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.
At all times material to this Complaint, Respondent was a
licensed physician within the State of Florida, having been issued license number ME 86117.
The Respondent's address of record is 6788 NW 117th Avenue Parkland, Florida 33076.
Cynthia M. Cadet, M.D.; 2009-15100
Filed March 15, 2012 11:19 AM Division of Administrative Hearings
The Respondent is board certified by the American Board of Emergency Medicine.
Roxicodone® is the brand name for oxycodone hydrochloride.
According to Section 893.03(2), Florida Statutes, 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.
Xanax® is the brand name for alprazolam and is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, 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.
Soma® is the brand name for carisoprodol, a muscle relaxant commonly prescribed to treat muscular pain. According to Section 893.03(4), Florida Statutes, carisoprodol is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the
Cynthia M. Cadet, M.O.; 2009-15100 2
United States. Abuse of carisoprodol may lead to limited physical or psychological dependence relative to the substances in Schedule III.
On or about March 25, 2009, Patient TG presented to Respondent for follow up at the pain management clinic where Respondent was employed.
On or about March 25, 2009, Respondent inappropriately and excessively prescribed Roxicodone® 30mg 180 pills, Soma® 350mg 60 pills, and Xanax® 2mg 60 pills, to Patient TG in potentially lethal combination and doses, without medical justification or without documenting medical justification.
On or about March 25, 2009, Respondent did not make an appropriate assessment or diagnosis of Patient TG prior to prescribing controlled substances to Patient TG or did not document an appropriate assessment or diagnosis.
On or about March 25, 2009, Respondent did not develop an appropriate treatment plan prior to prescribing controlled substances to Patient TG or did not document an appropriate treatment plan for Patient TG.
On or about March 25, 2009, Respondent did not obtain an adequate medical history from Patient TG prior to prescribing controlled
substances to Patient TG or did not document obtaining an adequate
Cynthia M. Cadet, M.D.; 2009 · 15100 3
medical history.
On or about March 25, 2009, Respondent did not verify Patient TG's prior prescription history prior to prescribing controlled substances to Patient TG.
On or about March 25, 2009, Respondent did not obtain records from prior treating physicians.
On or about March 25, 2009, Respondent did not diagnose Patient TG with intractable pain prior to prescribing controlled substances to Patient TG or did not document a diagnosis of intractable pain.
Section 458.326 Florida Statutes, (2008), titled Intractable pain; authorized treatment, provides in part:
For the purposes of this section, the term "intractable pain" means pain for which, In the generally accepted course of medical practice, the cause cannot be removed and otherwise treated.
Intractable pain must be diagnosed by a physician licensed under this chapter and qualified by experience to render such diagnosis.
Notwithstanding any other provision of law, a physician
may prescribe or administer any controlled substance under
Schedules rr-v, as provided for in s. 893.03, to a person for the treatment of intractable pain, provided the physician does so in
accordance with that level of care, skill, and treatment recognized by a reasonably prudent physician under similar conditions and circumstances.
Cynthia M. cadet, M.D.; 2009-15100 4
COUNT ONE
Petitioner re-alleges paragraphs 1 through 16 as if fully set forth herein.
Section 458.331(1)(nn), Florida Statutes (2008), provides that violating any provision of chapters 456 or 458, Florida Statutes, or any rules adopted pursuant thereto, is grounds for discipline by the Board of Medicine.
Respondent violated Section 458.331(1)(nn), Florida Statutes (2008), when she violated Section 458.326(3) Florida Statutes (2008), in one or more of the following ways:
By falling to diagnose Patient TG with Intractable pain;
By inappropriately and excessively prescribing controlled substances in potentially lethal combinations and doses, to Patient TG, without medical justification as described In paragraph 9;
By failing to make an appropriate assessment or
diagnosis of Patient TG prior to prescribing the controlled substances to Patient TG as described In paragraph 9;
Cynthia M. Cadet, M.D.; 2009-15100 5
By failing to develop an appropriate treatment plan prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
By failing to obtain an adequate medical history from Patient TG prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
By failing to verify Patient TG's prior prescription history
prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
By failing to obtain records from prior treating physicians.
Based on the foregoing, Respondent violated Section 458.331(1)(nn) when she violated Section 458.326 Florida Statutes as alleged in paragraph 19.
COUNTTWO
Petitioner re-alleges paragraphs 1 through 16 as if fully set forth herein.
Section 458.331(1)(t), Florida Statutes (2008), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50, Florida Statutes (2008), defines medical malpractice as the failure to practice medicine in
Cynthia M. Cadet, M.D.; 2009-15100 6
accordance with the level of care, skill, and treatment recognized in general law related to health care licensure.
For purposes of Section 458.331(1)(t), Florida Statutes (2008), the Board shall give great weight to the provisions of Section 766.102, Florida Statutes (2008), which provide that 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.
Respondent failed to meet the required standard of care, in regards to TG, in one or more of the following ways:
By inappropriately and excessively prescribing controlled substances in potentially lethal combinations and doses, to Patient TG, without medical justification as described In paragraph 9;
By failing to make an appropriate assessment or diagnosis of Patient TG prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
Cynthia M. Cadet, M.D.; 2009-15100 7
By failing to develop an appropriate treatment plan prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
By failing to obtain an adequate medical history from Patient TG prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
By failing to verify Patient TG's prior prescription history prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
By failing to obtain records from prior treating physicians.
Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes, by failing to meet the required standard of care with regard to Patient TG.
COUNT THREE
Petitioner re-alleges paragraphs 1 through 16 as if fully set forth herein.
Section 458.331(1)(q), Florida Statutes (2008) subjects a
licensee to discipline for prescribing controlled substances inappropriately or in excessive or inappropriate quantities.
Cynthia M. Cadet, M.D.; 2009-15100 8
Respondent prescribed controlled substances other than in the course of her professional practice by prescribing controlled substances inappropriately or excessively in one or more of the following ways:
By inappropriately and excessively prescribing controlled substances in potentially lethal combinations and doses, to Patient TG, without medical justification as described in paragraph 9;
By failing to make an appropriate assessment or diagnosis of Patient TG prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
By failing to develop an appropriate treatment plan prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
By failing to obtain an adequate medical history from Patient TG prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
By failing to verify Patient TG's prior prescription history prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
Cynthia M. cadet, M.D.; 2009-15100 9
Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes, by inappropriately or excessively prescribing potentially lethal, highly abused, controlled substances to M.G.
COUNT FOUR
Petitioner re-alleges paragraphs 1 through 16 as if fully set forth herein.
Section 458.331(1)(m), Florida Statutes (2008) provides:
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 and a violation thereof constitutes grounds for disciplinary action by the Board.
Respondent failed to keep legible medical records justifying the course of treatment for TG in one or more of the followlng ways:
Cynthia M. cadet, M.D.; 2009-15100
By failing to document a diagnosis of intractable pain for Patient TG;
By failing to document medical justification for prescribing the controlled substances in the combinations and doses as described in paragraph 9 to Patient TG; -
By failing document an appropriate assessment or diagnosis of Patient TG prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
By falling to document an appropriate treatment plan for Patient TG prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
By failing to document obtaining an adequate medical history from Patient TG prior to prescribing the controlled substances to Patient TG as described in paragraph 9;
By failing to document verification of Patient TG's prior
prescription history prior to prescribing the controlled substances to Patient TG as described in paragraph 9.
Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes, by falling to keep legible medical records
that justified the course of treatment for TG.
H. Frank Farmer, Jr., MD, PhD, FACP State Surgeon General
Respondent has the right to request a hearing to be conducted in accordance with Section· 1 20.569 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.
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.
