STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, ve CASE NO. 2011-03738 ERIC NATHAN GROSCH, M.D., RESPONDENT. ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through its undersigned counsel, files this Complaint before the Board of Medicine against Respondent, Eric Nathan. Grosch, 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 Statues; 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 50726. 3. Respondent does not hold any certifications from specialty Ao, boards recognized by the Florida board. 4. Respondent's address of record is P.O. Box 13934, Gainesville, Florida, 32604. 5. | From on or about January 9, 2009, to on or about February 25, 2011, Respondent had a physician-patient relationship with patient S.H. 6. On or about February 25, 2011, patient S.H was living in Ft. Myers, Florida. 7. On or about February 25, 2011, patient S.H. met with Respondent in Gainesville, Florida, to obtain prescriptions for oxycodone and Xanax. 8. On or about February 25, 2011, patient S.H. was twenty-six years old and pregnant. 9. On or about February 25, 2011, Respondent did not have a medical office. 10. Prior to February 25, 2011, on other occasions, patient S.H. had met the Respondent in Gainesville, Florida, usually in a parking lot, to obtain prescriptions for drugs. 11. Prior to February 25, 2011, on other occasions, Respondent examined patient S.H. in public restrooms in Gainesville, Florida. DOH v. Eric Nathan Grosch, M.D. 2 Case Number 2011-03738 . DOH v. Eric Nathan Grosch, M.D. Case Number 2011-03738 12. Respondent provided prescriptions to patient S.H. as follows: | Date Roxicodone | Roxicodone | oxycodone | Percocet | Xanax | Ativan | diaze- 30 mg. 15 mg. 40 mg. 10/325 | 2mg. | 1 mg. | pam 10 mg. 1/9/09 ___| #240 | | 1/23/09 | #240 #90 | | 1/23/09 |_ #90 2/7/09 #240 #120 2/20/09 #90 2/20/09 #90 3/10/09 | #120 C — 3/20/09 #240 4/6/09 #60 | | 4/16/09 #240 #60 6/2/09 __| #240 es 2 ee 6/12/09 ee ee Ee 7/12/09 | #240 a ee [8/12/09 | #240 Pf Cf#90 | 2/19/10 | #240 #90 3/18/10 __| #240 es ec: 6/13/10 | #240 #90 7/3/10 #120 #90 7/21/10 | #240 7/30/10 #240 8/30/10 #240 #120 9/3/10 #120 [9/11/10 | #240 9/26/10 | #240 | 10/11/10 | #240 #240 10/15/10 _ | #240 _o 11/25/10 | #240 11/28/10 | #240 12/28/10 | #240 [ | 2/9/2011 | #240 —_ 13. Roxicodone is the brand name for oxycodone. Oxycodone is a semi-synthetic opioid that 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. Abuse of oxycodone may lead to severe psychological or physical dependence. 14. Percocet is the brand name for a drug that contains oxycodone and acetaminophen 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 potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States. Abuse of oxycodone may lead to severe psychological or physical dependence. Acetaminophen is a non-prescription pain reliever. 45. 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 DOH v. Eric Nathan Grosch, M.D. 4 Case Number 2011-03738 lead to limited physical or psychological dependence relative to the substances in Schedule III. Alprazolam is a benzodiazepine. 16. Ativan is the brand name for lorazepam and is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, lorazepam 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 lorazepam may lead to limited physical or psychological dependence relative to the substances in Schedule ITI. 17. Diazepam is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, diazepam 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 diazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. 18. Respondent did not properly evaluate patient S.H. 19. Respondent did not document any evaluation of patient S.H. 20. Respondent did not develop a treatment plan for S.H. 21. Respondent did not document a treatment plan for patient S.H. DOH v. Eric Nathan Grosch, M.D. S Case Number 2011-03738 22. Respondent did not obtain informed consent and an agreement for treatment from patient S.H. 23. Respondent did not document receiving informed consent and an agreement for treatment from patient S.H. 24. Respondent did not conduct periodic reviews of patient S.H.’s course of treatment. 25. Respondent did not document periodic reviews of patient S.H.'s course of treatment. 26. Respondent did not refer patient S.H. to other appropriate health care providers. 27. Respondent did not document referring patient S.H. to other appropriate health care providers. 28. Respondent did not keep accurate and complete medical records of patient S.H. 29. Respondent did not maintain current medical records of patient S.H. available for review. 30. A reasonably prudent physician would not consider the care and treatment provided by the Respondent to patient S.H. appropriate and acceptable. DOH v. Eric Nathan Grosch, M.D. : 6 Case Number 2011-03738 31. A reasonably prudent physician would not consider the records kept by the Respondent appropriate and minimally adequate for the treatment prescribed by the Respondent to patient S.H. Count I 32. Petitioner re-alleges and incorporates paragraphs one through thirty-one (31) as if fully set forth herein. 33. Section 458.331(1)(t), Florida Statutes (2008-2010), provides that committing medical malpractice constitutes grounds for disciplinary action by the Board of Medicine. Medical Malpractice is defined in Section 456.50(g), Florida Statutes (2008-2010), 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. For purposes of Section, 458.331(1)(t), Florida Statutes (2008-2010), the Board shall give great weight to the provisions of Section 766.102, Florida Statutes (2008-2010), which provides that 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. DOH v. Eric Nathan Grosch, M.D. 7 Case Number 2011-03738 34. Respondent failed to practice medicine with that level of care, skill and treatment, which is recognized by reasonably prudent similar physiclans as being acceptable under similar conditions and circumstances, in the treatment of patient S.H. in one or more of the following ways: a. By failing to adequately assess patient S.H.’s complaints and symptoms; b. _ By failing to perform adequate physical examinations; c. _ By failing to refer patient S.H. to appropriate specialists; d. By prescribing excessive and/or inappropriate amounts of controlled substances without medical justification; c. By prescribing inappropriate combinations of drugs; d. By prescribing controlled substances at inappropriate intervals; e. By failing to utilize risk mitigation strategies to prevent diversion of controlled substances; f. By prescribing large quantities of controlled substances to patient S.H. during her pregnancy, and g. _ By failing to develop an appropriate treatment plan. DOH v. Eric Nathan Grosch, M.D. 8 Case Number 2011-03738 35. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2008-2010), by committing medical malpractice in treating patient S.H. Count Il 36. Petitioner re-alleges and incorporates paragraphs one (1) through thirty-one (31) as if fully set forth herein. 37. Section 458.331(1)(q), Florida Statutes (2008-2010), 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 or her intent. 38. Respondent prescribed, dispensed, and/or administered controlled substances other than in the course of her professional practice by prescribing, dispensing, and/or administering controlled substances DOH v. Eric Nathan Grosch, M.D. b) Case Number 2011-03738 inappropriately, without regard to the patient’s best interests or in excessive or inappropriate quantities to patient S.H. on or about the above described dates and in the above described quantities and combinations. 39. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2008-2010), by inappropriately prescribing excessive and inappropriate quantities of controlled substances to patient S.H. Count IIT 40. Petitioner re-alleges and incorporates paragraphs one (1) through thirty-one (31) as if fully set forth herein. 41. Section 458.31(1)(nn), Florida Statutes (2008-2010), 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. 42. Rule 64B8-9.013(3), Florida Administrative Code, provides as follows: (3) Standards. 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 10 DOH v. Eric Nathan Grosch, M.D. Case Number 2011-03738 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 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 individual 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. (c) Informed Consent and Agreement for Treatment. The physician should discuss the risks and benefits of the use of controlled substances with the patient, persons designated by the patient, or with the patient's surrogate or guardian if the patient is incompetent. The patient should receive prescriptions from one physician‘and one pharmacy where possible. If the patient is determined to be at high risk for medication abuse or have a history of substance abuse, the physician should employ the use of a written agreement between physician and patient outlining patient responsibilities, including, but not limited to: 1. Urine/serum medication levels screening when requested; 2. Number and frequency of all prescription refills; and 3. Reasons for which drug therapy may be discontinued (i.e., violation of agreement). (d) Periodic Review. At reasonable intervals based on the individual circumstances of the patient, the physician should review the course of treatment and any new information about the etiology of the pain. Continuation or modification of therapy should depend on the physician's evaluation of the patient's progress. If treatment goals are not being achieved, despite medication adjustments, the physician should reevaluate the appropriateness of continued treatment. The physician should monitor patient compliance in medication usage and related treatment plans. (e) Consultation. The physician should be willing to refer the patient as necessary for additional evaluation and treatment in order to achieve treatment objectives. Special attention should be given to those pain patients who are at risk for misusing their medications and those whose DOH v. Eric Nathan Grosch, M.D. li Case Number 2011-03738 living arrangements pose a risk for medication misuse or diversion. The management of pain in patients with a history of substance abuse or with a comorbid psychiatric disorder requires extra care, monitoring, and documentation, and may require consultation with or referral to an expert in the management of such patients. (f) Medical Records. The physician is required to keep accurate and complete records to include, but not be limited to: 1. The medical history and physical examination, including history of drug abuse or dependence, as appropriate; 2. Diagnostic, therapeutic, and laboratory results; 3. Evaluations and consultations; 4, Treatment objectives, 5. Discussion of risks and benefits; 6. Treatments; 7, Medications (including date, type, dosage, and quantity prescribed); 8. Instructions and agreements; and 9. Periodic reviews. Records must remain current and be maintained in an accessible manner and readily available for review. (g) Compliance with Controlled Substances Laws and Regulations. To prescribe, dispense, or administer controlled substances, the physician must be licensed in the state and comply with applicable federal and state regulations. Physicians are referred to the Physicians Manual: An Informational Outline of the Controlled Substances Act of 1970, published by the U.S. Drug Enforcement Agency, for specific rules governing controlled substances as well as applicable state regulations. Effective October 17, 2010, Rule 64B8-9.013(3), Florida Administrative Code, was amended to state that previously permissive standards for the use of controlled substances for pain contro! in sub-sections (3)(a) through (g) became mandatory, and (f)(9) and (10) were changed to read as follows: 9. Drug testing results; and DOH v. Eric Nathan Grosch, M.D. Case Number 2011-03738 12 10. Periodic reviews. Records must remain current, maintained in an accessible manner, readily available for review, and must be in full compliance with Rule 64B8-9.003, F.A.C, and Section 458.331(1)(m), F.S. Records must remain current and be maintained in an accessible manner and readily available for review. 43. Respondent violated Rule 64B8-9.013(3), Florida Administrative Code, by prescribing controlled substances to patient S.H. without performing and/or maintaining accurate and complete records of one or more of the following: appropriate histories, examinations, and evaluations; a written treatment plan that states objectives that will be used to determine treatment success; obtaining informed consent and an agreement for treatment, periodic serum and/or urine drug screening; periodic reviews stating patient S.H.’s progress toward treatment goals; referral to specialists in pain management and obstetrics; diagnostic, therapeutic and laboratory results; treatment objectives; discusssions of risks and benefits of treatment; instructions and agreements. 44, Based on the foregoing, Respondent violated Section 458.331(1)(nn), Florida Statutes (2008-2010), by violating a rule adopted pursuant to Chapter 458 because he failed to document and adhere to the Florida Board of Medicine standards for the use of controlled substances for DOH v. Eric Nathan Grosch, M.D. 13 Case Number 2011-03738 pain control contained within Rule 64B8-9.013(3), Florida Administrative Code, in his treatment of patient S.H. Count IV 45. Petitioner re-alleges and incorporates paragraphs one (1) through thirty-one (31) as if fully set forth herein. 46. Section 458.331(1)(m), Florida Statutes (2008-2010), subjects a licensee to discipline for failing to keep legible, as defined by department rule in consultation with the board, medical records that identify the licensed physician or the physician extender and supervising physician by name and professional title who is or are responsible for rendering, ordering, supervising, or billing for each diagnostic or treatment procedure and 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. 47. On or about the dates set forth above, Respondent failed to keep medical records that justified the course of treatment of patient S.H., ‘including his failure to keep legible patient histories; examination results; DOH v. Eric Nathan Grosch, M.D. 14 Case Number 2011-03738 test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. 48. Based on the foregoing, Respondent violated Section, 458.331(1)(m), Florida Statutes (2008-2010), by failing to keep medical records that justified the course of treatment of patient S.H. WHEREFORE, 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 and/or any other relief that the Board deems appropriate. SIGNED this_/3___ day of ) m4 , 2012. G J John H. Armstrong, M.D. Surgeon General and Secretary of Health Florida Department of Health DOH v. Eric Nathan Grosch, M.D. 15 Case Number 2011-03738 FILED DEPARTMENT OF HEALTH DEPUTY CLERK CLERK Angel Sanders pATE = JUL 1-6 2012 PCP Date: July 13, 2012 B. Fricke, Jr. sistant General Counsel Fla. Bar No. 0901910 Florida Department of Health Office of the General Counsel 4052 Bald Cypress Way, Bin #C65 Tallahassee, FL 32399-3265 Telephone: (850) 245-4640 Facsimile: (850) 245-4683 PCP Members: Dr. Miguel, Dr. Bearison, and Ms. Goersch DOH v. ERIC NATHAN GROSCH, M.D.; CASE NUMBER 2011-03738 DOH v. Eric Nathan Grosch, M.D. Case Number 2011-03738 16 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 to any other discipline imposed. DOH v. ERIC NATHAN GROSCH, M.D.; CASE NUMBER 2011-03738 DOH v. Eric Nathan Grosch, M.D. 17 Case Number 2011-03738

Docket for Case No: 13-001687PL