STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO.: 2012-00762 STEVEN ERNEST RAHMAN, 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 the Respondent, Steven Ernest Rahman, 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 ME 83769. Respondent's address of record is 3319 State Road 7, Suite 109, Wellington, Florida 33449. | At all times material, Respondent's place of practice was Progressive Health Institute (hereinafter “Progressive”), located at 900 South U.S. Highway One, Suite 108, Jupiter, Florida 33477. FACTS SPECIFIC TO PATIENT F.C. On or about April 5, 2012, Patient F.C., a fifty-two (52) year old male, sent a facsimile to Progressive which included a completed medical history questionnaire, a therapy management agreement dated April 3, 2012, the results of laboratory tests dated March 2, 2012, a pre-placement physical examination form dated April 3, 2012, and a copy of his driver's license. Patient F.C.’s driver’s license was issued by the state of Massachusetts and he listed his residential address as Massachusetts. From about April 5, 2012 to September 28, 2012, Respondent treated Patient F.C. for difficulty sleeping, decreased energy, decreased muscle strength, decreased skin elasticity, decreased libido, thinning/loss of hair, muscle aches and pains, and increased muscle deterioration. The March 2, 2012 blood analysis results indicated that Patient F.C, possibly had hypogonadism and a pituitary gland tumor. DOH v. Steven Ernest Rahman, MD Case #2012-00762 Patient F.C.’s blood analysis results indicated the need for further evaluation by an endocrinologist. 10. Respondent did not provide adequate evaluation for Patient F.C.’s possible hypogonadism and possible pituitary gland tumor at any point during his treatment of Patient F.C. 11. Over the course of his treatment of Patient F.C., the Respondent prescribed the following legend drugs, supplements, and supplies at various times in various combinations, doses, and quantities: anastrozole!, HCG?, testosterone cypionate?, DHEA‘, B-12 cyanobalamin$, sermorelin/GHRP-6°, testosterone cypionate with zinc’, needles, and syringes. ' Anastrozole is a legend drug approved for the treatment of breast cancer and metastasis in both pre- and post- menopausal women. The primary use of anastrozole in men is to suppress the production of estrogen. ? HCG (human chorionic gonadotropin) is a hormone produced by the syncytiotrophoblast, a portion of the placenta, following implantation. In men, HCG has been used in combination with anabolic androgenic steroids maintain and restore testosterone production and prevent testicular atrophy. 3 Testosterone cypionate injections contain testosterone which is an anabolic steroid that promotes muscle growth. According to Section 893.03(3 Xd), Florida Statutes, testosterone is a Schedule IJ controlled substance that has a high potential for abuse and has a currently accepted by severely restricted medical use in treatment in the United States. Abuse of testosterone may lead to severe psychological or physical dependence. * DHEA is dehydroepiandrosterone. DHEA supplements are used by some people who believe they can improve sex drive, build muscle, fight the effects of aging, and improve some health conditions. 3 B-12 cyanocobalamin is an injectable form of vitamin B-12. ® Sermorelin/GHRP-6 is a growth hormone releasing hormone. {t stimulates the pituitary gland to secrete growth hormones. Sermorelin/GHRP-6 is used by some people who believe it can improve sex drive, build muscle, fight the effects of aging, and improve some health conditions. 7 Some people use zinc supplements in conjunction with testosterone because they believe that zinc can increase testosterone levels. DOH v, Steven Emest Rahman, MD Case #2012-00762 P25 13. 14. 15. 16. Respondent did not perform, or did not create or maintain documentation of performing, a physical examination of Patient F.C. at any point during Respondent's treatment of Patient F.C. The standard of care for prescribing anabolic steroids, growth hormone compounds, and hormone therapy required Respondent to physically examine Patient F.C. and take a complete history, with special attention paid to possible contraindications such as breast and prostate cancer. Additionally, a diagnosis of low serum testosterone must be established before prescribing hormone therapy. The laboratory tests should be current and should be measured with a morning sample and an additional confirmation sample. Respondent did not perform an adequate physical examination of Patient F.C. prior to prescribing steroids, growth hormone compounds, and hormone therapy. Respondent did not order adequate laboratory tests to establish Patient F.C.’s baseline hormone levels. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing testosterone to Patient F.C. ata higher level than the standard replacement dosages. DOH v. Steven Ernest Rahman, MD Case #2012-00762 17. 18. 19, 20. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing HCG and sermorelin to Patient F.C without laboratory test results indicating a growth hormone deficiency. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing anastrozole, an estrogen inhibitor that may be prescribed to increase the effectiveness of testosterone, to Patient F.C. Count I — Patient F.C. Violation of Section 458.331(1)(t) Petitioner re-alleges and incorporates paragraphs five (5) through eighteen (18) as if fully set forth herein. Section 458.331(1)(t), Florida Statutes (2011-2012), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2011- 2012), 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. Section 766.102, Florida Statutes (2011-2012), provides that the prevailing standard of care for a given healthcare provider shall be that level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as 5 DOH v. Steven Ernest Rahman, MD Case #2012-00762 21. 22. acceptable and appropriate by reasonably prudent similar health care providers. Respondent fell below the minimum standard of care in his treatment of Patient F.C. in one or more of the following ways: f. By failing to perform adequate physical examinations of Patient FC.; . By failing to order current laboratory tests to establish Patient F.C.’s baseline hormone levels; , . By failing to perform an adequate evaluation for Patient F.C.’s possible hypogonadism and/or pituitary tumor; . By failing to refer Patient F.C. to an endocrinologist for evaluation of Patient F.C.’s abnormal test results; . By inappropriately prescribing steroids, growth hormone compounds, and anastrozole; and/or By prescribing excessive dosages of testosterone. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2011-2012). DOH v., Steven Ernest Rahman, MD Case #2012-00762 23. 24. 25. Count II — Patient F.C. Violation of Section 458.331(1)(q) Petitioner re-alleges and incorporates paragraphs five (5) through eighteen (18) as if fully set forth herein. Section 458.331(1)(q), Florida Statutes (2011-2012), subjects a licensee to discipline for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, fnduding any controlled substance, other than in the course of the physician's professional practice. For the purposes of the 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. Respondent prescribed legend drugs, including controlled substances, other than in the course of his professional practice in one or more of the following ways: a. By inappropriately prescribing HCG and sermorelin to Patient F.C. without medical justification; a DOH v. Steven Ernest Rahman, MD Case #2012-00762 26. 27. 28. b. By inappropriately prescribing testosterone to Patient F.C. without performing the proper evaluation for treatment; c. By inappropriately prescribing dosages of testosterone at a level higher than is recommended by the standard of care; and/or d. By inappropriately prescribing anastrozole as a supplement to the testosterone treatment when the testosterone treatment was inappropriate. Based on the foregoing, Respondent violated ‘Section 458.331(1)(q), Florida Statutes (2011-2012). Count III — Patient F.C. Violation of Section 458.331(1)(m) Petitioner re-alleges and incorporates paragraphs five (5) through eighteen (18) as if fully set forth herein. Section 458.331(1)(m), Florida Statutes (2011-2012), provides that 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 professiona! 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 8 DCH v. Steven Ernest Rahman, MD Case #2012-00762 29. 30. 31. histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations, is grounds for disciplinary action by the Board and/or Department. Respondent failed to maintain complete and adequate medical records that justified the course of treatment provided for Patient F.C. in one or more of the following ways: . a. By failing to document adequate physical examinations of Patient F.C.; and/or b. By failing to document a medical justification for the care and treatment provided to Patient F.C. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2011-2012). FACTS SPECIFIC TO PATIENT R.K. On or about April 19, 2012, Patient R.K., a thirty-four (34) year old male, sent a facsimile to Progressive which included a completed medical history questionnaire, a high school pre-participation physical fitness evaluation form dated April 12, 2012, laboratory results dated April 12, 2012, and documentation regarding Patient R.K.’s prior microdiskectomy. DOH v. Steven Ernest Rahman, MD Case #2012-00762 32. 33." From about April 19, 2012 to April 23, 2012, Respondent treated Patient R.K. for decreased concentration, increased stress levels, difficulty sleeping, decreased energy, decreased muscle strength, decreased libido, increased fatigue, stiff joints, and muscle aches and pains. On or about April 23, 2012, Respondent prescribed the following legend drugs, supplements, and supplies to Patient R.K.: anastrozole, HCG, testosterone cypionate, nandrolone®, danazol®, B-12 cyanocobalamin, MIC Injectable, MIC Capsule, testosterone suspension'!, GAC!2, and needles and syringes in various sizes. 34, Respondent did not perform, or did not create or maintain documentation of performing, a physical examination of Patient R.K. at any point during his treatment of Patient R.K. 35. The standard of care for prescribing anabolic steroids and growth hormone compounds required Respondent to physically examine Patient ® Nandrolone is an anabolic steroid that promotes muscle growth. According to Section 893.03(3\(d), Florida Statutes, nandrolone is a Schedule III controlled substance that has a high potential for abuse and has a currently accepted by severely restricted medical use in treatment in the United States. Abuse of nandrolone may lead to severe psychological or physical dependence. ° Danazol, synthetic steroid derived from ethisterone and is primarily used to treat endometriosis. That suppresses the production of gonadotrophins and has some weak androgenic effects. ‘© MIC injections contain methionine, inositol and choline and are generally utilized in medically supervised weight loss. "| Testosterone suspension is an anabolic steroid in an injectable form: According to Section 893.03(3)(d). Florida Statutes, testosterone is a Schedule II] controlled substance that has a high potential for abuse and has a-currently accepted by severely restricted medical use in treatment in the United States. Abuse of testosterone may lead to severe psychological or physical dependence. GAC is a supplement containing glutamine, arginine, and carnitine and is generally used for weight loss and muscle building. 10 DOH v, Steven Ernest Rahman, MD Case #2012-00762 36. 37. 38. 39. RK. and take a complete history, with special attention paid to possible contraindications such as breast and prostate cancer. Additionally, a diagnosis of low serum testosterone “must be established before prescribing hormone therapy. The laboratory tests should be current and should be measured with a morning sample and an additional confirmation sample. Respondent did not perform an adequate physical examination of Patient R.K. prior to prescribing steroids and growth hormone compounds. Respondent did not order adequate laboratory tests to establish Patient R.K.'s baseline hormone levels. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing steroids and growth hormone compounds to Patient R.K. without evidence of hypogonadism or any other hormonal abnormality or deficiency. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing anastrozole, an estrogen inhibitor that may be prescribed to increase the effectiveness of testosterone, to Patient F.C, Count IV — Patient R.K. Violation of Section 458.331(1)(t) DOH v. Steven Emest Rahman, MD Case #2012-00762 40. 41. 42. Petitioner re-alleges and incorporates paragraphs thirty-one (31) through thirty-nine (39) as if fully set forth herein. Section 458.331(1)(t), Florida Statutes (2011), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2011), 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 fleersores Section 766.102, Florida Statutes (2011), provides that the prevailing standard of care for a given healthcare 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 fell below the minimum standard of care in his treatment of Patient R.K. in one or more of the following ways: a. By failing to perform adequate physical examinations of Patient R.K.; b. By failing to order current laboratory tests to establish Patient ow R.K.'s baseline hormone levels; and/or DOH v. Steven Ernest Rahman, MD Case #2012-00762 43. 45. ¢. By inappropriately prescribing steroids, growth hormone compounds, and anastrozole. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2011). Count V — Patient R.K. Violation of Section 458.331(1)(q) Petitioner re-alleges and incorporates paragraphs thirty-one (31) through thirty-nine (39) as if fully set forth herein. Section 458.331(1)(q), Florida Statutes (2011), 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 the paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend — including all controlied 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. Respondent inappropriately prescribed legend drugs, including controlled substances, other than in the course of his professional practice by DOH v. Steven Ernest Rahman, MD Case #2012-00762 47. 48. 49. prescribing steroids and growth hormone compounds to Patient R.K- without performing the proper evaluation for treatment. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2011). Count VI — Patient R.K. Violation of Section 458.331(1)(m) Petitioner re-alleges and incorporates paragraphs thirty-one (31) through thirty-nine (39) as if fully set forth herein., , Section 458.331(1)(m), Florida Statutes (2011), provides that 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, is grounds for disciplinary action by the Board and/or Department. DOH v. Steven Ernest Rahman, MD Case #2012-00762 50. - SL. 52. 53. 54. Respondent failed to maintain complete and adequate medical records that justified the course of treatment provided for Patient R.K. in one or more of the following ways: a. By failing to document adequate physical examinations of Patient R.K.; and/or b. By failing to document a medical justification for prescribing Patient R.K. the aforementioned legend drugs. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2011). FACTS SPECIFIC TO PATIENT C.B. On or about March 3, 2012, Patient C.B., a thirty-five (35) year old male, completed a medical history questionnaire and therapy management agreement for treatment at Progressive. Patient C.B. provided Progressive with medical records from a surgery he had in 2005, documentation of blood analysis results dated May 20, 2010 and July 7, 2011, documentation of a physical examination conducted on October 12, 2011, and a copy of his driver's license. Patient C.B.’s driver's license was issued by New Jersey and he listed his residential address as California. DOH v. Steven Ernest Rahman, MD Case #2012-00762 55. 56. 57. 58. From about April 11, 2012 to July 27, 2012, Respondent treated Patient C.B. for decreased concentration, increased stress levels, decreased energy, decreased muscle strength, decreased skin elasticity, decreased libido, thinning or loss of hair, decreased long and short term memory, decreased testicle size, increased muscle deterioration, thinning and dry skin, and increased joint pain. On or about April 11, 2012, Respondent prescribed the following medications to Patient C.B.: anastrozole, HCG, sildenafil'?, testosterone cypionate, methylcobalamin"*, and nandrolone. Respondent did not perform, or did not create or maintain documentation of performing, an adequate physical examination of Patient C.B. at any point during Respondent's treatment of Patient C.B. The standard of care for prescribing anabolic steroids, hormones, and growth hormone compounds required Respondent to physically examine Patient C.B. and take a complete history, with special attention paid to possible contraindications such as breast and prostate cancer. Additionally, a diagnosis of low serum testosterone must be established before prescribing hormone therapy. The laboratory tests should be 13 Sildenafil, otherwise known as Viagra, is a legend drug commonly prescribed to treat erectile dysfunction. 14 Methylcobalamin is a form of vitamin B12. DOH v. Steven Emest Rahman, MD Case #2012-00762 59. 60. 61. 62. 63. current and should be measured with a morning sample and an additional confirmation sample. Respondent did not perform an adequate physical examination of Patient C.B. prior to prescribing steroids and growth hormone compounds. Respondent did not order current and adequate laboratory tests to establish Patient C.B.’s baseline hormone levels. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing growth hormone compounds to Patient C.B. without laboratory test results indicating a growth hormone deficiency. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing steroids and hormone therapy to Patient C.B. without laboratory test results indicating hypogonadism or any other hormonal abnormality or deficiency. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing anastrozole, an estrogen inhibitor that may be prescribed to increase the effectiveness of testosterone, to Patient C.B. Count VII — Patient C.B. Violation of Section 458.331(1)(t) DOH v, Steven Ernest Rahman, MD Case #2012-00762 64. 65. 66. Petitioner re-alleges and incorporates paragraphs fifty-two (52) through sixty-three (63) as if fully set forth herein. Section 458.331(1)(t), Florida Statutes (2011-2012), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2011- 2012), 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. Section 766.102, Florida Statutes (2011-2012), provides that the prevailing standard of care for a given healthcare 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 fell below the minimum standard of care in his treatment of Patient C.B. in one or more of the following ways: a. By failing to perform adequate physical examinations of Patient C.B.; b. By failing to order current laboratory tests to establish Patient ” C.B.'s baseline hormone levels; and/or DOH ’v, Steven Ernest Rahman, MD Case #2012-00762 67. 68. 69. ¢. By inappropriately prescribing steroids, growth hormone compounds, and anastrozole in the absence of hypogonadism or any other hormone deficiency. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2011-2012). . Count VIII — Patient C.B. Violation of Section 458.331(1)(q) Petitioner re-alleges and incorporates paragraphs fifty-two (52) through sixty-three (63) as if fully set forth herein. Section 458.331(1)(q), Florida Statutes (2011-2012), 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 the 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. Steven Ernest Rahman, MD Case #2012-00762 70. Respondent prescribed legend drugs, including controlled substances, other than in the course of his professional practice by inappropriately prescribing anabolic steroids, HCG, anastrozole, and testosterone to Patient C.B. in the absence of a hormonal imbalance or any other medical justification. 71. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2011-2012). Count IX — Patient C.B. Violation of Section 458.331(1)(m) 72. Petitioner re-alleges and incorporates paragraphs fifty-two (52) through sixty-three (63) as if fully set forth herein. 73. Section 458.331(1)(m), Florida Statutes (2011-2012), provides that 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 preseribed, dispensed, or administered; and reports of consultations and 20 DOH v. Steven Emest Rahman, MD Case #2012-00762 74. 75. 76. 77. hospitalizations, is grounds for disciplinary action by the Board and/or Department. Respondent failed to maintain complete and adequate medical records that justified the course of treatment provided for Patient C.B. in one or more of the following ways: a. By failing to document adequate physical examinations of Patient C.B.; and/or b. By failing to document a diagnosis or medical justification for prescribing Patient C.B. the aforementioned medications. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2011-2012). . FACTS SPECIFIC TO R.W. From about June 15, 2012 to August 29, 2012, Respondent treated Patient R.W. for decreased concentration, increased stress levels, difficulty sleeping, increased wrinkles, thinning and loss of hair, decreased sex drive, decreased endurance, increased fat deposits, and increased joint pain. Ove the course of Respondent’s treatment of Patient RW., the Respondent prescribed the following medications and supplies at various 21 DOH v. Steven Ernest Rahman, MD Case #2012-00762 78. 79. 80. times in various combinations, doses, and quantities: anastrozole, testosterone cypionate, HCG, sildenafil, glucosamine’, amino blend with lidocaine injection**, nandrolone, needles, and syringes. Respondent did not perform, or did not create or maintain documentation of performing, an adequate physical examination prior to prescribing steroids, growth hormone compounds, and hormone therapy. The standard of care for prescribing anabolic steroids, growth hormone compounds, and hormone therapy required Respondent to physically examine Patient R.W. and take a complete history, with special attention paid to possible contraindications such as breast and prostate cancer. Additionally, a diagnosis of low serum testosterone must be established before prescribing hormone therapy. The laboratory tests should be current and should be measured with a morning sample and an additional confirmation sample. Respondent did not document physical examinations of Patient R.W. at any point during his treatment of Patient R.W. 5 Glucosamine is a dietary supplement believed by some to relieve symptoms of osteoarthritis. 'S An amino blend is‘a dietary supplement consisting of several amino acids believed by some to assist with weight loss. Lidocaine. an anesthetic, is included in the injections as well. : 22 DOH v. Steven Ernest Rahman, MD Case #2012-00762 81. 82. 83. 84. 85. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing growth hormone compounds to Patient R.W. without laboratory test results indicating a growth hormone deficiency. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing steroids and hormone therapy to Patient R.W. without laboratory test results indicating hypogonadism or any other hormonal abnormality or deficiency. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing anastrozole, an estrogen inhibitor that may be prescribed to increase the effectiveness of testosterone, to Patient R.W without laboratory test results indicating a hormonal deficiency. Count X — Patient R.W. Violation of Section 458.331(1)(t) Petitioner re-alleges and incorporates paragraphs seventy-six (76) through eighty-three (83) as if fully set forth herein. Section 458.331(1)(t), Florida Statutes (2011-2012), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2011- 2012), defines medical malpractice as the failure to practice medicine in 23 DOH v. Steven Ernest Rahman, MD Case #2012-00762 accordance with the level of care, skill, and treatment recognized in general law related to health care licensure. Section 766.102, Florida Statutes (2011-2012), provides that the prevailing standard of care for a given healthcare 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. 86. Respondent fell below the minimum standard of care in his treatment of Patient R.W. in one or — of the following ways: a. By failing to perform adequate physical examinations of Patient R.W.; | b. By failing to order current laboratory tests to establish Patient R.W/s baseline hormone levels; and/or c. By inappropriately prescribing steroids, growth hormone compounds, and anastrozole in the absence of hypogonadism or any other hormone deficiency. 87. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2011-2012). Count XI — Patient R.W. Violation of Section 458.331(1)(q) 24 DOH v. Steven Ernest Rahman, MD Case #2012-00762 88. 89. 90. 91. Petitioner re-alleges and incorporates paragraphs seventy-six (76) through eighty-three (83) as if fully set forth herein. Section 458.331(1)(q), Florida Statutes (2011-2012), 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 the 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. Respondent prescribed legend drugs, including controlled substances, other than in the course of his professional practice by inappropriately prescribing anabolic steroids, HCG, anastrozole, and testosterone to Patient R.W. in the absence of any hormonal imbalance or any other medical justification. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2011-2012). 25 DOH v. Steven Ernest Rahman, MD Case #2012-00762 92. 93. 94. Count XII — Patient R.W. Violation of Section 458.331(1)(m) Petitioner re-alleges and incorporates paragraphs seventy-six (76) through eighty-three (83) as if fully set forth herein. Section 458.331(1)(m), Florida Statutes (2011-2012), provides that 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, is grounds for disciplinary action by the Board and/or Department. Respondent failed to maintain complete and adequate medical records that justified the course of treatment provided for Patient R.W. in one or more of the following ways: a. By failing to document adequate physical examinations of Patient R.W.; and/or 26 DOH v. Steven Ernest Rahman, MD Case #2012-00762 b, By failing to document a diagnosis or medical justification for prescribing Patient R.W. the aforementioned medications. 95. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2011-2012). FACTS SPECIFIC TO D.A. 96. From on or about February 15, 2012 to July 2, 2012, Respondent prescribed Patient D.A. the following legend drugs, supplements, and equipment in various quantities and dosages: anastrozole, HCG, Lipo Max!?, testosterone cypionate, L-arginine!®, L-glutamine’, danazol, triamtereme”, phentermine2!, testosterone propionate2, needles, and syringes. 97. There is no documentation of any health complaints or issues reported by Patient D.A. that would indicate Respondent's justification for his treatment of Patient D.A. " Lipo Max is a weight loss supplement. '8 L-arginine is an amino acid used for improving athletic performance. 19 L-glutamine is an amino acid used for improving exercise performance. ° Triamtereme is a diuretic used to treat fluid retention. Diuretics are used by some people to assist in weight loss. 2) Phentermine is an appetite suppressant drug and is medically prescribed as a diet pill. According to Section 893.03(4), phentermine is a Schedule IV controlled substance which has a low potential for abuse and is currently accepted for medical use in the United States. Abuse of the substance may lead to limited physical or psychological dependence. o” ® Testosterone propionate is an anabolic steroid. According to Section 893.03(3)(d), Florida Statutes, testosterone is a Schedule HI controlled substance that has a high potential for abuse and has a currently accepted by severely restricted medical use in treatment in the United States. Abuse of testosterone may lead to severe psychological or physical dependence. 27 DOH v. Steven Ernest Rahman, MD Case #2012-00762 98. 99. 100. 101. 102. Respondent did not perform, or did not create or maintain documentation of performing, physical examinations of Patient D.A. at any point during his treatment of Patient D.A. The standard of care for prescribing anabolic steroids, growth hormone compounds, and hormone therapy required Respondent to physically examine Patient D.A. and take a complete history, with special attention paid to possible contraindications such as breast and prostate cancer. Additionally, a diagnosis of low serum testosterone must be established before prescribing hormone therapy. The laboratory tests should be current and should be measured with a morning sample and an additional confirmation sample. Respondent did not perform an adequate physical examination prior to prescribing steroids, growth hormone compounds, and hormone therapy. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing growth hormone compounds to Patient D.A. without laboratory test results indicating a growth hormone deficiency. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing steroids and hormone therapy to Patient 28 DOH v. Steven Ernest Rahman, MD Case #2012-00762 103. 104. 105. D.A. without laboratory test results indicating hypogonadism or any other hormonal abnormality or deficiency. Respondent did not justify, or did not create or maintain documentation adequately justifying, prescribing anastrozole, an estrogen inhibitor that may be prescribed to increase the effectiveness of testosterone, to Patient D.A. without laboratory test results indicating a hormonal deficiency. Count XIII — Patient D.A. Violation of Section 458.331(1)(t) Petitioner re-alleges and incorporates paragraphs ninety-six (96) through one hundred three (103) as if fully set forth herein. Section 458.331(1)(t), Florida Statutes (2011), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2011), 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. Section 766.102, Florida Statutes (2011), provides that the prevailing standard of care for a given healthcare provider shall be that level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as Pa 29 DOH v. Steven Ernest Rahman, MD Case #2012-00762 106. 107. 108. 109. acceptable and appropriate by reasonably prudent similar health care providers. Respondent fell below the minimum standard of care in his treatment of Patient D.A. in one or more of the following ways: a. By failing to perform adequate physical examinations of Patient D.A.; b. By failing to order current laboratory tests to establish Patient D.A.’s baseline hormone levels; and/or c. By inappropriately prescribing steroids, growth hormone compounds, and anastrozole in the absence of hypogonadism or any other hormone deficiency. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2011). Count XIV — Patient D.A. Violation of Section 458.331(1)(q) Petitioner re-alleges and incorporates paragraphs ninety-six (96) through one hundred three (103) as if fully set forth herein. Section 458.331(1)(q), Florida Statutes (2011), subjects a licensee to discipline for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than 30 DOH v. Steven Ernest Rahman, MD Case #2012-00762 A 110. 111. 112. 113. in the course of the physician’s professional practice. For the purposes of the 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. Respondent prescribed legend drugs, including controlled substances, other than in the course of his professional practice by inappropriately prescribing anabolic steroids, HCG, anastrozole, and testosterone to Patient D.A. in the absence of a hormonal imbalance or any other medical justification. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2011). Count XV — Patient D.A. Violation of Section 458.331(1)(m) Petitioner re-alleges and incorporates paragraphs ninety-six (96) through one hundred three (103) as if fully set forth herein. Section 458.331(1)(m), Florida Statutes (2011), provides that failing to keep legible, as defined by department rule in consultation with the board, medical records that identify the licensed physician or the physician 31 DOH v. Steven Ernest Rahman, MD Case #2012-00762 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, is grounds for disciplinary action by the Board and/or Department. 114. Respondent failed to maintain complete ‘and adequate medical records that justified the course of treatment provided for Patient D.A. in one or more of the following ways: a, By failing to document adequate physical examinations of Patient D.A.; and/or b. By failing to document a diagnosis or medical justification for prescribing Patient D.A. the aforementioned medications. 115. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2011). 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, 32: DOH v. Steven Ernest Rahman, MD Case #2012-00762 impositign of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. SIGNED this_29 — day of Jannae| , 2016. John H. Armstrong, MD, FACS State Surgeon General and Secretary of Health Assistant General CouriSel DOH Prosecution Services Unit FILED 4052 Bald Cypress Way, Bin C-65 Depeenat Of He Tallahassee, Florida 32399-3265 Deputy Florida Bar Number 0085797 ome . MAK —— (850) 245 - 4444 Telephone a ee (850) 245 - 4683 Facsimile SEC/ PCP: 1/22/2016 PCP Members: G. El-Bahri, M.D., S. Terkonda, M.D., Ms. B. Goersch 33 DOH v. Steven Ernest Rahman, MD Case #2012-00762 NOTICE OF RIGHTS Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested. A request or petition for an administrative hearing must be in writing and must be received by the Department within 21 days from the day Respondent received the Administrative Complaint, pursuant to Rule 28-106.111(2), Florida Administrative Code. If Respondent fails to request a hearing within 21 days of receipt of this Administrative Complaint, Respondent waives the right to request a hearing on the facts alleged in this Administrative Complaint pursuant to Rule 28-106.111(4), Florida Administrative Code. Any request for an administrative proceeding to challenge or contest the material facts or charges contained in the Administrative Complaint must conform to Rule 28-106.2015(5), Florida Administrative Code. Please be advised that mediation under Section 120.573, Florida Statutes, is not available for administrative disputes involving this agency action. NOTICE REGARDING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition any other discipline imposed. 34 DOH v. Steven Ernest Rahman, MD Case #2012-00762

Docket for Case No: 20-000699PL