STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, PETITIONER, v. CASE NO. 2010-20197 WILLIAM TODD OVERCASH, M.D., RESPONDENT. ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, by and through undersigned counsel, files this Administrative Complaint before the Board of Medicine against Respondent, William Todd Overcash, 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. At all times material to this Complaint, Respondent was a licensed medical doctor within the state of Florida, having been issued license number ME 56492. 3. Respondent’s address of record is 14311 Southeast 128" Street, Ocklawaha, Florida 32179. 4. Respondent is board certified in general surgery by the American Board of Surgery. 5. At all times relevant to this complaint, Respondent was practicing medicine at 219 South Main Street, Williston, Florida 32179 and subsequently at a Pain Management Clinic located at 412 Noble Avenue, Williston, Florida 32696. 6. Oxycodone is commonly 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, and abuse of oxycodone may lead to severe psychological or physical dependence. 7. Oxycodone/APAP (brand names Percocet, Roxicet) is a Schedule II controlled substance which contains oxycodone and acetaminophen, or Tylenol. 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, and abuse of oxycodone may lead to severe psychological or physical dependence. 8. Hydrocodone is a Schedule II controlled substance and in certain dosage forms such as hydrocodone/APAP, Vicodin, Lortab is Schedule III. Hydrocodone is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes, hydrocodone 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 hydrocodone may lead to severe psychological or physical dependence. 9. Vicoprofen is a Schedule III controlled substance consisting of hydrocodone and ibuprofen, a non steroidal anti-inflammatory drug (NSAID). 10. Valium is the brand name for diazepam and 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, and abuse of diazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. 11. Alprazolam, which is sold under the brand name Xanax, is a benzodiazepine in Schedule IV. 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, and abuse of the substance may lead to limited physical or psychological dependence relative to the substances in Schedule III. 12. Temazepam is prescribed to treat insomnia. According to Section 893.03(4), Florida Statutes, temazepam 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, and abuse of temazepam may lead to limited physical or psychological dependence relative to the substances in Schedule IIT. 13. Tramadol, commonly known by the brand name Ultram, is an opioid class medication prescribed to treat pain. Tramadol is a legend drug, but not a controlled substance. Tramadol, like all opioid class drugs, can affect mental alertness, is subject to abuse, and can be habit forming. 14. Fentanyl in the form of a transdermal patch is an opioid, Schedule II, that delivers the drug fentanyl through the skin and is 4 prescribed to treat pain. According to Section 893.03(2), Florida Statutes, fentanyl 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 fentany! may lead to severe psychological or physical dependence. 15. Rule 64B8-9.013, Florida Administrative Code (2003), requires 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 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 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. Tiscussion 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. 16. This portion of the Rule remained the same until the Board of Medicine enacted a new Rule effective October 17, 2010. At that time the requirements became mandatory and (f) added the requirement that medical records include drug testing results. Patient SM 17. Patient SM, is a 51 year-old disabled male with a history of a work related injury resulting in pain in his neck, arms, back and legs. He had received two previous lumbar surgeries in 1984 and 1987 and, in addition to pain in the listed areas, he reported a medical history of anxiety, panic attacks, depression, hypertension and insomnia. The patient reported that he was currently on hydrocodone 20 mg. 4 times a day. Previously in his history SM reported that his pain without medication was 10/10 and with medication was 5/10. 18. The patient also presented with a letter dated April 7, 2005, from Shands showing that he was disabled from degenerative disk disease in his lower back and remained in intractable pain in his lower extremities 19. Based on SM’s patient history and an incomplete or undocumented physical examination at the first visit on July 27, 2010, Respondent changed SM’s prescription to hydrocodone 10/325 mg. (Lortab) 4 times a day for 180 tabs and Xanax 1 mg. 1 time per day for 30 tabs. 20. | Respondent maintained these prescriptions monthly until November 19, 2010, when SM had not been seen in October and he reported he was out of medication. Respondent changed the prescription to Percocet 10/325 mg. 150 tabs without clear documentation to support the change and did not prescribed Xanax. 21. From December 16, 2010, through February 11, 2011, Respondent continued to prescribe the Percocet 10/325 mg. 150 tabs and no Xanax. On February 11, 2011, SM requested an increase in the Percocet and Respondent refused. 22. On March 10, 2011, Respondent increased the quantity of Percocet to 180 tabs and prescribed Xanax based on SM’s complaints of depression, but his medical records do not justify the changes in these prescriptions. 23. On October 5, 2011, SM’s oxycodone prescription had been reduced to 120 and the Xanax prescription had been terminated. Instead, SM was prescribed Temazepam 30 mg. 1 at bedtime. Respondent had changed to electronic record keeping and the records are substantially improved. Respondent documented that he was continuing to wean SM off of the opioids. 24. On November 1, 2011, SM’s prescription was changed to hydrocodone 10/325 mg. 110 tabs as part of Respondent's continuing treatment plan of weaning SM. 25. There are no urine drug screen results contained in the medical records. 26. Respondent’s medical records do not document an adequate physical examination, including history of drug abuse, at each visit, nor do they document treatment objectives. 27. Respondent's medical records do not document the risks and benefits of use of controlled substances or the medications prescribed. 28. Respondent's medical records do not document treatment plans justifying the course of treatment. 29. Respondent’s medical records do not comply with the requirements of Rule 64B8-9.013 (2003 and 2010) quoted above. These two versions of the Rule set forth the standard of care for Florida for the use of controlled substances for the treatment of pain. COUNT ONE 30. Petitioner realleges and incorporates paragraphs one (1) through twenty-nine (29) as if fully set forth herein. 31. Section 458.331(1)(t)1., Florida Statutes (2010-2011), subjects a medical doctor to discipline by the Board of Medicine for committing medical malpractice as defined in Section 456.50. Section 456.50, Florida Statutes (2008), 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. 32. 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 (2008), defines the standard of care to mean“ . . . 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. . . .” 33. Respondent fell below the acceptable standard of care in one or more of the following ways: a. By failing to perform and document an adequate history and physical examination on July 27, 2010, at SM’s first visit; b. By failing to perform or document performing a thorough physical examination at every visit with SM; c. By failing to reach an appropriate diagnosis consistent with the prescribing; d. _ By prescribing oxycodone and hydrocodone inconsistently without justification; e. By failing to perform urine drug screens; f. By failing to establish treatment objectives; g. By failing to establish treatment plans justifying the course of treatment. 34. Based on the foregoing, Respondent has violated Section 458.331(1)(t)1., Florida Statutes (2010-2011), by committing medical malpractice. COUNT TWO 35. Petitioner realleges and incorporates paragraphs one (1) through twenty-nine (29) as if fully set forth herein. 36. Section 458.331(1)(q), Florida Statutes (2010-2011), subjects a doctor to discipline 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 the 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. 37. Respondent inappropriately prescribed legend drugs, including controlled substances, to SM, in one or more of the following ways: a. — By inappropriately prescribing controlled substances to SM without any documented justification for doing so; b. By inappropriately prescribing controlled substances to SM without obtaining consultations from other experts or referring SM for other modalities of treatment; c. By inappropriately prescribing controlled substances to SM without performing urine drug screens; d. By inappropriately prescribing controlled substances to SM without performing adequate physical examinations to justify the prescriptions. 38. Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (2010-2011), by 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 the 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. COUNT THREE 39. Petitioner realleges and incorporates paragraphs one (1) through twenty-nine (29) as if fully set forth herein. 40. Section 458.331(1)(m), Florida Statutes (2010-2011), subjects a doctor to discipline for failing to keep legible, as defined by department 13 rule in consultation with the board, medical records . . . 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. 41. Respondent failed to maintain records that justify the course of treatment of SM as described in Section 458.331(1)(m), in one or more of the following ways: a. By failing to document a complete medical history of SM; b. By failing to maintain medical records that document an adequate physical examination, including history of drug abuse, at each visit; c. By failing to maintain medical records documenting treatment objectives; d. By failing to maintain medical records documenting the risks and benefits of use of controlled substances; e. By failing to maintain accurate medical records documenting medications prescribed; f. By failing to maintain medical records documenting drug testing results; g. By failing to maintain medical records documenting treatment plans; h. By failing to maintain medical records justifying the course of treatment. 42. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2010-2011), by failing to keep legible, as defined by department rule in consultation with the board, medical records . . . 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. Patient AJ 43. Patient AJ, a then 32 year-old male with a history of lower back pain after a lifting injury, was first seen on March 28, 2010, and last seen on November 1, 2011. At no time did Respondent take a complete medical history or complete an adequate physical examination. 44, During the visits between March 28, 2010, and November 1, 2011, Respondent prescribed oxycodone 7.5/325 mg. followed by hydrocodone beginning at 5 mg./325 mg. 90 tabs, increasing to hydrocodone 10/325 mg. 120 tabs. At no time did he document a justification for the changes in AJ's prescriptions. 45. An MRI was completed on November 22, 2010, which was abnormal, corroborated AJ's complaints, and supported Respondent diagnosis of “low back pain.” Thereafter Respondent reduced AJ’s hydrocodone to 7.5/325 mg. 46. On December 1, 2010, Respondent documented that a consultation with a neurologist should be considered. The patient was continuing to work, thereby increasing his pain to a 9/10. Respondent sent AJ to see a counselor. 47. Respondent continued AJ on hydrocodone 7.5/325 mg. 140 tabs with the documented plan to wean him off of the narcotics. 48. Respondent began weaning AJ off of the narcotics in late 2011 by reducing both the dosage and quantity of hydrocodone until November 1, 2011, when all narcotics were terminated and A) was switched to Tramadol. 49. Respondent's medical records do not document an adequate physical examination, including history of drug abuse, at each visit, nor do they document treatment objectives. There are no urine drug screens contained in the medical records. 50. Respondent’s medical records do not document the risks and benefits of use of controlled substances or the medications prescribed. 51. Respondent’s medical records do not document treatment plans justifying the course of treatment. 52. Respondent's medical records do not comply with the requirements of Rule 64B8-9.013 (2003 and 2010) quoted above. These two versions of the Rule set forth the standard of care for Florida for the use of controlled substances for the treatment of pain. COUNT FOUR 53. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), thirty-one (31), thirty-two (32) and forty-three (43) through fifty-two (52) as if fully set forth herein. 54. Respondent fell below the acceptable standard of care in one or more of the following ways: a. By failing to perform and document an adequate history and physical examination on AJ's first visit; b. By failing to perform or document performing a thorough physical examination at every visit with AJ; c. By failing to reach an appropriate diagnosis consistent with the prescribing; d. By prescribing oxycodone and hydrocodone inconsistently without justification; e. By failing to perform urine drug screens; f. By failing to establish treatment objectives; g. By failing to establish treatment plans justifying the course of treatment. 55. Based on the foregoing, Respondent has violated Section 458.331(1)(t)1., Florida Statutes (2010-2011), by committing medical malpractice. COUNT FIVE 56. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), thirty-six (36), and forty-three (43) through fifty-two (52) as if fully set forth herein. 57. Respondent inappropriately prescribed legend drugs, including controlled substances, to AJ, in one or more of the following ways: a. By inappropriately prescribing controlled substances to AJ. without any documented justification for doing so; b. By inappropriately prescribing controlled substances to AJ without obtaining consultations from other experts or referring AJ for other modalities of treatment; c. By inappropriately prescribing controlled substances to AJ without performing urine drug screens; d. By inappropriately prescribing controlled substances to AJ without performing adequate physical examinations to justify the prescriptions. 58. Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (2010-2011), by 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 the 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. COUNT SIX 59. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), forty (40), and forty-three (43) through fifty-two (52) as if fully set forth herein. 60. Respondent failed to maintain records that justify the course of treatment of AJ as described in Section 458.331(1)(m), in one or more of the following ways: a. __ By failing to document a complete medical history of AJ; b. By failing to maintain medical records that document an adequate physical examination, including history of drug abuse, at each visit; c. By _ failing to maintain medical records documenting treatment objectives; d. By failing to maintain medical records documenting the risks and benefits of use of controlled substances; e. By failing to maintain accurate medical records documenting medications prescribed; f. By failing to maintain medical records documenting drug testing results; g. By failing to maintain medical records documenting treatment plans; h. By _ failing to maintain medical records justifying the course of treatment. 20 61. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2010-2011), by failing to keep legible, as defined by department rule in consultation with the board, medical records . . . 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. Patient CP 62. Patient CP, a then 61 year-old male with a 40-year history of back pain and three prior lumbar surgeries, first visited Respondent on July 9, 2010. At that visit Respondent failed to take an adequate history or perform an adequate and complete physical examination. The patient reported that he was currently taking oxycodone and Xanax. Respondent prescribed oxycodone 15 mg. 240 tabs and Xanax for anxiety. 63. On August 10, 2010, Respondent prescribed CP oxycodone 15 mg. without specifying the doses or tabs and did not document prescribing Xanax. He did not document a physical examination or any justification for the prescriptions. 21 64. On September 10, 2010, Respondent prescribed oxycodone 240 tabs and Xanax 120 tabs without specifying the dosage or the reasons for the changes. 65. On October 8, 2010, he continued the oxycodone, but made no mention of the Xanax. 66. The next medical record for CP is February 7, 2011, when the records document something about “addiction”, being stabbed, and “playing me.” The patient was sent for MRIs of the neck and back, which were both abnormal. 67. On March 7, 2011, Respondent prescribed oxycodone 30 mg. 240 tab and no Xanax. On April 6, 2011, Respondent cut CP’s oxycodone in half by prescribing oxycodone 15 mg. 240 tabs and no Xanax. 68. The Patient did not return until October 3, 2011, at which time Respondent prescribed Xanax, oxycodone 10/325 mg. for 10 days 30 tabs and Fentanyl patches 50 mg. every 72 hours 10 patches. He also sent CP to a counselor and told him he would have to get any further Xanax from a psychiatrist. 69. On November 3, 2011, CP returned and advised Respondent that he had gone to other pain clinics and had failed their urine drug tests by testing positive for THC. Respondent terminated CP immediately. 22 70. Tetrahydrocannabinols (THC) are the psychoactive ingredients in marijuana, or cannabis. According to Section 893.03(1), Florida Statutes, THC is a Schedule I controlled substance that has a high potential for abuse and has no currently accepted medical use in treatment in Florida. Its use under medical supervision does not meet accepted safety standards. 71. Respondent’s medical records do not document an adequate physical examination, including history of drug abuse, at each visit, nor do they document treatment objectives. There are no urine drug screens contained in the medical records. 72. Respondent’s medical records do not document the risks and benefits of use of controlled substances or the medications prescribed. 73. Respondent's medical records do not document treatment plans justifying the course of treatment. 74. Respondent's medical records do not comply with the requirements of Rule 64B8-9.013 (2003 and 2010) quoted above. These two versions of the Rule set forth the standard of care for Florida for the use of controlled substances for the treatment of pain. COUNT SEVEN 75. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), thirty-one (31), thirty-two (32) and sixty-two (62) through seventy-four (74) as if fully set forth herein. 76. Respondent fell below the acceptable standard of care in one or more of the following ways: a. __By failing to perform and document an adequate history and physical examination on CP's first visit; b. By failing to perform or document performing a thorough physical examination at every visit with CP; c. By failing to reach an appropriate diagnosis consistent with the prescribing; d. By prescribing oxycodone and hydrocodone inconsistently without justification; e. By failing to perform urine drug screens; f. By failing to establish treatment objectives; g. By failing to establish treatment plans justifying the course of treatment. 24 77. Based on the foregoing, Respondent has violated Section 458.331(1)(t)1., Florida Statutes (2010-2011), by committing medical malpractice. COUNT EIGHT 78. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), thirty-six (36), and sixty-two (62) through seventy- four (74) as if fully set forth herein. 79. Respondent inappropriately prescribed legend drugs, including controlled substances, to CP, in one or more of the following ways: a. By inappropriately prescribing controlled substances to CP without any documented justification for doing so; b. By inappropriately prescribing controlled substances to CP without obtaining consultations from other experts or referring CP for other modalities of treatment; Cc. By inappropriately prescribing controlled substances to CP without performing urine drug screens; d. By inappropriately prescribing controlled substances to CP without performing adequate physical examinations to justify the prescriptions. 25 pr Couipeuruitv. 80. Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (2010-2011), by 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 the 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. COUNT NINE 81. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), forty (40), and sixty-two (62) through seventy-four (74) as if fully set forth herein. 82. Respondent failed to maintain records that justify the course of treatment of CP as described in Section 458.331(1)(m), in one or more of the following ways: a. __ By failing to document a complete medical history of CP; b. By failing to maintain medical records that document an adequate physical examination, including history of drug abuse, at each visit; c. By failing to maintain medical records documenting treatment objectives; d. By failing to maintain medical records documenting the risks and benefits of use of controlled substances; e. By failing to maintain accurate medical records documenting medications prescribed; f. By failing to maintain medical records documenting drug testing results; g. By failing to maintain medical records documenting treatment plans; h. By failing to maintain medical records justifying the course of treatment. 83. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2010-2011), by failing to keep legible, as defined by department rule in consultation with the board, medical records . . . 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. Patient RT 84. Patient RT was a 50 year-old male with a history of chronic neck pain following a work related injury in 2006. Respondent saw RT as both his primary care physician and for treatment of his chronic pain. His first visit was on July 13, 2010, at which time Respondent took an inadequate history and conducted an inadequate physical examination. Despite the fact that RT reported that he was on no current medications because he had no doctor and had a pain level of 5/10, Respondent prescribed hydrocodone 7.5/500 mg. 240 tabs. 85. Respondent next saw RT on August 4, 2010, and changed his medication to oxycodone 15 mg. ¥% to 1 every 6 hours 90 tabs. The records contain no justification for this change. On August 11, 2010, Respondent continued the oxycodone and added hydrocodone 10 mg. 240 tabs. Again, he did not document any justification for the added controlled substances. 86. For the next four months, Respondent prescribed only hydrocodone, but increased the number of tabs from 120 to 180. On December 31, 2010, Respondent again prescribed to RT Percocet 10/325 mg. 180 tabs. 87. The patient did have an MRI on December 22, 2010; however the records contain no report of the results. On January 25, 2011, there is no report of a prescription for controlled substances; however on February 24, 2011, there is a note to cut the Percocet. 88. There is an undated note stating something to do with RT having a stolen truck with wife, and patient and Respondent met with police to discuss patient and pain clinics. 89. The next date of treatment is September 30, 2011, at which time Respondent prescribed oxycodone mg. 10/325 mg. 200 tabs. On November 1, 2011, Respondent saw RT and the medical records show no prescriptions for controlled substances. Instead, the records indicate “PERSONAL HISTORY OF NONCOMPLIANCE WITH MEDICAL TREATMENT PRESENTING HAZARDS TO HEALTH (V15.81), Status: Active, onset: 11/01/2011. Chronic, Moderate, Noted (added)”. There are no further notes for RT. 90. Respondent’s medical records do not document an adequate physical examination, including history of drug abuse, at each visit, nor do they document treatment objectives. There are no urine drug screens contained in the medical records. 91. Respondent's medical records do not document the risks and benefits of use of controlled substances or the medications prescribed. 92. Respondent’s medical records do not document treatment plans justifying the course of treatment. 93. Respondent's medical records do not comply with the requirements of Rule 64B8-9.013 (2003 and 2010) quoted above. These two versions of the Rule set forth the standard of care for Florida for the use of controlled substances for the treatment of pain. COUNT TEN 94. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), thirty-one (31), thirty-two (32), and eighty-four (84) through ninety-three (93) as if fully set forth herein. 95. Respondent fell below the acceptable standard of care in one or more of the following ways: a. __ By failing to perform and document an adequate history and physical examination on RT’s first visit; b. By failing to perform or document performing a thorough physical examination at every visit with RT; c. By failing to reach an appropriate diagnosis consistent with the prescribing; d. By prescribing oxycodone and hydrocodone inconsistently without justification; e. By failing to perform urine drug screens; f. By failing to establish treatment objectives; g. By failing to establish treatment plans justifying the course of treatment. 96. Based on the foregoing, Respondent has violated Section 458.331(1)(t)1., Florida Statutes (2010-2011), by committing medical malpractice. COUNT ELEVEN 97. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), thirty-six (36), and eighty-four (84) through ninety- three (93) as if fully set forth herein. 98. Respondent inappropriately prescribed legend drugs, including controlled substances, to RT, in one or more of the following ways: a. By inappropriately prescribing controlled substances to RT without any documented justification for doing so; b. By inappropriately prescribing controlled substances to RT without obtaining consultations from other experts or referring RT for other modalities of treatment; c. By inappropriately prescribing controlled substances to RT without performing urine drug screens; d. By inappropriately prescribing controlled substances to RT without performing adequate physical examinations to justify the prescriptions. 99. Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (2010-2011), by 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 the 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. COUNT TWELVE 100. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), forty (40), and eighty-four (84) through ninety-three (93) as if fully set forth herein. 101. Respondent failed to maintain records that justify the course of treatment of RT as described in Section 458.331(1)(m), in one or more of the following ways: a. __ By failing to document a complete medical history of RT; b. By failing to maintain medical records that document an adequate physical examination, including history of drug abuse, at each visit; c. By failing to maintain medical records documenting treatment objectives; d. _By failing to maintain medical records documenting the risks and benefits of use of controlled substances; e. By failing to maintain accurate medical records documenting medications prescribed; f. By failing to maintain medical records documenting drug testing results; g. By failing to maintain medical records documenting treatment plans; h. By failing to maintain medical records justifying the course of treatment. 102. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2010-2011), by failing to keep legible, as defined by department rule in consultation with the board, medical records . . . 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. Patient ED 103. Patient ED, a 54 year-old disabled male with seizure disorder and cerebral arteriovenous malformation (AVM), began seeing Respondent on May 28, 2010, for both primary care and chronic pain management. Patient ED complained of back, leg, shoulder and hip pain. 104. Respondent failed to document an adequate history, instead relying on the thorough history from Dr. GB. Respondent did order appropriate radiographic studies, including MRIs and CTs, which over time showed progressive degenerative disc disease, ischemic white matter 34 changes, chondromalacia and L4-5 herniated nucleus pulposus with lumbar facet naturopathy. 105. Respondent referred ED for consultations with neurology for both management of his seizure disorder and obstructive sleep apnea. Respondent utilized variations of controlled substances, including hydrocodone and diazepam; however, the medical records do not adequately document the efficacy of the treatments during each visit. 106. Respondent continued as ED’s primary care physician until late 2011 when ED passed away from a seizure unrelated to Respondent's treatment of ED. 107. Respondent’s medical records do not document an adequate physical examination, including history of drug abuse, at each visit, nor do they document treatment objectives. There are no urine drug screens contained in the medical records. 108. Respondent’s medical records do not document the risks and benefits of use of controlled substances or the medications prescribed. 109. Respondent’s medical records do not document treatment plans justifying the course of treatment. 110. Respondent's medical records do not comply with the requirements of Rule 64B8-9.013 (2003 and 2010) quoted above. These 35 two versions of the Rule set forth the standard of care for Florida for the use of controlled substances for the treatment of pain. COUNT THIRTEEN 111. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), thirty-one (31), thirty-two (32), and one hundred- three (103) through one hundred-ten (110) as if fully set forth herein. 112. Respondent fell below the acceptable standard of care in one or more of the following ways: a. By failing to perform and document an adequate history and physical examination on ED’s first visit; b. By failing to perform or document performing a thorough physical examination at every visit with ED; c. By failing to reach an appropriate diagnosis consistent with the prescribing; d. By. prescribing hydrocodone _ inconsistently without justification; e. _ By failing to perform urine drug screens, f. By failing to establish treatment objectives; g. By failing to establish treatment plans justifying the course of treatment. 36 113. Based on the foregoing, Respondent has violated Section 458.331(1)(t)1., Florida Statutes (2010-2011), by committing medical malpractice. COUNT FOURTEEN 114. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), thirty-six (36), and one hundred-three (103) through one hundred-ten (110) as if fully set forth herein. 115. Respondent inappropriately prescribed legend drugs, including controlled substances, to ED, in one or more of the following ways: a. By inappropriately prescribing controlled substances to ED without any documented justification for doing so; b. By inappropriately prescribing controlled substances to ED without performing urine drug screens; c. By inappropriately prescribing controlled substances to ED without performing adequate physical examinations to justify the prescriptions. 116. Based on the foregoing, Respondent has violated Section 458.331(1)(q), Florida Statutes (2010-2011), by prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's 37 professional practice. For the 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. COUNT FIFTEEN 117. Petitioner realleges and incorporates paragraphs one (1) through sixteen (16), forty (40), and one hundred-three (103) through one hundred-ten (110) as if fully set forth herein. 118. Respondent failed to maintain records that justify the course of treatment of ED as described in Section 458.331(1)(m), in one or more of the following ways: a. By failing to document a complete medical history of ED; b. By failing to maintain medical records that document an adequate physical examination, including history of drug abuse, at each visit; c. By failing to maintain medical records documenting treatment objectives; 38 d. By failing to maintain medical records documenting the risks and benefits of use of controlled substances; e. By failing to maintain accurate medical records documenting medications prescribed; f. By failing to maintain medical records documenting drug testing results; g. By failing to maintain medical records documenting treatment plans; h. By failing to maintain medical records justifying the course of treatment. 119. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2010-2011), by failing to keep legible, as defined by department rule in consultation with the board, medical records . . . 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. 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 39 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_/s.% day of “@4rna oy 2013. John H. Armstrong State Surgeon General and Secretary of Health DEPARTMENT OF HEALTH DOH-Prosecution Services Unit CLERK aneetaY CLERK 4052 Bald Cypress Way-Bin C-65 DATE FEB anders Tallahassee, Florida 32399-3265 18 2013 Florida Bar # 233285 (850) 245-4640 (850) 245-4681 fax DKK PCP: February 15, 2013 PCP members: Dr. Avila & Dr. Stringer DOH v. William Todd Overcash, M.D., Case No. 2010-20197 DOH v. William Todd Overcash, M.D., Case No. 2010-20197 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. 4l

Docket for Case No: 14-001005PL