STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, Petitioner, v. CASE NO.: 2017-12689 THOMAS K. VELLEFF, Jr., M.D., Respondent. / ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, files this Administrative Complaint before the Board of Medicine against Respondent Thomas Karl Velleff, Jr., M.D., and in support thereof alleges: 1. Petitioner is the state agency charged with regulating the practice of Medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 458, Florida Statutes. 2. At all times material to this Complaint, Respondent was a licensed medical doctor within the State of Florida, having been issued license number ME 42998. 3. | Respondent's address of record is 5130 Pina Vista, Melbourne, Florida 32934. 4. At all times material to this complaint, Respondent practiced at Atlantis Pain Care in Melbourne, Florida. 5. Respondent treated Patient S.C., a then sixty-five (65) year old male, from on or about July 2014 to April 2016 at Atlantis Pain Care. 6. Respondent treated Patient S.C. for complaints of sleep problems and chronic pain in his right and left shoulder, neck, right and left ankles, and right knee. 7. Respondent diagnosed S.C. with severe diffuse rheumatoid arthritis. 8. During Respondent's treatment of Patient S.C., S.C. was obese and a cigarette-smoker. 9. During Respondent's treatment of Patient S.C., S.C. had a history of substance abuse disorder. 10. Respondent prescribed Oxycodone! in the amount of 30 mg four times daily for the management of S.C.’s chronic pain. 11. Respondent increased S.C.’s Oxycodone prescription to 30 mg six times daily for the management of S.C.’s chronic pain. 7 Oxycodone (opioid, Schedule I); Oxycodone is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes, oxycodone is a Schedule 1] controlied substance that has a high potential for abuse and has a currently accepted but severely restricted medical use In treatment in the United States, and abuse of oxycodone may lead to severe psychological or physical dependence. DOH v. Thomas Karl Velleff, Jr., M.D.; Case Number 2017-12689 2 12. Respondent prescribed 10 mg of Diazepam* to be taken in addition to S.C.’s Oxycodone prescription. 13. Respondent prescribed an excessive dose of oxycodone to S.C. 14. Respondent did not confirm, or document confirmation of S.C.‘s previous opioid regimen. 15. Respondent did not perform, or did not create or keep documentation of performing, a complete and proper history and physical examination of S.C. 16. Respondent did not identify or implement an appropriate treatment plan for S.C. 17. Respondent did not refer, or did not create or keep documentation of referring, S.C. to ancillary medical providers to co-manage his chronic pain. 18. Respondent did not refer, or did not create or keep documentation of referring, S.C. to a psychiatrist and/or addiction specialist for specialized consultations. 2 Diazepam (brand name Valium, benzodiazepine, Schedule IV, diazepam is metabolized into nordiazepam, temazepam, and oxazepam); Diazepam, commonly known by the brand name Valium, is prescribed to treat anxlety. According to Section 893.03(4), Florida Statutes, diazepam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States, and abuse of diazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. DOH v. Thomas Karl Velleff, Jr., M.D.; Case Number 2017-12689 3 19. Respondent’s handwritten entries in the medical records are difficult to read and, in some parts, illegible. 20. Respondent did not document his justification for prescribing high doses of Oxycodone to Patient S.C. 21. Respondent did not document his justification in increasing the dosage of Oxycodone to Patient S.C. during the treatment period. 22. The prevailing professional standard of care for a physician who is treating an elderly, obese, cigarette-smoking patient for complaints including but not limited to pain in his right shoulder, cervical spine, and knee, requires a physician to: a, Not prescribe high doses of Oxycodone to patient; b. Not prescribe Diazepam to be taken in addition to an Oxycodone prescription to patient; c. Confirm the patient’s previous opioid regimen; d. Perform a complete and proper medical history of the patient; e. Perform a physical examination of the patient; f. Identify and implement an appropriate treatment plan for the patient; DOH v. Thomas Karl Velleff, Jr., M.D.; Case Number 2017-12689 4 g. Refer the patient to ancillary medical providers to co-manage the patient’s chronic pain; and h. Refer the patient to a psychiatrist and/or addiction specialist for specialized consultations. 23. The Florida Board of Medicine has also adopted rule 64B8-9.013(3), Standards for the Use of Controlled Substances for the Treatment of Pain, which requires a physician to do the following: a. A complete medical history and physical examination conducted and documented in the medical record; and b. Develop a written treatment plan that state objectives that will be used to determine treatment success; and c. Be willing to refer the patient as necessary for additional evaluation and treatment in order to achieve treatment objectives; and d. Keep accurate and complete records such as treatment objectives, discussion of risks and benefits of treatments, medications, and drug testing results. DOH v. Thomas Karl Velleff, Jr., M.D.; Case Number 2017-12689 5 COUNT I 24. Petitioner realleges and incorporates paragraphs one (1) through eighteen (18) and paragraph twenty-two (22) and as if fully set forth herein. 25. Section 458.331(1)(t), Florida Statutes (2014-2016), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2014-2016), 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. Section 766.102, Florida Statutes (2014-2016), 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. 26. Respondent fell below the standard of care in his treatment of Patient S.C. in one or more of the following ways: a. By prescribing excessive doses of Oxycodone to patient; b. By prescribing Diazepam in combination with an Oxycodone prescription; c. By failing to confirm the patient’s previous opioid regimen; DOH v. Thomas Karl Velleff, Jr., M.D.; Case Number 2017-12689 6 d. By failing to perform a complete and proper medical history of the patient; e. By failing to perform a physical examination of the patient; f. By failing to identify and implement an appropriate treatment plan for the patient; g. By failing to refer the patient to ancillary medical providers to co-manage the patient’s chronic pain; and/or h. By failing to refer the patient to a psychiatrist and/or addiction specialist for specialized consultations. 27. Based on the foregoing, Respondent violated section 458.331(1)(t), Florida Statutes (2014-2016), by committing medical malpractice. COUNT II 28. Petitioner realleges and incorporates paragraphs one (1) through twenty-one (21) as if fully set forth herein. 29. Section 458.331(1)(m), Florida Statutes (2014-2016), subjects a licensee 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 DOH v. Thomas Karl Velleff, Jr., M.D.; Case Number 2017-12689 7 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. 30. Section 458.331(1)(nn), Florida Statutes (2014-2016), provides that violating any provision of this Chapter or Chapter 456, or any rules adopted pursuant thereto constitutes grounds for disciplinary action by the Board of Medicine. 31. Rule 64B8-9.003, F.A.C., the Board’s rule, states in relevant part, regarding medical records provides in subsection (3): 64B8-9.003 Standards for Adequacy of Medica! Records. (3) The medical record shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; reports of consultations and hospitalizations; and copies of records or reports or other documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient. 32. Respondent failed to create or keep medical records during Patient S.C.’s treatment period in one or more of the following ways: DOH v. Thomas Karl Velleff, 3r., M.D.; Case Number 2017-12689 8 a. By failing to create or keep documentation of confirmation of the patient's previous opioid regimen; b. By failing to create or keep documentation of a complete and proper history; c. By failing to create or keep documentation of a physical examination; d. By failing to create or keep documentation of his referrals to ancillary medical providers to co-manage Patient S.C.’s chronic pain; e. By failing to create or keep documentation of referral to a psychiatrist and/or addiction specialist for specialized consultations; f. By failing to create or keep legible medical records; g. By failing to document his justification for prescribing excessive doses of Oxycodone; and/or h. By failing to document his justification for increasing the dosage of Oxycodone to Patient S.C. 33. Based on the foregoing, Respondent has violated section 458.331(1)(m), Florida Statutes (2014-2016), and/or section DOH v. Thomas Karl Veileff, Jr., M.D.; Case Number 2017-12689 9 458.331(1)(nn), Florida Statutes (2014-2016), by violating Rule 64B8-9.003, F.A.C. 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 and/or any other relief that the Board deems appropriate. SIGNED this [2 day of___ Novamee_, 2019. Scott A. Rivkees, M.D. State Surgeon General Florida Bar No. 103037 DOH-Prosecution Services Unit 4052 Bald Cypress Way-Bin C-65 Tallahassee, Florida 32399-3265 ° DEPUTY CLERK (850) 558-9846 telephone ser Angel bandos (850) 245-4684 fax FILED DEPARTMENT OF HEALTH DATE NOV 1 2 ang E-Mail: jasmine.green@flhealth.gov PCP Date: November 8, 2019 PCP Members: Robert London, M.D., Zachariah Zachariah, M.D. DOH v. Thomas Karl Velleff, Jr., M.D.; Case Number 2017-12689 10 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. Mediation under Section 120.573, Florida Statutes, is not available to resolve this Administrative Complaint. 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. DOH v. Thomas Karl Velleff, Jr., M.D.; Case Number 2017-12689 11

Docket for Case No: 20-003000PL