STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO. 2010-14667 NATHAN R. PERRY, JR., M.D., RESPONDENT. / ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Medicine against the Respondent, Nathan R. Perry, Jr., M.D., and in support thereof alleges: 1. Petitioner is the state department 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 physician within the State of Florida, having been issued license number 61123. At 3. | Respondent’s address of record is 1301 Monument Road, Suite 21, Jacksonville, Florida 32225. 4. Xanax is the brand name for alprazolam and is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, alprazolam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States. Abuse of alprazolam may lead to limited physical or psychological dependence relative to the substances in Schedule III. 5. | Methadone is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, methadone is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States. Abuse of methadone may lead to severe psychological or physical dependence. 6. | Oxycodone/APAP contains oxycodone and acetaminophen, or Tylenol. 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 DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 the United States. Abuse of oxycodone may lead to severe psychological or physical dependence. 7. Valium is the brand name for diazepam and is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, diazepam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States. Abuse of diazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. 8. Roxicodone contains oxycodone and is a Schedule II controlled substance, pursuant to Chapter 893, Florida Statutes. A substance in Schedule II has a high potential for abuse and has a currently accepted but severely restricted medical use for the relief of moderate to severe pain. Abuse of the substance may lead to severe psychological or physical dependence. 9. Rule 64B8-9.013(3), Florida Administrative Code, provides as follows: The Board has adopted the following standards for the use of controlled substances for pain control: DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 (a) Evaluation of the Patient. A complete medical history and physical examination must be conducted and documented in the medical record. The medical record should document the nature and intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and history of substance abuse. The medical record also should document the presence of one or more recognized medical indications for the use of a controlled substance. (b) Treatment Plan. The written treatment plan should state objectives that will be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and should indicate if any further diagnostic evaluations or other treatments are planned. After treatment begins, the physician should adjust drug therapy to the Patient medical needs of each patient. Other treatment modalities or a rehabilitation program may be necessary depending on the etiology of the pain and the extent to which the pain is associated with physical and psychosocial impairment. 10. On or about February 2, 2005 through March, 19, 2010, Respondent prescribed the controlled substances methadone, diazepam, oxycodone, roxicodone and alprazolam without justification and in strengths and quantities which were potentially lethal to JM, a 44 year-old, male who presented to Respondent with complaints of lower back pain. 11. On or about October 20, 2008 through July 15, 2010, Respondent prescribed the controlled substances methadone, diazepam, 4 DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 oxycodone, roxicodone and alprazolam without justification and in strengths and quantities which were potentially lethal to BM, a 36 year-old, female, and the wife of JM, who presented to Respondent with complaints of knee pain. 12. Respondent did not refer or did not document a referral for JM or BM to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain management specialist. 13. Respondent did not document or did not perform a complete medical history and physical exam on JM or BM. 14. Respondent prescribed the controlled substance drugs methadone, diazepam, oxycodone, roxicodone and alprazolam without documenting or determining the following: a. | The nature or intensity of JM and BM’s pain; b. Current or past treatments of JM and BM’s pain; c. The effect of pain on JM and BM’s physical or psychological function; d. Any history of substance abuse for JM and BM; e. Whether JM and BM were taking the prescribed medications or whether JM and BM were taking DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 illicit drugs by performing any drug screens by an outside laboratory during the course of treatment; f. Obtaining any diagnostic studies on JM and BM; g. Obtaining any consultations from other specialists on JM and BM; h. Counsel JM and BM on the potential danger of addiction and abuse of the medication being prescribed. i. Respondent did not develop or did not document a treatment plan for JM and BM. COUNT ONE 15. Petitioner realleges and incorporates paragraphs 1 through 14 as if fully set forth herein. 16. Section 458.331(1)(q), Florida Statutes (2006-2010), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician’s professional practice. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately 6 DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 or in excessive or inappropriate quantities is not in the best interest of the patient and is not in the course of the physician’s professional practice, without regard to his intent. 17. Respondent prescribed controlled substances inappropriately or in excessive or inappropriate quantities in one or more of the following ways: a. By prescribing the controlled substances, methadone, diazepam, oxycodone, roxicodone and alprazolam without justification to patients JM and BM, as outlined in paragraphs 1 through 14; 18. Based on the forgoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2006-2010) when he prescribed the controlled substances, methadone, diazepam, oxycodone, roxicodone and alprazolam without justification and in potentially lethal doses, to JM and BM, as outlined in paragraphs 1 through 9. COUNT TWO 19. Petitioner realleges and incorporates paragraphs 1 through 14 as if fully set forth herein. DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 20. Section 458.331(1)(m), Florida Statutes (2006-2010), provides that failing to keep legible medical records that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations, constitutes grounds for disciplinary action by the Board of Medicine. 21. Respondent failed to keep legible medical records justifying the course of treatment for JM and BM in one or more of the following ways: a. By failing to document justification for prescribing methadone, diazepam, oxycodone, roxicodone and alprazolam to JM and BM; b. By failing to document referrals for JM and BM to a psychiatrist, an orthopedic surgeon, a_ physical therapist, or an interventional pain specialist; c. By failing to document performance of a complete medical history and physical exam on JM and BM; d. __ By failing to document the nature or intensity of JM and BM’s pain; DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 e. By failing to document current or past treatments of JM and BM's pain; f. By failing to document the effect of pain on JM and BM's physical or psychological function; g. By failing to document any history of substance abuse for JM and BM; h. By failing to document a treatment plan for JM and BM; i By failing to document a urine drug screen from an outside laboratory on JM and BM; j. By failing to document any diagnostic studies on JM and BM. 22. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2006-2010), by failing to keep legible medical records that justify the course of treatment for JM and BM. COUNT THREE 23. Petitioner realleges and incorporates paragraphs 1 through 14 as if fully set forth herein. DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 24. Section 458.331(1)(t), Florida Statutes (2006-2010), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50, Florida Statutes (2006- 2010), defines medical malpractice as the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure. 25. 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(1), Florida Statutes. Section 766.102(1), Florida Statutes, defines the standard of care to mean“ . . . The prevailing professional standard of care for a given health care provider shall be that level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers. . . .” 26. Respondent failed to meet the required standard of care in one or more of the following ways: a. By prescribing methadone, diazepam, oxycodone, roxicodone and alprazolam to JM and BM without DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 justification, as outlined in paragraphs 1 through 14; b. By prescribing methadone, diazepam, oxycodone, roxicodone and alprazolam to JM and BM in potentially lethal doses, as outlined in paragraphs 1 through 14; c. _ By failing to refer JM and BM to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain specialist; d. By failing to obtain a complete medical history perform a physical exam on JM and BM; e. By failing to obtain the nature or intensity of JM and BM's pain; f. By failing to obtain the current or past treatments of JM and BM‘s pain; g. _ By failing to obtain information on the effect of pain on JM and BM’s physical or psychological function; h. By failing to obtain any history of substance abuse for JM and BM; DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 i. By failing to develop a treatment plan for JM and BM; j. By failing to obtain a urine drug screen from an outside laboratory on JM and BM; k. By failing to review or obtain any diagnostic studies on JM and BM. 27. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2006-2010), by committing medical malpractice. COUNT FOUR 28. Petitioner reincorporates and realleges paragraphs 1 through 14 as if fully set forth herein. 29. Section 458.331(1)(nn), Florida Statutes(2006-2010), provides that violating any provision of chapters 456 or 458, Florida Statutes, or any rules adopted pursuant thereto, is grounds for discipline by the Board of Medicine. 30. Respondent violated Section 458.331(1)(nn), Florida Statutes (2006-2010)) when he violated Rule 64B8-9.013(3), FAC in one or more of the following ways: DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 a. By failing to document justification for prescribing methadone, diazepam, oxycodone, roxicodone and alprazolam to JM and BM; b. By failing to document referrals for JM and BM to a psychiatrist, an orthopedic surgeon, a_ physical therapist, or an interventional pain specialist; c. By failing to document performance of a complete medical history and physical exam on JM and BM; d. __ By failing to document the nature or intensity of JM and BM'‘s pain; e. By failing to document current or past treatments of JM and BM’s pain; f. By failing to document the effect of pain on JM and BM’s physical or psychological function; g. _ By failing to document any history of substance abuse for JM and BM; h. By failing to document a treatment plan for JM and BM; DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 i. By failing to document a medication management agreement on any visits but still prescribing controlled substances; j. By failing to document a urine drug screen from an outside laboratory on JM and BM; k. By failing to document any diagnostic studies on JM and BM. 31. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2006-2010), by violating Rule 64B8- 9.013(3), FAC. DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 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 or any other relief that the Board deems appropriate. SIGNED this__<%%_ day of ghee ___, 2012. John H. Armstrong, MD State Surgeon General and Secretary of Health Tan Brown Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, BIN C-65 FILED aurH Tallahassee, FL 32399-3265 DEPART TTY CLERK Florida Bar #499048 CLERK Angel Sanders Telephone (850) 245-4640 pare JUL 1 6 2012 Fax (850) 245-4681 IB/jb PCP Date: 7/13/2012 PCP Members: Dr. Miguel, Dr. Bearison & Ms. Goersch DOH v. Nathan B. Perry, M.D., Case No. 2010-14667 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. 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. Nathan B. Perry, M.D., Case No. 2010-14667

Docket for Case No: 20-004833PL