STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, Petitioner, v. CASE NUMBER 2012-10332 JAYAM KRISHNA-IYER, M.D., Respondent. D i ¢ 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, Fromon or about August 30, 2007, to on or about March 23, 2009, Respondent treated Patient C.G. for complaints of chronic pain associated with fibromyalgia. 5. During Respondent’s treatment of Patient C.G., Respondent routinely prescribed oxycodone, Percocet, and Xanax to Patient C.G. 6. Oxycodone is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes, oxycodone is a Schedule IT 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, Percocet is the brand name for a drug that contains oxycodone and acetaminophen and is prescribed to treat pain. . 8. Xanax is the brand name for alprazolam and 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 DOH vy. Jayam Krishna-Tyer, MD DOH Case Number 2012-10332 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 III. 9. Specifically, from on or about October 8, 2007, to on or about March 23, 2009, Respondent prescribed controlled substances to Patient C.G,, in part, as follows!: 9/8/08 #180 #150 Date | Oxycodone Percocet Xanax 2mq 30mg 5ma/325m¢ 10/8/07 #120 #120 | 11/8/07 #120 #120 sd 12/4/07 #120 [#120 | #30(img) | CCCs 1/2/08 #120 #150 | #30(img) | 1/28/08 #150 #150 2/26/08 #180 #150 ee 3/25/08 #180 #150 #90 4/22/08 #180 | __ #150 #90 5/19/08 #180 #150 #90 | 6/16/08 #180 #150 #90 #150 #0 | 8/11/08 #180 #90 12/1/08 12/29/08 | #240 #120 1/26/09 #240 #120 30ml 2/23/09 #240 #120. |. «sd 30m | 3/23/09 | __—~ #240 #120 #90 1 From on or about October 8, 2007, to on or about January 2, 2008, Respondent examined Patient C.G, and ordered the controlled substances, however ancther physician in Respondent's office signed the prescriptions. DOH y, Jaya Krishna-lyer, MD OOH Case Number 2012-10332 10. Oxydose is the brand name of the oral, liquid form of oxycodone. 11. On or about August 30, 2007, as a condition of Respondent's willingness to prescribe controlled substances to Patient C.G., Respondent required Patient C.G. to comply with a Long-Term Controlled Substances Therapy for Chronic Pain Agreement (Agreement). 12. Among other things, the Agreement required Patient C.G. to take her medications only as prescribed by Respondent. 13. Respondent frequently renewed Patient C.G.’s medications early, which indicates that Patient C.G. was not taking her medications as prescribed. 14. The prevailing standard of care required Respondent to: obtain adequate objective documentation of Patient C.G.’s prior injuries and treatments; enforce the Agreement signed by Patient C.G.; consider other modalities for the treatment of Patient C.G.‘s pain; employ appropriate compliance monitoring; and prescribe controlled substances appropriately and with adequate justification. 15. Respondent failed to obtain adequate objective documentation of Patient C.G.’s prior injuries and treatments. . OOH v. Jayam Krishna-lyer, MD DOH Case Number 2012-10332 16. Respondent failed to enforce the Agreement ‘when presented with evidence that Patient C.G. was not taking her medications as prescribed. 17. Respondent failed to consider other modalities for the treatment of Patient C.G.’s pain. 18. Respondent failed to employ appropriate compliance monitoring to ensure Patient C.G. was taking her medications as prescribed and not taking any other medications. 19. Respondent prescribed controlled substances to Patient C.G. inappropriately. 20. Respondent prescribed controlled substances to Patient C.G. without adequate justification. 21. Respondent’s medical records fy the course of treatment of Patient C.G. COUNT ONE 22. Petitioner realleges and incorporates by reference the allegations in paragraphs one (1) through twenty-one (21) as if fully set forth herein. DOH vy. Jayam Krishna-lyer, MD DOH Case Number 2012-10332 23. 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 jaw related to heaith 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 prevalling 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. 24, 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). _ 25. 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: DOH v. Jayam Krishne-lyer, Ml DOH Case Nuraber 2011 2- 0332 a. By failing to obtain adequate objective documentation of Patient C.G.'s prior injuries and/or treatments; b. By failing to enforce the Agreement when presented with evidence that Patient C.G. was not taking her medications as prescribed; c. By falling to consider other modalities for the treatment of Patient C.G.’s pain; d. By failing to employ appropriate compliance monitoring to ensure Patient C.G. was taking her medications as prescribed and/or not taking any other medications; e. By prescribing controlled substances to Patient CG. inappropriately; and/or f. By prescribing controlled substances to Patient C.G. without adequate justification. COUNT TWO 26. Petitioner realleges and incorporates by reference the allegations in paragraphs one (1) through twenty-one (21) as if fully set: forth herein. 27. Section 458.331(1)(q), Florida Statutes (2007-2008), subjects a licensee to discipline for prescribing, dispensing, administering, mixing, or DOH y, Jayam Krishna-lyer, MD DOH Case Number 2012-10332 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. 28. Respondent violated Section 458.331(1)(q), Florida Statutes (2007-2008), by inappropriately prescribing controlled substances to Patient C.G. COUNT THREE 29. Petitioner realleges and incorporates by reference the allegations in paragraphs one (1) through twenty-one (21) as If fully set forth herein. . 30. 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 of treatment of the patient, including, but not limited to, patient histories; DOH v. Jayam Krishna-lyer, MD DOH Case Number 2012-10332 examination results; test results; records of drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. 31. 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 C.G, 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 2012-10332 SIGNED this _23 day of ____& ph abn ___, 2013. John H. Armstrong, MD, FACS State Surgeon General and Secretary of Health , Thomas3--Morton Assistant General Counsel FILED DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 CE NR CLERK Tallahassee, FL 32399-3265 CLERK Angel Sanders Florida Bar # 13771 DATE SEP 2 3 2013 (850) 245-4444 x 8212 PHONE (850) 245-4684 FAX thomas_morton@doh.state.fi.us PCP Date: 9/20/13 PCP Members: Dr. El-Bahri, Dr. S. Rosenberg, Mr. Mullins 10 OOH v, Jayam Krishna-lyer, MD DOH Case Number 2012-10332 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 ARDING MENT OF 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. il DOH v. Jayam Krishna-lyer, MD DOH Case Number 2012-16332

Docket for Case No: 18-000447PL