Sep 23 2009 16:35 Sep 23 2009 16:30 P.O3 a : ~ mn a ral STATE OF FLORIDA | DEPARTMENT OF HEALTH | DEPARTMENT OF HEALTH, PETITIONER, _ - | v. . CASE NO. 2006-32754 HECTOR ROLANDO CORZO, M.D., | RESPONDENT, / ! A i 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 the Respondent, Hector Rolando Corzo, M.D., and in support thereof alleges | 1. Petitioner is the oh department charged with reguating the practice of medicine pursuant to Section 20.43, Florida Sats 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 ME 35773. KQ-A7-77) Sep 23 2009 16:35 Sep 23 2009 16:30 P04 on, 3. The Respondent's) address of record is 7955 66" Street North, Suite C, Pinellas Park, Florida | 33781. 4. The Respondent | is board certified in Psychiatry by the American Board of Psychiatry jand Neurology. 5. On or about September 14, 2006, Patient VR, a thirty-six (36) year old female voluntarily admitted herself into the general psychiatric unit at Windmoor Healthcare of Clearwater (“Windmoor”) due to complaints of being depressed and confused and for cocaine dependence. Patient V.R. indicated upon admission she had been using approximately one hundred dollars ($100) worth of cocaine per day, and had not slept for three (3) weeks due to overuse and dependence of cocaine. Patient V.R. also advised she had been non-compliant with her medications, and she suffered from chronic back pain. ' i i | i 6. On or about September 14, 2006, the Respondent prescribed the following medications : Windmoor: Geodon, eighty ( r Patient V.R. upon her admission to 0) mg, one (1) to be taken in the morning and two (2) to be taken at bpctine; Abilify, thirty (30) mg daily; Navane, ten (10) mg three (3) times la day; Xanax, two (2) mg four (#) times a day; Ambien, ten (10) mg “(ets Artane, two (2) mg daily; Flexeril, ten (10) mg two (2) times a Gay; Lexapro, ten (10) mg three (3) times a J:\PSU\Medical\ Matthew Casey\Cases\Status 70 cases\Corzo 06-32754\(q) & (t} over prescribing a¢.doc' 2 Dh Sep 23 2009 16:35 Sep 23 2009 16:91 P.O5 rn -_ day; Seroquel, two hundred (200) mg twice daily and two (2) at bedtime; Relafen, five hundred (500); mg two (2) times a day; Skelaxin, eight hundred (800) mg three (3) times a day; Trileptal, three hundred (300) mg twice a day; Strattera, forty (40) mg daily; and Morphine Sulfate ER, thirty (30) mg two (2) times a day. | | | I i t i 7. Geodon (Ziprasidone), Abilify (Aripiprazole), Seroquel (Quetiapine), and Navane (Thiothixene) are medications used to treat certain mental/mood disorders such as schizophrenia or manic/mixed episodes associated with bipolar disorder. These drugs are anti-psychotic that work by helping to rest re the balance of certain natural substances (neurotransmitters) in the brain. | 8 Xanax (Alprazolan ) is used to treat anxiety ond panic disorders. Xanax is a benzodiazepine which acts-on n the brain and nerves to produce a calming effect, Ambien (Zolpidem) ‘is used to treat sleep problems (insomnia). Ambien also acts on the brain to produce a calming effect. 9. Artane (Trihexyphenidyl) is used to treat symptoms of Parkinson’s disease or involuntary movements due to the side effects of | certain psychiatric drugs. | Flexeril (Cyclobenzaprine): and Skelaxin (Metaxalone) are medicationg used to relax muscles. These drugs are J:\PSU\Medical\Matthew Casey\Cases\Status 70 cases\Corzd 06+32754\(q) & (t) over prescribing aedoe 3 - oh o4e ii Sep 23 2009 16:36 Sep 23 2009 16:91 P06 ef a used to decrease muscle pain and spasms associated with strains, sprains, i | or other muscle injuries. | 10. Lexapro (Escitalo ram) is an anti-depressant used to treat depression and . anxiety, It works by restoring the balance of certain natural substances (neurdtransmitters) in the _ brain. | Relafen (Nabumetone) is used to reduce pain, swelling, and joint snes from arthritis. Relafen is a non-ste foidal anti- inflammatory drug (NSAID). 11. Trileptal (Oxcarbazepine) is a medication used to treat seizure disorders such as epilepsy. | Strattera (Atomoxetine) is used to treat attention-deficit hyperactivity Misorder (ADHD). Strattera works by helping to restore the balance of neurotransmitters in the brain. Morphine Sulfate _ ER is a narcotic analgesic (opioid) used to treat moderate to severe pain. It acts upon specific receptors in the brain and spinal cord to decrease the feeling of pain and to reduce te emotional response to pain. | 12. On or about September 14, 2006, at approximately 5:30 p.m., the Respondent also ordered| the following prescriptions for Patient V.R.: Morphine Sulfate, fifteen (15) mg three (3) times a day and Vicodin 10/750, two (2) times a dab. Vicodin is a combination of a narcotic (Hydrocodone) and a ronparat (Acetaminophen) used to relieve | | moderate to severe pain. J:\PSU\Medical\Matthew Casey Cases\ Status 70 cases\Corzo 06: ~B27S4\a) & (t) over préscrting acdoc; | re) a : Sep 23 2009 16:36 Sep 23 2009 16:31 P.O? fo | o 13. The Respondent failed to note in Patient V.R.’S medical records an explariation for why he prescribed the patient two (2) short acting opiate medications (“plain” Morphine Sulfate and Vicodin) in addition to a long acting agent (Morphine Sulfate ER). | 14. The Respondent inappropriately prescribed scheduled Morphine Sulfate ER, Morphine Sulfate,/and Vicodin to Patient V.R. at the same time on or about September 14, 2006. The standard of care typically would be to prescribe a long acting al (such as Morphine Sulfate ER) with an as needed dose of a short acting agent (such as “plain” Morphine Sulfate or Vicodin). | 15. The Respondent failed to note in Patient V.R.’s medical records an explanation for why he prescribed the patient such a large number of medications, particularly four (4) anti-psychotic drugs at once. ! 16. The Respondent |inappropriately prescribed Geodon, Abilify, Seroquel, and Navane to Patient V.R. at the same time on or about ‘September 14, 2006. | 17, The Respondent failed to note in Patient V.Rs' medical records an explanation for why he prescribed the patient two (2) muscle relaxant medications (Flexeril and Skelaxin) at the same time. JAPSU\Medical\ Matthew Casey\Cases\status 70 cases\Corzo 06-32754\(q) & (t) aver prescribing ac.dog 5 | boas i toa # Sep 23 2009 16:36 Sep 23 2009 16:32 P. 08 ~ | A 18. The Respondent, inappropriately prescribed Rener and Skelaxin to Patient V.R. at thelsame time on or about September 14, 2006. 19. The Respondent fel below the standard of care by placing Patient V.R. back on the rge number of medications described in Paragraphs Six (6) and/or [Twelve (12) rather. than re-assessing the situation for the patient and starting her gradually on medications. 20. The Respondent failed to address several potential drug-drug interactions when prescribing to Patient V.R. on or about September 14, 2006, and the combination of medications prescribed by the Respondent may have had an overly sedating effect on the patient due to a lack of tolerance for the medications since Patient VR. admitted being non- compliant in taking her medications upon admission to Windmoor. 21. On or about September 15, 2006, orders were | written to discontinue Patient V.R’s morning dose of Seroquel and Xanax, and the pharmacist at Windmoor requested the Respondent determine whether the patient needed Flexeril and Skelaxin since both were muscle relaxants. 22. The Respondent ta to note a response to the pharmacist’s query in Patient V.R.'s medical |records. J:\PSU\Medical\Matthew Casey\Cases\Status 70 cases\Corzo 06-32754\(q) & (t) oer een acdog 6 boa Sep 23 2009 16:36 Sep 23 2009 16:32 P.09 23, On or about September 16, 2006, at approximately 9:30 a.m, a group progress note regarding Patient V.R. noted she slept curing most of the group “due to her medication. " 24. On or about September 16, 2006, at approximately 6:30 p.m., @ nurse noted in a clinical progress note for Patient V.R. she was “very _ lethargic” and falling asleep while walking and eating, | 25. On or about September 17, 2006, a nurse noted’ in another clinical progress note for Patient V.R. she was lethargic and “unsteady on feet when she returned from smoke break this a.m.” The nurse also indicated Patient VR. refused to go to breakfast or lunch and she responded with “slurred speech” when asked about going to lunch, 26, On of about September 17, 2006, at approximately 1:15 p.m., a nurse performing a fifteen (15) minute check on Patient V.R. was unable to wake her. Patient V.R.’s pulse was weak and thready and her’ respiration was shallow. A code and 911 were called, and cardiopulmonary resuscitation (CPR) was begun , 27. On or about September 17, 2006, at approximately 2 p.m., Patient V.Ri was transported to Northside Hospital in Tampa, Florida, where 4 1 | | i she was pronounced dead on rn J:\PSU\Medicall Matthew Casey\Cases\Status 70 cases\Corzo 06-32754\(q) & (0) over prescbing x.doe! 7 i Sep 23 2009 16:37 Sep 23 2009 16:32 P.10 n | - 28. On or about September 17, 2006, at approximately 1:45 p.m, a nurse noted on the interfacility transfer form for Patient VR. “? over medicated” as the transfer ree (per physician), 29. On or about September 18, 2006, at approximately 9:40 a.m, an autopsy was performed on Patient V.R. The medical examiner noted the patient’s cause of death | s Hydrocodone toxicity and the manner of death as an accident. The examiner found Patient V.R, had an extremely high blood opiate level. | | | 30. Petitioner realleges and incorporates: paragraphs one (1) through twenty-nine (29) as f fully set forth herein. | 31. Section 458.331(1)(t), Florida Statutes (2006), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section 456,50, Florida Statutes (2006), defines medical | malpractice as the failure to in medicine in accordance with the level ecognized in general law releted to health | i i i of care, skill, and treatment care licensure, 32. Level of care, sil and treatment recognized’ in general law related to health care berm means the standard of care specified in Section 766.102. Section 766, 102(1), Florida Statutes (2006), d opfines the J APSU\Medical\Matthew Cagay\Casas\Status 70 cases\Corzo 06-32754\(q) & (t) ever prescribing ac.doc |* 8 a i ae i Sep 23 2009 16:37 Sep 23 2009 16:32 Pldd ob Hl | nA os standard of care to mean“, . . The prevailing professional standard of care for.a given health care provider shall be that level of care, skill, and | treatment which, in light of| all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar t | health caré providers. .. .” 33. Respondent failed| to meet the prevailing standard of care in regard to Patient V.R. in one|or more of the following ways: | by placing Patient V.R. back on the large number of medications described in Paragraphs Six (6) and/or Twelve (12) rather than re-assessing the Situation for the patient and starting her gradually on medications; by prescribing scheduled Morphine Sulfate ER, Morphine Sulfate, and Vicodin to Patient V.R, at the same time on or about September 14, 2006, when the standard of care typically would be to prescribe a long acting agent (such as Morphine Sulfate ER) with an as needed dose of a short acting agent (such as “plain” Morphine Sulfate or Vicodin); by prescribing Geodon, Abilify, Seroquel, and Navane to Patient VR. at the same time on or about September 14, 2006; by prescribing Flexeril and Skelaxin to Patient V.R. at the same se or about September 14, 2006; and/or by failing to address several “ drug-drug interactions when Prescribing to Patient V.R. on or about September 14, 2006, | i 3 he f 43 f J:\PSU\Medical\Matthew Casey\Cases\Status 70 cases\Corzo 06-32754\(q) & (t) over prescribing ae.doc i 4 Sep 23 2009 16:37 Sep 23 2009 16:33 PT an ~ 34. Based on the foregoing, the Respondent has violated Section 458.331(1)(t), Florida Statutes (2006), by committing medical malpractice. ‘COUNT TWO | 35. Petitioner realleges and incorporates paraoroe one (1) through twenty-nine (29) as iff fully set forth herein, 36, Section 458,.331(1)(q), Florida Statutes (2006), provides prescribing, dispensing, administering, mixing, or’ otherwise preparing a legend drug, including any cantrolled 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 this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and is not in the course of the physician's professional practice, without regard to his or her intent. 37,. The Respondent ohescribed, 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 one or more of the following ways: | by prescribing scheduled Morphine Sulfate ER, Morphine Sulfate, and Vigodin to Patient V.R, at the same time on or | | J:\PSU\Medical\Matthew Casey Cases\ Status ri) cases\Corzo 06- r32754\(Q) & (t) over prescribing ac.dod 10 \ : : i i. Sep 23 2009 16:38 Sep 23 2009 16:33 P.13 pm ~ 1 about September 14, 2006, when the standard of care typically would be. to prescribe a long acting agent (such as Morphine Sulfate ER) with an as needed dose of a short acting agent (such as “plain” Morphine Sulfate or Vicodin); by prescribing Geodon, Abilify, Seroquel, and Navane to Patient V.R. at the same time on or about September 14, 2006; by prescribing - Flexeril and Skelaxin to Patient VR. at the same time on or about September 14, 2006; and/or /by failing to address ‘several potential drug- drug interactions when presctibing to Patient V.R. on or about September 14, 2006. | 38. Based on the foregoing, the Respondent has violated Section 458.331(1)(q), Florida sates (2006), by prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, for a V.R. other than in the coprse of the physician's professional practice. 39. Petitioner realleges and incorporates paragraphs one (1) through twenty-nine (29) as if fully set forth herein. | 40. . Section 458,331(1\m), Florida Statutes (2006), provides failing to keep legible, as defined by nae rule in consultation with the board, medical records that id ntify the licensed physician or the physician J:\PSU\Medicai\Matthew Casey\CasestStatus 70 cases\Corzo 06-32754\(q) & (t) over presen ac.doc I ; ; . ! i Sep 23 2009 16:38 Sep 23 2009 16:33 P14 Fa | a extender and supervising physician by name and professional title who is Or are responsible for renderi ig, ordering, supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment of the patient, including, but rot limited to, patient histories; examination results;.test results; records of drugs prescribed, dispensed, or’ administered; and reports of densutaton and hospitalizations constitutes grounds for disciplinary action by the Board of Medicine. 41, The Respondent failed to keep legible medical records that identify the licensed physician. or the physician extender and supervising physician by name and professional title who is or are responsible for rendering,.ordering, supervising, or billing for each diagnostic of treatment procedure and that justify the|course of treatment of the patient in one or more of the following ways: by failing to note in Patient VR’s medical records an explanation for wny he prescribed the patient two (2) short acting opiate medications Cpiain” Morphine Sulfate and Vicodin) n addition ta a long acting agent (Morphine Sulfate ER); by failing: to note in Patient V.R.'s medical records an explanation for why he prescribed the patient such a large number of medications, particularly four (4) anti- psychotic drugs at once; ona by failing to note in Patient VR. medical J:\PSU\Medical\Matthew Casey\Cases\Status 70 cases\Corza 06-32754\(q) & (t} over mesg accdog 12 : Pde Sep 23 2009 16:38 Sep 23 2009 16:33 P.15 | eae oe records an explanation for why he prescribed the patient two (2) muscle relaxant medications (Flexeril | nd Skelaxin) at the same time. 42. . Based on the foregoing, the Respondent has violated Section 458.331(1)(m), Florida Statutes (2006), by failing to keep legible medical records that identify the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for rendering, valve supervising, or billing for each diagnostic:or treatment procedure and that justify the course of, treatment of Patient V.R. | : WHEREFORE, the Petitioner respectfully requests that the Board of Medicine enter an order impasing 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 Responden on probation, corrective action, refund of fees billed: or collected, mn education and/or any other relief that the : | Board deens appropriate. JAPSU\Medical\ Matthew Casay\Cases\Status 70 casds\Corto 06-32754\(q) & (t) over ci ac.dog 13 ae ki | 1 qe i Sep 23 2009 16:38 Sep 23 2009 16:34 P.16 ne — ~ SIGNED this_/" day of ut 2008. 4 Ana M. Viamonte Ros, M.D., M.P.H State Surgeon General - Matthew ot r Assistant General Counsel DOH Prosecution Services Unit 4052 Baid Cypress Way, Bin C-65 FILED Tallahassee, FL 32399-3265 ° 7 ll Florida Bar # 0115320 cunt oo ee (850) 245-4640 ext. 8173- phone pare_te "lio O (850) 245-4681 — fax PCP Date: June 13, 2008 PCP Members: Ashkar, Chizner & Beebe 7:\PSU\Medical\Matthew Casey\Cases\itats 70 cases\Corz0.06-22754\(q) & (t) over prescribing ac.doc i4 ) | | le i 1s i Pod ij 3 Sep 23 2009 16:39 Sep 23 2009 16:34 om A DOH v. Hector Rolando Corzo,/M.D., Case #2006-32754 NOTICE OF RIGHTS | conducte Florida Statutes, to be represented by counsel or oth representative, to present evidence and argument, cross-examine witnesses and to have subpoena and PL? Respondent has the right to request a hearing to be ein accordance with Section 120.569 and 120,57, e qualified call and subpoena duces tecum issued on his pr her behalf if a hearing is requested. | . ' NOTICE REGARING ASSESSMENT OF COSTS Respondent is placed on notice that Petitioner h Ss incurred costs related to the investigation and prosecution of this matter. Pursuant! to Section 456.072(4), Florida Statutes, the ard shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours on the Respondent in addition to any other discipline im J:\PSU\Medical\ Matthew Casey\Cases\ Status 70 cases\Corzo 06-32754\(g) & (t) over Presattng ac.dog _ Piet qh i nd costs, posed.

Docket for Case No: 09-005230PL