STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, Vv. CASE NO.: 2009-11459 MICHAEL R. SHOOK, M.D., RESPONDENT. . eC 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, Michael R. Shook, M.D., and in support this 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. At all times material to this Complaint, Respondent was a licensed physician within the State of Florida, having been issued license J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc i ro'd ootOL aloe - Jay Took ofoz T 4dH number ME 50883 and Respondent was also Board Certified in Internal Medicine, 3. Respondent's address of record is 2764 West Oakland Park Blvd. Oakland Park Florida 33311. 4, At all times material hereto, between May, 2008 and September, 2009, Respondent while practicing medicine in the State of Fiorida treated three (3) patients for chronic pain management. These patients are referred to by their initials as ST, JS, and TH. : FACTS SPECIFIC TO PATIENT ST 5. on or about July 24, 2008, ST presented to Respondent with complaints of knee pain. Respondent there and then prescribed 240 tablets of oxycodone 30 milligrams (“mg”) for ST based solely on the verbal patient history that ST related to Respondent concerning his current pain management regimen. Respondent did not have the benefit of any of ST's prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs in. ST’s system. J:\PSU\Medical\Rabert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final fram GK.doc 2 god LOtOk oloz - Jay ZOI0T OTOZ T dy 6. Oxycodone is commonly prescribed to treat pain. According to section 893,03(2), Florida Statutes, oxycodone is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States, and abuse of oxycodone may lead to severe psychological or physical dependence. 7. On or about August 21, 2008, Respondent prescribed 240 tablets of methadone 10 mg for ST, 8. “Methadone is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, methadone is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States, and abuse of methadone may lead to severe psychological or physical dependence. 9. Respondent continued to provide multiple prescriptions for large amounts of oxycodone and methadone to ST as outlined in the following table: J:\PSU\Medical\Rabert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final fram GK.doc 3 god LOtOk oloz - Jay zo:agt otoz T dy rm Date of Medication Type of Quantity Prescription Prescribed Medication 7/24/08 Oxycodone 30 mg | Schedule II 240 tablets analgesic 8/21/08 Oxycodone 30 mg | Schedule II 240 tablets analgesic 8/21/08 Methadone 10 mg | Schedule II 240 tablets analgesic - 10/21/08 Oxycodone 30 mg | Schedule II 240. tablets analgesic 10/21/08 Methadone 10 mg | Schedule II 180 tablets analgesic 11/13/08 | Methadone 10mg | Schedule Ii 180 tablets analgesic | 12/15/08 | Oxycodone 30mg | Schedule Ii 240 tablets analgesic | 1/13/09 7 Methadone 10 mg | Schedule II 240 tablets analgesic 1/13/08 | Oxycodone 30 mg | Schedule II 240 tablets analgesic 2/10/09 Methadone 10 mg | Schedule II 240 tablets analgesic _———- ——— 3/9/09 Oxycodone 30 mg | Schedule II 240 tablets analgesic "4/9709 | Oxycodone 30 mg | Schedule TI 240 tablets analgesic JAPSU\Medicel\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doe éo'd LOtOk oloz - Jay ZOI0T OTOZ T dy oon. a”, Date of Medication Type of Quantity Prescription Prescribed Medication 4/9/09 Methadone 10 mg | Schedule II 240 tablets analgesic 5/7/09 Methadone 10 mg | Schedule II 240 tablets analgesic 6/8/09 | Oxycodone 30mg | Schedule II 240 tablets analgesic 7/6/09 ~ | Oxycodone 30mg | Schedule II 240 tablets analgesic 7/6/09 Methadone 10 mg | Schedule IT 240 tablets analgesic 8/4/09 Methadone 10 mg | Schedule II 240 : tablets analgesic 9/1/09 Oxycodone 30mg | Schedule I 240 tablets analgesic 9/21/09 | Methadone 10 mg | Schedule II 240 tablets analgesic 9/21/09 Oxycodone 30 mg | Schedule II 240 tablets analgesic 10. Between approximately July 24, 2008, and September 21, 2009, while Respondent prescribed these controlled substances in very high dosages to ST, Respondent's medical records fail to show in his J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final fram GK.doc 5 aod LOtGk oboz bo Jay ZOI0T OTOZ T dy an) | “nm evaluation of the patient and in his treatment plan one or more of the following: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) Documentation of 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/or history of substance abuse; c) The presence of one or more recognized medical indications for the use of a controlled substance; d) A written treatment plan with stated objectives: that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient: J)\PSU\Medical\Robert Milna\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 6 60"d LOtOk oloz - Jay ZOI0T OTOZ T dy an ~ f) ~~ Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and/or psychosocial impairment; Gg) . Verification from ST's previous physicians whether his treatment was terminated for substance abuse/diversion; : h) Diagnostic testing for illicit drug use diversion of opioids. , FACTS SPECIFIC TO PATIENT JS 11. On or about August 11, 2008, JS presented to Respondent with complaints of neck and back pain, Respondent there and then prescribed 135 tablets of oxycodone 30 milligrams for JS; based solely on the verbal patient history that JS related to Respondent concerning his current pain management regimen. Respondent did not have the benefit of any of JS’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present, nor did Respondent exclude the presence of other drugs. 12. On September 9, 2008, Respondent prescribed to JS 30 tablets of Xanax 2 mg. 13, Xanax (alprazolam) is an anti-anxiety agent benzodiazepine, used primarily for short-term relief of mild to moderate anxiety and J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc ' 7 aob'd zOi0L aloe - Jay SO:0T OTOZ T dy os ann nervous tension and is a schedule IV legend drug controlled pursuant to Chapter 393.03, Florida Statutes, and has a low potential for abuse which may lead to limited physical or psychological dependence and has a currently accepted medical use in treatment in the United States. 14. Between approximately August 11, 2008, and June 30, 2009, Respondent issued the following prescriptions for oxycodone, Methadone and Xanax to patient JS on the dates and in the amounts specified below: Date of Medication Type of Quantity Prescription Prescribed Medication 8/11/08 | Oxycodone 30 mg | Schedule Il 135 tablets analgesic 9/9/08 Xanax 2 mg tablets | Schedule IV 30 : anti-anxiety 9/9/08 | Oxycodone 30mg | Schedule II 270 tablets analgesic 10/7/08 Xanax 2 mg tablets | Schedule IV 90 10/7/08 Methadone 10 mg | Schedule II 270 tablets analgesic 11/4/08 Oxycodone 30 mg ; Schedule II 270 tablets analgesic 11/4/08 Xanax 2 mg tablets | Schedule IV 90 anti-anxiety 12/2/08 Methadone 10 mg | Schedule II 240 tablets analgesic J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc zOiOL oboe - Jay SO:0T OTOZ T dy Lk “d nn ran Date of Medication Type of Quantity Prescription Prescribed Medication 12/2/08 Oxycodone 30 mg | Schedule II 240 tablets analgesic 12/30/08 Xanax 2 mg tablets | Schedule IV 90 anti-anxiety . 12/30/08 Methadone 10 mg | Schedule Ti 240 : tablets analgesic 1/27/09 Oxycodone 30 mg | Schedule II 210 tablets analgesic 1/27/09 Xanax 2 mg tablets | Schedule IV 90 anti-anxiety 2/24/09 | Methadone 10 mg | Schedule Ti 240 . tablets analgesic . 3/24/09 | Oxycodone 30mg | Schedule Ti 240.2 . tablets anaigesic 4/6/09 Xanax 2 mg tablets | Schedule IV 90 anti-anxie 4/6/09 Methadone 10 mg | Schedule II 240 tablets analgesic 5/5/09 Oxycodone 30 mg | Schedule I! 240 tablets analgesic 5/5/09 Xanax 2 mg tablets | Schedule IV 90 anti-anxiety 6/2/09 Methadone 10 mg | Schedule IT 240 } tablets analgesic e—V—_—_—_—————— ——$————————| 6/2/09 Oxycodone 30 mg | Schedule II 240 tablets analgesic J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doe él‘d So:oT éO7OL Oboe - Ady otoz T dy Date of Medication Type of Quantity Prescription Prescribed Medication 6/2/09 Xanax 2 mg tablets | Schedule IV 90 anti-anxiety 6/30/09 Methadone 10 mg | Schedule IT 240 | tablets analgesic 6/30/09 Oxycodone 30 mg | Schedule II 240 tablets analgesic 6/30/09 Xanax 2 mg tablets | Schedule IV 90 anti-anxiety 15. Between approximately August 11, 2008, and June 30, 2009, while Respondent prescribed these controlled substances in very ‘high dosages to JS, Respondent's medical records fail to show in his evaluation of the patient and in his treatment plan one or more of the following: a) A complete medical history and physical examination that was conducted and documented in the medical record; b) — Documentation of 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/or history of substance abuse; 3:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final froin GK.doc 10 el'd zOi0L aloe - Jay SO:0T OTOZ T dy ¢) The presence of one or more recognized medical indications for the use of a controlled substance; d) A-written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned; e) After treatment began, why Respondent adjusted drug therapy to the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain is associated with physical and psychosocial impairment; 9) Verification from ST’s previous physicians whether his treatment was terminated for substance abuse/diversion; h) Diagnostic testing for illicit drug use/diversion of Opioids, FACTS SPECIFIC TO PATIENT TH 16. On or about July 8, 2008, TH presented to Respondent with complaints of neck and back pain. Respondent there and then prescribed 180 tablets of oxycodone 30 milligram for TH; based solely on the verbal J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc ia Pled eO7OL oboe - Jay po:ot ofoz T dy ae o patient history that TH related to Respondent concerning his current pain management regimen. Respondent did not have the benefit of any of TH’s prior medical records and Respondent did not verify through diagnostic testing whether the alleged prescription medications were present and did not exclude the presence of other drugs. 17, On or about September 4, 2008 Respondent prescribed to TH 90 tablets of Soma 350 mg. 18. Soma (muscle relaxant, Schedule IV) is the brand name for carisoprodol, a muscle relaxant commonly prescribed to treat muscular pain, According to Section 893.03(4), Florida Statutes, carisoprodol is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States, and abuse of carisoprodo! may lead to limited physical or psychological dependence relative to the substances in Schedule ITI, 19. Between approximately July 8, 2008, and August 27, 2009, Respondent prescribed oxycodone, Methadone, Xanax and Soma to TH on the dates and in the amounts specified below: JAPSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 12 gk'd eO70L oboe - Jay po:ot ofoz T dy on Date of Medication Type of Quantity Prescription Prescribed Medication 7/8/08 Oxycodone 30 mg | Schedule II 180 tablets analgesic 8/5/08 Methadone 10 mg | Schedule II 180 tablets analgesic 8/5/08 Xanax 2 mg tablets | Schedule IV 30 anti-anxiety ee a —- 8/5/08 Oxycodone 30 mg | Schedule II 270 tablets analgesic 9/4/08 Methadone 10 mg | Schedule II 240 tablets analgesic 9/4/08 Xanax 2 mg tablets | Schedule IV 90 anti-anxiety 9/4/08 Soma 350 mg Schedule IV 90 tablets . muscle relaxant 10/6/08 Oxycodone 30 mg | Schedule II 270 tablets analgesic 10/6/08 Methadone 10 mg | Schedule II 270 tablets analgesic 10/6/08 Xanax 2 mg tablets | Schedule IV 120 anti-anxiety 11/4/08 Soma 350 mg Schedule IV 120 . tablets muscle . relaxant 11/4/08 Oxycodone 30 mg | Schedule II 270 : tablets analgesic 11/4/08 Methadone 10 mg | Schedule IT 300 tablets analgesic 7:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc gL ‘d BOOL O02 - Ady fOIOT OTOZ T dy on Date of Medication Type of Quantity Prescription Prescribed Medication 12/2/08 | Xanax 2 mg tablets , Schedule IV 120 , anti-anxiety 12/2/08 Soma 350 mg Schedule IV 120 tablets muscle relaxant 12/29/08 — Oxycodone 30mg | Schedule II 240 tablets analgesic 12/29/08 | Methadone 10mg | Schedule II 240 analgesic . 12/29/08 Xanax 2 mg tablets | Schedule IV 120 ; anti-anxiety ; 1/27/09 Soma 350mg | Schedule IV 120 tablets muscle relaxant 1/27/09 | Oxycodone 30 mg | Schedule 240 tablets analgesic | 1/27/09 | Oxycodone 30 mg | Schedule II 240 : tablets analgesic 1/27/09 Methadone 10 mg | Schedule II 240 tablets analgesic | 2/24/09 | Xanax 2 mg tablets | Schedule iv 150 anti-anxiety 2/24/09 Soma 350 mg Schedule IV 120 tablets muscle relaxant J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc él'd eO7OL oboe - Jay fOIOT OTOZ T dy J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc al'd pOTOL aloe - 4ay cO:oT oTOz T dy o = Date of Medication Type of Quantity Prescription Prescribed Medication 4/6/09 Oxycodone 30 mg | Schedule IT 200 . tablets analgesic 4/6/09 Methadone 10 mg | Schedule II 240 | tablets analgesic 4/6/09 Xanax 2 mg tablets; Schedule IV 150 anti-anxiety 5/4/09 Soma 350 mg Schedule IV 120 tablets muscle relaxant 5/4/09 Oxycodone 30 mg | Schedule II 240 tablets analgesic 6/2/09 Oxycodone 30 mg | Schedule IT 240 tablets analgesic 6/2/09 Xanax 2 mg tablets | Schedule IV 150 anti-anxiety 6/2/09 Soma 350mg | Schedule IV 120 tablets muscle relaxant 6/29/09 Oxycodone 30 mg | Schedule II 210 tablets analgesic 6/29/09 Methadone 10 mg | Schedule II 240 tablets analgesic 7/28/09 Xanax 2 mg tablets | Schedule IV 150 anti-anxiety os Date of Medication Type of Quantity Prescription Prescribed Medication 7/28/09 Soma 350mg | Schedule iV 120 ' tablets muscle relaxant 7/28/09 Oxycodone 30 mg | Schedule II 210 tablets analgesic 8/27/09 Methadone 10 mg | Schedule II 240 tablets analoesic 8/27/09 | Xanax 2 mg tablets| Schedule IV 150 anti-anxiety | 8/27/09 Soma 350mg | Schedule IV 120 tablets muscle relaxant 8/27/09 Oxycodone 30 mg | Schedule II 240 tablets analgesic — 20, Between approximately July 8, 2008, and August 27, 2009, while Respondent prescribed these controlled substances in very high dosages to TH, Respondent's medical records fail to show in his evaluation of the patient and in his treatment plan one or more of the following: a) A complete medical history and physical examination that was conducted and documented in the medical record; Bld POOL OlOe Lo Ady cO:oT oTOz T dy J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final fram GK.doc b) Documentation of 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/or history of substance abuse; o) The presence of one or more recognized medical indications for the use of a controlled substance; 4) A written treatment plan with stated objectives that would be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and/or failed to indicate if any further diagnostic evaluations or treatments were planned: e) After treatment began, why Respondent adjusted drug therapy to. the medical needs of the patient; f) Other treatment modalities or a rehabilitation program depending on the etiology of the pain and the extent to which the pain s associated with physical and/or psychosocial impairment; 9) Verification fromn ST’s previous physicians whether his treatment was terminated for substance abuse/diversion: h) Diagnostic testing for illicit drug use/diversion of opioids. J:\PSU\Madical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.cloc 17 oZ'd ss POTOL «loz Lo aay cO:oT oTOz T dy COUNT ONE 21. Petitioner reincorporates and realleges paragraphs 1 through 20 as if fully set forth herein. 22. Section 458.331(1)(nn), Florida Statutes (2007, 2008 and 2009), provides that violating any provision of chapters 456 or 458, Florida Statutes (2007, 2008 and 2009), or any rules adopted pursuant thereto, is grounds for discipline by the Board of Medicine. 23. Rule 64B8-9.013(3), Florida Administrative Code, provides as foliows: | | The Board has adopted the following standards for 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. The medical record also should document the presence of one or more recognized medical indications for the use of a controlled substance. (b) Treatment Plan. The written treatment plan should state objectives that will be used to determine treatment success, such as pain relief and improved physical and psychosocial function, and should indicate if any further diagnostic evaluations or other treatments are planned. After treatment begins, the physician should adjust drug therapy to the individual medical needs of each patient. Other treatment J:\PSU\Medical \Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 18 l2"d pOTOL aloe - Jay cO:oT oTOz T dy oA ~ modalities or a rehabilitation program may be necessary depending on the etiology of the pain and the extent to which the pain is associated with physical and psychosocial impairment. 24, On or near the dates listed in paragraphs 9, 14 and 19, above, Respondent Violated Rule 6488-9.013(3), Florida Administrative Code, by prescribing Oxycodone, Methadone and Soma in the quantities described therein, without conducting or documenting complete medical histories or physical examinations on Patients ST, JS and TH and without documenting one or more of the following: the nature and intensity of the patient’s pain; current and past treatments for pain; underlying or coexisting diseases or conditions; the effect of the pain on physical and/or psychological function or history of substance abuse; the presence of one or more recognized medical indications for the use of a controlled substance; and without documenting written treatment plans that state objectives that would be used to determine treatment success or indicate if any furthis diagnostic evaluations or other treatments are planned. 25. Based on the foregoing, Respondent has: violated Section 458.331(1) (nn), Florida Statutes (2007, 2008 and 2009), by violating Rule 64B8-9.013(3), Florida Administrative Code. J:APSU\Madical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from Gk.doc 19 ze'd gO70L aloe - Jay Q0:0T OTOZ T dy COUNT TWO 26. : Petitioner reincorporates and realleges paragraphs 1 through 20 as if fully set forth herein. 27, | Chapter 64B8-9.013(3), Florida Administrative Code, as more particularly set forth in paragraph 23 herein of is adopted and realleged as if fully set forth. 28, | Section 458,331(1)(t), Florida Statutes (2007, 2008 and 2009), provides that the 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 is grounds for discipline by the Board of Medicine. i 29. | Respondent failed to practice medicine with that level of care, skill and treatment which is recognized by a reasonably prudent similar physician bs being acceptable under similar conditions and circumstances in treating Patient ST, in one or more of the following ways: ! 4) ~ By failing to show in the medical record justification for prescribing oxycodone 30 mg tablets 8 per day; 2:\PSU\Medical\Robert Milné\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 20 eed gO70L aloe - Jay Q0:0T OTOZ T dy b) By failing to show in the medical records justification for prescribing Methadone in the high doses prescribed: c) By failing to order diagnostic testing in view of the high dosages of opioids prescribed; 4) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; e) By failing to rule out other treatment modalities for the management of pain; f) By prescribing excessive and or inappropriate quantities of controlled substances. 30, 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 conditions and circumstances in the treatment of patient JS in one or more of the following ways: a) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code: 3:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc ai Pe'd gO70L aloe - Jay 90:01 oToz T dy b) By failing to show in the medical record on September 9, 2008, the justification for doubling the dose of Oxycodone 30 mg from the previous month; ¢) — By failing to show in the medical record on October 7, 2008, the justification for tripling the prescribed dose of Xanax 2 mg tablets to 3-times-a-day from the previous month; d) By failing to show in the medical record on September 9, 2008, the justification for prescribing an initial dosage of Methadone at 8 tablets per day; ) By failing to order diagnostic testing in view of the high dosages of opioids prescribed: A By failing to rule out other treatment modalities for the management of pain; g) — By prescribing inappropriate and or excessive quantities of controlled substances. 31. 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 conditions and circumstances in the treatment of patient TH in one or more of the following ways: — J:\PSU\Madical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.dac 22 gz"d gO70L aloe - Jay Q0:0T OTOZ T dy a) By prescribing inappropriate. and or excessive quantities of Xanax 2-mg four times a day on multiple occasions without referral toa psychiatrist: b) By failing to adequately document in the medical record a , medical justification for Xanax; °) By failing to show in the medical record the justification for prescribing high doses of Methadone and oxycodone in the dosages prescribed; | d) By failing to show in the medical record the justification for prescribing Soma in conjunction with Methadone and oxycodone; e) By violating the standards for the use of controlled substances for pain control provided by the Board of Medicine in Rule 64B8-9.013(3), Florida Administrative Code; f) By failing to show in the medical record the justification for prescribing high doses of Xanax; 9) By prescribing inappropriate and or excessive amounts of benzodiazepines: h) By prescribing inappropriate and or excessive amounts of opioids; J.\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 23 9é°d GOO. Oboe bo 44y 90:01 oToz T dy i) By failing to order diagnostic testing in view of the high dosages of opioids prescribed; j By failing to rule out other treatment modalities for the management of pain. 32. Based on the foregoing, Respondent has. violated Section 458.331(1)(t), Florida Statutes (2007, 2008 and 2009). | COUNT THREE 33. Petitioner reincorporates and realleges paragraphs 1 through 20 as if fully set forth herein. 34, Chapter 64B8-9.013(3), Florida Administrative Code, as more particularly set forth in paragraph 23 herein of is adopted and realleged. 35, ‘Section 458.331(1)(m), Florida Statutes (2007, 2008 and 2009), subjects a licensee to discipline for failing to keep legible, as defined by department rule in consultation with the board, medical records that identify the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; J:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 24 it'd gO70L oboe - Jay 20:07 OTOZ T dy oo oS records of drugs prescribed, dispensed, or administered: and reports ‘of consultations and hospitalizations. 36. ‘On or about the dates set forth in paragraphs 9, 14 and 19 Respondent failed to perform a legal obligation placed upon him as a physician contained within Rule 64B8-9.013(3), Florida Administrative Code, by prescribing, Methadone, oxycodone and Soma to patients ST, JS - and TH in the quantities and combinations described: therein, without conducting or documenting complete medical histories or physical examinations on patients ST, JS and TH and.without documenting one or more of the following: the nature and intensity of the patients’ pain; current and past. treatments for pain; underlying or coexisting diseases or conditions; the effect of the pain on physical and psychological function or history of substance abuse; the presence of one or more recognized medical indications for the use of a controlled substance; and without documenting written treatment plans that state objectives that would be used to determine treatment success or indicate if any further diagnostic _ evaluations or other treatments are planned, J:\PSU\Madical\Robert Mitne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final fram GK,doc 23 az"d gO70L oboe - Jay 20:0— oToz T dy 4 ir weg ; a | 37, Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2007, 2008 and 2009), by violating Rule 64B8-9.013(3), Florida Administrative Code, , COUNT FOUR 38, | Petitioner reincorporates and realleges paragraphs 1 through 20 as if fully set forth herein. 39. Section 458.331(1)(q), Florida Statutes (2007, 2008 and 2009), provides as follows: 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 is grounds for discipline by the Board of Medicine. For 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 intent. 40. : Respondent prescribed inappropriately or in excessive or inappropriate quantities, controlled substances to patients ST, JS and TH 1:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 26 Beds OL LOZ Lay 20:07 OTOZ T dy nq ~ on the dates and in the quantities more particularly described in paragraphs 9,14 and 19. 41, ‘Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (2007, 2008 and 2009). 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 0" day of thas __, 2010. L . Ana M. Viamonte Ros, M.D., M.P.H. DEPARTM ENT OF HEALTH State Surgeon General OLERK: : €z 212020 Altace. Kion fet one. Robert A. Milne ( ENE 3036) Assistant General Counsel iM Florida Bar # 622338 DOH Prosecution Services Unit 4052 Bald Cypress Way-Bin C-65 Tallahassee, Florida 32399-3265 (850) 245-4640 Office (850) 245-4681 Facsimile 3:\PSU\Medical\Robert Milne\Gases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 27 ag"d gO70L oboe - Jay 20:0— oToz T dy > ) PCP Members: El Bahrei, Nuss, Mullin PCP: 2/26/10 4:\PSU\Medical\Robert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doe Led éO70L oboe - say eO:0T OTTO T dW 28 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 his 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 i in addition to any other discipline imposed. 1:\PSU\Medical\Rabert Milne\Cases\SHOOK 2009-07675\SHOOK 2009-11459\AC Final from GK.doc 29 ze"d fO70L oboe - Jay sa:ra0t otoz T dy

Docket for Case No: 10-001733PL