STATE OF FLORIDA meh DEPARTMENT OF HEALTH 0% M2 PH 2:99 Olyic ic: {\ 1 DEPARTMENT OF HEALTH, MINTS RAG ve Petitioner, Vv. DOH Case Nos. 1998-03060, 2000-01578, 2000- 01648, 2000- 12409, 2000-12418, 2000-12432, 2000-12527, MARVIN REICH, M.D., 2000-12535, 2000-12538, 2000-12549 Respondent. ; O L| _ L| | | | P _ 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 Respondent, Marvin Reich, 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. | Respondent is and has been at all times material hereto a licensed physician in the state of Florida, having been issued license number ME 0051631. Respondent's last known address is Deerfield Eye Institute, 1979 West Hillsboro Boulevard, Suite 4, Deerfield Beach, Florida, 33442. Respondent is board certified in Ophthalmology. 3. a. Section 458.331(1)(g), Florida Statutes, provides that failing to perform any statutory or legal obligation placed upon a licensed physician constitutes grounds for disciplinary action by the Board of Medicine, and Section 766.111(1), Florida Statutes, provides that no health care provider licensed pursuant to chapter 458, shall order procure, provide, or administer unnecessary diagnostic tests, which are not reasonably calculated to assist the health care provider in arriving at a diagnosis and treatment of a patient's condition. b. Section 458.331(1)(m), Florida Statutes, 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 are grounds for disciplinary action by the Board of Medicine. c. Section 458.331(1)(n), Florida Statutes, provides that exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, which shall include, but not be limited to, the promoting or selling of services, goods, appliances, or drugs are grounds for disciplinary action by the Board of Medicine. d. Section 458.331(1)(q), Florida Statutes, provides that 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 constitutes grounds for disciplinary action by the Board of Medicine. For the purposes of paragraph 458.331(1)(q), it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and not in the course of the physician’s professional practice, without regard to his or her intent. e. Section 458.331(1)(t), Florida Statutes, provides that gross or repeated malpractice or 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 is grounds for discipline by the Board of Medicine. Case Number 1998-03060 PATIENT C.M. 4. Onor about March 14, 1996, Patient C.M. a forty-five (45) year old female presented to the Metabolic Treatment Center for evaluation of obesity and weight loss therapy. 5. Patient C.M. filled out an extensive questionnaire on subjective symptoms. 6. Patient C.M. underwent blood testing and extensive nerve conduction testing prior to being examined by the Respondent. 7. Respondent ordered an array of bloods tests and diagnostic tests that included but were not limited to a CBC (complete blood count), serum electrolytes, serum chemistries, blood lipid profiles, liver function enzymes and a complete panel a hormonal assays to rule out any metabolic disorders to include a thyroid profile (13, T4, free and total T3 and T4, TSH) FSH, LH. These tests were within normal limits. 8. The physical examination revealed no significant abnormalities other than dry course skin, subjectively decreased biceps and Achilles STRs bilaterally and old surgical scar on the abdomen. 9, Respondent diagnosed Patient C.M. with panhypopituitarism (defective or absent function of the entire pituitary gland), peripheral neuropathy, diabetes, Chronic Fatigue Syndrome, hypercholesterolemia, depression and possible candidiasis. 10. On or about March 21, 1996, Patient C.M. presented to Respondent for follow-up and review of her laboratory tests and complaints of increasing pain in her neck and her back. 11. Patient C.M. had a mildly elevated cholesterol level of 239. 12. Patient C.M/’s laboratory tests were within normal limits and most were performed in a non-fasting state when they should have been performed in a fasting state to have any validity. 13. Despite normal thyroid studies, Patient C.M. was started on Cytomel (thyroid hormone) and given instructions to follow-up in two weeks. 14. On or about April 14, 1996, Patient C.M. presented to Respondent for follow-up of the March 21, 1996 visit. 15. At this visit, Patient C.M. had complaints of coming down with a cold and continued complaints of back and neck pain. 16. Respondent performed a brief history and physical examination and ordered a battery of blood and diagnostic tests, which include but were not limited to a CBC and lower Somatasensory Evoked Potential test. COUNT ONE FAILING TO PERFORM STATUTORY OBLIGATION 17. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), as if fully set forth herein this Count One. 18. Respondent failed to perform a statutory or legal obligation placed upon a licensed physician, in that Respondent engaged in unnecessary diagnostic testing, in that the results of these tests were within acceptable limits, without medical justification and were not reasonably calculated to assist the diagnosis and treatment of Patient C.M. 19. Based on the foregoing, Respondent has violated Section 458.331(1)(g), Florida Statutes (1995), by failing to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent violated Section 766.111(1), Florida Statutes, which provides that no health care provider licensed pursuant to chapter 458, shall order procure, provide, or administer unnecessary diagnostic tests, which are not reasonably calculated to assist the health care provider in arriving at a diagnosis and treatment of a patient’s condition. COUNT TWO INADEQUATE MEDICAL RECORDS 20. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), as if fully set forth herein. 21. Respondent failed to keep legible medical records that justify the course of treatment of the patient, in that Respondent failed to accurately document and justify the course of treatment utilized in the care of Patient C.M. 22. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (1995), by 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. COUNT THREE EXPLOITING PATIENT FOR FINANCIAL GAIN 23. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), as if fully set forth herein. 24. Respondent exercised influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, in that Respondent repeatedly ordered excessive and unnecessary tests on Patient C.M. without medical justification. 25. Based on the foregoing, Respondent has violated Section 458.331(1)(n), Florida Statutes (1995), by exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, which shall include, but not be limited to, the promoting or selling of services, goods, appliances, or drugs. COUNT FOUR INAPPROPRIATE PRESCRIBING 26. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), as if fully set forth herein. 27. Respondent prescribed, dispensed, administered, mixed, or otherwise prepared a legend drug, including any controlled substance, other than in the course of the physician’s professional practice, in that Respondent inappropriately prescribed thyroid replacement medications based on laboratory tests that were within normal limits. 28. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (1995), by prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlied substance, other than in the course of the physician's professional practice. For the purposes of this section, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and not in the course of the physician’s professional practice, without regard to his intent. COUNT FIVE STANDARD OF CARE 29. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), as if fully set forth herein. 30. Respondent committed gross or repeated malpractice or 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 conditions and circumstances in one or more of the following ways: a. Respondent ordered inappropriate and excessive testing of Patient C.M. without medical justification. b. | Respondent failed to perform an adequate history and physical examination. c. | Respondent's diagnosis of Patient C.M.’s condition was inadequate, inappropriate and inaccurate. d. Respondent prescribed thyroid replacement medications in an inappropriate manner. 31. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (1995), by committing gross or repeated malpractice or failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonable prudent similar physician as being acceptable under similar conditions and circumstances. Case Number 2000-01578 PATIENT S.A. 32. On or about June 3, 1998, Patient S.A., a fifty-four (54) year- old female, presented to the Metabolic Treatment Center for evaluation of obesity and weight loss therapy. 33. At this visit, Respondent performed a brief history and physical examination. 34. Respondent ordered numerous lab studies, which included but were not limited to progesterone, EBV, prolactin level and candida. 35. Respondent made a diagnosis of hyperthyroidism despite normal thyroid function studies. 36. On or about July 2, 1998, Patient S.A. presented to the Respondent for follow up. At this visit, Respondent ordered an immune panel for a sore throat and additional lab studies. 37. Onor about July 23, 1998, Patient S.A. presented for follow-up. At this visit, Respondent ordered an array of lab studies, which included but were not limited to zinc, thiamine, riboflavin and CBC. 38. Patient S.A. was given a T3 and T5 supplement without medical necessity. COUNT SIX FAILING TO PERFORM STATUTORY OBLIGATION 39. Petitioner realleges and incorporates paragraphs one (1) through three (3) and thirty-two (32) through thirty-eight (38), as if fully set forth herein. 40. Respondent failed to perform a statutory or legal obligation placed upon a licensed physician, in that Respondent engaged in unnecessary diagnostic testing, in that the results of these tests were within acceptable limits, without medical justification and were not reasonably calculated to assist the diagnosis and treatment of Patient S.A. 41. Based on the foregoing, Respondent has violated Section 458.331(1)(g), Florida Statutes (1997), by failing to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent violated Section 766.111(1), Florida Statutes, which provides that no health care provider licensed pursuant to chapter 458, shall order procure, provide, or administer unnecessary diagnostic tests, which are not reasonably calculated to assist the health care provider in arriving at a diagnosis and treatment of a patient’s condition. COUNT SEVEN INADEQUATE MEDICAL RECORDS 42. Petitioner realleges and incorporates paragraphs one (1) through three (3) and thirty-two (32) through thirty-eight (38) as if fully set forth herein. 43. Respondent failed to keep legible medical records that justify the course of treatment of the patient, in that Respondent failed to accurately document and justify the course of treatment utilized in the care of Patient S.A. 44. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (1997), by 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. COUNT EIGHT EXPLOITING PATIENT FOR FINANCIAL GAIN 45. Petitioner realleges and incorporates paragraphs one (1) through three (3) and thirty-two (32) through thirty-eight (38) as if fully set forth herein. 46. respondent exercised influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, in that Respondent repeatedly ordered excessive and unnecessary tests on Patient S.A. without medical justification. 47. Based on the foregoing, Respondent has violated Section 458.331(1)(n), Florida Statutes (1997), by exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, which shall include, but not be limited to, the promoting or selling of services, goods, appliances, or drugs. COUNT NINE INAPPROPRIATE PRESCRIBING 48. Petitioner realleges and incorporates paragraphs one (1) through three (3) and thirty-two (32) through thirty-eight (38) as if fully set forth herein. 49. Respondent prescribed, dispensed, administered, mixed, or otherwise prepared a legend drug, including any controlled substance, other than in the course of the physician's professional practice, in that Respondent prescribed thyroid replacement medications in an inappropriate manner base on laboratory tests that were within normal limits. 50. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (1997), 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 section, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and not in the course of the physician’s professional practice, without regard to his intent. COUNT TEN STANDARD OF CARE 51. Petitioner realleges and incorporates paragraphs one (1) through three (3) and thirty-two (32) through thirty-eight (38) as if fully set forth herein. 52. Respondent committed gross or repeated malpractice or 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 conditions and circumstances in one or more of the following ways: a. Respondent ordered inappropriate and excessive testing of Patient S.A. without medical justification. b. | Respondent failed to perform an adequate history and physical examination. c. | Respondent's diagnosis of Patient S.A’s condition was inadequate, inappropriate and inaccurate. d. Respondent prescribed thyroid replacement medications in an inappropriate manner. 53. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (1997), by committing gross or repeated malpractice or failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonable prudent similar physician as being acceptable under similar conditions and circumstances. Case Number 2000-01648 PATIENT J.H. 54. On or about March 6, 1997, Patient J.H., a thirty-nine (39) year- old female, presented to the Metabolic Treatment Center for evaluation of obesity and weight loss therapy. 55. Prior to seeing the Respondent, an EKG and blood test were performed on Patient J.H., which were normal. 56. At this visit, Respondent performed a brief history and physical examination. Patient J.H. also underwent nerve conduction study of the lower and upper extremities. 57. The nerve conduction study suggested that she had bilateral ulnar neuropathies and that more proximal lesions in the peripheral nerves or cervical roots should be considered. Respondent did not evaluate or treat the nerve study abnormalities. 58. On or about March 12, 1997, Patient J.H. presented to the Respondent for follow-up. At this visit the prior test results were reviewed. The chart indicates that they were suggestive of myelofiborosis or a related myeloproliferative disorder. 59. Respondent ordered numerous lab studies, which included but were not limited to a CBC, which were within normal limits. 60. On or about March 25, 1997, Patient J.H. presented to her primary care physician who repeated the lab tests performed by Respondent, which indicated all were within normal limits. Her primary care physician also found no evidence of any blood disorder. COUNT ELEVEN FAILING TO PERFORM STATUTORY OBLIGATION 61. Petitioner realleges and incorporates paragraphs one (1) through three (3) and fifty-four (54) through sixty (60), as if fully set forth herein. 62. Respondent failed to perform a statutory or legal obligation placed upon a licensed physician, in that Respondent engaged in unnecessary diagnostic testing, in that the results of these tests were within acceptable limits, without medical justification and were not reasonably calculated to assist the diagnosis and treatment of Patient J.H. 63. Based on the foregoing, Respondent has violated Section 458.331(1)(g), Florida Statutes (1995), by failing to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent violated Section 766.111(1), Florida Statutes, which provides that no health care provider licensed pursuant to chapter 458, shall order procure, provide, or administer unnecessary diagnostic tests, which are not reasonably calculated to assist the health care provider in arriving at a diagnosis and treatment of a patient’s condition. COUNT TWELVE INADEQUATE MEDICAL RECORDS 64. Petitioner realleges and incorporates paragraphs one (1) through three (3) and fifty-four (54) through sixty (60) as if fully set forth herein. 65. Respondent failed to keep legible medical records that justify the course of treatment of the patient, in that Respondent failed to accurately document and justify the course of treatment utilized in the care of Patient J.H. 66. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (1995), by 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. COUNT THIRTEEN EXPLOITING PATIENT FOR FINANCIAL GAIN 67. Petitioner realleges and incorporates paragraphs one (1) through three (3) and fifty-four (54) through sixty (60) as if fully set forth herein. 68. Respondent exercised influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, in that Respondent repeatedly ordered excessive and unnecessary tests on Patient J.H. without medical justification. 69. Based on the foregoing, Respondent has violated Section 458.331(1)(n), Florida Statutes ( 1995), by exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, which shall include, but not be limited to, the promoting or selling of services, goods, appliances, or drugs. COUNT FOURTEEN STANDARD OF CARE 20 70. Petitioner realleges and incorporates paragraphs one (1) through three (3) and fifty-four (54) through sixty (60) as if fully set forth herein. 71. Respondent committed gross or repeated malpractice or 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 conditions and circumstances in one or more of the following ways: a. Respondent ordered inappropriate and excessive testing of Patient J.H. without medical justification. b. | Respondent failed to perform an appropriate history and physical examination. c. | Respondent’s diagnosis of Patient J.H. condition was inadequate, inappropriate and inaccurate. 72. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (1995), by committing gross or repeated malpractice or failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonable prudent similar physician as being acceptable under similar conditions and circumstances. Case Number 2000-12409 PATIENT B.H.-M. 73. On or about April 22, 1997, Patient BH-M, a 52 year-old female, presented to Respondent, with complaints of numbness, burning or tingling in hands/feet, muscle weakness, dizziness, ear pain/deafness, pressure above ears, tendency to bruise easily, abdominal pain, constipation, bloating, brittle nails, low libido, urinary frequency, fatigue, inability to lose weight and a feeling of heart skipping beats. 74. Patient BH-M also complained of poor concentration and memory, depression, faulty memory, and swelling eyelids. 75. During Patient BH-M's visit, an EKG was performed and was within normal limits. Respondent ordered and array of blood tests for Patient BH-M, including CBC, chemistry, lipid profile, thyroid functions, insulin, prolactin, cortisol, DHEA, basal growth hormone, ferritin, IGF-1, progesterone, and LH/FSH. 76. Respondent noted in Patient BH-M’s medical records a working diagnosis of endocrine disorder, chronic fatigue and panhypopituitarism (defective or absent function of the entire pituitary gland.) 22 77. On or about May 1, 1997, Respondent performed a nerve conduction study of Patient BH-M‘s upper and lower extremities to rule our diabetic neurophathies. 78. An EKG was also performed and was within normal limits. Respondent began Patient BH-M on Cytomel 5mg, and Rezulin 400mg despite normal thyroid tests. 79. On or about May 29, 1997, Patient BH-M returned to the center with reports she has never felt better. 80. Respondent's working diagnosis was endocrine disorder, chronic fatigue, hypercholesterolemia, and hypothyroidism. Respondent repeated Patient BH-M’s CBC profile, chemistry and lipid profile, and tested thyroid functions and insulin levels. 81. On or about July 22, 1997, Patient BH-M returned to the center as directed by Respondent. 82. Respondent ordered two blood profile tests to rule out any thyroid disorders. 23 83. Respondent’s working diagnosis was endocrine disorder, hypothyroidism, and dyspituitarism. 84. Respondent repeated Patient BH-M’s CBC profile, chemistry and lipid profile, thyroid functions, insulin levels and LH/FSH, prolactin, cortisol, ACTH, DHEA, growth hormone, and feritin levels. 85. On or about November 7, 1997, Patient BH-M returned to the center as directed by Respondent with reports that she was feeling wonderful. Respondent ordered two blood profile tests and somatomedin C, and prescribed Regenesis. Respondent repeated Patient BH-M’s CBC profile, chemistry and lipid profile, thyroid functions, and insulin levels. 86. On or about December 5, 1997, Patient BH-M returned to the center as directed by Respondent who ordered ABO, somatomedin C, and repeated Patient BH-M’s CBC profile, chemistry and lipid profile, thyroid functions, and insulin levels. 87. Respondent ordered tests for Patient BH-M that were excessive and unnecessary, and were not reasonably calculated to assist the diagnosis and treatment of Patient BH-M. 88. Respondent failed to refer Patient BH-M to a neurologist to follow up on neuropathy shown in the upper extremity nerve conduction study. 89. Respondent failed to justify excessive and inappropriate testing without medical justification in that Respondent ordered FSH/LH tests, which measures menopause status. Patient BH-M was menopausal and already on estrogen replacement therapy. 90. Respondent failed to appropriately treat and failed to appropriately prescribe medications to Patient BH-M in that Respondent switched thyroid medication from Synthroid to Cytomel despite lab findings indicating the patient’s thyroid functions were within normal limits. COUNT FIFTEEN FAILING TO PERFORM STATUTORY OBLIGATION 91. Petitioner realleges and incorporates paragraphs one (1) through three (3) and seventy-three (73) through ninety (90), as if fully set forth herein. 92. Respondent failed to perform a statutory or legal obligation placed upon a licensed physician, in that he engaged in unnecessary diagnostic testing, and in that the results of these tests were within 25 acceptable limits, without medical justification and not reasonably calculated to assist the diagnosis and treatment of Patient B.H-M. 93. Based on the foregoing, Respondent has violated Section 458.331(1)(g), Florida Statutes (1996 and 1997), by failing to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent violated Section 766.111(1), Florida Statutes, which provides that no health care provider licensed pursuant to chapter 458, shall order procure, provide, or administer unnecessary diagnostic tests, which are not reasonably calculated to assist the health care provider in arriving at a diagnosis and treatment of a patient's condition. COUNT SIXTEEN INADEQUATE MEDICAL RECORDS 94. Petitioner realleges and incorporates paragraphs one (1) through three (3) and seventy-three (73) through ninety (90), as if fully set forth herein. 95. Respondent failed to keep legible medical records that justify the course of treatment of the patient, in that Respondent failed to accurately document and justify the course of treatment utilized in the care of Patient J.H. 26 96. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (1996 and 1997), by 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. COUNT SEVENTEEN EXPLOITING PATIENT FOR FINANCIAL GAIN 97. Petitioner realleges and incorporates paragraphs one (1) through three (3) and seventy-three (73) through ninety (90), as if fully set forth herein. 98. Respondent exercised influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, in that Respondent repeatedly ordered excessive and unnecessary tests on Patient B.H.-M without medical justification. 99. Based on the foregoing, Respondent has violated Section 458.331(1)(n), Florida Statutes (1996 and 1997), by exercising influence on the patient or client in such a manner as to exploit the patient or client 27 for financial gain of the licensee or of a third party, which shall include, but not be limited to, the promoting or selling of services, goods, appliances, or drugs. COUNT EIGHTEEN INAPPROPRIATE PRESCRIBING 100. Petitioner realleges and incorporates paragraphs one (1) through three (3) and seventy-three (73) through ninety (90), as if fully set forth herein. 101. Respondent prescribed, dispensed, administered, mixed, or otherwise prepared a legend drug, including any controlled substance, other than in the course of the physician’s professional practice, in that Respondent prescribed thyroid replacement medications in an inappropriate manner based on laboratory tests that were within normal limits. 102. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (1996 and 1997), 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 section, it shall be legally presumed that prescribing, dispensing, administering, mixing, or 28 otherwise preparing a legend drug, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and not in the course of the physician's professional practice, without regard to his intent. COUNT NINTEEN STANDARD OF CARE 103. Petitioner realleges and incorporates paragraphs one (1) through three (3) and seventy-three (73) through ninety (90), as if fully set forth herein. 104. R espondent committed gross or repeated malpractice or 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 conditions and circumstances in one or more of the following ways: a. Respondent ordered inappropriate and excessive testing of Patient B.H.-M without medical justification. b. Respondent failed to perform an adequate history and physical examination. c. | Respondent’s diagnosis of Patient B.H.-M condition was inadequate, inappropriate and inaccurate. 105. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (1996 and 1997), by committing gross or repeated malpractice or failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonable prudent similar physician as being acceptable under similar conditions and circumstances. Case Number 2000-12418 PATIENT S.B. 106. On or about July 18, 1996, Patient S.B. presented to Respondent with complaints of being tired and course hair. 107. An EKG was performed prior to Patient S.B. seeing the Respondent. The EKG was within normal limits. 108. Respondent performed a_ brief history and_ physical examination. 109. Respondent’s positive findings were dry skin, course hair, reduced reflexes in the deep tendons and an old ruptured tympanic membrane. 110. Respondent’s plan of treatment was to perform nerve conduction velocities, a Barnes’ basal temperature and a CBC. 30 111. On or about July 24, 1996, Patient S.B. presented to Respondent for follow-up and performance of nerve conduction velocities, a Barnes’ basal temperature but not limited to the above test. 112. Respondent performed a nerve conduction velocity study despite Patient S.B. having no symptoms of muscle weakness. 113. On or about August 1, 1996, Patient S.B. presented to Respondent for the results of the tests performed on July 24, 1996, which were within normal limits. 114. Respondent's diagnosis was hyperinsulinemia with insulin resistance, probable hypothyroidism, despite normal thyroid blood chemistries, probable hypoglycemia and Patient S.B. was treated with niacin, L-carnitine, L-gilutamic acid. COUNT TWENTY FAILING TO PERFORM STATUTORY OBLIGATION 115. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred six (106) through one hundred fourteen (114), as if fully set forth herein. 116. Respondent failed to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent engaged in 31 unnecessary diagnostic testing, in that the results of these tests were within acceptable limits, without medical justification and were not reasonably calculated to assist the diagnosis and treatment of Patient S.B. 117. Based on the foregoing, Respondent has violated Section 458.331(1)(g), Florida Statutes (1996), by failing to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent violated Section 766.111(1) Florida Statutes, which provides that no health care provider licensed pursuant to chapter 458, shall order procure, provide, or administer unnecessary diagnostic tests, which are not reasonably calculated to assist the health care provider in arriving at a diagnosis and treatment of a patient's condition. COUNT TWENTY ONE INADEQUATE MEDICAL RECORDS 118. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred six (106) through one hundred fourteen (114), as if fully set forth herein. 119. Respondent failed to keep legible medical records that justify the course of treatment of the patient, in that Respondent failed to accurately document and justify the course of treatment utilized in the care of Patient S.B. 120. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (1996), by 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. COUNT TWENTY TWO EXPLOITING PATIENT FOR FINANCIAL GAIN 121. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred six (106) through one hundred fourteen (114), as if fully set forth herein. 122. Respondent exercised influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, in that Respondent repeatedly ordered excessive and unnecessary tests on Patient S.B. without medical justification. 33 123. Based on the foregoing, Respondent has violated Section 458.331(1)(n), Florida Statutes (1996), by exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, which shall include, but not be limited to, the promoting or selling of services, goods, appliances, or drugs. COUNT TWENTY THREE INAPPROPRIATE PRESCRIBING 124. P etitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred nine (109) through one hundred seventeen (117) as if fully set forth herein. 125. Respondent prescribed, dispensed, administered, mixed, or otherwise prepared a legend drug, including any controlled substance, other than in the course of the physician's professional practice, in that Respondent prescribed thyroid replacement medications in an inappropriate manner based on laboratory tests that were within normal limits. 126. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (1996), by prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any 34 controlled substance, other than in the course of the physician’s professional practice. For the purposes of this section, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and not in the course of the physician’s professional practice, without regard to his intent. COUNT TWENTY FOUR STANDARD OF CARE 127. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred six (106) through one hundred fourteen (114), as if fully set forth herein. 128. Respondent committed gross or repeated malpractice or 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 conditions and circumstances in one or more of the following ways: a. | Respondent ordered inappropriate and excessive testing of Patient $.B. without medical justification. b. | Respondent failed to perform an appropriate history and physical examination. c. | Respondent’s diagnosis of Patient S.B. condition was inadequate, inappropriate and inaccurate. 129. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (1996), by committing gross or repeated malpractice or failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonable prudent similar physician as being acceptable under similar conditions and circumstances. Case Number 2000-12432 PATIENT R.B. 130. On or about July 11, 1997, Patient R.B. presented to Respondent with a history of diabetes, hypertension, kidney stones and hepatitis B. 131. Respondent failed to perform an adequate history and physical examination on Patient R.B. 132. Respondent's plan of treatment included but was not limited to a battery of labs and Barnes’ basal temperature. 133. On or about July 18, 1997, Patient R.B. presented to the Respondent with a blood pressure of 148/98. Patient R.B. was instructed by Respondent to return on July 22, 1997. 134. On or about July 22, 1997, Patient R.B. presented to Respondent who ordered a battery of labs and tests that included but were not limited to an EB virus, chem. profile and EKG, which was normal. 135. Patient R.B. also underwent a nerve conduction study, which indicated multiple abnormalities. Respondent failed to evaluate and treat the abnormalities. COUNT TWENTY FIVE FAILING TO PERFORM STATUTORY OBLIGATION 136. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred thirty (130) through one hundred thirty seven (135), as if fully set forth herein. 137. Respondent failed to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent engaged in unnecessary diagnostic testing, in that the results of these tests were within acceptable limits, without medical justification and were not reasonably calculated to assist the diagnosis and treatment of Patient R.B. 37 138. Based on the foregoing, Respondent has violated Section 458.331(1)(g), Florida Statutes (1997), by failing to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent violated Section 766.111(1), Florida Statutes, which provides that no health care provider licensed pursuant to chapter 458, shall order, procure, provide, or administer unnecessary diagnostic tests, which are not reasonably calculated to assist the health care provider in arriving at a diagnosis and treatment of a patient’s condition. COUNT TWENTY SIX INADEQUATE MEDICAL RECORDS 139. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred thirty (130) through one hundred thirty seven (135), as if fully set forth herein. 140. Respondent failed to keep legible medical records that justify the course of treatment of the patient, in that Respondent failed to accurately document and justify the course of treatment utilized in the care of Patient R.B. 141. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (1997), by failing to keep legible medical records that justify the course of treatment of the patient, including, but 38 not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. COUNT TWENTY SEVEN EXPLOITING PATIENT FOR FINANCIAL GAIN 142. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred thirty (130) through one hundred thirty seven (135), as if fully set forth herein. 143. Respondent exercised influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, in that Respondent repeatedly ordered excessive and unnecessary tests on Patient R.B. without medical justification. 144. Based on the foregoing, Respondent has violated Section 458.331(1)(n), Florida Statutes (1997), by exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, which shall include, but not be limited to, the promoting or selling of services, goods, appliances, or drugs. 39 COUNT TWENTY EIGHT STANDARD OF CARE 145. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred thirty (130) through one hundred thirty seven (135), as if fully set forth herein. 146. Respondent committed gross or repeated malpractice or 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 conditions and circumstances in one or more of the following ways: a. Respondent ordered inappropriate and excessive testing of Patient R.B. without medical justification. b. | Respondent failed to perform an appropriate history and physical examination. c. | Respondent’s diagnosis of Patient R.B. condition was inadequate, inappropriate and inaccurate. 147. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (1997), by committing gross or repeated malpractice or failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonable prudent similar physician as being acceptable under similar conditions and circumstances. Case Number 2000-12527 PATIENT P.G. 148. On or about July 3, 1997, Patient P.G., a 43-year old female, presented to Respondent with complaints of pain and swelling joints, depression and inability to lose weight. 149. Respondent noted a working diagnosis of hypothyroidism, hypertension, hypercholesterolernia, endocrine gland disorder, chronic fatigue, and rule out pituitary access disorder were established. 150. Respondent ordered complete blood work to include serum insulin, DHEA, ferritin, iron, SMAC 19, T3, T4, TSH, CBC w/dif, somatomedin C, HDL, LDL, VLDL, ACTH, FSH serum, cortisol, human growth hormone, prolactin, and serum LH. 151. Respondent also instructed patient P.G. how to take Barnes Basal Temperature assessment, and to return in one week. 152. On or about July 7, 1997, Patient P.G., presented to Respondent to redraw blood work due to a problem with the lab. 153. On or about July 11, 1997, Patient P.G. presented to Respondent to discuss the results of the lab tests. 4] 154. Respondent’s notes indicate that the lab results confirm hyperinsulemia, hyperglycemia, hypothyroid both by temperature and symptoms. Lab results also confirm diagnosis of panhypopituitarism. 155. Respondent started Patient P.G. on Cytomel 0.5mcg, L Glutamic, Rezulin 400mcg, Acid 500mcg, Chromium GTF 600mcg, L- Carnitine 1000mg, CoQi0 100mg, and Pro GH., with instructions to return in one week. 156. On or about July 17, 1997, Patient P.G., presented to Respondent who increased the dosage of Cytomel despite normal thyroid tests. In addition, GH was administered despite no evidence of deficiency. 157. On or about August 22, 1997, Patient P.G. presented to Respondent to draw Alcat and Profile II to further rule out food allergens, ingested allergens, and environmental allergens. Respondent also performed an upper NCV to further rule our diabetic neuropathy. 158. On or about October 3, 1997, Patient P.G. again presented to Respondent. 159. On or about October 23, 1997, Patient P.G. again presented to Respondent. 42 160. On or about November 25, 1997, Patient P.G. presented to Respondent who changed medication from T3 to p.r.o. 2.5mg/100mg, and discussed growth hormone injections. Respondent drew a Spectrocel 3000 test to further check the way cells operate internally and metabolize different ingestions. COUNT TWENTY NINE FAILING TO PERFORM STATUTORY OBLIGATION 161. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred forty eight (148) through one hundred sixty (160), as if fully set forth herein. 162. Respondent failed to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent engaged in unnecessary diagnostic testing, in that the results of these tests were within acceptable limits, without medical justification and were not reasonably calculated to assist the diagnosis and treatment of Patient P.G. 163. Based on the foregoing, Respondent has violated Section 458.331(1)(g), Florida Statutes (1997), by failing to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent violated Section 766.111(1), Florida Statutes, which provides that no 43 health care provider licensed pursuant to chapter 458, shall order procure, provide, or administer unnecessary diagnostic tests, which are not reasonably calculated to assist the health care provider in arriving at a diagnosis and treatment of a patient's condition. COUNT THIRTY INADEQUATE MEDICAL RECORDS 164. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred forty eight (148) through one hundred sixty (160), as if fully set forth herein. 165. Respondent failed to keep legible medical records that justify the course of treatment of the patient, in that Respondent failed to accurately document and justify the course of treatment utilized in the care of Patient P.G. 166. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (1997), by 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. 44 COUNT THIRTY ONE EXPLOITING PATIENT FOR FINANCIAL GAIN 167. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred forty eight (148) through one hundred sixty (160), as if fully set forth herein. 168. Respondent exercised influence on the patient or client in such a manner as to exploit the patient for financial gain of the licensee or of a third party, in that Respondent repeatedly ordered excessive and unnecessary tests on Patient P.G. without medical justification. 169. Based on the foregoing, Respondent has violated Section 458.331(1)(n), Florida Statutes (1997), by exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, which shall include, but not be limited to, the promoting or selling of services, goods, appliances, or drugs. COUNT THIRTY TWO INAPPROPRIATE PRESCRIBING 170. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred fifty three (153) through one hundred sixty five (165) as if fully set forth herein. 45 171. Respondent prescribed, dispensed, administered, mixed, or otherwise prepared a legend drug, including any controlled substance, other than in the course of the physician's professional practice, in that Respondent prescribed thyroid replacement medications in an inappropriate manner based on laboratory tests that were within normal limits. 172. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (1997), 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 a legend drug, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and not in the course of the physician’s professional practice, without regard to his intent. COUNT THIRTY THREE STANDARD OF CARE 46 173. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred forty eight (148) through one hundred sixty (160), as if fully set forth herein. 174. Respondent committed gross or repeated malpractice or 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 conditions and circumstances in one or more of the following ways: a. | Respondent ordered inappropriate and excessive testing of Patient P.G. without medical justification. b. | Respondent failed to perform an appropriate history and physical examination. c. | Respondent's diagnosis of Patient P.G.’s condition was inadequate, inappropriate and inaccurate. 175. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (1997), by committing gross or repeated malpractice or failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonable prudent similar physician as being acceptable under similar conditions and circumstances. 47 Case Number 2000-12535 PATIENT C.H. 176. On or about June 6, 1996, Patient C.H., a forty-six (46) year old female, presented to the Respondent with various complaints, that included but not limited to hair loss, fatigue and weight gain. 177. Patient C.H. underwent extensive lab testing that included but was not limited to a nerve conduction study, which was normal. Patient C.H. also underwent an examination that did not disclose any abnormalities. 178. On or about June 13, 1996, Patient C.H. presented to the Respondent. At this visit, Patient C.H. was started on Cytomel despite normal thyroid tests. 179. On or about June 20, 1996 and June 27, 1996 Patient C.H.’s Cytomel was increased despite normal thyroid tests. 180. On or about July 17, 1996, Patient C.H.’c Cytomel was stopped due to the side effects. Patient C.H. returned for follow-up on or about July 24, 1996 and August 9, 1996. COUNT THIRTY FOUR FAILING TO PERFORM STATUTORY OBLIGATION 181. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred seventy six (176) through one hundred eighty (180), as if fully set forth herein. 182. Respondent failed to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent engaged in unnecessary diagnostic testing, in that the results of these tests were within acceptable limits, without medical justification and were not reasonably calculated to assist the diagnosis and treatment of Patient C.H. 183. Based on the foregoing, Respondent has violated Section 458.331(1)(g), Florida Statutes (1995), by failing to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent violated Section 766.111(1), Florida Statutes, which provides that no health care provider licensed pursuant to chapter 458, shall order procure, provide, or administer unnecessary diagnostic tests, which are not reasonably calculated to assist the health care provider in arriving at a diagnosis and treatment of a patient’s condition. COUNT THIRTY FIVE INADEQUATE MEDICAL RECORDS 49 184. P etitioner ‘realleges and incorporates paragraphs one (1) through three (3) and one hundred seventy six (176) through one hundred eighty (180), as if fully set forth herein. 185. Respondent failed to keep legible medical records that justify the course of treatment of the patient, in that Respondent failed to accurately document and justify the course of treatment utilized in the care of Patient C.H. 186. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (1995), by 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. COUNT THIRTY SIX EXPLOITING PATIENT FOR FINANCIAL GAIN 187. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred seventy six (176) through one hundred eighty (180), as if fully set forth herein. 188. Respondent exercised influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, in that Respondent repeatedly ordered excessive and unnecessary tests on Patient C.H. without medical justification. 189. Based on the foregoing, Respondent has violated Section 458.331(1)(n), Florida Statutes (1995), by exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, which shall include, but not be limited to, the promoting or selling of services, goods, appliances, or drugs. COUNT THIRTY SEVEN INAPPROPRIATE PRESCRIBING 190. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred seventy six (176) through one hundred eighty (180), as if fully set forth herein. 191. Respondent prescribed, dispensed, administered, mixed, or otherwise prepared a legend drug, including any controlled substance, other than in the course of the physician’s professional practice, in that Respondent prescribed thyroid replacement medications in an inappropriate manner based on laboratory tests that were within normal limits. 192. 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 section, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and not in the course of the physician’s professional practice, without regard to his intent. COUNT THIRTY EIGHT STANDARD OF CARE 193. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred seventy six (176) through one hundred eighty (180), as if fully set forth herein. 194. R espondent committed gross or repeated malpractice or failed to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as being acceptable $2 under similar conditions and circumstances in one or more of the following ways: a. Respondent ordered inappropriate and excessive testing of Patient C.H. without medical justification. b. | Respondent failed to perform an appropriate history and physical examination. c. Respondent's diagnosis of Patient C.H. condition was inadequate, inappropriate and inaccurate. 195. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (1995), by committing gross or repeated malpractice or failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonable prudent similar physician as being acceptable under similar conditions and circumstances. Case Number 2000-12538 PATIENT L.L. 196. On or about May 30, 1996, Patient L.L., a forty eight (48) year old female, presented to Respondent with complaints of inability to lose weight, menstrual problems, fatigue, tingling in arms or legs, swollen feet, swollen eyelids, excess thirst, cold hands, cold feet, neck and back pain. 197. An examination was performed that revealed optic atrophy and depressed reflexes. 198. Lab testing and nerve conduction studies of both Patient L.L.’s upper and lower limbs were measured and somatosensory evoked potentials were recorded and were within normal limits. Patient L.L. was also asked to record her baseline temperature. 199. On or about June 6, 1996, Patient L.L. presented to the Respondent and was started on Cytomel despite normal thyroid functions. COUNT THIRTY NINE FAILING TO PERFORM STATUTORY OBLIGATION 200. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred ninety six (196) through one hundred ninety nine (199), as if fully set forth herein this Count Forty-One. 201. Respondent failed to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent engaged in unnecessary diagnostic testing, in that the results of these tests were within acceptable limits, without medical justification and were not reasonably calculated to assist the diagnosis and treatment of Patient L.L. 202. Based on the foregoing, Respondent has violated Section 458.331(1)(g), Florida Statutes (1995), by failing to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent violated Section 766.111(1), Florida Statutes, which provides that no health care provider licensed pursuant to chapter 458, shall order procure, provide, or administer unnecessary diagnostic tests, which are not reasonably calculated to assist the health care provider in arriving at a diagnosis and treatment of a patient’s condition. COUNT FORTY INADEQUATE MEDICAL RECORDS 203. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred ninety six (196) through one hundred ninety nine (199), as if fully set forth herein. 204. R espondent failed to keep legible medical records that justify the course of treatment of the patient, in that Respondent failed to accurately document and justify the course of treatment utilized in the care of Patient L.L. 205. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes, by failing to keep legible medical records that justify the course of treatment of the patient, including, but not 35 limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. COUNT FORTY ONE EXPLOITING PATIENT FOR FINANCIAL GAIN 206. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred ninety six (196) through one hundred ninety nine (199), as if fully set forth herein. 207. Respondent exercised influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, in that Respondent repeatedly ordered excessive and unnecessary tests on Patient L.L. without medical justification. 208. Based on the foregoing, Respondent has violated Section 458.331(1)(n), Florida Statutes (1995), by exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, which shall include, but not be limited to, the promoting or selling of services, goods, appliances, or drugs. 56 COUNT FORTY TWO INAPPROPRIATE PRESCRIBING 209. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred ninety six (196) through one hundred ninety nine (199), as if fully set forth herein. 210. Respondent prescribed, dispensed, administered, mixed, or otherwise prepared a legend drug, including any controlled substance, other than in the course of the physician's professional practice, in that Respondent prescribed thyroid replacement medications in an inappropriate manner based on laboratory tests that were within normal limits. 211. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (1995), 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 section, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and not in the course of the physician's professional practice, without regard to his intent. COUNT FORTY FIVE STANDARD OF CARE 212. Petitioner realleges and incorporates paragraphs one (1) through three (3) and one hundred ninety six (196) through one hundred ninety nine (199), as if fully set forth herein. 213. Respondent committed gross or repeated malpractice or 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 conditions and circumstances in one or more of the following ways: a. | Respondent ordered inappropriate and excessive testing of Patient L.L. without medical justification. b. Respondent failed to perform an appropriate history and physical examination. c. | Respondent's diagnosis of Patient L.L. condition was inadequate, inappropriate and inaccurate. 58 214. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (1995), by committing gross or repeated malpractice or failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonable prudent similar physician as being acceptable under similar conditions and circumstances. Case Number 2000-12549 PATIENT S.B. 215. On or about September 5, 1996, Patient S.B., a fifty-six (56) year old female, presented to Respondent with complaints of cold feet, tingling of arms, tingling of legs, dizziness, leg pain, back pain, constipation, brittle nails, hoarseness, depression, low libido, blurred vision, swollen eyelids, excessive urination, fatigue, weight gain, inability to lose weight, shortness of breath and a history of high cholesterol and gestational diabetes. 216. An examination was performed that did not disclose any abnormalities. 217, Lab testing was performed that included thyroid function tests and nerve conduction study, which were within normal limits. 218. On or about September 12, 1996, Patient S.B. presented to Respondent who started Patient S.B. on Cytomel despite normal thyroid functions. 219. On or about September 20, 1996, Respondent discontinued Patient S.B. on Cytomel because of side effects and started Patient S.B. on niacin. COUNT FORTY FOUR FAILING TO PERFORM STATUTORY OBLIGATION 220. Petitioner realleges and incorporates paragraphs one (1) through three (3) and two hundred fifteen (215) through two hundred nineteen (219), as if fully set forth herein. 221. Respondent failed to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent engaged in unnecessary diagnostic testing, in that the results of these tests were within acceptable limits, without medical justification and were not reasonably calculated to assist the diagnosis and treatment of Patient S.B. 222. Based on the foregoing, Respondent has violated Section 458.331(1)(g), Florida Statutes (1996), by failing to perform any statutory or legal obligation placed upon a licensed physician, in that Respondent 60 violated Section 766.111(1), Florida Statutes, which provides that no health care provider licensed pursuant to chapter 458, shall order procure, provide, or administer “unnecessary diagnostic tests, which are not reasonably calculated to assist the health care provider in arriving at a diagnosis and treatment of a patient’s condition. COUNT FORTY FIVE INADEQUATE MEDICAL RECORDS 223. Petitioner realleges and incorporates paragraphs one (1) through three (3) and two hundred fifteen (215) through two hundred nineteen (219), as if fully set forth herein. 224. R espondent failed to keep legible medical records that justify the course of treatment of the patient, in that Respondent failed to accurately document and justify the course of treatment utilized in the care of Patient S.B. 225. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (1996), by 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. 61 COUNT FORTY SIX EXPLOITING PATIENT FOR FINANCIAL GAIN EAFLOULTING PATIENT FOR FINANCIAL GAIN 226. Petitioner realleges and incorporates paragraphs one (1) through three (3) and two hundred fifteen (215) through two hundred nineteen (219), as if fully set forth herein. 227. Respondent exercised influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, in that Respondent repeatedly ordered excessive and unnecessary tests on Patient S.B. without medical justification. 228. Based on the foregoing, Respondent has violated Section 458.331(1)(n), Florida Statutes (1996), by exercising influence on the patient or client in such a manner as to exploit the patient or client for financial gain of the licensee or of a third party, which shall include, but not be limited to, the promoting or selling of services, goods, appliances, or drugs. COUNT FORTY SEVEN INAPPROPRIATE PRESCRIBING 229. Petitioner realleges and incorporates paragraphs one (1) through three (3) and two hundred fifteen (215) through two hundred nineteen (219),as if fully set forth herein. 230. Respondent prescribed, dispensed, administered, mixed, or otherwise prepared a legend drug, including any controlled substance, other than in the course of the physician’s professional practice, in that Respondent prescribed thyroid replacement medications in an inappropriate manner based on laboratory tests that were within normal limits. 231. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (1996), 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 a legend drug, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and not in the course of the physician's professional practice, without regard to his intent. COUNT FORTY EIGHT STANDARD OF CARE 232. Petitioner realleges and incorporates paragraphs one (1) through three (3) and two hundred fifteen (215) through two hundred nineteen (219), as if fully set forth herein. 233. Respondent committed gross or repeated malpractice or 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 conditions and circumstances in one or more of the following ways: a. | Respondent ordered inappropriate and excessive testing of Patient S.B. without medical justification. b. Respondent failed to perform an appropriate history and physical examination. c. Respondent's diagnosis of Patient S.B. condition was inadequate, inappropriate and inaccurate. 234. Based on the foregoing, Respondent has violated Section 458.331(1)(0), Florida Statutes (1996), by committing gross or repeated 64 malpractice or failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonable prudent similar physician as being acceptable under similar conditions and circumstances. 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. SIGNED this_ 25." day of __ C272 ber , 2004. John Agwunobi, M.D., M.B.A., M.P.H. Secretary, Department of Health FILED DEPARTMENT OF HEALTH Irving Levine DEPUTY CLERK CLERK Assistant/General Counsel pate. (10-277 cH DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C65 Tallahassee, Fl 32399-3265 Florida Bar # 0822957 (850) 414-8126 (850) 488-7723 Fax Reviewed and approved by: Quiw (initials) ih fos PCP: october 22, 2004 PCP Members: m)-panri, Patrowicz, Long Marvin Reich, M.D., Case 1998-03060 and nine others 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 cal! 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.

Docket for Case No: 04-004111PL

Orders for Case No: 04-004111PL