Jun 10 2010 12:40 Jun 10 2010 12:37 PLO? STATE OF FLORIDA | DEPARTMENT OF HEALTH : DEPARTMENT OF HEALTH, | PETITIONER, v. CASE NOS. 2 ALFRED EVERSLEY SOYCE, D.O., RESPONDENT. nn ARHINISTRATIVE COMPLAINT COMES NOW Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint: before the Board of Osteopathic Medicine against Respondent, Alfred Eversley Boyce, D.0., and in support thereof alleges: | i. Petitioner is the state department charged with regutating the Practice of osteopathic medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 459, Florida Statutes, , 2, At all times material to this Order, Respondent was iicensed to practice as an ostedpathi¢ physician having been issued license number OS 5977 on about March 26, 1979, During all times relevant to this order, Respondent Was. practicing pain management at Broward Chronic Pain and Recovery Center J\PSU\Medical Tobey \stea\Acs Boyes, Alfred multiple caset-pain management.doc 4 Jun 10 2010 12:40 Jun 10 2010 12:38 P. 08 Respondent is. not board-certified in pain management, 3, Respondent’s address of record Is 1007 West ‘Commercial Boulevard, Fort Lauderdale, Florida 33309. | 4, From ‘about July 23, 2009 through December 11, 2009, the Department of Health received five separate complaints that Respondent appeared to be prescribing excessive quantities of controlled substances, The allegations were supported by pharmacy records indicating out-of-state patients attempted to fill prescriptions for controlled substances written by Resvondent in Fort Lauderdale, Florida. 5. Reasonable cause subpoenas. were issued, ‘in accordance with Section 456.057(9)(a}1, Florida Statutes (2009), to obtain the medical records of six. (6) patients who ‘were being prescribed high dosages of controlied ses Such as oxycodone, Percocet and Xanax. 6 Opioid, or opiate, drugs have similar actions as the drug opium and are typically prescribed to treat pain. Opioid drugs. are synthetically manufactured, while opiate drugs are naturally occurring, but the tems opioid and opiate are often used interchangeably. Opioid drugs are uti and subject to abuse. 7. Benzodiazepines are a class of drugs that cause sedation and can be habit forming. Benzodiazepines are typically prescribed to treat anxiety or insomnia. 8. Oxycodone fs a semi-synthetic opioid that Is prescribed to treat J:\PSU\Madizal\Tobey\Geteo\AC\Boyce, Alfred multiple. cases-pain management.doc 8 Jun 10 2010 12:40 Jun 10 2010 12:38 P.09 pain. According to: Section 893.03(2), Florida Statutes, oxycodone Is. a Schedule H 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, ard abuse of oxycodone may lead to severe psychological or physical dependence. . | 9, OxyContin is the brand name for a drug that contains oxycodone, which Is described above, | 10, Percocet is the brand frame for a drug that contains oxyeotione, Which is:described above. Percocet also contains acetaminophen, or Tylenol . 11. Xanax is the brand name for alprazolam ard is prescribed to treat anxiety. According to Section 693.03(4), Florida Statutes, alprazolam Is a Schedule TV controlled substance that has.a low potential for abuse relative to the substances in Schedule Ili and has a currently accepted medical use in treatment in the United States, and abuse of alprazolam may lead to limited physical or psychological dependence relative to the substances in Stet It. Alprazoiam is a benzodiazepine. | 11.. ‘The investigation prompted a Department. osteopathic medicine expert review of the records for patients DT, JC, RD, WM, JF, arid JL , 12. Of the six (6) patients, two (2) are residents of Kentucky, tee (3) ate residents of West Virginia, and one (1) is a resident of Tennessee, 13. The expert's medical opinion for each of these six (6) patients confirmed: the allegations. of inappropriete prescribing of excessive and T:\PSU\Medieal Tobey Gsten\aCelBoyce, Alfred mulliple cases-paty managetient.doc Jun 10 2010 12:41 Jun 10 2010 12:38 P.10 inappropriate quantities and combinations of controlled -substan¢es without medical records justifying these prescriptions. | 14. During the course of approximately ten (10) months, for the si (6) patients described above, Respondent prescribed a total of about 10,800 tablets of controlled substarices. | Faets Specific to Patient DT 15, Framon or about August 14, 2009, through on or about September 17, 2009, patient DT presented to Respondent. with complaints of tower back pain. : 16. Respondent's medical records show that he prescribed multiple prescriptions for large amounts of oxycodone and Xanax for patient: DT on the dates, dosages, and in the quantities described in the following table: 8/14/09 240 tablets — 17, The above chart represents a total of 900 tablets of controlled substances prescribed to patient DT over the course of an approximately one (1) Fronth period, ! 18. On or about August 14, 2009, Respondent documented petfortning @ Cursory physical. examination revealing. only “exaggerated lordosis, normal reflexes.” Lordosis is-an increased curving of the spine. J:APSU\ Medical Tobey \OstaoACE\boyaH, Alffed rhultinie exees-pain management.doe 4 Jun 10 2010 12:41 Jun 10 2010 12:39 P.11 19. A reasonably prudent osteopathic physician would not consider the August 14, 2009, physical examination minimally adequate for the condition complained of by patient DT. | 20. Neither prior to nor while prescribing these drugs on or about September 17, 2009, did Respondent perform and/or document the performance of a minimally adequate physical examination appropriate for the condition complained of by the patient. | 21. According to the expert, Respondent’s medical records a not contain medical justification for the frequency and simultaneous peso of such large quantities of oxycodone together with Xanax. 22. According to the expert, the medications prescribed to patient DT Were excessive and Inappropriate. | 23, A reasonably prudent osteopathic physician would not ! have simultaneously prescribed such large quantities of oxycodone together with Xanax and would have performed at least. minimally adequate physical examinations appropriate for the condition complained of by the patient. , Facts Specific to Patient JC 24. From: on of about February 12, 2009, through: on or about October 1, 2009, patient JC presented to. Respondent with complaints of lowef back pain, 25. Respondent’s medical records show that he prescribed multiple simultaneous prescriptions for large amounts of oxycodone and Xanax for patient J:\PSU\Medical\Tobey (Ostend AGs\Roys, Alfred midtinie casesepain managemunt.ddc. 5 Jun 10 2010 12:41 Jun 10 2010 12:39 P.12 ! | JC’ on the dates. and in the quantities and dosages described in the following table: 7/15/09 240 tablets 1 8/18/09 240 tablets 10/1/09 240 tablets 26. The above chart represents a total of 1,290 tablets of controlled Substances prescribed to patient JC over the course of approximately eight (8) months, 27. Neither prior to nor while prescribing these drugs, did Respondent perform and/or documient the performance of a minimally. adequate physical éxamination appropriate for the condition complained of by the patient. ! 28. According to the expert, Respondent's medical records do not contain: medical justification for the high frequency and simultaneous prescription of such large quantities of oxycodone together with Xanax. ! 28. According to the expert, the medications prescribed to: patient Ic were excessive and inappropriate. | 30. A reasonably prudent osteopathic physician would _ not have simultaneously prescribed such Jarge quantities of oxycodone: together wth 2:\F5U\Madical\ Tobey\Oste0\Abe\Boyes, Alfred muitipie cases-pain management.doc 6 Jun 10 2010 12:42 Jun 10 2010 12:39 P.13 Yanax and would have performed a minimally adequate physical examination appropriate for the condition complained of by the. patient. | Facts Specific to Patient RD | ‘31, Fromon or about February 17, 2009 through on or about April 9, 2009, patlent RIS presented to Respondent with complairits of lower back pain, 32, Respondent’s medical records show that he prescribed 240 30mg oxycodone tablets for patient RD on both February 17, 2009, and April 9, 2009. 33. This represents a total of 480 tablets of controlled substances prescribed to patient RD over the course of approximately two months. , 34. ‘Neither prior to nor while prescribing these drugs, did Respondent perform. and/or document the performance of a minimally adequate physical exariination appropriate for the condition complained of by the patient. | 35, According to the expert, Respondent's medical records do not contain meciical justification. for the quantity of oxycodone provided to patient RD. 36, According to the expert, the madications prescribed to patient RD were excessive and inappropriate. | 37. A reasonably prudent osteopathic physidan would not have prescribed such large quantities of oxycodone and would have pérformed at least & minirially adequate physical exartination “appropriate for the contition complained of by the patient. | JH\PSUI Metical Tobey \OsteniACe\Boycs, Alfred niultple cases-pain managemerit.doc | 7 Jun 10 2010 12:42 Jun 10 2010 12:40 P14 Facts Specific to Patient WM | 38. From.on or about February 10, 2009, through an or about July 28, 2009, patient WM presented to Respondent with complaints of lower back pan, 39. Respondent’s medical records show that he’ prescribed multiple simultaneous. prescriptions for large amounts of oxycodone arid Xanax for patient WM on the dates and in the quantities and dosages described in the following table: 3Q tablets 5/5/09 2mg | 30 tablets 6/2/09 2 mg 30 tablets 6/30/09 z2mg 30:tablets _ 7(28/09 2mg 30 tablets Jun 10 2010 12:42 Jun 10 2010 12:40 P.15 40. ‘The above. chart represents a total of 2,040 ‘tablets of controlled substances prescribed to patient WM over the course of approximately six (6) months. 7 | 41. Neither prior to nor while prescribing these-drugs,. did Respondent perform and/or document the performance of a minimally adequate physical examination appropriate for the condition complained of by the patierit. : 42. According to the expert, Respondent's medical reccrds do not contain medical justification for the frequency and simultaneous prescription of such large quantities of oxycodone together with Xanax to patient WM. : 43, According to the expert, the medications prescribed to patient WM were excessive and inapprapriate. 4 44, A reasonably prudent osteopathic physician would: not ‘have simuttaneously prescribed such large quantities of oxycodone together with Xanax. and would have performed a minimally adequate physical examination appropriate for the condition complained of by’the patient. Facts Specific to Patient JF 45, From on or about March 23, 2009, through on: or about November 16, 2009, patient JF presented to Respondent with back pain: | 46. Respondent's medical records show that he prescribed multiple Simultaneous prescriptions for large amounts of oxycodone along with Percocet OxyContin and Xanax for patient JF on the dates and in the ccsages and Quantities described {n the following table: J.\PSU\Medleal Tobey Osteo WiC \Boyee, Alfred multiple eages-patn managemeni.dec i og Jun 10 2010 12:43 Jun 10 2010 12:40 P.16 cm a Read pe a 3/23/09 | 120 tablets 2mg 10/325mg 30 tablets ; 126 tablets 4/2209 4/22/09 4/22/09 240 tabiats 2mg 10/325mq 30 tablets 120 tablets 5/27/09 ad 5/27/09 246 tablets 10/325mg xs 0 able ts 120 tablets | 6430709 6/30/09 6/30/09 240 tablets amg 10/325mg 30 tablets 120 tablets tes [Foe | | tl O ab lets 180 tabiets 240 tablets 8/27/09 8/27/09 8/2 27/08 180 tablets 240 tablets 30 30 ablets ; 9/24/09 9/24/09 9/24/09 180 tablets 240 tablets amq 30 tablets 11/16/08 F LEf 16/09 me 16/05 180 tablets 240 cplets 30 ble | 47. The above chart represents a total of 3,240 tablets of controlied substances prescribed to patient JF over the course of approximately eight {8} months. 48. Neither prior to ror while prescribing these drugs, did Respondent perform and/or document tie performance of a minimally adequate physical examiation appropriate for the condition complained of by the patient 49, According to the expert, Respondent's medital records dt contain medical justification for the frequency and simultaneous prescription of J:\PSU\Mackeal\ Tobey Qeten AC Boyes, Alfred miuttiple cases-pain management.doc 49 Jun 10 2010 12:43 Jun 10 2010 12:41 PL? stich large quantities of oxycodone together with Percocet, OxyContin and Xanax to patient JF. | 50. According to the expert, the medications preseribed to patient JF were excessive and inappropriate. | | 51, A reasonably prudent osteopathic physician would not have simultaneously prescribed such large quantities of oxycodone together with Percocet, OxyContin and Xanax and would have performed @ minimally adequate physical examination appropriate for the condition complained of by the patient. | Facts Specific to Patient JL | 52. ) From on or about December 36, 2008, throught of or about August 31, 2009, patient JL presented to Respondent with pain "through het back, knee &-carpal bunriel.” | 53. Respondent's. medical records show that he: prescribed multiple prescriptions for large amounts of oxycodone along with Perencet and xanax for patient JL on thé dates and in the dosages. and quantities desctibed in the following tabie: | wilt 12730/08 30mg 240 tablets Jun 10 2010 12:43 Jun 10 2010 12:41 P.18 mg 150 tablets 54. The above chart represents a total of 2,850 tablets of controlled Substances prescribed to patient JL over the course of approximately nine (9) months, | 56 Neither prior to nor while prescribing these drugs, did’ Respondent Perforn and/or document the performance of @ minimally adequate physical examination appropriate for the condition complained of by the patient. | 56. According to the expert, Respondent's medical records donot contain médical justification for the frequency and simuitaneous prescription of I:NPSU\Medical Tobey Ostes\ACa Boyce, Alfred muftipie caes-nain management dc ar’) Jun 10 2010 12:43 Jun 10 2010 12:41 PTS 7 such large quantities of exycodone together with Percocet, and Xariax to patient 1k , 57. According. to the expert, the medications prescribed to patient IL were excessive and inappropriate. | : | 58. Abcording to Respondent's records, Patient JL submitted to a drug test on January 30, 2009 that was negative for both dpiates and benzodiazepines. | | 59, According to the expert, the negative drug test is an “overt indication of drug diversion by JL.” 6D. A reasonably prudent osteopathic physician would have stopped "(prescribing controlled substances to patient JL in light of the negative drug best. 61. A reasonably prudent osteopathic physician would not have simultaneously prescribed such large amounts of oxycodone together with Percocet and Xanax and would have performed a minimally adequate physical examination appropriate for the condition complained of by the patient. Count One 62. Petitioner realleges and Incorporates paragraphs one (1) through sixty-one (61) as if fully set forth herein, | 63. Section 459.015(1)(x), Florida Statutes (2008-2009), provides that committing medical malpractice constitutes grounds: for disciplinary action by the Board of Osteopathic Medicine. Medical Malpractice Is definéd in Section 456.5, Florida. Statutes (2008-2009), as the failure to practice medicine in aocordance EAPSU\Medical\ Tobey \Osten\aCalBoyce, Alfred muftinte casse-pain management dée | 13 Jun 10 2010 12:44 Jun 10 2010 12:42 P. 20 with the level of care, skill, and treatment recognized in general law related to health care iIcensure. For purposes of Section 459. 015(1)(x), Florida Statutes (2008-2009), the Board shalt give great weight to the provisions of Section 766,102, Florida Statutes (2008-2009), which provides that the prevating professional standard of care for @ given health care provider shall be that level of care, skill, and treatment which, In light of all relevant surrounding dreumstances, is’ recognized as acceptable and appropriate by. reasonably prudent similar heath care providers, | 64. Respondent failed to practice medicine with that ievel/of cark, skill and treatment, which Is recognized by a reasonably prudent similar physidan as being acceptable under similar conditions and drcumstances, in the treatment of patients DT, JC, RD, WM, JF, and JL in one or more of the following ways: by failing to conduct: appropriate. examinations; by prescribing excessive and/or inappropriate amounts. of opioids and benzodiazepines; by continuing to prescribe: narcotics and/or benzodiazepines in light of a negative drug tes; or by failing to show in the medical record the justification for praseribing oplods or benzodiazepines in:the dosages prescribed. . 65. Based on the foregoing, Respondent has violated Section 459.015(1)(x), Florida Statutes (2008-2009), by committing medical malpractice in treating Patients DT, 1C, RD, WM, JF and eo | | J:\PSUIMedical Tobey Osteo ACsiGoyee, Altied mullisie cases:pain managementoc aa Jun 10 2010 12:44 Jun 10 2010 12:42 P. 21 | 66. Petitioner realleges and incorporates paragraphs one: 1) through sixty-one (61).a5 if fully set forth herein. 67. Section 459.015(1)(t), Florida Statutes (2008-2009), subjects a licensee to discipline, including suspensin, for preseribing, dispensing, adininisteting, mixing, or otherwise preparing a legend drug, Including any controlled substance, other than in the course of the osteopathic physician's professional practios. For purposes of this paragraph, it shall be legally presumed that: prescribing, dispensing, administering, mbing, or otherwise preparing legend drugs, including all controlled substances, tnappropriatey or in excessivé or Inappropriate quantities is not in the best Interest of the patient and is not in the course of the physiciati’s professional practice, without regard to his or-her intent. | 68. Respondent prescribed, cisperssed, and/or administered controlled substances other than in the course of his professional practice by’ prescribing, dispensing, and/or administering controlled substances inappropriately, without regard to the patient's best interests or In excessive or inappropriate cuantties to patients DT, JC, RD, WM JL, and JF on or about the dates. and mn the quantities and combinations more particularly described above. 69. Based on the foregoing, Respondent has violated Scie 459.015(1xt), Florida Statutes, (2008-2009), by inappropriately prescribing J:\PSU\Memieal\ Tobey Osteo\ACe\Boyee, ANTEC multi casee-pait manadententdod : 4a Jun 10 2010 12:44 Jun 10 2010 12:42 P. 22 excessive and inappropriate quantities of controlled substances to patients DT, IC, RD, WM, JF and AL. Count Three | 70. Petitioner realleges and incorporates paragraphs one (1) through sixty-one (61).as if fully set forth herein. 71, Section 459.015(1)(pp),, Florida Statutes (2008-2009), provides that Violating any provision of chapters 456 or 459, Florida Statutes, ér any rules adopted pursuant thereto, is grounds for escpline by the Board of Osteopathic Medicine. | | 72. Rule '64B15-14.005(3), Florida Administrative Code, provides as follows: | The Board has. adopted the following quidelines when evaluating — the use of controlled substances for pain control: (@). Evaluation of the Patient. A complete medical history: and physical examination must be conducted and documented ip the medical record. The medical retord should document the ngture and intensity of the pain, current. and past treatments for pain, underlying: or coexisting diseases or conditions, the ‘effect of the pain on physical arid psychological function, anti history of substance abuse. The medical record also should document the presence of Ohe dr more recognized medical indications for thé use Of-a controlled substarica. (b): Treatment Plan. The written treatment plan should state Objectives. thet will be used to determine treatment guecess, such &8 pain relief and improved physical and psychosocial function, and Should indleate if any further diagnostic evaluatiofis or dther treatments are planned, After treatment begins, the osteopathic physician ‘should adjust drug therapy to the individual. medical needs of each patient, Other treatment modalities, incutfing osteopathic manipulative treatment and applications, of a rehabilitation program may be necessary depending on the etiology ‘Of the pain and the extent to which the pain is associated with physical and psychosocial impairment, TAPSUAMedicall Tobey Osten Aceoyce, Aiftad multiple Caseispain management doe | 16 Jun 10 2010 12:45 Jun 10 2010 12:43 PL 23 (c) informed Consent and Agreement for Treatment. The osteopathic physician should discuss the risks and benefits of. the usé of controled substances with the patient, persons designated by the patient, or with the patient's surrogate or guardian if the patient is ireompetent. The patient should receive prescriptions from one osteopathic physician and.one pharmacy where possible. If the aap is determined to be at high risk for medication Abuse | or havea history of substance abuse, the osteopathic physician tay employ the use of a written agreement between physician and patient outlining patient responsibilities, includirig, but not limited to: : 1. Urine/serum medication levels screening when requested; ! 2. Number and frequency of all prescription refills; and 3, Reasons: for which drug therapy may be discontinued | (Le., | violation of agreement), : (d} Periodic: . At reasonable intervals based on the individual Circumstances of the patient, the osteopathic physician should review the course of treatment and any new information about the @tiology of the pain. Continuation or modification of herapy Id depend on the osteopathic physician's evaluation of progress toward stated treatment objectives such as improvemest in patient's pairt intensity and improved physical and/ot psychosocial function, i.@., ability to work, need of health care resources, activities of daily living, and quality of social life, If treatment goals | are not being achieved, despite medication adjustments, the ‘Osteopathic ‘physician. should reevaluate. the appropriateness of | continued treatment. The osteopathic physician etd manitor peer compliance In medication usage and relat teatinent ans. | (e) Constitation, ‘The osteopathic physician should he willirig to refer the patient as necessary for additional evaluation | and treatment in order to achleye treatment objectives. Special attention shauld be given to those pain patients who are at risk for Misusing their medications and. those whose living atrangements pose a risk for medication misuse or diversion. The management of pain in patients with a history of substance abuse or with a comorbid psychiatric disorder may require extra care; monitoring, documentation, and consultation with or referral to an expert inthe — Management of such patients. 73. Ono about the dates set forth above, Respondent vidiated Rule 64615-14.005(3), Florida Administrative Code, by prescribing one oF more of the J: PSU Medical Fobey Osten ACstBoyce, Alfred muliipte cases:pain management.doc , (17 i Jun 10 2010 12:45 Jun 10 2010 12:43 PL 2d following controlled substances: oxycodone, Percocet and, Xanax to patients DT, JC, RO, WM, JF and JL in the quantities and combinations descilbed above, without conducting or documenting complete physical examinations of DT, JC, RD, WM, JF or JL. 74, Respondent also violated Rule 64B15-14,005(3), “FAC, by prescribing these substances without decumenting one or niore of the Following: written treatment plans that state objectives that will be used to determine treatment succes or indicate if any further clagnostic evaluations or other treatments are planned; 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 psychosocial function or history of substance abuser and, the presence of one or more recognized medical indications foe the use of controlled substance. | 75, Based on the foregoing, Respondent has violated Section 459.015(1Xpp), Florida Statutes, (2008-2009), by violating a rule adspted pursuant to Chapter 459 because he failed to document and adiiere t9 the Florida Board of Osteopathic. Medicine standards for the use of contoled substances for pin contol contained within Rule 64615-14.005(3), Frid Administrative Code, (2008-2009) in his treatment of patients DT, IC, RD, wm, JF and JL. a:\PSU\Medical Tobey \Gaten\ACs\Buytd, Alfred midtiple tasee-nain mentagement.coc ' 18 Jun 10 2010 12:45 Jun 10 2010 12:43 P. 25 Count Four - 76. Petitioner realleges and incorporates paragraphs one (1) through sixty-one as If fully set forth herein. . : | 77. Section 459.015(1X0), Florida Statutes (2008-2009), subjects a licansee to discipline for falling to keep legible, as defined by department rule in consultation with the board, medical records that identify the licensed osteopathic physician or the osteopathic physician extender and ‘supervising osteopathic physician by name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic of treatment procedure and that justify the course of treatment of the patient, including, but not ‘irhited to, ‘patient histories; examination results; test reaults; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. 7 78. On or about the dates set forth above, Respondent violated Section 459.015(1)(0), Florida Statutes (2008-2009), by failing to keep medical records that justified the course of treatment of patients DT, JC, RD, WM, JF and Jk, 79. Based on the foregoing, Respondent has violated Section 459.015(1)(0), Florida Statutes, (2008- 2009), by falling to keep ‘medical records that justified the course of treatment of patients DT, JC, RD, WWM, JF and 2. WHEREFORE, Petitioner respectfully requests tidt the | Board of Osteapathic Medicine enter an order Imposing one or mare of the follawing penalties: permanent revocation or suspension of Respondent's license, JAPSU\edtical\ Tobey \Oetio YAce\Boyce, Alfred Multiple cases-palh shanagerientidos | 49 Jun 10 2010 12:45 Jun 10 2010 12:44 restriction of practice, imposition of an administrative fine, Issuance : | P. 26 of a reprimand, placement of the Resporident.on probation, cortective adtion, refund of fees billed or collected, remedial education and/or any ‘other relief that the Board deems appropriate, SIGNED this_(3"__ day of Mo, 2010, Ana M. Viamonte Rés, M.D., MPH, State Surgeon General FILED DOH Proseaution Services Unit an DEPARTMENT OF HEALTH 052 dont Cypress Wey Bin C65 | RK ethegped dllahasses, FL.32399-3265 : bare ST ig Florida Bar No. 0542131 10 (850) 245-4640, @xt,.8176 (850) 245-4684 FAX pop: Slitl!O Andple + Rare J)\PSU\Medicall Yobey\Osteo\Acs\poyee, Alffed multiple cases-pain manayement.doc Jun 10 2010 12:45 Jun 10 2010 12:44 P.2? NOTICE OF RIGHTS Respondent has the right to request a oer fe be cond in accordance with Section 120.569 and 120.57, Flo tes, to be fepresented by counsel or other qualified rep: te p evidence and argument, to call and tihed repreed have subpoena and subpoena duces tecum Issued on his or her if-a hearing is requested. | NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has ra nro related to the Investigation and prosecution of Section 456,072(4), Florida Statutes, the Soar’ 4 "hall aacess costs related to the investigation arid prosecution of a plinary mbtter, which may include attomey hours and costs, on the Respondent in addition to-ary other discipline imposed. J:APSu\Mettcal\Tobey\steo\ACe\Boyce, Alired muitle céses-pain hanagement.doc oan

Docket for Case No: 10-003167PL