STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, CASE NOS.: 2012-01856 Vv. 2012-08389 MIRIAM RUBANO, D.D.S., RESPONDENT. a ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health, by and through its undersigned counsel, and files this Administrative Complaint before the Board of Dentistry against the Respondent, Miriam Rubano, D.D.S., and in support thereof alleges: 1. The Department of Health is the state agency charged with regulating the practice of dentistry, pursuant to Chapters 20, 456 and 466, Florida Statutes. 2. At all times material to this Order, Respondent was licensed to practice as a dentist in the State of Florida, pursuant to Chapter 466, Florida Statutes (2011-2012). DOH v. Miriam R. Rubano, D.D.S. DOH Case Nos.: 2012-01856 and 2012-08389 Filed January 4, 2013 12:44 PM Division of Administrative Hearings 3. Respondent holds license number DN 17016. 4, Respondent’s address of record is 9064 Palomino Drive, Lake Worth, Florida 33467. 5. On February 5, 2012, an Atlantis Police Department officer observed Respondent's seven year-old son alone in an idling vehicle at the JFK Medical Center in Atlantis, Florida. 6. The police officer approached the child. The child told the police officer, “My mommy will be back, she went inside the hospital.” 7. The police officer observed an empty alprazolam bottle in the front seat of the car. 8. Alprazolam is a benzodiazepine prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes (2012), 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 IIT. 9. After obtaining her phone number from the child, the police officer called Respondent. DOH v. Miriam R. Rubano, D.D.S: DOH Case Nos.: 2012-01856 and 2012-08389 10. When the police officer asked Respondent to get her child, Respondent yelled, “F__k you, there is nothing illegal about leaving my child alone in the car,” and “Get the f__k away from my kid and my car.” 11. While still on the phone with Respondent, the police officer observed Respondent walking toward the car. Respondent continued to yell at the police officer while “walking from side to side, as if she had trouble keeping balance.” 12. As she approached, the police officer recalled that on the previous night, February 4, 2012, Respondent “fled from the sixth floor [of the JFK Medical Center] and pulled her own IV out in her vehicle and bled in her car.” During that prior incident, the police officer believed Respondent was under the influence of narcotics based on her “slurred speech, her lack of balance, [and] her erratic behavior.” 13. When Respondent reached her car, she continued to act erratically. She yelled at her child to get back in the car. She then pointed out the blood in her car from the previous night and shouted, “Look at all the blood in my car, the officers here are beating me.” 14. Ultimately, Respondent attempted to back out of her parking space and leave the scene. A parked police car, however, prevented her DOH v. Miriam R. Rubano, D.D.S. DOH Case Nos.: 2012-01856 and 2012-08389 from backing out. Respondent then proceeded to drive forward through a hedge and over a curb and drove away at a high rate of speed. 15. As Respondent drove away, the police officer who first responded observed that the child was not restrained by a seat belt and was “banging both his fists and screaming and crying in fear with his mouth wide open.” 16. Later that night, officers from the Palm Beach Gardens Police Department made contact with Respondent at the Palm Beach Gardens Medical Center. Respondent told the officers that she had “lupus, and other illnesses,” and wanted a drug screening to confirm that she was not under the influence of narcotics. 17. The responding police officers confirmed that emergency department personnel would administer a drug screen per Respondent's request. Thereafter, however, Respondent became uncooperative and refused the drug screen and any other medical care. 18. The police officers eventually informed Respondent that the Department of Children and Families would take custody of her son. At that point, Respondent ran to the lobby, grabbed her son, and attempted to flee. DOH v. Miriam R. Rubano, D.D.S. DOH Case Nos.: 2012-01856 and 2012-08389 19. The police officers struggled with Respondent to get the child away from her and to provide her with treatment. During the course of this struggle, Respondent kicked one police officer in the “thigh groin area” and kicked another police officer in the groin and scratched his wrist. 20. Respondent was arrested and booked shortly after midnight on February 6, 2012. Respondent was booked for the following charges: Two counts of battery on a law enforcement officer in violation of section 784.07, Florida Statutes (2011); two counts of cruelty toward a child in violation of section 827.03, Florida Statutes (2011); resisting a law enforcement officer with violence in violation of section 843.01, Florida Statutes (2011); and leaving the scene of a crash involving damage to property in violation of section 316.061, Florida Statutes (2011). 21. At the time of her arrest, Respondent had one prior arrest from June 9, 2011, for resisting an officer without violence in violation of section 843.02, Florida Statutes (2010). Charges were dropped in that case after Respondent completed the requirements of the pretrial diversion program. 22. On or about February 12, 2012, Respondent referred herself to Professionals Resource Network, Inc. (“PRN”). PRN is the impaired practitioner program for the Board of Dentistry established by section DOH v. Miriam R. Rubano, D.D.S. DOH Case Nos.: 2012-01856 and 2012-08389 456.076, Florida Statutes (2012), to monitor the evaluation, care, and treatment of impaired practitioners. 23. PRN referred Respondent for an evaluation by Dr. A.M., a physician board-certified in Psychiatry and Addiction Psychiatry. 24. Dr. A.M. performed his evaluation of Respondent over the course of three separate visits on February 23, 2012, March 1, 2012, and April 2, 2012. 25. During her evaluation, Respondent denied any history of psychiatric illness other than depression. 26. Respondent admitted to receiving limited treatment by a psychiatric nurse practitioner and a psychologist. Both providers described Respondent as “noncompliant” with treatment and each believed Respondent probably suffered from an Axis II personality disorder. Common Axis II disorders include: paranoid personality disorder, borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, and obsessive-compulsive personality disorder. The nurse practitioner also stated Respondent might suffer from bipolar disorder, an Axis I mental disorder. DOH v. Miriam R. Rubano, D.D.S. DOH Case Nos.: 2012-01856 and 2012-08389 27. Respondent revealed a complicated medical history during the evaluation which included a diagnosis of systemic lupus erythematosus (SLE). Respondent is under the care of a rheumatologist, nephrologist, and a pain management specialist for her SLE. 28. Respondent denied being violent with police officers despite the fact that she was ultimately tasered by the police officers during the course of her arrest. She told Dr. A.M., “I ticked off the cops . . . that’s why they did it.” 29. Dr. A.M. opined that Respondent did not suffer from a substance abuse disorder. He believed that the “recent arrest was precipitated by the bolus of prednisone [steroid treatment for SLE] superimposed on her current stress (psychosocial stressors and chronic medical problem).” 30. Dr. A.M. recommended that Respondent seek treatment by a psychiatrist and participate in individual psychotherapy. 31. Dr. A.M. concluded: “It is my opinion that [Respondent] can practice safely. I recommend a PRN contract to ensure that this safety is not compromised by her psychiatric/medical issues.” DOH v. Miriam R. Rubano, D.D.S DOH Case Nos.: 2012-01856 and 2012-08389 32. By a letter dated May 2, 2012, PRN presented Respondent with a monitoring contract. PRN advised Respondent to execute the monitoring contract within 10 days of the date of the letter. 33. Respondent subsequently failed to execute the monitoring contract presented to her by PRN. 34. On or about June 4, 2012, PRN advised the Department of Respondent’s failure to comply with PRN’s recommendations and requirements. The Medical Director for PRN stated: Dr. Rubano was sent a Licensure Long (due to pain and use of steroids) Concurrent Illness contract in early May. After much discussion she was given until May 25, 2012, to return her contract. As of this date, she has not returned the contract and due to the fact that she has had multiple arrests, and multiple medical problems that require the use of steroids, I feel she is a danger to the citizens of the State of Florida. PRN has closed her file. 35. As of the date of this Administrative Complaint, Respondent has yet to execute a PRN contract or otherwise comply with PRN‘s recommendations and requirements. 36. On June 12, 2012, the Department entered an Order Compelling an Examination and Production of Medical Reports. The Order DOH v. Miriam R. Rubano, D.D.S DOH Case Nos.: 2012-01856 and 2012-08389 directed Respondent to submit to an examination by Dr. B.K., an osteopathic physician board-certified in addiction medicine. 37. Respondent complied with the Order and underwent an evaluation by Dr. B.K. on August 7, 2012. 38. Dr. B.K. examined Respondent, administered a urine drug screening, and reviewed collateral information which included “probable cause affidavits, attending physician’s PRN report, Department of Health investigative reports, and witness reports.” Dr. B.K. also spoke with Respondent's current nephrologist and a psychiatric nurse practitioner who previously treated Respondent. 39. During the evaluation, Respondent admitted to using opiates and benzodiazepines. 40. Opiates are used to treat pain and have similar actions as the drug opium. Opiate drugs are addictive and subject to abuse. Benzodiazepines are used to treat anxiety and may lead to limited physical or psychological dependence. Opiates and benzodiazepines are controlled substances under section 893.03, Florida Statutes (2012). 41. Respondent claimed to use opiates for the management of pain caused by SLE. DOH v. Miriam R. Rubano, D.D.S. DOH Case Nos.: 2012-01856 and 2012-08389 42. Respondent claimed to use benzodiazepines as a sleep aid because prescription and over-the-counter sleep aids caused intolerable side effects. 43. Respondent admitted to Dr. B.K. that she had dispensed “Tylenol III Codeine” tablets to herself when she could not obtain prescriptions from her pain management doctor. 44. Tylenol III refers to a combination of over-the-counter analgesic, acetaminophen, and an opiate, codeine. According to Section 893.03(2), Florida Statutes (2011-2012), Tylenol HI 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 Tylenol III may lead to moderate or low physical dependence or high psychological dependence. 45. Respondent’s nephrologist told Dr. B.K. that Respondent “has been very non-compliant with her treatment with him and that the present opiates that she is on are definitely not consistent and not needed for her pain with the Lupus at this time.” 46. Respondent's psychiatric nurse practitioner told Dr. B.K. that Respondent had not presented for treatment “for at least a year.” DOH v. Miriam R. Rubano, D.D.S. DOH Case Nos.: 2012-01856 and 2012-08389 10 47. Respondent’s urine drug screening was positive for her prescribed opiates and benzodiazepines. It was also positive for “Tylenol III Codeine tablets that she diverted from her own office supply.” 48. In reviewing Respondent's urinalysis results, Dr. B.K. spoke with the medical review officer of the lab which performed the testing. The medical review officer informed Dr. B.K. that Respondent’s levels were “high, above the cut-off consistent with just use.” 49. Based upon the information available to Dr. B.K., she diagnosed Respondent with opiate dependence and benzodiazepine abuse. 50. Ultimately, Dr. B.K provided the following recommendation: It is my recommendation that this client secure a PRN contract and it is my opinion that she should not be practicing dentistry until she is under the auspices of the PRN. 51. Respondent is presently incapable of practicing dentistry with reasonable skill and safety. 52. Two separate medical experts have thoroughly evaluated Respondent and recommended Respondent's participation with PRN to ensure the safety of Respondent's patients. DOH v. Miriam R. Rubano, D.D.S. DOH Case Nos.: 2012-01856 and 2012-08389 11 53. Respondent has demonstrated a history of noncompliance with her psychiatric treatment plan. Monitoring by PRN is necessary to ensure Respondent seeks the psychiatric care she requires. 54. Respondent's history of noncompliance further demonstrates that she will not overcome her controlled substance dependence and abuse problem without the assistance of PRN. 55. Respondent has repeatedly refused to enter into a PRN monitoring contract. COUNT ONE 56. Petitioner realleges and incorporates Paragraphs one (1) through fifty five (55), as if fully set forth herein. 57. Section 466.028(1)(s), Florida Statutes (2012), subjects a dentist to discipline for being unable to practice dentistry with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, chemicals or any other type of material or as a result of any mental or physical condition. 58. Respondent is in violation of section 466.028(1)(s), Florida Statutes (2012), in that she is presently impaired by her mental condition DOH v. Miriam R. Rubano, D.D.S. DOH Case Nos.: 2012-01856 and 2012-08389 12 and her use of drugs. In the absence of monitoring by PRN, Respondent is unable to practice dentistry with reasonable skill and safety to her patients. COUNT TWO 59. Petitioner realleges and incorporates Paragraphs one (1) through fifty five (55), as if fully set forth herein. 60. Section 466.028(1)(q), Florida Statutes, subjects a dentist to discipline for prescribing, procuring, dispensing, or administering any medicinal drug appearing on any schedule set forth in chapter 893, by a dentist to herself or himself, except those prescribed, dispensed, or administered to the dentist by another practitioner authorized to prescribe them. 61. Respondent violated section 466.028(1)(q), Florida Statutes (2012), by dispensing “Tylenol III Codeine tablets” from her office to herself without a valid prescription from another practitioner. WHEREFORE, the Petitioner respectfully requests that the Board of Dentistry 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 DOH v. Miriam R. Rubano, D.D.S. DOH Case Nos.: 2012-01856 and 2012-08389 13 fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. SIGNED this__ 274 __ day of No yember 2012. JOHN H. ARMSTRONG, MD Surgeon General and Secretary of Health A Martin M. Randall Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar # 00659940 (850) 245-4640 Telephone (850) 245-4662 FAX PCP: November 9, 2012 PCP Members: Dr. Morgan, Dr. Gesek and Dr. Robinson DOH v. Miriam R. Rubano, D.D.S. DOH Case Nos.: 2012-01856 and 2012-08389 14 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. DOH v. Miriam R. Rubano, D.D.S. DOH Case Nos.: 2012-01856 and 2012-08389 15

Docket for Case No: 13-000010PL