STATE OF FLORIDA DEPARTMENT OF HEALTH 04 Uy py 24g DEPARTMENT OF HEALTH, priVici “OMIM Ta, _ Petitioner, OY JOEL “ARINGS VS. CASE NO. 2002-15991 PETER N. BRAWN, M.D., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW Petitioner, Department of Health, by and through undersigned counsel, and files this Administrative Complaint before the Board of Medicine against Respondent, Peter N. Brawn, 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 hereto, Respondent has been a duly licensed physician in the State of Florida, having been issued license number ME 75202. 3. Respondent's address of record is 525 Caroline Street, Key West, Florida 33040. 4, Respondent is Board certified in Pathology. 5. In or about May 2002, Patient J.T., a 16 year-old male wrote Respondent via the Internet, described his symptoms (of falling and straining muscles in his upper body) and sent Respondent a money order for medication. 6. On or about May 14, 2002, Respondent dispensed Carisoprodol to Patient J.T. 7. Carisoprodol, a legend drug, is used for the relief of discomfort associated with acute, painful musculoskeletal conditions. 8. | The standard of care for prescribing Carisoprodo! requires the physician to do the following: (a) Perform a physical examination on the patient prior to prescribing Carisoprodol; (b) Obtain a complete history on the patient prior to prescribing Carisoprodol; and, (c) Make a diagnosis or treatment plan for the patient prior to prescribing Carisoprodol. 9. Respondent did not conduct a physical examination of Patient J.T. prior to prescribing Carisoprodol. 10. Respondent did not obtain a complete history prior to prescribing Carisoprodol for Patient J.T. 11. Respondent did not make a diagnosis or treatment plan for Patient J.T. prior to prescribing Carisoprodol. 12. Onor around May 16, 2002, Patient J.T. received a white bottle containing the Carisoprodol tablets. 13. The Carisoprodol bottle contained the following information on the label (typed information in regular print and handwritten information in bold): Peter Nelson Brawn, M.D. 525 Caroline St. Key West Florida 33040, 305.292-1917 1-888-491-4545 Patient Name ___ xx __Txxxxx Date Dispensed 5/14/02 Name & Strength of Drug (bottle has blank line)__ Directions for Use _1 tablet 4x/day 14. Further, the Carisoprodol bottle manufacturer’s label was partially obliterated by the above listed label; however the bottle contained the following information on one side (side A): _mide __armaceutical, Inc. 2152-136-02 __RISOPRODOL __BLETS, USP _0mg Rx only 100 TABLETS and the remaining information on the other side (side B): Each Tablet Contains: Carisoprodol... cesses 350 mg Usual Dosage: Adults: One tablet times daily and at bedtime. See accompanying literature for full prescribing information. Dispense in a tight, light-resistant container, as defined in the USP. Store at controlled room temperature 15°-30° C (59°-86°F). KEEP THIS AND ALL MEDICATION OUT OF THE REACH OF CHILDREN. 15. Onor around May 17, 2002, Patient J.T. appeared at his high school and had to be assisted from a class to a school administrative office as he was impaired. 16. Patient J.T. produced a white plastic bottle of Carisoprodol from his pants pocket that had the marking and labeling as found in paragraphs 12, 13 and 14 above. 17. Respondent was subpoenaed by Petitioner to produce his patient medical records for Patient J.T., and to date has failed to produce any medical records regarding his involvement with Patient JT. COUNT I- STANDARD OF CARE 18. Petitioner re-alleges and incorporates paragraphs one (1) through seventeen (17) as if fully set forth herein. 19. Section 458.331(1)(t), Florida Statutes (2001), provides that gross or repeated malpractice or the failure 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 constitutes grounds for disciplinary action by thé Board of Medicine. 20. Chapter 64B8-9, Florida Administrative Code (FAC), sets forth standards of practice for medical doctors. Rule 64B8-9.003(2), FAC (2001), defines the standard of practice for adequacy of medical records and provides that a licensed physician shall maintain patient records in a legible manner and with sufficient detail to clearly demonstrate why the course of treatment was undertaken or why an apparently indicated course of treatment was not undertaken. 21. Respondent failed 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 circumstances, by doing one or more of the following: (a) Failing to perform a physical examination on Patient J.T. prior to prescribing Carisoprodol; (b) Failing to obtain a complete history on Patient J.T. prior to prescribing Carisoprodol; or (c) Failing to make a diagnosis or treatment plan for Patient J.T. prior to prescribing Carisoprodol. (d) Failing to maintain Patient J.T.’s medical records with sufficient detail to demonstrate Patient J.T.’s condition, history, diagnosis and/or treatment plan such to warrant the prescription of Carisoprodol. 22. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2001), by failing to practice medicine with that level of care, skill and treatment that is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances; and Respondent has violated Section 458.331(1)(t) Florida Statutes (2001), as further defined by Rule 64B8-9.003(2) FAC, by failing to practice medicine with that level of care, skill and treatment that is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances by failing to maintain Patient J.T.’s medical records with sufficient detail. COUNT II — MEDICAL RECORDS 23. Petitioner re-alleges and incorporates paragraphs one (1) through seventeen (17) as if fully set forth herein this Count Two. 24. Section 458.331(1)(m), Florida Statutes (2001), provides that 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, constitutes grounds for disciplinary action by the Board of Medicine. 25. Rule 64B8-9.003, Florida Administrative Code, provides, in relevant part: 64B8-9.003 Standards for Adequacy of Medical Records. * * * (3) The medical record shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course of 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. 26. Respondent failed to keep written medical records justifying the course of treatment of Patient J.T., in that Respondent has failed to provide any medical records that document an adequate medical history on the patient or that justify the treatment of Patient J.T. with Carisoprodol. 27. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2001), and Rule 64B8-9.003, Florida Administrative Code, by failing to keep legible, as defined by department rule in consultation with the board, 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. COUNT III- Prescribing 28. Petitioner re-alleges and incorporates paragraphs one (1) through seventeen (17) as if fully set forth herein this Count Three. 29. Section 458.331(1)(q), Florida Statutes (2001), provides that a physician may be subject to discipline 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 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. 30. Respondent inappropriately prescribed and/or dispensed Carisoprodol to Patient J.T., a sixteen year-old male via a single Internet exchange. 31. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2001), 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, by virtue of inappropriately prescribing Carisoprodol to Patient J.T. WHEREFORE, Petitioner respectfully requests the Board of Medicine 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, and/or any other relief that the Board deems appropriate. 4 ot / SIGNED this _<’/ day of___ [pncanr va John O. Agwunobi, M.D., M.B.A. ss gg mrs Secretary, Department of Health FILED YeeeP DEPUTY CLERK cue Nag daa , Ly aA 4) “A é on “Lynne A. Qdimby-Pennock DATE {21 ——Hetfoy Assistant General Counsel Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 OEPAATMENT OF HEALTH 10 Florida Bar No. 0394572 (850) 414-8126 (850) 488-1989 Fax laqp Reviewed and approved by: J)" (initials) _{2¢l9> (date) PCP: /] 16/2004 o L PCP Members: €/-Bakec, Visa gemagan, Beeke. Peter N. Brawn, M.D., Case No. 2002-15991 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. 11

Docket for Case No: 04-002075PL