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STATE OF FLORIDA DEPARTMENT OF HEALTH

DEPARTMENT OF HEALTH,

PETITIONER,

v.

ATAUR RAHMAN, M,D.,

·. RESPONDENT, ,/

ADMINISTRATIVE COMPLAiffit

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COMES NOW, Petitioner, Department of Healtll, by and th¥>ugh its

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undersigned counsel, and flies this Administrative Cpmpl int bef°re the

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,Board of Medicine. against the Respondent, Ataur hman, M.o.1 and in

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support thereof alleges:

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1. Petitioner is the state department charged •. with regulating the

   
   

   practice of medicine pursuant to Section 20.43, Florida Statutes; 'Chapter

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   456, Florida Statutes; and Chapter 458, Florida Statute . 1

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2. Af all times material to this Complaint, .!lespondent 1 was a

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   licensed physician within the State of Florida, having been issued !license

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   number ME 95010.

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3. The Respondent's address of record is 42341 Chadswort Lane,

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   Port Orange, Florida 32129.

   
   

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4. The Respondent is board certified· by t111e American\ Board of

   Family Medicine.

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5. A Department of Health investigator (''Q.O.H.I.") m de three

   visits to Respondent in 2010, posing as a patient. I i

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6. On or_ about May 13, 2010, the DOHI ,went to Respondent's

office located at 900 North Swallowtail Drive, Unit 105, Port( Orange,

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Florida, for his first visit. The DOH! did not provide any pharmacy records

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at this visit.

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At the first visit, on or about May 13, 20'10, Respondent took

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the DOHI into an exam room and asked the DOHI if n was curre1tly using

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any prescriptions. The DOHI said that he had not 1.been for a ut three

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months.

1. At the first visit, on or about May 13, 20to, Respondent told

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   the DOHI that he could not give him a prescription for oxycod¢>ne, but

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   could give him one prescription for hydrococlone 10, for 120 tabl .

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2. Respondent then took the DOHI to the reception area and

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   asked the receptionist to prepare a new folder for hiH,. When thb folder

   had been made, the Respondent took the OOHI back to the exam rbom.

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3. At the first visit, on or about May 13, 2010, the DOljll gave Respondent a magnetic resonance imaging (M.R.I.} rep¢:,rt.

4. The MRI report Is dated December 15, 200 . The reporit ·;s ·not

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   signed by a doctor, but purports to be from Dr. Natalia Nagorn ya. The

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   report is not on letterhead and contains no indication of where the MRI

   was performed. Under the heading of IMPRESSION, the MRI rea s:

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   2.

   l. No evidence for cord injury within the thoraci or lumbar spine. . :

   No evidence for bone marrow e ma to suggest

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   fracture. ·

   3. Mild spondylosls at the r11 121evet and L4·5, ':

   and LS Sl.

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5. At the first visit, on or about May 13, 201!0, Respond,nt ask\2(1

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   the DOHI if he was allergic to any medications, took his blood ressure,

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   listened to his chest and abdomen with a stethoscope and testedIhis knee

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   reflex. I

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6. At the first visit, on or about May 13, 20!10, R.espon4ent told

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   the DOHI that he was going to give him 'Lortab lQ;I Respondept asked

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   the DOHI if he needed anything else. The DOHI sta d that he w' puld like

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   some Soma to loosen up his back. Respondent said t t he would ive him

   
   

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   a prescription for Soma.

   
   

7. Lortab is the brand name for a drug that cqntains hydrQCOdon

   and is prescribed to treat pain. According. to Sectiorn 893.03(3),\ Florida

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   Statutes, hydrocodone, in the dosages found in Lortal;), Is a Sc:hef!ule III

   controlled substance that has a potential for abl!Jse less th1an the

   
   

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   substances in Schedules I and II and has a currently;accepted m dical use

   
   

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   in treatment in the United States. Abuse of the s bstance m y lead to

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   moderate or low physical dependence or high psychological deper\ldence.

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8. Soma is the brand name for carisoprocl¢11, a muscle relaxant

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   commonly prescribed to treat muscular pain. ;\ccording ttj Section

   893.03(4), Florida Statutes, carisoprodol is a St'j. ledule IV ci ;on rolled

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   substance that has a low potential for abuse relative, to the substances in

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   Schedule III and has a currently accepted medical u in treatmJnt in the

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   United States. Abuse of carisoprodol may lead tb limited ph ical or

   psychological dependence relative to the substances irl Schedule III.

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9. At the first visit, on or about May 13, 20ll0, Respond mt gave the DOHI a prescription for Lortab 10/500, 120 tablets and a pr iption for Soma 350mg, 60 tablets.

10. On or about July 27, 2010, the DOHI returned to Resp ndenfs

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    office for a second appointment.

11. On ot about July 27, 2010, Respondent tot!k the DOHI bad< to

    • the exam room and took the DOHI's blood pressure.

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12. Respondent then wrote the OOHI prescHptions for'i Lortab 10/500, 120 tablets and Soma 350mg, 60 tablets. Respondent han¢ied the prescriptions to the DOH!.

    
    

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    2010.

13. The DOHI's third appointment was sch$iuled for AWgust 24,

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14. On or about August 19, 2010, approxi tely five days before

    
    

    the DOHI's scheduled appointment, the DOHI went ttj Respondent's office.

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15. On or about August 19, 2010, Respondent took the DOHI back

    • to an exam room. Respondent· asked the DOH! why he was ttiere early and said that the DOHI's 'medicine was not due.' The DpHI told

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      Respondent that he was out of medicine.

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16. On or about August 19, 2010, the Respondent _ask d if four

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    tablets a day of the Lortab were not enough and If five tablets a day would

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    be enough. The DOHI said that five tablets would be good.

17. On or about August 19, 2010, Respondeht asked the'! DOH! if

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    he wanted more·soma. The DOHI told Respondent th t he had S ma left,

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    but asked for more. Respondent agreed to give him more soma. '1

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18. At the third visit, on or about August 1 , 2010, pendent

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    placed the blood pressure cuff on the DOHI, pump ;it up to 12 mm/Hg, quickly released the pressure and removed the c ff.· Approximat ly three seconds elapsed from the time Respondent stopped pumping th cuff to

    the 'time he took the cuff off.

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19. ReSJ)()ndent made some notes in the DOHl'S folder, theh wrote

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    him prescriptions for Lortab 10/500, 150 tablets anp Soma. 3S0rr,g, 60

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    tablets.

20. On or about September 1, . 2010, the DOHI i, went to

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    Respondent's office and obtained a copy of his medical records. i

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21. In the DOHI's medical record, dated May 19, 2010, oh the first

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    page of the· document titled ''Initial Exam . and Pelin Assessm-mt Tool"

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      Respcndent indicated that the patient rated his pafn: as a "4" and that the

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      worst pain the patient gets is "9."

22. At no time did Respondent ask the DOHI .how he ra

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    his pain

    
    

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    or if he was in pain.

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23. In the DOHI's medical record, dated May 19, 2010, oh the first page of the document titled "Initial Exam and Pain Assessmqnt Tool" Respondent indicated that the DOHI's pulse was 72.

24. At no time during this Investigation did R'.espondent or ar'lyone

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else at the Respondent's office take the DOHI's pulse,! .

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32.. In the DOHI's medical record, dated Mar 19, 2010; on the

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second page of the "Initial Exam and Pain Assessmant Tool" d umemt

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Respondent Indicated "difficulty" for the "stance: heel, tiptoe tendoh walk."

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33. The OOHI did not perform a "heel, tip e tendon alk" for

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Respondent, on or about May 19, 2010.

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34; In the DOHI's medical record, dated May 19, 2010,i

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on the

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second page of the "Initial Exam and Pain Assessm nt Tool" dqcument

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Respondent indicated under the Range of Motion·, "well prese;rved'' for

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shoulders, elbows, wrists, hips, knees and ankles.

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35, Respondent did not perform range of 1T1@tlon tests qn one or

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more of the DOHI's body: shoulders, elbows, hip, khees or ankles on or about May 19, 2010.

1. In the DOHI's medical record, on the pr,gress note for July

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     27, 2010, Respondent indicated that the OOHI's besl!,!paln level during the

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     past month was a "2" and the worst pain level during! the past m nth was

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     a ''2."

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2. Respondent did not ask the DOHI how thei DOHI rated\ his pain

   . on or about July 27, 2010.

3. In the OOHI's medical record, on the progress notes for August

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   19, 2010, Respondent placed circles around the number 2 an circles

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   around the numbers 4, 5, and 6, In response to the question: "W;hat was your pain level at its best during the past month."

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4. Respondent did not ask the DOHI how he 1nated his paih, on or

   
   

   about August 19, 2010.

5. At no time did the Respondent diagnd$e the intractable pain.

   
   

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   DOlilI with

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6. At no time did the Respondent document :that the DO I had

   Intractable pain.

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7. At no time did the Respondent document the source r nature

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   of the·DOHI's pain.

   
   

8. At no time did the Respondent document current '1, or past

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   treatments for the DOHI's pain. ,,

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9. At no time did the Respondent document any unde lylng or

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   coexisting diseases or conditions of the OOHI.

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10. At no time did the Respondent document t e effect of fhe pain

    on physical and/or psychological function of the DOHJ.:·. \

11. At no time did the Respondent documer.t if there +as any history of substance abuse for the DOHI.

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    . 46. Petitioner re-alleges and incorporates paragraphs 1 thrqugh 45

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    as if fully set forth herein.

12. Section 458.33l(l)(nn), Florida Statutes (2()09-2010), Vides

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    that violating any provision of chapters 456 or 458, Floripa Statutes,1 or any

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    rules adopted pursuant thereto, ls grounds for disciplil1e by the Bqarcl of

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    Medicine.

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13. Section 458.326(3), Florida Statutes (200,9.\2010), pro lI des a

    
    

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    physician ·may prescribe or administer· any controlledI substance \ under Schedules II-V, as provided for in Section 893.03, Flori a Statutes (2009-

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    2010), to a person for the treatment of intractabl pain, proiided the

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    . physician does so in accordance with that level of ca e, skill and treatment recognized by a reasonably prudent physician under i,$imilar condi ions and circumstances

14. Respondent violated Section 458.331(1)(hn), Florida\ Statutes

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(2009 2010), when he violated Section 458.326(3) FIQrlda Statute\;, Florida

Statutes (2009·2010), in one or more of the following ways:

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1. by falling to diagnose the DOHI witH, !intractable qain;

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2. · by prescribing excessive narcotics tp the DOH!\ without

   , asking the DOHI If he was in pain; ·· 1

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3. , by prescribing controlled substance( ) to a peJon who did not have intractable pain. · \

so. Based on the foregoing, the Respondent: has violated! Section

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458.331(l)(nn), Florida Statutes (2009·2010), when ,he violated\ Section

458.326 Florida Statutes.

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CQONTJWQ

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1. Petitioner realleges and incorporates paragraphs 1 thrqugh 45

   as if fully set forth herein.

2. Section 458.331(1)(nn), Florida Statutes (2<)09·2010), rovides

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   that violating any. provision of chapters 456 or 458, Aorlda Statutes) or any

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   rules adopted pursuant thereto, is grounds for discli,line by the1,,Board of

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   Medicine.

   
   

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3. The Standards for the Use of Controllal Substance for the

   Treatment of Pain is found in Rule 64B8-9.013(3)(a); F.A.C., and\ provir:f,as

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   In part: 'i

   .. (3) Standards. The Board has adop d the follo1ng standards for the use of controlled substances for Piclin control: . · · :

   · (a) Evaluation of the Patient. A r\Jlplete med;I histo.ry ·•·.·.a.nd physical examinati.on must bei µ>. ndu¢ted nd

   docum•nted in the medical record. The Imedical rec·. rd

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   shord

   should document the nature and intensl of th.e in, current. and past treatments for pain. u,;nderlying or coexisting diseases or conditions, the e · of the p in on physical and psychological function, ,$nd history lof

   . substance abuse. The medical record, also document the presence of one or m recogni · medicaHndlcatlons for the use of a control substanc .

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4. Respondent violated Rule 64B8•9.013(3)(a), F.AiC., by

   prescribing controll.ed substances and failing to cdrltduct an atequate

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   evaluation and document one or more of the followtng:i ·.. I ·

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   1. the existence, nature or Intensity of the DOHrs purpo pain;

   2. ·current and past treatments for the DOHl' pain (oth r than

      
      

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      that the DOHI's had taken Lortab in the past); '

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   3. . the und rlying or coexisting diseases or>conditions pf the

      DOHI;

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      1. the effect of pain on the DOHI's physjcal or psy hologlcal

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         function;

      2. any history of substance abuse.

      
      

      
      

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5. Based on the forgoing, Respondent violfted 458.33 (l )( nn),

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   Florida Statutes (2009-2010), by violating Rule 6488-9.013(3)(al), F.A.C.,

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   when he failed to document the nature of the In, current ,nd past

   
   

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   treatments for pain, underlying or coexisting diseas¢.s or conditjons, the effect of the pain on physical and psychological fun ion, and istory of substance abuse.

   COUNT THREE

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6. Petltlon r re-alleges and incorporates paragraphs 1 through 45

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   as If fully set forth herein. ·,

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7. Section 458.331(1)(k), Florida Statutes (2¢109-2010), provides

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   that making deceptive, untrue, or fraudulent represen tions in o related

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   to the practice of medicine, constitutes grounds for c;ftsclplinary a on by

   the Board of Medicine.

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8. Respondent made untrue representations related to the 1practice

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   of medicine in one or more of the following ways: :

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   1. when, on or abOut May 19, 2010, Respon nt Indicated on the first page of the document titled "Initial Exam d Pain ssr:nent Tool" that the patient rated his pain as a "4" al"ld that the Ipatient

      
      

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      rated his war pain a "9" without asking for ;that informa ion from the DOHI; . , !

      
      

   2. when, on or about May 19, 2010, on tt,e first pa;:e of the document titled "Initial Exam and Pain Assessfllent Tool" Re pandeint

      indicated that the DOHI's pulse was 72 but:Respondent I had not

      taken the DOHI's pulse. ; 't

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   3. when, on or about May 19, 2010, on th second pa· e of the "Initial Exam and Pain Assessment Tool" · d*ument Re pandent indicated "difficulty" for the "stance: heel, tiPtt,e tendon all<" but Respondent did not ask the DOH! to perform t I! heel, ti tendon

      walk;

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      pa;

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   4. when, on or about May 19, 2010, on th 1 second of the

   "Inlti.al. Exam and Pain Assessment Tool" d .umment Re pori.den.t indicated under the Range of Motion, "well p ed" for II areas

   - listed; however, Respondent did not perform rattge of motior, test(s) on the DOHI; · ·, · : '.

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   · e) . when, on or about July 27, 2010, Respontnt indica on the

   . progress notes that the DOHI rated his pain pain rev I durlf1g

   · the past inonth as a "2" and the worst pain vel dutlng he past

   month as a "2" but did not ask for that informatipn from the OHI;

   f) when, on or about August 19, 2010, on\ e prog · r,otes,

   . Re. sponden·t, p.la.ced circles round the. number .· and circle's aro.und,·

   · the num rs 4, 5, and 6, in response to the qµestion _ "W at was

   yaur pain level at its best during the past month1ibut did not psk that question of the DOHI. · :

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9. Based on the foregoing, the Respondent nas violated \Section

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   458.331(1)(k), Florida Statutes (2009-2010), when•· he made I untrue

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   • representations related to the practice of medicine in the medical r cord of

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   the DOHI. i,

   
   

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   COUNT FOUR

10. Petitioner re-alleges and incorporates par$! g'· raphs 1 th loug: h 45

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    as if fully set forth herein. 1

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11. Section 458.331(1)(q), Florida Statutes (2©09·2010), s bjects:a

    licensee to discipline, Including suspension, for pra$cribing, disbensing,

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    administering, mixing, or otherwise preparing a legen drug, inclu lng any

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    controlled substance, other than In the course,

    , of the physician's

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    professional practice. For purposes of Section 458,l$1(1)(q), It hall be

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    legally presumed that prescribing, dispensing, admirtistering, mi ing, or

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    otherwise prepa'ring legend drugs, including all ca,l!ltrolled su nces,

    inappropriately or·1n excessive or inappropriate quantiti s is not In the best

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    interest of the patient and is not in the course:·, of the phtsiclan's

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    professional practice, without regard to his or her intent.

12. Respondent prescribed legend drugs otheF'. than in thJ course

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    of his professional practice by prescribing comtrolled. su nces

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    inappropriately or excessively in one or more of the follqwlng ways: I

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    1. by prescribing controlled substances base¢! on or rel,ted to

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       medical records that the Respondent crea and we not

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       substantiated by his interactions with the DOHI; 1

    2. by prescribing controlled substances to th DOHI wit ut.ani adequate physical examinatipn;

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    1. by prescribing controlled substances to, the DOHl r1thout a

       
       

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       {lledical diagnosis; '1

    2. by prescribing controlled substances ti)> the

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       ooHiI

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       without

       adequate medical justification;

    3. · by •• prescribing controlled substancesi · without

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       existance, nature or intensity of the DOHI's pain

       
       

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       isoussi'ng

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    4. by prescribing controlled subStances without disc ssing or

       
       

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       attempting alternative pain management modall es. 1

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    5. by increasing the DOHI's prescription of!iLortab, on I about

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    August 18, 2010, without medical justification!pr inquiring\ whether

    the DOHI was abusing or diverting the prescri medication\.

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13. Based on the foregoing, the Respondent has violated! Section

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458.331(1)(q), Florida Statutes (2009·2010), for presq:ijlbing a legeh! d' drug: ,

including any controlled substance, other than in Jthe course\

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physician's professional practice.

of the

. WHEREFORE, the Petitioner respec;:tfully reque that the rd af

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Medicine enter an order imposing one or more of thel_ following nalties: permanent revoaitton or suspension of Respandent's. H nse, restriftiori of practice, imposition of an administrative fine, issuantie of a rep imand,

placement of the Respondent on probation, correctlV1$ action, ref1und of

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fees billed or collected, remedial education and/or any other relie that the

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Board deems appropriate. !

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SIGNED this. &day of.,...--=CJ,l.,Q,f+h-"--11 - -.....1• 2q10.

!

Ana M. Viamonte s, M.D., M.R.H

State Surgeon Gen ral ! .

       0 04 .. ·· ¢W ; .,: i I ,,

FILED

DEPARTMENT OF HEALTH 0EPIJTV CLEltK

CLERK Angel Simders

DATE \O· \5·/D

SLB/

PCP Date: October 15, 2010

...Shirley L. Bates · •' · J7,_ Assistant General Qtj>unsel i DOH Prosecution rvices Unit I 4052 Bald Cypress ay, BIN C-65 Tallahassee, FL 32 99-3265 I Florida Bar #946311! · (850) 245-4640 VdllCE

(850) 245-4681 FA)(.]

PCP Members: · ·

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NOTICE OF RIGHTS

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R•!iiPf)ndent has the right to request :' ,,a hearingI

to'

b' e

conducted in accordance with Sectlo'1 12015 69 and 120.517,

Florida Statut,s, to be represented by counset or other ilalified

· representative, to present evidence and arg.,nent, to II and cro•-examlne witnesses and to have sub ,na and s bpoena duces tecum issued on his or her behalf if a heal lng Is raq•ste1d.:

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NOflCE REGARDING ASSESSMENT <>If COSTS . i

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Resp·o.·ndent.. is 1:11aced on notice that. .:·•.,na.r hu, l c,.rr$1 costs related to the ,r,vestlgatlon and prosecu n of.this matter. Pursuant to Sect...•Ion 456.072(4), Florida StatutWs., '.th Boa ',sh•II assess costs related to the investigation an I, prosecutl n , of !a

disdplinary ma,.tee.r, which may include attom .ho.urs •n q,sts,

on the Respondent in addition to any other di ·. · line lmpo .

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l>OH v Ataur Rahman, M,D,, Case # 20ij0-07365

J:\PSU\Medic:al\Bltes Shltley\Rahman\AC 10.8.10,docm 16

Docket for Case No: 12-000700PL