STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, CASE NO.: 2008-18673 10 4. TPL ELIZABETH LOPEZ, M.D., RESPONDENT. a | 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, Elizabeth Lopez, M.D., and in support this 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 ME 62775. 3. Respondent's address of record is 1855 NE 8™ Street, Homestead, Florida, 33033. In Re: Emergency Suspension of License of 1 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 4. At all times material to this Complaint Respondent was not Board Certified in Pain Management. 5. At all times material to this cause between June 2008 and September 2009, Respondent treated twenty two (22) patients for chronic pain management. 6. These twenty-two (22) patients are referred to by their initials as DC, RC, DB, MB, KD, JF, MK, DL, TM, PM, GR, LR, BC, JC, JC2, WF, JH,TL, EM, WM, SR, and JT. 7. The Department commenced an investigation of Respondent from May 2009, through September 2009; partly as a result of a complaint in July 2008 from a Walgreen’s pharmacist in Jupiter, Florida, alleging that Respondent was prescribing suspicious amounts of controlled substances to patients with Florida addresses but with Kentucky telephone numbers and partly because of a June 2009 inspection of Respondent's medical office where it appeared that excessive and inappropriate amounts of controlled substances were being prescribed to patients in Ohio and Kentucky. 8. The types of controlled substances in question that were prescribed by Respondent are listed as follows: a) Xanax (brand name for alprazolam, benzodiazepine, Schedule IV) is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, (2009), alprazolam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in NS Elzabeth Lopes MD. ; License No. ME 62775 Case No, 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc In Re: Schedule III and has a currently accepted medical use in treatment in the United States and abuse of the substance may lead to limited physical or psychological dependence relative to the substances in Schedule III. b) Hydromorphone (brand name Dilaudid, opioid, Schedule II, a metabolite of hydrocodone) is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes, (2009), hydromorphone 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 in the United States, and abuse of hydromorphone may lead to severe psychological or physical dependence. c) Oxycodone (opioid, Schedule II) is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes, (2009), 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 in the United States, and abuse of oxycodone may lead to severe psychological or physical dependence. d) OxyContin is the brand name of a time-release formula of oxycodone referred to above. e) Oxydose is the brand name for the liquid preparation of oxycodone referred to above. f) . Roxicodone is the brand name of an instant or rapid release formula of oxycodone referred to above. Emergency Suspension of License of 3 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc g) Percocet is the brand name for the formulation of oxycodone and acetaminophen (Tylenol). h) Soma (see carisoprodol, muscle relaxant, Schedule IV) is the brand name for carisoprodol, a muscle relaxant commonly prescribed to treat muscular pain. According to Section 893.03(4), Florida Statutes, (2009), carisoprodol is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III 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. i) Valium (class benzodiazepine, Schedule IV) is the brand name for diazepam and is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, (2009), diazepam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States, and abuse of diazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. FACTS SPECIFIC TO PATIENT DC 9. From on or about June 5, 2008 until on or about April 13, 2009, Patient DC presented to Respondent with complaints of lower back and leg pain with a diagnosis of lumbar radiculopathy. Respondent there and then prescribed In Re: | Emergency Suspension of License of 4 Elizabeth Lopez, M.D. License No. ME 62775 Case No, 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 90 tablets of Roxicodone 30 milligrams (‘mg”), 60 tablets of Xanax 2 mg, and 60 tablets of Soma 350 mg for DC based solely on the verbal patient history that DC related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of DC’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in DC’s system. 10. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams, Roxicodone 15 milligrams, and Soma 350 milligrams for DC on the dates and in the quantities described in the following table: Roxicodone Roxicodone In Re: Xanax (oxycodone) (oxycodone) (alprazolam) 30 mg 15 mg Soma 6/5/2008 6/5/2008 6/5/08 2 mg 30 mg 350 mg #60 #90 #60_—. 7/3/2008 7/3/2008 7/3/2008 2mg 30 mg 350 mg #60 #120 #60 8/18/2008 8/28/2008 8/28/08 2mg 30 mg 350 mg #90 #120 #60 9/25/2008 9/25/2008 2mg 30 mg #90 #150 10/23/2008 | 10/23/2008 2 mg 30 mg #90 #150 11/19/2008 11/19/2008 2 mg 30 mg #90 #150 Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC ~ LOPEZ 2008-18673 21710 FINAL 030910.doc Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) alprazolam 30 mg 15 mg Soma 12/16/2008 12/16/2008 12/16/2008 2mg 30 mg 15 mg #90 #150 #90 1/19/2009 1/19/2009 2mg 30 mg #90 #45 . 1/19/2009 30 mg #150 2/16/2009 2/16/2009 2mg 30 mg #90 #45 2/16/2009 30 mg #150 3/16/2009 3/16/2009 3/16/09 2mg 30 mg 15 mg #90 #150 #90 4/13/2009 4/13/09 4/13/09 2mg 30 mg 15 mg #90 #60 #90 4/13/09 | 30 mg L__ #90 | 11. In medicine, titration is the process of gradually adjusting the dose of a medication until the desired effect is achieved. 12. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: A complete medical history and physical examination that a) was conducted and documented in the medical record; In Re: — Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc b) = Documentation of 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/or history of substance abuse; c) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from DC’s previous physicians whether his treatment was terminated for substance abuse/diversion. FACTS SPECIFIC TO PATIENT RC 13. From on or about June 6, 2008 until on or about July 29, 2008, Patient RC presented to Respondent with complaints of lower back pain from a fall with a diagnosis of lumbar radiculopathy. Respondent there and then In Re: Emergency Suspension of License of 7 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc prescribed 120 tablets of Roxicodone 30 milligrams (‘mg”), 120 tablets of Soma 350 mg and 60 tablets of Xanax 2 mg for RC based solely on the verbal patient history that RC related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of RC’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in RC’s system. | 14. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams, and Soma 350 milligrams for RC on the dates and in the quantities described in the following table: Roxicodone Xanax (oxycodone) (alprazolam) 30 mg Soma 6/6/08 6/6/2008 6/6/2008 2 mg 30 mg 350 mg _ #60 #120 #60 7/3/2008 7/3/2008 7/3/2008 2 mg 30 mg 350 mg #60 #150 #60 7/29/2008 7/29/2008 | 7/29/2008 2mg 30 mg 350 mg #60 #150 #60 15. | Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: a) A complete medical history and physical examination that was conducted and documented in the medical record; In Re: Emergency Suspension of License of 8 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc b) Documentation of 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/or history of substance abuse; c) ~ The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from RC’s previous physicians whether his treatment was terminated for substance abuse/diversion. FACTS SPECIFIC TO PATIENT DB 16. From on or about February 12, 2008 until on or about April 24, 2009, Patient DB presented to Respondent with complaints of back problems from a fall and neck pain from a motor vehicle accident with a diagnosis of lumbar radiculopathy. Respondent there and then prescribed 240 tablets of In Re: Emergency Suspension of License of 9 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Roxicodone 30 milligrams (‘mg”) and 60 tablets of Xanax 2 mg for DB based solely on the verbal patient history that DC related to Respondent concerning the Current pain management regimen. Respondent did not have the benefit of any of DB’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in DB’s system. 17. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams, Roxicodone 15 milligrams, Percocet 10 milligrams, Soma 350 milligrams and/or Valium 10 milligrams for DB on the dates and in the quantities described in the following table: Roxicodone Roxicodone Percocet Xanax (oxycodone) (oxycodone) (oxycodone) (alprazolam) 30 mg _ 15 mg 10 mg Soma Valium 2/12/2008 2/12/2008 2mg 30 mg #60 #240 i | 6/23/2008 6/23/2008 6/23/2008 30 mg 15 mg 10 mg #240 #60 #60 11/7/2008 11/7/2008 11/7/2008 2 mg 30 mg 15 mg #60 #240 #60 12/5/2008 12/5/2008 12/5/2008 i- 2mg 30 mg 10 mg #60 #240 #60 1/2/2009 1/2/2009 10 mg 350 mg #325 #20 1/30/2009 1/30/2009 | 1/30/2009 | 1/30/2009 2 mg _ 30mg 10 mg 350 mg #60 #? #60 #20 In Re: — Emergency Suspension of License of 10 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Roxicodone Roxicodone Percocet Xanax (oxycodone) (oxycodone) (oxycodone) _(alprazofam) 30 mg 15 mg 10m Soma Valium 2/26/2009 2/26/2009 2/26/2009 2/26/2009 2mg 30 mg 15 mg 10 mg #60 #180 #120 #325 3/27/2009 3/27/2009 3/27/2009 2mqg 30 mg 10 mg #60 #40 #60 3/27/2009 30 mg | #200 4/24/2009 4/24/2009 4/24/2009 2mqg 30 mg 10 mg #60 #240 #325 4/24/2009 2mg #325 18. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; c) The presence of one or more recognized medical indications for the use of a controlled substance; In Re: — Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No, 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc il d) — A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; 9) Verification from DB’s previous physicians whether his treatment was terminated for substance abuse/diversion; . h) A failure to justify the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Xanax 2 milligrams and Roxicodone 15 milligrams and or Percocet 10 milligrams from on or about February 12, 2008 to on or about April 24, 2009. FACTS SPECIFIC TO PATIENT MB 19. From on or about February 28, 2008 until on or about March 30, 2009, Patient MB presented to Respondent with complaints of repeated work injuries causing neck and upper back pain with a diagnosis of cervical radiculopathy. Respondent there and then prescribed 210 tablets of Roxicodone 30 milligrams (‘mg’), 120 tablets of Roxicodone 15 mg, and 60 tablets of Xanax In Re: Emergency Suspension of License of 12 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 2 mg for MB based solely on the verbal patient history that MB related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of MB’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in MB's system. 20. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams, and Roxicodone 15 milligrams for MB on the dates and in the quantities described in the following table: Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) (alprazolam) 30 mg 15 mg 2/28/2008 2/28/2008 2/28/2008 2 mg 30 mg 15 mg #60 #210 ___ #120 3/27/2008 3/27/2008 2mg 30 mg #60_ #270 4/24/2008 4/24/2008 2mg 30 mg #60 #270 5/28/2008 5/28/2008 2mg 30 mg |__—~#60 #270 7/22/2008 7/22/2008 2mg 30 mg #60 #270 11/10/2008 11/10/2008 | 2mg 30 mg #60 #270 In Re: — Emergency Suspension of License of 13 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 4J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) (alprazolam) 30mg 15 mg 12/8/2008 12/8/2008 2mg 30 mg #60 #270 | 1/5/2009 1/5/2009 | 2 mg 30 mg #60 #270 2/2/2009 2/2/2009 2/2/2009 2mqg 30 mg 15 mg #60 #210 =| ~—s #120 3/2/2009 3/2/2009 3/2/2009 2mg 30 mg 15 mg #60 #270 #120 3/30/2009 3/30/2009 3/30/2009 2 mg 30 mg 15 mg #60 #270 #120 21. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: In Re: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; Cc) The presence of one or more recognized medical indications for the use of a controlled substance; Emergency Suspension of License of 14 Elizabeth Lopez, M.D. License No. ME 62775 "Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; Q) Verification from MB’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent's medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Roxicodone 15 . milligrams and Xanax 2 milligrams from on or about February 28, 2008, to on or about March 30, 2009. FACTS SPECIFIC TO PATIENT KD 22, From on or about March 27, 2008 until on or about August 24, 2009, Patient KD presented to Respondent with complaints of a previous hip replacement and subsequent thoracic pain with a diagnosis of compression fracture and thoracic radiculopathy. Respondent there and then prescribed 180 In Re: Emergency Suspension of License of 15 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 . J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc tablets of Roxicodone 30 milligrams (‘mg”), 90 tablets of Soma 350 mg, and 60 tablets of Xanax 2 mg for KD based solely on the verbal patient history that KD related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of KD’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in KD’s system. 23. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams, Oxydose 20 milligrams per cc, and Soma 350 milligrams for KD on the dates and in the quantities described in the following table: Dilaudid Roxicodone Xanax (hydro- (oxycodone) oxycodone (alprazolam) morphone) Oxydose 30 mg 10 mg Soma 3/27/2008 3/27/2008 3/27/2008 2 mg ; 30 mg 350 mg #60 #180 #90 4/24/2008 4/24/2008 4/24/2008 4/24/2008 2 mg 20 mg/cc 30 mg 350 mg #60 1 bottle #180 i a #90 6/19/2008 6/19/2008 6/19/2008 6/19/2008 2mg | 20 mg/cc 30 mg 350 mg #60 2 bottles #180 #90 | 11/10/200 11/10/2008 8 11/10/2008 11/10/2008 2mg icc 30 mg 350 mg #60 3 bottles #200 #90 12/8/2008 12/8/2008 12/8/2008 12/8/2008 | 2mg 20 mg/cc 30 mg 350 mg #60 |__3 bottles #200 #90 In Re: — Emergency Suspension of License of 16 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Mitne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Dilaudid Roxicodone Xanax (hydro- (oxycodone) oxycodone _(alprazolam) morphone) Oxydose 30 mg 10 mg Soma 1/5/2009 1/5/2009 1/5/2009 1/5/2009 2mg 20 mg/cc 30 mg 350 mg #60 3 bottles #? #90 2/2/2009 2/2/2009 2/2/2009 2/2/2009 2 mg 20 mg/cc 30 mg 350 mg #60 3 bottles #200 #90 3/2/2009 3/2/2009 3/2/2009 3/2/2009 2mg 4mg 20 mg/cc 350 mg #60 #150 3 bottles #90 6/2/2009 2mg #60 6/29/2009 6/29/2009 2 mg 30 mg #60 #240 8/24/2009 8/24/2009 8/24/2009 2 mg 30. mg 10 mg #60 #240 #120 24. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: a) was conducted and documented in the medical record; b) A complete medical history and physical examination that Documentation of the nature and intensity of the pain, In Re: current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and/or history of substance abuse; Cc) The presence of one or more recognized medical indications for the use of a controlled substance; Emergency Suspension of License of 17 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from KD’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent's medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Oxydose 20 milligrams per cc, Soma 350 milligrams and Xanax 2 milligrams from on or about March 27, 2008 to on or about August 24, 2009. FACTS SPECIFIC TO PATIENT JF 25. From on or about October 1, 2007, until on or about August 20, 2009, Patient JF presented to Respondent with complaints of back pain foliowing a fall in 2005 with a diagnosis of lumbar radiculopathy. Respondent there and ‘then prescribed 60 tablets of Xanax 2 milligrams (‘mg”) for JF based solely on In Re: Emergency Suspension of License of 18 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc the verbal patient history that JF related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of JF’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in JF’s system. 26. | Respondent’s medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams, and Roxicodone 15 milligrams for JF on the dates and in the quantities described in the following table: Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) oxycodone (alprazolam) 30 MG 15 MG 10 MG 10/1/2007 2mg #60 T 10/16/2007 15 mg #90 10/16/2007 15 mg #30 [ ~ | 10/16/2007 | 15mg I #120 11/13/2007 11/13/2007 2 mg 10 mg #60 #90 12/11/2007 12/11/2007 2mg 15 mg #60 | __ #90 | 1/5/2008 1/5/2008 2mqg 15 mg #60 #60 In Re: — Emergency Suspension of License of 19 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc In Re: Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) oxycodone (alprazolam) 30 MG 15 MG 10 MG 2/8/2008 2/8/2008 2/8/2008 2mg 30 mg 15 mg #60 #150 #90 3/4/2008 3/4/2008 3/4/2008 2mg 30 mg 15 mg #60 #150 #90 4/11/2008 4/11/2008 2mg 30 mg #60 #195 4/29/2008 4/29/2008 2mg 15 mg #60 #90 , 4/29/2008 30 mg #180 5/27/2008 5/27/2008 2mg 30 mg #60 #225 L 6/24/2008 6/24/2008 2mg 30 mg #60 #225 7/22/2008 7/22/2008 2mg 30 mg #60 #225 8/19/2008 8/19/2008 2mg 30 mg #60 #240 12/8/2008 12/8/2008 2mg 30 mg #60 #240 | T 1/5/2009 30 mg #240 2/2/2009 2/2/2009 2mg 15 mg #60 [ #60 3/3/2009 3/3/2009 3/3/2009 2mg 30 mg 15 mg #60 #240 #60 Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No, 2008-18673 J:\PSU\Medical\Robert Miine\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 20 Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) oxycodone (alprazolam) 30 MG 15 MG 10 MG 3/31/2009 3/31/2009 3/31/2009 2mg 30 mg 15 mg #60 #50 #60 3/31/2009 30 mg — #190 4/28/2009 4/28/2009 4/28/2009 2mg 30 mg 15 mg #60 #240 #60 5/26/2009 5/26/2009 5/26/2009 2mg 30 mg 15 mg #60 #240 #60 6/23/2009 6/23/2009 6/23/2009 2mg 30 mg 15 mg #60 #240 #60 7/21/2009 7/21/2009 7/21/2009 2mg 30 mg 15 mg #60 #240 #60. 8/20/2009 8/20/2009 8/20/2009 2mg 30 mg 15 mg #60 #240 #120 27. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: In Re: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; Emergency Suspension of License of 21 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Cc) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from JF’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent's medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams and Xanax 2 milligrams from on or about October 1, 2007, to on or about August 20, 2009. FACTS SPECIFIC TO PATIENT MK 28. From on or about November 10, 2008, until on or about June 22, 2009, Patient MK presented to Respondent with complaints of construction work- related lower back and thoracic disc pain with a diagnosis of jumbar and cervical In Re: Emergency Suspension of License of 22 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc radiculopathy. Respondent there and then prescribed 240 tablets of Roxicodone 30 milligrams (“mg”), 60 tablets of Percocet 10 mg, 90 tablets of Soma 350 mg, and 60 tablets of Xanax 2 mg for MK based solely on the verbal patient history that MK related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of MK’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in MK’s system. 29. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Dilaudid 4 milligrams, Roxicodone 30 milligrams, Roxicodone 15 milligrams, and Soma 350 milligrams for MK on the dates and in the quantities described in the following table: Roxicodone Roxicodone Percocet Xanax Dilaudid (oxycodone) (oxycodone) (oxycodone) (alprazolam) (hydrocodone) 30mg __ i5m 10m Soma 11/10/2008 “11/10/2008 | 11/10/2008 | 11/10/2008 2 mg 30 mg 10 mg 350 mg #60 #240 #60 #90 12/8/2008 12/8/2008 12/8/2008 12/8/2008 2mg 30 mg 15 mg 350 mg #60 #240 #60 #120 1/5/2009 1/5/2009 1/5/2009 2mg 30 mg 350 mg #60 #240 #120 1/5/2009 30 mg #30 In Re: Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 23 Roxicodone Roxicodone Percocet Xanax Dilaudid (oxycodone) (oxycodone) (oxycodone) (alprazolam) (hydrocodone) 30 mg 15 mg 10 mg Soma 2/2/2009 2/2/2009 2/2/2009 2/2/2009 2mg 30 mg 15 mg 350 mg #60 #240 #60 #120 3/2/2009 3/2/2009 3/2/2009 3/2/2009 2mg 4mg 15 mg 350 mg #60 #200 #60 #120 3/30/2009 3/30/2009 3/30/2009 3/30/2009 2mg 4mg 15 mg 350 mg #60 #60 #60 #120 4/27/2009 4/27/2009 4/27/2009 4/27/2009 2mg 4mg 15 mg 350 mg #60 #240 #60 #120 6/22/2009 6/22/2009 15 mg 350 mg #90 #120 30. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: In Re: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; c) The presence of one or more recognized medical indications for the use of a controlled substance; Emergency Suspension of License of 24 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from MK’s previous physicians whether his treatment was terminated for substance abuse/diversion; | h) Respondent's medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams, Xanax 2 milligrams, Soma 350 milligrams and/or Dilaudid 4 milligrams from on or about November 10, 2008, to on or about June 22, 2009. | FACTS SPECIFIC TO PATIENT DL 31. From on or about November 14, 2007, until on or about February 27, 2009, Patient DL presented to Respondent with complaints of lower back pain with a diagnosis of lumbar radiculopathy. Respondent there and then prescribed 60 tablets of Xanax 2 milligrams (*mg”) for DL based solely on the In Re: Emergency Suspension of License of 25 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc verbal patient history that DL related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of DL’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in DL’s system. 32. Respondent’s medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Oxydose 20 milligrams per cc, Roxicodone 30 milligrams, Roxicodone 15 milligrams, and Soma 350 milligrams for DL on the dates and in the quantities described in the Valium following table: Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) (alprazolam) _Oxydose 30 mg 15 mg Soma 11/14/2007 2 mg | _—«#60 6/4/2008 6/4/2008 2 mg 30 mg #60 | #180 | 7/1/2008 7/1/2008 2 mg 30 mg - #60 #240 9/19/2008 | 9/19/2008 9/19/2008 2mg 30 mg 15 mg [ #60 #240 #60 10/17/2008 | 10/17/2008 30 mg 350 mg #240 #60 11/14/2008 11/14/2008 | 11/14/2008 30 mg 15 mg 350 mg #240 #60 #60 In Re: Elizabeth Lopez, M.D. License No. ME 62775 Case No, 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Emergency Suspension of License of {ft | 10/17/2008 10 mg #60 26 Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) (alprazolam) _Oxydose 30 mg 15 mg Soma Valium 12/12/2008 | 12/12/2008 | 12/12/2008 12/12/2008 2 mg 20m 30 mg 15 mg #60 1 bottle #240 #60 T 12/28/2008 350 mg #60 1/6/2009 1/6/2009 1/6/2009 1/6/2009 2mg 20m 15 mg 350 mg #60 2 bottles #60 #60 2/2/2009 2/2/2009 2/2/2009 2/2/2009 2mg 20m 15 mg 350 mg #60 2 bottles #60 #60 2/27/2009 2/27/2009 2/27/2009 2/27/2009 2/27/2009 2mqg 30 mg 15 mg 350 mg #60 2 bottles #240 #60 #60 33. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of the nature and intensity of the pain, In Re: current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and/or history of substance abuse; Cc) The presence of one or more recognized medical indications for the use of a controlled substance; Emergency Suspension of License of 27 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from DL’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent’s’ medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams, Xanax 2 milligrams, Oxydose 20 milligrams per cc and/or Soma 350 milligrams from on or about November 14, 2007 to on or about February 27, 2009. FACTS SPECIFIC TO PATIENT TM 34. From on or about January 31, 2008, until on or about June 24, 2009, Patient TM presented to Respondent with complaints of lower back pain from two motorcycle accidents with a diagnosis of lumbar radiculopathy. Respondent there and then prescribed 90 tablets of Roxicodone 30 milligrams In Re: Emergency Suspension of License of 28 Elizabeth Lopez, M.D. License No, ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc (‘mg”) and 60 tablets of Xanax 2 mg for TM based solely on the verbal patient history that TM related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of TM’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in TM’s system 35. | Respondent’s medical records show that she prescribed multiple prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams, Roxicodone 15 milligrams, and Percocet 10 milligrams for TM on the dates and in the quantities described in the following table: Dilaudid Roxicodone Roxicodone Percocet Xanax (hydro- (oxycodone) (oxycodone) (oxycodone) (alprazolam) morphone contin 30m 15 mg 10 mg 1/31/2008 1/31/2008 2mg 30 mg #60 #90 3/5/2008 3/5/2008 2mg 30 mg | #60 | #120 5/28/2008 5/28/2008 2mg 30 mg #60 L #180 9/17/2008 9/17/2008 30 mg 10 mg #210 ; #30 11/12/2008 11/12/2008 10 mg 30 mg #30 #210 12/10/2008 12/10/2008 30 mg 10 mg #210 #30 In Re: Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 29 Dilaudid Roxicodone Roxicodone Percocet Xanax (hydro- (oxycodone) (oxycodone) (oxycodone) (alprazolam) morphone) Oxycontin 30mg i5m 10 mg 1/7/2009 30 mg #240 2/4/2009 15 mg #120 3/4/2009 3/4/2009 4mg 10 mg #240 #120 4/1/2009 4/1/2009 40 mg 10 mg #60 #120 4/29/2009 30 mg ee #240 5/27/2009 30 mg a #240 6/24/2009 6/24/2009 30 mg 15 mg | #240 #120 36 Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; In Re: — Emergency Suspension of License of 30 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 ; J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc c) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from TM’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent’s medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams and Xanax 2 milligrams and or Percocet 10 milligrams from on or about January 31, 2008, to on or about June 24, 2009. FACTS SPECIFIC TO PATIENT PM 37. From on or about October 27, 2008, on or about until April 16, 2009, Patient PM presented to Respondent with complaints of knee pain with a diagnosis of lumbar radiculopathy. Respondent there and then prescribed 150 In Re: Emergency Suspension of License of 31 Elizabeth Lopez, M.D. License No, ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc tablets of Roxicodone 30 milligrams (*mg”), 60 tablets of Roxicodone 15 mg, and 30 tablets of Xanax 2 mg for PM based solely on the verbal patient history that PM related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of PM’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in PM’s system. | 38. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams, and Roxicodone 15 milligrams for PM on the dates and in the quantities described in the following table: Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) _(alprazolam) 30 mg _ 15 mg 10/27/2008 10/27/2008 10/27/2008 2mqg 30 mg 15 mg #30 #150 #60 : 11/13/2008 11/13/2008 11/13/2008 2mg 30 mg 15 mg #45 #225 #90 1/2/2009 1/2/2009 1/2/2009 2mg 30 mg 15 mg #30 #150 #60 1/28/2009 1/28/2009 1/28/2009 2mg 30 mg 15mg #60 #300 #120 3/20/2009 3/20/2009 3/20/2009 2 mg 30 mg i5 mg #60 #150 #120 In Re: Emergency Suspension of License of 32 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) alprazolam) 30 mg 15 mg 4/16/2009 4/16/2009 4/16/2009 2mg 30 mg 15 mg #60 #90 #120 4/16/2009 30 mg #60 39. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: In Re: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; c) The presence of one or more recognized medical indications for the use of a controlled substance; d) -A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; Emergency Suspension of License of 33 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; 9g) Verification from PM’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent's medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams and Xanax 2 milligrams from on or about October 27, 2008, to on or about April 16, 2009. FACTS SPECIFIC TO PATIENT GR 40. From on or about February 19, 2007, until on or about August 12, 2009, Patient GR presented to Respondent with complaints of disc problems and a diagnosis of lumbar radiculopathy. Respondent there and then prescribed 90 tablets of Xanax 2 milligrams (“mg”) for GR based solely on the verbal patient history that GR related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of GR's prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in GR’s system. In Re: Emergency Suspension of License of 34 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 41. Respondent’s medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams, and Roxicodone 15 milligrams for GR on the dates and in the quantities described in the following table: Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) (alprazolam) 30 mg _ 15 mg 2/19/2007 2mg #90 6/14/2007 6/14/2007 2mg 30 mg #90 #240 LU i 7/19/2007 7/19/2007 2mg 30 mg #90 #240 8/16/2007 8/16/2007 2mg 30 mg #90 #240 9/13/2007 9/13/2007 2mg 30 mg #90 #240 10/11/2007 10/11/2007 2mg 30 mg #90 #240 11/26/2007 11/26/2007 2mg 30 mg #90 #240 12/19/2007 30 mg #240 1/16/2008 1/16/2008 2mg 30 mg #90 #240 2/14/2008 2 mg #90 In Re: | Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 35 Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) alprazolam 30m 15m 2/18/2008 30 mg #240 3/13/2008 3/13/2008 2mg 30 mg #90 #240 4/10/2008 4/10/2008 2mg 30 mg #90 #240 5/8/2008 5/8/2008 2mg 30 mg #90 #240 1 6/5/2008 30 mg L #240 7/17/2008 7/17/2008 2mg 30 mg #90 #240 | 8/14/2008 8/14/2008 2mg 30 mg #90 #240 9/11/2008 9/11/2008 2mg 30 mg #90 | #240 10/19/2008 10/19/2008 2mg 30.mg #90 #240 11/6/2008 11/6/2008 2mg 30 mg #90 #240 12/2/2008 2mg #90 12/8/2008 30 mg #240 In Re: — Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) (alprazolam) 30mg (és A'S mg 1/5/2009 1/5/2009 1/5/2009 2 mg 30 mg 15 mg #90 #240 #60 [ 1/28/2009 1/28/2009 1/28/2009 2 mg 30 mg 15 mg #90 #240 #60 2/25/2009 2/25/2009 2/25/2009 2mg 30 mg 15 mg #90 #240 #60 3/25/2009 3/25/2009 3/25/2009 2mg 30 mg 15 mg #90 #240 #60 4/22/2009 4/22/2009 2mg 30 mg #90 #240 ; 5/20/2009 5/20/2009 5/20/2009 2mg 30 mg 15 mg #90 #240 #60 5/22/2009 15 mg #60 6/17/2009 6/17/2009 6/17/2009 2mg 30mg 15 mg #90 #240 #60 7/14/2009 7/14/2009 7/14/2009 2mg 30 mg 15 mg #90 #240 #30 8/12/2009 8/12/2009 8/12/2009 2mg 30 mg 15 mg #90 #240 #60 42. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: a) A complete medical history and physical examination that was conducted and documented in the medical record; In Re: Emergency Suspension of License of 37 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc In Re: b) Documentation of 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/or history of substance abuse; c) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other. treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from GR’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent's medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams and Xanax 2 milligrams from on or about February 19, 2007, to on or about August 12, 2009. Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 38 FACTS SPECIFIC TO PATIENT LR 43. From on or about March 11, 2008, until on or about February 10, 2009, Patient LR presented to Respondent with complaints of low back pain from a construction accident 10 years prior with a diagnosis of lumbar radiculopathy. Respondent there and then prescribed 120 tablets of Roxicodone 30 milligrams ("mg"), 90 tablets of Xanax 2 mg, and 90 tablets of Roxicodone 15 mg for LR based solely on the verbal patient history that LR related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of LR’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in LR’s system. 44. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams and Roxicodone 30 milligrams for LR on the dates and in the quantities described in the following table: Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) alprazolam 30 mg 15m 3/11/2008 3/11/2008 3/11/2008 2mg 30 mg 15mg #90 #120 #90 5/6/2008 5/6/2008 2mg 30 mg _ #90 #165 6/3/2008 6/3/2008 | | 2mg 30 mg #90 #165 In Re: — Emergency Suspension of License of 39 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) _(alprazolam) 30 mg 15 mg 7/1/2008 7/1/2008 2mg 30 mg #90 #195 11/19/2008 11/19/2008 2 mg 30 mg #105 #210 1/2/2009 1/2/2009 2mg 30 mg #105 #240 2/10/2009 2/10/2009 2mg 30 mg #105 #240 45. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: In Re: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; c) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved Emergency Suspension of License of 40 Elizabeth Lopez, M.D. : License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment, g) Verification from LR’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent's medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Xanax 2 milligrams from on or about March 11, 2008, to on or about February 10, 2009. FACTS SPECIFIC TO PATIENT BC 46. From on or about October 8, 2008, until on or about August 4, 2009, Patient BC presented to Respondent with compiaints of back and leg pain with a diagnosis of lumbar radiculopathy. Respondent there and then prescribed 90 tablets of Roxicodone 30 milligrams (“mg”) and 60 tablets of Xanax 2 mg for BC based solely on the verbal patient history that BC related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of BC’s prior medical records and Respondent did not verify In Re: Emergency Suspension of License of 41 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 3:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in BC’s system. 47. Respondent's medical records show that. she prescribed multiple simultaneous prescriptions for large amounts Xanax 2 milligrams, Roxicodone 30 milligrams and Percocet 10 milligrams for BC on the dates and in the quantities described in the following table: In Re: Roxicodone Roxicodone Percocet Xanax (oxycodone) (oxycodone) (oxycodone) (alprazolam) —« 30. mg 15 mg 10 mg 10/8/2008 10/8/2008 2mg 30 mg #60 #90 11/7/2008 11/7/2008 2mg 30 mg #60 #120 12/9/2008 12/9/2008 12/9/2008 2mqg 30 mg 10 mg #60 #120 #90 1/9/2009 10 mg #90 2/6/2009 2/6/2009 2/6/2009 2mg 30 mg 10 mg #60 #120 #90 3/10/2009 3/10/2009 3/10/2009 2mg 30 mg 10 mg #60 #150 #120 4/9/2009 4/9/2009 4/9/2009 2mg 30 mg 10 mg #60 #150 #120 5/7/2009 5/7/2009 5/7/2009 2mg 30 mg 10 mg #60 #150 #120 6/16/2009 6/16/2009 6/16/2009 2mqg 30 mg 15 mg #60 #180 #120 Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 42 Roxicodone Roxicodone Percocet Xanax (oxycodone) (oxycodone) (oxycodone) alprazolam 30 mg 15 mg 10m 8/4/2009 8/4/2009 8/4/2009 2 mg 30 mg 15 mg #60 #180 #120 48. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: Tn Re: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; c) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical: needs of the patient; Emergency Suspension of License of 43 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment, g) Verification from BC’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent’s medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Xanax 2 milligrams and Roxicodone 15 milligrams and/or Percocet 10 milligrams from on or about October 8, 2008, to on or about August 4, 2009. FACTS SPECIFIC TO PATIENT JC 49. From on or about January 24, 2008, until on or about June 9, 2009, Patient JC presented to Respondent with complaints of lower back pain with a diagnosis of lumbar radiculopathy. Respondent there and then prescribed 180 tablets of Roxicodone 30 milligrams (*mg”), 60 tablets of Roxicodone 15 mg, and 60 tablets of Valium 10 mg for JC based solely on the verbal patient history that JC related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of JC’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in JC’s system. Emergency Suspension of License of 44 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 50. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts Roxicodone 30 milligrams, Roxicodone 15 milligrams, and Valium 10 milligrams for JC on the dates and in the quantities described in the following table: Dilaudid Roxicodone Roxicodone Xanax (hydro- (oxycodone) (oxycodone) oxycodone alprazolam) morphone 30 mg 15mg 10mg __sValium 1/24/2008 1/24/2008 1/24/2008 30 mg 15 mg 10 mg #180 #60 #60 2/26/2008 2/26/2008 2/26/2008 30 mg 15 mg 10 mg #180 #60 #60 3/25/2008 3/25/2008 3/25/2008 30 mg 15 mg 10 mg #240 #60 #60 4/22/2008 4/22/2008 4/22/2008 30 mg 15 mg 10 mg #240 #60 #60 11/3/2008 11/3/2008 11/3/2008 30 mg 15 mg 10 mg #240 #60 #60 12/1/2008 12/1/2008 12/1/2008 2 mg 30 mg 15 mg #60 #240 |. #60 1/5/2009 1/5/2009 [ja 30 mg 15mg 10 mg #240 #60 #60 2/2/2009 2/2/2009 2/2/2009 30 mg 15mg 10 mg #240 #60 #60 3/2/2009 3/2/2009 | 3/2/2009 4mg 10 mg 10 mg #190 #60 #60 3/31/2009 3/31/2009 3/31/2009 4mg 15 mg 10 mg #90 #60 #60 In Re: Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 Emergency Suspension of License of J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 45 Dilaudid Roxicodone Roxicodone Xanax (hydro- (oxycodone) (oxycodone) oxycodone alprazolam) morphone 30 mg 15 mg 10 mg Valium 6/9/2009 2mg #60 51. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; c) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; mee elnabetnLoper MD. * License No. ME 62775 Case No, 2008-18673 J:\PSU\Medica!\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from JC’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent's medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams and Valium 10 milligrams from on or about January 24, 2008 to on or about June 9, 2009. FACTS SPECIFIC TO PATIENT JC2 52. From on or about September 9, 2008 until on or about June 17, 2009, Patient JC2 presented to Respondent with complaints of herniated discs, cervical, mid and low back pain with a diagnosis of cervical radiculopathy. Respondent there and then prescribed 150 tablets of Roxicodone 30 milligrams (‘mg’) and 60 tablets of Xanax 2 mg for JC2 based solely on the verbal patient history that JC2 related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of JC2’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present; nor did Respondent exclude the presence of other drugs in JC2's system. In Re: Emergency Suspension of License of 47 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 53. Respondent’s medical records show that she prescribed multiple 30 milligrams and Roxicodone 15 milligrams for JC2 on the dates and in the quantities described in the following table: In Re: Roxicodone Roxicodone Percocet Xanax (oxycodone) (oxycodone) (oxycodone) (alprazolam) 30 mg 15 mg 10mg | 9/9/2008 9/9/2008 2mg 30 mg #60 #150 10/7/2008 10/7/2008 2mg 15 mg #60 #90 | 11/4/2008 11/4/2008 11/4/2008 2mg 30 mg 15mg #60 #150 #90 12/2/2008 12/2/2008 2mg 30 mg #60 #150 12/30/2008 12/28/2008 2mg 30 mg #60 #120 2/25/2009 2/25/2009 T 2/25/2009 2mg 30 mg 15 mg #60 #180 #90 3/25/2009 3/25/2009 3/25/2009 2mg 30 mg 10 mg #60 #180 #120 4/20/2009 30 mg #120 4/22/2009 : 4/22/2009 30 mg 15 mg #180 #120 4/22/2009 30 mg #60 fmergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 48 Roxicodone Roxicodone Percocet Xanax (oxycodone) (oxycodone) (oxycodone) (alprazoiam) 30 mg 15 mg 10 mg 5/20/2009 2mg #60 oe 6/15/2009 2mg #60 6/17/2009 2mg #60 54. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: In Re: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; Cc) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 49 e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from JC2’s previous physicians whether his treatment was terminated for substance abuse/diversion,; h) Respondent's medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams and Xanax 2 milligrams from on or about September 9, 2008 to on or about June 17, 2009. FACTS SPECIFIC TO PATIENT WF 55. From on or about February 7, 2008 until on or about June 10, 2009, Patient WF presented to Respondent with complaints of back and leg pain with a diagnosis of lumbar radiculopathy. Respondent there and then prescribed 210 tablets of Roxicodone 30 milligrams (‘mg”), 90 tablets of Xanax 2 mg, and 90 tablets of Percocet 10 mg for WF based solely on the verbal patient history that WF related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of WF's prior medical records and Respondent did not verify through diagnostic testing whether the In Re: Emergency Suspension of License of 50 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc alleged prescription medications were present, nor did Respondent exclude the . presence of other drugs in WF’s system. 56. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams and Roxicodone 15 milligrams for WF on the dates and in the quantities described in the following table: Dilaudid Roxicodone Roxicodone Percocet Xanax (hydro- (oxycodone) (oxycodone) (oxycodone) _(alprazolam) morphone) 30m 15 mg 10 mg 2/7/2008 2/7/2008 2/7/2008 2mg 30 mg 10 mg #90 #210 #90 3/6/2008 3/6/2008 3/6/2008 2mg 30 mg 10 mg #90 #210 #90 6/4/2008 6/4/2008 6/4/2008 2mg 30 mg 15 mg #90 | #210 #90 10/2/2008 10/2/2008 10/2/2008 2mg 30 mg 15 mg #120 #210 #90 | 11/5/2008 11/5/2008 11/5/2008 2 mg 30 mg 15 mg #120 #240 #90 12/5/2008 12/5/2008 2 mg 30 mg #120 #240 12/5/2008 i 30 mg #45 1/5/2009 1/5/2009 2 mg 30 mg #120 #45 ) 1/5/2009 | 30 mg #240 | InRe: Emergency Suspension of License of 51 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Dilaudid Roxicodone Roxicodone Percocet Xanax (hydro- (oxycodone) (oxycodone) (oxycodone) (alprazolam) morphone) 30mg 15 mg 10m 2/3/2009 2/3/2009 2/3/2009 2 mg 30 mg 15 mg #120 #240 #90 3/2/2009 3/2/2009 3/2/2009 2 mg 4mg 10 mg #120 #210 —_ #90 4/6/2009 4/6/2009 4/6/2009 2mqg 30 mg 15 mg #120 #240 LL #90 6/10/2009 6/10/2009 6/10/2009 2mg 30 mg 15 mg #120 #240 #90 57. Respondent's medical records fail to show in her evaluation of the patient and in his treatment pian one or more of the following: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; c) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would. In Re: be used to determine treatment success, such as pain relief and improved Emergency Suspension of License of 52 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment, g) Verification from WF’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent’s medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams and Xanax 2 milligrams from on or about February 7, 2008 to on or about June 10, 2009. FACTS SPECIFIC TO PATIENT JH 58. From on or about April 29, 2008 until on or about June 3, 2009, Patient JH presented to Respondent with complaints of back pain radiating into the lower extremities with a diagnosis of lumbar radiculopathy. Respondent there and then prescribed 200 tablets of Roxicodone 30 milligrams (“mg”), 90 tablets of Roxicodone 15 mg, and 60 tablets of Xanax 2 mg for JH based solely on the verbal patient history that JH related to Respondent concerning the current pain Tn Re: Emergency Suspension of License of 53 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc management regimen. Respondent did not have the benefit of any of JH’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in H's system. 59. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams and Roxicodone 15 milligrams for JH on the dates and in the quantities described in the following table: Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) (alprazolam) 30 mg 15 mg 4/29/2008 4/29/2008 4/29/2008 2mg 30 mg 15 mg #60 #200 #90 10/29/2008 10/29/2008 10/29/2008 2mg 30 mg 15 mg #60 #240 #120 11/25/2008 11/25/2008 ‘11/25/2008 2mg 30 mg 15 mg #60 #240 #120. 12/29/2008 12/29/2008 12/29/2008 2mg 30 mg 15 mg #60 #240 #120 1/27/2009 1/27/2009 2mg 30 mg #60 #60 1/27/2009 ~ 30 mg #240 3/3/2009 3/3/2009 3/3/2009 2mg 30 mg 15 mg #60 #240 #120 In Re: — Emergency Suspension of License of 54 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) 15 mg 6/3/2009 30 mg #240 60. Respondent's medical records fail to show in her evaluation of the 6/3/2009 2mg #60 patient and in his treatment plan one or more of the following: In Re: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; c) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After. treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; Emergency Suspension of License of 55 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; | g) Verification from JH’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent's medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams and Xanax 2 milligrams from on or about April 29, 2008 to on or about June 3, 2009. FACTS SPECIFIC TO PATIENT TL 61. From on or about November 10, 2008 until on or about August 6, 2009, Patient TL presented to Respondent with complaints of chronic arthritis and deteriorated discs with a diagnosis of lumbar and cervical radiculopathy. Respondent there and then prescribed 180 tablets of Roxicodone 30 milligrams (*mg”), 90 tablets of Roxicodone 15 mg, and 60 tablets of Xanax 2 mg for TL based solely on the verbal patient history that TL related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of TL’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in TL’s system. In Re: Emergency Suspension of License of 56 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 62. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams, Roxicodone 15 milligrams and Oxydose 20 milligrams. per cc for TL on the dates and in the quantities described in the following table: Roxicodone Roxicodone Percocet Xanax (oxycodone) (oxycodone) (oxycodone) (alprazolam) _Oxydose 30 mg 15mg _ 10 mg 11/10/2008 11/10/2008 11/10/2008 2mg 30 mg 15 mg #60 #180 #90 12/16/2008 12/16/2008 12/16/2008 2 mg ; 30 mg 15 mg #60 #180 #120 1/13/2009 1/13/2009 1/13/2009 1/13/2009 2mg 30 mg 15mg 10 mg #60 #180 #120 #120 5/12/2009 5/12/2009 5/12/2009 5/12/2009 2mg 20 mg 30 mg 15 mg #60 1 bottle #210 #210 6/10/2009 6/10/2009 6/10/2009 6/10/2009 2 mg 20 mg 30 mg 15 mg #60 1 bottle #210. | #120 7/7/2009 7/7/2009 7/7/2009 7/7/2009 2 mg 20 mg 30 mg 15mg #60 1 bottle #60 #120 7/7/2009 30 mg #210 8/6/2009 8/6/2009 8/6/2009 8/6/2009 | 2mg 20 mg 30 mg 15 mg #60 1 bottle #210 #120 63. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: In Re: | Emergency Suspension of License of 57 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc In Re: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; c) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from TL’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent's medical records do not contain medical justification for the high frequency simultaneous prescription of such large Emergency Suspension of License of 58 Elizabeth Lopez, M.D. - License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams, Oxydose 20 milligrams per cc and Xanax 2 milligrams from on or about November 10, 2008 to on or about August 6, 2009. FACTS SPECIFIC TO PATIENT EM 64. From on or about November 11, 2008 until on or about December 5, 2009, Patient EM presented to Respondent with complaints of neck and arm pain with a diagnosis of cervical and lumbar radiculopathy. Respondent there and then prescribed 30 tablets of Roxicodone 30 milligrams (‘mg”) and 60 tablets of Xanax 2 mg for EM based solely on the verbal patient history that EM related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of EM’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in EM’s system. 65. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams and Roxicodone 15 milligrams for EM on the dates and in the quantities described in the following table: Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) oxycodone alprazolam 30m i5mg 10mg _ 11/11/2008 11/11/2008 2mg 30 mg #60 #30 In Re: — Emergency Suspension of License of 59 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) oxycodone (alprazolam) 30 mg 15 mg 10 mg 11/11/2008 30 mg #120 _—_| 12/8/2008 12/8/2008 12/8/2008 2 mg 30 mg 15 mg #60 #120 #120 _ 1/5/2009 30 mg | #120 | 1/5/2009 30 mg #60 Z 2/2/2009 2/2/2009 2/2/2009 2mg 30 mg 15 mg #60 #150 #120 3/9/2009 3/9/2009 3/9/2009 2mqg 30 mg 10 mg #60 #180 #120 4/6/2009 4/6/2009 | 30 mg 15mg #180 #120 _ 5/4/2009 5/4/2009 2mg 15 mg L #60 #120 6/8/2009 6/8/2009 6/8/2009 2 mg 30 mg 15 mg ; #90 #270 #180 | 7/20/2009 7/20/2009 7/20/2009 2 mg 30 mg 15 mg #90 #270_ #180 12/5/2009 , 2mqg #60 66. —_—_—_——_ Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: In Re: Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc In Re: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; Cc) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from EM’s previous physicians whether _ his treatment was terminated for substance abuse/diversion; h) Respondent’s medical records do not contain medical justification for the high frequency simultaneous prescription of such large Emergency Suspension of License of 61 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams and Xanax 2 milligrams from on or about November 11, 2008 to on or about December 5, 2009. FACTS SPECIFIC TO PATIENT WM 67. From on or about December 2, 2008 until on or about June 16, 2009, Patient WM presented to Respondent with complaints of pinched nerves and lumbar pain with a diagnosis of lumbar radiculopathy. Respondent there and then prescribed 240 tablets of Roxicodone 30 milligrams c’mg”), 60 tablets of Roxicodone 15 mg, and 60 tablets of Xanax 2 mg for WM based solely on the verbal patient history that WM related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of WM's prior medical records and Respondent did not verify- through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in WM's system. 68. Respondent’s medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams and Roxicodone 15 milligrams for WM on the dates and in the quantities described in the following table: Dilaudid Roxicodone Roxicodone Xanax (hydro- (oxycodone) (oxycodone) alprazolam) morphone) 30m 12/2/2008 12/2/2008 2mg 30 mg #60 #240 In Re: Emergency Suspension of License of 62 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 12/2/2008 15 mg #60 Dilaudid Roxicodone Roxicodone Xanax (hydro- (oxycodone) (oxycodone) (alprazolam) morphone) (30 mg) _(15 mg) 12/30/2008 12/30/2008 12/30/2008 2mg 30 mg 15 mg #60 #240 #60 1/27/2009 1/27/2009 2mg 30 mg #60 #30 1/27/2009 30 mg #240 2/24/2009 2/24/2009 2/24/2009 2/24/2009 2mg 4mg 30 mg 15mg #60 #120 #90 #60 3/24/2009 3/24/2009 3/24/2009 2 mg 30 mg 15 mg #60 #240 #60 3/24/2009 3/24/2009 30 mg 15 mg #200 #140 4/21/2009 4/21/2009 4/21/2009 2mg 30 mg 15 mg #60 #240 #60 5/19/2009 5/19/2009 2mg 30 mg #60 #240 | 6/16/2009 6/16/2009 6/16/2009 2mqg 30 mg 15 mg #60 #240 | _—«#120 69, Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: In Re: a) A complete medical history and physical examination that was conducted and documented in the medical record; Emergency Suspension of License of Elizabeth Lopez, M.D. License No, ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc In Re: b) Documentation of 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/or history of substance abuse; c) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from WM’s previous. physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent's medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams and Xanax 2 milligrams from on or about December 2, 2008 to on or about June 16, 2009. Emergency Suspension of License of 64 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc FACTS SPECIFIC TO PATIENT SR 70. From on or about September 10, 2008 until on or about June 10, 2009, Patient SR presented to Respondent with complaints of lower back pain with a diagnosis of lumbar radiculopathy, Respondent there and then prescribed 120 tablets of Roxicodone 30 milligrams (‘mg”}, 60 tablets of Xanax 2 mg, and 90 tablets of Soma 350 mg for SR based solely on the verbal patient history that SR related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of SR’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in SR’s system. 71. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams, Roxicodone 15 milligrams and Soma 350 milligrams for SR on the dates and in the quantities described in the following table: Roxicodone Roxicodone Xanax (oxycodone) (oxycodone) oxycodone _(alprazolam 30 mg 15 mg 10m Soma 9/10/2008 9/10/2008 9/10/2008 2mg 30 mg 350 mg #60 #120 #90 10/20/2008 10/20/2008 10/20/2008 10/20/2008 2mg 30 mg 15 mg 350 mg #60 #150 #60 #90 11/17/2008 11/17/2008 11/17/2008 11/17/2008 2mg 30 mg 15mg 350 mg #60 #150 #60 #90 In Re: Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Roxicodone Roxicodone (oxycodone) (oxycodone) oxycodone Xanax (alprazolam) 30 mg 15 mg 10 mg ; Soma 12/15/2008 12/15/2008 | 12/15/2008 12/15/2008 2mg 30 mg 15 mg 350 mg #60 #150 #90 #90 1/12/2009 1/12/2009 1/12/2009 1/12/2009 2mg 30 mg 15 mg 350 mg #60 #150 #90 | #90 2/10/2009 2/10/2009 2/10/2009 2/10/2009 2mg 30 mg 15 mg #60 #180 #120 2/11/2009 30 mg 350 mg #90 3/10/2009 15 mg #120 #60 3/10/2009 3/10/2009 2mg 30 mg #60 #180 4/13/2009 4/13/2009 2 mg 30 mg #90 #180 6/10/2009 6/10/2009 2mg 30 mg #90 #240 6/10/2009 15 mg #120 4/13/2009 10 mg #120 3/10/2009 350 mg #90 4/13/2009 350 mg #90 6/10/2009 350 mg #90 72. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; In Re: — Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 66 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Cc) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from SR’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent’s medical records do not contain medical justification for the high frequency simultaneous prescription of such large quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams, Soma 350 milligrams and Xanax 2 milligrams from on or about September 10, 2008 to on or about June 10, 2009. FACTS SPECIFIC TO PATIENT JT 73. From on or about August 29, 2008 on or about until August 3, 2009, Patient JT presented to Respondent with complaints of herniated discs and a diagnosis of lumbar radiculopathy. Respondent there and then prescribed 180 In Re: Emergency Suspension of License of 67 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc tablets of Roxicodone 30 milligrams (‘mg”), 90 tablets of Roxicodone 15 mg, and 60 tablets of Xanax 2 mg for JT based solely on the verbal patient history that JT related to Respondent concerning the current pain management regimen. Respondent did not have the benefit of any of JT’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in JT’s system. 74. Respondent's medical records show that she prescribed multiple simultaneous prescriptions for large amounts of Xanax 2 milligrams, Roxicodone 30 milligrams, Roxicodone 15 milligrams and Valium 10 milligrams for JT on the dates and in the quantities described in the following table: Dilaudid Roxicodone Roxicodone Xanax (hydro- (oxycodone) (oxycodone) alprazolam) morphone 30 m 15mg Valium 8/29/2008 8/29/2008 8/29/2008 2.mg 30 mg 15mg #60 #180 #90 9/29/2008 9/29/2008 9/29/208 2 mg 30 mg 15 mg #60 #210 #180 i. 10/23/2008 10/23/2008 10/23/2008 2 mg 30 mg 15 mg #60 #240 #180 11/24/2008 11/24/2008 11/24/2008 2mg 30 mg 15 mg #60 #240 #180 12/22/2008 12/22/2008 12/22/2008 2mg 30 mg 15 mg #60 #240 #180 1/21/2009 1/21/2009 30 mg 10 mg #240 #60 In Re: — Emergency Suspension of License of 68 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc Dilaudid Roxicodone Roxicodone Xanax (hydro- (oxycodone) (oxycodone) alprazolam) morphone 30 mg 15m Valium 1/21/2009 30 mg #90 2/23/2009 2/23/2009 2/23/2009 4mqg 30 mg 10 mg #60 #180 #60 2/23/2009 30 mg L #240 | 2/23/2009 30 mg #60 3/3/2009 3/3/2009 30 mg 15 mg #120 #120 4/3/2009 10 mg #60 5/3/2009 5/3/2009 30 mg 15 mg #120 #60 6/17/2009 6/17/2009 | 6/17/2009 30 mg 15 mg 10 mg #240 #180 #60 7/17/2009 7/17/2009 | 7/17/2009 30 mg 15 mg 10 mg #240 #180 #60 8/3/2009 mi 8/3/2009 30 mg 10 mg #240 #60 75. Respondent's medical records fail to show in her evaluation of the patient and in his treatment plan one or more of the following: In Re: — Emergency Suspension of License of 69 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc In Re: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; C) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; g) Verification from JT’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Respondent's medical records do not contain medical justification for the high frequency simultaneous prescription of such large Emergency Suspension of License of 70 Elizabeth Lopez, M.D. License No. ME 62775 Case No, 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc quantities of Roxicodone 30 milligrams together with Roxicodone 15 milligrams and Xanax 2 milligrams from on or about August 29, 2008 to on or about August 3, 2009. COUNT ONE 76. Petitioner reincorporates and realleges paragraphs 1 through 75 as if fully set forth herein. 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 77. Section 458.331(1)(nn), Florida Statutes (2007, 2008 and 2009), Medicine. 78. Rule 64B8-9.013(3), Florida Administrative Code, provides as follows: In Re: The Board has adopted the following standards for the use of controlled substances for pain control: (a) Evaluation of the Patient. A complete medical history and physical examination must be conducted and documented in the medical record. The medical 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 controlled substance. (b) Treatment Plan. The written treatment plan should state objectives that will be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and should indicate if any further diagnostic evaluations or other treatments are planned. After treatment begins, the physician should adjust drug therapy to the Patient medical needs of each patient. Other treatment modalities or a rehabilitation program may Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 71 be necessary depending on the etiology of the pain and the extent to which the pain is associated with physical and psychosocial impairment. 79. Between June 2007 and September 2009, Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, by prescribing one or more of the following controlled substances; Hydrocodone, Oxycodone, Oxydose, Percocet, Roxicodone and or Soma to patients DC, RC, DB, MB, KD, JF, MK, DL, T™, PM, GR, LR, BC, JC, 3C2, WF, JH,TL, EM, WM, SR, and JT in the quantities and combinations described above, without conducting or documenting complete medical histories or physical examinations of DC, RC, DB, MB, KD, JF, MK, DL, TM, PM, GR, LR, BC, JC, JC2, WF, JH,TL, EM, WM, SR, and JT and without documenting one or more of the following: the nature and intensity of the patients’ pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function or history of substance abuse, the presence of one or more recognized medical indications for the use of a controlled substance and without documenting written treatment plans that state objectives that will be used to determine treatment success or indicate if any further diagnostic evaluations or other treatments are planned. 80. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2007, 2008, and 2009), by violating Rule 64B8- 9.013(3), Florida Administrative Code. In Re: — Emergency Suspension of License of 72 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC ~ LOPEZ 2008-18673 21710 FINAL 030910.doc COUNT TWO 81. Petitioner reincorporates and realleges paragraphs 1 through 75 as if fully set forth herein. 82. Chapter 64B8-9.013(3), Florida Administrative Code, as more particularly set forth in paragraph 78 herein is adopted and realleged as if fully set forth. 83. Section 458.331(1)(t), Florida Statutes (2007, 2008 and 2009), provides that committing medical malpractice constitutes grounds for disciplinary action by the Board of Medicine. Medical Malpractice is defined in Section 456.50, Florida Statutes (2007, 2008 and 2009), 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. For purposes of Section 458.331(1)(t), Florida Statutes the Board shall give great weight to the provisions of Section 766.102, Florida Statutes (2007, 2008 and 2009), which provide that 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 84. 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 treating Patient DC in one or more of the following ways: In Re: Emergency Suspension of License of 73 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; c) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; 9g) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; h) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule .64B8-9.013(3), Florida Administrative Code; i) By failing to record in the medical record any evidence of physical examinations or the documentation of function. 85. Respondent failed to practice medicine with that level of care, skill and treatment which is recognized by a reasonably prudent similar physician as In Re: Emergency Suspension of License of 74 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc being acceptable under similar conditions and circumstances in the treatment of patient RC in one or more of the following ways: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; Cc) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to require a specialized consultation from a board certified pain specialist in view of the extent of medications prescribed; g) By failing to consider the prescription of anything other than controlled substances for the management of pain; h) By failing to consider or use any other treatment modalities for chronic pain included but not limited to nonscheduled medications, adjuvant medications, medical procedures, spinal cord stimulators, physical therapy, a morphine pump and or interventional management. 86. Respondent failed to practice medicine with that level of care, skill and treatment which is recognized by a reasonably prudent similar physician as In Re: Emergency Suspension of License of 75 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Mitne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc being acceptable under similar conditions and circumstances in the treatment of patient DB in one or more of the following ways: In Re: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; c) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; g) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; h) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; i) By failing to record in the medical record any evidence of physical examinations or the documentation of function; j By failing to have an appropriate treatment plan; Emergency Suspension of License of : 76 License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc k) By failing to justify the prescription of Soma in the medical records; 1) By prescribing an excessive or inappropriate amount of Soma; m) By inappropriately prescribing an excessive and or dangerous combination of opioids and benzodiazepines. 87. 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 the treatment of patient MB in one or more of the following ways: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By failing to refer the patient to a board certified psychiatrist in view of the high dosages of benzodiazepines being prescribed; Cc) By prescribing excessive and or inappropriate amounts of benzodiazepines; d) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; e) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; f) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; In Re: | Emergency Suspension of License of Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 77 In Re: g) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; h) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; i) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; j) By failing to consider the prescription of anything other than controlled substances for the management of pain; k) By prescribing excessive and inappropriate dosages and combinations of opioids; ») By failing to record in the medical record any evidence of physical examinations or the documentation of function; m) By failing to requirea specialized consultation from a board certified pain specialist in view of the extent of medications prescribed; n) By failing to have an appropriate treatment plan; 0) By failing to consider or use any other treatment modalities for chronic pain included but not limited to nonscheduled medications, adjuvant medications, medical procedures, spinal cord stimulators, physical therapy, a morphine pump and or interventional management; Emergency Suspension of License of 78 Elizabeth Lopez, M.D. License No. ME 62775 Case No, 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc p) By inappropriately prescribing an excessive and dangerous combination of opioids and benzodiazepines; q) By immediately prescribing high doses of opioids instead of titrating the dosage until an effective level of pain management was reached. 88. 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 the treatment of patient KD in one or more of the following ways: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; c) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; In Re: Emergency Suspension of License of 79 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc In Re: g) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; h) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; . i) By failing to consider the prescription of anything other than controlled substances for the management of pain; jp By prescribing excessive and inappropriate dosages and combinations of opioids; k) By failing to have an appropriate treatment plan; !) By failing to consider or use any other treatment modalities for chronic pain included but not limited to nonscheduled medications, adjuvant medications, medical procedures, spinal cord stimulators, physical therapy, a morphine pump and or interventional management; m) By failing to justify the prescription of Soma in the medical records; n) By prescribing an excessive or inappropriate amount of Soma; 0) By inappropriately prescribing an excessive and dangerous combination of opioids and benzodiazepines and Soma; p) By failing to fully assess the patient. Emergency Suspension of License of 80 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 89. 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 the treatment of patient JF in one or more of the following ways: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; c) By failing to note in the medical records in prescribing "benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; i) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; jp By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; In Re: | Emergency Suspension of License of 81 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Miine\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc k) By failing to consider the prescription of anything other than controlled substances for the management of pain; 1) By prescribing excessive and inappropriate dosages and combinations of opioids. m) _ By failing to have an appropriate treatment plan; n) By failing to fully assess the patient; 0) By immediately prescribing high doses of opioids instead of titrating the dosage until an effective level of pain management was reached. 90. 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 the treatment of patient MK in one or more of the following ways; In Re: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; c) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; d) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; Emergency Suspension of License of 82 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Miine\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc e) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; f) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; g) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; h) By prescribing excessive and inappropriate dosages and combinations of opioids; i) By failing to have an appropriate treatment plan. 91. 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 the treatment of patient DL in one or more of the following ways: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By failing to refer the patient to a board certified psychiatrist in view of the high dosages of benzodiazepines being prescribed; c) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; ke Bleabeth Lopes MDs ° License No. ME 62775. Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; g) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; h) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; i) By prescribing excessive and inappropriate dosages and combinations of opioids; jp By failing to record in the medical record any evidence of physical examinations or the documentation of function; k) By failing to have an appropriate treatment plan. 92. 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 the treatment of patient TM in one or more of the following ways: In Re: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; Emergency Suspension of License of 84 Elizabeth Lopez, M.D. License No. ME 62775 Case No, 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc c) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; g) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; h) ~° By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; i) By prescribing excessive and inappropriate dosages and combinations of opioids; p By failing to have an appropriate treatment plan. 93. 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 the treatment of patient PM in one or more of the following ways: In Re: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; Emergency Suspension of License of 85 Elizabeth Lopez, M.D, License No, ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc In Re: b) By prescribing excessive and or inappropriate amounts of benzodiazepines; c) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; g) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; h) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; i) By prescribing excessive and inappropriate dosages and combinations of opioids; jp By inappropriately prescribing an excessive and or dangerous combination of opioids, and benzodiazepines; k) By failing to fully assess the patient; Emergency Suspension of License of 86 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc I) By immediately prescribing high doses of opioids instead of titrating the dosage until an effective level of pain management was reached. 94. 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 the treatment of patient GR in one or more of the following ways: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; c) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; g) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; In Re: Emergency Suspension of License of 87 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc h) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; i) By failing to consider the prescription of anything other than controlled substances for the management of pain; jp By prescribing excessive and inappropriate dosages and combinations of opioids; k) By failing to have an appropriate treatment plan; )) By failing to fully assess the patient. 95. 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 the treatment of patient LR in one or more of the following ways: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; c) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; In Re: Emergency Suspension of License of 88 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc In Re: e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; g) By failing to require a specialized consultation from . a board certified pain specialist in view of the extent of medications prescribed; h) By violating the standards for the use of controlled substances for pain contro! provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; i) By failing to consider the prescription of anything other than controlled substances for the management of pain; p By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; k) By failing to have an appropriate treatment plan; I) By failing to consider or use any other treatment modalities for chronic pain included but not limited to nonscheduled medications, adjuvant medications, medical procedures, spinal cord stimulators, physical therapy, a morphine pump and or interventional management; m) By inappropriately prescribing an excessive and dangerous combination of opioids, and benzodiazepines; Emergency Suspension of License of 89 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc n) By failing to fully assess the patient, 0) By immediately prescribing high doses of opioids instead of titrating the dosage until an effective level of pain management was reached; p) By prescribing excessive and inappropriate dosages and combinations of opioids. 96. 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 the treatment of patient BC in one or more of the following ways: In Re: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; Cc) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; Emergency Suspension of License of 90 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc g) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; h) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; i) By prescribing excessive and inappropriate dosages and combinations of opioids; j) By failing to require a specialized consultation from a board certified pain specialist in view of the extent of medications prescribed; k) By failing to have an appropriate treatment plan; I) By failing to consider or use any other treatment modalities for chronic pain included but not limited to nonscheduled medications, adjuvant medications, medical procedures, spinal cord stimulators, physical therapy, a morphine pump and or interventional management; m) By inappropriately prescribing an excessive and dangerous combination of opioids and benzodiazepines; n) By failing to fully assess the patient. 97. 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 the treatment of patient JC in one or more of the following ways: In Re: Emergency Suspension of License of 91 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc In Re: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; Cc) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids f) the dosages prescribed; g) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; h) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; i) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; j) By prescribing excessive and inappropriate dosages and combinations of opioids; k) By failing to have an appropriate treatment plan; I) By failing to consider or use any other treatment. modalities for chronic pain included but not limited to nonscheduled medications, Emergency Suspension of License of 92 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc adjuvant medications, medical procedures, spinal cord stimulators, physical therapy, a morphine pump and or interventional management; m) By inappropriately prescribing an excessive and dangerous combination of opioids and benzodiazepines; n) By failing to fully assess the patient; 0) By immediately prescribing high doses of opioids instead of titrating the dosage until an effective level of pain management was reached. 98. 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 the treatment of patient JC2 in one or more of the following ways: In Re: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; c) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; . d) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; e) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; Emergency Suspension of License of 93 Elizabeth Lopez, M.D. License No, ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc f) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; g) By prescribing excessive and inappropriate dosages and combinations of opioids; h) By failing to have an appropriate treatment plan; i) By failing to justify in the medical record the increase why the Roxicodone was increased; 5») By inappropriately prescribing an excessive and dangerous combination of opioids and benzodiazepines; k) By failing to fully assess the patient. 99. 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 the treatment of patient WF in one or more of the following ways: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; | c) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; In Re: — Emergency Suspension of License of 94 Elizabeth Lopez, M.D. License No, ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Miine\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc In Re: d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; g) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; h) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; i) By prescribing excessive and inappropriate dosages and combinations of opioids; jp By failing to record in the medical record any evidence of physical examinations or the documentation of function; k) By failing to require a specialized consultation from a board certified pain specialist in view of the extent of medications prescribed; l) By failing to have an appropriate treatment plan; m) By failing to consider or use any other treatment modalities for chronic pain included but not limited to nonscheduled medications, Emergency Suspension of License of 95 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc adjuvant medications, medical procedures, spinal cord stimulators, physical therapy, a morphine pump and or interventional management; n) By inappropriately prescribing an excessive and dangerous combination of opioids and benzodiazepines; 0) By failing to fully assess the patient; p) By immediately prescribing high doses of opioids instead of titrating the dosage until an effective level of pain management was reached. 100. 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 the treatment of patient JH in one or more of the following ways: In Re: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; c) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; d) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; e) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; Emergency Suspension of License of 96 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc f) By violating the standards for the use of controlled substances for pain contro! provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; g) By prescribing excessive and inappropriate dosages and combinations of opioids; h) By failing to have an appropriate treatment plan; i) By inappropriately prescribing an excessive and dangerous combination of opioids and benzodiazepines; jp By failing to fully assess the patient; k) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder. . 101. 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 the treatment of patient TL in one or more of the following ways: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; c) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; mee Bizebeth Lopen MD. ” License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; g) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; h) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; i) By prescribing excessive and inappropriate dosages and combinations of opioids; 5?) By failing to have an appropriate treatment plan; k) By immediately prescribing high doses of opioids instead of titrating the dosage until an effective level of pain management was reached; 1) By inappropriately prescribing an excessive and dangerous combination of opioids and benzodiazepines; m) _ By failing to fully assess the patient. 102. Respondent failed to practice medicine with that level of care, skill and treatment which is recognized by a reasonably prudent similar physician as In Re: Emergency Suspension of License of 98 Elizabeth Lopez, M.D, License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc being acceptable under similar conditions and circumstances in the treatment of patient EM in one or more of the following ways: In Re: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; . c) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; d) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; e) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; f) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; g) By prescribing excessive and inappropriate dosages and combinations of opioids; h) By failing to have an appropriate treatment plan; i) By failing to consider or use any other treatment modalities for chronic pain included but not limited to nonscheduled medications, adjuvant medications, medical procedures, spinal cord stimulators, physical therapy, a morphine pump and or interventional management; Emergency Suspension of License of 99 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc j) By inappropriately prescribing an excessive and dangerous combination of opioids and benzodiazepines; k) By failing to fully assess the patient; I) By failing to require a specialized consultation from a board certified pain specialist in view of the extent of medications prescribed; m) By failing to have an appropriate treatment plan. 103. 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 the treatment of patient WM in one or more of the following ways: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; C) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for Prescribing a combination of two or more immediate release opioids; In Re: — Emergency Suspension of License of 100 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Mitne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc g) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; h) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; i) By prescribing excessive and inappropriate dosages and combinations of opioids; jp By failing to require a specialized consultation from a board certified pain specialist in view of the extent of medications prescribed; k) By failing to have an appropriate treatment plan; l) By failing to consider or use any other treatment modalities for chronic pain included but not limited to nonscheduled medications, adjuvant medications, medical procedures, spinal cord stimulators, physical therapy, a morphine pump and or interventional management; m) By inappropriately prescribing an excessive and dangerous combination of opioids, benzodiazepines and Soma; n) By failing to fully assess the patient. 104. 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 the treatment of patient SR in one or more of the following ways: In Re: Emergency Suspension of License of 101 Elizabeth Lopez, M.D. License No. ME 62775 Case No, 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc In Re: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; c) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; g) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; h) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; i) By prescribing excessive and inappropriate dosages and combinations of opioids; j) By failing to have an appropriate treatment plan; k) By inappropriately prescribing an excessive and dangerous combination of opioids, benzodiazepines and Soma; Emergency Suspension of License of 102 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 1) By failing to fully assess the patient; m) — By immediately prescribing high doses of opioids instead of titrating the dosage until an effective level of pain management was reached; 105. 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 the treatment of patient JT in one or more of the following ways: a) By failing to show in the medical record the justification for prescribing benzodiazepines in such high doses; b) By prescribing excessive and or inappropriate amounts of benzodiazepines; c) By failing to note in the medical records in prescribing benzodiazepines that the patient was suffering from an anxiety disorder; d) By failing to order urine drug screening in view of the high dosages of opioids and benzodiazepines being prescribed; e) By failing to show in the medical record the justification for prescribing opioids in the dosages prescribed; f) By failing to show in the medical record the justification for prescribing a combination of two or more immediate release opioids; g) By prescribing concurrent prescriptions of immediate release opioids in combination and at the dosages prescribed; In Re: — Emergency Suspension of License of 103 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc h) By violating the standards for the use of controlled substances for pain contro! provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; i) By prescribing excessive and inappropriate dosages and combinations of opioids; j) By failing to have an appropriate treatment plan; k) By inappropriately prescribing an excessive and dangerous combination of opioids and benzodiazepines; 1) By failing to fully assess the patient. 106. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2007-2009). COUNT THREE 107. Petitioner reincorporates and realleges paragraphs 1 through 75 as if fully set forth herein. 108. Chapter 64B8-9.013(3), Florida Administrative Code, as more particularly set forth in paragraph 78 herein is adopted and realleged as of fully set forth. 109. Section 458.331(1)(m), Florida Statutes (2007, 2008 and 2009), subjects a licensee to discipline for 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 In Re: — Emergency Suspension of License of 104 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc and professional title who is or are 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. 110. Between June 2007 and September 2009, Respondent failed to perform a legal obligation placed upon him as a physician contained within Rule 64B8-9.013(3), Florida Administrative Code, by prescribing, Hydrocodone, Oxycodone, Oxydose, Percocet, Roxicodone and/or Soma to patients DC, RC, DB, MB, KD, JF, MK, DL, TM, PM, GR, LR, BC, JC, JC2, WF, JH,TL, EM, WM, SR, and JT in the quantities and combinations described therein, without conducting or documenting complete medical histories or physical examinations on patients DC, RC, DB, MB, KD, JF, MK, DL, TM, PM, GR, LR, BC, JC, JC2, WF, JH,TL, EM, WM, SR, and JT and without documenting one or more of the following: the nature and intensity of the patients’ pain; current and past treatments for pain; underlying or coexisting diseases or conditions; the effect of the pain on physical and psychological function or history of substance abuse; the presence of one or more recognized medical indications for the use of a controlled substance; and without documenting written treatment plans that state objectives that would be used to determine treatment success or indicate if any further diagnostic evaluations or other treatments are planned. In Re: Emergency Suspension of License of 105 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 111. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2007, 2008 and 2009), by violating Rule 64B8- 9.013(3), Florida Administrative Code. COUNT FOUR 112. Petitioner reincorporates and realleges paragraphs 1 through 75 as if fully set forth herein. 113. Section 458,.331(1)(q), Florida Statutes (2007, 2008 and 2009), provides as follows: 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 is grounds for discipline by the Board of Medicine. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including ali 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 intent. 114. Between June 2007 and September 2009, on the dates and in the quantities more particularly described in the paragraphs above Respondent prescribed inappropriately and/or in excessive or inappropriate quantities, controlled substances to patients DC, RC, DB, MB, KD, JF, MK, DL, TM, PM, GR, LR, BC, JC, JC2, WF, JH,TL, EM, WM, SR, and JT. 115. Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (2007, 2008 and 2009). In Re: Emergency Suspension of License of 106 Elizabeth Lopez, M.D. . License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc 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. : SIGNED this f ie day of __/ bol \ , 2010. NT OF HEALTH DEP ARM ETY CLERK oun Uiraela Bartin~ (Wtelzove Assistant General Counsel pate_ Sl lors Florida Bar # 622338 DOH Prosecution Services Unit 4052 Bald Cypress Way-Bin C-65 Tallahassee, Florida 32399-3265 (850) 245-4640 Office (850) 245-4681 Facsimile PCP Members: GakKav JS! song, seen enh Pcp: YI aol /a, ato In Re: — Emergency Suspension of License of 107 Elizabeth Lopez, M.D. License No. ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL.doc 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 cail and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or his 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. In Re: Emergency Suspension of License of 108 Elizabeth Lopez, M.D. License No, ME 62775 Case No. 2008-18673 J:\PSU\Medical\Robert Milne\Cases\LOPEZ 2008-18673\AC - LOPEZ 2008-18673 21710 FINAL 030910.doc

Docket for Case No: 10-002467PL