STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, . PETITIONER, . ow CASE NO: 2011-19969 HOSSEIN FARSAD, M.D., RESPONDENT. | ADMINISTRATIVE COMPLAINT The Petitioner, Department of Health, by and through the undersigned counsel, files this Administrative Complaint (Complaint) before the Board of Medicine (Board) against the Respondent, Hossein Farsad, M.D., and in support thereof alleges: 1. The Petitioner is the state department charged with regulating the practice of medicine pursuant to Section 20.43, Florida Statutes; Chapters 456 and 458, Florida Statutes. ) 2. At all times material to this Complaint, the Respondent was a licensed physician within the State of Florida, having been issued license number ME 98132. DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 3. The Respondent's address of record is 1700 Kennedy Causeway, 1009, North Bay Village, Florida 33141, 4. The Respondent is not board certified in any recognized area by the Florida Board of Medicine. 5. ' At all times material to this Complaint, the Respondent worked at the office Margate Pain Management (clinic), located’ in Margate, Florida. 6. The Respondent prescribed scheduled drugs to his patients as the primary means of controlling their pain. The Respondent prescribed a combination of an opiate with other drugs to treat his patients.’ 7. . Oxycodone is an opioid 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. “Abuse of oxycodone may lead to severe psychological or physical dependence. 8. Xanax is the brand name for alprazolam and is prescribed to treat anxiety. Alprazolam is a benzodiazepine. According to Section 893.03(4), Florida Statutes, alprazolam is a Schedule IV controlled 2 . DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 substance that has a low potential for abuse relative to the substances in “Schedule IIT 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. 9. Restoril is the brand name for temazepam, a benzodiazepine used to treat insomnia. According to Section 893.03(4), Florida Statutes, temazepam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule NI and has a currently accepted medical use in treatment in the United States. Abuse of temazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. 10. Generally, the standard of care for patients experiencing certain types of pain is to provide them a combination of non-scheduled drugs, or treatment modalities such as exercise, or physical therapy. A patient can be referred to a specialist such as orthopedist, neurosurgeon or a board certified pain specialist who can provide interventional therapies such as injections, nerve blocks or spinal cord stimulation. DOH vy, HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 11. The Respondent failed to meet the standard of care by prescribing large volumes of narcotics and failing to evaluate and/or justify -treatment of his patients based on their pathology, ) . Facts Specific to Patient A.D. 12. On or about May 27, 2009, Patient A.D. (A.D.), a 27 year-old male, presented to the clinic with complaints of neck pain, low back pain and left knee pain. A.D. indicated that the complaints started in 2004, when he was attacked by a dog. Another physician evaluated and treated A.D. at this visit. The patient records include MRI reports of A.D.'s cervical spine and left shoulder dated March 4, 2009, and March 23, 2009. . 13. On or about July 23, 2009, A.D. presented to the clinic for a follow-up visit. ~ Respondent was the treating physician for this Visit Respondent's diagnosed him with -cervical spine bulging disc, bursitis/tendonitis of the left shoulder and back strain. Respondent documented that the examination of the head, neck, arm, shoulder and musculoskeletal was positive. The physical examination was incomplete. He prescribed A.D. Oxycodone 30 mg (90 pills), Oxycodone 15 mg (60 pills) and Naproxen (non-steroidal anti-inflammatory) 500 mg (60 pills). DOH y. HOSSEIN FARSAD, M.D., CASE NO. 2011-19969 14. The Respondent inappropriately prescribed high dose narcotics that in combination could be lethal. -15. The Respondent failed to refer A.D. to a pain management specialist. 16. The Respondent prescribed high dose narcotics for normal degenerative changes in A.D. 17. The Respondent failed to complete and/or perform a physical examination, 18. The Respondent's medical records are inadequate in that they do not explain his medical reasoning or justify the course of treatment he provided. 19. The Respondent’s medical records do not explain what a positive examination means. COUNT ONE (Standard of Care for Patient A.D.) 20. The Petitioner realleges and incorporates paragraphs 1-19 as if fully set forth in this count. 21, Section 458.331(1)(t), Florida Statutes (2009), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes 5 DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 (2009), states medical malpractice means the failure to practice medicine in accordance with the level of care, skill, and treatment ‘recognized in general law related to health care licensure. 22. 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 (2009), 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...” 23. The Respondent fell below the standard of care in one or more of the following ways: a. The Respondent inappropriately prescribed high dose narcotics in a possibly lethal combination. b. The Respondent failed to refer A.D. to a pain management specialist. c. The Respondent inappropriately prescribed high dose - narcotics for normal degenerative changes in A.D. DOH v, HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 d. The Respondent failed to complete and/or perform a physical examination. 24. Based on the foregoing, the Respondent violated Section 458.331(1)(t), Florida Statutes, (2009), by committing medical malpractice and is subject to disciplinary action by the Board of Medicine. COUNT TWO (Inappropriate Prescribing for Patient A.D.) 25. The Petitioner realleges and incorporates paragraphs 1-19 as if fully set forth in this count. | 26. Section 458.331(1)(q), Florida Statutes (2009), subjects a licensee to discipline 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 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. DOH v. HOSSEIN FARSAD, M.D., CASE NO. 2011-19969 27. The Respondent prescribed a legend drug other than in the course of his professional practice by prescribing a legend drug ' inappropriately or in excessive or inappropriate quantities in one or more of the following ways: a. The Respondent prescribed excessive or inapproptiate quantities of narcotic medication that could be lethal. b. The Respondent inappropriately prescribed narcotic medication for normal degenerative changes in A.D. c. The Respondent _ inappropriately prescribed narcotic medication without completing and/or performing a physical on A.D. 28. Based on the foregoing, the Respondent violated Section - 458.331(1)(q), Florida Statutes (2009), by prescribing excessively and inappropriately and is subject to disciplinary action by the Board of Medicine. | COUNT THREE (Medical Records for Patient A.D.) 29. The Petitioner realleges and incorporates paragraphs 1-19 as if fully set forth in this count, ’ DOH v, HOSSEIN FARSAD, M.D., CASE NO. 2011-19969 30. Section 458.331(1)(m), Florida Statutes (2009), provides that a licensee is subject to discipline for failing to keep legible, as defined by department rule in consultation with the board, medical. records that identify the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. 31. The Respondent failed to maintain adequate medical records in one or more of the following ways: a. The Respondent’s medical records do not explain why he prescribed narcotic medication in possibly lethal levels. b. The Respondent's medical records do not contain a complete physical examination. c. The Respondent's medical records do not explain what a positive examination means. DOH v. HOSSEIN FARSAD, M.D., CASE NO. 2011-19969 32. Based on the foregoing, the Respondent violated Section 458.331(1)(m), Florida Statutes (2009), by failing to keep adequate medical records and is subject to disciplinary action by the Board of Medicine. | | Facts Specific to Patient B.B. 33.. On or about June 29, 2009, Patient B.B. (B.B.), a then 30 year- ~ old male, presented to the clinic with complaints of neck pain and limited movement that started five or six years prior when he was in a fight. Another physician treated B.B. at this visit, and records show a positive drug screen for THC (tetrahydrocannabinols — psychoactive isomer), benzodiazepines, and opioids, and previous medical records from another pain management clinic in Fort Lauderdale. B.B. was currently on prescription medication from the other clinic that supported his positive test for opioids and benzodiazepines. An MRI from 2006, showed C5-C6 neuroforaminial narrowing and bulging disc without canal stenosis. 34, Patients that are currently taking opioids and benzodiazepines should not test positive for THC. 35. On or about July 16, 2009, B.B. presented to the clinic for a follow-up visit. The Respondent was the treating physician at this visit. He DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 lists positive for physical examinations without explanation of what that means. The Respondent diagnosed him with neck pain and arm pain, and scheduled B.B. for an MRI in August. He prescribed Roxicodone (Oxycodone) 30 mg (150 pills), but did not perform a urine screen. 36. On or about August 13, 2009, B.B. presented to the Respondent for a follow-up visit. The Respondent diagnosed B.B. with neck pain and arm pain. The Respondent did not perform a_ physical examination and only included a pain score and vital signs. He did not perform a urine screen. He ordered a CT scan for B.B., but did not address why the MRI for August was not performed. The Respondent prescribed B.B. Oxycodone 30 mg (140 pills). 37. The Respondent inappropriately prescribed high doses narcotics that could be lethal. 38. The Respondent failed to refer B.B. to a pain management specialist. . 39, The Respondent inappropriately prescribed high doses of narcotics without a pathology that justifies this treatment. 40. The Respondent failed to perform a urine screen on follow-up visits, when B.B. tested positive for THC ona prior visit, DOH v. HOSSEIN FARSAD, M.D,, CASE NO. 2011-19969 41. The Respondent failed to complete and/or perform a history - and physical examination. 42. The Respondent's medical records do not justify his prescribing high dose narcotics to B.B. | 43. The Respondent's medical records do not explain what positive "results mean in B.B/s physical. . COUNT FOUR (Standard of Care for Patient B.B.) 44, The Petitioner realleges and incorporates paragraphs 1-11 and 33-43, as if fully set forth in this count. 45. Section 458.331(1)(t), Florida Statutes (2009), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2009), states medical malpractice means the fallure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure. 46. 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 (2009), defines the standard of care to mean“ . . . The prevailing professional standard of DOH v. HOSSEIN FARSAD, M.D., CASE NO. 2011-19969 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. .. .” 47. The Respondent fell below the standard of care in one or more of the following ways: a. The Respondent inappropriately prescribed high dose narcotics that could be lethal. . The Respondent failed to refer B.B. to a pain management specialist . The Respondent inappropriately prescribed high dose narcotics without pathology to justify this treatment. . The Respondent failed to perform a urine screen on a follow-up visit when B.B. tested positive for THC on a prior visit. . The Respondent failed to complete and/or perform a history and physical examination on B.B. DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 48. Based on the foregoing, the Respondent violated Section 458.331(1)(t), Florida Statutes (2009), by committing medical malpractice and is subject to disciplinary action by the Board of Medicine, COUNT FIVE (Inappropriate Prescribing for Patient B.B.) 49, The Petitioner realleges and incorporates paragraphs 1-11 and 33-43, as if fully set forth in this count. 50. Section 458.331(1)(q), Florida Statutes (2009), subjects a licensee to discipline 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 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. | | 5i. The Respondent prescribed a legend drug other than in the course of his. professional practice by prescribing a legend drug DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 inappropriately or in excessive or inappropriate quantities in one or more of the.following ways: a. The Respondent prescribed inappropriate amounts of high dose narcotics that could be !ethal. ° b. The Respondent inappropriately prescribed narcotic medication without pathology to justify this treatment. c. The Respondent inappropriately prescribed _ narcotic medication without performing a urine screen ona follow-up visit when B.B. tested positive for THC on a prior visit. d. The Respondent — inappropriately prescribed narcotic medication without performing and/or completing a physical on B.B. 52. Based on the foregoing, the- Respondent violated Section 458.331(1)(q), Florida Statutes (2009), by prescribing excessively and > inappropriately | and is subject to disciplinary action by the Board of Medicine. COUNT SIX (Medical Records for Patient B.B.) 53. The Petitioner realleges and incorporates paragraphs 1-11 and 33-43, as if fully set forth in this count. DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 54. Section 458.331(1)(m), Florida Statutes (2009), provides that a licensee is subject to discipline for failing to-keep legible, as defined by department rule in consultation with the board, medical records that identify the licensed physician or the physician extender and supervising physiclan by name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. | ‘95. The Respondent failed to maintain adequate medical records in one or more of the failowing ways: a. The Respondent's medical records do not explain why he prescribed narcotic medication In possibly lethal levels. b. The Respondent’s medical records do not justify why he prescribed narcotic medication without pathology to justify this treatment. c. The Respondent's medical records do not contain a complete physical examination. DOH v. HOSSEIN PARSAD, M.D., CASE NO. 2011-19969 d. The Respondent's medical records do not explain what a positive examination means. 56. Based on the foregoing, the Respondent violated Section 458.331(1)(m), Florida Statutes (2009), by failing to keep adequate medical records and is subject to disciplinary action by the Board of Medicine. Eacts Specific to Patient C.S. 57. On or about April 27, 2009, Patient C.S. (C.S.), a 27 year-old male at the time of his visit, presented to the clinic with complaints of lower back pain from a fall in 2003, and sleep problems. He confirmed that he was taking Xanax and Oxycodone. Another physician treated CS. on this visit, and records show an MRI of the lumbar spine dated September 11, 2008, a “Criminal Registrant” Identification Card from the Sheriff's Office and a urine drug screen that was negative for “opr” and “BZO,” but positive for “AMP.” 58. Patients that are currently taking Oxycodone ‘and Xanax prescriptions should test positive on urine drug screens for opioids (OPI) and benzodiazepine (BZO). They should not test positive for amphetamine . (AMP). DOH vy. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 59. On or about July 17, 2009, C.S, presented to the clinic for a follow-up visit. The Respondent was the treating physician for this visit. The Respondent diagnosed C.S. with 14-5 bulging, lumbar strain, and insomnia. He prescribed Xanax 2 mg (30 pills) and Roxicodone 30 mg (120 pills). A urine drug screen dated July 17, 2009, tested positive for “OPI,” “COC,” and “BZO." | 60. Patients that are currently taking Oxycodone and Xanax prescriptions should test positive on urine drug screens for opioids and benzodiazepine. They should not test positive for cocaine (COC). . 61. . The Respondent inappropriately prescribed high dose narcotics ‘that could be lethal. 62. The Respondent failed to refer CS. to a pain managernent specialist. 63. The Respondent inappropriately. prescribed high doses of narcotics without a pathology that justifies this treatment, — 64. The Respondent failed to account for negative urine screen on C.S/s first visit, and failed to account for cocaine on his follow-up visit. 65. The Respondent's medical records do not justify his prescribing high dose narcotics to C.S. DOH vy. HOSSEIN FARSAD, M.D., CASE NO. 2011-19969 66, The Respondent's medial records do not justify his prescribing Oxycodone for the patient without a treatment plan in place. COUNT SEVEN (Standard of Care for Patient ¢.S.) 67, The Petitioner realleges and incorporates paragraphs 1-11 and 57-66, as if fully set forth in this count. . 68. Section 458.331(1)(t), Florida Statutes (2009), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2009), states medical malpractice means the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure. | 69. 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 (2009), 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... .” DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 70. The Respondent fell below the standard of care in one or more of the following ways: a. The Respondent inappropriately prescribed high dose narcotics that could be lethal. . | b. The Respondent failed to refer C.S. to a pain management specialist | c. The Respondent inappropriately prescribed high dose narcotics without pathology to justify this treatment. | | d. The Respondent failed to account for a negative urine drug Screen on C.S.'s first visit, and failed to account for a positive urine screen that showed cocaine use by C.S. on a follow-up visit. 71. Based on the foregoing, the Respondent violated Section 458.331(1)(t), Florida Statutes, (2009), by committing medical malpractice and is subject to disciplinary action by the Board of Medicine. COUNT EIGHT (Inappropriate Prescribing for Patient C.S.) 72. The Petitioner realleges and incorporates paragraphs 1-11 and 57-66, as if fully set forth in this count. 20 DOH v. HOSSEIN FARSAD, M.D., CASE NO. 2011-19969 73. Section 458.331(1)(q), Florida Statutes (2009), subjects a licensee to discipline 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 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, 74, The Respondent prescribed a legend drug other than in the course of his professional practice by prescribing a legend drug inappropriately or in excessive or Inappropriate quantities in one or more of the following ways: a. The Respondent prescribed inappropriate amounts of high dose narcotics that could be lethal. b. The Respondent inappropriately prescribed narcotic medication without pathology to justify this treatment. 21 DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011+19969 c. The Respondent inappropriately prescribed narcotic medication after urine drug screens that tested negative for prescriptions on C.S/ first Visit and positive for cocaine on a follow-up visit. . 75. Based on the foregoing, the Respondent violated Section 458.331(1)(q), Florida Statutes, (2009), by prescribing excessively and inappropriately and is subject to disciplinary action by the Board of Medicine. | COUNT NINE (Medical Records for Patient C.S.) 76. The Petitioner realleges and incorporates paragraphs 1-11 and 57-66, as if fully set forth in this count. ) 77. Section 458.331(1)(m), Florida Statutes (2009), provides that a licensee is subject to discipline for failing to keep legible, as defined by department rule in consultation with the board, medical records that identify the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; 22 DOH vy. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. . | 78, The Respondent failed to maintain adequate medical records in . one or more of the following ways: a. The Respondent's medical records do not explain why he prescribed narcotic medication at possibly fethal levels. b. The Respondent’s medical records do not explain why he prescribed narcotic medication without pathology to justify this treatment. c. The Respondent’s medical records do not explain why he failed to account for a negative urine drug screen for C.S/s5 first visit, and failed to account for a positive urine drug screen for cocaine on his follow-up visit. 79, Based on the foregoing, the Respondent violated Section 458.331(1)(m), Florida Statutes (2009), by failing to keep adequate medical records and Is subject to disciplinary action by the Board of Medicine. 23 DOH vy, HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 Facts Specific to Patient J.S. 80. On or about June 17, 2009, Patient J.S. (J.S.), a then 29 year- old male, presented to the clinic with complaints of low back, and left hip pain that started a couple of years prior. Another physician treated J.S. on this visit, and records include an MRI report of hit lumbar spine dated August 14, 2008, that showed bulging disc in L4L5 and neuroforaminal narrowing bilaterally in L3L4. A hip MRI showed a tear of the gluteus medius. He was prescribed Oxycodone 30 mg (180 pills) and Restoril. 81. On or about July 15, 2009, J.S. presented to the clinic for a follow-up appointment. The Respondent was his treating physician. The Respondent did not perform a physical exam or diagnosis. He did not perform a urine drug screen. The Respondent then prescribed Oxycodone 30 mg (180 pills), Xanax 1 mg (90 pills) and Naproxen (nonsteroidal anti- - inflammatory) 500 mg (60 pills). 82, The Respondent inappropriately prescribed high dose narcotics _ that could be lethal. 83. The Respondent failed to refer J.S. to a pain management specialist. : 24 DOH v. HOSSEIN FARSAD, M.D., CASE NO. 2011-19969 84. The Respondent inappropriately prescribed high doses. of narcotics without a pathology that justifies this treatment. 85. The Respondent failed to perform a urine drug screen on J.S. 86. The Respondent failed to perform a complete physical examination on 1.8, 87. The Respondent's medial records do not justify his prescribing large amounts of Oxycodone and Xanax for J.S. . | COUNT TEN (Standard of Care for Patient J.S.) 88. The Petitioner’ realleges and incorporates paragraphs 1-11 and 80-87, as fully set forth in this count. 89. Section 458.331(1)(t), Florida Statutes (2009), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2009), states medical malpractice means the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure, 90. 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 (2009), defines the 25 DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 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 {reatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers. wl 91. The Respondent fell below the standard of care in one or more of the following ways: - a. The Respondent inappropriately prescribed high dose narcotics that could be lethal. ion - The Respondent failed to refer J.S. to a pain management specialist . The Respondent inappropriately prescribed high dose a narcotics without pathology to justify this treatment. Q . The Respondent failed to perform a urine drug screen on 1S. €. The Respondent failed to complete and/or perform a physical examination on J.S. DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 92. Based on the foregoing, the Respondent violated Section 458.331(1)(t), Florida Statutes, (2009), by committing ‘medical malpractice and is subject to disciplinary action by the Board of Medicine. COUNT ELEVEN (Inappropriate Prescribing for Patient J.S.) 93. The Petitioner realleges and incorporates paragraphs 1-11 and 80-87, as fully set forth in this count. 94. Section 458.331(1)(q), Florida Statutes (2009), subjects a licensee to discipline 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 the purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, or 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. | 95. The Respondent prescribed a legend drug other than in the course of his professional practice by prescribing a legend drug 27 DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 inappropriately or in excessive or inappropriate quantities in one or more of the following ways: | a. The Respondent prescribed inappropriate amounts of high dose narcotics that could be lethal. b. The Respondent inappropriately prescribed narcotic medication without pathology to justify this treatment. c. The Respondent inappropriately prescribed narcotic medication without performing a urine drug screen on J.S. d. The Respondent inappropriately prescribed narcotic medication without performing and/or completing a physical examination on J.S. 96. Based on the foregoing, the Respondent violated Section 458.331(1)(q), Florida Statutes, (2009), by prescribing excessively and inappropriately and is subject to disciplinary action by the Board of Medicine. . COUNT TWELVE (Medical Records for Patient J.S.) 97. The Petitioner realleges and incorporates paragraphs 1-11 and 80-87, as fully set forth in this count. DOH v, HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 98. Section 458.331(1)(m), Florida Statutes (2009), provides that a licensee is subject to discipline for failing to keep legible, as defined by department rule in consultation with the board, medical records that identify the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. 99. The Respondent failed to maintain adequate medical records in one or more of the following ways: | a. The Respondent's: medical records do not explain why he prescribed narcotic medication at possibly lethal levels. b. The Respondent's medical records do not explain why he prescribed narcotic medication and Xanax without pathology to justify this treatment. c. The Respondent's medical records do not explain why he did not perform a urine drug screen on J.S. 29 DOH v. HOSSEIN FARSAD, M.D., CASE NO. 2011-19969 100. Based on the foregoing, the Respondent violated Section 458.331(1)(m), Florida Statutes (2009), by failing to keep adequate medical records and is subject to disciplinary action by the Board of Medicine. Facts Specific to Patient L.B. 101. On or about June 17, 2009, Patient L.B. (L.B.), a then 25 year- old female, presented to the clinic with complaints of back pain and hip pain that originated from car accidents and a slip and fall years prior. Another physician treated her at this visit and records show a drug screen from this date tested positive for THC, opioids and benzodiazepines. An MRI report of the lumbar spine dated August 24, 2007, showed herniation in L5-S1 without nerve impingement. | 102. On or about July 16, 2009, L.B. presented for a follow-up appointment. The Respondent was her treating physician at this visit, and his impression v was L5-S1 disc herniation. The Respondent marked in the patient record that her physical examination was normal. He prescribed L.B. Oxycodone 30 mg, (180 pills) and Percocet (Oxycodone and Acetaminophen) 10/35 mg (60 pills). DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 103. On or about August 13, 2009, L.B. presented to the clinic for a follow-up visit. The Respondent was her treating physician at this visit and marked in the patient record that L.B’s physical examination was normal. He prescribed her Oxycodone 30 mg (180 pills) and Percocet 10/325 mg (60 pills). 104, The Respondent inappropriately prescribed high does narcotics that could be lethal. 105. The Respondent failed to refer L.B. to a pain management specialist. 106. The Respondent inappropriately prescribed high doses of narcotics without pathology that justifies this treatment. 107. The Respondent failed to account for a positive urine drug . " screen on L.B.’s first visit, for THC, opioids and benzodiazepines: 108. The Respondent failed to perform and/or complete a physical examination on L.B. 109. The Respondent's medial records do not justify his prescribing large amounts of narcotic medication to L.B. DOH v. HOSSEIN FARSAD, M.D., CASE NO. 2011-19969 COUNT THIRTEEN (Standard of Care for Patient L.B.) 110. The Petitioner realleges and incorporates paragraphs 1-11 and . 101-109 as fully set forth in this count. lil. Section 458.331(1)(t), Florida Statutes (2009), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2009), states medical malpractice means the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure, | 112. 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 (2009), 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...” 113. The Respondent fell below the standard of care in one or more of the following ways: DOH v, HOSSEIN FARSAD, M.D., CASE NO. 2011-19969 . The Respondent inappropriately prescribed high dose ~ ow narcotics that could be lethal. b. The Respondent failed to refer L.B. to a pain management specialist. a . The Respondent inappropriately prescribed high dose narcotics without pathology to justify this treatment. a . The Respondent failed to account for a positive urine drug screen on LBs first visit for THC, opioids and benzodiazepines. io) . The Respondent failed to complete a physical examination on L.B. 114. Based on the foregoing, the Respondent violated Section 458.331(1)(t), Florida Statutes, (2009), by committing medical malpractice and is subject to disciplinary action by the Board of Medicine. COUNT FOURTEEN (Inappropriate Prescribing for Patient LB) 115. The Petitioner realleges and incorporates paragraphs: 1-11 and 101-109 as fully set forth in this count. DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 116. Section 458.331(1)(q), Florida Statutes (2009), subjects a licensee to discipline 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 the purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, or 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. ' 117. The Respondent prescribed a legend drug other than in the course of his professional practice by prescribing a legend drug inappropriately or in excessive or inappropriate quantities in one or more of the following ways: a, The Respondent prescribed inappropriate amounts of high dose narcotics that could be lethal. b. The Respondent inappropriately prescribed -narcotic medication without pathology to justify this treatment. 34 DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 c. The Respondent inappropriately prescribed narcotic medication without accounting for a positive urine drug screen for THC, opioids and benzodiazepines, on L.B. d. The Respondent prescribed inappropriate amounts of controlled substances by prescribing scheduled drugs for treatment of L.B.’s symptoms without performing a complete physical examination. 118, Based on the foregoing, the Respondent violated Section 458.331(1)(q), Florida Statutes, (2009), by prescribing excessively and inappropriately and is subject to disciplinary action by the Board of Medicine, | . COUNT FIFTEEN (Medical Records for Patient L.B.) 119. The Petitioner realleges and incorporates paragraphs 1-11 and 101-109 as fully set forth in this count. 120, Section 458.331(1)(m), Florida Statutes (2009), provides that a licensee is subject to discipline for failing to keep legible, as defined by department rule in consultation with the board, medical records that " identify the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for 35 DOH y. HOSSEIN FARSAD, M.D., CASE NO. 2011+19969 rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. -121. The Respondent failed to maintain adequate medical records in one or more of the following ways: a. The Respondent's medical records do not explain why he . prescribed narcotic medication at possibly lethal levels. b. The Respondent's medical records do not explain why he prescribed narcotic medication without pathology to justify this treatment. c, The Respondent’s medical records do not explain why he failed to account for a positive urine drug screen for THC, opioids, and benzodiazepines, on L.B. d. The Respondent's medical records do not explain why he prescribed narcotic medication without completing a physical examination for L.B. 36 DOH v, HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 122, Based on the foregoing, the Respondent violated Section 458.331(1)(m), Florida Statutes (2009), by failing to keep adequate medical records and is subject to disciplinary action by the Board of Medicine. COUNT SIXTEEN (Prescribing with Skill and Safety to Patients) 123. The Petitioner realleges and incorporates Paragraphs 1-122 as fully set forth in this count. 124, Section 456.072(1)(gg), Florida Statutes (2009), provides that a licensee is subject to discipline for engaging in a pattern of practice when prescribing medicinal drugs or controlled substances which demonstrates a ~ lack of reasonable skill or safety to patients, a violation of any provision of Chapter 456, a violation of the applicable practice act, or any violation of any rules adopted pursuant to Chapter 456 or the applicable practice act of the prescribing practitioner. 125. The Respondent engaged in a pattern of practice when prescribing drugs which demonstrates a lack of reasonable skill or safety to patients in one or more of the following ways: 37 DOH v. HOSSEIN FARSAD, M.D., CASE NO. 2011-19969 a. The Respondent offered his patients large and possibly fatal amounts of opioid medications without pathology or records to justify this treatment. | b. The Respondent failed to account for positive urine drug screens and/or failed to perform urine drug screens on his . patients. c. The Respondent failed to refer his patients to pain management specialists to assist with their treatment. d. The Respondent failed to complete physical examinations Prior to prescribing narcotic medications to his patients. 126. Based on the foregoing, the Respondent violated Section ; 456.072(1)(g9), Florida Statutes (2009), by engaging in a pattern of Practice when prescribing medicinal drugs or controlled substances which demonstrates a lack of reasonable skill or safety to patients, and is subject to disciplinary action by the Board of Medicine. WHEREFORE, 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 38 DOH y. HOSSEIN FARSAD, M.D., CASE NO. 2011-19969 reprimand, placement of Respondent on probation, corrective action, refund of fees bitled or collected, remedial education and/or any other relief that the Board deems appropriate. SIGNED this 25 day of ZK 2013. John Armstrong, MD, FACS Surgeon General and Secretary of Health ee nathan achem Assistant General Counsel DEPARTMENT ¢ OF HEALTH DOH-Prosecution Services Unit DEPUTY on 4052 Bald Cypress Way-Bin C-65 CLERK AngelSan " 2585 Merchants Row, Suite 105 Express mail pare OCT 28 2012 Tallahassee, Florida 32399-3265 Florida Bar # 0083617 (850) 245-4444 Ext. 8117 (850) 245-4684 fax IRZ Email: Jonathan_Zachem@doh.state.fl.us PCP: October 25, 2013 PCP Members: Dr. El-Bahri, Dr. Stringer, Ms. Pardue 39 DOH v. HOSSEIN FARSAD, M.D., CASE NO, 2011-19969 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 cail 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 to any other discipline imposed. 40 DOH y, HOSSEIN FARSAD, M.D., CASE NO. 2011-19969

Docket for Case No: 14-001650PL