STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, Petitioner, v. CASE NUMBER 2012-03732 JAYAM KRISHNA-IYER, M.D., Respondent. ADMINISTRA LAINT 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 April 22, 1996, to on or about August 3, 2010, Respondent treated Patient C.H.B. for multiple complaints of musculoskeletal pain, including neck pain, low back pain, arm pain and leg pain. . 5. During Respondent’s treatment of Patient C.H.B., Respondent routinely prescribed Oxycontin, Actiq, Dilaudid and/or oxycodone to Patient C.H.B. for his 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 0 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. Actiq is a lozenge or popsicle that delivers fentanyl through the tissues in the mouth and is prescribed to treat severe pain. Fentanyl is an opioid drug that can decrease mental alertness and affect judgment. 2 DOH y. Jayam Krishna-lyer, MD DOH Case Number 2012-03732 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, Abuse of fentanyl may lead to severe psychological or physical dependence. 8. Dilaudid is the brand name for hydromorphone and is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, hydromorphone isa Schedule Il 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 hydromorphone may lead to severe psychological or physical dependence. 9. Specifically, from on or about May 15, 2007, to on or about August 3, 2010, Respondent prescribed controlled substances to Patlent C.H.B. as follows: 1 From on or about August 6, 2007, to on or about October 1, 2007, Respondent examined Patient C.H.B. and ordered the medications, however a different physician in Respondent's office signed the actual prescriptions. 3 DOH v. Jayam Krishna-lyer, MD DOH Case Number 2012-03732 Date | Oxycontin 80mg 8/6/07 60 Te 9/4/07 120 1) ae 10/1/07 120 (1200mcg) | 120 — ee 60 120 (1200mceg 30 11/26/07 60 ij 120 SY 12/20/07 60 120 | ——— 1/17/08 60 120 1/31/08 60 Cd 2/14/08 | =O 120 3/12/08 | 120 120 4/9/08 120 120 5/7/08 120 120 6/4/08 120 120 | 120 120 | 7/30/08 120 120 /28/ 120 120 120 120 120 120 | 11/20/08 120 120 12/17/08 | 120 120 1/14/09 120 120 1/26/09 20 2/9/09 120 120 _ 120 3/9/09 120 120 180 4/6/09 120 | 120 180 120 180 _| [~ 120 180 | 120 180 120 120 240, | 8/20/09 120 120 240. | 9/14/09 120 120 240 9/29/09 120 120 240 10/12/09 120. | 120 240 DOH v. Jayam Krishna-lyer, MD DOH Case Number 2012-03732 240 100 ‘180 12/28/09 1/18/10 120 2/22/10 120 3/22/10 120 4/19/10 120 5/10/10 120 | 6/8/10 120 10. On numerous occasions, Patient C.H.B. failed to take controlled substances as prescribed by Respondent, including, but not limited to, the following: | a. On or about January 31, 2008, Patient C.H.B. informed Respondent that he took greater dosages of Actiq than he was prescribed. b. On or about February 9, 2009, Patient C.H.B. informed Respondent that he took greater dosages of controlled substances than he was prescribed. c. On or about August 20, 2009, Patient C.H.B. informed Respondent that he took greater dosages of controlled substances than he was prescribed. DOH v, Jayam Krishna-lyer, MD DOH Case Number 2012-03732 d. Onor about September 14, 2009, Patient C.H.B. informed Respondent that he took greater dosages of controlled substances than he was prescribed. e. Onor about September 29, 2009, Patient C.H.B. informed Respondent that he took greater dosages of controlled substances than he was prescribed. f. On or about November 30, 2009, Patient C.H.B. informed Respondent that he took greater dosages of controlled substances than he was prescribed. | g. On or about January 18, 2010, Patient C.H.B. informed Respondent that he took greater dosages of controlled substances than he — was prescribed. h. On or about May 10, 2010, Patient C.H.B. informed Respondent that he took greater dosages of Actiq than he was prescribed. 11. The prevailing standard of care required Respondent to: obtain documentation of Patient C.H.B.'s prior injuries and treatments, formally refer Patient C.H.B. to a substance abuse specialist; document clear communications showing co-management with C.H.B.’s primary care provider. and psychiatrist; not prescribe Actiq to Patient C.H.B.; DOH y. Jayam Krishna-lyer, MO DOH Case Number 2012-03732 appropriately prescribe Oxycontin, Dilaudid and oxycodone to Patient C.H.B.; employ other treatment modalities for the treatment of Patient C.H.B.’s pain; and employ more stringent compliance monitoring. 12. Respondent failed to obtain documentation of Patient C.H.B.’s prior injuries and treatments. 13. Respondent failed to formally refer Patient C.H.B. to a substance abuse specialist. 14. Respondent failed to document clear communications showing co-management with C.H.B,’s primary care provider and psychiatrist. 15. Respondent inappropriately prescribed Actiq to Patient C.H.B. 16. Respondent prescribed Actiq to Patient C.H.B. without adequate justification. 17. Respondent prescribed Oxycontin, Dilaudid and/or oxycodone to Patient C.H.B. in excessive and/or inappropriate quantities, _— 18. Respondent failed to consider and/or employ other modalities for the treatment of Patient C.H.B.’s pain. 19. Respondent falled to employ more stringent compliance monitoring. DOH v. Jayam Krshna-lyer, MD DOH Case Number 2012-03732 20. Respondent's medical records for Patient C.H.B. do not adequately justify the course of treatment. COUNT ONE 21. Petitioner realleges and incorporates by reference the allegations in paragraphs one (1) through twenty (20) as if fully set forth herein. 22, Section 458.331(1)(t)1, Florida Statutes (2007-2010), subjects a physician to discipline for committing medical malpractice as defined in Section 456.50, Florida Statutes (2007-2010). “Medical malpractice” is defined by Section 456,.50(1)(g), Florida Statutes (2007-2010), as “the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure.” Section 456.50(1)(e), Florida Statutes (2007-2010), provides that the “evel 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 (2007-2010), 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 ail relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar health care providers. 8 DOH v. Jayam Krishna-lyer, MD DOH Case Number 2012-03732 23. Section 458.331(1)(t)1, Florida Statutes (2007-2010), directs the Board of Medicine to give “great weight” to this provision of Section 766.102, Florida Statutes (2007-2010). 24. Respondent failed to meet the prevailing standard of care and, therefore, violated Section 458.331(1)(t)1, Florida Statutes (2007-2010), in one or more of the following manners: | a. By failing to obtain documentation of C.H.B.’s_ prior injuries and/or treatments; b. By failing to formally refer Patient C.H.B. to 4 substance abuse specialist; c. _ By inappropriately prescribing Actiq to Patient C.H.B. d. By prescribing Actiq to Patient C.H.B. without adequate justification; e. By prescribing Oxycontin, Dilaudid and/or oxycodone to Patient C.H.B. in excessive and/or inappropriate quantities; f, By failing to consider and/or employ other modalities for the treatment of C.H.B.’s pain; and/or g. By failing to employ more stringent compliance monitoring. DOH vy. Jayam Krishna-Iyer, MO DOH Case Number 2012-03732 COUNT TWO 25. Petitioner realleges and incorporates by reference the allegations in paragraphs one (1) through twenty (20) as if fully set forth herein. 26. Section 458.331(1)(q), Florida Statutes (2007-2010), 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. 27. Respondent violated Section 458,331(1)(q), Florida Statutes (2007-2010), in one or more of the following ways: a. By Inappropriately prescribing Actiq to Patient C.H.B.; and/or b. By prescribing Oxycontin, Dilaudid and/or oxycodone to Patient C.H.B. in excessive and/or Inappropriate quantities. 10 DOH y, Jayam Krishna-lyer, MD DOH Case Number 2012-03732 COUNT THREE 28. Petitioner realleges and incorporates by reference the allegations in paragraphs one (1) through twenty (20) as if fully set forth herein. 29. Section 458.331(1)(m), Florida Statutes (2007-2010), 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 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. 30. Respondent violated Section 458.331(1)(m), Florida Statutes (2007-2010), by failing to keep legible medical records that justified - Respondent’s course of treatment of Patient C.H.B. 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 11 DOH v. Jayam Krishna-lyer, MD DOH Case Number 2012-03732 collected, remedial education and/or any other relief that the Board deems appropriate. SIGNED this _s*_ day of___—e/7 , 2013. TH MENT OF HEAL DePaul cue ct San ers oven ities 5 2013 DATE PCP Date: July 12, 2013 John H. Armstrong, MD, FACS State Surgeon General and Secretary of Health I ae pteteramn ae sone 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., Onelia G. Lage, M.D. DOH v. Jayam Krishna-lyer, MD DOH Case Number 2012-03732 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. E 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. Jayam Krishna-lyer, MD OOH Case Number 2012-03732

Docket for Case No: 18-000446PL