Judges: R. T. CARPENTER
Agency: Department of Business and Professional Regulation
Latest Update: Jul. 26, 1984
Summary: Respondent prescribed Percodan excessively/innappropriately and kept poor records. Recommend probation and supervision.
83-2015.PDFSTATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF MEDICAL ) EXAMINERS, )
)
Petitioner, )
)
vs. ) CASE NO. 83-2015
)
RUDOLF ORGUSAAR, M.D., )
)
Respondent. )
)
RECOMMENDED ORDER
This matter came on for hearing on February 7 and 8, 1984, 1/ in Pensacola, Florida, before the Division of Administrative Hearings and its duly appointed Hearing Officer, R. T. Carpenter. The parties were represented by:
For Petitioner: Joseph W. Lawrence, Esquire
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
For Respondent: Melissa Fletcher Allaman, Esquire
ERVIN, VARN, JACOBS, ODOM & KITCHEN
Post Office Box 1170 Tallahassee, Florida 32302-1170
This case arose on Petitioner's administrative complaint charging Respondent with violating various provisions of Section 458.331, Florida Statutes (F.S.). Specifically, Respondent is charged with excessive prescription of substances controlled under Chapter 893, F.S., and failure to maintain adequate patient records.
The parties submitted proposed findings of fact and conclusions of law. To the extent these proposed findings have not been adopted or otherwise incorporated herein, they are found to be subordinate, cumulative, immaterial, unnecessary or not supported by the evidence.
FINDINGS OF FACT
Respondent is a medical doctor, licensed to practice in Florida, and holds license number ME 0009310, issued by Petitioner. Respondent specializes in family practice and has been board certified by the American Academy of Family Physicians since 1974.
Percodan is the manufacturer's brand name for oxycodone, which is a Schedule II controlled substance pursuant to Chapter 893, F.S. 2/ It is a drug used for the relief of pain, a synthetic analgesic, and is both a physically and psychologically dependent producing drug. It can cause drowsiness, urinary
retention, nausea, vomiting, and interacts unfavorably with other sedative drugs, and is considered a depressant.
On December 30, 1966, Evelyn Milstead, a 30 year old woman, came to Respondent's office complaining of nausea and a rash in her mouth. Respondent conducted a physical examination, took her medical history and thereafter prescribed tigan for the nausea. Ms. Milstead became a regular patient of Respondent's and he continued treating her for various ailments over a period of years. During the course of Respondent's treatment, Milstead developed a chronic urinary tract infection and kidney condition in which she passed kidney stones. On occasion Milstead was treated by Dr. Gillespie, a specialist in the field of urology for her kidney condition. In 1978, Respondent also referred instead to the Ochsner Clinic for evaluation of her urinary tract and kidney problems. She was evaluated at Ochsner Clinic and received prescriptions for darvocet, a pain medication, and keflex, an antibiotic, and was told that she would continue to have a chronic kidney problem. Over the years, Milstead was hospitalized several times by Dr. Gillespie for treatment of her kidney condition.
The testimony of Dr. William H. Nass and Dr. Robert P. Johnson established that Respondent's initial prescriptions of percodan to Milstead were appropriate. However, Respondent's percodan prescriptions to Milstead eventually became inappropriate. Specifically, the prescriptions for 2,668 percodan tablets between August, 1980 and November, 1982, were established as excessive.
On July 30, 1977, Bruce White, a 25 year old male, came to Respondent for medical treatment for headaches and thereafter returned to Respondent for treatment of various medical problems. Mr. White's wife, Vicki White, and their children were also seen by Respondent as their family doctor. On May 18, 1981, White came to Respondent complaining of neck and back pain from an automobile accident in which he also fractured his left lower leg. Respondent noted that White had been seen by a neurologist and an orthopedic surgeon for his head and leg. In addition to other medication, Respondent prescribed percodan to White for pain. White had also developed arthritis in his left leg, as a result of the car accident and fracture, and on one occasion was hospitalized for swelling of his left leg. Respondent referred White to Dr. Tippett, a neurosurgeon, concerning his headaches and to Dr. Graybiel, a rheumatologist, concerning his arthritis. However, White continued to see Respondent as his medical doctor because his work schedule on an offshore oil rig would only permit Saturday appointments with his doctor and Respondent's offices are open on Saturday mornings. White also found it difficult to pay the fees charged by specialists.
Between May 8, 1981 and September 30, 1982, Respondent prescribed 780 percodan tablets for Bruce White. The testimony of Dr. Nass and Dr. Johnson established that Respondent's initial prescriptions of percodan to White were appropriate. However, the percodan prescriptions to White became inappropriate over time due to their excessiveness. The seriousness of this lapse is underscored by Respondent's failure to try other pain alleviating measures and failure to investigate abuse possibilities.
On October 18, 1979, Vicki White, the wife of Bruce White, a 23 year old woman, came to Respondent's office seeking treatment. She complained of migraine headaches and stated that her father was in the hospital with cancer. She also stated that she had seen Dr. Eyser, a neurosurgeon, for her headaches. Respondent prescribed wygesic for her pain. She subsequently returned to Respondent for treatment of various complaints including chronic migraine
headaches, colds, and a dislocated right shoulder. Initially, Respondent prescribed norcet for relief of this pain, and on July 31, 1981, first prescribed percodan for her migraine headaches. Respondent prescribed percodan on other occasions in response to her complaints of pain from migraine headaches and back strain. Respondent considered referring her to a neurologist for the headaches but White stated that she could not afford to see a specialist.
Respondent prescribed 590 percodan tablets for Vicki White between July 31, 1981 and September 22, 1982. Percodan is an appropriate and acceptable medicine for the relief of migraine headaches, and Respondent's initial prescription of percodan to Ms. White was appropriate. However, his prescriptions became excessive over time since percodan is not to be used for long term treatment of migraine headaches.
On September 7, 1982, M. D. Medlen, an Escambia County Deputy Sheriff, went to Respondent's office as an undercover police officer, under the assumed name of Donna Slay. She had been asked by Robert Powers, a narcotics officer with the Escambia County Sheriff's Department and Charles Deckard, an investigator with the Department of Professional Regulation, to go to Respondent's office in an undercover capacity and attempt to obtain a prescription for percodan. Medlen/Slay first gave general information to the receptionist, including identification, in the name of Donna Slay, chief complaint of a backache, previous illnesses, drug allergies, address, social security number, and insurance information. Medlen/Slay was shown to an examination room where her blood pressure and weight were taken by the nurse and a urinalysis was performed. Respondent then came in and asked Medlen/Slay what her problem was. She informed him that she had been pushed into a wall during a fight, and had injured her back. Respondent checked her pulse, did a range of motion test, and checked the alleged injured area by palpation. Each time Respondent pressed on the alleged injured area, Medlen/Slay told him it hurt. Respondent did not visually inspect the alleged injured area but asked Medlan/Slay if there was a bruise and she said no. In order to get the percodan, Medlen/Slay told Respondent that she had injured her back one other time and a doctor in Louisiana had prescribed percodan for that injury. Respondent asked how long ago Medlen/Slay had taken the percodan and she said one year ago. Respondent discussed the dangers of drug addiction with Medlan/Slay and then prescribed 20 tablets of percodan for pain and 30 tablets of indocin to reduce inflammation. Upon leaving Respondent's office, Medlen/Slay did not fill the prescriptions but turned them over to Deckard.
Percodan is an acceptable medicine for back and shoulder pain. However, Respondent should have considered the possibility of fracture, visually examined the area to ascertain the presence of a hematoma (blood clot) and listened to the patient's chest to determine the presence of lung injury. Respondent did not perform an appropriate examination prior to prescribing percodan, and the prescription was therefore inappropriate.
Respondent used poor judgment in his excessive prescriptions of percodan to the patients discussed herein. However, there is no evidence that Respondent prescribed the percodan for personal financial gain or that any patient was injured by Respondent's prescribing practices.
The testimony of the expert witness established that the records maintained on these patients were inadequate. Frequently, the only notation for a given visit was the prescription for percodan, with no evaluation of the patient's condition. Further, Respondent's patient records did not even list all the percodan prescriptions issued. Thus, these records essentially reflect
partial inventories of prescriptions issued, and do not justify the course of prescribing, which is important to the safe practice of medicine.
CONCLUSIONS OF LAW
Section 458.331, F.S., provides in part:
The following acts shall consti- tute grounds for which the disciplinary actions specified in subsection (2) may be taken:
* * *
(n) Failing to keep written medical records justifying the course of treatment of the patient, including, but not limited to, patient histories, examination results, and test results.
* * *
(q) Prescribing, dispensing, admini- stering, mixing, or otherwise preparing a legend drug, including any controlled sub- stance, other than in the course of the physician's professional practice. For the purposes of this paragraph, it shall be legally presumed that prescribing, dis- pensing, administering, mixing, or other- wise 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.
* * *
(t) Gross or repeated malpractice
or the failure to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably pru- dent similar physician as being accept- able under similar conditions and cir- cumstances. The board shall give great weight to the provisions of s. 768.45 when enforcing this paragraph.
* * *
When the board finds any person guilty of any of the grounds set forth in subsection (1) , it may enter an order im- posing one or more of the following penalties:
Refusal to certify to the department an application for licensure.
Revocation or suspension of a license.
Restriction of practice.
Imposition of an administrative fine not to exceed $1,000 for each count or separate offense.
Issuance of a reprimand.
Placement of the physician on probation for a period of time and subject to such conditions as the board may specify, including, but not limited to, requiring
the physician to submit to treatment, to attend continuing education courses, to submit to reexamination, or to work under the supervision of another physician.
Respondent is charged with violating the above provisions with respect to the patients described herein. 3/ It was demonstrated by substantial, competent evidence that Respondent prescribed the controlled substance percodan inappropriately in the case of Donna Medlen/Slay and in excessive quantities in the case of Mr. and Mrs. White and Ms. Milstead, in violation of Subsection 458.331(1)(q) F.S.
It was also demonstrated by substantial, competent evidence that Respondent failed to maintain medical records on these patients which justified his course of prescribing. He is therefore guilty of violating Subsection 458.331(1)(n), F.S. as charged.
Finally, Respondent's excessive and inappropriate prescriptions of percodan and his failure to maintain adequate records constitutes a failure to practice medicine with a level of care and skill which is considered by his peers to be acceptable. He is therefore guilty of violating Subsection 458.331(1)(t), F.S. as charged.
Respondent should be placed on probation for a period of five years as authorized by Subsection 458.331(2)(f), F.S. This provision also permits the imposition of a requirement that a physician found guilty of violations of Subsection 458.331(1), F.S. may be required to work under the supervision of another physician. Such a requirement should be imposed for a one year period. Further, Respondent's authority to prescribe Schedule II controlled substances should be restricted so long as he is practicing under the supervision of another physician.
RECOMMENDATION
Based on the foregoing, it is
RECOMMENDED that Petitioner enter a final order placing Respondent on probation for a period of five years, require that Respondent practice under the supervision of another physician to be named by Petitioner during the initial year of his probation and that Petitioner restrict Respondent's license against prescribing Schedule II controlled substances while he is under such supervision. 4/
DONE and ENTERED this 24th day of April, 1984 in Tallahassee, Florida.
R. T. CARPENTER, Hearing Officer Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32301
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 24th day of April, 1984.
ENDNOTES
1/ Companion Case, Number 83-493 was heard on these same dates and is the subject of a separate Recommended Order.
2/ Subsection 893.03(2), F.S. provides that a substance in Schedule II 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 the substance may lead to severe psychological or physical dependence.
3/ Counts 9 and 10, pertaining to patient Bowman were dismissed.
4/ This disciplinary action is intended to be applied concurrently with that recommended in Case No. 83-493.
COPIES FURNISHED:
Joseph W. Lawrence, Esquire Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32301
Melissa Fletcher Allaman, Esquire ERVIN, VARN, JACOBS, ODOM & KITCHEN
Post Office Box 1170 Tallahassee, Florida 32302-1170
Dorothy Faircloth, Executive Director
Board of Medical Examiners Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32301
Fred Roche, Secretary Department of Professional
Regulation
130 North Monroe Street Tallahassee, Florida 32301
=================================================================
AGENCY FINAL ORDER
================================================================= BEFORE THE BOARD OF MEDICAL EXAMINERS
DEPARTMENT OF PROFESSIONAL REGULATION,
Petitioner,
vs. DOAH CASE NO. 83-2015 26178
DPR CASE N0. 0025114 83-0493
RUDOLF ORGUSAAR LICENSE NO. 9310,
Respondent.
/
FINAL ORDER OF
THE BOARD OF MEDICAL EXAMINERS
This cause came before the Board of Medical Examiners (Board) pursuant to Section 120.57(1)(b)(9), Florida Statutes on June 9, 1984, in Palm Beach, Florida for the purpose of considering the hearing officer's recommended order (a copy of which is attached hereto) in the above-styled cause. Petitioner, Department of Professional Regulation, was represented by Joseph W. Lawrence, II, Esquire; Respondent, Rudolf Orgusaar, M.D. was represented by Wilfred C. Varn, Esquire and Melissa Fletcher Allaman, Esquire. Upon review of the recommended order, the argument of the parties, and after a review of the complete record in this case, the Board makes the following findings and conclusions.
FINDINGS OF FACT
The hearing officer's findings of fact are approved and adopted in toto and are incorporated by reference herein.
There is competent substantial evidence to support the Board's findings of fact.
CONCLUSIONS OF LAW
The hearing officer's conclusions of law are approved and adopted in toto and are incorporated by reference herein.
There is competent substantial evidence to support the Board's conclusions of law.
PENALTY
Based upon a review of the complete record, the Board determines that the penalty recommended by the hearing officer be modified to include a longer period of supervision and a restriction upon Respondent's Schedule II privileges. Therefore, it is hereby
ORDERED AND ADJUDGED that Respondent be placed on probation for 5 years, during which time he shall practice under the supervision of Dimitri Polizo,
in accordance with the Proposed Plan for Supervision (a copy of which is attached hereto and incorporated herein). During the period of probation, Respondent shall appear semiannually before the Board. Quarterly reports of Respondent's practice shall be submitted to the Board by Dr. Polizo. Respondent has waived confidentiality with regard to the investigative reports prepared by the department during the period of probation. The period of probation in this case shall run currently with that period determined in Department of Professional Regulation, Board of Medical Examiners v. Rudolf Orgusaar, M.D., DOAH Case No. 83-493, DPR Case No. 002 6178. This Order takes effect upon filing.
DONE AND ORDERED this 21st day of July, 1984.
Board of Medical Examiners
Richard J. Feinstein Chairman
cc: All Counsel of Record Rudolf Orgusaar, M.D.
=================================================================
AGENCY AMENDED FINAL ORDER
================================================================= BEFORE THE BOARD OF MEDICAL EXAMINERS
DEPARTMENT OF PROFESSIONAL REGULATION,
Petitioner,
vs. DOAH CASE NO. 83-2015
DPR CASE NO. 0026178
RUDOLF ORGUSAAR LICENSE NO. 9310,
Respondent.
/
AMENDED FINAL ORDER OF
THE BOARD OF MEDICAL EXAMINERS
This cause came before the Board of Medical Examiners (Board) pursuant to Section 120.57(1)(b)(9), Florida Statutes on June 9, 1984, in Palm Beach, Florida for the purpose of considering the hearing officer's recommended order (a copy of which is attached hereto) in the above-styled cause. Petitioner, Department of Professional Regulation, was represented by Joseph W. Lawrence, II, Esquire; Respondent, Rudolf Orgusaar, M.D. was represented by Wilfred C. Varn, Esquire and Melissa Fletcher Allaman, Esquire. Upon review of the recommended order, the argument of the parties, and after a review of the complete record in this case, the Board makes the following findings and conclusions.
FINDINGS OF FACT
The hearing officer's findings of fact are approved and adopted in toto and are incorporated by reference herein.
There is competent substantial evidence to support the Board's findings of fact.
CONCLUSIONS OF LAW
The hearing officer's conclusions of law are approved and adopted in toto and are incorporated by reference herein.
There is competent substantial evidence to support the Board's conclusions of law.
PENALTY
Based upon review of the complete record, the Board determines that the penalty recommended by the hearing officer be modified to include a longer
period of supervision and a restriction upon Respondent's Schedule II privileges. Therefore, it is hereby
ORDERED AND ADJUDGED that Respondent be placed on probation for 5 years, during which time he shall practice under the supervision of Dimitri Polizo,
M.D. in accordance with the Proposed Plan for Supervision (a copy of which is attached hereto and incorporated herein). During the period of probation Respondent shall appear semiannually before the Board. Quarterly reports of Respondent's practice shall be submitted to the Board by Dr. Polizo. Respondent has waived confidentiality with regard to the investigative reports prepared by the department during the period of probation. The period of probation in this case shall run concurrently with that period determined in Department of Professional Regulation, Board of Medical Examiners v. Rudolf Orgusaar, M.D., DOAH Case No. 83-493, DPR Case No. 0025114. This Order takes effect upon filing.
DONE AND ORDERED this 29th day of August, 1984.
Board of Medical Examiners
cc: All Counsel of Record Rudolf Orgusaar, M.D.
Richard J. Feinstein Chairman
Docket for Case No: 83-002015
Orders for Case No: 83-002015
| Issue Date |
Document |
Summary |
|
Jul. 21, 1984 |
Agency Final Order
|
|
|
Apr. 24, 1984 |
Recommended Order
|
Respondent prescribed Percodan excessively/innappropriately and kept poor records. Recommend probation and supervision.
|
