Apr 30 2009 13:37 APR-38-2889 13:44 P3717 _ STATE OF FLORIDA u DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, Petitioner, , Vv. CASE NO, 2007-31375 MARGARET BUZAN, L.C.S.W., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW the Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling (Board) against Margaret Buzan, L.C.S.W, and alleges: 1. Petitioner ig the state agency charged with regulating the practice of clinical social work, marriage and family therapy, and mental health counseling pursuant to section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 491, Florida Statutes. 2. Respondent is, and has been at all times material hereto, a licensed clinical social worker in the State of Florida, having been issued license number SW 3533 on January 28, 1994. 3, Respondent's address of record is 1001 Butler Creek Court, Oviedo, Florida 32765. Apr 30 2009 13:33 APR-38-2089 12:44 P.a4-17 4, Professionals Resource Network (“PRN”) is the impaired practitioners program for the Board of Licensed Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling, pursuant to Section 456.076, Florida Statutes. PRN is the program that monitors the evaluation, care, and treatment of impaired healthcare professionals, PRN oversees random drug screens and provides for the exchange of information between treatment providers and the Department for the protection of the public. 5. Raymond M. Pomm, M.D. (Dr. Pomm”), a Board-certified psychiatrist and Y addictionologist, is the Medical Director of PRN and is charged with responsibility for the oversight of the program and documentation of compliance and noncompliance with PRN monitoring contracts. 6. In or about April 2007, PRN received a report that Respondent may be abusing prescribed narcotics and consuming alcohol. The anonymous report indicated Respondent had been in violation of her pain contract several times with her primary care physician, that she was missing appointments, and requesting refill requests too soon. Respondent had also admitted to her primary care physician that in addition to consuming prescribed narcotics, she was drinking alcohol every night. 7. In response to this report, PRN contacted Respondent regarding these allegations. Respondent denied that she had a problem with the prescribed narcotics or consuming alcohol, but consented to have an evaluation conducted by a PRN-approved physician and evaluator. 8. On or about May 15, 2007, Respondent was evaluated by William Jacobs, Apr 30 2009 13:33 APR-38-2089 13:45 P.@5/17 ” Jr., M.D. Dr. Jacobs is a PRN-approved Addictionist and certified pain control physician. 9. During her evaluation, Respondent denied that she had admitted to her primary care physician that she drank alcohol at night, and denied having a problem with prescribed narcotics. 10. Respondent advised that her primary care physician had prescribed her oxycontin but she asked to be taken off of it because it was impairing her. 11. The notes on Respondent from her primary care physician were not consistent with the information Respondent gave to Dr. Jacobs during the evaluation. 12. The notes on Respondent from the primary care physician indicated that Respondent had been prescribed hydrocodone, Respondent had requested her primary care physician to prescribe her Oxycontin, and the notes further indicated that Respondent had overused Xanax and Ambien and had admitted to drinking alcohol every night. . 13. Oxycontin contains oxycodone, a Schedule IT controlled substance under Chapter 893, Florida Statutes, 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. 14. Xanax contains alprazolam and is a Schedule IV controlled substance under Chapter 893, Florida Statutes. Alprazolam is indicated for the management of anxiety. Alprazolam has a low potential for abuse relative to the substances in Apr 30 2009 13:33 APR-38-2089 13:45 Schedule III] and abuse of alprazolam may lead to limited psychological and physical dependence. 15. Ambien is the brand name for the drug zolpidem, prescribed to treat insomnia. According to Title 21, Section 1308.14, Code of Federal Regulations, zolpidem is a Schedule IV controlled substance. Zotpidem can cause dependence and is subject to abuse, 16. During her evaluation, Respondent denied that she was abusing prescribed narcotics and that she drank alcohol every night. Respondent reported that she had a history of chronic low back pain, and chronic radicular leg pain that had worsened as a result of a fall in mid March. 17. ‘Dr. Jacobs asked Respondent what medications she was taking, and she answered that she was taking Vicodin, Xanax, and Oxycontin. 18. Vicodin contains hydrocodone and is prescribed to treat pain. According to Section 893.03(3), Florida Statutes, hydrocodone, in the dosages found in Vicodin, is a Schedule TIL controlled substance that has a potential for abuse less than the substances in Schedules I and II and has a currently accepted medical use in treatment in the United States, and abuse of the substance may lead to moderate or low physical dependence or high psychological dependence, 19. In addition, Respondent told Dr. Jacobs that she decided on her own which medications she would take. She would intermittently discontinue, increase and decrease the following medications: Oxycontin, Vicodin, Soma, Ultram XL, and tramadol. Respondent advised Dr. Jacobs that she had previously taken Ambien CR P6717 Apr 30 2009 13:33 APR-38-2089 13:45 Perel? once a day at bedtime but denied current use at the time of her examination by Dr. Jacobs. 20. Soma is the brand name for carisoprodol, a muscle relaxant commonly 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 II] and has a currently accepted medical use in treatment in the United States, and abuse of carisoprodol may lead to limited physical or psychological dependence relative to the substances in Schedule III. 21. Ultram is the brand name for tramadol, an opioid class medication prescribed to treat pain. Ultram is a legend drug, but not a controlled substance. Ultram, like all opioid class drugs, can affect mental alertness, is subject to abuse, and can be habit forming. 22. During her evaluation with Dr. Jacobs, Respondent admitted to taking Vicodin, Xanax, in addition to other over-the-counter and prescription drugs. 23. Vicodin contains hydrocodone and Is prescribed to treat pain. According to Section 893.03(3), Florida Statutes, hydrocodone, in the dosages found in Vicodin, is a Schedule TIT controlled substance that has a potential for abuse less than the substances in Schedules I and II and has a currently accepted medical use in treatment in the United States, and abuse of the substance may lead to moderate or low physical dependence or high psychological dependence, 24. AS part of her evaluation by Dr. Jacobs, Respondent submitted to a Urine Drug Screen (UDS). The results of the drug screen were that Respondent tested Apr 30 2009 13:39 APR-38-2089 12:46 P.@8/17 positive for hydrocodone with no hydromorphone metabolite, benzodiazepines, ethylglucuronide, and Soma. 25, Benzodiazepines are a class of drugs that cause sedation and can be habit forming. Benzodiazepines are typically prescribed to treat anxiety or insomnia. This class includes Xanax (brand name for alprazolam) and Ambien (brand name for zolpidem). 26. These results are significant, because if Respondent had been taking Vicodin as she described, the metabolite hydromorphone would have been present in her results, and it was not. 27. The results of the UDS were not consistent with the information given to Dr. Jacobs by Respondent, nor were the results consistent with the information 7 contained in the medical records provided by her primary care physician regarding the ) drugs Respondent was taking. 28. AS a result of his examination, Dr. Jacobs opined that Respondent suffered from sedative hypnotic and alcohol abuse. Dr. Jacobs recommended that Respondent attend a multi-day evaluation at a treatment facility for healthcare professionals. Dr. Jacobs found that the results of the UDS were inconsistent with the information Respondent provided regarding her drug and alcohol use, and were inconsistent with the information provided by Respondent's primary care physician. Dr. Jacobs further recommended Respondent for an in-house extended day evaluation, and probable residential treatment based on the outcome of his evaluation. 29. PRN contacted Respondent and gave her a choice of multi-day treatment Apr 30 2009 13:39 APR-38-2089 12:46 P.@9o717 facilities to attend. Subsequent to the evaluation and diagnosis by Dr. Jacobs and recommendation by PRN, Respondent admitted herself to Shands Vista, in Gainesville, Florida. Shands Vista is a PRN approved facility for the evaluation of alcohol dependence, opioid dependence, and sedative dependence. 30. Scott Teitelbaum, M.D., a PRN-approved addictionist, conducted an evaluation of Respondent at the facility. Dr. Teitelbaum diagnosed Respondent with Alcohol Dependency with Withdrawal, Opioid Dependence with Withdrawal, Sedative Dependence with Withdrawal, and Mood Disorder NOS, Dr. Teitelbaum recommended that Respondent complete her detoxification and be admitted to a treatment center. Dr. Teitelbaum concluded that Respondent’s relapse potential was high based on Respondent's poor coping strategies to deal with both her emotional and physical discomfort. 31. On July 2, 2007, Respondent admitted herself to the residential treatment center at Shands Vista. 32. Respondent remained at the facillty until July 27, 2007. Initially upon admittance to the facility, Respondent denied that she had an alcohol problem. However, she eventually admitted that she had been drinking prior to seeing patients. In addition, Respondent admitted taking prescribed opiates for reasons other than those for which they were prescribed. Respondent also admitted that she had received treatment in 1995 for alcohol and benzodiazepine abuse. 7 33. Because of Respondent’s concerns about her adult disabled daughter, Shands Vista agreed to discharge her after one month, contrary to their concerns. On Apr 30 2009 13:39 APR-38-2089 12:46 P.1a/17 her discharge summary of July 27, 2007, Respondent was given aftercare recommendations to participate in an intensive outpatient program, to see Dr. Chowallur “Dev” Chacko for medication management of psychiatric medications and Subutex, a narcotic used for withdrawal fram opioids and pain control, to attend individual therapy meetings, and to attend Alcoholics Anonymous meetings. PRN was contacted regarding her discharge and advised of the recommendations that Respondent needed to follow-up on after discharge, 34. Respondent's discharge diagnosis was Alcohol Dependence, Opioid Dependence, Sedative Dependence, Chronic Back and Neck Pain, GERD (Gastroesophagael Reflux Disease), and Hypothyroidism. 35. Shands Vista did not recommend that Respondent return to work as of the date of discharge, but left instructions for the psychiatric care provider and the intensive outpatient program provider in her hore area to make a determination as to when Respondent could return to work. On the treatment progress update form provided to PRN, under the notation for ability to practice, Shands Vista indicated “no”. 36. Contrary to Shands Vista’s and PRN’s instructions, Respondent, failed to f, contact PRN to follow-up with her discharge instructions from Shands Vista. 37. On August 6, 2007, a PRN representative made contact with Respondent. Respondent indicated that she would call back but she had been experiencing health problems, 38. On August 7, 2007, Dr. Dev Chacko’s office contacted PRN in order to receive paperwork for Respondent’s intended appointment. PRN advised that Apr 30 2009 13:40 APR-38-2089 12:47 P.ii/17 Respondent was not being referred to Dr. Chacko for a PRN evaluation, but for pain medication management and for an intensive outpatient program in compliance with her discharge instructions from Shands Vista. 39. On August 7, 2007, a PRN representative contacted Respondent. At that time, Respondent stated that because of health reasons, she could not comply with the recommendations of PRN, and further denied that she was an alcoholic. 40. Respondent agreed to seek an intensive outpatient program, an individual therapist, and to obtain medical records from an alleged recent hospitalization and mail them to PRN. 41. Later in the afternoon of August 7, 2007, Dr. Chacko’s office contacted PRN and advised that Respondent had cancelled her appointment. i 42. PRN made several attempts to contact Respondent between August 9, . 2007 and September 5, 2007. Those attempts consisted of leaving several telephone messages for Respondent. 43. | Respondent was also sent a certified letter advising if Respondent did not execute her PRN contract, her case would be referred to the Department of Health for immediate action. 44. On September 14, 2007, Respondent contacted PRN and advised that her attorney had advised her not to sign any documents from PRN. 45. On October 4, 2007, Dr. Pomm notified the department that Respondent is a chemically dependent impaired individual, who is unsafe to practice as determined by her evaluator and treating physician, Dr. Scott Teitelbaum. Further, Respondent has Apr 30 2009 13:40 APR-38-2089 12:47 P.12/17 refused to follow the recommendations of Dr. Teitelbaum and PRN. 46. On or about July 25, 2008, pursuant to an Order Compelling an Examination, Respondent reported to Martha Brown, M.D., a psychiatrist, for the purpose of determining if Respondent could practice clinical social work with reasonable skill and safety. 47. On or about August 10, 2008, Dr. Brown drafted a report on the examination of Respondent, but did not issue the report because Respondent had failed or refused to execute a patient release of information for Dr. Brown. 48, After providing patient release of information forms to Respondent by mail, facsimile and e-mail, Respondent finally furnished an executed release to Dr. Brown on or about October 8, 2008. 49, Onor about October 8, 2008, Dr. Brown completed an amended report of her evaluation of Respondent. 50. In her report, Dr. Brown noted significant concerns about Respondent as follows: 1) She had been using multiple prescription medications in the past and it \ was reported by Dr. Conavay that she asked for early refills, did not follow her contract with him, and was using more than prescribed, as well as she had supposedly said that she drank daily; 2) She admits to a hospitalization in the 1990's for getting detoxed off Xanax; 3) She was admitted to Shands on June 25, 2007 and it was felt that she was in Opioid Withdrawal at the time. She was subsequently placed on Subutex, but did not follow up as she should have upon discharge from Shands; 4) She admits to drinking on the medications Dr. Conavay prescribed but appears to want to justify it in that she states she just : drank on the weekends; and 5) She was diagnosed at some point with ‘ ADD and placed on Wellbutrin, but quit taking it. She had a history of Mood Disorder NOS, but has not been on any medication recently despite taking multiple medications in the past. 10 Apr 30 2009 13:40 APR-38-2089 12:47 P.13/17 51. Dr. Brown gave a diagnosis of Respondent of: Axis I: Opiate Dependency, Sedative-Hypnotic Dependency, Alcoho! Dependency, R/O Alcohol Abuse; Axis JI: deferred; Axis If]: 3 sinus operations; 3 corneal transplants; tonsillectomy; breast reduction; hypothyroidism; Axis IV: moderate to severe; Axis V: Current GAF=>60. 52, GAF is short for Global Assessment Functioning score. A person with a GAF of 61-70 means the person has some mild symptoms, or some difficulty in social, occupational, or school functioning, but generally functioning pretty well, and has some meaningful interpersonal relationships. 53. In her report, Dr. Brown states that Respondent cannot practice with reasonable skill and safety, needs further assessment and treatment, should participate in PRN and follow all recommendations they deem appropriate, should have frequent urine drug screens with EtG, with prognosis unknown at this time, but could be good if Respondent is able to get into a stable recovery program. 54, Respondent furnished a copy of a report by Vicki Rossler, Licensed Mental Health Counselor, Certified Addictions Prevention Specialist, who is a psychotherapist sn and addictionologist, but not a physician or psychiatrist, stating that Respondent: Has been a full participant in therapy and has made significant progress in maintaining a prescription medication and alcohol free lifestyle for the last 14 months. She has addressed her dependence on prescription medication and recognized how it may have negatively impacted her life. [She] has no indication of impairment and has the ability to regain her career. She has been open and willing throughout her treatment and I fully endorse her return to private practice, She will continue to be seen by this clinician in the individual psychotherapy in order to provide her and [sic] avenue to process her issues with continuing long-term support. il Apr 30 2009 13:41 APR-38-2089 12:47 P.14-17 55. Ms. Rossler does not refer to any drug screens taken by Respondent, as recommended by Dr. Brown, to indicate that Respondent is free of prescription medication or alcohol. Ms. Rassler does indicate that Respondent requires treatment for her issues. 56. Section 491.009(1)(p), Florida Statutes (2007, 2008), subjects Respondent to discipline by the Board for: Being unable to practice the profession for which he or she is licensed, registered, or certified under this chapter with reasonable skill or competence or by reason of illness, drunkenness; or excessive use of drugs, narcotics, chemicals, or any other substance. 57. Based to the opinions and diagnoses of Dr. Jacobs, Dr. Tietlebaum, Dr. we Chako and Dr Brown, Respondent is unable to practice with reasonable skiil or competence because Respondent suffers from alcohal, narcotic and/or sedative dependence. ' 58. Based on the foregoing, Respondent has violated Section 491.009(1)(p), i Florida Statutes (2007, 2008), by being unable to practice as a licensed clinical social worker with reasonable skill or competence or by reason of excessive use of drugs, narcotics, chemicals, or any other substance. WHEREFORE, the Petitioner respectfully requests that the Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling 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, 12 Apr 30 2009 13:41 APR-38-2089 12:48 P.15/17 * refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. SIGNED this (2 day of “/6&489 , 2009, Ana M. Viarnonte Ros, M.D., M.P.H., State Surgeon General Patrick L. Butler Assistant General Counsel DOH Prosecution Services Unit FILED 4052 Bald Cypress Way, Bin C-65 DEPARTMENT OF HEALTH Tallahassee, FL 32399-3265 DEPUTY CLERK Florida Bar # 0762776 CLERK Rachel Brooky DATE eh Sy pee: 2.// 2] 2004 . PCP Members: Zachary Day, Doug IAS 850.245.4640 850.245.4682 FAX 13 Apr 30 2009 13:41 APR-38-2089 13:48 P.16/17 7 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. 14

Docket for Case No: 09-002397PL