STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NOS. 1999-55618 2001-05263 PHILIP K. SPRINGER, M.D., RESPONDENT. a 5OSUOF L / mm ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through undersigned counsel, and files this Administrative Complaint before the Board of Medicine against Respondent, Philip K. Springer, M.D., and in support thereof alleges: FACTS RELEVANT TO ALL CASE NUMBERS AND COUNTS 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. At all times material to this Complaint, Respondent was a licensed physician within the State of Florida, having been issued license number ME17474. 3. Respondent's mailing address of record is 701 SW 80" Drive, Gainesville, Florida 32607. 4, Respondent is not board certified, but his area of practice at all times material to this Administrative Complaint was psychiatry. 5. In order to receive payment for services rendered to a Medicaid/Medicare eligible patient, qualifying medical providers in the State of Florida submit fee-for-service claims to Medicaid, Florida Medicare, and/or private insurance carriers. Claims submitted to both Medicaid and Medicare utilize current procedural terminology codes, known as CPT, which correspond to a description of the specific treatment provided to the patient. Both Medicaid and Medicare share the same procedural codes. 6. It is improper to bill both Medicare and Medicaid for single services rendered to one particular patient. 7. It is an unlawful billing procedure for an eligible medical provider to bill Medicare, Medicaid, or a private insurer for medical services that were not necessary or were never performed. 8. It is an unlawful billing procedure for a provider to bill Medicare, Medicaid, or a private insurer at the highest CPT Code level for a service rendered unless that level of service was actually performed. 9, It is an unlawful billing procedure for a provider to bill Medicare, Medicaid, or a private insurer for services rendered by the license provider 2 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 when it was actually performed by a person other than the licensed provider or performed without the proper supervision of the licensed provider. 10. Medicaid permits certain billed procedures to be performed by a licensed clinic staff member under Respondent's supervision. However, the State of Florida, Agency for Health Care Administration licensing records reveal that the Springer Group did not retain any licensed staff members other than Respondent. 11. Section 409.920, Florida Statutes (1999), establishes what practices constitute Medicaid provider fraud. The statute states, in pertinent parts: (2) It is unlawful to: (a) Knowingly make, cause to be made, or aid and abet in the making of any false statement or false representation of a material fact, by commission or omission, in any claim submitted to the agency or its fiscal agent for payment... (c) Knowingly charge, solicit, accept, or receive anything of value, other than an authorized copayment from a Medicaid recipient, from any source in addition to the amount legally payable for an item or service provided to a Medicaid recipient under the Medicaid program or knowingly fail to credit the agency or its fiscal agent for any payment received from a third-party source. 12. Rule 64B8-9.013, Florida Administrative Code (1999), outlines the guidelines for a pain management physician when evaluating a patient for the 3 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 use of controlled substances for pain control. The rule states, in pertinent part: (3) The Board has adopted the following guidelines when evaluating the use of controlled substances for pain control: (a) Evaluation of the Patient. A complete medical history and physical examination MUST be conducted and documented in the medical record. The medical record should document the nature and _ intensity of the pain, current and past treatments for pain, underlying or coexisting diseases or conditions, the effect of the pain on physical and psychological function, and history of substance abuse... (d) Periodic Review. At reasonable intervals based on the individual circumstances of the patient the physician should review the course of treatment and any new information about the etiology of the pain. Continuation or modification of therapy should depend on the physician’s evaluation of progress toward stated treatment objectives. If treatment goals are NOT being achieved, ... the physician should reevaluate the appropriateness of continued treatment... (f) Medical Records. The physician is required to keep accurate and complete records to include, but not limited to: 1. the medical history and physical examination; 2. diagnostic, therapeutic, and laboratory results; 3. evaluations and consultation; 4. treatment objectives; 5. discussion of risks and benefits; 6. treatments; 7. medications; 8. instructions and agreements; and 9. periodic reviews. (Emphasis added.) 4 DOH v¥. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 FACTS AND COUNTS RELEVANT TO CASE NUMBER 1999-55618 13. THE SPRINGER GROUP, P.A. (the Group) is a psychiatry and pain management clinic operating at 9120 N.W. 36" Place in Gainesville, Florida. 14, Respondent, a licensed physician practicing as a psychiatrist in Gainesville, was the principal physician involved with the Group. 15. An “Investigative Taskforce” used a confidential informant (CI), who had prior direct dealings as a patient with Respondent, to make undercover visits to the Group. 16. The undercover visits to the Group took place between April 21, 1999 and September 14, 1999. 17. During each undercover visit to the Group, CI was provided with copies of medical evaluation documents which contained fraudulent subjective information allegedly provided by CI. 48. During several of the undercover visits, CI had no personal contact, dialogue, or evaluation with Respondent. 19. Respondent failed to maintain adequate medical records that justified the course of treatment provided to CI by Respondent. 20. On several occasions, individuals not employed with the Group, or licensed to perform medical services, were allowed to take CI's vital signs. FACTS RELATING TO APRIL 21, 1999 OFFICE VISIT 5 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 21. Onor about April 21, 1999, (the first visit) CI, with the assistance of the Drug Enforcement Administration (DEA), made a controlled, undercover visit to the Group. 22. During this first visit, Cl attended a group therapy session with approximately twenty (20) other people. 23. During this first visit, Cl obtained the following prescriptions, all dated April 21, 1999: one prescription for one-hundred twenty (120) tablets of Lortab 10mg (Schedule III); one prescription for thirty-six (36) tablets of Mepergan Fortis 50mg (Schedule IT); one prescription for thirty (30) tablets of Trazadone 150 mg (Schedule IT); four (4) boxes (eight (8) total tablets) of Maxalt 10mg (Schedule II); and a medical evaluation report. 24, Lortab contains hydrocodone bitartrate, a Schedule III controlled substance listed in Chapter 893, Florida Statutes, which is indicated for the relief of moderate to moderately severe pain. The abuse of hydrocodone bitartrate can lead to physical and psychological dependence. 25. Mepergan Fortis is a brand name for promethazine with meperidine. Mepergan Fortis contains meperidine, a Schedule II controlled substance listed in Chapter 893, Florida Statutes, which is indicated for the relief of nausea and vomiting, and the treatment of moderate to severe pain. 6 DOH v. Philip K. Springer, M.D.. DOH Case Nos. 1999-55618 & 2001-05263 Abuse of meperidine may lead to limited physical or psychological dependence. 26. ‘Trazadone is a Schedule II controlled substance listed in Chapter 893, Florida Statutes, and is an antidepressant which may act by preventing the reuptake of serotonin into neurons. Abuse of trazadone may lead to limited physical or psychological dependence. 27. Maxalt is a Schedule II controlled substance listed in Chapter 893, Florida Statutes, and is indicated for the acute treatment of migraine attacks with or without aura in adults. Abuse of maxalt may lead to limited physical or psychological dependence. 28. At no time during the first visit did Respondent conduct any type of medical examination on CI or perform any therapy or tests. 29. Respondent electronically submitted an independent claim to Medicaid using CPT Code 90807 for services allegedly rendered to CI on April 21, 1999. This CPT Code corresponds to the profile for a 45-55 minute individual psychotherapy session. 30. Respondent did not provide an individual psychotherapy session to CI during the first visit. 7 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 FACTS RELATING TO JUNE 9, 1999 OFFICE VISIT 31. On or about June 9, 1999 (second visit), Cl made another controlled undercover visit to the Group and attended another “group therapy” session. 32, The receptionist at the Group gave CI prescriptions, issued by Respondent, without CI having any contact with Respondent concerning the prescriptions. CI exited the premises. 33. Shortly thereafter, CI realized the receptionist had given him another patient's prescriptions and CI returned to the Group. 34. After Cl had returned to the Group, he met with Respondent for approximately seven (7) minutes to clarify the mix-up, and the prescriptions were exchanged. No assessment, evaluation, or testing was conducted on Cl to validate his claims. 35. Cl obtained the following prescriptions during the second visit: all dated June 9, 1999: one prescription for thirty-six (36) tablets of Mepergan Fortis 50mg; one prescription for one-hundred twenty (120) tablets of Lortab 10mg; one prescription for one-hundred twenty (120) tablets of Valium (Schedule II); one prescription for forty-two (42) pills of Phenergan 25mg (Schedule IT); one prescription for forty-two (42) tablets of Soma 350mg 8 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 (Schedule III); four (4) boxes (eight (8) total tablets) of Maxalt; and a two- page medical evaluation report. 36. Valium is a brand name for the drug diazepam, a Schedule II controlled substance listed in Chapter 893, Florida Statutes, which is used as a muscle relaxant and may relieve pain in people who have muscle spasms. Abuse of diazepam may lead to limited physical or psychological dependence. 37. Phenergan is a brand name for promethazine, a Schedule II controlled substance listed in Chapter 893, Florida Statutes, which is an antihistamine that blocks the effects of naturally occurring chemical histamine in the body. Promethazine is used to treat allergic symptoms and reactions. Abuse of promethazine may lead to limited physical or psychological dependence. 38. Soma is a brand name for carisoprodol, a Schedule III controlled substance listed in Chapter 893, Florida Statutes, which is used as a muscle relaxant. Abuse of carisoprodol can lead to physical or psychological dependence. 39. Respondent electronically submitted an independent Medicaid claim on behalf of CI for the second visit. Respondent used CPT Code 90862, corresponding to an individual psychotherapy session lasting 45-54 minutes, which was never provided to CI during the second visit. 9 DOH v. Philip K. Springer, M.D.. DOH Case Nos. 1999-55618 & 2001-05263 FACTS RELATING TO JUNE 29, 1999 OFFICE VISIT 40. On or about June 29, 1999, the CI made a third undercover controlled visit to the Group. Once again, CI attended a “group therapy” session. 41. During the third visit “group therapy” session, CI obtained the following prescriptions: one prescription for thirty-six (36) pills of Mepergan Fortis 50 mg; one prescription for one-hundred twenty (120) tablets of Lortab 10mg; one prescription for eight (8) tablets of Maxalt 10mg, one prescription for forty-two (42) tablets of Soma, 350mg; and a two-page medical evaluation report. 42. Respondent subsequently billed Medicaid for services allegedly performed by Respondent on CI during the third visit. 43. Respondent also billed Medicare for services allegedly performed by Respondent on CI during the third visit. 44, Respondent did not evaluate or examine CI during the third visit. FACTS RELATING TO JULY 29, 1999 OFFICE VISIT 45. On July 29, 1999, CI made a fourth undercover controlled visit to the Group. Once again, CI attended a “group therapy” session. 46. During the fourth visit, Cl obtained the following prescriptions: one prescription for thirty-six (36) pills of Mepergan Fortis 50 mg; one 10 DOH v. Philip K. Springer, M-D., DOH Case Nos. 1999-55618 & 2001-05263 prescription for forty-two (42) Phenergan 25 mg; one prescription for eight (8) tablets of Maxalt 10mg; one prescription for forty-two (42) tablets of Soma 350 mg; and a two-page medical evaluation report. 47. During the subsequent debriefing with the DEA, it was discovered that the evaluation sheet, given to CI by Respondent, said that Cl should have received five total prescriptions, instead of the four he was given; a prescription for one-hundred twenty (120) tablets Lortab, 10mg, had not been provided to Cl. 48. At approximately 12:50pm, Cl returned to Respondent's office. CI met with Respondent and asked for the missing Lortab prescription. 49. Respondent did not conduct any investigation as to whether a prior prescription was ever written for CI or conduct any examination or assessment of CI before subsequently writing out and signing a prescription for the Lortab. 50. Respondent electronically submitted a Medicaid claim on behalf of CI using CPT codes 90807 and 90862, which correspond to an_ individual psychotherapy session lasting 45-50 minutes, and pharmacological management including prescription. 51. Respondent did not conduct an individual psychotherapy session or pharmacological evaluation of CI during the fourth visit. li DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 FACTS RELATING TO AUGUST 18, 1999 OFFICE VISIT 52. On August 18, 1999, CI, with the assistance of the DEA, made a fifth controlled undercover visit to the Group. 53. Cl obtained the following prescriptions, all dated August 18, 1999: one prescription for thirty-six (36) pills of Mepergan Fortis 50 mg; one prescription for one-hundred twenty (120) tablets of Lortab 10mg; one prescription for eight (8) tablets of Maxalt 10mg; one prescription for forty- two (42) tablets of Soma, 350mg; and a two-page medical evaluation report. 54. Respondent electronically submitted a Medicaid claim on behalf of CI using CPT code 90862, corresponding to the profile for pharmacological management including prescription. 55. Respondent had no personal contact with CI and did not conduct a pharmacological management consultation during the fifth visit. FACTS RELATING TO SEPTEMBER 14, 1999 OFFICE VISIT 56. On or about September 14, 1999, CI made a sixth controlled undercover visit to the Group. 57. During the sixth visit, CI again attended a “group therapy” session and obtained the following prescriptions: one prescription for one-hundred twenty tablets of Lortab 10mg; one prescription for thirty-six (36) tablets of Mepergan Fortis 50mg; one forty-two (42) count prescription of Soma 42mg; 12 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 one eight (8) count prescription of Maxalt 10mg; and a two-page medical evaluation report. 58. Respondent electronically submitted a Medicaid claim on behalf of CI using the CPT Code 90805, corresponding to the profile of an individual! psychotherapy session. 59. Respondent had no personal contact or conversation with Cl during the sixth visit. 60. Respondent never provided individual psychotherapy to CI during the sixth visit. COUNT ONE 61. Petitioner realleges and incorporates paragraphs one (1) through sixty (60) as if fully set forth herein. 62. Section 458.331(1)(h), Florida Statutes (1999), provides that making or filing a report which the licensee knows to be false or intentionally or negligently failing to file a report or record required by state or federal law constitutes grounds for disciplinary action by the Board of Medicine. 63. Respondent willfully filed fraudulent claims with Florida Medicaid and Medicare in one or more of the following ways: a. Respondent knowingly made or caused to be made false statements and false representations of material fact in claims 3 DOH vy. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 submitted to Medicare and Medicaid for payment on behalf of CI on the following dates: April 21, 1999; June 6, 1999; June 29, 1999; July 29, 1999; August 18, 1999, and September 14, 1999; or b. Respondent knowingly charged, solicited, accepted, or received payments, other than an authorized co-payment from CI, from Medicare in addition to the amount legally payable for an item or service provided to a CI under the Medicaid program by submitting duplicate claims to Medicare for treatments or procedures already billed to Medicaid on behalf of CT. 64. Based on the foregoing, Respondent has violated Section 458.331(1)(h), Florida Statutes (1999), by knowingly filing fraudulent claims with the Florida Medicare and Medicaid programs and filing materially fraudulent reports and records required by state and federal law to substantiate his fraudulent claims. COUNT TWO 65. Petitioner realleges and incorporates paragraphs one (1) through sixty (60) as if fully set forth herein. 66. Section 458.331(1)(k), Florida Statutes (1999), provides that making deceptive, untrue, or fraudulent representations in or related to the 14 DOH v. Philip K. Springer, M-D., DOH Case Nos. 1999-55618 & 2001-05263 practice of medicine or employing a trick or scheme in the practice of medicine constitutes grounds for disciplinary action by the Board of Medicine. 67. Respondent submitted fraudulent documentation, made fraudulent billing claims, and employed deceptive methods with CI to defraud the Florida government of Medicaid and Medicare funds. 68. Based on the foregoing, Respondent has violated Section 458.331(1)(k), Florida Statutes (1999), by making deceptive, untrue, or fraudulent representations in or related to the practice of medicine. COUNT THREE 69. Petitioner realleges and incorporates paragraphs one (1) through sixty (60) as if fully set forth herein. 70. Section 458.331(1)(m), Florida Statutes (1999), provides that failing to keep legible, as defined by department rule, medical records that justify the course of treatment of the patient including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations constitutes grounds for disciplinary action by the Board of Medicine against the licensee. 71. Respondent failed to maintain adequate medical records for CI by failing to include records of Cl’s_ physical examination results and 15 DOH v. Philip K. Springer, M-D.. DOH Case Nos. 1999-55618 & 2001-05263 comprehensive medical history during the office visits that occurred on: April 21, 1999; June 6, 1999; June 29, 1999; July 29, 1999; August 18, 1999, and September 14, 1999. 72. Respondent failed to maintain adequate medical records that justified the necessity for the prescriptions of controlled substances issued to CI during his office visits on: April 21, 1999; June 6, 1999; June 29, 1999; july 29, 1999; August 18, 1999, and September 14, 1999. 73. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (1999), by failing to keep adequate medical records that justify the course of treatment of the patient. COUNT FOUR 74, Petitioner realleges and incorporates paragraphs one (1) through sixty (60) as if fully set forth herein. 75. Section 458.331(1)(q), Florida Statutes (1999), provides that prescribing, dispensing, administering, or otherwise preparing a 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 purpose of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive quantities is not in the 16 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 best interest of the patient and is not in the course of the physician's professional practice, without regard to his or her intent. 76. Respondent prescribed controlled substances to CI, on April 21, 1999; June 6, 1999; June 29, 1999; July 29, 1999; August 18, 1999, and September 14, 1999, without first performing a physical examination of Cl. 77. Respondent prescribed controlled substances to CI, on April 21, 1999; June 6, 1999; June 29, 1999; July 29, 1999; August 18, 1999, and September 14, 1999, without creating/maintaining adequate medical records for CI. 78. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (1999), by prescribing, dispensing, administering, supplying, selling, or otherwise preparing a controlied substance other than in the course of his professional practice. COUNT FIVE 79, Petitioner realleges and incorporates paragraphs one (1) through sixty (60) as if fully set forth herein. 80. Section 458.331(1)(t), Florida Statutes (1999), 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 17 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 physician as being acceptable under similar conditions and circumstances constitutes grounds for disciplinary action by the Board of Medicine. 81. Respondent failed to practice medicine with that level of care that is recognized by reasonably prudent similar physician as being acceptable under similar conditions and circumstances in one or more of the following ways: a. Respondent prescribed Lortab, Mepergan Fortis, Zyprexa, Trazadone, Maxalt, Phenergen, Valium, and Soma, all controlled substances requiring a prescription, to Cl without conducting an adequate evaluation, including a history and physical examination, before prescribing said controlled substances to CI; b. Respondent did not render a proper diagnosis for CI before prescribing said controlled substances; or c. Respondent did not maintain adequate medical records for CI. 82. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (1999), by failing to practice medicine with that level of care, skill, and treatment which is recognized by a reasonably prudent similar physician as acceptable under similar conditions and circumstances. 18 DOH vy. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2003-05263 COUNT SIX 83, Petitioner realleges and incorporates paragraphs one (1) through sixty (60) as if fully set forth herein. 84. Section 458.331(1)(w), Florida Statutes (1999), provides that delegating professional responsibilities to a person when the licensee delegating such responsibilities knows or has reason to know that such person is not qualified by training, experience, or licensure to perform them is grounds for disciplinary action against the licensee by the Board of Medicine. 85, Respondent knowingly allowed unlicensed staff members and patients present at his clinic during “group therapy” sessions to take vital signs and other medical information to be used in Respondent’s medical records and documentation for CI. 86. Respondent violated Section 458.331(1)(w), Florida Statutes (1999), by delegating his professional duties to persons the Respondent knew or had reason to know were not qualified by training, experience, or licensure to perform. 19 DOH vy. Philip K. Springer, M-D.. DOH Case Nos. 1999-55618 & 2001-05263 FACTS AND COUNTS RELEVANT TO CASE NUMBER 2001-05263 87, On or about March 21, 2000, Respondent initially evaluated Patient S.H., a twenty-three (23) year-old male, for chronic pain and recorded his notes on a “Personal Progress Interactive Note” (hereinafter Note 1). 88. Respondent did not conduct a complete physical examination or make mention of a history of lower back pain during the initial evaluation of Patient S.H. However, Respondent's Note 1 listed a diagnosis of “Pain Disorder; predominantly medical (chronic).” 89, In Note 1, Respondent described Patient S.H.’s course of treatment as: “The patient began treatment on March 21, 2000 and is currently in Treatment Phase 1” 90, Phase I was further defined within Note 1 as: (1) Initially exploratory individual psycholotherapy with attention to personal, developmental and family issues. (2) Further exploration for appropriate medication. (3) Sharing findings with patient as we proceed so as to mobilize patient initiative. (4) Continuing to share the complexities of the Initial Evaluation with special emphasis on how the personality or character may influence anxiety and depression and (5) offering the 12-step process is emphasized as a means of restoring hope and healing damages to character and personality while comparing it with traditional methods. (6) Recommend early entry into Group Psychotherapy which will run parallel to individual work. 91. Although Respondent's Note 1 for Patient S.H. reflected a plan outline to include “psychological Treatment, Physical Treatment, and 20 DOH v. Philip K. Springer. M.D.. DOH Case Nos. 1999-55618 & 2001-05263 Pharmacological Treatment”, there were no written directions beside any of the options for any treatment follow up for or by Patient S.H. 92, Through a Psychiatric Examination Report, dated March 21, 2000, Respondent recommended the following treatment for Patient S.H.: “individual therapy, group therapy, and medication.” 93. On or about April 4, 2000, Patient S.H. presented to Respondent. Respondent's Personal Progress Interactive Note (hereinafter Note 2) recorded that Patient S.H. has “spondylolysis and spondylolisthesis,” but he was not a surgical candidate.” 94. Further, Note 2 reflected that Patient S.H. had been “given Oxycontin for pain relief for a year in Tenn. but has not had pain medication for the last 6 months.” Note 2 reflects that Patient S.H. has been taking “a great deal of Tylenol.” 95. Respondent's assessment of Patient S.H. in Note 2 stated: “Though he has reached partial control with the help of medication, chronic pain still remains a significant problem for” Patient S.H. Further, Note 2 states: Patient S.H. “has a chronic pain problem with some evidence of obsessional night thinking (about pain.) We will use Oxycontin and a trial of Zyprexa at night only.” 2) DOH v. Philip K. Springer. M.D., DOH Case Nos. 1999-55618 & 2001-05263 96. Respondent's Note 2 for Patient S.H. reflected the following “Plan” outline: “Psychological Treatment: Group and Individual”; “Physical Treatment: Dr Scott”; “Pharmacological Treatment: see list”; and “Social/Vocational: active and working full time”. 97. Respondent initiated pharmacological treatment for Patient S.H. on or about April 4, 2000 with Oxycontin and Topamax. 98. Respondent's Note 2 recorded the prescriptions of Oxycontin and Topamax, however no amount, strength, or directions are recorded in Respondent's Note 2. 99. Oxycontin is a Schedule II controlled substance under Chapter 893, Florida Statutes. A Schedule IJ substance has a high potential for abuse and has a currently accepted, but severely restricted, medical use. Abuse of a Schedule II substance may lead to severe psychological or physical dependence. 100. Topamax is a legend drug intended for use as an antiepileptic drug, available for oral administration. 101. On or about April 17, 2000, Patient S.H. again presented to Respondent with complaints of pain. Ona scale of 1 (less pain) to 10 (more pain), the pain was recorded as an eight (8) on Patient S.H.’s Personal Progress Interactive Note (hereinafter Note 3). 22 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1998-55618 & 2001-05263 102. Respondent's patient assessment and description of Patient S.H.’s course of treatment as found in Note 3 stated: “Though he has reached partial control with the help of medication, chronic pain still remains a significant problem for “TS.H.]” As there are no suicidal thoughts or dangerous pians,”. This statement is not completed in Note 3. 103. Although Respondent's Note 3 for Patient S.H. reflected the following “Plan” outline, “Psychological Treatment: Physical Treatment: Pharmacological Treatment: and Social/Vocational:’, there were no written directions for any of these treatment modalities. 104. Respondent again prescribed 100 Oxycontin 40 mg tablets, with instruction for no refills, and directions “one every 8 hours as needed”, and 30 Topamax 25 mg tablets to Patient S.H. 105. The recommended starting dose for Oxycontin is 10 mg by mouth, twice per day. Respondent began Patient S.H.'s Oxycontin dosage at 40 mg twice a day, for a total of four times the amount recommended as a starting daily dosage. 106. Respondent recommended that Patient S.H. return to the office in one month. 107. Approximately two weeks later, on or about May 1, 2000, Patient S.H. presented to Respondent with complaints of pain. The pain was recorded 23 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 as a 6 ona scale of 1 (less pain) to 10 (more pain) on his Personal Progress Interactive Note (hereinafter Note 4). 108. Respondent's assessment of Patient S.H. in Note 4 stated: “Though he has reached partial contro! with the help of medication, chronic pain still remains a significant problem for [Patient S.H.] As there are no suicidal thoughts or dangerous plans[.]” Similar to the first three office notes, Note 4 is incomplete. 109. Respondent's Note 4 for Patient S.H. reflected the following “Plan” outline: “Psychological Treatment: Physical Treatment: Pharmacological Treatment: and Social/Vocational [.]” There were no written directions for any of the individual treatment plans. 110. Respondent again prescribed 100 tablets of Oxycontin 40 mg, with instructions for no refills, and directions “one every 8 hours as needed” to Patient S.H. 111. On or about May 15, 2000, Patient S.H. presented to Respondent, however no pain level was recorded in Respondent's Personal Progress Interactive Note (hereinafter Note 5) for Patient S.H. 112. Respondent's assessment of Patient S.H. as found in Note 5 stated: “The chronic pain of [S.H.] remains a significant problem with partial 24 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 control from medications. He has no suicidal ideas or dangerous plans, and there is no need for more intense psychiatric intervention.” 113. In Respondent's Note 5, Respondent described Patient S.H.'s course in treatment as: “The patient began treatment on March 21, 2000 and is currently in Treatment Phase 1.” Respondent's view of Patient S.H.’s “mental health is higher than their own view.” 114. Respondent's Note 5 for Patient S.H. reflected the following “Plan” outline, “Psychological Treatment: Group”; “Physical Treatment: [BLANK]; ’Pharmacological Treatment: (BLANK]; and Social/Vocational: active and working”. 115. Respondent's Note 5 records that Respondent again prescribed 100 Oxycontin 40 mg tablets, with instructions for no refills, and directions “one every 8 hours as needed” and 60 Topamax 25 mg tablets to Patient S.H., despite the fact that Respondent had already prescribed the same amount of Oxycontin to Patient S.H. on May 1, 2000, two weeks earlier. 116. Approximately two weeks later, on or about May 29, 2000, Patient S.H. again presented to Respondent with complaints of pain with a rating of 6 on a scale of 1 (less pain) to 10 (more pain) as documented in Respondent's Personal Progress Interactive Note (hereinafter Note 6) for Patient S.H. 25 DOH vy. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 117. Respondent's assessment of Patient S.H. as found in Note 6 stated: “Though he has reached partial control with the help of medication, chronic pain still remains a significant problem for [S.H.]. As there are no suicidal thoughts or dangerous plans,” This thought is not completed in Note 6. 118. In Respondent's Note 6, Respondent described Patient S.H.'s course in treatment as: “The patient began treatment on March 21, 2000 and is currently in Treatment Phase I. The mental health of [S.H.] appears to be higher than he reports.” 119. In Respondent's Note 6, Respondent recorded the following “Plan” outline, “Psycological Treatment: group and individual”; “Physical Treatment: pain management”, “Pharmacological Treatment: [BLANK]; and Social/Vocationa!: active an working”. 120. Respondent's Note 6 records that Respondent again prescribed 100 Oxycontin 40 mg tablets, with instructions for no refills, and directions “one every 8 hours as needed”, to Patient S.H. 121. Respondent prescribed a total of 300 40 mg tablets of Oxycontin to Patient S.H. within the month of May 2000. 122. On or about June 12, 2000, Patient S.H. again presented to Respondent with complaints of pain with a rating of 6 on the same scale of 1 26 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 to 10 as documented in Respondent's Personal Progress Interactive Note (hereinafter Note 7) for Patient S.H. 123. Respondent's assessment of Patient S.H. as found in Note 7 stated: “Though he has reached partial control with the help of medication, chronic pain still remains a significant problem for [S.H.]. As there are no suicidal thought or dangerous plans,” This thought is not completed in Note 7. 124. In Respondent's Note 7, Respondent described Patient S.H/s course in treatment as: “The patient began treatment on 3/21/2000 and is currently in Treatment Phase I.” S.H. “sees himself as mentally less health than I do.” 125. In Respondent's Note 7, Respondent recorded the following “Plan” outline, “Psychological Treatment: group and individual”; “Physical Treatment: pain management”; “pharmacological Treatment: [BLANK]; and Social/Vocational: active an working”. 126. Respondent recorded in his Note 7 that he again prescribed 100 Oxycontin 40 mg tablets, with instructions for no refills, and directions “one every 8 hours as needed”, and 60 tablets of Topamax 25 mg to Patient S.H. 27 DOH v. Philip K. Springer. M.D., DOH Case Nos. 1999-55618 & 2001-05263 127. Respondent failed to outline his plan for pharmacological treatment for Patient S.H. in Note 7, however Respondent continued to prescribe 100 Oxycontin 40 mg tablets to Patient S.H. 128. Approximately two weeks later, on or about June 26, 2000, Patient S.H. presented to Respondent, however no pain level was recorded in Respondent's Personal Progress Interactive Note (hereinafter Note 8) for Patient S.H. 129. Respondent’s assessment of Patient S.H. as found in Note 8 stated: S.H’s “chronic pain is still a significant problem, but has reached partial control with the aid of medication. There are no suicidal ideas present, and I see no reason for his more intense psychiatric intervention.” 130. In Note 8, Respondent described Patient S.H’s course in treatment as: “The patient began treatment on 3/21/2000 and is currently in Treatment Phase I.” S.H. “sees himself as mentally less health than I do.” 131. In Note 8, Respondent recorded the following “Plan” outline, “Psychological Treatment: group and individual”; “Physical Treatment: pain management”; “Pharmacological Treatment: [BLANK]; and “Social/Vocational: active an working full time”. 132. Respondent’s Note 8 also records that Respondent again prescribed 100 Oxycontin 40 mg tablets, with instructions for no refills, and 28 DOH v. Philip K. Springer. M-D., DOH Case Nos. 1999-55618 & 2001-05263 directions “one every 8 hours as needed”, and 60 Topamax 25 mg tablets to Patient S.H. 133. On or about July 10, 2000, Patient S.H. presented to Respondent. However, no pain level was recorded in Respondent's Personal Progress Interactive Note (hereinafter Note 9) for Patient S.H. 134. Respondent's assessment of Patient S.H. as found in Note 9 stated: “Though he has reached partial control with the help of medication, chronic pain still remains a significant problem for” S.H. “As there are no suicidal thoughts or dangerous plans,” This thought is not completed in Note 9. 135. Respondent's Note 9 records that Respondent prescribed 120 Oxycontin 40 mg tablets, with instructions for no refills, and directions ‘one every 8 hours as needed” to Patient S.H. 136. On or about July 24, 2000, Patient S.H. again presented to Respondent with no indication of Patient's pain level recorded in Respondent's Personal Progress Interactive Note (hereinafter Note 10). 137. Respondent's assessment of Patient S.H. as found in Note 10 stated: “Though he has reached partial control with the help of medication, chronic pain still remains a significant problem for [S.H.]. As there are no 29 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 suicidal thoughts or dangerous plans,” This thought is not completed in Note 10. 138. In Respondent's Note 10, he described Patient S.H.’s course in treatment as “The patient began treatment on 3/21/2000 and is currently in Treatment Phase I.” The mental health of S.H. “appears to be higher than he reports.” 139. Respondent's Note 10 for Patient S.H. recorded the following “Plan” outline, “Psychological Treatment: group and individual’; “Physical Treatment: pain management”; “Pharmacological Treatment: [BLANK]; and “Social/Vocational: active an working full time.” 140. Respondent’s Note 10 recorded that Respondent prescribed 120 tablets of Oxycontin 40 mg, with instructions for no refills, and directions “one every 8 hours as needed”, to Patient S.H. 141. Respondent's Note 10 did not include any reason/justification for the increase in the number of Oxycontin prescribed to Patient S.H. 142. On or about August 7, 2000, Patient S.H. presented to Respondent with complaints of pain with a rating of 10 as recorded in Respondent’s Personal Progress Interactive Note (hereinafter Note 11) for Patient S.H. 30 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 143. Respondent's assessment of Patient S.H. as found in Note 11 stated: Patient S.H.’s “chronic pain is still a significant problem, but has reached partial control with the aid of medication. There are no suicidal ideas present, and I see no reason for his more intense psychiatric intervention.” 144, Respondent's description of Patient S.H’s course of treatment in Note 11 stated: S.H’s “chronic pain is still a significant problem, but has reached partial contro! with the aid of medication. There are no suicidal ideas present, and I see no reason for his more intense psychiatric intervention.” 145. Respondent's Note 11 for Patient S.H. reflected the following “plan” outline, “Psychological Treatment: group and individual”; “Physical Treatment: pain management”; “Pharmacological Treatment: “[BLANK]”; and *Social/Vocational: active and working full time.” 146. Note 11 recorded that Respondent provided two (2) prescriptions for 120 tablets of Oxycontin 40 mg with instructions for no refills, and directions “one or two every 8 hours as needed”, in addition to a prescription for 60 tablets of Topamax 25 mg to Patient S.H. 147. Respondent's Note 11 reflects that Respondent recommended Patient S.H. return to the office in one month. 31 DOH v. Philip K. Springer, M.D.. DOH Case Nos. 1999-55618 & 2001-05263 148. Approximately two weeks later, on or about August 22, 2000, Patient S.H. presented to Respondent. No pain level was recorded in Respondent's Personal Progress Interactive Note (hereinafter Note 12) for Patient S.H. 149. In Note 12, Respondent describes Patient S.H.'s course in treatment as: “The patient began treatment on 3/21/2000 and is currently in Treatment Phase IV.” Respondent also records that Patient S.H.’s mental health “appears to be higher than he reports.” 150. Phase IV is defined in Note 12 as: This period is a growth in awareness of how personal change actually takes place. It is seen in the “mirror” of others in the Group as they find and use the tools of personal change. The inertia is strong as well as the fear of venturing to a new level of awareness. This phase corresponds to Step 4 (of 12-Step) as there is need to turn character “flaws” into a higher power [sic] rather than continue to act out the flaws repeatedly, as well as to share with one who has successfully dealt with the Phases and Steps. 151. Respondent's Note 12 for Patient S.H. recorded the following “pian” outline, “Psychological Treatment: group and individual”; “Physical Treatment: pain management”; “Pharmacological Treatment: “[BLANK]”; and “Social/Vocational: active and working full time. 152. Note 12 recorded that Respondent again provided two (2) prescriptions for 120 tablets of Oxycontin 40 mg, with instructions for no 32 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 refills and directions to take “one or two every 8 hours as needed” to Patient S.H. 153. On or about September 18, 2000, Patient S.H. presented to Respondent with a pain rating of 8, as recorded in Respondent’s Personal Progress Interactive Note (hereinafter Note 13) for Patient S.H. 154. Respondent's Note 13 recorded Patient S.H. as appearing to be very depressed and worried, honest, and wanting to cease further use of prescription medications. Note 13 also dictates that there was an indication of a ‘biologic or chemical depression” because of a relative drop in basic functions such as mood and sleep. 155. Note 13 does not record what, if any, recommendations or treatment options were provided to Patient S.H. by Respondent. 156. Although Patient S.H. had a specialized consultation prior to presenting to Respondent's clinic, at no time during Respondent’s care and treatment of Patient S.H. did Respondent enroll, recommend, or prescribe that Patient S.H. participate in a multidisciplinary treatment program to consider other pain relieving treatments and or physical rehabilitative modalities to reduce the need for opioid medications. 157. Respondent had available a neurosurgeon’s January 4, 2000 recommendation that Patient S.H. undergo a pain relieving injection 33 DOH v. Philip K. Springer, M-.D., DOH Case Nos. 1999-35618 & 2001-05263 procedure to treat his lower back pain. At no time during Respondent's care and treatment of Patient S.H. did Respondent recommend or perform any palliative injection therapies or procedures to relieve Patient S.H’s lower back pain. 158. Plain radiographs and an MRI of Patient S.H.'s lumbar spine, that were available to Respondent, had findings of bilateral L5 pars defect, a form of spondylolysis (loss of bone), but no evidence of spondylolesthesis (slip of one vertebral bone in relation to another.) 159. A diagnosis of spondylolysis without a subsequent physical examination is not sufficient, in and of itself to be an explanation for the patient's persistent lower back pain and thus not a valid indication for the continued prescribing of chronic opioid medication restricted for individuals who have been determined to have “intractable pain.” 160. At no time during Respondent's care and treatment of Patient S.H. did Respondent recommend or prescribe any pain relieving physical modalities or non-narcotic adjuvant medications for Patient S.H. 161. Respondent prescribed Oxycontin to Patient S.H. in an excessive and/or inappropriate manner by failing to initiate the dosage orally at 10 mg, twice a day, and progressively increasing the dosage after a trial period dependent upon Patient S.H/s analgesic tolerance and response. 34 DOH v. Philip K. Springer. M.D., DOH Case Nos. 1999-55618 & 2001-05263 162. Respondent prescribed Oxycontin to Patient S.H. in an excessive and/or inappropriate manner by prescribing approximately sixty-five times the recommended initiating dosage (approximately eight-thousand milligrams/month instead of the recommended 120 milligrams) and increasing the dosage to twice his own recommended dosage per month. 163. There are no medically recognized circumstances in which Oxycontin should be dosed “Pro Re Nata ” (PRN), or as needed, as Respondent did for Patient S.H. 164. There are no medically recognized circumstances in which Oxycontin should be prescribed twice or three times per day as needed or one or two tablets three times per day, as prescribed by Respondent to Patient S.H. COUNT SEVEN 165. Petitioner realleges and incorporates paragraphs one (1) through four (4) and eighty-seven (87) through one hundred sixty-four (164) as if fully set forth herein. 166. Section 458.331(1)(q), Florida Statutes (1999, 2000), provides that prescribing, dispensing, administering, 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 35 DOH v. Philip K. Springer. M_D., DOH Case Nos. 1999-55618 & 2001-05263 the Board of Medicine. For the purposes of this paragraph, it shall be legally presumed that prescribing 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. 167. Respondent inappropriately prescribed Oxycontin to Patient S.H. when he did one or all of the following: a) Failing to conduct a physical examination of Patient S.H.; b) Failing to initiate the Oxycontin dosage according to DEA guidelines at 10 mg orally, twice a day, and increase the dosage upward after a trial period dependant upon Patient S.H.'s analgesic tolerance and response to the initial dosage; or c) Providing Patient S.H. with instructions that his prescription of Oxycontin should be taken “twice or three times per day as needed”. 168. Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (1999, 2000), by prescribing, dispensing, administering, mixing, or otherwise preparing a Schedule II controlled substance other than in the course of Respondent's professional practice. COUNT EIGHT 169. Petitioner realleges and incorporates paragraphs one (1) through five (5) and eighty-seven (87) through one hundred sixty-four (164) as if fully set forth herein. 36 DOH v. Philip K. Springer. M.D., DOH Case Nos. 1999-55618 & 2001-05263 170. Section 458.331(1)(t), Florida Statutes (1999, 2000) 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 the Board of Medicine. 171. 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, in one or more of the following ways: (a) Failing to perform the requisite physical examination on Patient S.H. prior to prescribing Oxycontin; (b) Failing to obtain a complete history of Patient S.H. prior to prescribing Oxycontin; (d) Failing to make a comprehensive diagnosis and/or treatment plan for Patient S.H. prior to prescribing Oxycontin; and/or (e) Prescribing Oxycontin to Patient S.H. PRN, or as needed. 172. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes, (1999, 2000) by gross or repeated malpractice or the failure to practice medicine with that level of care, skill, 37 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263 and treatment which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances. WHEREFORE, 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 Respondent on probation, corrective action, refund of fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. Lewln 2004. John O. Agwunobi, M.D., M.B.A., M.P.H. Secretary, Department of Health FILED hu U! LT 2 Z DEPARTMENT OF HEALTH Orne. Ads by-PéAnock DEPUTY CLERK bw SIGNED this _/7 day of LI Assistant General Counsel CLERK N , Colman DOH Prosecution Services Unit pare__|g.-13- Oc} _ 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar # 0394572 (850) 414-8126 (850) 488-7723 FAX 38 DOH v. Philip K. Springer, M_D., DOH Case Nos. 1999-55618 & 2001-05263 Reviewed and approved by: _ fuc- (initials) als) p¢__(date) PCP: Devember 10, 200+ . venein| ) Tob PCP Members: Gustave Leon, M.D. (Chasperson), Mammen Zachariah, MD, and ol 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. 39 DOH v. Philip K. Springer, M.D., DOH Case Nos. 1999-55618 & 2001-05263

Docket for Case No: 05-000560PL