STATE OF FLORIDA DEPARTMENT OF HEALTH Florida Department of Health, Petitioner, v. Case Number: 2011-06824 Eric Osvaldo Pantaleon, M.D., Respondent. / ADMINISTRATIVE COMPLAINT Petitioner Department of Health files this Administrative Complaint before the Board of Medicine against Respondent Eric Osvaldo Pantaleon, M.D., and states: 1. The Department of Health (“Department”) is the state agency charged with regulating the practice of medicine, pursuant to Chapters 20, 456 and 458, Florida Statutes (2010-2011). 2. At all times material to this Order, Respondent was licensed to practice as a physician in the State of Florida, pursuant to Chapter 458, Florida Statutes (2010-2011). Respondent’s address of record is 7761 N.W. 146 Street, Miami, Florida 33016. 3. At all times material to this Order, Respondent treated patients at Urgent Care and Surgery Center, a pain management clinic located in Hollywood, Florida (the “Clinic”. Filed December 8, 2011 3:50 PM Division of Administrative Hearings Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 4. In April 2011, the Department commenced an investigation of Respondent. As part of its investigation, the Department obtained patient records for three separate patients (hereafter identified as “N.G.,” “A.F.” and “F.K.”) treated by Respondent at the Clinic. 5h As set forth in more detail below, Respondent fell below the standard of care in his treatment of Patients N.G., A.F. and F.K. Patient N.G. — December 16, 2010 6. On December 16, 2010, N.G., a 40-year-old male, first presented to the Clinic with complaints of back and hip pain. 7. N.G. reported taking 150 dosage units of oxycodone 30 mg and 120 dosage units of oxycodone 15 mg per month, but there is no evidence in the patient’s record that N.G. was actually taking the medications or that the medications were provided by a physician. 8. The patient record for this visit indicates Respondent performed a cursory physical examination of N.G., which he documented by circling exam parameters on a pre-printed form. No substantive examination notes were made by Respondent during the course of this visit. There is no data in the patient record to confirm the patient had any pathology in his back or leg. 9. The patient record indicates Respondent prescribed 150 dosage units of oxycodone 30 mg, 120 dosage units of oxycodone 15 mg, 150 dosage units of Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 Soma 30 mg and naproxen 500 mg to N.G. at the conclusion of this visit. There were, however, no prescriptions included in the patient record for this visit. 10. Oxycodone is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes (2010-2011), 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. Abuse of oxycodone may lead to severe psychological or physical dependence. Oxycodone is an opioid. Opioid, or opiate, drugs have similar actions as the drug opium and are typically prescribed to treat pain. Opioid drugs are synthetically manufactured, while opiate drugs are naturally occurring, but the terms opioid and opiate are often used interchangeably. Opioid drugs are addictive and subject to abuse. 11. Soma is a brand name of carisoprodol, a muscle relaxant commonly prescribed to treat muscle pain. According to Section 893.03(4), Florida Statutes (2010-2011), 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. Abuse of carisoprodol may lead to limited physical or psychological dependence relative to the substances in Schedule III. 12. Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) Department of Health v. Eric 0, Pantaleon, M.D. Case Number: 2011-06824 commonly used for the reduction of pain, fever, inflammation and stiffness. Patient N.G. — January 13, 2011 13. On January 13, 2011, N.G. presented to Respondent for a follow-up appointment. The patient’s record contains no notes for this visit. Notwithstanding the lack of notes, the patient record reflects that Respondent prescribed 60 dosage units of Naproxen 500 mg, 60 dosage units of Chantix 1 mg, 60 dosage units of Soma 350 mg, 110 dosage units of oxycodone 15 mg, 150 dosage units of oxycodone 30 mg, 60 dosage units of Chantix 1 mg, 60 dosage units of Soma 350 mg, 60 dosage units of Naproxen 500 mg, 60 dosage units of Soma 350 mg, 110 dosage units of oxycodone 15 mg, 150 dosage units of oxycodone 30 mg, 60 dosage units of Naproxen 500 mg and 60 dosage units of Chantix 1 mg to the patient. While some of these duplicates appear to have been marked “void,” it is impossible to determine which medications were actually prescribed due to the lack of notes for the visit. 14. Chantix is a brand name for varenicline tartrate, a prescription medication used to treat smoking addiction. Patient N.G. — February 10, 2011 15. On February 10, 2011, N.G. returned to Respondent’s office. The patient record reflects Respondent performed another cursory examination of the patient and ordered an orthopedic consultation for N.G. There is, however, no 4 Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 prescription for an orthopedic consultation contained in the patient record. Respondent’s cursory physical examination of N.G. was documented by circling exam parameters on a pre-printed form. No substantive examination notes were made by Respondent during the course of this visit. 16. Respondent notes in N.G.’s record that the medications he previously prescribed have been effective, which is inconsistent with N.G.’s reported pain level of 9 on a scale of 1 through 10. 17. At the conclusion of this visit, Respondent prescribed 150 dosage units of oxycodone 30 mg, 105 dosage units of oxycodone 15 mg, 150 dosage units of Soma 30 mg and 60 dosage units of Naproxen 500 mg to N.G. Patient N.G. — March 10, 2011 18. On March 10, 2011, N.G. returned to Respondent’s office. The patient record reflects Respondent performed another cursory examination of the patient, which was, again, documented on a pre-printed form. No substantive examination notes were made by Respondent during the course of this visit. 19. The patient record indicates N.G. was scheduled to receive a spinal block in April 2011. There is, however, no prescription for a spinal block in the record; nor is there any indication N.G. underwent the orthopedic consultation ordered by Respondent during N.G.’s previous visit. 20. Respondent notes in N.G.’s record that the medications he previously Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 prescribed to the patient were effective, which is entirely inconsistent with N.G.’s reported pain level of 10 on a scale of 1 through 10. 21. At the conclusion of this visit, Respondent prescribed 150 dosage units of oxycodone 30 mg, 100 dosage units of oxycodone 15 mg, 60 dosage units of Soma 350 mg, 60 dosage units of Chantix 1 mg and 30 dosage units of Motrin 800 mg to N.G. 22. Motrin 800 mg is a prescription nonsteroidal anti-inflammatory drug (NSAID) used to treat pain. Patient N.G. ~— April 7, 2011 23. On April 7, 2011, N.G. returned to the Clinic for a follow-up visit. The patient record indicates neurological or orthopedic consultations, as well as physical therapy referrals, were made, but the record lacks any actual prescriptions for these referrals. There is no mention in the record to the fact that previous reported consultations were never completed. 24. A note in the patient record indicates the patient reported undergoing an epidural by another physician, but there is no confirmation in the record that the procedure was actually performed. 25. Respondent notes in N.G.’s record that the medications he previously prescribed to the patient were effective, which is entirely inconsistent with N.G.’s reported pain level of 9 on a scale of 1 through 10. As with prior visits, no Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 substantive examination notes were made by Respondent during the course of this visit. 26. At the conclusion of this visit, Respondent prescribed 168 dosage units of oxycodone 30 mg, 90 dosage units of oxycodone 15 mg, 60 dosage units of Soma 350 mg, 60 dosage units of Chantix 1 mg and 40 dosage units of Motrin 800 mg to N.G. Patient N.G. — May 5, 2011 27. On May 5, 2011, N.G. returned to Respondent’s office. The patient record for this visit reflects Respondent performed another cursory examination of the patient, which he documented on a pre-printed form. No substantive examination notes were made by Respondent during the course of this visit. 28. Respondent notes in N.G.’s record that the medications he previously prescribed to the patient were effective, which is, once again, entirely inconsistent with N.G.’s reported pain level of 9 ona scale of 1 through 10. 29. At the conclusion of this visit, Respondent prescribed 168 dosage units of oxycodone 30 mg, 90 dosage units of oxycodone 15 mg, 60 dosage units of Soma 350 mg, 60 dosage units of Chantix 1 mg and 40 dosage units of Motrin 800 mg to N.G. Patient N.G. — June 2, 2011 30. On June 2, 2011, N.G. was seen again by Respondent. The patient Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 record for this visit reflects Respondent performed another cursory examination of the patient, which he documented on a pre-printed form. 31. Respondent notes in N.G.’s record that the medications he previously prescribed to the patient were effective, which, again, is not consistent with N.G.’s reported pain level of 7 on a scale of 1 through 10. No substantive examination notes were made by Respondent during the course of this visit. 32. At the conclusion of this visit, Respondent prescribed 168 dosage units of oxycodone 30 mg, 85 dosage units of oxycodone 15 mg, 60 dosage units of Soma 350 mg, 40 dosage units of Motrin 800 mg and 15 dosage units of Ambien 5 mg to N.G. 33. Ambien is a brand name for zolpidem, a prescription medication used for the short-term treatment of insomnia. Patient A.F. — December 16, 2010 34. On December 16, 2010, A.F., a 40-year-old female, first presented to the Clinic with complaints of back and leg pain. A.F. reported taking 180 dosage units of oxycodone 30 mg, 90 dosage units of oxycodone 15 mg, 30 dosage units of Xanax 2 mg, 60 dosage units of Naproxen 500 mg and 30 dosage units of Flexeril 5 mg per month, but there is no evidence in the patient’s record that A.F. was actually taking the medications or that the medications were provided by a physician. Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 35. The patient record for this visit indicates Respondent performed a cursory physical examination of A.F., which he documented by circling exam parameters on a pre-printed form. No substantive examination notes were made by Respondent during the course of this visit. 36. There is no data in the patient record to confirm the patient had any pathology in her back or leg. There was no MRI contained in the patient record for this visit. 37. The patient record indicates an orthopedic consultation was ordered, but there is no prescription for this referral contained in the patient record. 38. At the conclusion of this visit, Respondent prescribed 180 dosage units of oxycodone 30 mg, 90 dosage units of oxycodone 15 mg, 30 dosage units of Xanax 2 mg, 60 dosage units of Naproxen 500 mg and 30 dosage units of Flexeril 5 mg to A.F. 39. Flexeril is a muscle relaxant that contains cyclobenzaprine. Patient A.F. — January 21, 2011 40. On January 21, 2011, A.F. presented to Respondent for a follow-up appointment. The patient record reflects Respondent performed another cursory examination of the patient and ordered an orthopedic consultation for A.F. There is, however, no prescription for an orthopedic consultation contained in the patient record. Respondent’s cursory physical examination of A.F. was documented by Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 circling exam parameters on a pre-printed form. No substantive examination notes were made by Respondent during the course of this visit. 41. Respondent notes in A.F.’s record that the medications he previously prescribed have been effective, which is not consistent with the patient’s reported pain level of 8 on a scale of 1 through 10. 42. Respondent made a note to A.F.’s record for this visit indicating that ALF. “Need[s] to have MRI at the next visit.” 43. At the conclusion of this visit, Respondent prescribed 180 dosage units of oxycodone 30 mg, 85 dosage units of oxycodone 15 mg, 30 dosage units of Xanax 2 mg, 60 dosage units of Naproxen 500 mg and 30 dosage units of Flexeril 5 mg to A.F. Patient A.F. — February 18, 2011 44. On February 18, 2011, A.F. presented to Respondent for a follow-up appointment. Despite the fact that Respondent’s notes for A.F.’s previous visit indicate the patient needed to have an MRI on the next visit, no MRI was produced, 45. The patient record reflects Respondent performed another cursory examination of the patient and ordered neurosurgery, physical therapy and interventional pain consultations for A.F. There are, however, no prescriptions for these referrals in the patient record. Respondent’s cursory physical examination of 10 Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 A.F. was documented by circling exam parameters on a pre-printed form. No substantive examination notes were made by Respondent during the course of this visit. 46. Respondent notes in A.F.’s record that the medications he previously prescribed have been effective, which is inconsistent with the patient’s reported pain level of 9 on a scale of 1 through 10. At the conclusion of this visit, Respondent prescribed 196 dosage units of oxycodone 30 mg, 60 dosage units of oxycodone 15 mg, 30 dosage units of Xanax 2 mg, 60 dosage units of Naproxen 500 mg and 30 dosage units of Flexeril 5 mg to A.F. Patient A.F, — March 18 and April 20, 2011 47. On March 18 and April 20, 2011, A.F. presented to Respondent for follow-up appointments. Once again, A.F. did not produce an MRI during either visit. Once again, Respondent performed a cursory examination of the patient and ordered consultations for which there are no actual prescriptions in the record. Respondent’s cursory physical examination of A.F. during each visit was documented by circling exam parameters on a pre-printed form. No substantive examination notes were made by Respondent during the course of either visit. Nor is there any evidence in the record that previous referral appointments were kept by the patient. 48. During each visit, Respondent, again, notes in A.F.’s record that the 11 Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 medications he previously prescribed have been effective. This is contrary to the patient’s reported high pain level. 49. At the conclusion of each visit, Respondent prescribed 196 dosage units of oxycodone 30 mg, 60 dosage units of oxycodone 15 mg, 30 dosage units of Xanax 2 mg, 60 dosage units of Naproxen 500 mg and 30 dosage units of Flexeril 5 mg to A.F. 50. On May 18, 2011, A.F, returned to the Clinic for a final visit. During this visit, A.F. produced an MRI dated March 2010. Yet again, Respondent performed a cursory examination of the patient and ordered consultations for which there are no actual prescriptions in the record. There is no evidence previous referral appointments have been kept by the patient. Respondent’s cursory physical examination of A.F. during was documented by circling exam parameters on a pre-printed form. No substantive examination notes were made by Respondent during the course of this visit. 51. Respondent notes in A.F.’s record that the medications he previously prescribed have been effective, which is inconsistent with the patient’s reported high pain level. 52. According to the patient record, Respondent prescribed 196 dosage units of oxycodone 30 mg, 60 dosage units of oxycodone 15 mg, 30 dosage units of Xanax 2 mg, 60 dosage units of Naproxen 500 mg and 30 dosage units of 12 Department of Health v. Eric O. Pantaleon, M.D. Case Number: 201 1-06824 Flexeril 5 mg to A.F. during this visit. There are no prescriptions contained in the patient record for this visit, though. Patient F.K. — December 27, 2010 53. On December 27, 2010, F.K. first presented to the Clinic with complaints of neck and bilateral trapezius pain related to a fall. 54. _A.F. reported receiving prior physical therapy for his pain, but there is no documentation in the patient record confirming this. 55. A.F. also reported a history of taking oxycodone 30 mg, oxycodone 15 mg, Xanax 2 mg, Soma 350 mg and ibuprofen, but there is no evidence in the patient’s record that F.K. was actually taking these medications or that the medications were provided by a physician. 56. The patient record for this visit indicates Respondent performed a cursory physical examination of F.K., which he documented by circling exam parameters on a pre-printed form. No substantive examination notes were made by Respondent during the course of this visit. 57. There is a section in the patient record indicating F.K.’s urine drug screen was “as expected,” but there is no evidence a urine toxicology screen was actually performed. 58. There is no data in the patient record to confirm the patient had any pathology in his neck or trapezius. There was no MRI contained in the patient 13 Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 record for this visit, and there is no indication one was ordered. 59. The patient record indicates a neurological consultation was ordered, but there is no prescription for this referral contained in the patient record. 60. At the conclusion of this visit, Respondent prescribed 180 dosage units of oxycodone 30 mg, 30 dosage units of oxycodone 30 mg, 55 dosage units of oxycodone 15 mg, 45 dosage units of Xanax 2 mg, 60 dosage units of Motrin 800 mg and 30 dosage units of Soma 350 mg to F.K. COUNT I - SECTION 458.331(1)(t)1, FLORIDA STATUTES 61. Section 458.331(1)(t)1, Florida Statutes (2010-2011), subjects a physician to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes (2010-2011). “Medical malpractice” is defined by Section 456.50(1)(g), Florida Statutes (2010-2011), 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.” Section 456.50(1)(e), Florida Statutes (2010- 2011), provides that the “level of care, skill, and treatment recognized in general law related to health care licensure" means the standard of care that is specified in Section 766.102(1), Florida Statutes (2010-2011), which is set forth as follows: 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 14 Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 appropriate by reasonably prudent similar health care providers. Section 458,331(1)(t)1., Florida Statutes (2010-2011), directs the Board to give “great weight” to this provision of Section 766.102, Florida Statutes (2010-2011). 62. Respondent failed to meet the prevailing standard of care in one or more of the following manners: a. By prescribing excessive or inappropriate quantities and doses of controlled substances to N.G., A.F. and F.K.; b. By prescribing excessive or inappropriate quantities of controlled substances to N.G., A.F. and F.K. without justification; and/or c. By prescribing excessive or inappropriate doses and quantities of controlled substances to N.G., A.F. and F.K. without performing an adequate evaluation of the patients. COUNT I - SECTION 458.331(1)(q), FLORIDA STATUTES 69. Section 458.331(1)(q), Florida Statutes (2010-2011), subjects a physician to discipline for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician’s professional practice. For the purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, 15 Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 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 70. Respondent violated Section 458.331(1)(q), Florida Statutes (2010- 2011), in one or more of the following manners: a. By prescribing excessive or inappropriate quantities and doses of controlled substances to N.G., A.F. and F.K.; b. By prescribing excessive or inappropriate doses and quantities of controlled substances to N.G., A.F. and F.K. without performing adequate evaluation of the patients. COUNT Jil - SECTION 458.331(1)(nn), FLORIDA STATUTES 71. Section 458.331(1)(nn), Florida Statutes (2010-2011), subjects a physician to discipline for violating any provision of Chapters 456 or 458, Florida Statutes, or any rules adopted pursuant thereto. 72. Rule 64B8-9.013, Florida Administrative Code, sets forth the standards for the use of controlled substances for the treatment of pain, in part, as follows: (3) Standards. 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 16 Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 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. (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: 17 Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 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. Records must remain current and be maintained in an accessible manner and readily available for review. 73. Respondent violated Section 458.331(1)(nn), Florida Statutes (2010- 2011), by violating Rule 64B8-9.013, Florida Administrative Code, in one or more of the following manners: a. By failing to obtain a complete medical history for N.G., A.F. and F.K.,; b. By failing to conduct adequate physical examinations or meaningful medical evaluations of N.G., A.F. and F.K.; c. By failing to set forth an adequate treatment plan for N.G., A.F. and F.K.; d. _— By failing to refer N.G., A.F. and F.K. to evaluations or consultations with specialists or other treatment providers; 18 Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 e. By failing to perform a periodic review of the treatment of N.G., A.F, and F.K. and/or f. By failing to adequately monitor N.G., A.F. and F.K. for diversion or substance abuse. WHEREFORE, Petitioner respectfully requests 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 the Board deems appropriate.. SIGNED this __/ | day of Now tir hu. 2011. H. Frank Farmer, Jr., M.D., Ph.D., F.A.C.P. Chigt Legal Counsel FILED DOH Prosecution Services Unit DEPARTMENT a hl 4052 Bald Cypress Way, Bin C-65 CLERK Angel Sanders Tallahassee, FL 32399-3265 DATE NOV 15 2011 Florida Bar # 176834 (850) 245-4640 (850) 245-4681 FAX PCP Date November 10, 2011 PCP Members: Leon, Bearison and Levine. 19 Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824 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 any other discipline imposed. 20 21 Department of Health v. Eric O. Pantaleon, M.D. Case Number: 2011-06824

Docket for Case No: 11-006231PL