STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, Petitioner, Vv. CASE NUMBER 2012-02069 JAYAM KRISHNA-IYER, M.D., Respondent. ADMINISTRATIVE COMPLAINT COMES NOW, Petitioner, Department of Health (Department), by and through Its undersigned counsel, and files‘ this Administrative Complaint before the Board of Medicine against Respondent, Jayam Krishna-lyer, M.D., and in support thereof alleges: 1. Petitioner is the state department charged with regulating the practice of medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida Statutes; and Chapter 458, Florida Statutes. 2. Respondent's address of record is 1012 Druid Road East, Clearwater, Florida 33756. 3, At all times material to this Complaint, Respondent was licensed to practice as a physician In the State of Florida, pursuant to Chapter 458, Florida Statutes, having been issued license number ME 44742. 4, From on or about January 4, 2002, to on or about February 17, 2009, Respondent treated Patient K.P. for multiple complaints of musculoskeletal pain, including neck pain, low back pain, and knee pain. 5. During Respondent's treatment of Patient K.P., Respondent prescribed the controlled substances Oxycontin 80mg and Dilaudid 4mg to Patient K.P. on a monthly basis for her complaints of pain. 6. Oxycontin is the brand name for oxycodone and is prescribed to treat pain. Oxycodone is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes, oxycodone Is a Schedule Tl 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. 7. Dilaudid is the brand name for hydromorphone and is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, hydromorphone Is a Schedule IZ controlled substance that has a high potential for abuse and has a currently accepted but severely restricted 2 DOH v. Jayam Krishna-lyer, MD DOH Case Number 2012-02069 medical use in treatment in the United States. Abuse of hydromorphone may lead to severe psychological or physical dependence. 8. Oxycodone and hydromorphone are opioids. Opioid, or opiate, drugs have similar actions as the drug opium and are typically prescribed to treat pain. Opioid drugs are synthetically manufactured, while opiate drugs are naturally occurting, but the terms opioid and opiate are often used interchangeably. Opioid drugs are addictive and subject to abuse. 9. During Respondent's treatment of Patient K.P., Patient K.P. exhibited signs of aberrant behavior, which were suggestive of inappropriate use of controlled substances, including the following: a. On or about May 31, 2002, Patient K.P. informed Respondent that she lost her medications while traveling. b. On or about September 4, 2002, Respondent noted that Patient K.P. ran out of her medications early. c. On or about July 20, 2004, Patient K.P. informed Respondent that she lost her medications while hospitalized. d. On or about April 15, 2005, Patient K.P. informed Respondent that she lost her medications when her husband accidently caused her medications to fall into a sink full of water. 3 DOH v. Jayam Krishna-lyer, MD. DOH Case Number 2612-02069 e. On or about October 8, 2007, Patient, K.P. informed Respondent that she took additional paln medications while traveling abroad. f. On or about May 20, 2008, Patient K.P. was transported by ambulance to the Helen Ellis Memorial Hospital emergency room, in Tarpon Springs, Florida, for a possible overdose of Oxycontin and Dilaudid. The emergency room physician noted that Patient K.P. was experiencing hallucinations and psychosis. 10. During Respondent’s treatment of Patient K.P., Patient K.P. submitted to several urine drug screens that indicated Patient K.P. was not taking her medications as prescribed by Respondent, or was taking other drugs which were not prescribed by Respondent, including the following: | a. Onor about March 17, 2004, Patient K.P. tested positive for tetrahydrocannibinol (“THC”). . b. On or about April 25, 2005, Patient K.P. tested negative for hydromorphone despite having been prescribed 180 dosage units of Dilaudid 4mg on or about March 25, 2005, and 45 dosage units of Dialudid 4mg on or about April 15, 2005. DOH v, Jayam Krishna-lyer, MD DOH Case Number 2012-02069 c. Onor about August 9, 2005, Patient K.P. tested negative for alprazolam despite having been prescribed 120 dosage units of ; alprazolam .25mg on or about July 11, 2005. d. | Onor about May 22, 2007, Patient K.P. tested positive for oxazepam. e. On or about October 11, 2007, Patient K.P. tested positive for THC. 11. THC is the psychoactive ingredient 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. 12. 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. Abuse of alprazolam may lead to limited physical or psychological dependence relative to the substances In Schedule ITT. DOH v, Jayam Krshna-lyer, MD DOH Case Number 2012-02069 13. Oxazepam is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, oxazepam 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 oxazepam may lead to limited physical or psychological dependence relative to the substances in Schedule ITI. 14. Specifically, from on or about July 17, 2007, to on or about February 17, 2009, Respondent prescribed controlled substances to Patient K.P. as follows:? 1 From on or about July 17, 2007, to on of about October 8, 2007, Respondent examined Patient K.P, and ordered the medications, however a different physician in Respondent's office signed the actual prescriptions. 6 DOH v. Jayam Krishna-lyer, MD DOH Case Number 2012-02069 (Date | Oxycontin soma _| Klonipin img | Dilaudid 4ma ma 350mq 7/17/07 20 | | 240 [| || 8/14/07 120 120 240 120. 9/10/07 120. 120. 240 120 10/8/07 120 120 240 11/5/07 | 120 120 240 120 12/3/07 _| 120 | 240 Cd 12/31/07 120 = 240 1/28/08 120 240 2/25/08 120 120 240 120 "3/24/08 120 240 4/18/08 120 240 5 120 240 120 120 240 120 120 240 [8/5/08 120 240 9/2/08 120 240 9/30/08 120 ~{___120 240 120 10/24/08 20 40 | 10/31/08 120 240 11/25/08 120 240 _ 240 12/23/08 120 [1/20/09 : 120 120 240° 120 2/17/09 120 240 15. Klonopin is the brand name for clonazepam and Is prescribed to treat anxiety. According to Section 893.03(4), Florida Statutes, clonazepam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States. Abuse of DOH v. Jayam Krishna-Lyer, MD DOH Case Number 2012-02069 clonazepam may lead to limited physical or psychological dependence relative to the substances In Schedule IIT. 16. Soma Is the brand name for carisoprodol, a muscle 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 ITI. 17. Respondent prescribed opioids without adequate justification, inappropriately, and/or in excessive quantities, to Patient K.P. 18. Respondent prescribed Klonipin without adequate justification and/or inappropriately, to Patient K.P. 19. Respondent failed to obtain documentation of Patient K.P,’s injuries and prior treatments. 20. Respondent falled to refer Patient K.P. to a substance abuse specialist. . 21. Respondent failed to refer Patient K.P. to a psychiatrist. DOH v, Jayam Krishna-lyer, MD DOH Case Number 2012-02069 22. Respondent’s medical records for Patient K.P, do not adequately justify the course of treatment. COUNT ONE 23. Petitioner realleges and incorporates by reference the allegations in paragraphs one (1) through twenty-two (22) as if fully set forth herein. 24. Section 458.331(1)(t)1, Florida Statutes (2007-2008), subjects a physician to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes (2007-2008). “Medical malpractice” is defined by Section 456.50(1)(g), Florida Statutes (2007-2008), as “the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure.” Section 456.50(1)(e), Florida Statutes (2007-2008), provides that the “level of care, skill, and treatment recognized in general law related to : health care licensure" means the standard of care that is specified in Section 766.102(1), Florida Statutes (2007-2008), which states as follows: 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. 9 DOH v, Jayam Krishna-lyer, MD DOH Case Number 2012-02069 25. Section 458.331(1)(t)1, Florida Statutes (2007-2008), directs the Board of Medicine to give “great weight” to this provision of Section 766.102, Florida Statutes (2007-2008). 26. Respondent failed to meet the prevailing standard of care and, therefore, violated Section 458.331(1)(t)1, Florida Statutes (2007-2008), In one or more of the following manners: a. By prescribing oploids without adequate justification, inappropriately, and/or in excessive quantities to Patient K.P.; b. By prescribing Klonipin without adequate justification and/or inappropriately, to Patient K.P.; c. By failing to obtain documentation of Patient K.P.’s injuries and prior. treatments; d. By failing to refer Patient K.P. to a substance abuse specialist; and/or e. By failing to refer Patient K.P. to a psychiatrist. COUNT TWO 27. Petitioner realleges and incorporates by reference the allegations in paragraphs one (1) through twenty-two (22) as if fully set forth hereln. 10 DOH v. Jayam Krishna-Iyer, MD DOH Case Number 2012-02069 28, Section 458.331(1)(q), Florida Statutes (2007-2008), subjects a licensee 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. It Is 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. 29. Respondent violated Section 458.331(1)(q), Florida Statutes (2007-2008), by prescribing opioids and/or Klonipin inappropriately or. in excessive or inappropriate quantities to Patient K.P. COUNT THREE 30. Petitioner realleges and incorporates by reference the allegations in paragraphs one (1) through twenty-two (22) as if fully set forth herein. 31, Section 458.331(1)(m), Florida Statutes (2007-2008), subjects a licensee to discipline for failing to keep legible, as defined by department rule in consultation with the board, medical records that justify the course 11 DOH v, Jayam Krishna-lyer, MD DOH Case Number 2012-02069 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. 32. Respondent violated Section 458.331(1)(m), Florida Statutes (2007-2008), by failing to keep legible medical records that justified Respondent's course of treatment of Patient K.P. 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, 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. DOH v, Jayam Krishna-lyer, MD DOH Case Number 2012-02069 SIGNED this _/5™ day of DEPART! ENTO MENT OF HEALTH DEPUTY CLERK CLERK pare UT S25" PCP Date: July 12, 2013 sy 2013. John H. Armstrong, MD, FACS State Surgeon General and Secretary of Health —— Trond) ¢ Morton Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar # 13771 (850) 245-4444 x 8212 PHONE (850) 245-4684 FAX thomas_morton@doh.state.fl.us PCP Members: Mark Avila, M.D., Onella G. Lage, M.D. DOH v, Jayam Krishna-lyer, MD DOH Case Number 2012-02069 OTICE 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. TICE REGARDING ASSESSMENT OF COST: 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, Jayam Krishna-lyer, MD DOH Case Number 2012-02069

Docket for Case No: 18-000445PL