RESPONDENT. ,/
Petitioner, Department of Health, files this Administrative Complaint before the Board of Medicine against Respondent, John Anthousis, M.D., and in support thereof alleges:
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.
At all times material to this complaint, Respondent was a licensed physician within the State of Florida, having been issued license number 39480.
Filed December 27, 2012 3:30 PM Division of Administrative Hearings
Respondent holds no certifications recognized by the Board of Medicine.
Respondent's address of record is 18552 Kingbird Drive, Lutz, Florida 33558.
Oxycodone is a Schedule II controlled substance, pursuant to Chapter 893, Florida Statutes. A substance in Schedule II has a high potential for abuse and has a currently accepted but severely restricted medical use for the relief of moderate to severe pain. Abuse of the substance may lead to severe psychological or physical dependence. Oxycontin and Roxicodone are brand names for medications containing oxycodone.
Alprazolam is a medication prescribed to treat anxiety.
According to Section 893.03(4), Florida Statutes, alprazolam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States. Abuse of alprazolam may lead to limited physical or psychological dependence relative to the substances in
.Schedule III.
Carisoprodol is 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.
Oxycontin is the brand name of a semi-synthetic opiate that contains oxycodone hydrochloride, a Schedule II controlled substance defined in Chapter 893, Florida Statutes, which is indicated for the relief of moderate to severe pain. Oxycontin has a high potential for abuse and has a currently accepted, but limited, medical use in treatment in the United States. Abuse of this substance may lead to severe physical and psychological dependence.
Methadone is a medication 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.
Hydromorphone is a medication prescribed to treat pain. According to Section 893.03(2), Florida Statutes, hydromorphone 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 hydromorphone may lead to severe psychological or physical dependence.
At all times material to this complaint, Respondent practiced medicine at a clinic located at 2901 West Busch Boulevard, Suite 601, Tampa, Florida 33618 (the "Clinic"). At various times material to this complaint, the Clinic was known as Bay Area Pain Clinic, LLC, Pain Management of Tampa, Inc., and Pain Management of Tampa, LLC.
While practicing at the Clinic, Patient MV presented to Respondent in January 2006 as a 23-year-old male complaining of lower back pain, which Respondent diagnosed as being caused by herniated lumbar discs.
Respondent provided treatment to MV during a period from January 2006 through December 2007.
In January 2006, Respondent prescribed to MV concurrent prescriptions of 90 Roxicodone 30 mg, 90 alprazolam 1mg, and 90 carisoprodol 350 mg.
Respondent subsequently increased the dosage of alprazolam from 1 mg to 2 mg, and also increased the number of prescribed tablets from 90 to 120.
Respondent also subsequently increased the number of prescribed tablets of Roxicodone from 90 to 120, from 120 to 150, from 150 to 180, and from 180 to 210.
Respondent also added 60 Oxycontin 20 mg to the prescription mix, and later increased the dosage of Oxycontin from 20 mg to 40 mg.
Thereafter, Respondent discontinued the Oxycontin prescription, and added 120 methadone 10 mg to the prescription mix. Respondent later increased the number of prescribed tablets from 120 to 150.
Finally, Respondent discontinued the methadone prescription, and added 120 hydromorphone 4 mg to the prescription mix.
These controlled substances were prescribed by Respondent were inappropriate for MV, and/or were prescribed in excessive and/or inappropriate quantities and/or combinations.
Respondent continued to prescribe to MV multiple prescriptions for the above-mentioned controlled substances that were inappropriate for MV, and/or were prescribed in excessive and/or inappropriate quantities and/or combinations during the remainder of the treatment period.
Respondent prescribed, and continued to prescribe to MV the above-mentioned controlled substances without adequate justification or without documenting adequate justification in the medical record.
Respondent did not refer or did not document a referral for MV to a psychiatrist or any other medical specialist.
Respondent did not develop a treatment plan for MV, or the medical records maintained by Respondent did not completely document and justify the course of treatment utilized in the care of MV.
MV died on or about January 19, 2008 at the age of 24. The cause of death was determined to be intoxication by the combined effects of methadone, alprazolam and oxycodone.
COUNT ONE
Section 458.331(1)(q), Florida Statutes
Petitioner realleges and incorporates paragraphs one (1) through twenty-five (25) above, as if fully set forth herein.
Section 458.331(1)(q), Florida Statutes (2005-2007), 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.
Respondent prescribed controlled substances oxycodone, alprazolam, carisoprodol, oxycontin, methadone and hydromorphone inappropriately or in excessive or inappropriate quantities.
Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2005-2007).
COUNT TWO
Section 458.331(1)(m), Florida Statutes
Petitioner realleges and incorporates paragraphs one (1) through twenty-five (25) above, as if fully set forth herein.
Section 458.331(1)(m), Florida Statutes (2005-2007), 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.
Respondent failed to keep legible medical records justifying the course of treatment for Patient MV in, including, but not limited to, one or more of the following ways:
By failing to document justification for prescribing controlled substances to MV; and
By failing to document referrals for MV to a psychiatrist, or any other specialist.
Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2005-2007), by failing to keep legible medical records that justify the course of treatment for Patient MV.
COUNT THREE
Section 458.331(1)(t)1
Petitioner realleges and incorporates paragraphs one (1) through twenty-five (25) above, as if fully set forth herein.
Section 458.331(1)(t)l, Florida Statutes (2005-2007), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2005-2007), 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.
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 "
Respondent failed to meet the required standard of care in his
treatment of MV in one or more of the following ways:
By prescribing oxycodone, alprazolam, carisoprodol, methadone and hydromorphone to MV without adequate justification;
by prescribing oxycodone, alprazolam, carisoprodol, oxycontin, methadone and hydromorphone to MV in potentially lethal doses;
By failing to refer MV to a psychiatrist or any other medical specialist.
Based on the foregoing, Respondent has violated Section 458.331(1)(t)1, Florida Statutes (2005-2007), by committing medical malpractice.
WHEREFORE, the Petitioner respectfully requests that the Board of Medicine enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand,
placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education any other relief that the Board
deems appropriate.
Assistant General Counsel Fla. Bar No. 70394
Florida Department of Health Office of the General Counsel 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399- 3265
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.
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.
