STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO. 2011-17168 BASIM IBRAHIM ELHABASHY, M.D., RESPONDENT. / ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Medicine against the Respondent, Basim Ibrahim Elhabashy, M.D., and in support thereof alleges: 1. Petitioner is the state agency 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 94356. DOH v. Basim Ibrahim Elhabashy, M.D. DOH Case Number 2011-17168 Filed July 13, 2012 2:48 PM Division of Administrative Hearings 3. | Respondent's address of record is 2230 West Atlantic Avenue, Delray Beach, Florida, 33445. 4. At all times relevant to this Complaint, Dr. Elhabashy practiced medicine at Peace of Mind Lab and Pain Clinic, a pain management clinic located in Delray Beach, Florida (the “Clinic”). 5. | While practicing at the Clinic, Dr. Elhabashy treated multiple patients with extremely high doses of controlled substances without medical justification for doing so. 6. In October 2011, the Department commenced an investigation of Dr. Elhabashy based upon information received from the Palm Beach County Sheriff's Department indicating that Dr. Elhabashy may have _ been inappropriately prescribing controlled substances. 7. As part of its investigation, the Department obtained patient records for five separate patients (hereafter identified as “RW,” “TB,” “SG,” “PB,” and “PH"”) treated by Dr. Elhabashy at the Clinic. In treating these patients, Dr. Elhabashy prescribed: Roxicodone, Oxycontin, Percocet, Dilaudid, Xanax, Flexeril, Mobic, Motrin, Amoxicillin, Azithromycin, Keflex and Morphine. 8. _Roxicodone is a brand name for Oxycodone. Roxicodone is commonly prescribed to treat pain. According to Section 893.03(2), Florida DOH v. Basim Ibrahim Elhabashy, M.D. 2 DOH Case Number 2011-17168 Statutes (2011), Roxicodone 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 Roxicodone may lead to severe psychological or physical dependence. Roxicodone is an opioid. 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. 9. Percocet is the brand name for a drug that contains oxycodone and is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, Percocet 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. 10. Oxycontin is the brand name for a drug that contains oxycodone hydrochloride and is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, Oxycontin 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. DOH v. Basim Ibrahim Elhabashy, M.D. 3 DOH Case Number 2011-17168 11. Dilaudid is the brand name for hydromorphone and is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, Dilaudid 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 Dilaudid may lead to severe psychological or physical dependence. Dilaudid is an opioid. 12. Xanax is the brand name of alprazolam. Xanax is used to treat anxiety disorders, panic disorders, and anxiety caused by depression. According to Section 893.03(4), Florida Statutes (2011), Xanax 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 Xanax may lead to limited physical or psychological dependence relative to the substances in Schedule III. 13. Flexeril is the brand name for cyclobenzaprine. Flexeril is a muscle relaxant used to treat pain from skeletal muscle conditions or injury. 14. Mobic is the brand name of meloxicam. Mobic is a nonsteroidal anti- inflammatory drug (NSAID) commonly used to treat pain and inflammation. DOH v. Basim Ibrahim Elhabashy, M.D. 4 DOH Case Number 2011-17168 15. Motrin is a brand name of ibuprofen. Motrin is a nonsteroidal anti- inflammatory drug (NSAID) commonly used to reduce fever and treat pain or inflammation. 16. Amoxicillin is a penicillin antibiotic. Amoxicillin is used to treat infections caused by bacteria. 17. Azithromycin is an antibiotic used to treat infections caused by bacteria. 18. Keflex is a brand name for cephalorsporin. Cephalosporin is an antibiotic used to treat infections caused by bacteria. 19. Morphine is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, morphine 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. 20. According to U.S. Drug Enforcement Agency statistics, Dr. Elhabashy was the 48" largest purchaser of Oxycodone in the United States in 2010. Dr. Elhabashy purchased 283,220 units of Oxycodone in 2010; an average 776 units per day. Facts specific to Patient RW DOH v. Basim Ibrahim Elhabashy, M.D. 5 DOH Case Number 2011-17168 21. On July 28, 2010, RW, a 34 year-old white male first presented to Dr. Elhabashy. The patient record indicates that RW had previously received treatment from Dr. A.T. on June 23, 2010 at another Peace of Mind Lab and Pain Clinic located in Deerfield, Florida. The patient record, however, contains no initial evaluation notes by Dr. A.T. or Dr. Elhabashy. None of the nine “Follow Up Visit” forms completed by Dr. Elhabashy in the patient record contain a diagnosis or description of RW’s chief complaint. 22. In total, RW presented to Dr. Elhabashy nine times between July 2010 and April 2011. In each case, the patient record reflects Dr. Elhabashy performed a cursory examination of the patient. Dr. Elhabashy’s cursory physical examinations of RW were documented by checking exam parameters on a pre-printed form. No substantive examination notes were made by Dr. Elhabashy during the course of any of RW’s visits. 23. Upon the conclusion of each follow up visit, Dr. Elhabashy prescribed a variety of medications which consistently included large quantities of opiates and Xanax. The medications prescribed by Dr. Elhabashy to RW are set forth below. DOH v. Basim Ibrahim Elhabashy, M.D. 6 DOH Case Number 2011-17168 a. — July 28, 2010 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone, 60 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg; b. August 24, 2010 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone, 60 dosage units of Percocet 10/325 mg, and 30 dosage units of Flexeril 10 mg; c. | September 24, 2010 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone, 60 dosage units of Percocet 10/325 mg, and 20 dosage units of Motrin 800 mg; d. October 20, 2010 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone, 60 dosage units of Percocet 10/325 mg, and 20 dosage units of Motrin 800 mg; e. December 27, 2010 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone, 40 dosage units of Dilaudid 4 mg, 10 dosage units of Motrin 800 mg, and 30 dosage units of Amoxicillin 500 mg; f. January 22, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone, 45 dosage units of Dilaudid 4 mg, 30 dosage units of Motrin 800 mg, and 5 dosage units of Azithromycin 500 mg; DOH v. Basim Ibrahim Elhabashy, M.D. 7 DOH Case Number 2011-17168 g. February 21, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone, 60 dosage units of Dilaudid 4 mg, 20 dosage units of Flexeril 10 mg, and 30 dosage units of Mobic 7.5 mg; h. March 22, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone, 45 dosage units of Dilaudid 4 mg, and 20 dosage units of Flexeril 10 mg; and i. April 18, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone, 45 dosage units of Dilaudid 4 mg, 30 dosage units of Flexeril 10 mg, 10 dosage units of Motrin 800 mg, and 30 dosage units of Keflex 500 mg. 24. Dr. Elhabashy did not include additional handwritten remarks on any of the Follow Up Visit forms for the above-referenced dates. 25. Dr. Elhabashy discharged RW on May 14, 2011. In discharging RW, Dr. Elhabashy cited the fact that the patient “Refused to get another MRI.” The patient record reveals that Dr. Elhabashy treated RW for more than 8 months before prescribing a lumbar spine MRI to diagnose back pain. 26. The patient record for RW contained no confirmation of previous treatment other than a single lumbar spine Magnetic Resonance Imaging DOH v. Basim Ibrahim Elhabashy, M.D. 8 DOH Case Number 2011-17168 (“MRI”) report dated January 29, 2008, and a medication log for the period from February 2008 through May 2008. 27. The patient records indicate the administration of only one drug screening during Dr. Elhabashy’s treatment of RW A urine drug screening report dated March 22, 2011, indicated a positive result for morphine. This drug screening occurred nearly eight months after RW first presented to Dr. Elhabashy. Although Dr. Elhabashy had not prescribed morphine to RW during this period, the patient record reflected no action or explanation concerning this discrepancy. Facts Specific to Patient TB 28. On April 23, 2010, TB, a 30 year-old male, first presented to Dr. Elhabashy. TB complained of middle and lower back pain stemming from a fall from a building three years earlier. Dr. Elhabashy indicated a diagnosis of a herniated disc at the T10-11 level with “impingement.” The patient record included lumbar spine MRI report dated May 29, 2008, a lumbar spine MRI report dated March 12, 2010, and a prescription profile from September and October 2009. At the conclusion of this visit, Dr. Elhabashy prescribed 60 dosage units of Xanax 2 mg and 200 dosage units of Roxicodone 30 mg. DOH v. Basim Ibrahim Elhabashy, M.D. 9 DOH Case Number 2011-17168 29. In total, TB presented to Dr. Elhabashy 17 times for follow up visits between May 2010 and November 2011. In each case, the patient record reflects Dr. Elhabashy performed a cursory examination of the patient. Dr. Elhabashy’s cursory physical examinations of TB were documented by checking exam parameters on a pre-printed form. No substantive examination notes were made by Dr. Elhabashy during the course of any of TB’s visits. 30. Upon the conclusion of each follow up visit, Dr. Elhabashy prescribed a variety of medications which consistently included large quantities of opiates and Xanax. The medications prescribed by Dr. Elhabashy to TB, as well as a description of any written comments included on the patient notes, if any, are set forth below: a. May 21, 2010 -- 60 dosage units of Xanax 2 mg and 200 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” b. June 29, 2010 -- 60 dosage units of Xanax 2 mg and 180 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” DOH v. Basim Ibrahim Elhabashy, M.D. 10 DOH Case Number 2011-17168 c. August 9, 2010 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 45 dosage units of Percocet 10/325 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” d. September 8, 2010 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 45 dosage units of Percocet 10/325 mg, and 30 dosage units of Mobic 15 mg; e. October 4, 2010 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 45 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. The foregoing prescriptions, however, were dated October 5, 2010. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” f. November 12, 2010 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 45 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” g. | December 8, 2010 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 30 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” DOH v. Basim Ibrahim Elhabashy, M.D. 1 1 DOH Case Number 2011-17168 h. January 6, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 45 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg; i. February 2, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 45 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg; j. March 9, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 45 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg; k. March 29, 2011 -- Dr. Elhabashy prescribed a lumbar spine MRI to diagnose back pain. There are no patient notes for this date and no indication in the patient record that TB subsequently underwent a lumbar spine MRI; April 5, 2011-- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 45 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy noted that TB’s blood pressure was elevated because “he just had a long walk for 2 miles;” DOH v. Basim Ibrahim Elhabashy, M.D. 12 DOH Case Number 2011-17168 m. May 4, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 45 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy noted that follow up would be required because TB’s blood pressure was still elevated; n. July 11, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 30 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy noted that TB’s blood pressure was “better than last month.” The patient record, however, contains no follow visit notes for the previous month, June 2011; o. August 10, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 30 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy included a handwritten note concerning TB’s “rt A/C joint separation” but no mention of the fact that TB’s blood pressure was 147/97 mm Hg versus 130/90 mm Hg the previous month; p. September 8, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 45 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg; DOH v. Basim Ibrahim Elhabashy, M.D. 13 DOH Case Number 2011-17168 q. October 4, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 45 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. The foregoing prescriptions, however, were dated October 6, 2011. Dr. Elhabashy noted “L1-5” tenderness and included a brief written observation concerning TB’s muscle tone; and r. November 5, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 45 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. The foregoing prescriptions, however, were dated November 4, 2011. Dr. Elhabashy noted “T12- L3” tenderness and included a brief written observation concerning TB’s muscle tone. 31. The patient record contains one drug screening report dated November 12, 2010. That drug screening revealed a positive result for tetrahydrocannabinol (THC). There is no explanation or documentation concerning any action taken by Dr. Elhabashy concerning the positive result for THC. 32. THC is the psychoactive ingredient in marijuana, or cannabis. According to Section 893.03(1), Florida Statutes, THC is a Schedule I controlled DOH v. Basim Ibrahim Elhabashy, M.D. 14 DOH Case Number 2011-17168 substance that has a high potential for abuse and has no currently accepted medical use in treatment in Florida. Facts Specific to Patient SG 33. On May 3, 2011, SG, a 28 year-old male, first presented to Dr. Elhabashy. SG complained of lower back and left leg pain resulting from an automobile accident in 2005. The exam notes indicate a herniated disc at the L5-S1 level “encroaching on the S1 nerve.” The patient record contained a lumbar spine MRI report dated September 14, 2010, and a prescription record from January 2011 through March 2011. At the conclusion of this visit, Dr. Elhabashy prescribed 30 dosage units of Xanax 2 mg, 120 dosage units of Roxicodone 30 mg, 60 dosage units of Roxicodone 15 mg, and 30 dosage units of Motrin 800 mg. 34. In total, SG presented to Dr. Elhabashy 5 times for follow up visits between July 2011 and December 2011. In each case, the patient record reflects Dr. Elhabashy performed a cursory examination of the patient. Dr. Elhabashy’s cursory physical examinations of SG were documented by checking exam parameters on a pre-printed form. No substantive examination notes were made by Dr. Elhabashy during the course of any of SG’s visits. DOH v. Basim Ibrahim Elhabashy, M.D. 15 DOH Case Number 2011-17168 35. Upon the conclusion of each follow up visit, Dr. Elhabashy prescribed a variety of medications which consistently included large quantities of opiates and Xanax. The medications prescribed by Dr. Elhabashy to SG, as well as a description of any written comments included on the patient notes, if any, are set forth below: a. July 15, 2011 -- 30 dosage units of Xanax 2 mg, 120 dosage units of Roxicodone 30 mg, 60 dosage units of Roxicodone 15 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy noted that SG had left town due to his mother’s death; b. September 5, 2011 -- 30 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy included handwritten notes referencing his instructions for SG to monitor his blood pressure; c. October 4, 2011 -- 30 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Motrin 800 mg; d. November 2, 2011 -- 30 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy noted that he would continue to follow up on SG’s blood pressure; and DOH v. Basim Ibrahim Elhabashy, M.D. 16 DOH Case Number 2011-17168 e. December 3, 2011 -- 30 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy again noted that he would continue to follow up on SG's blood pressure. 36. The patient record contains two drug screening reports for the period during which Dr. Elhabashy treated SG dated May 3, 2011, and July 15, 2011. Each report indicated a negative result for benzodiazepines. Despite SG’s history of being prescribed Xanax, the patient record shows no explanation or action by Dr. Elhabashy to follow up on SG’s compliance. Facts Specific to PB 37. On April 26, 2011, PB, a 34 year-old female, first presented to Dr. Elhabashy. PB complained of lower back and leg pain resulting from an automobile accident in 2009. The exam notes indicate a herniated disc at the L4-L5 level. The patient record contained a lumbar spine MRI report dated January 6, 2011, and a prescription record from February and March 2011. At the conclusion of this visit, Dr. Elhabashy prescribed 30 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 30 dosage units of Flexeril 10 mg, and 30 dosage units of Mobic 7.5 mg. DOH v. Basim Ibrahim Elhabashy, M.D. 17 DOH Case Number 2011-17168 38. In total, PB presented to Dr. Elhabashy four (4) times for follow up visits between May 2011 and August 2011. In each case, the patient record reflects Dr. Elhabashy performed a cursory examination of the patient. Dr. Elhabashy’s cursory physical examinations of PB were documented by checking exam parameters on a pre-printed form. No substantive examination notes were made by Dr. Elhabashy during the course of any of PB's visits. 39. Upon the conclusion of each follow up visit, Dr. Elhabashy prescribed a variety of medications which consistently included large quantities of opiates and Xanax. The medications prescribed by Dr. Elhabashy to PB, as well as a description of any written comments included on the patient notes, if any, are set forth below: a. May 25, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Mobic 7.5 mg; b. June 22, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Mobic 7.5 mg; c. July 20, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Motrin 800 mg; and d. August 19, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Motrin 800 mg. DOH v. Basim Ibrahim Elhabashy, M.D. 18 DOH Case Number 2011-17168 40. The patient record contains two drug screening reports for the period during which Dr. Elhabashy treated PB dated April 26, 2011, and June 22, 2011. Each report indicated a negative result for benzodiazepines. The June 22, 2011, report indicated a positive result for morphine. Despite the fact that these results were discordant with PB’s prescription history, the patient record shows no explanation or action by Dr. Elhabashy to follow up on PB’s compliance. Facts Specific to Patient PH 41. On June 26, 2008, PH, a 58 year-old female, first presented to Dr. Elhabashy. PH complained of lower back, neck, shoulder, and arm pain resulting from a work related accident in 2001. The exam notes indicated an unspecified cervical disc disorder with an additional handwritten notation indicating degenerative disc disease, spondylosis, and neural foraminal narrowing at the C3 through C6 levels. The patient record contained a cervical spine MRI report from May 2001, a normal thoracic spine MRI report from May 2001, a copy of a neurosurgery consult from January 2002, a cervical spine plain film report from June 22, 2008, a bone scan report from October 2009, and prescription records from April and May 2008. At the conclusion of this visit, Dr. Elhabashy DOH v. Basim Ibrahim Elhabashy, M.D. 19 DOH Case Number 2011-17168 prescribed 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Mobic 7.5 mg. 42. In total, PH presented to Dr. Elhabashy 40 times for follow up visits between July 2008 and November 2011. In each case, the patient record reflects Dr. Elhabashy performed a cursory examination of the patient. Dr. Elhabashy’s cursory physical examinations of PH were documented by checking exam parameters on a pre-printed form. No substantive examination notes were made by Dr. Elhabashy during the course of any of PH’s visits. 43. Upon the conclusion of each follow up visit, Dr. Elhabashy prescribed a variety of medications which consistently included large quantities of opiates and Xanax. The medications prescribed by Dr. Elhabashy to PH, as well as a description of any written comments included on the patient notes, if any, are set forth below: a. — July 25, 2008 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Mobic 7.5 mg. Dr. Elhabashy’s handwritten remarks consisted only of “good pain control;” b. August 22, 2008 -- 60 dosage units of Xanax 2 mg, 220 dosage units of Roxicodone 30 mg, and 30 dosage units of Mobic 7.5 mg. DOH v. Basim Ibrahim Elhabashy, M.D. 20 DOH Case Number 2011-17168 Dr. Elhabashy’s handwritten remarks consisted only of “pain score 4- 5;” c. September 19, 2008 -- 60 dosage units of Xanax 2 mg, 200 dosage units of Roxicodone 30 mg, and 30 dosage units of Mobic 7.5 mg. Dr. Elhabashy’s handwritten remarks consisted only of “doing fine;” d. October 17, 2008 -- 60 dosage units of Xanax 2 mg, 200 dosage units of Roxicodone 30 mg, and 30 dosage units of Mobic 7.5 mg. Dr. Elhabashy’s handwritten remarks consisted only of “doing ok;” e. | November 14, 2008 -- 60 dosage units of Xanax 2 mg, 200 dosage units of Roxicodone 30 mg, and 30 dosage units of Mobic 7.5 mg. Dr. Elhabashy’s handwritten remarks consisted only of “doing ok;” f. December 12, 2008 -- 60 dosage units of Xanax 2 mg, 200 dosage units of Roxicodone 30 mg, and 30 dosage units of Mobic 7.5 mg. Dr. Elhabashy’s handwritten remarks consisted only of “doing ok;” g. January 9, 2009 -- 60 dosage units of Xanax 2 mg, 200 dosage units of Roxicodone 30 mg, and 30 dosage units of Mobic 7.5 mg. Dr. Elhabashy's handwritten remarks consisted only of “doing ok;” DOH v. Basim Ibrahim Elhabashy, M.D. 1 DOH Case Number 2011-17168 h. February 6, 2009 -- 60 dosage units of Xanax 2 mg and 200 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” i. March 6, 2009 -- 60 dosage units of Xanax 2 mg, 200 dosage units of Roxicodone 30 mg, and 60 dosage units of Percocet 10/325 mg. Dr. Elhabashy's handwritten remarks consisted only of “ok;” j. March 17, 2009 -- 100 dosage units of Roxicodone 15 mg and 100 dosage units of Oxycontin 40 mg. The patient record contains no documentation of a follow up visit on March 17, 2009; k. April 7, 2009 -- 60 dosage units of Xanax 2 mg and 200 dosage units of Roxicodone 30 mg. Dr. Elhabashy's handwritten remarks consisted only of “ok” and “pt quite” [sic] in reference to smoking; May 2, 2009 -- 60 dosage units of Xanax 2 mg and 200 dosage units of Roxicodone 30 mg. Dr. Elhabashy's handwritten remarks consisted only of “ok;” m. May 29, 2009 -- 60 dosage units of Xanax 2 mg and 200 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” DOH v. Basim Ibrahim Elhabashy, M.D. 22 DOH Case Number 2011-17168 n. June 25, 2009 -- 60 dosage units of Xanax 2 mg and 200 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” o. July 23, 2009 -- 300 dosage units of Roxicodone 30 mg. Dr. Elhabashy‘s handwritten remarks consisted only of “ok;” p. August 19, 2009 -- 60 dosage units of Xanax 2 mg and 220 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” q. September 16, 2009 -- 60 dosage units of Xanax 2 mg and 240 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” r. October 13, 2009 -- 60 dosage units of Xanax 2 mg and 240 dosage units of Roxicodone 30 mg. Dr. Elhabashy's handwritten remarks consisted only of “ok;” S. November 10, 2009 -- 60 dosage units of Xanax 2 mg and 240 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” DOH v. Basim Ibrahim Elhabashy, M.D. 23 DOH Case Number 2011-17168 t. December 8, 2009 -- 60 dosage units of Xanax 2 mg and 240 dosage units of Roxicodone 30 mg. Dr. Elhabashy's handwritten remarks consisted only of “ok;” u. January 5, 2010 -- 60 dosage units of Xanax 2 mg and 240 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” v. February 2, 2010 -- 60 dosage units of Xanax 2 mg and 240 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” w. February 27, 2010 -- 60 dosage units of Xanax 2 mg and 240 dosage units of Roxicodone 30 mg. Dr. Elhabashy's handwritten remarks consisted only of “ok;” x. March 27, 2010 -- 60 dosage units of Xanax 2 mg and 240 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” y. April 24, 2010 -- 60 dosage units of Xanax 2 mg and 240 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” DOH v. Basim Ibrahim Elhabashy, M.D. 24 DOH Case Number 2011-17168 aa. bb. cc. dd. ee. ff. May 22, 2010 -- 60 dosage units of Xanax 2 mg and 240 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” June 21, 2010 -- 60 dosage units of Xanax 2 mg and 240 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” July 20, 2010 -- 60 dosage units of Xanax 2 mg and 180 dosage units of Roxicodone 30 mg. Dr. Elhabashy’s handwritten remarks consisted only of “ok;” October 7, 2010 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Mobic 7.5 mg. Dr. Elhabashy's handwritten remarks consisted only of “ok;” November 4, 2010 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Mobic 7.5 mg; December 3, 2010 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Motrin 800 mg; January 7, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Motrin 800 mg; DOH v. Basim Ibrahim Elhabashy, M.D. 25 DOH Case Number 2011-17168 gg. February 7, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, and 30 dosage units of Motrin 800 mg; hh. March 8, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 30 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg; ii. | April 4, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 30 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy also prescribed a cervical spine MRI to diagnose neck pain. There is no indication in the patient record that PH subsequently underwent a cervical spine MRI; jj. May 23, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 30 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy also prescribed a lumbar spine MRI to diagnose back pain. There is no indication in the patient record that PH subsequently underwent a lumbar spine MRI; kk. June 20, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 30 dosage units of Percocet 10/325 mg, and DOH v. Basim Ibrahim Elhabashy, M.D. 26 DOH Case Number 2011-17168 30 dosage units of Motrin 800 mg. Dr. Elhabashy noted “mild L4-5” tenderness and included a brief written observation concerning PH’s muscle tone; ll. July 19, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 30 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy included a brief written observation concerning PH’s muscle tone; mm. August 16, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, Dr. Elhabashy noted “mild L1-2” tenderness and included a brief written observation concerning PH’s muscle tone; nn. October 4, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 30 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy noted “mild L1-5” tenderness and included a brief written observation concerning PH’s muscle tone; and 00. November 2, 2011 -- 60 dosage units of Xanax 2 mg, 180 dosage units of Roxicodone 30 mg, 60 dosage units of Percocet 10/325 mg, and 30 dosage units of Motrin 800 mg. Dr. Elhabashy noted “mild DOH v. Basim Ibrahim Elhabashy, M.D. 27 DOH Case Number 2011-17168 L1-3” tenderness and included a brief written observation concerning PH’s muscle tone. 44. The patient record contains no drug screening reports for PH. COUNT ONE 45. Petitioner realleges and incorporates Paragraphs one (1) through forty-four (44), as if fully set forth herein. 46. Section 458.331(1)(t)1., Florida Statutes (2011), subjects a physician to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes, and shall give great weight to the provisions of Section 766.102, Florida Statutes. 47. “Medical malpractice” is defined by Section 456.50(1)(g), Florida Statutes (2010-2011), 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(1)(e), Florida Statutes (2010-2011), 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, Florida Statutes, 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 DOH v. Basim Ibrahim Elhabashy, M.D. 28 DOH Case Number 2011-17168 acceptable and appropriate by reasonably prudent similar health care providers. 48. Respondent failed to meet the prevailing standard of care in one or more of the following ways: a. _ By prescribing excessive or inappropriate quantities and doses of controlled substances to Patients RW, TB, SG, PB and/or PH; b. By prescribing excessive or inappropriate quantities of controlled substances to Patients RW, TB, SG, PB and/or PH, without justification; and/or Cc. By prescribing excessive or inappropriate quantities and doses of controlled substances to Patients RW, TB, SG, PB and/or PH, without performing an adequate evaluation. 49. Based on the foregoing, Respondent has violated Section 458.331(1)(t)1., Florida Statutes (2011), by committing medical malpractice. COUNT TWO 50. Petitioner realleges and incorporates Paragraphs one (1) through forty-four (44), as if fully set forth herein. 51. Section 458.331(1)(q), Florida Statutes (2011), allows the Board of Medicine to discipline a physician for prescribing, dispensing, administering, mixing or otherwise preparing a legend drug, including any controlled DOH v. Basim Ibrahim Elhabashy, M.D. 29 DOH Case Number 2011-17168 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. 52. Respondent violated Section 458.331(1)(q), Florida Statutes (2011), by prescribing excessive or inappropriate quantities and doses of controlled substances to Patients RW, TB, SG, PB and/or PH. 53. Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (2011), by _ prescribing excessive or inappropriate quantities and doses of controlled substances. COUNT THREE 54. Petitioner realleges and incorporates Paragraphs one (1) through forty-four (44), as if fully set forth herein. 55. Section 458.331(1)(nn), Florida Statutes (2011), allows the Board to discipline a physician for violating any provision of Chapters 456 or 458, Florida Statutes (2011), or any rules adopted pursuant thereto. DOH v. Basim Ibrahim Elhabashy, M.D. 30 DOH Case Number 2011-17168 56. Rule 64B8-9.013, Florida Administrative Code, sets forth the standards for the use of controlled substances for the treatment of pain, in part, as follows: (3) Standards. The Board has adopted the following standards for the use of controlled substances for pain control: (a) Evaluation of the Patient. A complete medical history and physical examination must be conducted and documented in the medical record. The medical record should document the nature and intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and history of substance abuse. The medical record also should document the presence of one or more recognized medical indications for the use of a controlled substance. (b) Treatment Plan. The written treatment plan should state objectives that will be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and should indicate if any further diagnostic evaluations or other treatments are planned. After treatment begins, the physician should adjust drug therapy to the individual medical needs of each patient. Other treatment 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. (d) Periodic Review. At reasonable intervals based on the 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 DOH v. Basim Ibrahim Elhabashy, M.D. DOH Case Number 2011-17168 31 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 to 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. Discussion of risks and benefits; 6. Treatments; 7. Medications (including date, type, dosage, and quantity 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 maintained in an accessible manner and readily available for review. * * * 57. Respondent violated Section 458.331(1)(nn), Florida Statutes (2011), by violating Rule 64B8-9.013, Florida Administrative Code, in one or more of the following manners: DOH v. Basim Ibrahim Elhabashy, M.D. 32 DOH Case Number 2011-17168 a. Failing to obtain complete medical histories for Patients RW, TB, SG, PB and/or PH; b. Failing to conduct adequate physical examinations or meaningful medical evaluations of Patients RW, TB, SG, PB and/or PH; Cc. Failing to set forth an adequate treatment plan for Patients RW, TB, SG, PB and/or PH; d. Failing to refer Patients RW, TB, SG, PB and/or PH to evaluations or consultations with specialists or other treatment providers; e. Failing to perform a periodic review of the treatment of Patients RW, TB, SG, PB and/or PH; and or f. Failing to adequately monitor Patients RW, TB, SG, PB and/or PH for diversion or substance abuse. 58. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2011), by violating Rule 64B8-9.013, Florida Administrative Code. 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, DOH v. Basim Ibrahim Elhabashy, M.D. 33 DOH Case Number 2011-17168 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 25 day of Huy , 2012. JOHN H. ARMSTRONG, MD Surgeon General and Secretayy| of Health Martin M. Randall Assistant General Counsel DEPARTMENT OF HE DOH Prosecution Services Unit DEPUTY CLERK 4052 Bald Cypress Way, Bin C-65 pau Angel Sanders Tallahassee, FL 32399-3265 DATE MAY 29 2012 Florida Bar # 00659940 (850) 245-4640 telephone (850) 245-4662 facsimile MMR/tgc PCP: May 25, 2012 PCP Members: Miguel, Stringer and Levine DOH v. Basitn Ibrahim Elhabashy, M.D. 3 4 DOH Case Number 2011-17168 BASIM IBRAHIM ELHABASHY, M.D. Case No. 2011-17168 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 any other discipline imposed. DOH v. Basim Ibrahim Elhabashy, M.D. 35 DOH Case Number 2011-17168

Docket for Case No: 12-002471PL