or obtain a patient evaluation, including history and physical examination to establish a diagnosis for the condition for which he prescribed Patient G.D. testosterone; or b) By failing to conduct or obtain a patient evaluation, including _ history and physical examination to establish a FAPSU\Medical\Bates Shirley\Perelman 08-13844 AC (qtm)\PerelmanAC 2008-13844 (an).doc 1 6 y ty i : Apr 22 2009 13:36 Apr 22 2009 12:94 P. 08 diagnosis for the condition for which he prescribed Patient G.D. Isotropin; or ) | | c) __ By failing to discuss with Patient G.D. treatment options and the risks and benefits of treatment prior to. prescribing testosterone to Patient G.D.; or d) By failing to discuss with Patient G.D. treatment options and the risks and benefits of treatment prior to prescribing . Isotropin to Patient G.D.; or ——-— e} By failing to maintaim-contermperaneous medical records for his treatment of Patient G.D. 25. Based on the foregoing, Respondent has violated Section 458,331(1)(t), Florida Statutes (2007), and Rule 64B8-9,014, Florida Administrative Code, by failing 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. | COUNT TWO 26. Petitioner realleges and incorporates paragraphs one (1) through nineteen (19) as if fully set forth herein. : 7 I APSU\Medieal\Bates, Shirley\Pereiman 08-13844 AC (qtmn)\PerelmanAC 2008-138 (nn),doc ; ey e Apr 22 2009 13:36 Apr 22 2009 12:96 P.09 27. Section 458.331(1)(q), Florida Statutes (2007), provides that a physician may be subject to discipline for prescribing, : dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. For the purposes of this paragraph, 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. 28. Respondent prescribed, dispensed, administered, mixed, or otherwise prepared a legend drug, including ahy controlled substance, other than in the course of the physician's professional practice, in one or more of the following ways: a) By inappropriately prescribing testosterone, a legend drug, for Patient G.D. via the internet without conducting or obtaining a patient evaluation, including history and physical examination to establish a diagnosis for the condition for which he prescribed Patient G.D. the medications, or JAPSU\Medical\Bates Shirley\Perelman 08-13844 AC (qtm)\PerelmanAC 7008-13844 (nn).doc . 8 } i Apr 22 2009 13:36 Apr 22 2009 12:96 P.10 b) By failing to discuss with Patient GD. treatment options and the risks and benefits of treatment prior to prescribing testosterone to Patient G.D.; or ¢) By inappropriately prescribing Isotropin, a legend drug, for Patient G. D. via the internet without ‘conducting pr obtaining a patient evaluation, including history and physical examination to establish a diagnosis for the condition for which he prescribed Patient G.D. the medications; or d) ~By~ failing to—-discuss—with—Patient .G.B:| concerning treatment options and the risks and benefits of treatment prior | to prescribing Isotropin to Patient G.D. 29. Based on the foregoing, Respondent veloted Section 458. 3314(1)(a), Florida Statutes (2007), by inappropriately prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than. in the course of the physician's professional practice. COUNT THREE 30. Petitioner realleges and incorporates paragraphs one (1) through nineteen (19) as if fully set forth herein. i : JAPSU\Medical\Bates Shirley\Perelman 08-13844 AC (qtm)\Perelman AC 2008-13844 (nn).doc 5 , 9 ne Apr 22 2009 13:37 Apr 22 2009 12:96 P.11 31. Section 458.331(1)(nn), Florida Statutes (2007), provides that a physician may be subjected to discipline for violating any provision of chapter 458 or chapter 456, or any rules adopted pursuant thereto. 32. The Respondent failed to comply with Rule 64B8-9.014, Florida Administrative Code, in one or more of the following ways: a) By failing to conduct or obtain. a patient evaluation, indluding history and physical examination to establish a diagnosis for the condition for which he prescribed Patient G.D. ~ testosterone;or =~ b) By failing to conduct or obtain a patient evaluation, ‘including history and physical examination to establish a diagnosis for the condition for which he prescribed Patient G.D. Isotropin; or c) By failing to discuss with Patient G.D. treatment options and the risks -and benefits of treatment prior to prescribing testosterone to Patient G.D.; or d) By failing to discuss with Patient G.D. treatment options and the risks and benefits of treatment prior to prescribing tsotropin to Patient G.D.; or JAPSU\Medical\Bates Shirley\Perelman 08-13844 AC (qtm)\PerelmanAC zoe 284 fr). dos Bo 10 i : i i ; a : Apr 22 2009 13:37 Apr 22 2009 12:96 P.12 e) By failing to maintain contemporaneous medical records for his treatment of Patient G.D. 33. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2007), by violating any provision of chapter 458 or chapter 456, or any rules adopted pursuant thereto by violating Rule 64B8-9.014, Florida Administrative Code. COUNT FOUR 34. Petitioner realleges and incorporates: paragraphs one (1) through nineteen-(19)-as if fully set forth herein: 35. Section 458.331(1)(m), Florida Statutes (2007), provides that a | physician’ may be subject to discipline for failing to keep legible medical records that justify the course of treatment. of the patient, i neluding but not. limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, of administered; and consultations and hospitalizations. reports of 36. Respondent failed to keep legible, as defined by department rule in consultation with the board, medical records that licensed physician or the physician extender and supervising identify the physician by name and professional title who is or are responsible for rendering, JAPSU\Medical\Bates Shirley\Perelman 08-13844 AC (qtm)\PerelmanAC sonst fon). doe : Apr 22 2009 13:37 Apr 22 2009 12:56 P.13 ordering, supervising, or billing for each diagnostic or treatment procedure | and that justify the course of treatment of the patient, in one or more of the following ways: , a) By failing to maintain contemporaneous medical records of Patient G.D., meeting the requirements of Rule 64B8-9,003, Florida Administrative Code; or b) By failing to maintain medical records documenting a "patient evaluation, including history and physical examination to establish a diagnosis for the condition for which he prescribed Patient G.D. testosterone, or oO By failing to maintain medical: records documenting a patient evaluation, including history and physical examination to establish a diagnosis for the condition: for which he prescribed Patient G.D. Isotropin. 37, Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2007), by failing to: keep legible, as defined by department rule in consultation with the board, medical records that identify. the licensed physician or the physician extender and supervising physician by name and professional title who is or are TAPSU\Meilical\Bates Shirley\Perelman 08-13844 AC (qim)\PerelmanAC 708-1 a. A 2 a. st i : Apr 22 2009 13:37 Apr 22 2009 12:56 P14 responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and 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. WHEREFORE, the Petitioner respectfully requests that the Board of Medicine enter an order imposing one or more of the following penalties: restriction of the Respondent's practice, imposition of an administrative fine, issuance of a reprimand, corrective action and/or any other relief that the Board deems appropriate. SIGNED this - /9_ day of fl tcl foes, 2008. Ana M, Viamonte Ros, M.D., M.P.H FILED PEASY Ci aR be. State Surgeon ¢ General CLERK: aa ATE (woot ¥ Shirley L. Bates: Assistant enetal Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, a C-65 Tallahassee, FL 32399-326 Florida Bar # 0946311 (850) 245- -4640 (850) 245- 4681 FAX IAPSUAMedieal\Bates Shirley\Perelman 08-13844 AC (qum)\PerelmanAC neo Bo 13 on + 4G i Apr 22 2009 13:38 Apr 22 2009 12:56 P.15 SLB/bs PCP: 12/19/08 PCP Members: El-Bahri & Patrowics DOH v. Jeffrey Robert Perelman, M.D., case No. 2008-13844 J:A\PSU\Medical\Bates Shirley\Perelman 08-13844 AC (qtm)\PerelmanAC re : Apr 22 2009 13:38 Apr 22 2009 12:56 P.16 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: 09-002147PL