STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, CASE NO.: 2009-11459 MICHAEL R. SHOOK, M.D., RESPONDENT, _. ——/ 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, Michael R. Shook, M.D., and in support this alleges: 1. Petitioner is the state department charged with regulating the practice of nedicine 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 1:\PSU\Medical\Robert Mitne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final fram GK.doc ] | 90d . éptlt OlO@ OL *ON 2h:OT ode OT A0N ae a | number ME 50883 and Respondent was also Board Certified in Internal Medicine. i 3. Respondent’ address of record is 2764 West Oakland Park Bivd,, Oakland Park Florida 33311. 4, At all times material hereto, between May, 2008 and September, 2009, Respondent while practicing medicine in the State of Florida treated three (3) patients for chronic pain management. These patients are referred to by their initials as ST, JS, and TH. | FACTS SPECIFIC TO PATIENT ST 5. On or about July 24, 2008, ST presented to Respondent with complaints of knee pain. Respondent there and then prescribed 240 tablets of oxycodone 30 milligrams (“mg”) for ST based solely on the verbal patient history that ST related to Respondent concerning his current pain management regimen. Respondent did not have the benefit of any of ST'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 ST’s system. 1:\P8U\Madical\Rebert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.dee 2 90 ‘d éPtlt OlO@ OL *ON 2F:0T Ode OT AON 7: . | ~ ~ 6. Oxycodone is commonly prescribed to treat pain. According to Section 893.0312), Florida Statutes, oxycodone is a Schedule IT 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, “7, , On or about August 21, 2008, Respondent prescribed 240 tablets of methadone 10 mg for ST. ; 8. Methadone is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, methadone 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 methadone may lead to severe psychological or physical dependence, 9, Respondent continued to provide multiple prescriptions for large amounts of oxycodone and methadone to ST as outlined in the following table: | 2:\PSU\Medical\Robert MiIne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 3 ! é0‘d . éPtlt OlO@ OL *ON 2F:0T Ode OT AON [ Date of Medication Type of Quantity Prescription Prescribed Medication Lo | 7/24/08 Oxycadone 30 mg | Schedule IT 240 tablets analgesic 8/21/08 Oxycodone 30 mg | Schedule IT 240 tablets analgesic ' 8/21/08 | Methadone 10 mg | Schedule Il 240 tablets analgesic ms of 10/21/08 Oxycodone 30 mg | Schedule IT 240 | tablets analgesic 10/21/08 | Methadone 10mg |” Schedulell | 180 tablets analgesic 11/13/08 | Methadone 10mg | Schedule Tl 180 tablets analgesic 12/15/08 | Oxycodone 30mg | Schedule II 240 tablets analgesic 1/ 13/09 Methadone 10 mg | Schedule II 240 | tablets analgesic J 1/13/08 Oxycodone 30 mg | Schedule IT 240 ! tablets analgesic 2/ 10/09 Methadone 10mg | Schedule Ir 240 | tablets analgesic 3/9/09 | Oxycodone 30mg | Schedulell | 340 : tablets analgesic 4/9/09 | Oxycodone 30mg | Schedule il 240 | tablets analgesic J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 80 ‘d aR: LL OlOG Ob 4°N BP:OT OT0e OT A0N a | Date of Medication Typeof | Quantity Prescription Prescribed Medication | 4/9/09 | Methadone 10 mg | Schedule H 240 | tablets analgesic 5/7/09 | Methadone 10mg | Schedule Ti 240 tablets analgesic 6/8/09 | Oxycodone 30 mg | Schedule i 240 | tablets analgesic 7/6/09 ~ | Oxycodone 30 mg | Schedule IL 240 tablets analgesic 7/6/09 Methadone 10 mg | Schedule II 240 tablets analgesic | 8/4/09 | Methadone 10mg | Schedulelf | 240 | tablets analgesic 9/4708 Oxycodone 30 mg | Schedule Ir 240 tablets analgesic ir THe Methadone 10mg | Schedule II 240 tablets analgesic an Oxycodone 30mg ) Schedule Ii 240 ‘tablets analgesic 10. Between approximately July 24, 2008, and: September 21, 2009, while Respondent prescribed these controlled substances in very high dosages to ST, Respondent's medical records. fail to show in his J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11 459\AC Final fram GK.doc B0'd RE LL OlOe Ob 4°N Br:0T Ode OT AON on 5 evaluation of the patient and in his treatment plan one or more of the following: ! 2) 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; ¢) 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; J:\PSU\Medical\ Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 6 | Ol‘d BRFLL OlO@ OL *ON BP:OT OT0e OT A0N | 5 Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain : associated with physical and/or psychosocial impairment; 9) Verification from ST's previous physicians whether his treatment was terminated for substance abuse/diversion; h) Diagnostic testing for illicit drug use diversion of opioids. , FACTS SPECIFIC TO PATIENT JS ii. On or about August 11, 2008, 3S presented to Respondent with complaints of neck and back pain. Respondent there and then prescribed 135 tablets of oxycodone 30 milligrams for JS; based solely on the verbal patient history that JS related to Respondent concerning his current pain management regimen. Respondent did not have the benefit of any of JS’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. 12, on September 9, 2008, Respondent prescribed to JS 30 tablets of Xanax 2 mg. 13. Xanax (alprazolam) is an anti-anxiety agent benzodiazepine, used primarily for short-term relief of mild to moderate anxiety and | J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Finai from GK.doc : 7 Ld BRFLL OlO@ OL *ON BP:OT OT0e OT A0N nervous tension and is a schedule IV legend drug controlled pursuant to Chapter 893.03, Florida Statutes, and has a low potential for abuse which may lead to limited physical or psychological dependence and has a currently accepted medical use in treatment in the United States. 14, Between approximately August 11, 2008, and June 30, 2009, Respondent issued the following prescriptions for oxycodone, Methadone and Xanax to patient JS on the dates and in the amounts specified below: Date of Medication Type of Quantity Prescription Prescribed Medication 8/1 1/0 8 Oxycodone 30 mg | Schedule II 135 tablets analgesic a 9/9/08, Xanax 2 mg tablets | Schedule IV 30 ; anti-anxiety 9/9/08 | Oxycodone 30mg | Schedule Ii 270 tablets analgesic 16/7/0 8 Xanax 2 mg tablets | Schedule IV 90 | anti-anxiety 10/7/08 Methadone 10 mg | Schedule II 270 tablets analgesic 11/4708 | Oxycodone 30mg | Schedule Tl 270 tablets analgesic 11/4/08 Xanax 2 mg tablets Schedule IV 90 anti-anxiety 12/2/08 Methadone 10 mg | Schedule II 240 . tablets analgesic J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc él‘d BRFLL OLO@ OL “ON 6F:0T Ode OT AON | we rH: . ‘ ao | Date of Medication Type of Quantity Prescription Prescribed Medication 12/2/08 | Oxycodone 30mg | Schedule II 240 | | tablets analgesic 12/30/08 | Xanax 2 mg tablets | Schedule IV 90 anti-anxiety . 12/30/08 Methadone 10 mg | Schedule II 240 | tablets analgesic 1/27/09 Oxycodone 30 mg | Schedule IT 210 , | tablets analgesic _ I 1/27/09 | Xanax 2 mg tablets |" Schedule IV 90 anti-anxiety 2/24/09 | Methadone 10 mg | Schedule II 240 | tablets analgesic | ee 2/24/09 Oxycodone 30mg | Schedule II 240 | tablets anaigesic 4/6/09 Xanax 2 mg tablets | Schedule IV 90 | anti-anxie 4/6/09 | Methadone 10 mg” Schedule II 240 tablets analgesic 5/5/09 Oxycodone 30 mg | Schedule II 240 | tablets analgesic 5/5/09 Xanax 2 mg tablets | Schedule IV 90 anti-anxiety 6/2/09 Methadone 10 mg | Schedule II 240 tablets analgesic 6/2/09 | Oxycodone 30mg | Schedule II 240 tablets analgesic i J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-1:459\AC Final from GK.doc Bld BReLL OLO@ OL “ON 6F:0T Ode OT AON i Date of Medication Type of Quantity Prescri ption Prescribed Medication 6/2/09 Xanax 2 mg tablets) Schedule IV 90 anti-anxiety 6/30/09 | Methadone 10 mg | Schedule IT 240 | tablets analgesic . 6/30/09 Oxycodone 30 mg | Schedule II 240 | tablets analgesic i 6/30/09 | Xanax 2 mg tablets " Schedule IV 90 ! anti-anxiety 15. Between approximately August 11, 2008, and June 30, 2009, while Respondent prescribed these controlled substances in very high dosages to 1S, Respondent's medical records fail to show in his 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; 9;\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doe 10 i | tl od . BRtLL OlO@ OL *ON BROT OT0e OT AON ) 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 psychosocial impairment; g) Verification from ST's previous physicians whether his treatment was terminated for substance abuse/diversion; h) Diagnostic testing for illicit drug use/diversion of opioids. | FACTS SPECIFIC TO PATIENT TH 16. On or about July 8, 2008, TH presented to Respondent with complaints of neck and back pain, Respondent there and then prescribed 180 tablets of oxycodone 30 milligram for TH; based solely on the verbal 7:\PSU\Medical\Robert Milne \Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final frorn GK.doe il i Sled BR FLL OlO@ OL AON 6F:0T Ode OT AON a an a patient history that TH related to Respondent concerning his current pain management regimen. Respondent did not have the benefit of any of TH’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present and did not exclude the presence of other drugs. 17. On or about September 4, 2008 Respondent prescribed to TH 90 tablets of Soma 350 mg. 18. Soma (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, ‘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 i 1 in treatment in the United States, and abuse of carisoprodol may lead to limited physical or psychological dependence relative to the substances in Schedule Mm. 19, Between approximately July 8, 2008, and August 27, 2009, Respondent prescribed oxycodone, Methadone, Xanax and Soma to TH on the dates and in the amounts specified below: | J:\PSU\Medical\Robert Milne\Gases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final fram GK.doc 12 | gL ‘d . BRtLL OlO@ OL *ON BROT OT0e OT AON Heo rt an or Date of Medication Type of Quantity Prescription Prescribed Medication | 7/8/08 Oxycodone 30 mq | Schedule II 180 tablets analgesic rr ee a 8/5/08 Methadone 10mg | Schedule II 180 | tablets analgesic 8/5/08 | Xanax 2 mg tablets | Schedule Iv 30 anti-anxiety 8/5/08 Oxycodone 30 mg | Schedule II 270 tablets analgesic 9/4/08 Methadone 10 mg | Schedule II 240 tablets analgesic { 9/4/08 Xanax 2 mg tablets | Schedule IV 90 | anti-anxiety 9/4/08 ' Soma 350 mg Schedule IV 90 | tablets | muscle {_ relaxant 10/6/08 Oxycodone 30 mg | Schedule II 270 | tablets analgesic 10/6/08 | Methadone 10mg | Schedule It 270 | tablets analgesic 10/6/08 | Xanax 2 mg tablets Schedule IV 120 ; anti-anxiety 11/4/08 Soma 350 mg Schedule IV 120 | tablets muscle | relaxant 11/4/08 Oxycodone 30 mg |. Schedule II 270 tablets analgesic 11/4/08 Methadone 10 mg | Schedule II * 300 tablets analgesic ees ee J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from Gk.doc él‘d OS?LL OlO@ OL *ON OS:0T ode OT AON ye A A a Date of Medication Type of Quantity Prescription Prescribed Medication 12/2/08 | Xanax 2 mg tablets | Schedule IV 120 , anti-anxiety 12/2/08 | Soma350mg | ScheduleIV | 120 tablets muscle | relaxant 12/29/08 | Oxycodone 30 mg | Schedule II 240 tablets analgesic - — ee 12/29/08 Methadone 10 mg | Schedule II 240 | analgesic . + _— 12/29/08 Xanax 2 mg tablets | Schedule IV 120 | anti-anxiety 1/27/09 Sema 350 mg Schedule IV 120 tablets muscle relaxant — | 1/27/09 Oxycodone 30 mg | Schedule IT 240 tablets analgesic 1/27/09 | Oxycodone 30 mg | Schedule Ii 240 | ' tablets analgesic — 1/27/09 Methadone 10 mg | Schedule II 240 | : tablets analgesic 2/24/09 Xanax 2 mg tablets |; Schedule IV 150 | anti-anxiety 2/24/09 Soma 350mg | Schedule IV 120 tablets muscle - relaxant J:\PSU\Madical\Robert Mitne\Cases\SHOOK 2009-07675 \SHOOK 2009-11459\AC Final From GK.doc OS?LL OlO@ OL *ON OS:0T ode OT AON Bld de om. — ; ; . Date of Medication Type of Quantity Prescription Prescribed Medication 4/6/09 Oxycodone 30 mg | Schedule II 200 | tablets analgesic | 4/6/09 Methadone 10mg | Schedule IT 240 tablets analgesic 4/6/09 Xanax 2 mg tablets | Schedule IV 150 | anti-anxiety 5/4/09 Soma 350 mg Schedule IV 120 " tablets muscle relaxant —. 5/4/09 Oxycodone 30 mg | Schedule II 240 | ' tablets analgesic "6/2/09 | Oxycodone 30mg | Schedule It 240 tablets analgesic 6/2/09 Xanax 2 mg tablets | Schedule IV 150 anti-anxiety , ees + 6/2/00 Soma 350mg | Schedule IV 120 tablets muscle relaxant | 6/29/09 | Oxycodone 30mg | Schedule II 210 tablets analgesic 6/29/09 Methadone 10 mg | Schedule IT 240 ~ tablets analgesic oe —}— 7/28/09 Xanax 2 mg tablets | Schedule IV 150 | anti-anxiety 2:\PSU\Medicai\Robert Miine\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc Blid oS “LL OlOe OL 4°N OS:0T ode OT AON i _ ~~ ~ Date of Medication Type of | Quantity Prescription Prescribed Medication . 7/28/09 Soma 350 mg Schedule IV 120 '. tablets muscle relaxant 7/28/09 | Oxycodone 30mg | ScheduleIT | 210 - tablets analgesic | 8/27/09 Methadone 10 mg | Schedule II 240 | tablets analgesic 8/27/09 Xanax 2 mg tablets | Schedule IV 150 | anti-anxiety —+ + 8/27/09 | Soma 350 mg Schedule IV 120 tablets muscle | relaxant | 8/27/09 Oxycodone 30mg ; Schedule II 240 _, tablets analgesic = 20, Hetween approximately July 8, 2008, and August 27, 2009, while Respondent prescribed these controlled substances in very high dosages to TH, Respondent's medical records fail to show in his 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: J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK, doc 16 i Qed . OS?LL OlO@ OL *ON OS:0T ode OT AON an | na A 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 1 planned ; @) 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 ST's previous physicians whether his treatment was terminated for substance abuse/diversion; h) Diagnostic testing for illicit drug use/diversion of opioids. 3:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 17- lévd LGFLL Olde OL AON TS:0T OT02 OT ACN al. | COUNT ONE Petitioner reincorporates and realleges paragraphs 1 through 20 as if fully set forth herein. 22. Section 458;331(1)(nn), Florida Statutes (2007, 2008 and 2009), provides that violating any provision of chapters 456 or 458, Florida Statutes (2007, 2008 and 2009), or any rules adopted pursuant thereto, is grounds for discipline by the Board of Medicine. 23. follows: Rule 64B8-9.013(3), Florida Administrative Code, provides as 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 individual medical’:needs of each patient. Other treatment J\PSU\Medical\Robert Milhe\Cases\SHOOK 2009-07675\SHOOK 2009-21459\AC Final from Gk.doc aed LGFLL Olde OL AON TS:0T OT02 OT ACN ‘an O modalities or 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. 24, on or near the dates listed in paragraphs 9, 14 and 19, above, Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, by prescribing Oxycodone, Methadone and Soma in the quantities described therein, without conducting or documenting complete medical histories or physical examinations on Patients ST, JS and TH and without documenting one or more of the following: the nature and intensity of the patient’s pain; current and past treatrnents for pain; underlying or coexisting diseases or conditions; the effect of the pain on physical and/or 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 furthis diagnostic evaluations or other treatments are planned. 25. 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. i . \ J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 19. 86 “d LGFLL Olde OL AON TS:0T OT02 OT ACN | . COUNT TWO 26. Petitioner reincorporates and realleges paragraphs 1 through 20 as if fully set forth herein. 27. Chapter 64B8-9,013(3), Florida Administrative Code, as more particularly set forth in paragraph 23 herein of is adopted and realleged as if fully set forth. 28. Section 458.331(1)(t), Florida Statutes (2007, 2008 and 2009), provides that the gross. or repeated malpractice or the failure 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 is grounds for discipline by the Board of Medicine. 29. Respondent failed to practice medicine with that level of care, skill and treatment which is recognized by a reasonably prudent similar physician ag being acceptable under similar conditions and circumstances in treating Patient ST, in one or more of the following ways: | a) By failing to show in the medical record justification for | prescribing oxycodone 30 mg tablets 8 per day: J:\P5U\Medical\Robert Milne\Cases\SHOOK. 2009-07675\SHOOK 2009-11459\AC Final from GK.dac 20° | teed SLL Olde OL AON TS:0T OT02 OT ACN nt : ae b) By failing to show in the medical records justification for prescribing Methadone in the high doses prescribed; c) By failing to order diagnostic testing in view of the high dosages of opioids prescribed; d) 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; @) By failing to rule out other treatment modalities for the management of pain; f) By prescribing excessive and or inappropriate quantities of controlled substances, 30. 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 JS in one or more of the following ways: a) By violating the standards for the use of controlied substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; | . J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doe 21 ged . eS*tb OlO@ OL “ON é2o:agT Ode OT A0N 2008, b) By failing to show in the medical record on September 9, the justification for doubling the dose of Oxycodone 30 mg from the previous month; 2008, tablet: | 2008, ¢) By failing to show in the medical record on October 7, the justification for tripling the prescribed dose of Xanax 2 mg S to 3-times-a-day from the previous month; d) By failing to show in the medical record on September 9, the justification for prescribing an initial dosage of Methadone at 8 tablets per day; ®) ‘By failing to order diagnostic testing in view of the high dosages of opioids prescribed; p By falling to rule out other treatment modalities for the management of pain; 9) By prescribing inappropriate and or excessive quantities of controlled substances. 3i, 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 TH in one or more of the following ways: T:\PSU\Medical\Robe ft Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 22 | 96d éS*Lt OlO@ OL *ON eo:aoT ode OT AON 2) ‘By prescribing inappropriate. and or excessive quantities of Xanax 2-mg four times a day on multiple occasions without referral to a psychiatrist; b) By failing to adequately document in the medical record a medical justification for Xanax; ' ¢) By failing to show in the medical record the justification for prescribing high doses of Methadone and oxycodone in the dosages prescribed; , d) By failing to show in the medical record the justification for prescribing Soma in conjunction with Methadone and oxycodone; @) 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; 6) By failing to show in the medical record the justification for prescribing high doses of Xanax: g) By prescribing inappropriate and or excessive amounts of | benzodiazepines: h, By prescribing inappropriate and or excessive amounts of opioids; J:\PSU\Medical\Robert [tine\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final fram GK.doc 23 fécd 6S-LL Olde OL AON eo:aoT ode OT AON D By failing to order diagnostic testing in view of the high _ dosages of opioids prescribed; j) By failing to rule out other tréatment modalities for the management of pain. 32. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2007, 2008 and 2009). COUNT THREE 33, Petitioner reincorporates and realleges paragraphs 1 through 20 as if fully set forth herein. , 34. Chapter 64B8-9.013(3), Florida Administrative Code, as more . particularly Set forth in paragraph 23 herein of is adopted and réalleged, 35, 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 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; | 3:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 24 86 “d éS*Lt OlO@ OL *ON eo:aoT ode OT AON records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. 36. On or about the dates set forth in paragraphs 9, 14 and 19 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, Methadone, oxycodone and Soma to patients ST, 3S and TH in |the quantities and combinations described: therein, without { conducting or documenting complete medical histories or physical examinations on patients ST, JS and TH 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. J:\PSU\Medical\Robert Milne\Cages\SHOOK '2009-07675\SHOOK 2009-11459\AC Final from GK.doc 25 i fé“d . BS?LL OlO@ OL *°N So:0T ode OT A0N a an ~ 37. 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 38. Petitioner raincorporates and realleges paragraphs 1 through 20 as if fully set forth herein. 39, 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: all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest. of the patient and is not in the course of the physician's professional practice, without regard to his intent, 40. Respondent prescribed inappropriately or in excessive or inappropriate quantities, controlled substances to patients ST, JS and TH | J\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2008-11459\AC Final from Gk.doe 26 | Oe ‘d BS*LL OlO@ OL SON So:0T ode OT A0N eG i j on the dates and in the quantities more particularly described in | paragraphs 9, 14 and 19. 41, Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (2007, 2008 and 2009). ! at 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 _<("* day of