STATE OF FLORIDA oy i a) DEPARTMENT OF HEALTH APR iy : Aon io, Is DEPARTMENT OF HEALTH, ) EAR Ray, ) MGS YE PETITIONER, ) ) v. ) CASE NO, 1999-52109 ) MICHAEL BERNARD JACOBS, M.D. _) Of- 1297 PL ) RESPONDENT. _) a) ADMINISTRATIVE COMPLAINT COMES NOW the Department of Health (Petitioner), and files this Administrative Complaint before the Board of Medicine (the Board) against Michael Bernard Jacobs, M.D. (Respondent), and alleges: . 1. Petitioner is the state agency charged with regulating the practice of medicine under to Section 20.43 and Chapters 456 and 458, Florida Statutes. Under Section 20.43(3)(g), Florida Statutes, Petitioner has contracted with the Agency for Health Care Administration to provide consumer complaint, investigative, and prosecutorial services required by the Division of Medical Quality Assurance, councils, or boards, as appropriate. 2. Respondent is and has been at all times material hereto a licensed physician in the state of Florida, having been issued license number ME 0056736. Respondent's last known address is 836 Prudential Drive, Suite 1400,. Jacksonville, Florida 32207. 3. Respondent is board certified in internal medicine. 4. Butorphanol tartrate (brand name Stadol) is a legend drug as defined by Section 465.003(7), Florida Statutes (1995). Stadol is a narcotic analgesic used as a pain relief medication and can be administered intravenously, intermuscularly, or through nasal spray. 5. On or about August 31, 1992, Patient R.P., a thirty-five (35) year old female, presented to Respondent following a referral for chest pain, dyspepsia (upset stomach), and various aches and pains. Patient R.P. told Respondent she had a history of migrane headaches. 6. During the course of treatment of Patient R.P., Patient R.P. complained frequently of chronic headaches and Respondent prescribed Stadol for her to relieve the pain associated with these headaches. 7. On or about September 12, 1992, Respondent prescribed Stadol nasal spray #3 for Patient R.P., with six (6) refills. 8. In 1994, Respondent prescribed Stadol nasal spray #3 for Patient R.P. on or about the following dates: June 15 (no refill); September 7 (one (1) refill); September 21 (no refill); and October 6 (no refill). . 9. In 1995, Respondent prescribed Stadol nasal spray #3 for Patient R.P. on or about the following dates: March 29 (two (2) refills); April 11 (no refil); April 28 (two (2) refills); May 4, 1995 (two (2) refills); May 17 (three (3) refills); May 31 (three (3) refills); July 10 (four (4) refills); September 6 (four (4) refills); September 18 (no refill); October 3 (no refill); and October 9 (no refill, and later that day again with one (1) refill). 10. In 1996, Respondent prescribed Stadol nasal spray #3 for Patient R.P. on or about the following dates: unknown date in January 1996 (three (3) refills); March 13 (no refill); April 22 (four (4) refills); and May 14 (no refill). 11. On or about April 22, 1996, Patient R.P. altered Respondent's written prescription for Stadol nasal spray #3 from four (4) refills to twenty-four (24) refills. 12. After prescribing Stadol for Patient R.P. on or about May 14, 1996, Respondent learned Patient R.P. had altered her previous prescription. Respondent wrote a letter to Patient R.P. notifying her that Respondent would terminate further medical care for Patient R.P. based on the altered prescription. Mail records show this letter was not received by Patient R.P. until June 26, 1996. 13. On or about May 16, 1996 patient R.P. presented to Respondent and Respondent confronted her about the prescription alteration. Written medical records show Respondent told Patient R.P. that Respondent thought she needed help for possible addiction. 14. | On or about October 28, 1996, Respondent again prescribed Stadol nasal spray #3 for Patient R.P. with one (1) refill. 15. During the course of treatment of Patient R.P., Respondent did not refer Patient R.P. to a neurologist for an evaluation to determine the cause of her chronic headaches. 16. Respondent did not document in the medical records of Patient R.P. a referral to a neurologist for an evaluation of her chronic headaches. 17. During the course of treatment of Patient R.P., Respondent did not order tests such as a computed axial tomography (CAT) scan of the brain, and/or a radiographic evaluation of Patient R.P.’s head and/or neck for the purpose of determining the cause of her chronic headaches. 18. Respondent did not document in the medical records of Patient R.P. an order for a CAT scan and/or radiographic evaluation of her head and/or neck for the purpose of determining the cause of her chronic headaches. 19. During the course of treatment of Patient R.P., Respondent did not diagnose the cause of Patient R.P.’s chronic headaches. 20. During the course of treatment of Patient R.P., Respondent did not document in Patient R.P.’s medical records a diagnosis for her chronic headaches. 21. The medical records maintained by Respondent for Patient R.P. contain no information such as a neurological or radiographic evaluation that would justify prescribing Stadol for a four-year period. COUNT ONE 22. Petitioner realleges and incorporates paragraphs one (1) through twenty- one (21), as if fully set forth herein this Count One. 23. Respondent failed to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being 4 acceptable under similar conditions and circumstances, in that Respondent failed to do one or more of the following: (a) refer Patient R.P. to a neurologist for an evaluation to determine the cause of Patient R.P.'s chronic headaches; (b) order tests such as a CAT scan of Patient R.P.’s brain and/or a radiographic evaluation of Patient R.P.’s head and/or neck for the purpose of determining the cause of her chronic headaches; or . (c) Diagnose the cause of Patient R.P.’s chronic headaches. 24. Based on the foregoing, Respondent violated Section 458.331(1){t), Florida Statutes, by committing gross or repeated malpractice or by failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. COUNT TWO 25. Petitioner realleges and incorporates paragraphs one (1) through twenty-. one (21) and paragraph twenty-three (23), as if fully set forth herein this Count Two. 26. Respondent failed to keep written medical records justifying the course of treatment of Patient R.P., in that Respondent failed to do one or more of the following: (a) Document in Patient R.P.’s medical records a referral to a neurologist for an evaluation to determine the cause of her chronic headaches; (b) Document in Patient R.P.’s medical records an order for a CAT scan and/or a radiographic evaluation of her head and/or neck for the purpose of determining the cause of her chronic headaches; or (c) Document in Patient R.P.’s medical records a diagnosis for her chronic headaches. 27. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (1995), by failing to keep written medical records justifying 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. COUNT THREE 28. Petitioner realleges and incorporates paragraphs one (1) through twenty- one (21), paragraph twenty-three (23), and paragraph twenty-six (26), as if fully set forth herein this Count Three. ) 29. | Respondent prescribed a legend drug other than in the course of the - physician’s professional practice, in that Respondent prescribed Stadol to Patient R.P. in inappropriate and excessive numbers. 30. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes, by 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 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 or her intent. WHEREFORE, Petitioner respectfully requests the Board enter an order imposing one or more of the following penalties: permanent revocation or suspension of the Respondent's license, restriction of the Respondent's practice, imposition of an administrative fine, issuance of a reprimand, placement of the Respondent on probation, the assessment of costs related to the investigation and prosecution of this case as provided for in Section 456.072(4), Florida Statutes (2000), and/or any other relief the Board deems appropriate. SIGNED this 13tbiy of Me ae w, / ven ED am = Fh DEPUTY CLERK Chief Medical Attorney CLERK Ubi ke Kenen pave_ LIF LS

Docket for Case No: 01-001297PL