Respondent's address of record is 1520 AlA Highway, Indialantic, Florida 32903.
At all times material to this Order, Respondent practiced medicine at Indialantic Internal Medicine, Inc. (Clinic), a registered pain management clinic located at 1520 AlA Highway, Indialantic, Florida, 32903.
While practicing at the Clinic, Respondent prescribed large doses and quantities of oxycodone, Lortab and Xanax to his patients.
Oxycodone (brand name Roxicodone) is an opioid and is commonly prescribed to treat pain. 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 terms opioid and opiate are often used interchangeably. Opioid drugs are addictive and subject to abuse. According to Section 893.03(2), Florida Statutes (2011), oxycodone is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States. Abuse of oxycodone may lead to severe psychological or physical dependence.
Hydrocodone/APAP (brand name Lortab) contains hydrocodone and acetaminophen, or Tylenol and is prescribed to treat pain. According to Section 893.03(3), Florida Statutes, hydrocodone, m the dosages found m
hydrocodone/ APAP is a Schedule III controlled substance that has a potential for abuse less than the substances in Schedules I and II and has a currently accepted medical use in treatment in the United States. Abuse of the substance may lead to moderate or low physical dependence or high psychological dependence.
Xanax is a brand of alprazolam (benzodiazepine) and is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes (2010-2011), alprazolam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States. Abuse of alprazolam may lead to limited physical or psychological dependence relative to the substances in Schedule III.
Facts specific to Patient M.J.
Patient M.J. presented to Respondent on or about June 12, 2006, with complaints of chronic obstructive pulmonary disease (COPD). Respondent evaluated the patient, diagnosed COPD and allergic rhinitis and prescribed 30 tablets of Temazepam 30 mg.
On four subsequent occasions between on or about October 20, 2008, and on or about January 16, 2009, Patient M.J. presented to Respondent for appointments regarding chronic pain.
Medical records indicate that Respondent diagnosed COPD and chronic lumbar pain and prescribed 120 tablets of Lortab 10/500 mg and 90 tablets
of Xanax 1 mg to Patient M.J. at each appointment.
Medical records indicate that Patient M.J. presented to Respondent on approximately 21 occasions between on or about February 13, 2009, and on or about September 2, 2010.
At each appointment, Respondent prescribed 150 tablets of Lortab 10/500 mg and 90 tablets of Xanax 1 mg to Patient M.J.
Medical records indicate that at approximately four appointments between on or about September 27, 2010, and on or about December 13, 2010, Respondent prescribed 150 tablets of oxycodone 15 mg and 120 tablets of Xanax 1 mg to Patient M.J. at each appointment.
At approximately six appointments between on or about January 5, 2011, and on or about May 25, 2011, medical records indicate that Respondent prescribed 150 tablets of oxycodone 30 mg and 120 tablets of Xanax 1 mg to Patient M.J. at each appointment.
On or about August 8, 2011, Patient M.J., equipped with undercover surveillance equipment, presented to Respondent to receive medical treatment.
Respondent prescribed 150 tablets of oxycodone 30 mg and 120 tablets of Xanax 1 mg to Patient M.J. without conducting any medical inquiry, medical evaluation or physical examination of the patient.
On or about September 6, 2011, Patient M.J., equipped with
undercover surveillance equipment, presented to Respondent for a follow-up appointment.
Respondent prescribed 150 tablets of oxycodone 30 mg and 120 tablets of Xanax 1 mg to Patient M.J. without conducting any medical inquiry, medical evaluation or physical examination of the patient.
On or about October 5, 2011, Patient M.J., equipped with undercover surveillance equipment, presented to Respondent for a follow-up appointment.
Respondent prescribed 150 tablets of oxycodone 30 mg and 120 tablets of Xanax 1 mg to Patient M.J. without conducting any medical inquiry, medical evaluation or physical examination of the patient.
Respondent prescribed inappropriate or excessive amounts of controlled substances to Patient M.J.
Patient M.J. was high-risk for drug abuse, as medical records indicate that she abused drugs as recently as 1999, however, Respondent did not adequately monitor her.
Respondent failed to reassess the course of treatment of Patient M.J., refer the patient to consult other practitioners regarding her condition or adequately monitor her use of controlled substances.
A reasonably prudent physician would have conducted an adequate medical evaluation(s) of Patient M.J. at appropriate intervals, would have obtained
an adequate medical history of the patient and would not have prescribed excessive amounts of controlled substances without a justification therefor.
Respondent's medical records fail to document a treatment plan; fail to contain an adequate medical history; fail to document any diagnosis for the patient between on or about September 2, 2010, and on or about October 5, 2011; fail to include copies of any prescriptions prescribed to Patient M.J.; fail to include any medical history of the patient; fail to include any confirmation tests of urine drug screens; and fail to justify the course of treatment of the patient.
Facts specific to Patient K.L.
On or about March 2, 2009, Patient K.L., a 20-year-old female, first presented to Respondent with complaints of left knee pain and presented a magnetic resonance imaging (MRI) report dated October 27, 2003, that identified a potentially dislocated knee.
Medical records indicate that Respondent diagnosed bilateral degenerative joint disease (DJD) in Patient K.L.'s knees and lumbar spine and prescribed 120 tablets of oxycodone 15 mg.
Patient K.L. presented to Respondent for a follow-up appointment on or about April 1, 2009.
Medical records indicate that that Respondent again diagnosed DJD and prescribed 120 tablets of oxycodone 30 mg.
Patient K.L. presented to Respondent for approximately 15 follow-up appointments between on or about April 30, 2009, and on or about January 18, 2010
Medical records indicate that Respondent prescribed 120 tablets of
oxycodone 30 mg to Patient K.L. at each appointment.
Medical records indicate that Respondent failed to perform any medical evaluation of the patient at any of her appointments.
Respondent prescribed inappropriate or excessive amounts of controlled substances to Patient K.L.
Respondent failed to reassess the course of treatment of the patient, refer Patient K.L. to consult other practitioners regarding her condition or adequately monitor the patient's use of controlled substances.
A reasonably prudent physician would have conducted an adequate medical evaluation(s) of Patient K.L. at appropriate intervals, would have obtained an adequate medical history of the patient and would not have prescribed excessive amounts of controlled substances without a justification therefor.
Respondent's medical records fail to document a treatment plan; fail to contain an adequate medical history; fail to document any diagnosis for the patient on 13 appointments; fail to include copies of any prescriptions prescribed to Patient K.L.; fail to include any medical history of the patient; fail to include any
confirmation tests of urine drug screens; and fail to justify the course of treatment of the patient.
Facts specific to Patient J.K.
Patient J.K., an 18-year-old female, first presented to Respondent on or about April 14, 2010, with complaints of memory loss and lower back pain resulting from a motor vehicle accident.
Medical records indicate that Respondent diagnosed Patient J.K. with traumatic brain injury, lumbar radiculitis and anxiety and prescribed 120 tablets of oxycodone 30 mg and 60 tablets of Xanax 2 mg to the patient.
Medical records indicate that Respondent prescribed 120 tablets of oxycodone 30 mg and 60 tablets of Xanax 2 mg to Patient J.K. at a follow-up appointment on or about May 12, 2010.
Medical records indicate that beginning on or about June 21, 2010, Respondent began prescribing Patient J.K. 150 tablets of oxycodone 30 mg and 60 tablets of Xanax 2 mg to Patient J.K.
Patient J.K. then presented to Respondent for approximately 13 appointments between on or about July 19, 2010, and on or about June 20, 2011.
Medical records indicate that Respondent prescribed 150 tablets of oxycodone 30 mg and 60 tablets of Xanax 2 mg to Patient J.K. at each appointment.
Patient J.K. presented to Respondent for approximately four follow-up appointments between on or about July 17, 2011, and on or about October 10, 2011.
Medical records indicate that Respondent prescribed 150 tablets of oxycodone 30 mg and 60 tablets of Xanax 2 mg to Patient J.K. at each appointment.
Medical records indicate that Respondent failed to perform any physical examination or medical evaluation of Patient J.K. at any of her appointments.
Respondent prescribed inappropriate or excessive amounts of controlled substances to Patient J.K.
Respondent failed to reassess the course of treatment of the patient, refer Patient J.K. to consult other practitioners regarding her condition or adequately monitor the patient's use of controlled substances.
A reasonably prudent physician would have conducted an adequate medical evaluation(s) of Patient J.K. at appropriate intervals, would have obtained an adequate medical history of the patient and would not have prescribed excessive amounts of controlled substances without a justification therefor.
Respondent's medical records fail to document a treatment plan; fail to contain an adequate medical history; fail to document any diagnosis for the
patient on 16 appointments; fail to include copies of any prescriptions prescribed to Patient J.K.; fail to include any medical history of the patient; fail to include any confirmation tests of urine drug screens; and fail to justify the course of treatment of the patient.
Facts specific to Patient S.R.
In or about October 2010, Respondent met Patient S.R., a 17-year-old female, in the parking lot of the Clinic.
Respondent began a sexual relationship with Patient S.R. while she was still a minor.
During their relationship, Respondent provided Patient S.R. with manJuana and Roxicodone 30 mg tablets on multiple occasions without a prescription.
Respondent also provided Patient S.R. with tablets of Valtrex to treat her genital herpes.
Marijuana contains tetrahydrocannabinols (THC), which are the psychoactive ingredients in marijuana. According to Section 893.03(1), Florida Statutes (2010-2011), THC is a Schedule I controlled substance that has a high potential for abuse and has no currently accepted medical use in treatment in Florida. Its use under medical supervision does not meet accepted safety standards.
Respondent established a physician-patient relationship with S.R.
Respondent provided controlled substances to Patient S.R. immediately prior to engaging her in sexual activities.
A reasonably prudent physician would not have provided Patient S.R. with Roxicodone for recreational use and would not have provided Patient S.R. with marijuana for recreational use.
COUNTONE
Petitioner realleges and incorporates Paragraphs 1 through 58, as if fully set forth herein.
Section 458.331(l)(t)l., Florida Statutes (2008-2011), subjects a physician to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes (2008-2011). "Medical malpractice" is defined by Section 456.50(1)(g), Florida Statutes (2008-2011), as "the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure." Section 456.50(l)(e), Florida Statutes (2008- 2011), provides that the "level of care, skill, and treatment recognized in general law related to health care licensure" means the standard of care that is specified in Section 766.102(1), Florida Statutes (2008-2011), which is set forth as follows:
The prevailing professional standard of care for a given health care provider shall be that level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers.
Section 458.331(l)(t)l., Florida Statutes (2008-2011), directs the Board to give "great weight" to this provision of Section 766.102, Florida Statutes (2008-2011).
Respondent violated Section 458.33 l(l)(t)l., Florida Statutes (2008- 2011), in one or more of the following manners:
By excessively or inappropriately prescribing or providing controlled substances to Patients M.J., K.L., S.R. and/or J.K.;
By failing to conduct an adequate medical evaluation of Patients M.J., K.L. and/or J.K. at one or more of each patient's medical appointments;
By failing to obtain an adequate patient history of Patients M.J.,
K.L. and/or J.K. prior to prescribing controlled substances to one or more of the patients;
By failing to adequately treat Patients M.J., K.L., S.R. and/or
J.K. regarding chronic pain;
By providing Patient S.R. with Roxicodone for recreational use;
and/or
By providing Patient S.R. with marijuana for recreational use.
Based on the foregoing, Respondent has violated Section 458.33l(l)(t)l., Florida Statutes (2008-2011), by committing medical malpractice.
COUNTTWO
Petitioner realleges and incorporates Paragraphs 1 through 58, as if fully set forth herein.
Section 458.331(l)(q), Florida Statutes (2008-2011), allows the Board of Medicine (Board) to discipline a physician 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 the 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.
Respondent prescribed controlled substances inappropriately or m excessive or inappropriate quantities in one or more of the following manners:
By prescribing potentially lethal doses and quantities of controlled substances to Patients M.J., K.L. and/or J.K.;
By prescribing controlled substances to Patients M.J., K.L.,
S.R. and/or J.K. without a justification therefor;
By continuing to prescribe controlled substances to Patients M.J., K.L. and/or J.K. without reassessing the course of treatment,
attempting to modify the course of treatment and/or referring one or more of the patients to receive consultations with other specialists;
By failing to conduct an adequate physical examination of Patients M.J., K.L. and/or J.K. prior to prescribing controlled substances to the patient(s);
By providing Roxicodone tablets to Patient S.R. without a
prescription; and/or
By providing marijuana to Patient S.R. for recreational use.
Based on the foregoing, Respondent has violated Section 458.331(l)(q), Florida Statutes (2008-2011), by physician 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.
COUNT THREE
Petitioner realleges and incorporates Paragraphs 1 through 58, as if fully set forth herein.
Section 458.33l(l)(nn), Florida Statutes (2011), subjects a physician
to discipline for violating any provision of Chapters 456 or 458, Florida Statutes, or any rules adopted pursuant thereto.
Section 458.3265(2)(c), Florida Statutes (2011), provides, in part:
A physician must perform a physical examination of a patient on the same day that he or she dispenses or prescribes a controlled substance to a patient at a pain-management clinic....
Respondent practiced medicine at a registered pam management
clinic.
Respondent violated Section 458.3265(2)(c), Florida Statutes (2011), in one or more of the following manners:
Respondent prescribed controlled substances to Patient M.J. on August 8, 2011, September 6, 2011, and/or October 5, 2011, without performing any physical examination of the patient; and/or
Respondent prescribed controlled substances to Patient J.K. on one or more appointments between July 17, 2011, and October 10, 2011, without performing any physical examination of the patient.
Based on the foregoing, Respondent violated Section 458.33l(l)(nn), Florida Statutes (2011), by violating any provision of Chapters 456 or 458, Florida Statutes, or any rules adopted pursuant thereto.
COUNT FOUR
Petitioner realleges and incorporates Paragraphs 1 through 58, as if fully set forth herein.
Section 456.072(l)(mm), Florida Statutes (2011), subjects a physician to discipline for failing to comply with controlled substance prescribing requirements of Section 456.44, Florida Statutes (2011).
Section 456.44(3), Florida Statutes (2011), sets forth the standards of practice for prescribing controlled substances and provides, in part:
... The medical record must, at a minimum, 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, a review of previous medical records, previous diagnostic studies, and history of alcohol and substance abuse. The medical record shall also document the presence of one or more recognized medical indications for the use of a controlled substance. Each registrant must develop a written plan for assessing each patient's risk of aberrant drug-related behavior, which may include patient drug testing. Registrants must assess each patient's risk for aberrant drug-related behavior and monitor that risk on an ongoing basis in accordance with the plan.
Each registrant must develop a written individualized treatment plan for each patient. The treatment plan shall state objectives that will be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and shall indicate if any further diagnostic evaluations or other treatments are planned. After treatment begins, the physician shall adjust drug therapy to the individual medical needs of each patient. Other treatment modalities, including a rehabilitation program, shall be considered depending on the etiology of the pain and the extent to which the pain is associated with physical and psychosocial
impairment. The interdisciplinary nature of the treatment plan shall be documented.
The patient shall be seen by the physician at regular intervals, not to exceed 3 months, to assess the efficacy of treatment, ensure that controlled substance therapy remains indicated, evaluate the patient's progress toward treatment objectives, consider adverse drug effects, and review the etiology of the pain. Continuation or modification of therapy shall depend on the physician's evaluation of the patient's progress. If treatment goals are not being achieved, despite medication adjustments, the physician shall reevaluate the appropriateness of continued treatment. The physician shall monitor patient compliance in medication usage, related treatment plans, controlled substance agreements, and indications of substance abuse or diversion at a minimum of 3-month intervals.
The physician shall refer the patient as necessary for additional evaluation and treatment in order to achieve treatment objectives. Special attention shall be given to those 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 requires consultation with or referral to an addictionologist or physiatrist.
(t) A physician registered under this section must maintain accurate, current, and complete records that are accessible and readily available for review and comply with the requirements of this section, the applicable practice act, and applicable board rules. The medical records must include, but are not limited to:
The complete medical history and a physical examination, including history of drug abuse or dependence.
Diagnostic, therapeutic, and laboratory results.
Evaluations and consultations.
Treatment objectives.
Discussion of risks and benefits.
Treatments.
Medications, including date, type, dosage, and quantity prescribed.
Instructions and agreements.
Periodic reviews.
Results of any drug testing.
A photocopy of the patient's government-issued photo identification.
If a written prescription for a controlled substance is given to the
patient, a duplicate of the prescription.
The physician's full name presented in a legible manner.
(g) Patients with signs or symptoms of substance abuse shall be immediately referred to a board:-certified pain management physician, an addiction medicine specialist, or a mental health addiction facility as it pertains to drug abuse or addiction unless the physician is board-certified or board-eligible in pain management. ...
Respondent failed to comply with the standards for prescribing controlled substances in one or more of the following manners:
By failing to assess the efficacy of treatment, ensure that controlled substance therapy remains indicated, evaluate the patient's progress toward treatment objectives and/or review the etiology of the pain in his treatment of Patient J.K.;
By failing to assess the efficacy of treatment, ensure that controlled substance therapy remains indicated, evaluate the patient's progress toward treatment objectives and/or review the etiology of the pain in his treatment of Patient M.J.
By failing to conduct or document a complete medical history of Patients M.J. and/or J.K.;
By failing to conduct or document a physical examination of Patients M.J. and/or J.K.;
By failing to document the nature and intensity of the pain for Patients M.J. and/or J.K.;
By failing to document the effect of the pain on physical and psychological function for Patients M.J. and/or J.K.;
By failing to document an indication for the controlled substances prescribed to Patients M.J. and/or J.K.;
By failing to set forth a treatment plan for Patients M.J. and/or
J.K.;
1. By failing to reassess the treatment of Patients M.J. and/or J.K.;
J. By failing to refer Patients M.J. and/or J.K. to treatment with other physicians or specialists;
By failing to consider or document the consideration of alternative modalities, such as non-steroid anti-inflammatories or injections, in the treatment of Patients M.J. and/or J.K.;
By failing to refer Patient M.J. to a board-certified pam management physician, an addiction medicine specialist, or a mental health addiction facility as it pertains to drug abuse; and/or
m. By failing to adequately monitor Patient M.J.
Based on the foregoing, Respondent violated Section 456.072(1)(mm), Florida Statutes (2011), by failing to comply with controlled substance prescribing requirements of Section 456.44, Florida Statutes (2011).
COUNT FIVE
Petitioner realleges and incorporates Paragraphs 1 through 58, as if fully set forth herein.
Section 458.331(1)G), Florida Statutes (2010-2011), subjects a physician to discipline for exercising influence within a patient-physician relationship for purposes of engaging a patient in sexual activity.
Respondent established a physician-patient relationship with Patient
S.R. by providing her controlled substances and Valtrex.
Respondent engaged in sexual activity with Patient S.R.
Respondent exercised influence within a patient-physician relationship for purposes of engaging Patient S.R. in sexual activity.
Based on the foregoing, Respondent violated Section 458.331(l)(j), Florida Statutes (2010-2011), by exercising influence within a patient-physician relationship for purposes of engaging a patient in sexual activity.
COUNT SIX
Petitioner realleges and incorporates Paragraphs 1 through 58, as if fully set forth herein.
Section 458.33l(l)(m), Florida Statutes (2008-2010), allows the Board to discipline a physician 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; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations.
Rule 64B8-9.003(3), Florida Administrative Code, provides the standards for the adequacy of medical records as:
The medical record shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; reports of
consultations and hospitalizations; and copies of records or reports or other documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician m determining the appropriate treatment of the patient.
Respondent failed to keep adequate medical records in one or more of the following manners:
Respondent failed to document the patient histories of Patients
M.J., K.L., S.R. and/or J.K.;
Respondent failed to maintain records of the drugs he prescribed or provided to Patients M.J., K.L., S.R. and/or J.K.; and/or
Respondent failed to justify the course of treatment of Patients
M.J., K.L., S.R. and/or J.K.
Based on the foregoing, Respondent failed to keep legible medical records in violation of Section 458.331(l)(m), Florida Statutes (2008-2010), and Rule 64B8-9.003(3), Florida Administrative Code.
COUNT SEVEN
Petitioner realleges and incorporates Paragraphs 1 through 58, as if fully set forth herein.
Section 458.33l(l)(nn), Florida Statutes (2010-2011), subjects a physician to discipline for violating any provision of Chapters 456 or 458, Florida Statutes, or any rules adopted pursuant thereto
Rule 64B8-9.013, Florida Administrative Code, effective October 17, 2010, sets forth the standards for the use of controlled substances for the treatment of pain, in part, as follows:
Standards. The Board has adopted the following standards for the use of controlled substances for pain control:
Evaluation of the Patient. A complete medical history and physical examination must be conducted and documented in the medical record. The medical record shall 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 shall document the presence of one or more recognized medical indications for the use of a controlled substance.
Treatment Plan. The written treatment plan shall state objectives that will be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and shall indicate if any further diagnostic evaluations or other treatments are planned. After treatment begins, the physician shall adjust drug therapy, if necessary, 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 the extent to which the pain is associated with physical and psychosocial impairment.
* * *
Consultation. The physician shall be willing to refer the patient as necessary for additional evaluation and treatment in order to achieve treatment objectives. Special attention must 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.
Medical Records. The physician is required to keep accurate and complete records to include, but not be limited to:
The complete medical history and a physical examination, including history of drug abuse or dependence, as appropriate;
Diagnostic, therapeutic, and laboratory results;
Evaluations and consultations;
Treatment objectives;
Discussion of risks and benefits;
Treatments;
Medications (including date, type, dosage, and quantity prescribed);
Instructions and agreements;
Drug testing results; and
Periodic reviews. Records must remain current, maintained in an accessible manner, readily available for review, and must be in full compliance with Rule 64B8-9.003, F.A.C, and Section 458.331(1)(m), F.S.
Records must remain current and be maintained m an accessible manner and readily available for review.
Respondent violated the standards for the use of controlled substances for the treatment of pain in one or more of the following manners:
By failing to conduct or document a complete medical history of Patients M.J. and/or J.K.;
By failing to conduct or document a physical examination of Patients M.J. and/or J.K.;
By failing to document the nature and intensity of the pain for Patients M.J. and/or J.K.;
By failing to document the effect of the pain on physical and psychological function for Patients M.J. and/or J.K.;
By failing to document an indication for the controlled substances prescribed to Patients M.J. and/or J.K.;
By failing to set forth a treatment plan for Patients M.J. and/or
J.K.;
By failing to reassess the treatment of Patients M.J. and/or J.K.;
By failing to refer Patients M.J. and/or J.K. to treatment with other physicians or specialists; and/or
By failing to utilize alternative modalities, such as non-steroid anti-inflammatories or injections, in the treatment of Patients M.J. and/or J.K.
Based on the foregoing, Respondent violated Section 458.33l(l)(nn), Florida Statutes (2010-2011), by violating any provision of Chapters 456 or 458, Florida Statutes, or any rules adopted pursuant thereto.
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 it{{: day of_}J_()J_e_V\\, b '2011.
FILED DEPARTMENT OF HEALTH
DEPUTY CLERK
CLERK Angel Sanders
DATE NOV 1 5 2011
Gavin D. urgess /
H. Frank Farmer, Jr., M.D., Ph.D., F.A.C.P. t Surgeon General
Assistant GeriefalCounsel DOH Prosecution ervices Unit
4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265
Florida Bar# 013311
(850) 245-4640
(850) 245-4681 FAX
gdb
PCP Date: November 10, 2011
PCP Members: Leon, Bearison, Levine, Gerbert
John M. Gayden, Jr., M.D. Case No. 2011-11227
John M. Gayden, Jr., M.D.
NOTICE OF RIGHTS
Case No. 2011-11227
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 any other discipline imposed.
