STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO. 2010-12384 JOHN NKOLO MUBANG, M.D., RESPONDENT. / ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through its undersigned counsel, files this Administrative Complaint before the Board of Medicine against Respondent, John Nkolo Mubang, M.D., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practice of medicine pursuant to Séction 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 55171. 3. Respondent's address of record is 741 Martin Luther King Boulevard West, Seffner, Florida 33584. Filed July 23, 2012 2:33 PM Division of Administrative Hearings 4. During the period May 30, 2006 through August 23, 2010 Respondent treated five patients for intractable pain, they are referred to throughout by their initials, AM, BB, CC, WB and MH; during this time Respondent prescribed to each of these patients one or more of the following controlled substances as more particularly set out below. 5. Oxycodone is commonly prescribed to treat pain. 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, and abuse of oxycodone may lead to severe psychological or physical dependence. 6. | Methadone is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, methadone 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, and abuse of methadone may lead to severe psychological or physical dependence. 7. 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. 8. Adderall® is the brand name for a drug that contains amphetamine, commonly prescribed to treat attention deficit disorder. According to Section 893.03(2), Florida Statutes, amphetamine 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 amphetamine may lead to severe psychological or physical dependence. 9. Fentanyl is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, Fentanyl 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 Fentanyl may lead to severe psychological or physical dependence. 10. Vicodin®, Lortab®, and Hydrocodone®, are the brand names for hydrocodone/APAP. Hydrocodone/APAP contains hydrocodone and acetaminophen, and is prescribed to treat pain. According to Section 893.03(3), Florida Statutes, hydrocodone, in the dosages found in 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. 11. Klonopin® is the brand name for Clonazepam and is commonly prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, Clonazepam 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 Clonazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. 12. Fliorinal® with codeine Is the brand name for a drug that contains butalbital and codeine and is commonly prescribed to treat migraine headaches. According to Section 893.03(3), Florida Statutes, butalbital 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 butalbital may lead to moderate or low physical dependence or high psychological dependence. 13. Codeine is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes, codeine 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 codeine may lead to severe psychological or physical dependence. 14. 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 ITI. 15. Valium® is the brand name for diazepam and is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, diazepam 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 diazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. 16. 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 United States. Abuse of carisoprodol may lead to limited physical or psychological dependence relative to the substances in Schedule III. 17. In treating these patients Respondent violated Section 458.326 Florida Statutes, (2005-2010) and Rule 64B8-9.013(3), Florida Administrative Code. Section 458.326 titled Intractable Pain; Authorized Treatment, provides in part: (1) 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. (2) Intractable pain must be diagnosed by a physician licensed under this chapter and qualified by experience to render such diagnosis. (3) Notwithstanding any other provision of law, a physician may prescribe or administer any controlled substance under Schedules IJ-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. Rule 64B8-9.013(3), Florida Administrative Code, provides in pertinent part: 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. Facts Specific to AM 18. Patient AM was a 22 year- old female with a past history of a motor vehicle accident on July 27, 2007 initially presenting with complaints of low back pain, Respondent prescribed methadone, Roxicodone®, and Soma®, for AM, on the dates and in the strengths and quantities described in the following table: Methadone Roxicodone® | Soma® 10 mg. 30 mg. 350 mg. 12/22/2009 12/22/2009 12/22/2009 10 mg. 30 mg. 350 mg, 90 pills 270 pills 90 pills 1/19/2010 1/19/2010 1/19/2010 10 mg. 30 mg. 350 mg. 270 pills 90 pills 2/16/2010 2/16/2010 30 mg. 350 mg, 270 pills 90 pills 3/16/2010 3/16/2010 3/16/2010 350 mg. 90 pills 4/12/2010 fF 350 mg. 270 90 pills 5/10/2010 5/10/2010 5/10/2010 10 mg. 30 mg. 350 mg. 120 pills 270 pills 90 pills 5/24/2010 5/24/2010 5/24/2010 10 mg. 30 mg. 350 mg. 120 pills 270 pills 90 pills 7/5/2010 10 mg. 120 pills 8/3/2010 8/27/2010 8/27/2010 10 mg. 30 mg. 120 pills 270 pills 19. From about December 22, 2009, through about August 27, 2010, Respondent prescribed potentially lethal doses of methadone, Roxicodone®, or Soma®, for AM inappropriately or in excessive or inappropriate quantities without justification and or without documenting justification for the course of treatment. 20. From about August 2, 2010, Respondent did not use the results of the urine screens appropriately or did not appropriately interpret the results, when he failed to address the positive drug result for benzodiazepines, which had not been prescribed, with AM, and continued to prescribe potentially lethal doses of methadone, Roxicodone®, or Soma®, for AM. 21. From about August 2, 2010, Respondent did not use the results of the urine screens appropriately or did not appropriately interpret the results, when he failed to address the negative drug result for methadone, which had been prescribed, with AM, and continued to prescribe potentially lethal doses of methadone, Roxicodone®, or Soma®, for AM. 22. From about December 22, 2009, through about August 27, 2010, Respondent did not perform or did not document a complete or adequate physical examination prior to prescribing potentially lethal doses of methadone, Roxicodone®, or Soma®, for AM. 23. From about December 22, 2009, through about August 27, 2010, Respondent did not obtain or did not document a complete medical history prior to prescribing potentially lethal doses of methadone, Roxicodone®, or Soma®, for AM. 24. From about December 22, 2009, through about August 27, 2010, Respondent did not diagnose AM with intractable pain prior to prescribing potentially lethal doses of methadone, Roxicodone®, or Soma®, for AM. Facts Specific to BB 25. Patient BB a 24 year-old female presented with complaints of pain In her neck, mid back and right knee, subsequent to two motor vehicle accidents and a cervical fusion, a fall precipitated her pain and her initial visit to the Respondent who prescribed Xanax®, oxycodone, and Soma®, for BB, on the dates and in the strengths and quantities described in the following table: 3/25/2010 350 mg. 120 pills 5/20/2010 5/20/2010 5/20/2010 2 mg, 30 mg. 350 mg. 60 pills 240 pills 120 pills 6/22/2010 6/22/2010 2 mg. 30 mg. 60 pills 240 pills 30 mg. 240 pills 8/23/2010 8/23/2010 2 mg. 60 pills 26. From about March 25, 2010, through about August 23, 2010, Respondent prescribed potentially lethal doses of Xanax®, oxycodone, or Soma®, for BB inappropriately or in excessive or inappropriate quantities 10 without justification and or without documenting justification for the course of treatment. 27. From about March 25, 2010, through about August 23, 2010, Respondent did not diagnose BB with an anxlety disorder or any other clinical indication to support prescribing potentially lethal doses of Xanax® to BB. 28. From about March 25, 2010, through about August 23, 2010, Respondent did not perform or did not document a complete or adequate physical examination on BB prior to prescribing potentially lethal doses of Xanax®, oxycodone, or Soma®, for Patient BB. 29. From about March 25, 2010, through about August 23, 2010, Respondent did not obtain or did not document a complete or adequate medical history for BB prior to prescribing potentially lethal doses of Xanax®, oxycodone, or Soma®, for BB. 30. From about March 25, 2010, through about August 23, 2010, Respondent did not diagnose BB with intractable pain prior to prescribing potentially lethal doses of Xanax®, oxycodone, or Soma®, for BB. il Facts Specific to CC 31. Patient CC a 32 year-old female first presented to Respondent on April 29, 2010, and Respondent's primary diagnosis was lumborsacral sprain secondary to L5S1 stenosis, right knee pain ulceration and abrasion and anxiety. Respondent prescribed Xanax®, Soma®, methadone, and oxycodone, for CC on the dates and in the strengths and quantities described in the following table: Xanax® 2 mg. 4/29/2010 Methadone 10 mg. 4/29/2010 Oxycodone 30 mg. 4/29/2010 0 5/27/2010 5/27/2010 2 mg, 350 mg. 60 pills 90 pilis 6/24/2010 5/27/2010 30 mg. 290 pills 7/22/2010 7/22/2010 7/22/2010 10 mg. 30 mg. 2mg. 180 pills 290 pills 60 pllis 8/19/2010 8/19/2010 8/19/2010 10 mg. 30 mg, 180 pills 290 pills 32. From about April 29, 2010, through about August 19, 2010, mg. 60 pills Respondent prescribed potentially lethal doses of Xanax®, Soma®, methadone, or oxycodone, inappropriately or in excessive or inappropriate quantities without justification and or without documenting justification for the course of treatment. 12 33. From about April 29, 2010, through about August 19, 2010, Respondent did not perform or did not document a complete or adequate physical examination on CC prior to prescribing potentially lethal doses of Xanax®, Soma®, methadone, or oxycodone to CC. 34. From about April 29, 2010, through about August 19, 2010, Respondent did not obtain or did not document a complete or adequate medical history on CC prior to prescribing potentially lethal doses of Xanax®, Soma®, methadone, or oxycodone to CC. 35. Respondent did not diagnose patient CC with intractable pain prior to prescribing potentially lethal doses of Xanax®, Soma®, methadone, or oxycodone to CC. Facts Specific to WB 36. Patient WB a 51 year-old male first presented on December 13, 2008. Respondent's primary diagnosis was with complaints of neck, pain, low back pain and right knee pain and Respondent prescribed Roxicodone®, Soma®, Xanax®, and Fiorinal® with codeine, to WB on the dates and in the strengths and quantities described in the following table: 13 30 mg. 12/13/2008 30 Mg. 1/10/2009 30 mg. 2/6/2009 30 mg. 180 pills 5/9/2009 30 mg. 240 pills 6/6/2009 30 mg. 240 pills 7/11/2009 30 mg. 270 pills 10/13/2009 30 mg. 270 pills 2/9/2010 30 mg. 270 pills 3/9/2010 30 mg. 270 pills 4/6/2010 5/4/2010 30 mg. 270 pills §/22/2010 30 mg. 270 pills 6/19/2010 30 mg. 270 pills 7/17/2010 30 mg. 270 pills 1/10/2009 350 mg. 30 pills Fiorinal® __| w/Codeine 30 pills 5/9/2009 350 mg. 30 pills 6/6/2009 350 mg. 38 pills 7/11/2009 350 mg. 30 pills 10/13/2009 350 mg. 30 pills 2/9/2010 350 mg. 30 pills 3/9/2010 350 mg. 30 pills 4/6/2010 350 mg. 30 pills 5/4/2010 350 mg. 30 plils 5/22/2010 350 mg. 30 pills 10/13/2009 img. 60 pills 2/9/2010 img. 60 pills 3/9/2010 img. 60 pills 4/6/2010 1mg, 60 pills 5/4/2010 img. 60 pills §/22/2010 img. 60 6/19/2010 img. 60 pills 7/11/2009 60 pills 10/13/2009 90 pills 2/9/2010 90 pills 3/9/2010 90 pills 4/6/2010 90 pills 5/4/2010 90 pills 5/22/2010 90 pills 6/19/2010 90 pills 7/17/2010 90 pills 14 Florinal® w/Codeine Roxicodone® | Soma®@ Xanax® A 350 mg. img. 8/24/2010 9 37. From about December 13, 2008, through about August 24, 2010, Respondent prescribed potentially lethal doses of Roxicodone®, Soma®, Xanax®, or Fiorinal® with codeine, to WB inappropriately or in excessive or inappropriate quantities without justification and or without documenting justification for the course of treatment. 38. From about November 10, 2009, Respondent did not use the results of the urine screens appropriately or did not appropriately interpret the results, when he failed to address the positive drug results for cocaine, an illegal drug and hydromorphone, which had not been prescribed to WB, and continued to prescribe potentially lethal doses of Raxiondloneds, Soma®, Xanax®, or Fiorinal® with codeine, to WB. 39. From about November 10, 2009, Respondent did not use the results of the urine screen appropriately or did not appropriately interpret the results, when he falled to address the negative drug result for Soma®, and Xanax®, which had been prescribed to WB, and continued to prescribe 15 potentially lethal doses of Roxicodone®, Soma®, Xanax®, or Fiorinal® with codeine, for Patient WB. 40. From about February 9, 2010, Respondent did not use the results of the urine screen appropriately or did not appropriately interpret the results, when he failed to address the fact that the urine test was negative for all controlled substances which had been prescribed to WB, and continued to prescribe potentially lethal doses of Roxicodone®, Soma®, Xanax®, or Fiorinal® with codeine, for Patient WB. 41. From about December 13, 2008, through about August 24, 2010, Respondent did not perform or did not document a complete or adequate physical examination on Patient WB prior to prescribing potentially lethal doses of Roxicodone®, Soma®, Xanax®, or Fiorinal® with codeine, to WB. 42. From about December 13, 2008, through about August 24, 2010, Respondent did not obtain or did not document a complete or adequate medical history on Patient WB prior to prescribing potentially lethal doses of Roxicodone®, Soma®, Xanax®, or Fiorinal® with codeine, to WB. 16 43. From about December 13, 2008, through about August 24, 2010, Respondent did not diagnose WB with intractable pain prior to prescribing potentially lethal doses of Roxicodone®, Soma®, Xanax®, or Fiorinal® with codeine to WB. Facts Specific to MH 44, Patient MH a 30 year-old female initially presented with complaints of insomnia, anxiety and attention deficit disorder. Respondent prescribed Vicodin®, Xanax®, Adderall®, Soma®, Valium®, clonazepam, fentanyl, and oxycodone, to MH on the dates and in the strengths and quantities described in the following table: Clona- Adderall Adderall 2005 | 1/10/2005 1/10/2005 | 1/10/ 750 Mg. 2 Mg. 10 Mg. | 60 Tablets | 30 Tablets_| 30 Tablets 2/9/2005 2/9/2005 2/9/2005 750 Mg. 2 Mg. 10 Mg. 60 Tablets | 30 Tablets | 30 Tablets 3/7/2005 3/7/2005 3/7/2005 750 Mg. 2 Mg. 10 Mg. | 60 Tablets | 30 Tablets | 30 Tablets 3/31/2005 | 3/31/2005 | 3/31/2005 750 Mg. 2 Mg. 20 Mg. 60 Tablets | 30 Tablets | 30 Tablets 5/9/2005 5/9/2005 5/9/2005 750 Mg. 2 Mg. 20 Mg. 60 Tablets | 30 Tablets | 30 Tablets 6/15/2005 | 6/15/2005 | 6/15/2005 6/15/2005 750 Mg. 2™g. 20 Mg. fs 60 Tablets | 30 Tablets | 30 Tablets 17 Soma 350 Mg. Fentanyl | Oxycodone Patch 15 Mg. Vicedin ES 750 Mg. 2 Mo. 8/31/2005 | 8/31/2005 | 8/31/2005 8/31/2005 750 Mg. 2Mg. 20 Mg. 10 Mg. 90 Tablets | 45 Tablets | 30 Tablets 60 Tablets 12/21/2005 | 12/21/2005 | 12/21/2005 12/21/2005 750 Mg. 2 Mg. 20 Mg. 10 Mg. 90 Tablets | 45 Tablets | 60 Tablets 60 Tablets 3/16/2006 | 3/16/2006 | 3/16/2006 3/16/2006 750 Mg. 2Mg. 20 Mg. 10 Mg. 60 Tablets | 30 Tablets | 60 Tablets 60 Tablets 5/30/2006 | 5/30/2006 | 5/30/2006 5/30/2006 750 Mg. 2 Mg. 20 Mg. 10 Mg. 60 Tablets _| 60 Tablets | 60 Tablets 60 Tablets 8/2/2006 8/2/2006 8/2/2006 8/2/2006 750 Mg. 2 Mg. 20 Mg. 10 Mg. 60 Tablets | 60 Tablets | 60 Tablets 60 Tablets 8/30/2006 | 8/30/2006 | 8/30/2006 8/30/2006 750 Mg. 2 Mg. 20 Mg. 10 Mg. 60 Tablets | 60 Tablets | 60 Tablets 60 Tablets 11/1/2006 | 11/1/2006 | 11/1/2006 11/1/2006 750 Mg. 2 Mg. 20 Mg. 60 Tablets | 30 Tablets | 60 Tablets 60 Tablets 12/13/2006 | 12/13/2006 | 12/13/2006 12/13/2006 750 Mg, 2Mg. 20 Mg. 10 Mg. 60 Tablets | 30 Tablets | 60 Tablets 60 Tablets 1/24/2007 | 1/24/2007 1/24/2007 2 Mg. 20 Mg. 10 Mg. 30 Tablets | 60 Tablets 60 Tablets 3/7/2007 3/7/2007 3/7/2007 3/7/2007 750 Mg. 2 Mg. 20 Mg. 10 Mg. 60 Tablets | 30 Tablets | 60 Tablets 60 Tablets 4/12/2007 | 4/12/2007 2Mg. 20 Mg. 30 Tablets | 60 Tablets 5/10/2007 | 5/10/2007 2 Mg. 20 Mg. 30 Tablets | 60 Tablets 7/5/2007 7/5/2007 7/5/2007 7/5/2007 750 Mg. 2Mg. 20 Mg. 10 Mg. 60 Tablets | 30 Tablets | 60 Tablets 60 Tablets 8/9/2007 750 Mg. 60 Tablets 8/9/2007 20 Mg. 60 Tablets 9/13/2007 | 9/13/2007 | 9/13/2007 750 Mg. 2Mg. 20 Mg. 60 Tablets | 30 Tablets | 60 Tablets 11/5/2007 | 11/5/2007 750 Mg. 2 Mg. 60 Tablets | 30 Tablets 11/5/2007 30 Mg. 30 Tablets ray 8 12/6/2007 750 Mg. 60 Tablets 12/6/2007 2 Mg. 30 Tablets derail 20 Mg. 1/22/2008 750 Mg. 60 Tablets 1/31/2008 750 Mg. 60 Tablets 1/31/2008 2 Mg. 30 Tablets 4/16/2008 750 Mg. 60 Tablets 90 Tablets 4/16/2008 2 Mg. 30 Tablets 8/6/2008 «5 Mg. 30 Tablets 1/6/2009 5 Mg. 30 Tablets 3/23/2009 750 Mg. 90 Tablets 5/18/2009 750 Mg. | 90 Tablets 7/9/2009 750 Mg, 120 Tablets 8/20/2009 750 Mg. 120 Tablets 9/21/2009 750 Mg. 120 Tablets 10/19/2009 750 Mg. 120 Tablets Oxycodone CR 15 Mg. 30 Mg. 12/6/2007 30 Mg. 30 Tablets. 1/31/2008 | 1/31/2008 30 Mg. 10 Mg. 60 Tablets | 60 Tablets 2/6/2008 30 Mg. 60 Tablets 3/10/2008 4/16/2008 30 Mg. 60 Tablets 8/6/2008 30 Mg. 60 Tablets 1/6/2009 30 Mg. oa || 4/16/2008 10 Mg. 60 Tablets 5/18/2009 2 Mg. 90 Tablets 7/9/2009 2 Mg. 90 Tablets 30 Mg. 60 Tablets 8/20/2009 2 Mg. 90 Tablets 8/20/2009 30 Mg. 60 Tablets 9/21/2009 2 Mg. 90 Tablets 9/21/2009 10/19/2009 30 Mg. 60 Tablets 19 Vicodin Adderall Valium Xanax Fentanyl | Oxycodone | Soma ES 20 Mg. 5mg & 2 Mg. Patch 15 Mg. 350 Mg. 750 Mg. 10 Mg 50 Mg. 11/16/2009 11/16/2009 11/16/2009 11/16/2009 750 Mg. 30 Mg. 2Mg. 15 Mg. 120 60 Tablets 90 Tablets 90 Tablets Tablets 12/14/2009 12/14/2009 12/14/2009 12/14/2009 750 Mg. 30 Mg. 2 Ma. 15 Mg. 120 60 Tablets 120 120 Tablets Tablets Tablets 1/11/2010 1/11/2010 1/11/2010 1/11/2010 750 Mg. 30 Mg. 2 Mg. 15 Mg. 120 60 Tablets 120 120 Tablets Tablets Tablets 2/8/2010 2/8/2010 2/8/2010 2/8/2010 750 Mg. 30 Mg. 2™Mg. 15 Mg. 120 60 Tablets 120 120 Tablets Tablets Tablets 3/8/2010 3/8/2010 3/8/2010 3/8/2010 3/8/2010 750 Mg. 30 Mg. 2Mg. 15 Mg. 350 Mg. 120 60 Tablets 120 120 Tablets | 90 Tablets Tablets 4/5/2010 4/5/2010 4/5/2010 4/5/2010 4/5/2010 750 Mg, 30 Mg. 2Mg. 15 Mg. 350 Mg. 120 60 Tablets 120 120 Tablets | 90 Tablets Tablets Tablets 5/17/2010 5/17/2010 5/17/2010 5/ 17/2010 | 750 Mg. 30 Mg. 15 Mg. 350 Mg. 120 60 Tablets 120 Tablets | 90 Tablets Tablets Tablets 6/23/2010 6/23/2010 6/23/2010 6/23/2010 750 Mg. 30 Mg. 2 Mg. 15 Mg. 120 60 Tablets 120 120 Tablets Tablets Tablets 7/26/2010 7/26/2010 7/26/2010 7/26/2010 750 Mg. 30 Mg. 2 Mg. 15 Mg. 120 60 Tablets 120 Tablets Tablets 8/23/2010 8/23/2010 8/23/2010 8/23/2010 750 Mg. 30 Mg. 2 Mg. 15 Mg. 120 60 Tablets 120 120 Tablets Tablets Tablets 45. From about January 10, 2005, through about August 23, 2010, Respondent prescribed potentially lethal doses of Vicodin®, Xanax®, Adderall®, Soma®, Valium®, clonazepam, fentanyl, or oxycodone, to MH 20 inappropriately or in excessive or inappropriate quantities without justification and or without documenting justification for the course of treatment. 46. From about January 10, 2005, through about August 23, 2010, Respondent did not diagnose Patient MH with attentlon deficit disorder (ADD), or any other clinical indication to support prescribing Adderall®, to MH. 47. From about January 10, 2005, through about August 23, 2010, Respondent did not perform or did not document a complete or adequate physical examination of MH prior to prescribing potentially lethal doses of Vicodin®, Xanax®, Adderali®, Soma®, Valium®, clonazepam, fentanyl, or oxycodone to Patient MH. 48. From about January 10, 2005, through about August 23, 2010, Respondent did not obtain or did not document a complete or adequate medical history of MH prior to prescribing potentially lethal doses of Vicodin®, Xanax®, Adderall®, Soma®, Valium®, clonazepam, fentanyl, or oxycodone to Patient MH. 21 49. Respondent did not diagnose MH with intractable pain prior to prescribing potentially lethal doses of Vicodin®, Xanax®, Adderall®, Soma®, Valium®, clonazepam, fentanyl, or oxycodone to Patient MH. COUNT ONE 50. Petitioner re-alleges paragraphs 1 through 23 as if fully set forth herein. 51. Section 458.331(1)(nn), Florida Statutes (2009-2010), subjects a doctor to discipline for violating any provision of chapter 458 or chapter 456, or any rules adopted pursuant thereto. 52. Respondent violated Section 458.331(1)(nn) when he violated Section 458.326 Florida Statutes (2009-2010) and or Rule 64B8-9.013(3), Florida Administrative Code with regard to AM, in one or more of the following ways: a. _ By failing to diagnose Patient AM with intractable pain prior to prescribing methadone, Roxicodone®, or Soma®, for Patient AM, from about December 22, 2009, through about August 27, 2010; b. By failing to perform a complete or adequate physical examination prior to prescribing potentially 22 lethal doses of methadone, Roxicodone®, or Soma®, for Patient AM, from about December 22, 2009, through about August 27, 2010; c. By failing to obtain a complete medical history on Patient AM prior to prescribing potentially lethal doses of methadone, Roxicodone®, or Soma®. 53. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes, by violating Section 458.326 Florida Statutes, COUNT TWO 54. Petitioner re-alleges paragraphs 1 through 23 as if fully set forth herein. 55. Section 458.331(1)(q), Florida Statutes (2009-2010), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician’s professional practice. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately 23 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 Intent. 56. Respondent prescribed controlled substances Inappropriately or in excessive or Inappropriate quantities, with regard to AM, as more particularly set out above. 57. Based on the forgoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2009-2010). COUNT THREE 58. Petitioner re-alleges paragraphs 1 through 23 as if fully set forth herein. 59. Section 458.331(1)(t), Florida Statutes (2009-2010), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2009-2010), defines medical malpractice 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. 60. Level of care, skill, and treatment recognized in general law related to health care Ilcensure means the standard of care specified in 24 Section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean“... 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. .. .” 61. Respondent failed to meet the required standard of care, with regard to AM, in one or more of the following ways: a. By failing to diagnose AM with intractable pain prior to prescribing potentially lethal doses of methadone, Roxicodone®, or Soma®, for Patient AM, from about December 22, 2009, through about August 27, 2010; By prescribing potentially lethal doses of methadone, Roxicodone®, or Soma®, for Patient AM without justification, from about December 22, 2009, through about August 27, 2010; By failing to use the results of the urine screens appropriately or falling to appropriately interpret the results, when Respondent failed to address the 25 positive drug result for benzodiazepines, which had not been prescribed, with AM, and continuing to prescribe potentially lethal doses of methadone, Roxicodone®, or Soma®, for AM, about August 2, 2010; By faillng to use the results of the urine screens appropriately or failing to appropriately interpret the results, when he failed to address the negative drug result for methadone, which had been prescribed, with Patient AM, and continuing to prescribe potentially lethal doses of methadone, Roxicodone®, or Soma®, for AM, about August 2, 2010; By failing to perform a complete or adequate physical examination prior to prescribing potentially lethal doses of methadone, Roxicodone®, or Soma®, for Patient AM, from about December 22, 2009, through about August 27, 2010; 26 f, By failing to obtain a complete medical history on AM prior to prescribing potentially lethal doses of methadone, Roxicodone®, or Soma®. 62. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes, (2009-2010). COUNT FOUR 63. Petitioner re-alleges paragraphs 1 through 23 as if fully set forth herein. 64. Section 458.331(1)(m), Florida Statutes (2009-2010), provides that failing to keep legible medical records 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, constitutes grounds for disciplinary action by the Board of Medicine. 65. Respondent failed to keep legible medical records justifying the course of treatment for AM in one or more of the following ways: a. By prescribing potentially lethal doses of methadone, Roxicodone®, or Soma®, for AM without documenting justification, from about 27 December 22, 2009, through about August 27, 2010; b. By failing to document a complete or adequate physical examination prior to prescribing potentially lethal doses of methadone, Roxicodone®, or Soma®, for AM, from about December 22, 2009, through about August 27, 2010; c. By failing to document a complete medical history on AM prior to prescribing potentially lethal doses of methadone, Roxicodone®, or Soma®. 66. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes, (2009-2010). COUNT FIVE 67. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 24 through 29, as If fully set forth herein. 68. Section 458.331(1)(nn), Florida Statutes (2009-2010), subjects a doctor to discipline for violating any provision chapter 458 or chapter 456, or any rules adopted pursuant thereto. 69. Respondent violated Section 458.331(1)(nn), Florida Statutes when he violated Section 458.326 Florida Statutes and or Rule 648B8- 28 9,013(3), Florida Administrative Code with regard to BB, in one or more of the following ways: a. By failing to diagnose BB with intractable pain prior to prescribing potentially lethal doses of oxycodone, or Soma®, for BB, from about March 25, 2010, through about August 23, 2010; By failing to perform a complete or adequate physical examination on BB prior to prescribing potentially lethal doses of oxycodone, or Soma®, for Patient BB, from about March 25, 2010, through about August 23, 2010; By failing to obtain a complete or adequate medical history for BB prior to prescribing potentially lethal doses of oxycodone, or Soma®, for BB, from about March 25, 2010, through about August 23, 2010. 70. Based on the foregoing, Respondent has violated Sectlon 458.331(1)(nn), Florida Statutes, (2009-2010) by violating Section 458.326 Florida Statutes (2009-2010). 29 COUNT SIX 71. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 24 through 29, as if fully set forth herein. 72. Section 458.331(1)(q), Florida Statutes (2009-2010), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best Interest of the patient and is not In the course of the physician’s professional practice, without regard to his intent. 73, Respondent prescribed controlled substances inappropriately or in excessive or inappropriate quantities, with regard to BB, as more particularly set out above. 74, Based on the forgoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2009-2010). 30 COUNT SEVEN 75. Petitioner re-allegeS paragraphs 1 through 16 and paragraphs 24 through 29, as if fully set forth herein. 76. Section 458.331(1)(t), Florida Statutes (2009-2010), subjects a doctor to discipline for committIng medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2009-2010), defines medical malpractice 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. 77. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in Section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean“... 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. .. .” 78. Respondent failed to meet the required standard of care with regard to Patient BB in one or more of the following ways: 31 By failing to diagnose BB with intractable pain prior to prescribing potentially lethal doses of Xanax®, oxycodone, or Soma®, for BB, from about March 25, 2010, through about August 23, 2010; By prescribing potentially lethal doses of Xanax®, oxycodone, or Soma®, for BB without justification, from about March 25, 2010, through about August 23, 2010; By failing to diagnose anxiety disorder or any other Clinical indication to support prescribing Xanax®, to BB, from about March 25, 2010, through about August 23, 2010; By failing to perform a complete or adequate physical examination on BB prior to prescribing potentially lethal doses of oxycodone, or Soma®, for Patient BB, from about March 25, 2010, through about August 23, 2010; By failing to obtain a complete or adequate medical history for BB prior to prescribing potentially lethal 32 doses of oxycodone, or Soma®, for BB, from about March 25, 2010, through about August 23, 2010. 79. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes, (2009-2010). COUNT EIGHT 80. Petitloner re-alleges paragraphs 1 through 16 and paragraphs 24 through 29 as if fully set forth herein. 81. Section 458.331(1)(m), Florida Statutes (2009-2010), provides that failing to keep legible medical records 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, constltutes grounds for disciplinary action by the Board of Medicine. 82. Respondent failed to keep legible medical records justifying the course of treatment for BB in one or more of the following ways: a. By prescribing potentially lethal doses of oxycodone, or Soma®, for BB without documenting justification, from about March 25, 2010, through about August 23, 2010; 33 b. By failing to document a complete or adequate physical examination on BB prior to prescribing potentially lethal doses of oxycodone, or Soma®, for Patient BB, from about March 25, 2010, through about August 23, 2010; c. By failing to document a complete or adequate medical history for BB prior to prescribing potentially lethal doses of oxycodone, or Soma®, for Patient BB, from about March 25, 2010, through about August 23, 2010. 83. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes, (2009-2010). COUNT NINE 84. Petitloner re-alleges paragraphs 1 through 16 and paragraphs 30 through 34, as if fully set forth herein. 85. Section 458.331(1)(nn), Florida Statutes (2009-2010), subjects a doctor to discipline for violating any provision chapter 458 or chapter 456, or any rules adopted pursuant thereto. 34 86. Respondent violated Section 458.331(1)(nn) Florida Statutes when he violated Section 458.326 Florida Statutes and or Rule 64B8- 9.013(3), Florida Administrative Code with regard to CC, in one or more of the following ways: a. By failing to diagnose CC with intractable pain prior to prescribing potentially lethal doses of Soma®, methadone, or oxycodone to CC, from about April 29, 2010, through about August 19; By prescribing potentially lethal doses of Soma®, methadone, or oxycodone, without justification, from about April 29, 2010, through about August 19; By failing to perform a complete or adequate physical examination on CC prior to prescribing potentially lethal doses of Soma®, methadone, or oxycodone to CC, from about April 29, 2010, through about August 19; By failing to obtain a complete or adequate medical history on CC prior to prescribing potentially lethal 35 doses of Soma®, methadone, or oxycodone to CC, from about April 29, 2010, through about August 19. 87. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes, (2009-2010) by violating Section 458.326 Florida Statutes (2009-2010). COUNT TEN 88. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 30 through 34 as if fully set forth herein. 89. Section 458.331(1)(q), Florida Statutes (2009-2010), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or In excessive or inappropriate quantitles 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 intent. 36 90. Respondent prescribed controlled substances inappropriately or In excessive or inappropriate quantities, with regard to Patient CC as more particularly set out above. 91. Based on the forgoing, Respondent violated Section 458.331(1)(q), Florida Statutes, (2009-2010). COUNT ELEVEN 92. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 30 through 34 as if fully set forth herein. 93. Section 458.331(1)(t), Florida Statutes (2009-2010), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2009-2010), defines medical malpractice as the fallure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure. 94. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified In Section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean“... The prevalling professional standard of care for a given health care provider shall be that level of care, skill, and 37 treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers... .” 95. Respondent failed to meet the required standard of care with regard to CC, in one or more of the following ways: a. By failing to diagnose patient CC with intractable pain prior to prescribing potentially lethal doses of Xanax®, Soma®, methadone, or oxycodone to CC, from about April 29, 2010, through about August 19; b. By prescribing potentially lethal doses of Xanax®, Soma®, methadone, or oxycodone, justification, from about April 29, 2010, through about August 19; c. By falling to perform a complete or adequate physical examination on CC prior to prescribing potentially lethal doses of Xanax®, methadone, or oxycodone to CC, from about April 29, 2010, through about August 19; 38 d. By failing to obtain a complete or adequate medical history on CC prior to prescribing potentially lethal doses of Xanax®, Soma®, methadone, or oxycodone to CC, from about April 29, 2010, through about August 19. 96. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes, by committing medical malpractice. COUNT TWELVE 97. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 30 through 34 as if fully set forth herein. 98. Section 458.331(1)(m), Florida Statutes (2009-2010), provides that falling to keep legible medical records that justify the course of treatment of the patient, including, but not limited to, patient historles; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations, constitutes grounds for disciplinary action by the Board of Medicine. 99. Respondent failed to keep legible medical records justifying the course of treatment for CC in one or more of the following ways: 39 a. By prescribing potentially lethal doses of Xanax®, Soma®, methadone, or oxycodone, to CC, without documenting justification, from about April 29, 2010, through about August 19; b. By falling.to document a complete or adequate physical examination on CC prior to prescribing potentially lethal doses of Xanax®, Soma®, methadone, or oxycodone to CC, from about April 29, 2010, through about August 19; c. By failing to document a complete or adequate medical history on CC prior to prescribing potentially lethal doses of Xanax®, Soma®, methadone, or oxycodone to CC, from about April 29, 2010, through about August 19. 100. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes, (2009-2010). COUNT THIRTEEN 101. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 35 through 42, as if fully set forth herein. 102. Section 458.331(1)(nn), Florida Statutes (2008-2010), subjects a doctor to discipline for violating any provision chapter 458 or chapter 456, or any rules adopted pursuant thereto. 103. Respondent violated Section 458.331(1)(nn) Florida Statutes when he violated Section 458.326 Florida Statutes and or Rule 64B8- 9.013(3), Florida Administrative Code with regard to WB, in one or more of the following ways: a. By failing to diagnose WB with intractable pain prior to prescribing potentially lethal doses of Roxicodone® and Soma® or Fiorinal® with codeine, to WB, from about December 13, 2008, through about August 24, 2010; By failing to perform a complete or adequate physical examination on WB prior to prescribing potentially lethal doses of Roxicodone®, Soma®, or Florinal® with codeine, to WB, from about December 13, 2008, through about August 24, 2010; 41 c. _ By failing to obtain a complete or adequate medical history on Patient WB prior to prescribing potentially lethal doses of Roxicodone®, Soma or Florinal® with codeine, to WB, from about December 13, 2008, through about August 24, 2010. 104. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes, (2008-2010). COUNT FOURTEEN 105. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 35 through 42 as if fully set forth herein. 106. Section 458.331(1)(q), Florida Statutes (2008-2010), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. For purposes of this paragraph, It shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the 42 patient and is not in the course of the physician’s professional practice, without regard to his intent. 107. Respondent prescribed controlled substances to WB inappropriately or in excessive or inappropriate quantities as more particularly set out above. 108. Based on the forgoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2008-2010). COUNT FIFTEEN 109. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 35 through 42 as if fully set forth herein. 110. Section 458.331(1)(t), Florida Statutes (2008-2010), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2008-2010), defines medical malpractice 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. 111. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in Section 766,102. Section 766.102(1), (2008-2010) Florida Statutes, 43 defines the standard of care to mean“. . . 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. .. .” 112. Respondent failed to meet the required standard of care with regard to WB in one or more of the following ways: a. __ By failing to diagnose WB with intractable pain prior to prescribing potentially lethal doses of Roxicodone®, Soma®, or Fiorinal® with codeine, to WB, from about December 13, 2008, through about August 24, 2010; b. By prescribing potentially lethal doses of Roxicodone®, Soma®, Xanax®, or Fiorinal® with codeine, to WB without justification, from about December 13, 2008, through about August 24, 2010; c. By falling to use the results of the urine screens appropriately or failing to appropriately interpret the results, when he failed to address the positive drug results for cocaine, an_ illegal drug and hydromorphone, which had not been prescribed to WB, and continued to prescribe potentially lethal doses of Roxicodone®, Soma®, Xanax®, or Fiorinal® with codeine, to WB, about November 10, 2009; By failing to use the results of the urine screen appropriately or failing to appropriately interpret the results, when he failed to address the negative drug result for Soma®, and Xanax®, which had been prescribed to WB, and continued to prescribe potentially lethal doses of Roxicodone®, Soma®, Xanax®, or Fiorinal® for WB, about November 10, 2009; By failing to use the results of the urine screen appropriately or did not appropriately interpret the results, when he failed to address the fact that the urine test was negative for all controlled substances 45 which had been prescribed to WB, and continued to prescribe potentially lethal doses of Roxicodone®, Soma®, Xanax®, or Florinal® for WB, about February 9, 2010; f. By failing to perform a complete or adequate physical examination on WB prior to prescribing potentially lethal doses of Roxicodone®, Soma®, or Fiorinal® with codeine to WB from about December 13, 2008, through about August 24, 2010; g. _ By failing to obtain a complete or adequate medical history on WB prior to prescribing potentially lethal doses of Roxicodone®, Soma®, or Fiorinal® with codeine, to WB, from about December 13, 2008, through about August 24, 2010. 113. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes, (2008-2010). COUNT SIXTEEN 46 114. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 35 through 42 as if fully set forth herein. 115. Section 458.331(1)(m), Florida Statutes (2008-2010), provides that failing to keep legible medical records 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, constitutes grounds for disciplinary action by the Board of Medicine. 116. Respondent failed to keep legible medical records justifying the course of treatment for WB in one or more of the following ways: a. By prescribing potentially lethal doses of Roxicodone®, Soma®, Xanax®, or Fiorinal® with codeine, to WB without documenting justification for the course of treatment from about December 13, 2008, through about August 24, 2010; By failing to document a complete or adequate physical examination on WB prior to prescribing potentially lethal doses of Roxicodone®, Soma®, or Fiorinal® with codeine, to WB, from about 47 December 13, 2008, through about August 24, 2010; c. By failing to document a complete or adequate medical history on WB prior to prescribing potentially lethal doses of Roxicodone®, Soma®, or Fiorinal® with codeine, to WB, from about December 13, 2008, through about August 24, 2010. 117. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes, (2008-2010). COUNT SEVENTEEN 118. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 43 through 48, as if fully set forth herein. 119. Section 458.331(1)(nn), Florida Statutes (2005-2010), subjects a doctor to discipline for violating any provision chapter 458 or chapter 456, or any rules adopted pursuant thereto. 120. Respondent violated Section 458.331(1)(nn), Florida Statutes (2005-2010) when he violated Section 458.326 Florida Statutes and or Rule 48 64B8-9.013(3), Florida Administrative Code with regard to MH, in one or more of the following ways: a. __ By failing to diagnose MH with intractable pain prior to prescribing potentially lethal doses of Vicodin®, Soma®, fentanyl, or oxycodone to MH, from about May 30, 2006 through about August 23, 2010; b. By failing to perform a complete or adequate physical examination of MH prior to prescribing potentially lethal doses of Vicodin®, Soma®, Valium®, fentanyl, or oxycodone to MH, from about May 30, 2006 through about August 23, 2010; c. By failing to obtain a complete or adequate medical history of MH prior to prescribing potentially lethal doses of Vicodin®, Xanax®, Adderall®, Soma®, Valium®, clonazepam, fentanyl, or oxycodone to MH. 121. Based on the foregoing, Respondent has ‘violated Section 458,331(1)(nn), Florida Statutes, by violating Section 458.326 Florida Statutes, (2005-2010). 49 COUNT EIGHTEEN 122. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 43 through 48 as if fully set forth herein. 123. Section 458.331(1)(q), Florida Statutes (2005-2010), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician’s professional practice. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including ail 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 physiclan’s professional practice, without regard to his intent. 124. Respondent prescribed controlled substances inappropriately or in excessive or inappropriate quantities to MH as more particularly set out above. 125. Based on the forgoing, Respondent violated Section 458.331(1)(q), Florida Statutes, (2005-2010). COUNT NINETEEN 50 126. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 43 through 48 as if fully set forth herein. 127. Section 458.331(1)(t), Florida Statutes (2005-2010), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2005-2010), defines medical malpractice 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. 128. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in Section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean“... 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... .” 129. Respondent failed to meet the required standard of care in one or more of the following ways: Ey By failing to diagnose MH with intractable pain prior to prescribing potentially lethal doses of Vicodin®, Soma®, fentanyl, or oxycodone to MH, from about May 30, 2006 through about August 23, 2010; By prescribing potentially lethal doses of Vicodin®, Xanax®, Adderall®, Soma®, Valium®, clonazepam, fentanyl, or oxycodone, to MH without justification, from about May 30, 2006 through about August 23, 2010; By failing to make a diagnosis or a finding to support a diagnosis of attention deficit disorder (ADD) or any other clinical indication to support prescribing Adderall®, to MH, from about January 10, 2005, through about August 23, 2010; By failing to perform a complete or adequate physical examination of MH prior to prescribing potentially lethal doses of Vicodin®, Soma®, fentanyl, or oxycodone to MH, from about January 10, 2005, through about August 23, 2010; 52 e. _ By failing to obtain a complete or adequate medical history of MH prior to prescribing potentially lethal doses of Vicodin®, Soma®, fentanyl, or oxycodone to Patient MH. 130. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes, (2005-2010). COUNT TWENTY 131. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 43 through 48 as if fully set forth herein. 132. Section 458.331(1)(cc), Florida Statutes (2005-2010), provides that prescribing, ordering, dispensing, administering, supplying, selling, or giving any drug which is a Schedule II amphetamine or a Schedule II sympathomimetic amine drug or any compound thereof, pursuant to chapter 893, to or for any person except for: 1. The treatment of narcolepsy; hyperkinesis; behavioral syndrome characterized by the developmentally inappropriate symptoms of moderate to severe distractability, short attention span, hyperactivity, emotional lability, and impulsivity; or drug-induced brain dysfunction; 2. The differential diagnostic psychiatric evaluation of depressi the treatment of depression shown to be refractory to other therapeutic modalities; or 53 3. The clinical investigation of the effects of such drugs or compounds when an Investigative protocol therefore is submitted to, reviewed, and approved by the board before such Investigation Is begun. constitutes grounds for disciplinary action by the Board of Medicine. 133. Respondent violated Section 458.331(1)(cc) with regard to MH, by failing to make a diagnosis or a finding to support prescribing Adderall®, to MH, from about May 30, 2006 through about August 23, 2010. 134. Based on the foregoing, Respondent violated Section 458.331(1)(cc), Florida Statutes,(2005-2010). COUNT TWENTY ONE 135. Petitioner re-alleges paragraphs 1 through 16 and paragraphs 43 through 48 as if fully set forth herein. 136. Section 458.331(1)(m), Florida Statutes (2005-2010), provides that failing to keep legible medical records 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, constitutes grounds for disciplinary action by the Board of Medicine. 54 137. Respondent failed to keep legible medical records justifying the course of treatment for MH in one or more of the following ways: a. By prescribing potentially lethal doses of Vicodin®, Xanax®, Adderall®, Soma®, Valium®, clonazepam, fentanyl, or oxycodone, to MH without documenting justification, from about May 30, 2006 through about August 23, 2010; b. By failing to document a complete or adequate physical examination of MH prior to prescribing potentially lethal doses of Vicodin®, Soma®, fentanyl, or oxycodone to Patient MH, from about January 10, 2005, through about August 23, 2010; e. By failing to document a complete or adequate medical history of MH prior to prescribing potentially lethal doses of Vicodin®, Soma®, fentanyl, or oxycodone to Patient MH. 138. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes, (2005-2010). 55 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 56 fees billed or collected, remedial education any other relief that the Board deems appropriate. SIGNED this_ (7H day of —§ Lez — , 2012. STEVEN L. HARRIS, M.D., M.Sc. Interim State Surgeon General Florida Department of Health Jennifer A. Tschetter Interim General Counsel Florida Department of Health VERONICA E. DONNELLY Attorney Supervisor Prosecution Services Unit GLth t.— fr Robert A. Milne, Esq. Assistant General Counsel FLED Florida Bar #622338 DEPARTMENT OF HEALTH DOH Prosecution Services Unit CLERK Angel Sanders 4052 Bald Cypress Way, BIN C-65 DATE MAY 17 2012 Tallahassee, FL 32399-3265 (850) 245-4640 VOICE (850) 245-4681 FAX RJM/jb PCP: 4/20/2012 PCP Members; Avila, Thomas & Levine 57 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-examinationine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. N D T 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. 58

Docket for Case No: 12-002517PL