STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, ‘PETITIONER, | | we CASE NO. 2009-22923 DEREK 8B. THORPE, 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, Derek B. Thorpe, 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 102365. 3. -Respondent does not hold any certifications from specialty boards recognized by the Florida board. 4. Respondent’s address of record is 3980 South 3rd Street, Jacksonville Beach, Florida 32250. 5. During all times relevant to this complaint, Respondent was practicing at Med-West Pain Management, located at 4028 Blanding Boulevard, Jacksonville, Florida 32210. 6. During all times relevant to this complaint, Respondent practiced medicine in the area of palin management. He was engaged in the treatment of pain by prescribing or dispensing controlled substance medications. ’ 7. On or about March 5, 2010, a reasonable cause subpoena was issued in accordance with Section 456.067(9)(a)1, Florida Statutes (2009), to obtaln the medical records of patients of Respondent at Med-West Pain Management, including patients B.A., C.W., G.P., J.F., and L.M., to whom the Respondent had prescribed controlled substances. 8. The medical records obtained in. response to the subpoena documented that Respondent had prescribed large amounts and doses of controlled substances to patients B.A., C.W., G.P., J.F., and LM. DOH v, DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 9. The controlled substances that Respondent had prescribed in large amounts and doses were Roxicodone, OxyContin, Morphine, Lortab, Soma, and Xanax. 10. Roxicodone is a 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. il. OxyContin is a brand name for time-released 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. 12. Morphine is an opiate prescribed to treat pain. According to Section 893.03(2), Florida Statutes, morphine is a Schedule II controlled DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 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 morphine may lead to severe psychological or physical. dependence. 13. Lortab-is a brand name for a drug that contains hydrocodone and is prescribed to treat pain. According to Section 893.03(3), Florida Statutes, hydrocodone, in the dosages found in Lortab, is a Schedule III controlied substance that has a potential for abuse fess than the substances in Schedules I and Il and has a currently accepted medical use in treatment in the United States. Abuse of the substance may lead to moderate or low physical dependence or high psychological dependence. 14. Soma is the brand name for carisoprodol, a musde relaxant commonly prescribed to treat muscular pain. According to Section 893.03(4), Florida Statutes, carisoprodol is a Schedule IV controlled substance that has a low potential for abuse relative to the substances In Schedule III and has a currently accepted medical use in treatment in the United States. Abuse of carisoprodol may lead to limited physical or psychological dependence relative to the substances in Schedule IIT. DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 . 15. Xanax is a brand name for alprazolam. Alprazolam is prescribed to treat anxiety. Alprazolam is a benzodiazepine. According to Section 893.03(4), Florida Statutes, alprazolam is a Schedule IV controlied 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 physica! or psychological dependence relative to the substances in Schedule IIL. 16. The standard of care required that the Respondent conduct and decument a complete medical examination and history of patients BA., - CW., GP, J.F., and L.M., adequately assess their condition, conduct adequate physical examinations, order adequate laboratory tests and x-ray examinations, obtain urine drug screen analysis tests, and refer patients B.A, CW., GP., J.F., and L.M. to specialists for consultations, to make evidence based diagnoses of their conditions, develop treatment plans, and justify the controlled substances prescribed to. patients B.A., C.W., G.P., LF, and LM. . Facts Specific to Patient B.A, 17. From on or about December 22, 2008, through on or about February 23, 2010, Respondent provided care and treatment to patient DOH y. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 B.A., a fifty year old female resident of Jacksonville, Florida, for complaints of low back pain. 18. Respondent prescribed controlled substances to patient B.A. as follows: DATE ROXI- XANAX [SOMA | MORPHINE] OXYCONTIN CODONE |2MG. /|350 30 MG. 30 MG. MG. 12/29/2008 | #90 [#30 [#60 [| [#60 | (01/23/2009 |#90 ——(‘és[#30— [OO HeO | #14 (03/04/2009 | #140 ——sd[#2e #56 | | | 03/30/2009 [#142 sf #28 #56 fT (03/30/2009 [#71 ss #28 HSS TCTs” eo 04/27/2009 | #714 #28 #56 (05/22/2009 [#75 | CT 1 05/22/2009 |#75 si “sf #30,—sdf#6OC| fl |o6/i9/2o09 [#77 | CE 06/19/2009 [#77 ssf #560 HOO FCC [07/17/2009 [#77_ | CT — |08/i4/2009 [#154 [#560 #eO, C|ti“‘ESSSC*C*;*C;SSCS |09/19/2009 [#152 sd #56~=CL #56 Cf Cd [20/09/2009 [#168 (“$sSs[ #56056 OTT tel 2008 4068 | #96 6 fd [12/29/2009 |#i86 isi #62, #o2_ | [01/26/2010 [#ie8 sisi #56 CT #56 fC Cd | 02/23/2010 [#ies ——(“§ «sd #5656 TCE DOH v. DEREK 8. THORPE, M.D. CASE NUMBER: 2009-22923 19. Patient B.A. had been dismissed from care by a previous health care provider for negative urine drug test results for the medications prescribed to her by that provider. - | . 20. While under the care of the Respondent, patient B.A. took medication more frequently and/or in greater amounts than prescribed to her by the Respondent. . 21. While under the care of the Respondent, patient B.A. took the . controlled drug Methadone prescribed to her daughter. ' 22. Methadone is an opioid and is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, methadone 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 methadone may lead to severe psychological or _ physical dependence. . . 23. Respondent did not obtain an adequate history of patient B.A.’s pain. 24. Respondent did not obtain an adequate history of patient B.A.’s prior treatment. - DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 25. Respondent did not perform adequate physical examinations of patient B.A. . 26. Respondent failed to adequately monitor patient B.A.’s compliance with controlled substances as prescribed. 27. Throughout the time of Respondent's care and treatment of patient B.A., Respondent did not provide or recommend other treatment modalities to patient B.A. Specific to Patient C.W, 28. From on or about August 4, 2009 through on or about March 12, 2010, Respondent provided care and treatment to patient CW., a twenty-six year old male resident of Jacksonville, Florida, for complaints of neck and low back pain. . 29. Respondent prescribed controlled substances to patient cw. as follows: DATE ROXICODONE | XANAX SOMA 30,MG. 2MG. 350 MG. 08/04/2009 #42 #42 #56 : #28 DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 12/18/2009 : foujis2oi0, | 01/15/2010 __| #140 #56 02/12/2010 __| #140 #112 ) 30. Patient C.W. had a medical history of polysubstance drug abuse, making him a very high risk patient that required strict control and compliance monitoring. 31. Respondent did not obtain an adequate medical history of patient C.W. 32, Respondent did not perform adequate physical examinations of patient C.W. - 33. Throughout the time of Respondent’s care and treatment of patient C.W., Respondent did not provide or recommend other treatment - modalities to patient CW. 34. Respondent did not perform additional tests to evaluate the : significance of findings on patient C.W.’s previous tests. _ 35. Respondent failed to adequately monitor patient C.W.’s compliance with controlled substances as prescribed. 36. Respondent identified Graves’ Disease and Hyperthyroidism as possible diagnoses for patient C.W. DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 37, Respondent did not order any laboratory tests of patient C.W. for evaluation of the possible diagnoses of Graves’ Disease and Hyperthyroldism. 38, Respondent did not refer patient C.W. to any other health care provider for evaluation of possible Graves’ Disease and Hyperthyroidism. Facts Specific to Patient G.P. 39. From on or about January 7, 2009, through on or about March 10, 2010, Respondent provided care and treatment to patient G.P., a forty- four year old fernale resident of St. Augustine, Florida, for complaints of shoulder and low back pain. 40, Respondent prescribed controlled substances to patient G.P. as follows: DATE ROXICODONE | XANAX | LORTAB | SOMA | XANAX MG. MG. loi/o7/zoo9{#i00—— is] CTC fo2/o6/2009; #112, | CTC Cd |o3/o5/2009, Cd] CT C‘]:C( (Cd HS (03/05/2009(#112,—sd[ #28) | CTC [04/02/2009/ #112, [#28 | CT CT (04/02/2009/#112,—is| #28 | | CTC 04/30/2009; #120 sf #56 |) Cd 10 [| }05/28/2009| #126 sist #56 | CTT [06/25/2009| #126 = | #56 [#20 | | #56 [ [| [| DOH vy. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 10 09/18/2009 | #168 #56 11/13/2009 | #175 #56 12/11/2009 | #175 #56 01/09/2010| #175 #56 02/10/2010 | #175 #56 03/10/2010 | #175 #56 - 41, - While under the care of the Respondent, patient G.P.’s urine drug screen tests were positive for cocaine. . . . 42, While under the care of the Respondent, patient G.P. took medication more frequently and/or in greater amounts than prescribed by _ the Respondent. 43. While under the care of the Respondent, patient G.P. took additional doses of the controlled drug Soma that she obtained from her | daughter. 44, While under the care of the Respondent, patient G.P. ran out of medications prescribed to her by.the Respondent before they should have been completed. | | 45. Respondent failed to adequately monitor patient G.P.’s compliance with controlled substances as prescribed. DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 46. Throughout the time of Respondent's care and treatment of “patient G.P., Respondent did not.provide or recommend other treatment modalities to patient G.P. . Facts Specific to Patient J.F, 47. From on or about February 9, 2009, through on or about September 24, 2009, Respondent provided care and treatment to patient IF., a twenty-seven year old male resident of Jacksonville, Florida, for -compiaints of neck and low back pain. i - 48, Respondent prescribed controlled. substances to patient 1.F. as follows: 03/02/2009 | #112 03/30/2009 | #115 | 04/27/2009 | #115 05/26/2009 | #115 06/22/2009 | #115 07/20/2009 _ 49. Patient J.F. had a history of a urine drug screen positive for cacaine. DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 120 50. While under the care of the Respondent, patient J.F. had high blood pressure. . . - 51. Respondent did not treat or refer patient J.F. to another health care provider for evaluation and treatment of patient J.F.’s high blood pressure. | . . 52. | Respondent did not obtain an adequate medical history of patient J.F. 53. While under the care of the Respondent, patient J.F. was. incarcerated for a period of time. 54, Respondent did not obtain or document the cause for patient _J.F.'s incarceration. 55. Throughout the time of Respondent’s care and treatment of ; patient J.F., Respondent did not provide or recommend other treatment modalities to patient JF. . 56. Respondent failed to adequately monitor patient FIs. compliance with controlled substances as prescribed. Facts Specific to Patient L.M. 57. From on or about July 14, 2009, through on or about March 5, ' 2010, Respondent provided care and treatment to patient L.M., a forty-nine DOH v. DEREK 8. THORPE, M.D. CASE NUMBER: 2009-22923 13 year old female resident of St. Augustine, Florida, for complaints of neck and back pain. 58. Respondent prescribed controlled substances to patient L.M. as 30 MG. 2.MG. #60 02/05/2010 #168 03/05/2010 #168 follows: 59. Patient L.M. had a medical history of obtaining controlled substances without a prescription. 60. Patient L.M. had a history of psychiatric problems. - 64. While under the care of the Respondent, patient L.M. reported multiple stressors. 62. While under the care of the Respondent, patient L.M. tested positive for cocaine on a urine drug screen. DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 : 14 _ 63. While under the care of the Respondent, patient L.M. ran out of medications prescribed to her by the Respondent before they should have been completed. 64. While under the care of the Respondent, patient L.M. took drugs that she obtained from friends and associates, 65. While under the care of the Respondent, patient L.M. reported to police that she had OxyContin 80 mg. stolen from her. 66. Respondent was provided a copy of patient L.M.’s report to the police that she had OxyContin 80 mg. stolen from her. 67. Respondent never prescribed OxyContin 80 mg. to patient L.M, _ 68. Respondent did not obtain an adequate medical history of patient L.M. 69. Respondent did not perform adequate physical examinations of patient LM. ‘70. Respondent did not refer patient L.M. to appropriate specialists. 71. Throughout the time of Respondent's care and treatment of patient L.M., Respondent did not provide or recommend other treatment modalities to patient L.M. DOH v. DEREK B. THORPE, M.D. CASE’ NUMBER: 2009-22923 72. Respondent failed to adequately monitor patient L.M.‘s . compliance with controlled substances as prescribed. COUNT I — PT. B.A. 73. Petitioner re-alleges and incorporates paragraphs one (1) through twenty-seven (27) as if fully set forth herein. 74, Section 458.331(1)(), Florida Statutes (2008-2009), 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 (2008-2009), 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 458.3311), Florida Statutes (2008-2009), the Board shall give great: weight to the provisions of Section 766.102, Florida Statutes (2008-2009), 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. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 75. Respondent failed to practice medicine with that level of care, skill and treatment, which is recognized by a reasonably prudent similar” physician as being acceptable under similar conditions and circumstances, in the treatment of patient B.A. in one or more of the following ways: a. By falling to obtain and document adequate medical histories; . b. By failing to do adequate physical examinations; c. By prescribing excessive and/or Inappropriate amounts of controlled substances without medical justification; - 'd. By failing to adequately monitor patient compliance with controlled substances as prescribed; @. By failing to develop appropriate treatment plans; - f—. By falling to request referrals to specialists; and/or gs By failing to prescribe or recommend other treatment modalities for treatment of pain. . | _ 76. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2008-2009), by committing medical malpractice in treating patient B.A. DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 17 COUNT IT — PT. B.A. | 77. Petitioner re-alleges and incorporates paragraphs one (1) through twenty-seven (27) as if fully set forth herein. 78. Section 458.331(1)(q), Florida Statutes (2008-2009), subjects a licensee to discipline, including suspension or revocation, 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 Section 458.331(1)(q), 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. | 79. Respondent prescribed, dispensed, and/or administered: controlled substances other than in the course of his professional practice by Prescribing, dispensing, and/or administering controlled substances inappropriately, without regard to the patient's best interests or in, excessive or inappropriate quantities to patient B.A. on or about the above deseribed dates and in the above described quantities and combinations. DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 18 . 80. Based on. the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2008-2009), by inappropriately prescribing excessive and inappropriate quantities of controlled substances to patient B.A. COUNT 11] ~ PT. B.A 81. Petitioner re-alleges and incorporates paragraphs one (1) through twenty-seven (27) as if fully set forth herein. . 82. Section 458.331(1)(nn), Florida Statutes (2008-2009), 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. | 83. 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 conditions, the effect of the pain on physical and psychological function, and history of: substance abuse. The medical record also should BOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 ig document the presence of one or more recognized ‘medical indications for the use of a controlled substance. (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. 84. Respondent violated Rule 64B8-9.013(3), Florida Administrative Code by prescribing controlled substances to patient B.A. without conducting a complete medical hlstory and physical and documenting them DOH v. DEREK B, THORPE, M.D. CASE NUMBER: 2009-22523 : 20 in the medical record, and by failing to keep accurate and complete medical records. 85. Based on the foregoing, Respondent violated Section 458.331(1)(nn), Florida Statutes (2008-2009), by violating a rule adopted pursuant to Chapter 458. COUNT TV - PT. B.A, 86. Petitioner re-alleges and incorporates paragraphs one (1) through twenty-seven (27) as if fully set forth herein. | 87. Section 458.331(1)(m), Florida Statutes (2008-2009), 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. DOH v. DEREK B. THORPE, M.D, CASE NUMBER: 2009-22923 : : 21 88. On or about the dates set forth above, Respondent failed to keep medical records that justified the course of treatment of patient B.A. . 89, Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2008-2009). COUNT V — PT. C.W. 90. Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) and twenty-eight (28) through thirty-eight (38) as if, - fully set forth herein. ' 91. Section 458.331(1)(t), Florida Statutes (2009), provides that committing medical malpractice constitutes grounds for disciplinary action by the Board of Medicine. Medical malpractice is defined in Section 456.50(q), Florida Statutes (2009), 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)(0), Florida Statutes (2009), the Board shall give great weight to the provisions of Section 766.102, Florida Statutes (2009), which provides that the prevailing professional standard of care for a given health care provider shail be that level of care, skill, and treatment which, in light of ali DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers. 92. Respondent failed to practice medicine with that level of care, skill and treatment, which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances, in the treatment of patient C. W. in one or more of the following ways: a. By failing to obtain and document adequate medical histories; b. By failing to do adequate physical examinations; — c. By prescribing excessive and/or inappropriate amounts of controlled substances without medical justification; | d. By falling to adequately monitor patient ‘compliance with controlled substances as prescribed; “ee By failing to develop appropriate treatment plans; f. By failing to request referrals to specialists; and/or g. By falling to prescribe or recommend other treatment modalities for treatment of pain. . 93. Based on the foregoing, Respondent violated Section 458,331(1)(t), Florida Statutes (2009), by committing medical malpractice in treating patient C.W. DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 23 COUNT VI — PT. C.W. , 94, Petitioner re-alleges and incorporates paragraphs one (12) through sixteen (16) and twenty-eight (28) through thirty-eight (38) as if fully set forth herein. 95. Section 458.331(1)(q), Florida Statutes (2009), subjects a licensee to discipline, including suspension or revocation, 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 Section 458.331(1)(q), 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. 96. Respondent prescribed, dispensed, and/or administered controlled substances other than in the course of his professional practice by prescribing, dispensing, and/or administering controlled substances inappropriately, without regard to the patient's best interests or in DOH v, DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 : 24 excessive or Inappropriate quantities to patient C.W. on or about the above ~ described dates and in the above desctibed quantities and combinations. 97. Based on the foregoing, Respondent violated Section '458.331(1)(q), Florida Statutes (2009), by inappropriately prescribing excessive and inappropriate quantities of controlled substances to patient cw. . COUNT VII — PT. CW, - | 98. Petitioner re-alleges and incorporates paragraphs one (1) through sixteén (16) and twenty-eight (28) through thirty-eight (38) as if fully set forth herein. . . 99. Section 458.331(1)(nn), Florida Statutes (2009), provides that violating any provision of chapters 456 or 458, Florida Statutes, or any 7 _ rules adopted pursuant thereto, is grounds for disciplIne by the Board of Medicine. a ~ 400. Rule 64B8-9.013(3), Florida Administrative Code, provides as follows: 8) 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 DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 : . 25 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. (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. DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 : 26 — 101. Respondent violated Rule 64B8-9.013(3), Florida Administrative Code by prescribing controlled substances to patient C.W. without conducting a complete medical history and physical and documenting them in the medical record, and by failing to keep accurate and complete medical records. ' 102. Based on the foregoing, Respondent violated Section 458.331(1)(nn), Florida Statutes (2009), by violating a rule adopted pursuant to Chapter 458. COUNT Viti - PT. €.W, 103. Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) and twenty-eight (28) through thirty-eight (38) as if fully set forth herein. | . 104. Section 458.331(1)(m), Florida Statutes (2009), 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 DOR v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 27 limited to, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered ; and reports of consultations and-hospitalizations. 105. On or about the dates set forth above, Respondent failed to keep medical records that justified the course of treatment of patient C.W. _ 106. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2009). COUNT IX — PT. GP, ; 107. Petitioner re-aileges and incorporates paragraphs one (1) through sixteen (16) and thirty-nine (39) through forty-six (46) as if fully set forth herein. | 108. Section 458.331(1)(t), Florida Statutes (2009), 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 (2009), 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 (2009), the Board shail give great welght to the provisions of Section 766.102, Florida Statutes (2009), which provides DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 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. . 109. Respondent failed to practice medicine with that level of care, skill and treatment, which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances, in the treatment of patient G.P. in one or more of the following ways: a. By failing to obtain and document adequate medical histories; _b. By failing to do adequate physical examinations; | c. By prescribing excessive and/or inappropriate amounts of controlled substances without medical justification; _d. By failing to adequately monitor patient compliance with controlled substances as prescribed: . e. By failing to develop appropriate treatment plans; f. By failing to request referrals to specialists; and/or | g. By falling to prescribe or recommend other treatment modalities for treatment of pain. DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 29 _ 110. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2009), by committing medical malpractice in treating patient G.P COUNT X — PT. G.P. | | 111. Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) and thirty-nine (39) through forty-six: (46) as if fully set forth herein. . "112. Section 458.331(1)(q), Florida Statutes (2009), subjects a licensee to discipline, including suspension or revocation, 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 Section 458.331(1)(q), 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. 113. Respondent prescribed, dispensed, and/or administered controlled substances other than in the course of his professional practice DOH v. DEREK B. THORPE, M.D. CASE ‘NUMBER: 2009-22923 30 by prescribing, dispensing, and/or administering controlled substances inappropriately, without regard to the patient’s best interests or in excessive or inappropriate quantities to patient G.P. on or about the above described dates and in the above described quantities and. combinations. , 114. Based .on the foregoing, Respondent violated . Section 458,.331(1)(q), Florida Statutes (2009), by inappropriately prescribing excessive and inappropriate quantities of controlled substances to patient GP. 115. Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) and thirty-nine (39) through forty-six (46) as if fully set forth herein, : . 116. Section 458.331(1)(nn), Florida Statutes (2008-2009), 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. | . 117. Rule 6488-9.013(3), Florida Administrative Code, provides as follows: DOH v. DEREK B. THORPE, M.D, CASE NUMBER: 2009-22923 , 31 (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. (f) Medical Records. The physician is required to keep accurate and complete records to include, but not be * limited to: , oe 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 DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 32 9. Periodic reviews. Records must remain current and be maintained in an accessible manner and readily available for review. - 118. Respondent violated. Rule 64B8-9.013(3), Florida Administrative Code by prescribing controlled substances to patient G.P. without conducting a complete medical history and physical and documenting them in the medical record, and by failing to keep accurate and complete medical records. 119. Based on the foregoing, Respondent violated Section 458:331(1)(nn), Florida Statutes (2008-2009), by violating a rule adopted pursuant to Chapter 458. , COUNT XII - PT. G.P. . 120. Petitioner re-alleges and incorporates paragraphs one. (1) through sixteen (16) and thirty-nine (39) through forty-six (46) as if. fully set forth herein. . _ 121, Section 458.331(1)(m), Florida Statutes (2008-2009), 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, DOH v. DEREK B, THORPE, M.D. CASE NUMBER: 2009-22923 33 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. 122, On or about the dates set forth above, Respondent failed to keep medical records that justified the course of treatment of patient G.P. 123. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2008-2009). COUNT XE — PT, JF, 124. Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) and forty-seven (47) through fifty-six (56) as if fully set forth herein. | 125. Section 458.331(1)(t), Florida Statutes (2008-2009), provides that committing ‘medical malpractice constitutes grounds for disciplinary action by the Board of Medicine. Medical malpractice is defined in Section 456.50(9), Florida Statutes (2008-2009), 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 DOH vy. DEREK 8, THORPE, M.D. CASE NUMBER: 2009-22923 ~” 458,331(1)(t), Florida Statutes (2008-2009), the Board shall give: great weight to the provisions of Section 766.102, Florida Statutes (2008-2009), 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. ' 126. Respondent falled to practice medicine with that level of care, skill and treatment, which is recognized by a reasonably prudent similar physician as being acceptable under similar conditions and circumstances, in the treatment of patient LE in one or more of the following ways: a. _ By failing to obtain and document adequate medical histories; b. By failing to do adequate physical examinations; . .c. By prescribing excessive and/or inappropriate amounts of controlled substances without medical justification; d. By failing to adequately monitor patient compliance with controlled substances as prescribed; e. _ By failing to develop appropriate treatment plans; f. By failing to request referrals to specialists; and/or | DOH v. DEREK B, THORPE, M.D. CASE NUMBER: 2009-22923 35 g. By failing to prescribe or recommend. other treatment modalities for treatment of pain. 127. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2008-2008), by committing medical malpractice in treating patient 1.F. COUNT XV JF. 128. Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) and forty-seven (47) through fifty-six (56) as if fully set forth herein. . 129. Section 458.331(1X4q), Florida Statutes (2008-2009), subjects a licensee to discipline, including suspension or revocation, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physiclan's professional practice. For purposes of Section 458.331(1)(q), 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. DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 : 36 130. Respondent prescribed, dispensed, and/or administered ‘controlled substances other than in the course of his professional practice . by prescribing, dispensing, and/or administering controlled substances inappropriately, without regard to the patient’s -best interests or in excessive or inappropriate quantities to patient J.F. on or about the above described dates and in the above described quantities and combinations. 131. Based ‘on the foregoing, | Respondent violated Section 458.331(1)(q), Florida Statutes (2008-2009), by inappropriately prescribing excessive and inappropriate quantities of controlled substances to patient IF. COUNT XV — PT. JF. - 132. Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) and forty-seven (47) through fifty-six (56) as if fully set forth herein. a _ 133. Section 458.331(1)(nn), Florida Statutes (2008-2009), 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. - DOH v. DEREK B. THORPE, M.D, CASE NUMBER: 2009-22923 . 37. 134. 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 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 médical indications for the use of a controlled substance. (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; DOH v. DEREK B, THORPE, M.D. CASE NUMBER: 2009-22923 38 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. 135, Respondent violated Rule 64B8-9.013(3), Florida Administrative Code by prescribing controlled substances to patient 4J.F. without conducting a complete medical history and physical and documenting them in the medical record, and by falling to keep accurate and complete medical records. 136. Based on the foregoing, Respondent violated Section 458.331(1)(nn), Florida Statutes (2008-2009), by violating a rule adopted pursuant to Chapter 458. | COUNT XVI - PT. J.F. 137. Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) and forty-seven (47) through fifty-six (56) as if fully set forth herein. 138, Section 458.331(1)(m), Florida Statutes (2008-2009), subjects a licensee to discipline for failing to keep legible, as defined by department DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 39 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. 139. On or about the dates set forth above, Respondent failed to keep medical records that justified the course of treatment of patient 1.F. ' 140. Based on the foregoing, Respondent - violated Section 458.331(1)(m), Florida Statutes (2008-2009). COUNT XVII - PT. LM, ~ 141, Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) and fifty-seven (57) through seventy-three (73) as if fully set forth herein. . 142. Section 458.331(1)(0), Florida Statutes (2009), provides that committing medical malpractice constitutes grounds for disciplinary action by the Board of Medicine. Medical malpractice is defined in Section DOH y. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 ‘ . 40 456.50(g), Florida Statutes (2009), 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}(0), Florida Statutes (2009), the Board shall give great weight to the provisions of Section 766.102, Florida Statutes (2009), 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. - 143. Respondent failed to practice medicine with that level of care, skill and treatment, which is recognized by a reasonably prudent similar physician as being acceptable under sirailar conditions and circumstances, in the treatment of patient L.M. in one or more of the following ways: a. __ By failing to ‘obtain and document adequate medical histories; “b, By failing to do adequate physical examinations; c. By prescribing excessive and/or inappropriate amounts of controlled substances without medical justification; ‘dd. By failing to adequately monitor patient compliance with controlled substances as prescribed; DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 4i e. By failing to develop appropriate treatment plans; f. By failing to request referrals to specialists; and/or . g. By falling to prescribe or recommend other treatment modalities for treatment of pain. 144. Based on the foregoing, Respondent violated Section 458.331(1)(0, Florida Statutes (2009), by committing medical malpractice in treating patient L.M. | COUNT XVITT — PT. LM, - 145. Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) and fifty-seven (57) through seventy-three (73) as if fully set forth herein. . 146. Section 458.331(1)(q), Florida Statutes (2009), subjects a licensee to discipline, including suspension or revocation, 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 Section 458.331(1)(q), 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 DOH v. DEREK B, THORPE, M.D. CASE NUMBER: 2009-22923 : 42 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. _ 147. Respondent prescribed, dispensed, and/or administered controlled substances other than in the course of his professional practice by prescribing, dispensing, and/or administering controlled substances inappropriately, without regard to the patient's best interests or in- excessive or inappropriate quantities to patient L.M. on or about the above described dates and in the above described quantities and combinations. 148. Based on the foregoing, Respondent violated Section 458.331(1)(q), Florida Statutes (2009), by inappropriately prescribing excessive and inappropriate quantities of controlled substances to patient LM. COUNT XIX — L.M. 149. Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) and fifty-seven (57) throtigh seventy-three (73) as if fully set forth herein.’ 7 , 150. Section 458.331(1)(nn), Florida Statutes (2009), provides that _ violating any provision of chapters 456 or 458, Florida Statutes, or any DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 43 rules adopted pursuant thereto, is grounds for discipline by the Board of Medicine. 151. 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 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. (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 phiysical 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; DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 © 44 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 réadily available for review. . 152. Respondent violated Rule 64B8-9.013(3), Florida Administrative Code by prescribing conirolled substances to patient L.M. without conducting a complete medical history and physical and documenting them in the medical record, and by failing to keep accurate and complete medical records. 153. Based on the foregoing, Respondent violated Section 458.331(1)(nn), Florida Statutes (2009), by violating a rule adopted pursuant to Chapter 458. COUNT XX - PT. L.M. 154. Petitioner re-alleges and incorporates paragraphs one (1) through sixteen (16) and fifty-seven (57) through seventy-three (73) as If fully set forth herein. DOH y. DEREK 8. THORPE, M.D. CASE NUMBER: 2009-22923 z 45 155. Section 458.331(1)(m), Florida Statutes (2009), 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. 156. On or about the dates set forth above, Respondent failed to keep medical records that justified the course of treatment of patient L.M. 157. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2009). | 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 DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 46 _ fees billed or collected, remedial education and/or any other relief that the Board deems appropriate. " stenep this /° day of f Nhe , 2013. FILED DEPARTMENT OF HEALTH DEPUTY CLERK CLERK Angel Sanders pate OCT 21 2013 PCP Date: 10/18/2013 John H. Armstrong, MD, FACS, FCCP State Surgeon General & Secretary of Health, State of Florida . Fricke, Jr. nt General Counsel ja. Bar No. 0901910 Florida Department of Health Office of the General Counsel 4052 Bald Cypress Way, Bin #C65 Tallahassee, FL:32399-3265 , Telephone: (850) 245-4444 Facsimile: (850) 245-4684 PCP Members: Dr. Fuad Ashkar, Dr. Nabil El-Sanadi, and Ms. Goersch DOH v. DEREK B. THORPE, M.D. CASE NUMBER: 2009-22923 47 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, DEREK B. THORPE, M.D, CASE NUMBER: 2009-22923 : 48

Docket for Case No: 14-004286PL