v. CASE NO.: 2009-06547
RESPONDENT.
Petitioner, Department of Health files this Administrative Complaint before the Board of Medicine against the Respondent, John Anthousis, M.D., and in support thereof 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's ..address of record is 18552 Kingbird Drive, Lutz, Florida 33558.
Respondent holds no certifications recognized by the Boarq of Medicine.
At all times material to this complaint, Respondent practiced medicine at a clinic located at 2901 West. Busch Boulevard, Suite 601, Tampa, Florida 33618 (the "Clinic''). At various times material to this complaint, the Clinic was known as Bay Area Pain Clinic, LLC, Pain Management of Tampa, Inc., and Pain Management of Tampa, LLC.
Oxycodone is an opiate and a Schedule II controlled substance, as defined in Chapter 893, Florida Statutes, which is indicated for the relief of moderate to severe pain. Oxycodone 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. Roxicodone is a brand name for a medication containing oxycodone.
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 subst.ance 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 ps;ychologic I depenqence relative to the substances in Schedule III.
Hydrocodone is prescribed to treat pain. According to Section 893.03(3), Florida Statutes, hydrocodone 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, and abuse of the substance may lead to moderate or low physical dependence or high psychological dependence. Norco, Lorcet and Lortab are brand names for medications that contain hydrocodone.
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.
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.
While practicing at tbe Clinic, Patient TC, a Z6-year-oJd male,
presented to Respondent in May 2006 complaining of lower back pain, which Respondent diagnosed as being caused by herniated lumbar discs.
Respondent provided treatment to TC during a period from May 2006 through November 2008.
According to his records, in May 2006, Respondent prescribed to TC concurrent prescriptions of 150 oxycodone 15 mg and 120 carisoprodol 350 mg. Subsequently, Respondent replaced oxycodone 15 mg with oxycodone 30 mg, and varied the number of tablets prescribed from between 120 to 180 tablets per prescription. Respondent prescribed no oxycodone from October 2006 to May 2007.
According to his records, Respondent began prescribing 90 hydrocodone 7.5 mg to TC in August 2006. In December 2006, the dosage was raised to 10 mg hydrocodone per tablet. Respondent prescribed no hydrocodone from July 2007 to November 2008.
According to his records, in October 2006, Respondent began
prescribing 90 alprazolam 1 mg to TC. In November 2006, the dosage was raised to 2 mg per tablet, and the tablets prescribed were reduced to 30 and then raised to 60 tablets per prescription
According to his records_ Respondent began prescribing 90 methadone 10 mg to TC in March 2008. In April 2008, the tablets prescribed were raised to 120 per prescription, and in July 2008 to 180 per prescription.
The controlled substances, noted above, that were prescribed by Respondent were inappropriate for TC, and/or were prescribed in excessive and/or inappropriate quantities and/or combinations.
Respondent continued to prescribe to TC multiple prescriptions for the above-mentioned controlled substances that were inappropriate for MV, and/or were prescribed in excessive and/or inappropriate quantities and/or combinations during the remainder of the treatment period.
Respondent prescribed, and continued to prescribe to TC 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 TC
to a psychiatrist or any other medical specialist.
Respondent failed to perform any urine screens on TC, or take any other compliance measures.
OA at least two-occasions, Respondent prescribed two types_ of
immediate release opioids together without any justification.
'
On or about November 24, 2008, TC's mother phoned the Clinic, and advised that TC had taken all of the alprazolam he had been prescribed on November 17, 2008 in one week. She further advised that TC was an addict, and asked that he not be prescribed any more medication. Despite this warning, on November 26, 2008, Respondent prescribed 180 oxycodone 30 mg, 60 alprazolam 2 mg, and 180 methadone 10 mg.
TC was found dead at a construction site near his home on November 30, 2008, having passed away sometime earlier. TC was 29 years-old at the time of his death.
The cause of death was determined to be multiple drug intoxication. Postmortem blood toxicology revealed measurable amounts of ethanol, alprazolam, methadone, oxycodone and oxymorphone, along with trace amounts of sertraline and desmethylsertraline.
COUNT ONE.
Section 458.331(1)(q), Florida Statutes
Petitioner realleges and incorporates paragraphs one (1) through twenty-five (25) above, as if fully set forth herein.
Section 458.331(1)(q), Florida Statutes (2006-2008), 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 e.xcessive 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.
Respondent prescribed the controlled substances oxycodone, carisoprodol, hydrocodone, alprazolam and methadone to TC inappropriately or in excessive or inappropriate quantities.
Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2006-2008) by inappropriate and excessive prescribing.
COUNT TWO
Section 458.331(1)(t), Florida Statutes
Petitioner realleges and incorporates paragraphs one (1) through twenty-five (25) above, as if fully set forth herein.
Section 458.331(1)(t), Florida Statutes (2006-2008), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes (2006-2008). Section 456.50 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.
The 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 " . . . [t]he 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. "
3J. -Respondent failed to meet the req1.Jired s.tandard of care in his treatment of TC. Respondent's actions and inactions include, but are not limited to, one or more of the following:
prescribing controlled substances without adequate justification;
prescribing controlled substances without performing a drug screen or taking any other compliance measures;
prescribing excessive doses of oxycodone for breakthrough pain;
prescribing a high dosage of alprazolam to TC without referring him to a psychiatrist, and without first prescribing a medication indicated for general anxiety disorders;
failing to refer TC to any medical specialist;
failing to obtain any diagnostic studies on TC which would justify the strengths and quantities of the medications prescribed;
failing to properly respond to TC's November 26, 2008, claim that his medications had been accidentally destroyed;
prescribing two types of immediate release opioids together without any justification; and
failing to properly respond to the telephone call from TC's
, mother on or about November 24, 2008.
34. Based on the foregoing, Respondent has violated Section 458.331(1)(t), Florida Statutes (2006-2008), 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 any other relief that the Board deems appropriate.
JOHN H. ARMSTRONG, MD
VERONICA E. DONNELLY
H. S FFOR
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.
