Jan 18 2011 10:24 Jan 18 2011) 11:23 — P.05 STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, | CASE NO. 2009-06687 v. MICHAEL I. ROSE, M.D., RESPONDENT. / IN VE Petitioner, Department of Health, by and through undersigned counsel, files this Administrative Complaint before the Board of Medicine against Respondent, Michael I. Rose, M.D., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the ‘practice of medicine pursuant to section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 458, Florida Statutes. 2. At all times -material to this Complaint, Respondent was a licensed physician within the state of Florida, having, been issued license number ME 10792. J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09 final.doc : 1 bos a | i | | | Jan 18 2011 10:24 dan 18 2011) 11:23 P.06 3. Respondent's address of records is 2001 Secoffee Street, Coconut Grove, Florida 33133. 4. Respondent is a dispensing practitioner in the State of Florida, pursuant to Section 465.0276, Florida Statutes. | 5. Respondent is board certified in psychiatry and in forensic psychiatry by the American Board of Psychiatry and Neurology. | 6. Respondent is the director of the 163” $treet Pain Clinic, Inc,, located at 1131 NE 163% Street, North Miami, Florida 33162. 7, Respondent prescribed inappropriate or excessive doses of controlled substances for two of his patients, B.D. and R.F. | 8. Respondent prescribed the following controlled substances in high doses to B.D.: Xanax, Oxycontin, Roxicddone and Percocet. Respondent prescribed the following controlled substances in high doses to R.F.: Oxycontin, Roxicodone, Endocet and Percocet. | a. Xanax is the brand name for alprazolam, which is prescribed to treat anxiety and panic disorders as well as depression caused by anxiety, According to Section 893.03(4)(a), Florida Statutes, alprazolam is a Schedule IV controlled substance that has a low potential for abuse relative J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc 2 Jan 18 2011 10:25 dan 18 2011 11:23 P.O? to the substances in Schedule III; 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 Schedule It. b. Oxycontin and Roxicodone are the brand names of a drug that contains oxycodone hydrochloride. Oxycodone is prescribed to treat pain. . | | C. Percocet and Endocet are the brand names of a drug that contains oxycodone hydrochloride and acetaminophen. d. According to Section 893.03(2)(a), Florida | Statutes, oxycodone, or any salt, compound, derivative, or preparation of oxycodone, is a Schedule II controlled substance that has a high potential for abuse; 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. | e. Oxycodone is also referred to as ani opioid. Opioids are Similar to opium, but are synthetically manufactured. Opioid drugs are addictive and subject to abuse. J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc : :3 a Jan 18 2011 10:25 Jan 18 2011) 11:24 P.08 9. The Board of Medicine has addressed’ ithe use of controlled substances, including opioids, for pain relief when it set out the Standards for the Use of Controlled Substances for the Treatment of Pain in Chapter 64B8-9.013, Florida Administrative Code. : 10. Chapter 64B8-9.013, F.A.C., reads in part: (3) Standards. The Board has adopted the following standards for the use of controlled substances for pain cantrol: (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 ipast 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 tréatment 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 modalities or a rehabilitation program may be necessary depending on the etiology of the pain and theiextent to which the pain .is associated with physical and psychosocial impairment. (c) Informed Consent and Agreement for Treatment. The physician should discuss the risks and benefi its of the use of controlled substances with the patient, persons designated by the patient, or with the patient’s surrogate or guardian if: the patient is incompetent. The patient should receive prescriptions from one physician and one pharmacy where’ possible. If’ the J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc | 4 Jan 18 2011 10:25 Jan 18 2011 11:24 P. patient is determined to be at high risk for medication abuse or have a history of substance abuse, the physician should employ the use of a written agreement between physician and patient outlining patient responsibilities, including, 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 (i.e., violation of agreement). ; (d) Periodic Review. At reasonable intervals based onthe individual circumstances of the patient, the physician should review the course of treatment and any new information about the etiology of the pain. Continuation or modification of therapy should depend on the physician’s evaluation ‘of the patient’s progress. If treatment goals are not being achieved, despite medication adjustments, the physician should reevaluate the appropriateness of continued treatment. The physician should ‘monitor patient compliance in medication usage and related treatment plans. (e) Consultation. The physician should be willing to refer the patient as necessary for additional evaluation and treatment in order to achieve treatment objectives. Special attention should be given to those pain patients who are at risk for misusing their medications and those whose living arrangements 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 requires extra care, monitoring, and documentation, and may require consultation with: or referral to an expert in the management of such patients. (f) Medical Records. The physician is required ta keep accurate and complete records to include, but not be limited to: 1. The medical history and physical examination, including history of drug abuse or dependence, as appropriate; : 2. Diagnostic, therapeutic, and laboratory results} 3. Evaluations and consultations; 4, Treatment objectives; 5. Tiscussion of risks and benefits; [sic] 6. Treatments; 7. Medications (including date, type, dosage, and quantity '_ J;\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc a Jan 18 2011 10:26 Jan 18 2011) 11:24 P.10 prescribed); 8, Instructions and agreements; and 9. Periodic: reviews. Records must remain current and’ be maintained in an accessible manner and readily available: for review. Records must remain current and be riaintained in an accessible manner and readily available for review. : Facts Related to Patient B.D. 11. Respondent treated patient B.D. on or about the following dates: October 20, 2008, November 17, 2008, and December 16, 2008. 12. B.D. was a 50 year-old man and a roofer at the time of his first visit. 13, B.D. presented to Respondent for pain in the center of his back and down his right side. | 14. Respondent did not complete an adequate evaluation of the patient as outlined in Chapter 6488-9.013(3)(a), F.A.C. a. Respondent did not adequately document BD's medical history. | : . | b. Respondent never attempted to get BD. medica] records from any previous health care provider. : c. Respondent did not adequately document if B.D. had any previous treatment for pain. J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc 6 Jan 18 2011 10:26 Jan 18 201) 11:25 PL. d. Respondent failed to perform a complete physical on B.D. Respondent did not perform a direct examination of the physical spine or muscle system. : 15. According to the form titled “Pain Disability Index”, B.D. scored “0” disability due to his pain, The scale is “0” for “no:disability” to “10” for “Worst Disability.” 16. According to the B.D.’s medical records, Respondent also performed a psychiatric examination of B.D, completed a treatment plan, as well examination of the “neurological examination-cranial neves” and “spinal cord levels.” 17. The. — psychiatric examination result$ appear | generic. Respondent did not diagnose B.D. with any psychdlogical or psychiatric disorder. 18. The treatment plan is generic and not specific to the patient B.D. | 19. Respondent did not evaluate B.D. for substance abuse. 20. Respondent ordered no diagnostic tests for B.D. Respondent did not order baseline liver function tests and follow- up tests. Respondent therefore fell below the standard of care. J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc Jan 18 2011 10:26 Jan 18 2011) 11:25 P.12 21. On or about October 20, 2008, Respondent prescribéd B.D. 60 pills of Xanax (2 mg), 240 pills of Raxicodone (30 mg) and 90 pills of Oxycontin (80 mg). | | 22. On or about November 17, 2008, Respondent prescribed B.D. 60 pills of Xanax (2 mg), 240 pills of Roxicodone (30 mg) and 180 pills of Percocet (10/650). ! 23. On or about December 16, 2008, Respondent prescribed B.D. 60 pills of Xanax (2 mg), 240 pills of Roxicodone (30 mg) and 60 pills of Oxycontin (80 mg). ' 24, Respondent had no evidence of B.D.’s drug tolerance when he prescribed the amount of opiates described above. B.D. was iat risk of death from overdose if he took the opiates and Xanax as prescribed and he did not have insufficient tolerance. Respondent thereby fell below the standard of care. 25. Respondent also fell below the standard of care by prescribing B.D. Xanax without any indication or any diagnosis. | 26. R.F, sought treatment at the 163% Street Pain Clinic from November 3, 2008, through July 14, 2009. 3:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc \ 8 Jan 18 2011 10:26 Jan 18 2011) 11:25 P.13 27, Respondent treated R.F., a 45 year-oldifemale initially, on or about the following dates: November 3, 2008, December 2, 2008, January 30, 2009, April 21, 2009, May 19, 2009, June 16, 2009, and on her fast visit on or about July 14, 2009. oe 28. Other doctors at the 163 Street Pain Management Clinic treated R.F. on December 29, 2008, February 27, 2009, and March 24, 2009, | Do 29. RF. presented with a constant, sharp, burning pain. The medical records indicate that R.F. had experienced pain for 15-16 years. 30, R.F.'s medical records indicate that she had the human immunodeficiency virus (HIV) and hepatitis C, 31. Hepatitis is the inflammation of the liver ‘and characterized. by jaundice, fever, liver enlargement and abdominal pain. Hepatitis Cisa type of hepatitis caused by a virus that tends to persist in the blood serum and is usually transmitted by infected blood (as by injection of an illicit drug, blood transfusion, or exposure to blood or blood products) and that accounts for most cases of non-A, non-B hepatitis, , 32. The form titled “Initial Pain Assessment” indicates that RF. had “blood work” and received antibiotics from her previous physicidns. The J:\PSU\Medical\Grace Kim\Rose, Michael 20093-06687\AC 11.06.09a.doc i, a 1, | thos, 4 Jan 18 2011 10:27 Jan 18 2011) 11:25 P.14 only medical records R.F. brought with her appear to be a phartnacy print out of the drugs that she was prescribed from November 5, 2007; to January 14, 2008: The doctors named in the initial assessment are not: the same physicians named on the pharmacy printout. | 33. Respondent appears to have made only one attempt to :get medical records; it was a fax dated November 3,:2008, and requested R.F.’S MRI. The fax did not name a health care provider, nor was there a confirmation sheet indicating that the fax was successfully received. There are no MRI or MRI reports in the patient’s records. | 34. Other than the pharmacy print out, Respondent did not get any other medical records, from R.F. or her previous physicians before’ he began treating her. | 35. R.F. also had a computerized tomography (C.T.) scan performed on her lower extremities on or about January 6, 2009. The'CT showed no significant findings and therefore the CT did not provide medical justification for the drugs which R.F. prescribed. 36. Respondent did not complete an adequate evaluation of the patient as outlined in Chapter 64B8-9.013(3), F.A.C. Respondent failed to J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc 7 D, 10 1 - 1 hoa pS i Jan 18 2011 10:27 Jan 18 2011) 11:26 PLT meet the standards of Chapter 64B8-9.013(3)(a), F.A.C. in one or more of the following ways: | a. Respondent did not document R.F.’s medical ‘history or - her pain treatment history; b. Respondent did not perform a complete physical examination that established the patient’s symptoms and condition; c. Respondent did not perform a direct examination of ‘the physica spine or of the muscle system; | | d. RFs medical records reflect a generic treatment plan and a generic psychiatric evaluation. . : , 37, Despite the lack of medical history, ‘medical justification, investigations of other possible medical conditions, Respondent prescribed the following medication to R.F.: J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc ; : | 1 oa boo | Jan 18 2011 10:27 Jan 18 2011 11:26 P16 Date Drug and Dosage : : November 3, 2008 | 240 pills of Roxicodone | 60 pills of Oxycontin 120 pills of Endocet January 30, 2009 30 mg) 80m December 2, 2008 | 240 pills of Roxicodone | 60 pills of Oxycontin 30 mq) | (80 mg) (10/650) 180 pills of Endocet 240 pills of Roxicodone | April 21, 2009 :| 240 pills of Roxicodone (30 mg) 60 pills of Oxytontin 80 m 60 pills of Oxyrontin 80m May 19, 2009 June 16, 2009 ‘| 240 pills of Roxicodone 240 pills of Roxicodone (30 mg) 60 pills of Oxycontin (80 m 240 pills of Roxicodone | 60 pills of Oxycontin 80 mq) Oye) .180 pills of Percocet 10/650 90 pills of Percocet 10/650 90 pills of Percocet 10/650) 90 pills of Percocet _ {10/650 60 pills of Oxycontin | (80 mg) 90 pills of Percocet (10/650) July 14, 2009 38. to: Respondent fell below the standard of care because he ordered no diagnostic tests, Respondent prescribed R.F. 3 tng of acetaminophen daily and Respondent should have ordered a baseline liver function test, as well as follow up liver function tests because she had a history of hepatitis 39. Respondent did not evaluate R.F. for: ‘substance abuse in contravention of Chapter 64B8-9.013(3), FAC. RF. hada history of HIV and hepatitis C; both of these conditions are associated with substance abuse. | 40. Respondent did not consult with a pain management expert in contravention of Chapter 64B8-9.013(3)(e), F.A.C. RE. suffered from pain J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc L : 12 Ls ae i: | ae Jan 18 2011 10:27 Jan 18 2011 11:26 P.17 for 15-16 years. Respondent made no determination about the source of her pain or refer ‘her to a pain management expert. COUNT I 41. Petitioner realleges and incorporates - paragraphs one | (1) through forty (40) as if fully set forth herein. : 42. Section 458.331(1)(m), Florida Statutes (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 extinder and supervising physician by name and professional title who is ar are respdnsible. 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. , | 43. Respondent failed to keep medical records that justify ‘the course of treatment including patient histories; examination results; test results; records of drugs prescribed, dispensed, or administéred; and J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06,09a.doc i. | 13 Jan 18 2011 10:28 Jan 18 2011) 11:27 P.18 reports of consultations and hospitalizations in one or more of the following ways: | a. __ by failing to document B.D. or R.F.’s medical histories; b. __ by failing to obtain B.D. or R.F.'s médical records; c. by failing to document full physical examinations of 8.D. or R.F,; . 2 d. by failing to record all of the drugs that were prescribed, dispensed or administered to B.D. or R.F.;, | e. by failing to document an indication or diagndsis which justified prescribing the types, dosages and quantities of drugs to B.D. or R.F.; . . | f. __ by failing to evaluate B.D. or R.F. fot substance abuse; g. _ by failing to document relevant treatment plans for B.D. or R.F.; or | _ h. by failing to justify the course of treatment for B.D.’ or RF. : | 44. Based: on the foregoing, Respondent has Violated Section 458.331(1)(m), Florida Statutes (2008 and 2009), :'for failing ‘to keep legible, as defined by department rule in consultation with the board, J:\PSU\Medical\Grace Kim\Rose, Michael 2009-O66B7\AC 11.06.09a.doc ! 14 L- Pet | Jan 18 2011 10:28 dan 18 2011) 11:27 P.19 medical records that identify the licensed physician or the physitian extender and supervising physician by name and professional title who is or are responsible for rendering, ordering, supervising, or bling 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. COUNT IT 45. Petitioner realleges and _ incorporates paragraphs: one ‘(1) through forty (40) as if fully set forth herein. : ! 46. Section 458.331(1)(q), Florida Statutes (2008 and - 2009), subjects a licensee to discipline for prescribing, dispansing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. 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 J:\PSU\Medical\Grace Kirr\Rase, Michael 2009-06687\AC 11.06.09a.doc AS i: ton 7 | Jan 18 2011 10:28 Jan 18 2011 11:2? P. 20 patient and is not in the course of the physician's: professional practice, without regard to his or her intent. 47. Respondent inappropriately or in excessive or inappropriate quantities prescribed legend drugs to B.D. or R.F., other than in the course of his professional practice in one or more of the folowing ways: » a. by prescribing B.D. or R.F. excessive or inappropriate doses. of controlled substances without adequate medical histories; : : | b. by prescribing B.D. or RF. excessive or inappropriate doses of controlled substances without adequate pain treatment histories; | c. by prescribing B.D. or R.F. excessive or inappropriate doses of controlled substances without “ordering basic diagnostic tests; : d. by prescribing B.D. or R.F. excestive or inappropriate doses of controlled substances without complete physical examinations; J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06,09a,doc | co ! 16 7 hai | Jan 18 2011 10:28 Jan 18 2011 11:27 Pd e, by: prescribing B.D. or R.F. excessive or inappropriate doses of controlled substances without adequate mental health histories; | f. by prescribing B.D. or R.F. excessive or inappropriate doses of controlled substances without: ‘evaluating either of them for a substance abuse disorders or the potential for drug ‘diversion; ! g. by prescribing B.D. or R.F. excessive or inappropriate doses of controlled substances without investigating ‘or diagnosing the source of his or her.pain; | h. by prescribing B.D. or R.F. excestive or Inappropriate doses of controlled substances without investigating ‘Or diagnosing if his or her pain was intractable; L by prescribing. B.D. or R.F. excessive or Inappropriate doses of controlled substances without investigating attemative methods of controlling his or her pain; . js by prescribing B.D. or R.F. excessive or inappropridte doses of controlled substances without metiical justification; J;\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc i 47 fo aa » i Jan 18 2011 10:29 Jan 18 2011 11:28 ; P.22 k. by prescribing B.D. excessive or inappropriate doses of controlled substances without evidence of B.D.'s tolerance to Opiates and Xanax; | : |. by inappropriately prescribing B.D. Xanax without a relevant diagnosis; | m. by prescribing excessive or inappropriate idoses of controlled substances without evaluating B.D. or R.F. for substance abuse; | | | n, by prescribing excessive or inappropriate doses ' of contralled substances without attempting !to get all of B.D., or R.F.’s_ medications prescribed by the, same heath care professional; , : 0. by prescribing excessive or inajipropriate doses of controlled substances without attempting to get all of B.D. or R.F.’s prescriptions filled at the same pharinacy; 3 p. by prescribing excessive or inappropriate doses of controlled substances to B.D. or R.F.: J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc i, : : | i | Jan 18 2011 10:29 Jan 18 2011 11:28 P.23 q. by prescribing excessive or inappropriate doses of controlled substances without monitoring B.D. or R.F. for substance abuse or drug diversion; r, by pfescribing excessive or inappropriate doses. of controlled substances without performing follow up diagnostic testing of B.D. or R.F.; or | Ss. by prescribing excessive or inappropriate doses’ of controlled substances without performing follow up diagnostic testing of B.D. or RLF. | — 48. Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (2008 and 2009), for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of. the patient and is not in the course of the physician’s professional practice, without regard to his or her intent. J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc | "19 7 Pe Jan 18 2011 10:29 Jan 18 2011) 11:28 P.24 COUNTIIT ! 49. Petitioner .realleges and incorporates "Paragraphs one : (1) through forty (40) as if fully set forth herein. | | 50. Section 458,331(1)(t), Florida Statutes (2008 and 2009), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50. | : 51. Section 456.50(1)(g), Florida Statutes (2008 and 2009), states ' that medical malpractice means the failure to: “practice medicine in accordance with the level of care, skill, and treatment rectgnized in general law related to health care licensure. 52. Respondent fell below the standard: of care in one or more of the following ways: | a. by failing to get adequate medical histories for B.D, or ORF; | : | b. by failing to document adequate medical histories for B.D. or R.F.; , : © by failing to record medical histories of ‘the pain treatments of B.D. or R.F.; J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc | | 20 a l Jan 18 2011 10:29 Jan 18 2011 11:28 P.25 d. by failing to perform complete physical examinations of B.D. or R.F.; ; e. by failing to perform a direct physical examination of the | i spine‘on B.D. orR.F.j; : f. by failing to perform a direct physi¢al examination of the muscle system on B.D. or R.F.; ; : @Q. by failing to perform basic baseline p beratiry tests on B.D. or RF; - PG h. by prescribing excessive —_s doses of opioids to B. D. or R.F. without first attempting alternative methods of treating their pain; | i. by prescribing excessive or inappropriate doses of opioids to B.D. or R.F. without establishing that either of ther suffered from intractable pain; or j. by prescribing excessive or inappropriate doses of opicids to B. D. or R. F, without monitoring his or her Safety. 53. Respondent fell below the standard of care by failing to comply with Chapter 64B8-9.013, F.A.C. in one or more of the folowing ways: 7:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc |. 4. 21 Jan 18 2011 10:30 Jan 18 2011 11:29 P.26 a. by failing to conduct complete ‘medical histories ' or physical examinations, or documenting them, on B.D. or R.F.; b. by failing to document B.D. or RiFVs current or past treatments for pain; | c. by failing to document B. D. or. R F,'s undering or coexisting diseases or conditions; . d. __ by falling to document the effect of the pain on B. D. or RF. 's physical or psychological function; : | e. by failing to document the presence of one! or more recognized medical indications for the use of contre substances for B.D. or R.F.; ' | f. by failing to adjust drug therapy toithe ravi medical needs of B.D. or R.F. after treatment began; g. _ by failing to address whether othet! treatment roca or a rehabilitation program may be necessary depending on the etiology of the pain in the treatment plan for B.D. or RF. ; h. by failing to state the extent to which B.D. or R's pain ig associated with physical or psychosocial! impairment; J:\PSU\Medical\Grace Kim\Rgse, Michael 2009-06687\AC 11.06.09a.doc : 22 Jan 18 2011 10:48 JAN-18-2811 18:15 FL DEPT OF HEALTH 850 488 1855) P2735 i. by failing to address whether R.F. or B.D. were receiving all their prescriptions from one physician or one pharmacy; j. by failing to assess whether R.F. or B.D. were at high risk of substance abuse; k. by failing to review the course of treatment for B.D. or R.F.; l. by failing to refer B.D. or R.F. for additional evaluations or treatments in order to achieve treatment objectives; m. — by failing to pay special attention to B.D. or R.F. for misusing their medications or diversion; n. by failing to keep accurate or complete medical records for B.D. or R.F. including: . medical history; ii. physical examination; iti. history of drug abuse or dependence; iv. diagnostic, therapeutic, or laboratory results; or Vv. evaluations or consultations. J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc 23 Jan 18 2011 10:48 JAN-18-2811 18:15 FL DEPT OF HEALTH 85@ 488 1855 P.28735 54, Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2008 and 2009), for committing medical malpractice as defined in Section 456.50. COUNT IV 55. Petitioner realleges and incorporates paragraphs one (1) through forty (40) as if fully set forth herein. 56. Section 456.331(1)(g), Florida Statutes (2008 and 2009) subjects a licensee to discipline for failing to perform any statutory or legal obligation placed upon a licensed physician. 57. Chapter 64B8-9.013, F.A.C., is titled Standards for the Use of Controlled Substances for the Treatment of Pain. 58. Respondent failed to meet the legal obligations of Chapter 64B8-9.013, F.A.C., in one or more of the following ways: by failing to conduct complete medical histories or physical examinations, or documenting them, on B.D. or RF. ; a. by failing to document B.D. or R.F.’s current or past treatments for pain; J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc 24 JAN-18-2011 Jan 18 2011 10:48 10:15 FL DEPT OF HEALTH 858 488 1855 P.29735 b. by failing to document B.D. or R.F.’s underlying or coexisting diseases or conditions; Cc. by failing to document the effect of the pain on B.D. or R.F.'s physical or psychological function; d. by failing to document the presence of one or more recognized medical indications for the use of controlled substances for B.D. or R.F.; e. by failing to adjust drug therapy to the individual medical needs of B.D. or R.F. after treatment began; f. by failing to address whether other treatment modalities or a rehabilitation program may be necessary depending on the etiology of the pain in the treatment plan for B.D. or R.F. ; g. __ by failing to state the extent to which B.D. or R.F.’s pain is associated with physical or psychosocial impairment; h. by failing to address Whether R.F. or B.D. were receiving all their prescriptions from one physician or one pharmacy; i. by failing to assess whether R.F. or B.D. were at high risk of substance abuse; J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc 25 Jan 18 2011 10:49 JAN-18-2011 10:16 FL DEPT OF HEALTH 858 488 1855 P.30/35 j. by failing to review the course of treatment for B.D. or R.F.; k. by failing to refer B.D. or R.F. for additional evaluations or treatments in order to achieve treatment objectives; I. by failing to pay special attention to B.D. or R.F. for misusing their medications or diversion; m. by failing to keep accurate or complete medical records for B.D. or R.F. including: } i, medical history; ii. physical examination; tii. history of drug abuse or dependence; iv. diagnostic, therapeutic, or laboratory results; or v. evaluations or consultations. 59. Based on the foregoing, Respondent has violated Section 458.331(1)(g), Florida Statutes (2008 and 2009), for failing to perform any Statutory or legal obligation placed upon a licensed physician. J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a,doc 26 Jan 18 2011 10:49 JAN-18-2611 10:16 FL DEPT OF HEALTH 85@ 488 1855 P.31735 COUNT V 60. Petitioner realleges and incorporates paragraphs one (1) through forty (40) as if fully set forth herein. 61. Section 458.331(1)(nn), Florida Statutes (2008 and 2009) subjects a licensee to discipline, for violating any provision of chapter 458 or chapter 456, or any rules adopted pursuant thereto. 62. Chapter 64B8-9.013, F.A.C., is titled Standards for the Use of Controlled Substances for the Treatment of Pain. Respondent failed to meet the legal obligations of Chapter 64B8-9.013, F.A.C., in one or more of the following ways: a. _ by failing to document B.D. or R.F.’s current or past treatments for pain; b. by failing to document B.D. or R.F.’s underlying or coexisting diseases or conditions; c. _ by failing to document the effect of the pain on B.D. or R.F.’s physical or psychological function; d. by failing to document the presence of one or more recognized medical indications for the use of controlled substances for B.D. or R.F.; J:\PSU\Medical\Grace Kim\Rose, Michae} 2009-06687\AC 11.06.09a.doc 27 Jan 18 2011 10:49 JAN-18-2011 10:16 FL DEPT OF HEALTH 85@ 488 1855 P.32/38 e. by failing to adjust drug therapy to the individual medical needs of B.D. or R.F. after treatment began; f. by failing to address whether other treatment modalities or a rehabilitation program may be necessary depending on the etiology of the pain in the treatment plan for B.D. or R.F.; g. _ by failing to state the extent to which B.D. or R.F.'s pain is associated with physical or psychosocial impairment; h. by failing to address whether R.F. or B.D. were receiving all their prescriptions from one physician or one pharmacy; i. by failing to assess whether R.F. ar B.D. were at high risk of substance abuse; j. by failing to review the course of treatment for B.D. or R.F.; k. by failing to refer B.D. or R.F. for additional evaluations or treatments in order to achieve treatment objectives; I, by failing to pay special attention to B.D. or R.F. for misusing their medications or diversion; m. by failing to keep accurate or complete medical records for B.D. or R.F. including: J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06 .09a.doc ; 28 Jan 18 2011 10:49 JAN-18-2011 10:16 FL DEPT OF HEALTH 85@ 488 1855 P.33/35 i. medical history; il. physical examination; li. history of drug abuse or dependence; iv. diagnostic, therapeutic, or laboratory results; or v. evaluations or consultations. 63. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2008 and 2009), for violating any provision of chapter 458 or chapter 456, or any rules adopted pursuant thereto. WHEREFORE, 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 Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc 29 Jan 18 2011 10:50 JAN-18-2011 18:17 FL DEPT OF HEALTH 85@ 488 1855 P.34735 SIGNED this _/3”" day of ~Zlevemte, , 2009. Ana M. Viamonte Ros, M.D., M.P.H. State Surgeon General Grace Kim Do EPARTMENT Gi EALTE: Assistant General Counsel CLERK: Garton DOH Prosecution Services Unit DATE ML italog 4052 Baid Cypress Way, Bin C-65 ~ Tallahassee, FL. 32399-3265 Florida Bar # 31096 (850) 245-4640, Ext. 8187 (850) 245-4681 FAX GK PCP; 11/13/04 PCP Members: % 9m , Jaermaw , Becbce Michael Rose, M.D. 2009-06687 J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc 30 Jan 18 2011 10:50 JAN-18-2011 10:17 FL DEPT OF HEALTH 858 488 1855) P. 35/35 MICHAEL I. ROSE M.D. DOH Case number 2009-06687 NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed. J:\PSU\Medical\Grace Kim\Rose, Michael 2009-06687\AC 11.06.09a.doc 31 TOTAL P.35

Docket for Case No: 11-000253PL