Respondent.
Petitioner, Department of Health, files this Administrative Complaint before the Board of Medicine against the Respondent, John Anthousis, M.D., and alleges:
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.
At all times material to this complaint, Respondent was a licensed physician within the State of Florida, having been issued license number 39480.
Respondent holds no certifications recognized by the Board of Medicine.
Filed December 27, 2012 3:26 PM Division of Administrative Hearings
Respondent's address of record is 18552 Kingbird Drive, Lutz, Florida 33558.
At all times material to this complaint, Respondent practiced medicine at Pain Management of Tampa, LLC.
While practicing at Pain Management of Tampa, LLC, respondent prescribed excessive and inappropriate quantities and/or combinations of oxycodone, morphine, alprazolam, carisoprodol, methadone, hydromorphone, temazepam to his patients.
Oxycodone is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, oxycodone is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States, and abuse of oxycodone may lead to severe psychological or physical dependence. Oxycontin and Roxicodone are brand names of medications containing oxycodone.
Morphine is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, morphine 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 morphine may lead to severe psychological or physical dependence.
Alprazolam 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.
carisoprodol is a muscle relaxant commonly prescribed to treat muscular pain. According to Section 893.03(4), Florida Statutes, carisoprodol is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States. Abuse of carisoprodol may lead to limited physical or psychological dependence relative to the substances in Schedule III.
Methadone is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, methadone is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States, and
abuse of methadone may lead to severe psychological or physical dependence.
Hydromorphone is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, hydromorphone 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 hydromorphone may lead to severe psychological or physical dependence.
Temazepam is prescribed to treat insomnia. According to Section 893.03(4), Florida Statutes, temazepam 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 temazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III.
FACTS SPECIFIC TO PATIENT DR
DR presented to Respondent in May 2008 as a 43-year-old male assessed with lower back pain and radiculopathy.
Respondent provided treatment to DR during a period from May 2008 to at least June 2009.
In May 2008, Respondent prescribed to DR concurrent prescriptions of 120 carisoprodol 350 mg, 90 alprazolam 2mg, 60 Oxycontin 40 mg, 210 Roxicodone 30 mg, and 30 temazepam 30.
Respondent continued to prescribe to DR multiple prescriptions for the above-mentioned controlled substances in excessive and/or inappropriate quantities and/or combinations during the remainder of the treatment period.
In August 2008, Respondent began prescribing 90 methadone
10 mg to DR. At the same time, Respondent discontinued prescribing Oxycontin. Respondent later increased the number of methadone pills to 120.
Respondent prescribed, and continued to prescribe to DR the above-mentioned controlled substances without adequate justification or without documenting adequate justification in the medical record.
Respondent did not refer or did not document a referral for DR to a psychiatrist or any other specialist.
Respondent did not develop a treatment plan for DR, or the
medical records maintained by Respondent did not completely document and justify the course of treatment utilized in the care of DR.
FACTS SPECIFIC TO PATIENT DB
DB presented to Respondent in September 2008 as a 54-year old male complaining of neck pain.
Respondent provided treatment to DB during a period from September 2008 to June 2009.
In September 2008, Respondent prescribed to DB concurrent prescriptions of 90 carisoprodol 350 mg, 180 hydromorphone 8 mg, and 230 oxycodone 30 mg.
Respondent continued to prescribe to DB multiple prescriptions for the above-mentioned controlled substances in excessive and/or inappropriate quantities and/or combinations during the remainder of the treatment period.
Respondent prescribed, and continued to prescribe to DB the above-mentioned controlled substances without adequate justification or without documenting adequate justification in the medical record.
Respondent did not develop a treatment plan for DB, or the medical records maintained by Respondent did not completely document and justify the course of treatment utilized in the care of DB.
Respondent concurrently prescribed large doses of two short acting opioids to DB without adequate justification.
FACTS RELATING TO PATIENT JC
JC presented to Respondent in January 2008 as a 46-year-old male complaining of chronic lower back pain as well as chronic pain resulting from a gun shot wound to his left ankle.
Respondent provided treatment to JC during a period from January 2008 to July 2009.
In January 2008, Respondent prescribed to JC concurrent prescriptions of 360 methadone 10 mg, 210 hydromorphone 4 mg, 120 alprazolam 2 mg, and 210 oxycodone 30 mg.
Respondent continued to prescribe to JC multiple prescriptions for the above-mentioned controlled substances in excessive and/or inappropriate quantities and/or combinations during the remainder of the treatment period.
Respondent prescribed, and continued to prescribe to JC the above-mentioned controlled substances without adequate justification or without documenting adequate justification in the medical record.
Respondent did not develop a treatment plan for DB, or the medical records maintained by Respondent did not completely document and justify the course of treatment utilized in the care of DB.
Respondent concurrently prescribed doses of two short-acting controlled analgesics, hydromorphone and oxycodone, to JC inappropriately, and without adequate justification.
Respondent did not refer or did not document a referral for JC to a psychiatrist or any other specialist.
Respondent did not develop a treatment plan for JC or the medical records maintained by Respondent did not completely document and justify the course of treatment utilized in the care of JC.
FACTS SPECIFIC TO PATIENT KG
KG presented to Respondent in January 2008 as a 28-year-old male complaining of chronic pain in his right knee.
Respondent provided treatment to KG during a period from January 2008 to December 2008.
In January 2008, Respondent prescribed to KG concurrent prescriptions of 90 carisoprodol 350 mg, 30 alprazolam 2 mg, and 150
oxycodone 30 mg. Beginning in April 2008, Respondent prescribed morphine to KG.
Respondent continued to prescribe to KG multiple prescriptions of the above-mentioned controlled substances in excessive and/or inappropriate quantities and/or combinations during the remainder of the treatment period.
In April 2008, Respondent added 60 morphine 30 mg to KG's prescription mix.
Respondent prescribed, and continued to prescribe to KG the above-mentioned controlled substances without adequate justification or without documenting adequate justification in the medical record.
Respondent did not develop a treatment plan for KG, or the medical records maintained by Respondent did not completely document and justify the course of treatment utilized in the care of KG.
Respondent did not refer or did not document a referral for KG
to orthopedics or any other specialty.
FACTS SPECIFIC TO PATIENT MW
MW presented to Respondent in April 2008 as a 38-year-old female complaining of chronic lower back pain.
Respondent provided treatment to MW during a period from April 2008 to at least August 2009.
In April 2008, Respondent prescribed to MW concurrent prescriptions of 120 carisoprodol 350 mg, 90 Oxycontin 80 mg, 180 oxycodone 30 mg, and 90 alprazolam 1 mg.
Respondent continued to prescribe to MW multiple prescriptions for the above-mentioned controlled substances in excessive and/or inappropriate quantities and/or combinations during the remainder of the treatment period.
Respondent prescribed, and continued to prescribe to MW the above-mentioned controlled substances without adequate justification or without documenting adequate justification in the medical record.
Respondent did not develop a treatment plan for MW, or the medical records maintained by Respondent did not completely document and justify the course of treatment utilized in the care of MW.
Respondent did not refer or did not document a referral for MW to a psychiatrist or other specialist.
Respondent did not document or did not determine whether MW was taking the prescribed medications or whether MW was taking illicit
drugs by performing any drug screens or taking any other compliance measures during the course of treatment of MW.
COUNT ONE
Section 458.331(1)(q), Florida Statutes (Patients DR, DB, JC, KG and MW)
Petitioner realleges and incorporates paragraphs one (1) through fifty-two (52) as if fully set forth herein.
Section 458.331(1)(q), Florida Statutes (2007-2008), 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.
During the treatment period, Respondent prescribed controlled substances to patients DR, DB, JC, KG, and MW inappropriately and or in excessive or inappropriate quantities and or combinations.
Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2007-2008).
COUNT TWO
Section 458.331(1)(m), Florida Statutes (Patients DB, JC, KG and MW)
Petitioner realleges and incorporates paragraphs one (1) through fourteen (14) and twenty-two (20) through fifty-three (53) as if fully set forth herein.
Section 458.331(1)(m), Florida Statutes (2007-2008), 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.
Respondent failed to keep legible medical records justifying the course of treatment for Patients DB, JC, KG and MW by failing to document justification for prescribing controlled substances.
Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2007-2008), by failing to keep legible medical records that justify the course of treatment for Patients DB, JC, KG and MW.
COUNT THREE
Section 458.331(1)(t), Florida Statutes (Patients DR, DB, JC, KG and MW)
Petitioner realleges and incorporates paragraphs one (1) through fifty-three (53) as if fully set forth herein.
Section 458.331(1)(t)1, Florida Statutes (2007-2008), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes (2007-2008). Section 456.50, Florida Statutes, 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.
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 "
Respondent failed to meet the required standard of care in his treatment of DR, DB, JC, KG and MW in one or more of the following ways:
By prescribing controlled substances without justification;
by prescribing excessive doses of breakthrough medication;
by prescribing concurrent doses of short acting analgesics inappropriately, and without adequate justification;
by failing to refer DR, DB, JC, KG and MW to a psychiatrist or other appropriate medical specialist; and
by prescribing controlled substances to DR, DB, JC, KG and MW without performing a drug screen or taking any other compliance measures.
Based on the foregoing, Respondent has violated Section 458.331(1)(t)1, Florida Statutes (2007-2008), by committing medical malpractice.
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 or any other relief that the Board deems appropriate.
JOHN H. ARMSTRONG, MD
VERONICA E. DONNELLY
H. STAFFOR
Assistant General Counsel Fla. Bar No. 70394
Florida Department of Health Office of the General Counsel 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265
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.
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.
