| | Ae Gk c STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, | PETITIONER, v. . CASE NO: 2009-24467 ASTRID ALEJANDRA FEBRE, 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, Astrid Alejandra Febre, 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; Chapter 456, Florida Statutes; and Chapter 458, Florida Statutes. 2. At all times material to this Complaint, Respondent was a licensed physician within the State of Florida, having been issued license number ME 57871. Astrid Alejandra Febre, M.D. Case No. 2009-24467 Filed May 22, 2012 10:47 AM Division of Administrative Hearings 3. Respondent’s address of record is 175 NW 121* Street, North Miami, Florida 33168. 4. 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. 5. Xanax is the brand name for alprazolam and is prescribed to . treat anxiety. According to Section 893.03(4), Florida Statutes, 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. 6. 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, oxycodone is a Schedule II controlled substance that has a high 2 Astrid Alejandra Febre, M.D. Case No. 2009-24467 | potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States, and abuse of oxycodone may lead to severe psychological or physical dependence. 7. Roxicodone contains oxycodone and is a Schedule II controlled substance, pursuant to Chapter 893, Florida Statutes. A substance in Schedule II has a high potential for abuse and has a currently accepted : but severely restricted medical use for the relief of moderate to severe pain. Abuse of the substance may lead to severe psychological or physical dependence. 8. Rule 64B8-9.013(3), Florida Administrative Code, 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 Astrid Alejandra Febre, M.D. Case No. 2009-24467 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 Patient 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. 9. Respondent prescribed percocet, xanax, roxicodone and oxycontin for RB, on the dates and in the strengths and quantities described in the following table: RB Alprazolam/Xanax Roxicodone Oxycontin Percocet 10/325 Mg. 2, Me. 15 Mg. & 30 Mg. 40 Mg. 4/7/2009 4/7/2009 4/7/2009 : 2 Mg. 30 Mg. 40 Mg. 60 Tablets 240 Tablets 60 Tablets | 4/8/2009 30 Mg. 120 Tablets 4/8/2009 30 Mg. 120 Tablets _| 6/1/2009 6/1/2009 10/325 Mg. 6/1/2009 6/1/2009 40 Mg. 210 Tablets 2 Mg. 30 Mg. 60 Tablets 60 Tablets 188 Tablets 6/1/2009 30 Mg. 52 Tablets Astrid Alejandra Febre, M.D. Case No, 2009-24467 Percocet 10/325 Mg. ate OMe. OOM. 6/29/2009 6/29/2009 6/29/2009 6/29/2009 10/325 Mg. 2 Mg. 30 Mg. 40 Mg. 210 Tablets 60 Tablets 40 Tablets 60 Tablets 6/29/2009 30 Mg. 200 Tablets 7127/2009 . 40 Mg. 712712009 7/27/2009 7/2712009 60 Tablets 10/325 Mg. 2 Mg. 30 Mg. 210 Tablets 60 Tablets 200 Tablets 7/27/2009 30 Mg. 40 Tablets 8/25/2009 8/25/2009 8/25/2009 8/25/2009 10/325 Mg. 2 Mg. 30 Mg. 40 Mg. 210 Tablets 60 Tablets 200 Tablets 30 Tablets 8/25/2009 8/25/2009 30 Mg. 40 Mg. . 40 Tablets 30 Tablets 9/22/2009 9/22/2009 9/22/2009 9/22/2009 10/325 Mg. 2 Mg. 30 Mg. 40 Mg. 210 Tablets 60 Tablets 200 Tablets 30 Tablets 9/22/2009 9/22/2009 30 Mg. 40 Mg. 40 Tablets 30 Tablets 10/20/2009 : 40 Mg. - 10/20/2009 10/20/2009 10/20/2009 30 Tablets 10/325 Mg. 2 Mg. 30 Mg. - 210 Tablets 60 Tablets 240 Tablets 10/20/2009 40 Mg. 30 Tablets Astrid Alejandra Febre, M.D. Case No. 2009-24467 Percocet 10/325 Mg. at ae a OMe. 12/7/2009 12/7/2009 12/7/2009 12/7/2009 10/325 Mg. 2 Mg. 30 Mg. 40 Mg. 120 Tablets 30 Tablets 210 Tablets 60 Tablets 2/3/2010 2/3/2010 2/3/2010 2/3/2010 10/325 Mg. 2 Mg. 30 Mg. 40 Mg. 120 Tablets 30 Tablets 240 Tablets 30 Tablets 2/3/2010 2/3/2010 30 Mg. 40 Mg. 210 Tablets 30 Tablets 4/27/2010 4/27/2010 4/27/2010 4/27/2010 10/325 Mg. 1 Mg. 30 Mg. 40 Mg. 120 Tablets ’ 30 Tablets 240 Tablets 30 Tablets 4/27/2010 40 Mg. 30 Tablets 10. The strengths and quantities of percocet, xanax, roxicodone and- oxycontin which Respondent prescribed were potentially lethal and were prescribed without justification and/or, without documenting justification in the medical record of patient RB. 11. Respondent did not refer or did not document a referral for RB to a psychiatrist, an orthopedic surgeon, a physical therapist, or an interventional pain management specialist. Astrid Alejandra Febre, M.D. Case No. 2009-24467 | 12. Respondent did not document or did not perform a complete medical history and physical exam on RB prior to prescribing a high dosage of opioids. | | 13. Respondent did not document or did not determine the following: a. The effect of pain on RB's physical or psychological function; b. Any history of substance abuse for RB; c. | Whether RB was taking the prescribed medications or whether RB was taking illicit drugs by performing any drug screens by an outside laboratory during the course of treatment; d. Obtaining any current diagnostic studies on RB; e. Obtaining any consultations from other specialists on RB; f. Counsel RB on the potential danger of addiction and abuse of the medication being prescribed. Astrid Alejandra Febre, M.D. Case No. 2009-24467 COUNT ONE 14. Petitioner realleges and incorporates paragraphs 1 through 13 as if fully set forth herein. 15. Section 458.331(1)(q), Florida Statutes (2009)(2010), subjects a licensee to discipline, including suspension, 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 purposes of this paragraph, it shall be legally presumed that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and is not in the course of the physician's professional practice, without regard to his intent. 16. Respondent prescribed controlled substances inappropriately or . in excessive or inappropriate quantities in one or more of the following “ways: a. By prescribing the controlled substances percocet, xanax, roxicodone and _ oxycontin without justification to patient RB, as outlined in paragraphs 1 through 13; Astrid Alejandra Febre, M.D. Case No. 2009-24467 ( b. — By prescribing the controlled substances, percocet, xanax, roxicodone and oxycontin in potentially ‘lethal doses to Patient RB, as outlined in paragraphs 1 through 13. 17. Based on the forgoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2009)(2010) when he prescribed the controlled substances, without justification and in potentially lethal doses, to patient RB, as outlined in paragraphs 1 through 13. | COUNT TWO , 18. Petitioner realleges and incorporates paragraphs 1 through 13 as if fully set forth herein. 19. Section 458.331(1)(m), Florida Statutes (2009)(2010), provides that failing to keep legible medical records 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, constitutes grounds for disciplinary action by the Board of Medicine. 20.. Respondent failed to keep legible medical records justifying the course of treatment for Patient RB in one or more of the following ways: Astrid Alejandra Febre, M-D. Case No. 2009-24467 | a. By failing to document justification for prescribing . percocet, xanax, roxicodone and oxycontin to RB; b. By failing to document referrals for RB to a psychiatrist, an orthopedic surgeon, a_ physical therapist, or an interventional pain specialist; c. _ By failing to document the effect of pain on RB's physical or psychological function ; d. By failing to document any history of substance abuse for RB; e. | By failing to document a medication management agreement on any visits but still prescribing controlled substances; f. By failing to document a urine drug screen from an outside laboratory on RB; g. By failing to document any current diagnostic studies on RB. 21. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2009)(2010), by failing to keep legible medical records that justify the course of treatment for Patient RB. Astrid Alejandra Febre, M.D. Case No. 2009-24467 COUNT THREE 22. Petitioner realleges and incorporates paragraphs 1 through 13 as if fully set forth herein. | 23. Section 458.331(1)(t), Florida Statutes (2009)(2010), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2009)(2010), 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. 24. Level of care, skill, and treatment recognized in general law related to health care licensure means the standard of care specified in Section 766.102. Section 766.102(1), Florida Statutes, defines the standard of care to mean“... The prevailing professional standard of care for a given health care provider shall be that level of care, skill, and treatment which, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers... .” . 25. Respondent failed to meet the required standard of care in one or more of the following ways: Astrid Alejandra Febre, M.D. Case No. 2009-24467 : | | | | | Astrid Alejandra Febre, M.D. Case No. 2009-24467 By prescribing percocet, xanax, roxicodone and oxycontin to RB without justification, as outlined in paragraphs i through 13; | By prescribing percocet, xanax, roxicodone and oxycontin to RB in potentially lethal doses, as outlined in paragraphs 1 through 13; By failing to refer RB to a_ psychiatrist, an orthopedic surgeon, a_ physical therapist, or an interventional pain specialist; By failing to obtain information on the effect of pain on RB's physical or psychological function; By failing to obtain any history of substance abuse for RB; By failing to obtain a urine drug screen from an -outside laboratory on RB; By failing to review or obtain any current diagnostic studies on RB. 26. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2009)(2010), by committing medical malpractice. COUNT FOUR 27. Petitioner reincorporates and realleges paragraphs 1 through 13 as if fully set forth herein. 28. Section 458.331(1)(nn), Florida Statutes (2009)(2010), 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. . 29. Respondent violated Section 458.331(1)(nn) Florida Statutes (2009)(2010) when he violated Rule 64B8-9.013(3), FAC in one or more of the following ways: a. By failing to document justification for prescribing percocet, xanax, roxicodone and oxycontin to RB; b. By failing to document referrals for RB to a psychiatrist, an orthopedic surgeon, a_ physical therapist, or an interventional pain specialist; Astrid Alejandra Febre, M.D. Case No. 2009-24467 c. By failing to document the effect of pain on RB's physical or psychological function; d. _By failing to document any history. of substance abuse for RB; e. By failing to document a medication management agreement on any visits but still prescribing controlled substances; f. By failing to document a urine drug screen from an outside laboratory on RB; g. _ By failing to document any current diagnostic studies on RB. 30. Based on the foregoing, Respondent has violated Section 458.331(1)(nn), Florida Statutes (2009)(2010), by violating Rule 64B8- 9.013(3), FAC. 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, Astrid Alejandra Febre, M.D. Case No. 2009-24467 . 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 32/day of Savikewher~ 2041. H. Frank Farmer, Jr, MD, PhD, FACP © State Surgeon General tee ee Tan Brown Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 eLED Tallahassee, FL 32399-3265 DEPARTMENT OF HEALTH Florida Bar # 499048 DEPUTY CLERK P- (850) 245-4640 F-(850) 245-4681 - ewe cLERK Angel Sanders DATE SEP 26 201 IB/jb PCP: September 23, 2011 PCP Members: El-Bahri, Rosenberg & Goersch Astrid Alejandra Febre, M.D. Case No. 2009-24467 | | | 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 counsei 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. Astrid Alejandra Febre, M.D. Case No. 2009-24467

Docket for Case No: 12-001858PL