STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, V, I1-40G2 PL CASE NO.: 2010-01128 JACINTA IRENE GILLIS, M.D., RESPONDENT. | 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, Jacinta Irene Gillis, M.D., and in support thereof alleges: 1. Petitioner is the state agency charged with regulating the practice of medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 458, Florida Statutes, Piled August 11, 2011 4:22 PM Division of Administrative Hearings 2. At all times material to this Complaint, Respondent was a licensed physician within the State of Florida, having been issued license number ME 99298. 3, Respondent's address of record is 12446 Pebble Stone Court, Fort Myers, Florida, 33913. 4. At all times material to this cause between December 2008 and January 2, 2010, Respondent treated patient M.G. 5. The Department of Health (Department) began an investigation of Respondent based on a complaint received by a physician who had completed a compulsory medical examination of M.G., 6. The reporting physician indicated that a prior treating physician other than Respondent may have addicted M.G. to narcotics, however, Respondent continued to maintain M.G.s’ narcotic usage. 7. The types of controlled substances in question that were prescribed by Respondent are listed as follows: a) Oxycodone (opioid) is commonly prescribed to treat Pain. According to Section 893.03(2), Florida Statutes, Oxycodone is a Schedule I 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. Abuse of Oxycodone may lead to severe psychological or physical dependence. b) Oxycontin is a semi-synthetic opiate that contains oxycodone hydrochloride, a Schedule II controlled substance defined in Chapter 893, Florida Statutes, which is indicated for the relief of moderate to severe pain. Oxycontin has a high potential for abuse and has a currently accepted, but limited, medical use in treatment in the United States. Abuse of this Substance may lead to severe physical and psychological dependence. C) Valium, which contains diazepam, is a Schedule IV controlled substance, pursuant to Section 893.03(4), Florida Statutes. Diazepam is indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety. It may be habit forming and can lead to psychological and physical dependence. 8. In medicine, a proper medical assessment includes the patient’s prior medical history, prior pain Management treatment history, intensity of pain, factors that make the pain worse or alleviate the pain, the pain’s intensity and location, verification of prior controlled substance Prescriptions including the date and quantity of the last prescription received, name of the previous treating physician, name and address of the pharmacy where the last controlled substance prescriptions were filled together with all relevant contact information and verification of all the foregoing by the physician personally contacting the previous pharmacy and treating physician, together with the reason for the referral, and verification for the reasons of referral with the prior treating physician. 9. On or about December 19, 2008 patient M.G. presented to Respondent with pain down his left leg and buttocks. 10. Respondent's medical records and M.G.’s patient profile from Bay Life Pharmacy and G & H Pharmacy indicate that Dr. Gillis prescribed the following controlled substances for M.G. on the dates and in the quantities desctibed in the following table: | Oxycontin Oxycodone Oxycodone Oxycontin Diazepam APAP 40 ng 30 mg 60 mg (Valium) 10-650 ng tL : 10 ng 12/19/08 12/19/08 12/19/08 | 220 pills 240 pills 30 pilis 1/16/09 1/16/09 1/16/09 120 pilis 240 pills 30 pills [3/22/09 120 pills | 2/2/09 30 pills 2753705 tT 120 pilis 3/12/09 120 pilis 7/9/09 120 pills 8/6/09 120 pills 7/9/09 240 pills 8/6/09 240 pills 8/76/09 | 4 pills 8/16/09 — } 40 pills | 9/9/09 9/9/09 120 pills 240 pills L. 10/7/09 10/7/09 240 pills 120 pills | 11/4/09 11/4/09 240 pills 150 pills 12/2/09 12/2/09 240 pills 12/30/09 240 pilis 120 pills 12730705 120 pilis | 11. Respondent's assessment of M.G. failed to adequately assess M.G.'s condition by not requiring any urine drug screens, by not requesting or reviewing prior medical records regarding previous medication use or history of opioid prescribing and/or by not Performing a thorough physical or clinical examination of M.G. 12. The medical records did not contain medical justification for the prescriptions oxycontin, oxycodone, or diazepam as described in Paragraph ten (10). COUNT ONE 13. Petitioner reincorporates and re-alleges paragraphs 1 through twelve (12) as if fully set forth herein. 14. Section 458.331(1)(nn), Florida Statutes (2008, 2009), provides that violating any provision of Chapters 456 or 458, Florida Statutes, or any rules adopted pursuant thereto is grounds for discipline by the Board of Medicine. 15. Rule 64B8-9.013(3), Florida Administrative Code (2008,2009) provides as follows: 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 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. C) Informed Consent and Agreement for Treatment. The physician should discuss the risks and benefits of the use of controlled substances with the patient, persons designated by the patient, or with the patient's surrogate or guardian if the patient is incompetent. The patient should receive Prescriptions from one physician and one pharmacy where possible. If the patient is determined to be at high risk for medication abuse or have a history of substance abuse, the physician should employ the use of a written agreement between physician and ‘patient outlining patient responsibilities, including, but not limited to: 1. Urine/serum medication levels screening when requested; 2. Number and frequency of all prescription refills; and 3. Reasons for which drug therapy may be discontinued (i.e., violation of agreement). 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 the patient’s progress. If treatment goals are not being achieved, despite medication adjustments, the physician should reevaluate the appropriateness of continued treatment. The physician should monitor patient compliance in medication usage and related treatment plans. e) Consultation. The physician should be willing to refer the patient as necessary for additional evaluation and treatment in order to achieve treatment objectives. Special attention should be given to those pain patients who are at risk for misusing their medications and those whose living arrangements pose a risk for medication misuse or diversion. The management of pain in patients with a history of substance abuse or with a comorbid psychiatric disorder requires extra care, monitoring, and documentation, and may require consultation with or referral to an expert in the management of such patients. f) Medical Records. The physician is required to keep accurate and complete records to include, but not be limited to: 1. The medical history and physical examination, including history of drug abuse or dependence, as appropriate; 2. — Diagnostic, therapeutic, and laboratory results; 3. Evaluations and consultations; 4. Treatment objectives; 5. _ Discussion of risks and benefits; 6. Treatments; 7. Medications (including date, type, dosage, and quantity Prescribed); 8. Instructions and agreements; and 9. Periodic reviews, | Records must remain current and be maintained in an accessible manner and readily available for review, 16. On or about December 19, 2008 Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, in one or more of the following ways: a) by failing to conduct a complete medical history and physical examination of M.G. b) by failing to refer M.G. to either a board certified pain specialist or someone with specialized treatment in chemical dependency; Cc) _ by failing to explore other treatment modalities or rehabilitation. 17. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2008,2009) by violating Rule 64B8- 9.013(3), Florida Administrative Code (2008, 2009). COUNT TWO 18. Petitioner reincorporates and re-alleges paragraphs 1 through twelve (12), fourteen (14), and fifteen (15) as if fully set forth herein. 19. On or about January 16, 2009 Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, in one or more of the following ways: a) by failing to conduct a complete medical history and physical examination of M.G. b) by failing to refer M.G. to either a board certified pain specialist or someone with specialized treatment in chemical dependency; c) _ by failing to explore other treatment modalities or rehabilitation. 20. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2008,2009) by violating Rule 64B8- 9.013(3), Florida Administrative Code (2008, 2009). COUNT THREE 21. Petitioner reincorporates and ‘re-alleges paragraphs 1 through twelve (12), fourteen (14), and fifteen (15) as if fully set forth herein, 22. On or about February 13, 2009 Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, in one or more of the following ways: a) _ by failing to conduct a complete medical history and physical examination of M.G. b) by failing to refer M.G. to either a board certified pain specialist or someone with specialized treatment: in chemical dependency; C) by failing to explore other treatment modalities or rehabilitation. 23. Based on the foregoing, Respondent has Violated Section 458.331(1)(nn), Florida Statutes (2008,2009) by violating Rule 64B8- 9,013(3), Florida Administrative Code (2008, 2009). COUNT FOUR 24. Petitioner reincorporates and re-alleges paragraphs 1 through twelve (12), fourteen (14), and fifteen (15) as if fully set forth herein. 25. On or about March 12, 2009 Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, in one or more of the following ways: a) __ by failing to conduct a complete medical history and physical examination of M.G. b) by failing to refer M.G. to either a board certified pain specialist or someone with Specialized treatment in chemical dependency; Cc) by failing to explore other treatment modalities or rehabilitation. 26. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2008,2009) by violating Rule 64B8- 9.013(3), Florida Administrative Code (2008, 2009), COUNT FIVE 27. Petitioner reincorporates and re-alleges paragraphs 1 through twelve (12), fourteen (14), and fifteen (15) as if fully set forth herein, 28. On or about June 12, 2009 Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, in one or more of the following ways: a) by failing to conduct a complete medical history and physical examination of M.G. b) by failing to refer M.G. to either a board certified pain specialist or someone with specialized treatment in chemical dependency; Cc) by failing to explore other treatment modalities or rehabilitation. 29. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2008,2009) by violating Rule 64B8- 9.013(3), Florida Administrative Code (2008, 2009). COUNT SIX 30. Petitioner reincorporates and re-alleges paragraphs 1 through twelve (12), fourteen (14), and fifteen (15) as if fully set forth herein. 31. On or about July 9, 2009 Respondent violated Rule 64B8- 9.013(3), Florida Administrative Code, in one or more of the following ways: . a) _ by failing to conduct a complete medical history and physical examination of M.G. b) by failing to refer M.G. to either a board certified pain specialist or someone with specialized treatment in chemical dependency; Cc) _ by failing to explore other treatment modalities or rehabilitation. 32. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2008,2009) by violating. Rule 64B8- 9.013(3), Florida Administrative Code (2008, 2009). Cc T SEVEN 33. Petitioner reincorporates and re-alleges paragraphs 1 through twelve (12), fourteen (14), and fifteen (15) as if fully set forth herein. 34, On or about August 6, 2009 Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, in one or more of the following ways: a) _ by failing to conduct a complete medical history and physical examination of M.G. b) by failing to refer M.G. to either a board certified pain specialist or someone with specialized treatment in chemical dependency; c) _ by failing to explore other treatment modalities or rehabilitation. - 35. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2008,2009) by violating Rule 64B8- 9.013(3), Florida Administrative Code (2008, 2009). COUNT EIGHT 36. Petitioner reincorporates and re-alleges paragraphs 1 through twelve (12), fourteen (14), and fifteen (15) as if fully set forth herein. 37. On or about September 9, 2009 Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, in one or more of the following ways: a) _ by failing to conduct a complete medical history and physical examination of M.G. b) by failing to refer M.G. to either a board certified pain specialist or someone with specialized treatment in chemical dependency; c) by failing to explore other treatment. modalities or rehabilitation. 38. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2008,2009) by violating Rule 64B8- 9.013(3), Florida Administrative Code (2008, 2009). COUNT NINE 39. Petitioner reincorporates and re-alieges paragraphs 1 through twelve (12), fourteen (14), and fifteen (15) as if fully set forth herein, 40. On or about October:7, 2009 Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, in one or more of the following ways: a) _ by failing to conduct a complete medical history and physical examination of M.G. b) by failing to refer M.G. to either a board certified pain specialist or someone with specialized treatment in chemical dependency; . _ C) _ by failing to explore other treatment modalities or rehabilitation. . 41. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2008,2009) by violating Rule 64B8- 9.013(3), Florida Administrative Code (2008, 2009). COUNT TEN 42. Petitioner reincorporates and re-alleges paragraphs 1 through twelve (12), fourteen (14), and fifteen (15) as if fully set forth herein. 43. On or about November 4, 2009 Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, in one or more of the following ways: a) by failing to conduct a complete medical history and physical examination of M.G. b) _ by failing to refer M.G. to either a board certified pain specialist or someone with specialized treatment in chemical dependency; C) by failing to explore other treatment modalities or rehabilitation. 44. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2008,2009) by violating Rule 64B8- 9.013(3), Florida Administrative Code (2008, 2009). COUNT ELEVEN . 45. Petitioner reincorporates and re-alleges paragraphs 1 through twelve (12), fourteen (14), and fifteen (15) as if fully set forth herein. 20 46. On or about December 2, 2009 Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, in one or more of the following ways: a) _ by failing to conduct a complete medical history and physical examination of M.G. b) _ by failing to refer M.G. to either a board certified pain specialist or someone with specialized treatment in chemical dependency; c) by failing to explore other treatment modalities or rehabilitation. 47, Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2008,2009) by violating Rule 6488- 9.013(3), Florida Administrative Code (2008, 2009). COUNT TWELVE 48. Petitioner reincorporates and re-alleges paragraphs 1 through twelve (12), fourteen (14), and fifteen (15) as if fully set forth herein. aL 49. On or about December 30, 2009 Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, in one or more of the following ways: a) _ by failing to conduct a complete medical history and physical examination of M.G. b) by failing to refer M.G. to either a board certified pain specialist or someone with specialized treatment in chemical dependency; | c) by failing to explore other treatment modalities or rehabilitation. 50. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2008,2009) by violating Rule 64B8- 9.013(3), Florida Administrative Code (2008, 2009). COUNT THIRTEEN 91. Petitioner reincorporates and re-alleges paragraphs i through twelve (12), and fifteen (15) as if fully set forth herein. 52. Section 458.331(1)(m), Florida Statutes (2008, 2009) provides: failing to keep legible, as defined by department rule in consultation with the board, medical records that identify the licensed 22 physician or the physician extender and Supervising physician by name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and that justify the course of treatment of the patient, including, but not limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations and a violation thereof constitutes grounds for disciplinary action by the Board. 53. Respondent failed to keep medical records on or about December 19, 2008, that justified the course of treatment for M.G., by failing to- record the justification for prescribing oxycontin , oxycodone or diazepam as described in paragraph ten (10). 54. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2008, 2009) by failing to keep legible medical records that justified the course of treatment for M.G., by not including one or more of the following: a complete patient medical history and physical examination, including history of drug abuse or dependence, as appropriate; diagnostic, therapeutic, and laboratory results; evaluations and consultations; examination 23 results, test results, records of drugs prescribed, dispensed, or administered; or reports of consultations and hospitalizations. COUNT FOURTEEN 55. Petitioner reincorporates and re-alleges paragraphs one (1) through twelve (12), fifteen (15) and fifty-two (52) as if fully set forth herein. 56. Respondent failed to keep medical records on or about January 16, 2009, that justified the course of treatment for M.G., by failing to record the justification for Prescribing oxycontin , oxycodone or diazepam as described in paragraph ten (10). 57. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2008, 2009) by failing to keep legible medical records that justified the course of treatment for M.G., by not including one or more of the following: a complete patient medical history and physical examination, including history of drug abuse or dependence, as appropriate; diagnostic, therapeutic, and laboratory results; evaluations and consultations; examination results, test results, records of drugs prescribed, dispensed, or administered; or reports of consultations and hospitalizations. 24 COUNT FIFTEEN 58. Petitioner reincorporates and re-alleges paragraphs one (1) through twelve (12), fifteen (15) and fifty-two (52) as if fully set forth herein. 59. Respondent failed to keep medical records on or about February 13, 2009, that justified the course of treatment for M.G., by failing to record the justification for prescribing oxycontin 1 oxycodone or diazepam as described in paragraph ten (10). 60. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2008, 2009) by failing to keep legible medical records that justified the course of treatment for M.G., by not including one or more of the following: a complete patient medical history and physical examination, including history of drug abuse or dependence, as appropriate; diagnostic, therapeutic, and laboratory results; evaluations and consultations; examination results, test results, records of drugs prescribed, dispensed, or administered; or reports of consultations and hospitalizations. 25 COUNT SIXTEEN 61. Petitioner reincorporates and re-alleges paragraphs one (1) through twelve (12), fifteen (15) and fifty-two (52) as if fully set forth herein. 62. Respondent failed to keep medical records on or about March 12, 2009, that justified the course of treatment for M.G., by failing to record the justification for prescribing oxycontin , oxycodone or diazepam as described in paragraph ten (10). 63. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2008, 2009) by failing to keep legible medical records that justified the course of treatment for M.G., by not including one or more of the following: a complete patient medical history and physical examination, including history of drug abuse or dependence, as appropriate; diagnostic, therapeutic, and laboratory results; evaluations and consultations; examination results, test results, records of drugs prescribed, dispensed, or administered; or reports of consultations and hospitalizations. COUNT SEVENTEEN 64. Petitioner reincorporates and re-alleges paragraphs one (1) through twelve (12), fifteen (15) and fifty-two (52) as if fully set forth herein. 65. Respondent failed to Keep medical records on or about June 12, 2009, that justified the course of treatment for M.G., by failing to record the justification for prescribing oxycontin , oxycodone or diazepam as described in paragraph ten (10). 66. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2008, 2009) by failing to keep legible medical records that justified the course of treatment for M.G., by not including one or more of the following: a complete patient medical history and physical examination, including history of drug abuse or dependence, as appropriate; diagnostic, therapeutic, and laboratory results; evaluations and consultations; examination results, test results, records of drugs prescribed, dispensed, or administered; or reports of consultations and hospitalizations. 27 COUNT EIGHTEEN 67. Petitioner reincorporates and re-alleges paragraphs one (1) through twelve (12), fifteen (15) and fifty-two (52) as if fully set forth herein, 68. Respondent failed to keep medical records on or about July 9, 2009, that justified the course of treatment for M.G., by failing to record the justification for prescribing oxycontin , oxycodone or diazepam as described in paragraph ten (10), 69. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2008, 2009) by failing to keep legible medical records that justified the course of treatment for M.G., by not including one or more of the following: a complete patient medical history and physical examination, including history of drug abuse or dependence, as appropriate; diagnostic, therapeutic, and laboratory results; evaluations and consultations; examination results, test results, records of drugs prescribed, dispensed, or administered; or reports of consultations and hospitalizations. 28 COUNT NINETEEN 70. Petitioner reincorporates and re-alleges paragraphs one (1) through twelve (12), fifteen (15) and fifty-two (52) as if fully set forth herein. 71. Respondent failed to keep medical records on or about August 6, 2009, that justified the course of treatment for M.G., by failing to record the justification for prescribing oxycontin , oxycodone or diazepam as described in paragraph.ten (10). 72. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2008, 2009) by failing to keep legible medical records that justified the course of treatment for M.G., by not including one or more of the following: a complete patient medical history and physical examination, including history of drug abuse or dependence, as appropriate; diagnostic, therapeutic, and laboratory results; evaluations and consultations; examination results, test results, records of drugs prescribed, dispensed, or administered; or reports of consultations-and hospitalizations. 29 COUNT TWENTY 73. Petitioner reincorporates and re-alleges Paragraphs one (1) through twelve (12), fifteen (15) and fifty-two (52) as if fully set forth herein. 74, Respondent failed to keep medical records on or about September 9, 2009, that justified the course of treatment for M.G., by failing to record the justification for prescribing oxycontin , oxycodone or diazepam as described in paragraph ten (10). 75. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2008, 2009) by failing to keep legible medical records that justified the course of treatment for M.G., by not including one or more of the following: a complete patient medical history and physical examination, including history of drug abuse or dependence, as appropriate; diagnostic, therapeutic, and laboratory results; evaluations and consultations; examination results, test results, records of drugs prescribed, dispensed, or administered; or reports of consultations and hospitalizations. COUNT TWENTY-ONE 76. Petitioner reincorporates and re-alleges paragraphs one (1) through twelve (12), fifteen (15) and fifty-two (52) as if fully set forth herein. 77. Respondent failed to keep medical records on or about October 7, 2009, that justified the course of treatment for M.G., by failing to record the justification for prescribing oxycontin , oxycodone or diazepam as described in paragraph ten (10). 78. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2008, 2009) by failing to keep legible medical records that justified the course of treatment for M.G., by not including one or more of the following: a complete patient medical history and physical examination, including history of drug abuse or dependence, as appropriate; diagnostic, therapeutic, and laboratory results; evaluations and consultations; examination results, test results, records of drugs prescribed, dispensed, or’ administered; or reports of consultations and hospitalizations. COUNT TWENTY-TWO 79. Petitioner reincorporates and re-alleges paragraphs one (1) through twelve (12), fifteen (15) and fifty-two (52) as if fully set forth herein. 80. Respondent failed to keep medical records on or about November 4, 2009, that justified the course of treatment for M.G., by failing to record the justification for prescribing oxycontin , oxycodone or diazepam as described in paragraph ten (10). 81. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2008, 2009) by failing to keep legible medical records that justified the course of treatment for M.G., by not including one or more of the following: a complete patient medical history and physical examination, including history of drug abuse or dependence, as appropriate; diagnostic, therapeutic, and laboratory results; evaluations and consultations; examination results, test results, records of drugs prescribed, dispensed, or administered; or reports of consultations and hospitalizations. 32 COUNT TWENTY-THREE 82. Petitioner reincorporates and re-alleges paragraphs one (1) through twelve (12), fifteen (15) and fifty-two (52) as if fully set forth herein. 83. Respondent failed to keep medical records on or about December 2, 2009, that justified the course of treatment for M.G., by failing to record the justification - for prescribing oxycontin , oxycodone or diazepam as described in paragraph ten (10). 84. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2008, 2009) by failing to keep legible medical records that justified the course of treatment for M.G., by not including one or More of the following: a complete patient medical history and physical examination, including history of drug abuse or dependence, as appropriate; diagnostic, therapeutic, and laboratory results; evaluations and consultations; examination results, test results, records of drugs prescribed, dispensed, or administered; or reports of consultations and hospitalizations. 33 COUNT TWENTY-FOUR 85. Petitioner reincorporates and re-alleges paragraphs one (1) through twelve (12), fifteen (15) and fifty-two (52) as if fully set forth herein, 86. Respondent failed to keep medical records on or about December 30, 2009, that justified the course of treatment for M.G., by failing to record the justification for prescribing oxycontin , oxycodone or diazepam as described in paragraph ten (10). 87. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2008, 2009) by failing to keep legible medical records that justified the course of treatment for M.G., by not including one or more of the following: a complete patient medical history and physical examination, including history of drug abuse or dependence, as appropriate; diagnostic, therapeutic, and laboratory results; evaluations and consultations; examination results, test results, records of drugs prescribed, dispensed, or administered; or reports of consultations and hospitalizations. 34 COUNT TWENTY-FIVE 88. Petitioner reincorporates and re-alleges paragraphs one (1) through twelve (12) as if fully set forth herein. 89. Chapter 64B8-9.013(3), Florida Administrative Code (2008-2009), as more particularly set forth in paragraph fifteen (15) herein is adopted and re-alleged as if fully set forth. 90. Section 458.331(1)(t), Florida Statutes (2008, 2009), subjects a licensee to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. Section 456.50, Florida Statutes (2008, 2009) defines medical malpractice as the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure. 91. For purposes of Section 458.331(1)(t), Florida Statutes, the Board shall give great weight to the provisions of Section 766.102, Florida Statutes (2008, 2009) which provide that the prevailing professional standard of care for a given health care provider shail be that level of care, skill, and treatment which, ini light 35 of ail relevant Surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers, 92. 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 treating M.G. in one or more of the following ways: | a) _ by prescribing controlled substances inappropriately or in excessive and/or inappropriate amounts; b) by failing to document in the medical record the justification for prescribing oxycontin or oxycodone or diazepam in the doses or quantities as described in paragraph ten (10) above; Cc) by failing to confirm whether M.G. presented to a psychiatrist or psychologist after the initial referral; ‘d) by failing to document in _the medical records whether there was any follow-up by M.G. after an initial referral to a psychiatrist or psychologist. 36 e) _ by failing to order urine drug screening in light of the prescribing of controlled substances to M.G. f) by failing to record in the medical record any evidence of thorough physical examinations or by failing to fully assess the patient. g) by failing to conduct a complete and thorough physical examination of M.G. 93. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2008, 2009). COUNT TWENTY-SIX 94. Petitioner reincorporates and re-alleges paragraphs 1 through twelve (12) as if fully set forth herein. 95. Section 458.331(1)(q), Florida Statutes (2008, 2009) subjects a licensee to discipline for prescribing controlled substances inappropriately or in excessive or inappropriate quantities, 96, Section 458.331(1)(q) states the following acts constitute grounds for disciplinary action: Prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled 37 substance, other than in the course of the physician's professional practice. For the purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and is not in the course of the physician's professional practice, without regard to his or her intent. 97. Respondent prescribed controlled substances other than in the course of her professional practice by prescribing controlled substances inappropriately or excessively in one or more of the following ways: a) by prescribing controlled substances without an adequate medical assessment of M.G. } b) by prescribing controlled substances without an adequate physical examination of M.G.; c) by prescribing controlled substances without discussing or attempting alternative pain management modalities; 38 d) by prescribing controlled substances without ordering urine drug screening. €) by prescribing controlled substances to M.G. without justification as outlined in paragraph ten (10). 98. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2008, 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. 39 ae SIGNED this _| FILED DEPARTMENT OF HEALTH . DEPUTY CLERK Angel Sanders DATE JUNOT 70H RIJB/das PCP Members: Mullins 4 Tackter PCP: Sune. G, Rol day of Ju Mm 2011, H, Frank Farmer, Jr., M.D., Ph.D., State Surgeon General De ent of Health Que > EU Robert J. Bobek Assistant General Counsel Florida Bar # 434337 DOH Prosecution Services Unit 4052 Bald Cypress Way-Bin C-65 Tallahassee, Florida 32399-3265 (850) 245-4640 Office (850) 245-4681 Facsimile 40 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 in addition to any other discipline imposed. 41

Docket for Case No: 11-004062PL