STATE OF FLORIDA AWD A WIT DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO.: 2011-15211 CHARLES D. SCARBOROUGH, 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 the Respondent, CHARLES D. SCARBOROUGH, M_.D., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practice of medicine pursuant to Section 20.43, Florida Statutes (2010-2011); Chapter 456, Florida Statutes (2010-2011); and Chapter 458, Florida Statutes (2010-2011). 2. At all times material to this Complaint, Respondent was a licensed physician within the State of Florida, having been issued license number ME 18474. Filed April 4, 2012 3:12 PM Division of Administrative Hearings 3. At all times material to this Complaint, owned and operated a family practice medical clinic (the clinic) in Macclenny, Florida, but was not board certified in any specialty. 4. Respondent’s address of record is 31 South Fifth Street, Macclenny, Florida 32063. 5. Respondent employs both licensed registered nurses and untrained staff at the clinic. This staff includes: A.S. and T.D., who possess licenses to practice as registered nurses in the State of Florida; and L.D., V.A. and C.A., who possess no healthcare licenses and little-to-no medical training. Treatment of Patients by A.S. 6. A.S. has worked for Respondent for about one year. She is a licensed registered nurse in the State of Florida and has been for approximately 15 years. A.S.’s duties at the clinic include documenting patients’ vitals signs and chief complaints, reviewing patients’ medical histories and addressing any problems they may have. In certain situation, A.S. determines which medications should be prescribed to patients and enters this information in the computer system before Respondent sees patients. These situations include those when patients have no changes in their conditions. A.S. spends approximately ten to twenty minutes with each patient she sees, while Respondent spends five to ten minutes with each patient. She typically sees between 13 and 17 patients per day. AS. also obtains refills of her husband’s medication without her husband seeing Respondent and sometimes without generating medical records for the refills. Treatment of Patients by L.D. 7. L.D. worked for Respondent from January 2010 through August 2011, as a “medical technician,” but possessed no type of healthcare licensure. L.D. has an Associate of Arts degree and an Associate of Science degree in legal studies. She claims to have completed a two-week classroom program to become a certified nursing assistant (CNA) and worked under supervision at St. Luke’s Hospital in Jacksonville, Florida, but she left the program before she earned her licensure. According to L.D., Respondent treated his unlicensed staff as nurse practitioners working under his direction and referred to them as “nurses” and the patients believed the employees were all licensed nurses. 8. L.D. was assigned her own exam room at Respondent’s clinic. Her duties primarily consisted of checking patients’ blood pressure and pulse, documenting patients’ complaints or reasons for their visits, reviewing patients’ current medications and test results and recommending treatment, dosages and medication adjustments based on test results. L.D. typically entered prescriptions into the clinic’s electronic database, after she made prescribing decisions, so that staff could print the prescriptions and have Respondent sign them. Sometimes L.D. saw multiple patients, including sets of friends or family members, at the same time. Dr. Scarborough met with patients in L.D.’s examination room, but only examined about half of the patients. It was especially common for Respondent not to examine all of the patients when multiple patients were present in L.D.’s exam room at the same time. 9. On some occasions, L.D. prescribed medications without Respondent examining patients or Respondent took action based only on L.D.’s interpretation of lab results or her summary of the patients’ complaints. In a sworn interview with Florida Department of Law Enforcement (FDLE) agents, L.D. referred to Respondent “seeing [her] patients” as though she had her own set of patients. L.D. also described Respondent as “slow” in his treatment of patients and stated that he would “skip a few corners.” The length of time that Respondent spent with “L.D.’s patients” depended on each patient’s situation. 10. L.D. administered injections, including Vitamin B12 injections, to patients at the clinic. Respondent instructed L.D. and other employees to inject the patients as required. However, L.D. admitted that her CNA training never included instructions on how to administer injections and Respondent never taught her how to do so either. Treatment of Patients by V.A. 11. V.A. began working for Respondent in October 2003 as a receptionist. Since then, she has also worked as the office manager of the clinic and as a medical assistant. V.A. had no medical training other than an at-home medical assistant course through Penn and Foster, for which she received no certificate or licensure. However, Respondent refers to V.A. as a nurse practitioner and tells patients that she is a nurse. 12. Shortly after V.A. began working at the clinic, Respondent began having her work with patients in an exam room. V.A.’s duties included taking patients’ blood pressure, reviewing patients’ current medications and writing out orders for X-rays and lab work. V.A. also reviewed and interpreted lab results and patients’ statements regarding their medical conditions and made recommendations based on those interpretations. For example, if V.A. saw that a patient’s lab results reflected high cholesterol, she would enter a prescription for cholesterol-lowering medication into the computer system so that Respondent only had to print it and sign it. Respondent sometimes reviewed the lab data himself, but often made treatment and prescribing decisions based on V.A.’s interpretations alone. V.A. also administered intramuscular injections, including Vitamin B12 and testosterone injections, to patients at the clinic. 13. V.A. saw between 12 and 20 patients per day. In a sworn interview with FDLE Agents, V.A. stated that she did not make recommendations for medication adjustments for patients that Respondent failed to see at all, but she regularly was the only person who saw recurring patients who only needed refills on their routine medications. Respondent would simply sign prescriptions for these patients without seeing them. V.A. stated that many of these patients were taking Lortab and Percocet as “just about everyone of [Respondent’s] patients” took pain medication. According to V.A., Respondent routinely failed to see about 25% of the patients. However, on a particular day just prior to Christmas 2009, V.A. saw 40 patients, all of whom needed refills on pain medications and none of whom saw Respondent. 14. Lortab is the brand name for a drug that contains hydrocodone and is prescribed to treat pain. According to Section 893.03(3), Florida Statutes (2010- 2011), hydrocodone, in the dosages found in Lortab, is a Schedule III controlled substance that has a potential for abuse less than the substances in Schedules I and II and has a currently accepted medical use in treatment in the United States. Abuse of hydrocodone may lead to moderate or low physical dependence or high psychological dependence. 15. Percocet is the brand name for a drug that contains oxycodone and is 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. 16. Starting in approximately January 2011, Respondent instructed V.A. to start seeing his patients at Macclenny Nursing and Rehabilitation (Macclenny Nursing), a nursing home, as he stated that he did not always have time to see them. On most weekday afternoons, V.A. went to Macclenny Nursing to review patients’ charts and lab results and to speak to the patients about any medical complaints they had. If patients needed medication adjustments, V.A. would sometimes call Respondent from Macclenny Nursing. However, the course of treatment Respondent implemented was based on V.A.’s examination of the patients, V.A.’s evaluation of the patients’ lab results and records and, often, V.A.’s recommendations. If V.A. did not speak to Respondent about a particular patient while at Macclenny Nursing, she typed up a medical record, briefed the doctor and made recommendations for treatment upon her return to the clinic. On average, V.A. saw four to five patients per day at Macclenny Nursing. Respondent went to Macclenny Nursing to see his patients within 24 hours of V.A. seeing them because Macclenny Nursing had a strict requirement that the patients be seen by a doctor. However, during a sworn interview with FDLE agents, V.A. could not recall any instances where Respondent disagreed with her “diagnosis or treatment” recommendations. 17. According to V.A., staff at Macclenny Nursing or a home health agency sometimes called the clinic regarding the results of a patient’s PT/INR test (a test to determine the clotting levels of blood). In those instances, V.A. took the phone call and made the determination to adjust the patients’ Coumadin prescriptions and only told Respondent she had done so after the fact. Initially, when these calls came in to the clinic, V.A. took the call, consulted with Respondent, and relayed the information to caller. On one occasion, staff at Macclenny Nursing called the clinic regarding Patient M.R., who was experiencing a urinary tract infection. Respondent instructed V.A. to “just prescribe something” and V.A. prescribed Cipro. On another occasion, staff at Macclenny Nursing called to report that a patient’s Coumadin level was low. V.A. instructed the staff to increase the dosage and only later informed Respondent of the conversation. Respondent told her that she had made the right decision, and, from that point on, he allowed her to adjust medications on her own. 18. Coumadin is a brand name for warfarin and is a drug used to prevent blood clots from forming or worsening. Coumadin is a legend drug, but not a controlled substance. 19. Cipro is a brand name for ciproflaxin and is an antibiotic used to treat infections, including urinary tract infections. Cipro is a legend drug, but not a controlled substance. Treatment of Patients by C.A. 20. C.A. is V.A.’s twenty-one-year-old daughter. She began working at Respondent’s clinic when she was thirteen and worked there until September 2011. C.A. only completed school through tenth grade, does not have a GED and has no medical training whatsoever. However, Respondent referred to her as a “nurse,” just as he did with his other unlicensed staff. 21. C.A.’s duties included taking patients’ vitals, reading patients’ lab results and talking to patients about their complaints. When patients came to the clinic for refills on their medications, C.A. entered the prescriptions into the computer database and Respondent would sign the prescriptions once staff printed them. According to C.A., Respondent changed prescriptions that C.A. wrote about twice per day. C.A. saw approximately 15 to 30 patients per day, which amounted to approximately half of the total patients seen at the clinic each day. Respondent did not always examine all of the patients that C.A. saw. Sometimes, he would simply enter C.A.’s exam room, make “small talk” with the patients and then leave. C.A. also administered intramuscular injections, including B12 and testosterone, approximately three days per week. Comprehensive Findings of Fact 22. According to C.A., patients often come to the clinic 30 to 45 minutes before Respondent arrives so that they can be evaluated and waiting for him upon his arrival. On some occasions, patients enter the clinic through the back door of the building, instead of entering through the patient entrance, and see Respondent without a record to document their visits. Other patients have their family members see Respondent on their behalf. Respondent regularly receives calls on his cell phone and instructs employees to contact pharmacies and order prescriptions for patients. For some of these instances, Respondent instructs staff to generate medical records for patients who did not visit the office as though they had presented to the office for examinations. In those instances, staff enters artificial blood pressure readings and other information for the patients into fictitious medical records so that the patients’ insurance companies can be billed for visits that did not occur. 23. It is especially common for Respondent to write prescriptions or give samples to employees’ family members without requiring them to present for an office visit. For example, Dr. Scaborough prescribed medications for L.D.’s sister-in-law, M.B., or L.D.’s husband, M.B.D., without seeing them. L.D. would simply ask Respondent to prescribe medications for them without having them come to the clinic. On one instance, M.B. was suffering from dental pain and L.D. spoke to Respondent, who prescribed Lortab for M.B. without any contact with M.B. and without generating any medical record for the incident. 24. On another instance, L.D. asked Respondent for a prescription for 10 Xanax for M.B.D. Respondent approved it even though it had been several months since M.B.D.’s last visit with Respondent, and L.D. had it filled at a local pharmacy. 25. Xanax is the brand name for alprazolam and is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes (2010-2011), alprazolam 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 alprazolam may lead to limited physical or psychological dependence relative to the substances in Schedule III. 26. Respondent pushes his staff to move through patient visits extremely quickly. He used to tell his staff that he needed to see 40 patients per day to “make payroll.” After he hired T.D., he began stating that he needed to see 60 patients per day to “make payroll.” He also told staff that treating the patients was not “rocket science.” During a sworn interview with FDLE agents, V.A. stated that when she asked Respondent to see patients for whom he already signed prescriptions he said, “I’ve already signed your patient’s scripts, get ‘em out and get another one in there.” Several times, V.A. told the clinic receptionists not to schedule new patients due to the large volume of patients in the clinic, but Respondent countermanded her each time. Instead, he instructed the receptionists that they were definitely seeing new patients with the “good insurance.” 27. Ona particular day in early 2011, Respondent was ill and unable to see any patients at all. He spent the entire day lying down in his office. V.A. and AS. saw all of the patients that day and only consulted with Respondent to have him sign the prescriptions for the patients. According to V.A., Respondent did not know what he was signing. On that date, V.A. also saw one patient with a new complaint that consisted of an ulcerated leg wound for which V.A. recommended treatment and prescribed antibiotics. 28. On or about April 5, 2011, Baker County Sheriff’s Deputy RS. (Deputy R.S.) initiated a traffic stop on C.L.', a twenty-year-old male, who was driving recklessly. Upon stopping the vehicle, Deputy R.S. asked C.L. for consent to search the vehicle, but C.L. refused consent. Shortly thereafter, C-.K., a K-9 officer with the Florida Department of Transportation, arrived and utilized his K-9 to perform an exterior search of C.L.’s vehicle. The K-9 alerted on the driver’s door of C.L.’s vehicle and a subsequent search of the interior of the vehicle revealed small bag containing approximately four grams of marijuana, a ten ml vial labeled “testosterone’” and approximately seven smaller vials labeled “Ommnadren.” C.L. told Deputy R.S. that he had a prescription for the “testosterone,” but stated that he purchased the “Omnadren” on the internet. ' C.L.’s mother is a former employee of Respondent. Deputy R.S. arrested C.L. for possession of the “testosterone” and “Ommnadren” without a prescription and possession of marijuana and booked him into the Baker County Detention Center (BCDC). According to Deputy R.S., the labels on the vials of “testosterone” and “Omnadren” did not contain the information typically found on prescription medication, including the name and birthday of the individual who received the prescription, the name of the prescribing physician and the name of the dispensing pharmacy. 29. Testerone and Omnadren are anabolic-androgenic steroids. Anabolic- androgenic steroids are steroid compounds, including testosterone and its synthetic relatives that possess anabolic and androgenic effects. Anabolics have the effect of building lean muscle mass, and androgens express male secondary sexual characteristics. Steroid users consume anabolic-androgenic steroids for their anabolic effects, but the androgenic effects are generally responsible for adverse reactions. Common adverse reactions include profound effects on the cardiovascular system, the liver, the musculoskeletal system, the hematological system, and the male and female reproductive systems. Several studies have also reported an association between anabolic-androgenic steroids and serious psychological problems, including psychosis, mania, hyperaggressiveness, and > The contents of the this vial were later identified as “Sustanon,” which is a trade name for a combination of four testosterone-based compounds that is not legally available in the United States and is not approved by the United States Food and Drug Administration for treatment of any conditions. dependency. 30. According to Section 893.03(3), Florida Statutes (2010-2011), anabolic steroids are Schedule III controlled substances that have a potential for abuse less than the substances contained in Schedules I and II. However, abuse of Schedule III substances may lead to moderate or low physical dependence or high psychological dependence, or, in the case of anabolic steroids, may lead to physical damage. 31. Upon his release from BCDC, C.L. went to the home of V.A., advised her that he had been arrested for possession of steroids and asked her for assistance in having the charges dismissed and having the steroids released from the Sheriff’s Department. V.A. spoke with Respondent and then directed C.L. to go to Respondent’s office. Upon arriving at Respondent's office, C.L. entered the exam room used by L.D. L.D., A.S. and Respondent entered the room and C.L. explained to Respondent that he had been arrested for possession of steroids, including Sustanon. C.L. lied to Respondent and stated that Sustanon was legal to possess and utilize. C.L. also stated that if he could show the State Attorney that he had a prescription for Sustanon, then the State Attorney would dismiss the possession charge. 32. Respondent initially instructed V.A. to research a medical condition called gynecomastia (benign enlargement of the male breast) and to research Sustanon, including what it is, what it does, and how it is to be prescribed. However, V.A. had to leave the clinic to see patients at Macclenny Nursing and Respondent instructed L.D. to complete the research. Respondent also instructed L.D. to generate a medical record for C.L. pertaining to treatment for gynecomastia and backdate that record so that it appeared that Respondent had been treating C.L. on an ongoing basis. 33. L.D. researched Sustanon and determined that it is used as an estrogen blocker and is commonly utilized by weightlifters. L.D. subsequently created a medical record that indicated C.L. was seen at Respondent’s clinic on Saturday, January 8, 2011, a date on which the clinic was closed. The contents of the medical record stated that C.L. came into the clinic and explained that he was “growing breasts” as a result of working out. The medical record also contains a lengthy explanation regarding gyencomastia and the use of tamoxifen (an estrogen blocker) and Sustanon to treat that condition. L:D. cut-and-pasted this explanation from the internet. The medical record further states that Respondent prescribed Sustanon 300 mg/1 cc, injected intramuscularly once per week, to C.L. Dr. Scarborough reviewed the medical record and advised L.D. what information to add or delete from it. 34. Respondent also directed his staff to generate a prescription for Sustanon as though he had prescribed it to C.L. Respondent normally issued 15 electronically-generated prescriptions, but A.S. handwrote the Sustanon prescription because she could not locate Sustanon in any of the drug databases at the clinic. Respondent signed the prescription. 35. C.L. returned to Respondent’s office on or about April 7, 2011, and L.D. handed him the handwritten prescription for Sustanon, which was dated April 5, 2011, and a patient record that fraudulently documented treatment that never occurred, V.A. and other staff overheard Respondent tell C.L. that he could “get into trouble” or lose his medical license if anyone found out what he had done. C.L. provided copies of these documents to his attorney who provided them to the State Attorney. The State Attorney dropped the steroid possession charges against C.L. and had the Baker County Sheriff’s Department release the Sustanon to C.L. 36. On or about September 30, 2011, C.L. stated, under oath, to FDLE Agents that he was not seen at the clinic on January 8, 2011 and that he purchased the Sustanon from “someone in Georgia.” COUNT I 37. Petitioner realleges and incorporates paragraphs 1 through 36 as if fully set forth herein. 38. Section 458.331(1)(f), Florida Statutes (2010-2011), subjects a licensee to discipline for aiding, assisting, procuring, or advising any unlicensed person to practice medicine contrary to Chapter 458, Florida Statutes (2010-2011) or to a rule of the department or the board. 39. Respondent aided, assisted, procured, or advised an unlicensed person to practice medicine contrary to Chapter 458, Florida Statutes (2010-2011) or to a rule of the department or the board in one or more of the following manners: a. By allowing or encouraging unlicensed staff, including L.D., V.A. and C.A. to make recommendations for treatment of patients; b. By allowing or encouraging unlicensed staff, including L.D., V.A. and C.A. to prescribe medications to patients; and/or c. By allowing or encouraging unlicensed staff, including L.D., V.A. and C.A. to administer injections to patients. 40. Based on the foregoing, Respondent violated Section 458.331(1)(), Florida Statutes (2010-2011), by aiding, assisting, procuring, or advising any unlicensed person to practice medicine contrary to Chapter 458, Florida Stautes (2010-2011), or to a rule of the department or the board. COUNT TWO 41. Petitioner realleges and incorporates paragraphs 1 through 36 as if fully set forth herein. 42. Section 458.331(1)(w), Florida Statutes (2010-2011), subjects a licensee to discipline for delegating professional responsibilities to a person when 17 the licensee delegating such responsibilities knows or has reason to know that such person is not qualified by training, experience, or licensure to perform them. 43. Respondent delegated professional responsibilities to a person when Respondent knew or had reason to know that such person was not qualified by training, experience, or licensure to perform them in one or more of the following manners: a. By allowing or encouraging unlicensed staff, including L.D., V.A. and C.A. to make recommendations for treatment of patients, b. By allowing or encouraging unlicensed staff, including L.D., V.A. and C.A. to prescribe medications to patients; and/or c. By allowing or encouraging unlicensed staff, including L.D., V.A. and C.A. to administer injections to patients. 44. Based on the foregoing, Respondent violated Section 458.331(1)(w), Florida Statutes (2010-2011), by delegating professional responsibilities to a person when Respondent knew or had reason to know that such person was not qualified by training, experience, or licensure to perform them. COUNT THREE 45. Petitioner realleges and incorporates paragraphs 1 through 36 as if fully set forth herein. 46. Section 458.331(1)(k), Florida Statutes (2010-2011), subjects a licensee to discipline for making deceptive, untrue, or fraudulent representations 18 in or related to the practice of medicine or employing a trick or scheme in the practice of medicine. 47. Respondent made deceptive, untrue, or fraudulent representations in or related to the practice of medicine or employed a trick or scheme in the practice of medicine in one or more of the following manners: a. By directing his office staff, including L.D., V.A. and A.S. to fabricate a medical record to make it appear that Respondent treated C.L. for gynecomastia; and/or b. By directing his office staff, including L-D., V.A. and A.S. to write a prescription for Sustanon for C.L. 48. Based on the foregoing, Respondent violated Section 458.331(1)(k), Florida Statutes (2010-2011), by making deceptive, untrue, or fraudulent representations in or related to the practice of medicine or employing a trick or scheme in the practice of medicine. COUNT FOUR 49. Petitioner realleges and incorporates paragraphs 1 through 36 as if fully set forth herein. 50. Section 458.331(1)(q), Florida Statutes (2010-2011), provides that 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. There is a legal presumption 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. 51. Respondent prescribed, dispensed, administered, mixed, or otherwise prepared legend drugs, including controlled substances, other than in the course of his professional practice by prescribing Sustanon, an anabolic-androgenic steroid which is illegal in the United States, to CLL. 52. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2009-2010), by prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of his professional practice. COUNT FIVE 53. Petitioner realleges and incorporates paragraphs 1 through 36 as if fully set forth herein. 54. Section 458.331(1)(u), Florida Statutes (2010-2011), subjects a licensee to discipline, including suspension, for performing any procedure or prescribing any therapy which, by the prevailing standards of medical practice in the community, would constitute experimentation on a human subject, without first obtaining full, informed, and written consent. 20 55. Respondent prescribed a therapy which, by the prevailing standards of medical practice in the community, would constitute experimentation on a human subject, without first obtaining full, informed, and written consent, by prescribing Sustanon, a therapy which is illegal in the United States, to C.L. 56. Based on the foregoing, Respondent has violated Section 458.331(1)(u), Florida Statutes (2010-2011), by prescribing a therapy which, by the prevailing standards of medical practice in the community, would constitute experimentation on a human subject, without first obtaining full, informed, and written consent. COUNT SIX 57. Petitioner realleges and incorporates paragraphs 1 through 36 as if fully set forth herein. 58. Section 458.331(1)(v), Florida Statutes (2010-2011), subjects a licensee to discipline, including suspension, for practicing or offering to practice beyond the scope permitted by law or accepting and performing responsibilities which the licensee knows or had reason to know that her or she is not competent to perform. 59. Respondent practiced beyond the scope permitted by law by prescribing Sustanon, an anabolic-androgenic steroid which is illegal in the United States, to C.L. 21 60. Based on the foregoing, Respondent had violated Section 458.331(1)(u), Florida Statutes (2010-2011), by practicing beyond the scope permitted by law. 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 2S day of OCW 2011. H. Frank Farmer, Its MD, PhD, FACP FILED DEPARTMENT OF HEALTH Assistant General Counsel cerK eae CLERK DOH Prosecution Services Unit ander: i DATE 10 ven s 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar # 21640 (850) 245-4640 ext. 8141 (850) 245-4681 FAX JLF/ PCP: October 28, 2011 PCP Members: Dr. El-Bahri; Dr. Tucker; Mr. Levine DOH V. CHARLES D. SCARBOROUGH, M.D. Case No. 2011-15211 22 DOH V. CHARLES D. SCARBOROUGH, M.D. Case No. 2011-15211 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. 23

Docket for Case No: 12-001199PL