STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO. 2015-07397 ROLAND BRUTUS, M.D., RESPONDENT. / ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through its undersigned counsel, and files this Amended Administrative Complaint (Complaint”) before the Board of Medicine (“Board”) against the Respondent, Roland Brutus, M.D., and 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 physician within the State of Florida, having been issued license number ME 83974. 3. | Respondent's address of record is 2126 Arden Oaks Drive, Ocoee, Florida 34761. Facts Specific to Patient M.B. 4. On or about August 7, 2014, Patient M.B. presented to Respondent with complaints of neck and back pain and headaches. 5. On or about August 22, 2014, Patient M.B. was arrested for driving under the influence. 6. Beginning on or about August 7, 2014, through on or about December 4, 2014, Respondent prescribed morphine’ extended release 60 mg, oxycodone? 30mg, and Klonopin? 2mg to Patient M.B. 7. On or about August 7, 2014, Patient M.B. completed a patient questionnaire and indicated that she had been prescribed oxycodone, morphine extended release, and clonazepam’, which is a benzodiazepine. 1 Morphine is commonly prescribed to treat pain. According to section 893.03(2), Florida Statutes, morphine is a Schedule || drug under section 893.03, Florida Statutes 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 the substance may lead to severe psychological or physical dependence. 2 Oxycodone is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes, oxycodone is a Schedule {| controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States, and abuse of oxycodone may lead to severe psychological or physical dependence. : 3 Klonopin is the brand name for clonazepam and is prescribed to treat anxiety. According to section 893.03(4), Florida Statutes, clonazepam is a Schedule !V 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 clonazepam may lead to limited physical or psychological dependence relative to the substances in Schedule lil. 4 Clonazepam is commonly prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, clonazepam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule II! and Page 2 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 8. Onor about August 14, 2014, Patient M.B. submitted to a urine drug test, which revealed the presence of opiates and oxycodone and the absence of benzodiazepines. 9. On or about December 14, 2014, Patient M.B. was found deceased. Cause of death was suicide and intoxication by morphine and clonazepam. 10. At all times material to this Complaint, the standard of care required Respondent to prescribe controlled substances appropriately and with adequate justification, communicate with the patient’s other treating physicians, complete a medical history and physical examinations, create a treatment plan, conduct urine drug tests to ensure compliance, and to address inconsistent urine drug tests. 11. The strengths and quantities of morphine, oxycodone and Klonopin which Respondent prescribed were excessive and were prescribed without justification and/or without documenting justification in the medical record of Patient M.B. has a currently accepted medical use in treatment in the United States, and abuse of clonazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. Page 3 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 12. Respondent did not communicate with and/or did not document communicating with any of Patient M.B.’s other treating physicians. 13. Respondent did not document and/or did not perform a complete medical history and physical exam on Patient M.B. at any time during the course of treatment. 14. Respondent did not develop and/or did not document a treatment plan for Patient M.B. 15. Respondent did not conduct and/or document conducting urine drug tests during the course of treatment, with the exception of the initial urine drug test, dated August 14, 2014. 16. Respondent did not address and/or failed to document addressing the inconsistent August 14, 2014 urine drug test. COUNT ONE — Patient M.B. Violation of Section 458.331(1)(q) 17. Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) as if fully set forth herein. 18. Section 458.331(1)(q), Florida Statutes (2014), 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 Page 4 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 practice. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and is not in the course of the physician's professional practice, without regard to his intent. 19. Between August 7, 2014 and December 4, 2014, 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, oxycodone, morphine, and Klonopin without justification to Patient M.B.; and/or b. By excessively prescribing the controlled substances, oxycodone, morphine, and Klonopin to Patient M.B. 20. Based on the forgoing, Respondent violated section 458.331(1)(q), Florida Statutes (2014) when he prescribed controlled substances excessively and/or without justification to Patient M.B. COUNT TWO ~— Patient M.B. Violation of Section 458.331(1)(m) 21. Petitioner incorporates paragraphs one (1) through sixteen (16) as if fully set forth herein. Page 5 of 33 DOH v. Roland Brutus, M.D, DOH Case #2015-07397 22. Section 458.331(1)(m), Florida Statutes (2014), 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 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. 23. Section 458.331(1)(nn), Florida Statues (2014), provides that violating any provision of Chapter 458 or 456, or any rules adopted pursuant thereto constitutes grounds for disciplinary action by the Board of Medicine. 24. Rule 64B8-9.003(d)(3), Florida Administrative Code (2006), provides that medical records 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 Page 6 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 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. 25. Between August 7, 2014 and December 4, 2014, Respondent failed to create and/or maintain adequate, legible medical records that justify the course of treatment of Patient M.B. and/or satisfy the requirements of Rule 64B8-9.003(d)(3), Florida Administrative Code (2006), in one or more of the following ways: a. By failing to create and/or maintain adequate, legible medical records that document justification for the strengths and quantities of morphine, oxycodone and Klonopin. which Respondent prescribed to Patient M.B.; b. By failing to create and/or maintain adequate, legible medical records that document communicating with any of Patient M.B.’s other treating physicians; c. _ By failing to create and/or maintain adequate, legible medical records that document performance of a complete medical Page 7 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 history and physical exam on Patient M.B. at any time during the course of treatment; d. _By failing to create and/or maintain adequate, legible medical records that document a treatment plan for Patient M.B.; e. _ By falling to create and/or maintain adequate, legible medical records that document conducting urine drug tests during the course of treatment of Patient M.B.; and/or f. By failing to create and/or maintain adequate, legible medical records that document addressing the inconsistent August 14, 2014 urine drug test. 26. Based on the foregoing, Respondent violated section 458.331(1)(m), Florida Statutes (2014), and/or section 458.331(1)(nn), Florida Statutes (2014). COUNT THREE — Patient M.B. Section 458.331(1)(t) 27. Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) as if fully set forth herein. 28. Section 458.331(1)(t), Florida Statutes (2014), subjects a doctor to discipline for committing medical malpractice as defined in section 456.50. Section 456.50, Florida Statutes (2014), defines medical malpractice as the Page 8 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure. 29. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean "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 healthcare providers..." 30. Between August 7, 2014 and December 4, 2014, Respondent failed to meet the required standard of care in one-or more of the following ways: a. By failing to communicate with Patient M.B.’s other treating physicians; b. By failing to perform a complete medical history and physical exam on Patient M.B. at any time during the course of treatment; c. By failing to develop a treatment plan for Patient M.B; d. ‘By failing to conduct urine drug tests during the course of treatment of Patient M.B., with the exception of the initial urine drug test on August 14, 2014; and/or Page 9 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 e. By failing to address the inconsistent August 14, 2014 urine drug test. 31. Based on the foregoing,. Respondent has violated Section 458.331(1)(t), Florida Statutes (2014), by committing medical malpractice. Facts Specific to Patient D.C. 32. On or about April 16, 2013, Patient D.C. presented to Respondent with a medical history significant for chronic lower back pain, neck pain, anxiety, hypertension, heart disease, and arthritis. 33. From on or about July 15, 2013 through on or about September 10, 2013, Respondent prescribed lisinopril? 20mg, propranolol® 40mg, Klonopin 0.5mg, Ambien’ 10mg, morphine sulphate 30mg, carisoprodol® 350mg, and Dilaudid? 8mg to Patient D.C., at various times. 5 Lisinopril is an ACE inhibitor which is used to treat high blood pressure and heart failure. 5 Propranolol is a beta blocker used to treat high blood pressure, angina, and atrial fibrillation. 7 Ambien is the brand name for the drug zolpidem, prescribed to treat insomnia. According to Title 21, Section 1308.14, Code of Federal Regulations, zolpidem is a Schedule IV controlled substance. Zolpidem can cause dependence and is subject to abuse. ® Carisoprodol, commonly known by the brand name Soma, is a muscle relaxant prescribed to treat muscular pain. According to Section 893.03(4), Florida Statutes, carisoprodol is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule Ill and has a currently accepted medical use in treatment in the United States, and abuse of carisoprodo! may lead to limited physical or psychological dependence relative to the substances in Schedule III. ° Dilaudid is the brand name for hydromorphone and is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, hydromorphone is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States, and abuse of hydromorphone may lead to severe psychological or physical dependence. Page 10 of 33 DOH v. Roland Brutus, M.D, DOH Case #2015-07397 34. On or about September 15, 2013, Patient D.C. was found to be deceased. The cause of death was severe coronary artery disease. Polysubstance abuse with the presence of morphine and hydrocodone was noted by the coroner. | 35. At all times material to this Complaint, the standard of care required Respondent to prescribe controlled substances appropriately and with adequate justification, refer the patient to appropriate specialists, complete medical history and physical examinations, and conduct urine drug tests to ensure compliance. 36. The strengths, quantities, and combination of the Klonopin, Ambien, morphine sulphate, carisoprodol, and Dilaudid which Respondent prescribed were excessive and were prescribed without justification and/or without documenting justification in the medical record of Patient D.C. 37. Respondent did not refer and/or did not document a referral for Patient D.C. to appropriate specialists for the treatment and management of his co-morbid disease and chronic pain. 38. Respondent did not document and/or did not perform a complete follow-up medical history and physical exams on Patient D.C. Page 11 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 39. Respondent did not monitor and/or did not document monitoring Patient D.C. for compliance and to minimize diversion. COUNT FOUR — Patient D.C. Violation of Section 458.331(1)(q) 40. Petitioner re-alleges and incorporates paragraphs one (1) through three (3) and paragraphs thirty-two (32) through thirty-nine (39) as if fully set forth herein. 41. Section 458.331(1)(q), Florida Statutes (2013), 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 shatl be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and is not in the course of the physician's professional practice, without regard to his intent. 42. Between July 15, 2013 and September 10, 2013, Respondent prescribed controlled substances inappropriately or in excessive or inappropriate quantities in one or more of the following ways: Page 12 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 a. By prescribing the controlled substances Klonopin, Ambien, morphine sulphate, carisoprodol, and Dilaudid without justification to Patient D.C.; and/or b. By prescribing the controlled substances, Klonopin, Ambien, morphine sulphate, carisoprodol, and Dilaudid in excessive doses to Patient D.C. 43. Based on the forgoing, Respondent violated section 458.331(1)(q), Florida Statutes (2013) when he prescribed controlled substances inappropriately or in excessive or inappropriate quantities. COUNT FIVE — Patient D.C. Violation of Section 458.331(1)(m) 44, Petitioner re-alleges and incorporates paragraphs one (1) through three (3) and paragraphs thirty-two (32) through thirty-nine (39) as if fully set forth herein. 45. Section 458.331(1)(m), Florida Statutes (2013), 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. Page 13 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 46. Section 458.331(1)(nn), Florida Statues (2014), provides that violating any provision of Chapter 458 or 456, or any rules adopted pursuant thereto constitutes grounds for disciplinary action by the Board of Medicine. 47, Rule 64B8-9.003(d)(3), Florida Administrative Code (2006), provides that medical records 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. 48. Between July 15, 2013 and September 10, 2013, Respondent failed to create and/or maintain adequate, legible medical records that justify | the course of treatment of Patient D.C. and/or satisfy the requirements of Rule 64B8-9.003(d)(3), Florida Administrative Code (2006), in one or more of the following ways: Page 14 of 33 DOH v. Rofand Brutus, M.D. DOH Case #2015-07397 a. By failing to document justification for prescribing Klonopin, Ambien, morphine sulphate, carisoprodol, and Dilaudid to Patient D.C.; b. By failing to document referrals for Patient D.C. to appropriate specialists for the treatment and management of his co-morbid disease and chronic pain; c. By failing to document performance of complete follow-up medical history and physical exams on Patient D.C.; and/or d. By failing to document monitoring Patient D.C. for compliance and to minimize diversion. 49. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2013). COUNT SIX — Patient D.C. Violation of Section 458.331(1)(t 50. Petitioner re-alleges and incorporates paragraphs one (1) through three (3) and paragraphs thirty-two (32) through thirty-nine (39) as if fully set forth herein. 51. Section 458.331(1)(t), Florida Statutes (2013), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2013), defines medical malpractice as the Page £5 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure. 52. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in Section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean "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 healthcare providers..." 53. Between July 15, 2013 and September 10, 2013, Respondent failed to meet the required standard of care in one or more of the following ways: a. _ By failing to refer Patient D.F. to appropriate specialists for the treatment and management of his co-morbid disease and chronic pain; b. By failing to perform of complete follow-up medical history and physical exams on Patient D.C.; and/or c. By failing to monitor Patient D.C. for compliance and to minimize diversion Page 16 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 54. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2013), by committing medical malpractice. Facts Specific to Patient A.H. 55. Onor about May 27, 2011, Patient A.H. presented to Respondent with complaints of low back pain. 56. On or about July 17, 2013 through on or about September 26, 2014, Respondent prescribed Roxicodone’®, Klonopin, Zanaflex!!, morphine sulphate, Opana*? oxycodone, and Dilaudid for Patient A.H. at various times and in various quantities. 57. On or about October 11, 2014, Patient A.H. was found to be deceased. The cause of death was cardiac arrest and cocaine abuse. 58. At all times material to this Complaint, the standard of care required Respondent to prescribe controlled substances appropriately and with adequate justification, refer the patient to appropriate specialists, complete medical history and physical examinations, consider medications © Roxicodone is the brand name for oxycodone. 1 Zanaflex if the brand name for tizanidine, a muscle relaxant. 2 Opana is the brand name for oxymorphone and is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, oxymorphone is a Schedule I! controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States, and abuse of oxymorphone may lead to severe psychological or physical dependence. Page 17 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 that were not controlled substances, and consider an alternative pain management program to reduce the use of controlled substances. 59. The strengths and quantities of the controlled substances which Respondent prescribed were exceedingly large and were prescribed without justification and/or without documenting justification in the medical record of Patient A.H. 60. Respondent did not refer and/or did not document a referral for Patient A.H. to a neurologist, an orthopedic surgeon, or an interventional pain specialist. 61. Respondent did not document and/or did not perform complete medical histories and physical exams on Patient A.H. 62. Respondent did not document and/or did not consider alternate medications that were not controlled substances, 63. Respondent did not consider and/or did not document considering an alternative pain management program to reduce the use of controlled substances. Page 18 of 33 DOH vy. Roland Brutus, M.D, DOH Case #2015-07397 COUNT SEVEN — Patient A.H. Violation of Section 458.331(1)(q) 64. Petitioner re-alleges and incorporates paragraphs one (1) through three (3) and paragraphs fifty-five (55) through sixty-three (63) as if fully set forth herein. 65. Section 458.331(1)(q), Florida Statutes (2013-2014), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and is not in the course of the physician's professional practice, without regard to his intent. 66. Between July 17, 2013 and September 26, 2014, Respondent prescribed controlled substances inappropriately or in excessive or inappropriate quantities in one or more of the following ways: Page 19 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 a. __ By prescribing the controlled substances Roxicodone, Klonopin, Zanaflex, morphine sulphate, Nucynta, Opana, oxycodone, and Dilaudid without justification to Patient A.H.; and/or b. By prescribing the controlled substances, Roxicodone, Klonopin, Zanaflex, morphine sulphate, Nucynta, Opana, oxycodone, and Dilaudid in excessive doses to Patient A.H. 67. Based on the forgoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2013-2014) when he prescribed the controlled substances, inappropriately or in excessive or inappropriate quantities. COUNT EIGHT — Patient A.H. Violation of Section 458.331(1)(m) 68. Petitioner re-alleges and incorporates paragraphs one (1) through three (3) and paragraphs fifty-five (55) through sixty-three (63) as if fully set forth herein. 69. Section 458.331(1)(m), Florida Statutes (2012-2014), 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 Page 20 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 administered; and reports of consultations and hospitalizations, constitutes grounds for disciplinary action by the Board of Medicine. 70. Section 458.331(1)(nn), Florida Statues (2012-2014), provides that violating any provision of Chapter 458 or 456, or any rules adopted pursuant thereto constitutes grounds for disciplinary action by the Board of Medicine. 71. Rule 64B8-9.003(d)(3), Florida Administrative Code (2012- 2014), provides that medical records 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. 72. Between July 17, 2013 and September 26, 2014, Respondent failed to create and/or maintain adequate, legible medical records that justify the course of treatment of Patient A.H. and/or satisfy the requirements of Page 21 of 33 DOH v. Roland Brutus, M.D. _ DOH Case #2015-07397 Rule 64B8-9.003(d)(3), Florida Administrative Code (2013-2014), in one or more of the following ways: a. 73. By failing to document justification for Prescribing the aforementioned controlled substances to Patient A.H.; By failing to document a referral for Patient A.H. to a neurologist, an orthopedic surgeon, or an interventional pain specialist; By failing to document performance of complete medical histories and physical exams on Patient A.H.; By failing to document considering alternate medications that were not controlled substances; and/or By failing to document considering an alternative pain management program to reduce the use of controlled substances. Based on the foregoing, Respondent violated section 458.331(1)(m), Florida Statutes (2013-2014). 74. COUNT NINE — Patient A.H. Violation of Section 458.331(1)(t) Petitioner re-alleges and incorporates paragraphs one (1) through three (3) and paragraphs fifty-five (55) through sixty-three (63) as if fully set forth herein. Page 22 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 75. Section 458.331(1)}({t), Florida Statutes (2013-2014), subjects a doctor to discipline for committing medical malpractice as defined in section 456.50. Section 456.50, Florida Statutes (2013-2014), 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. 76. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean "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 healthcare providers..." 77, Between July 17, 2013 and September 26, 2014, Respondent failed to meet the required standard of care in one or more of the following ways: a. By failing to refer Patient A.H. to a neurologist, an orthopedic surgeon, or an interventional pain specialist; b. By failing to perform complete medical histories and physical exams on Patient A.H.; Page 23 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 c. By failing to consider alternate medications that were not controlled substances; and/or d. By failing to consider an alternative pain management program to reduce the use of controlled substances. 78. Based on the foregoing, Respondent has violated Section 458.331(1)(), Florida Statutes (2013-2014), by committing medical malpractice. Facts Specific to Patient C.M. 79. Onor about July 20, 2012, Patient C.M. presented to Respondent with complaints of neck pain, back pain, high blood pressure, anxiety, and arthritis. 80. From on or about June 27, 2013 through August 22, 2014, Respondent prescribed Valium, methadone‘, Dilaudid, Ambien, and Restoril'5 for Patient C.M. at various times and in various quantities. 48 Diazepam, commonly known by the brand name Valium, 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, and abuse of diazepam may lead to limited physical or psychological dependence relative to the substances in Schedule I. 4% Methadone is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, methadone is a Schedule I controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States, and abuse of methadone may lead to severe psychological or physical dependence. 45 Restoril is the brand name for temazepam and is prescribed 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 Ill and has a currently accepted medical use in treatment in the United States, and abuse of temazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. Page 24 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 81. On or about August 31, 2014, Patient C.M. expired. The cause of death was acute cardiogenic shock secondary to a pulmonary embolus and endocarditis from intravenous drug abuse. 82. At all times material to this Complaint, the standard of care required Respondent to communicate with any of the patient’s other treating physicians, to refer the patient to a neurologist, an orthopedic surgeon, a neurosurgeon, or an anesthesiologist, and to perform a complete physical exam on the patient at any point during the treatment period. 83. The quantities of Valium, methadone, Dilaudid, Ambien, and Restoril, which Respondent prescribed, were excessive and were prescribed without justification and/or without documenting justification in the medical record of Patient C.M. 84. Respondent did not communicate with, and/or did not document communicating with, any of Patient C.M.’s other treating physicians. 85. Respondent did not refer and/or did not document a referral for Patient C.M.to a neurologist, an orthopedic surgeon, a neurosurgeon, or an anesthesiologist. Page 25 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 86. Respondent did not perform, and/or did not document performing, a complete physical exam on Patient C.M. at any point during the treatment period. 87. At times, Respondent's medical records for Patient C.M. were illegible and/or incomplete and/or missing altogether. COUNT TEN — Patient C.M. Violation of Section 458.331(1)(q) 88. Petitioner re-alleges and incorporates paragraphs one (1) through three (3) and paragraphs seventy-nine (79) through eighty-seven (87) as if fully set forth herein. 89. Section 458.331(1)(q), Florida Statutes (2012-2014), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. For purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and is not in the course of the physician's professional practice, without regard to his intent. Page 26 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 90. Between June 27, 2013 and August 22, 2014, Respondent prescribed controlled substances inappropriately or in excessive or inappropriate quantities in one or more of the following ways: a. By prescribing the aforementioned controlled substances, to Patient C.M., without justification; and/or b. By prescribing the aforementioned controlled substances, in excessive doses to Patient C.M. 91. Based on the forgoing, Respondent violated section 458.331(1)(q), Florida Statutes (2012-2014) when he prescribed controlled substances inappropriately or in excessive or inappropriate quantities. COUNT ELEVEN — Patient C.M. Violation of Section 458.331(1)(m) 92. Petitioner re-alleges and incorporates paragraphs one (1) through three (3) and paragraphs seventy-nine (79) through eighty-seven (87) as if fully set forth herein. 93. Section 458.331(1)(m), Florida Statutes (2012-2014), 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 Page 27 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 administered; and reports of consultations and hospitalizations, constitutes grounds for disciplinary action by the Board of Medicine. 94. Section 458.331(1)(nn), Florida Statues (2012-2014), provides that violating any provision of Chapter 458 or 456, or any rules adopted pursuant thereto constitutes grounds for disciplinary action by the Board of Medicine. 95. Rule 64B8-9.003(d)(3), Florida Administrative Code (2012- 2014), provides that medical records 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. 96. Between June 27, 2013 and August 22, 2014, Respondent failed to create and/or maintain adequate, legible medical records that justify the course of treatment of Patient C.M. and/or satisfy the requirements of Rule Page 28 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 64B8-9.003(d)(3), Florida Administrative Code (2012-2014), in one or more of the following ways: a. e. 97. By failing to document communicating with, any of Patient C.M.’s other treating physicians; By failing to document referrals for Patient C.M.to a neurologist, an orthopedic surgeon, a neurosurgeon, or an anesthesiologist; By failing to document performance of a complete medical history and physical exam on Patient C.M.; By failing to create and/or keep complete medical records for several treatment dates; and/or By creating and/or keeping iilegible medica! records. Based on the foregoing, Respondent violated section 458.331(1)(m), Florida Statutes (2012-2014). 98. COUNT TWELVE - Patient C.M. Violation of Section 458.331(1)(t) Petitioner re-alleges and incorporates paragraphs one (1) through three (3) and paragraphs seventy-nine (79) through eighty-seven (87) as if fully set forth herein. 99. Section 458.331(1)(t), Florida Statutes (2012-2014), subjects a doctor to discipline for committing medical malpractice as defined in section Page 29 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 456.50. Section 456.50, Florida Statutes (2012-2014), 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. 100. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean "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 ...." 101. Between June 27, 2013 and August 22, 2014, Respondent failed to meet the required standard of care in one or more of the following ways: a. By failing to communicate with any of Patient C.M.’s other treating physicians; b. By failing to refer Patient C.M.to a neurologist, an orthopedic surgeon, a neurosurgeon, or an anesthesiologist; and/or c. By failing to perform a complete physical exam on Patient C.M. at any point during the treatment period. Page 30 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397 102. Based on the foregoing, Respondent has violated section 458.331(1)(t), Florida Statutes (2012-2014), by committing medical malpractice. WHEREFORE, the Petitioner respectfully requests that the Board of Medicine enter an order imposing one or more of the following penalties: permanent revocation or suspension of Respondent's license, restriction of practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. [Signature on following page.] Page 31 of 33 DOH v. Roland Brutus,M.D. DOH Case #2015-07397 SIGNED this sA% day of JUNE , 2019. Scott Rivkees, M.D. State Surgeon General FILED DEPARTMENT OF HEALTH DEPUTY CLERK CLERK: Sarah Corriga pare: __ JUN 2 4 2018 Assistant General DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Florida Bar Number 0085797 (850) 558 - 9828 Telephone (850) 245 - 4683 Facsimile SEC/crv PCP Date: June 21, 2019 PCP Members: Mark Avila, M.D.; James Orr, Jr., M.D. DOH vy. Roland Brutus, M.D. DOH Case #2015-07397 Page 32 of 33 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. Page 33 of 33 DOH v. Roland Brutus, M.D. DOH Case #2015-07397

Docket for Case No: 21-000946PL