STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO. 2009-23414 JAMES ANASTASIO HALIKAS, M.D., RESPONDENT, / ADMINISTRATIVE COMPLAINT Petitioner, Department of Health files this Administrative Complaint before the Board of Medicine against Respondent, James Anastasio Halikas, 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 Statutes; and Chapter 458, Florida Statutes. 2, Respondent is, and at all times material to this administrative complaint was, a licensed physician within the state of Florida, having been issued license number ME 69324. - 3, Respondent's current address of record is 5445 Park Central Court, Naples, Florida 34109. 4, At all times material to this Complaint, Respondent was board certified in psychiatry by the American Board of Psychiatry and Neurology. 5, At all times material to this Complaint, Respondent was the supervising physician for Nurse S.H., an advanced registered nurse practitioner. 6. On or about August 12, 2008, Respondent prescribed 120 dosage units of clonazepam img and 120 dosage units of lithium 300mg to Patient C.R. 7. Clonazepam, known by the brand name Klonopin, is prescribed to treat anxiety. According to Section 893.03(4}, Florida Statutes, clonazepam 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 clonazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. Clonazepam is a sedative (a substance that induces sedation by reducing irritability or excitement.) 8. Lithium is used to treat and prevent episodes of mania in people with bipolar disorder. - 9. Respondent failed to document the August 12, 2008, prescriptions for clonazepam and lithium in Patient C.R.'s medical records. DOH v, James Anastasio Halikas, M.D. 2 Case No. 2009-23414 10. On or about August 28, 2008, Patient C.R. presented to Respondent's office for an initial psychiatric evaluation. Patient C.R. had a history of bipolar disorder, obsessive-compulsive cisorder, post-traumatic stress disorder, and bulimia nervosa. Nurse $.H. performed the initial evaluation of Patient C.R. Respondent failed to ensure that Nurse S.H. performed an appropriate mental status examination of Patient C.R. 11. On or about August 28, 2008, Nurse S.H. prescribed 90 dosage units of Fluoxetine 20mg to Patient C.R. 12, Fluoxetine, known by the trade name Prozac, Is used to treat depression, obsessive-compulsive disorder, some eating disorders and panic attacks. 13, From on or about September 4, 2008, to on or about December 11, 2008, Respondent and/or Nurse S.H. prescribed medications to Patient CLR. as follows: DOH v, James Anastasio Hallkas, M.D. 3 Case No, 2009-23414 7 Date | Venlafaxine | Fluoxetine | Trazodone | Clonazepam | Seroquel | Lamictal ; _ 75mg 20mg | 100mg img 100mg | 200mg 9/4/08 | #120 9/18/08 #120 #270 #180 (37.5mg) 9/22/08 . #90 {| ~=#120 _| 9/23/08 | #120 i iz 9/25/08 | #90, L 9/29/08 #90 10/3/08 10/14/08 | _#120 10/30/08 #120 11/3/08 #60 (.5mqg) | 11/14/08 | i #210 11/19/08 | #540 12/8/08 | 7 | #90 (.5mg) 12/11/08 #180 14. Venlafaxine, known by the brand name Effexor, is used to treat depression, generalized anxiety disorder, social anxiety disorder and panic disorder. 15, Trazodone, known by the brand name Oleptro, is used to treat depression, 16, Seroquel is the brand name for quetiapine fumarate and is used . to treat the symptoms of schizophrenia and to treat episodes of mania or depression in patients with bipolar disorder Quetiapine fumarate {s a sedative. DOH v. James Anastasio Halikas, M.D, Case No, 2009-23414 17, Lamictal is the brand name for lamotrigine and is used to treat seizures and to increase the time between episodes of depression and mania in patients with bipolar disorder. 18. Respondent and/or Nurse S.H., acting under Respondent's supervision, failed to document the following prescriptions in Patient C.R.'s medical records: a. The September 22, 2008, prescriptions for trazodone 100mg and clonazepam img; b. The October 3, 2008, prescription for venlafaxine 75mg; and c. The October 30, 2008, prescription for fluoxetine 20mg. 19, Respondent and/or Nurse S.H., acting under Respondent's supervision, failed to document a treatment plan for Patient C.R. 20. The medical records do not justify the psychopharmacological plan of treatment for Patient C.R. 21, Respondent and/or Nurse S,.H,, acting under Respondent's supervision, failed to legibly document justification for changing Patient C.R.’s medications and Patient C.R.‘s responses to the medications. 22, Respondent and/or Nurse S.H., acting under Respondent's supervision, prescribed sedative medication to Patient C.R. inappropriately, DOH v. James Anastasio Hallkas, M.D. 5 Case No. 2009-23414 23. Respondent failed to appropriately monitor the medications that were prescribed to Patient C.R. | 24, At no time during Patient C.R.'s treatment with Respondent's office did Respondent personally examine Patient C.R. 25, “Respondent failed to adequately supervise Nurse S.H. in the treatment of Patient C.R. COUNT ONE 26. Petitioner te-alleges and incorporates paragraphs one (1) through twenty-five (25) as if fully set forth herein. 27. Section 458,331(1)(t)1, Florida Statutes (2008), subjects a physician to discipline for cammitting medical malpractice as defined in Section 456.50, Florida Statutes (2008). ‘Medical malpractice” is defined by Section 456.50(1)(g), Florida Statutes (2008), 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.” Section 456.50(1)(e), Florida Statutes (2008), provides that the “level of care, skill, and treatment recognized in general law related to health care licensure" means the standard of care that is specified in Section 766.102(1), Florida Statutes (2008), which states as follows: DOH v, James Anastasio Halikas, M.D. 6 Case No, 2009-23414 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. 28. Section 458.331(1)(t)1, Florida Statutes (2008), directs the Board of Medicine to give “great weight” to this provision of Section 766.102, Florida Statutes (2008). 29. Respondent failed to meet the prevailing standard of care in one or more of the following manners: a. By failing to ensure that Nurse S.H. performed an appropriate mental status examination of Patient C.R.; b. By failing to prescribe, or ensure that Nurse S.H, prescribed, sedative medications appropriately; c. By failing to appropriately monitor the medications that were prescribed to Patient C.R.; and/or d. By failing to personally examine Patient C.R. 30. Based on the foregoing, Respondent violated Section 458.331(1)(t)1, Florida Statutes (2008), by committing medical malpractice, DOH v. James Anastasio Hallkas, M.D, 7 Case No. 2009-23414 COUNT TWO 30. Petitioner realleges and incorporates paragraphs one (1) through twenty-five (25) as if fully set forth herein. 31. Section 458.331(1)(dd), Florida Statutes (2008), subjects a physician to discipline for failing to supervise adequately the activities of those physician assistants, paramedics, emergency medical technicians, advanced registered nurse practitioners, or anesthesiologist assistants acting under the supervision of the physician. 32, Respondent failed to adequately supervise Nurse S.H, in the treatment of Patient C.R. 33, Based on the foregoing, Respondent violated Section 458.331(1)(dd), Florida Statutes (2008), by failing to adequately supervise the activities of Nurse S.H., an advanced registered nurse practitioner acting under the supervision of Respondent. COUNT THREE 34. Petitioner re-alleges and incorporates paragraphs one (1) through twenty-five (25), above, as if fully set forth herein, 35, Section 458.331(1)(m), Florida Statutes (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 DOH v, James Anastasio Hallkas, M.D, 8 Case No, 2009-23414 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. 31. Respondent failed to keep legible medical records that justified the course of treatment of Patient C.R. in one or more of the following ways: a. By failing to document the August 12, 2008, prescription(s) for clonazepam and/or lithium in Patient C.R.’s medical records; b. By failing to document the September 22, 2008, prescription(s) for trazodone and/or clonazepam in Patient C.R.’s medical records; | c. By failing to document the October 3, 2008, prescription for venlafaxine In Patient C.R.’s medical records; d. By failing to document the October 30, 2008, prescription for fluoxetine in Patient C.R’s medical records; e. By failing to document a treatment plan for Patient C.R.; f. By failing to document justification for | the psychopharmacological plan of treatment for Patient C.R.; DOH v. James Anastasio Hallkas, M.D, 9 Case No, 2009-23414 g. By failing to legibly document. justification for changing Patient C.R.’s medications; and/or | h. By failing to legibly document Patient C.R’s responses to the medications prescribed to her. 32, Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2008), by failing to maintain legible medical records that justified the course of treatment of Patient C.R. 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 Respondent on probation, corrective action, refund of fees billed or collected, remedial education and any other relief that the Board deems appropriate, DOH v, James Anastasio Hallkas, M.D, 10 Case No, 2009-23414 SIGNED this A. Noy of UCbOne 2013. John H. Armstrong, MD, FACS State Surgeon General and Lt a) Secretary of Health Fi NS I Coa yosts [lor | f) Ky } ~ fe Di DATE: uf O/AS/3 Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar # 13771 (850) 245-4444 x 8212 PHONE (850) 245-4684 FAX thomas_morton@doh.state. fl.us PCP Date: October 25, 2013 PCP Members: G. El-Bahri, M.D.; M. Stringer, M.D.; C. Pardue DOH v, James Anastaslo Halikas, M.D. qi Case No. 2009-23414 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. James Anastasio Halikas, M.D. 12 Case No. 2009-23414 1

Docket for Case No: 14-000005PL