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 Board 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, the Clinic was known as Pain Management of Tampa, Inc., and Pain Management of Tampa, LLC.
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.
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.
Oxycodone 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.
Oxycodone HCL IR 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. Roxicodone is a brand name for Oxycodone HCL IR.
Morphine is an opioid agonist and a Schedule II controlled substance, pursuant to Chapter 893, Florida Statutes. Morphine 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.
Oxycodone HCL ER 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. Oxycodone HCL ER 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. Oxycontin is a brand name for ox:ycodone HCL ER.
While practicing at the Clinic, Patient MD, a 21-year-old male
presented to Respondent in June 2008 complaining of lower back pain.
Respondent provided treatment to MD during a period from June 2008 through August 2009.
According to his records, in June 2008, Respondent prescribed to MD concurrent prescriptions of 90 carisoprodol 350 mg, 60 alprazolam 1 mg, 120 oxycodone HCL IR 15 mg, 60 morphine sulfate 30 mg. In July 2008, Respondent discontinued the morphine sulfate, and added 60 oxycodone HCL ER 20 mg to MD's prescription mix.
Also according to his records, Respondent increased the
number of tablets of oxycodone HCL IR 15 mg prescribed to MD from 120 to 180, and in March 2009, began prescribing 120 oxycodone HCL IR 30 mg.
Finally, according to his records, Respondent increased the
dosage of each tablet of oxycodone HCL ER prescribed to MD from 20 mg to 40 mg.
The controlled substances, noted above, that were prescribed by Respondent were inappropriate for MD, and/or were prescribed in excessive and/or inappropriate quantities and/or combinations.
Respondent continued to prescribe to MD 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 MD 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 or consultation for MD to a neurologist or other medical specialist.
Respondent failed to perform any urine screens or pill counts
on MD, or take any other measures to ensure compliance and proper use of the controlled substances prescribed.
Respondent failed to determine, or did not document determining, whether MD had a prior history of drug abuse or prior admission to a drug rehabllitation facility.
Respondent failed to contact, or did not document contacting, any member of MD's family regarding any history of drug abuse or drug rehabilitation facility admission, or MD's use of the prescribed controlled substances.
Respondent did not explore, or did not document exploring, other, more conservative treatment options for MD.
Respondent permitted MD to refill prescriptions for controlled substances early.
MD died on or about August 29, 2009 at age 22. The cause of death was determined to be intoxication by oxycodone. MD's last appointment with Respondent took place August 25, 2009.
COUNT ONE
Section 458.331{1){q), Florida Statutes
Petitioner realleges and incorporates paragraphs one (1) through twenty-six (26) above, 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.
Respondent prescribed the controlled substances noted above inappropriately or in excessive or inappropriate quantities in, including, but not limited to, one or more of the following ways:
by prescribing controlled substances for MD that were
inappropriate for MD, and/or were prescribed in excessive and/or inappropriate quantities and/or combinations;
by prescribing controlled substances for MD without adequate justification;
by failing to refer a referral or consultation for MD to a
neurologist or other medical specialist;
by failing to perform any urine screens or pill counts on MD, or to take any other measures to ensure compliance and proper use of the controlled substances prescribed.
by failing to determine whether MD had a prior history of drug abuse or prior admission to a drug rehabilitation facility;
by failing to contact any member of MD's family regarding any history of drug abuse or drug rehabilitation facility admission, or MD's use of the prescribed controlled substances;
by failing to explore other, more conservative treatment options for MD; and
by permitting MD to refill his prescriptions early.
Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes.
COUNT TWO
Section 458.331(1}(t), Florida Statutes
Petitioner realleges and incorporates paragraphs one (1)
.
through twenty-six (26) above, as if fully set forth herein.
Section 458.331(1)(t), Florida Statutes (2007-2008), subjects a doctor to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes. 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 "
Respondent failed to meet the required standard of care in his treatment of MD. Respondent's actions and inactions include, but are not limited to, the following:
prescribing controlled substances for MD that were inappropriate for MD, and/or were prescribed in excessive and/or inappropriate quantities and/or combinations;
prescribing controlled substances for MD without
adequate justification;
failing to refer a referral or consultation for MD to a neurologist or other medical specialist;
failing to perform any urine screens or pill counts on MD, or to take any other measures to ensure complianee and proper use of the controlled substances prescribed.
failing to determine whether MD had a prior history of drug abuse or prior admission to a drug rehabilitation facility;
failing to contact any member of MD's family regarding any history of drug abuse or drug rehabilitation facility admission, or MD's use of the prescribed controlled substances;
failing to explore other, more conservative treatment
options for MD; and
permitting MD to refill his prescriptions early.
Based on the foregoing, Respondent has violated Section 458.331(1)(t), 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
deems appropriate.
JOHN H. ARMSTRONG, MD
VERONICA E. DONNELLY
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W. AFFOR
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.
