Petitioner: DEPARTMENT OF HEALTH, BOARD OF MEDICINE
Respondent: STEVEN E. RAHMAN, M.D.
Judges: ROBERT S. COHEN
Agency: Department of Health
Locations: Tallahassee, Florida
Filed: Feb. 10, 2020
Status: Closed
Settled and/or Dismissed prior to entry of RO/FO on Tuesday, February 2, 2021.
Latest Update: Dec. 23, 2024
STATE OF FLORIDA
DEPARTMENT OF HEALTH
DEPARTMENT OF HEALTH,
PETITIONER,
v. CASE NO.: 2012-00762
STEVEN ERNEST RAHMAN, M.D.,
RESPONDENT.
/
ADMINISTRATIVE COMPLAINT —
Petitioner, Department of Health, by and through its undersigned
counsel, files this Administrative Complaint before the Board of Medicine
against the Respondent, Steven Ernest Rahman, M.D., and in support
thereof alleges:
Petitioner is the state agency charged with regulating the practice of
medicine pursuant to Section 20.43, Florida Statutes; Chapter 456, Florida
Statutes; and Chapter 458, Florida Statutes.
At all times material to this Complaint, Respondent was a licensed
physician within the State of Florida, having been issued license number
ME 83769.
Respondent's address of record is 3319 State Road 7, Suite 109,
Wellington, Florida 33449. |
At all times material, Respondent's place of practice was Progressive
Health Institute (hereinafter “Progressive”), located at 900 South U.S.
Highway One, Suite 108, Jupiter, Florida 33477.
FACTS SPECIFIC TO PATIENT F.C.
On or about April 5, 2012, Patient F.C., a fifty-two (52) year old male,
sent a facsimile to Progressive which included a completed medical history
questionnaire, a therapy management agreement dated April 3, 2012, the
results of laboratory tests dated March 2, 2012, a pre-placement physical
examination form dated April 3, 2012, and a copy of his driver's license.
Patient F.C.’s driver’s license was issued by the state of Massachusetts
and he listed his residential address as Massachusetts.
From about April 5, 2012 to September 28, 2012, Respondent treated
Patient F.C. for difficulty sleeping, decreased energy, decreased muscle
strength, decreased skin elasticity, decreased libido, thinning/loss of hair,
muscle aches and pains, and increased muscle deterioration.
The March 2, 2012 blood analysis results indicated that Patient F.C,
possibly had hypogonadism and a pituitary gland tumor.
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
Patient F.C.’s blood analysis results indicated the need for further
evaluation by an endocrinologist.
10. Respondent did not provide adequate evaluation for Patient F.C.’s
possible hypogonadism and possible pituitary gland tumor at any point
during his treatment of Patient F.C.
11. Over the course of his treatment of Patient F.C., the Respondent
prescribed the following legend drugs, supplements, and supplies at
various times in various combinations, doses, and quantities:
anastrozole!, HCG?, testosterone cypionate?, DHEA‘, B-12 cyanobalamin$,
sermorelin/GHRP-6°, testosterone cypionate with zinc’, needles, and
syringes.
' Anastrozole is a legend drug approved for the treatment of breast cancer and metastasis in both pre- and post-
menopausal women. The primary use of anastrozole in men is to suppress the production of estrogen.
? HCG (human chorionic gonadotropin) is a hormone produced by the syncytiotrophoblast, a portion of the placenta,
following implantation. In men, HCG has been used in combination with anabolic androgenic steroids maintain and
restore testosterone production and prevent testicular atrophy.
3 Testosterone cypionate injections contain testosterone which is an anabolic steroid that promotes muscle growth.
According to Section 893.03(3 Xd), Florida Statutes, testosterone is a Schedule IJ controlled substance that has a
high potential for abuse and has a currently accepted by severely restricted medical use in treatment in the United
States. Abuse of testosterone may lead to severe psychological or physical dependence.
* DHEA is dehydroepiandrosterone. DHEA supplements are used by some people who believe they can improve sex
drive, build muscle, fight the effects of aging, and improve some health conditions.
3 B-12 cyanocobalamin is an injectable form of vitamin B-12.
® Sermorelin/GHRP-6 is a growth hormone releasing hormone. {t stimulates the pituitary gland to secrete growth
hormones. Sermorelin/GHRP-6 is used by some people who believe it can improve sex drive, build muscle, fight the
effects of aging, and improve some health conditions.
7 Some people use zinc supplements in conjunction with testosterone because they believe that zinc can increase
testosterone levels.
DOH v, Steven Emest Rahman, MD
Case #2012-00762
P25
13.
14.
15.
16.
Respondent did not perform, or did not create or maintain documentation
of performing, a physical examination of Patient F.C. at any point during
Respondent's treatment of Patient F.C.
The standard of care for prescribing anabolic steroids, growth hormone
compounds, and hormone therapy required Respondent to physically
examine Patient F.C. and take a complete history, with special attention
paid to possible contraindications such as breast and prostate cancer.
Additionally, a diagnosis of low serum testosterone must be established
before prescribing hormone therapy. The laboratory tests should be
current and should be measured with a morning sample and an additional
confirmation sample.
Respondent did not perform an adequate physical examination of Patient
F.C. prior to prescribing steroids, growth hormone compounds, and
hormone therapy.
Respondent did not order adequate laboratory tests to establish Patient
F.C.’s baseline hormone levels.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing testosterone to Patient F.C. ata higher
level than the standard replacement dosages.
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
17.
18.
19,
20.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing HCG and sermorelin to Patient F.C
without laboratory test results indicating a growth hormone deficiency.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing anastrozole, an estrogen inhibitor that
may be prescribed to increase the effectiveness of testosterone, to Patient
F.C.
Count I — Patient F.C.
Violation of Section 458.331(1)(t)
Petitioner re-alleges and incorporates paragraphs five (5) through
eighteen (18) as if fully set forth herein.
Section 458.331(1)(t), Florida Statutes (2011-2012), subjects a licensee
to discipline for committing medical malpractice as defined in Section
456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2011-
2012), 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. Section 766.102, Florida
Statutes (2011-2012), provides that the prevailing standard of care for a
given healthcare provider shall be that level of care, skill, and treatment
which, in light of all relevant surrounding circumstances, is recognized as
5
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
21.
22.
acceptable and appropriate by reasonably prudent similar health care
providers.
Respondent fell below the minimum standard of care in his treatment of
Patient F.C. in one or more of the following ways:
f.
By failing to perform adequate physical examinations of Patient
FC.;
. By failing to order current laboratory tests to establish Patient
F.C.’s baseline hormone levels; ,
. By failing to perform an adequate evaluation for Patient F.C.’s
possible hypogonadism and/or pituitary tumor;
. By failing to refer Patient F.C. to an endocrinologist for evaluation
of Patient F.C.’s abnormal test results;
. By inappropriately prescribing steroids, growth hormone
compounds, and anastrozole; and/or
By prescribing excessive dosages of testosterone.
Based on the foregoing, Respondent violated Section 458.331(1)(t),
Florida Statutes (2011-2012).
DOH v., Steven Ernest Rahman, MD
Case #2012-00762
23.
24.
25.
Count II — Patient F.C.
Violation of Section 458.331(1)(q)
Petitioner re-alleges and incorporates paragraphs five (5) through
eighteen (18) as if fully set forth herein.
Section 458.331(1)(q), Florida Statutes (2011-2012), subjects a licensee
to discipline for prescribing, dispensing, administering, mixing, or
otherwise preparing a legend drug, fnduding any controlled substance,
other than in the course of the physician's professional practice. For the
purposes of the 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.
Respondent prescribed legend drugs, including controlled substances,
other than in the course of his professional practice in one or more of the
following ways:
a. By inappropriately prescribing HCG and sermorelin to Patient F.C.
without medical justification; a
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
26.
27.
28.
b. By inappropriately prescribing testosterone to Patient F.C.
without performing the proper evaluation for treatment;
c. By inappropriately prescribing dosages of testosterone at a level
higher than is recommended by the standard of care; and/or
d. By inappropriately prescribing anastrozole as a supplement to
the testosterone treatment when the testosterone treatment was
inappropriate.
Based on the foregoing, Respondent violated ‘Section 458.331(1)(q),
Florida Statutes (2011-2012).
Count III — Patient F.C.
Violation of Section 458.331(1)(m)
Petitioner re-alleges and incorporates paragraphs five (5) through
eighteen (18) as if fully set forth herein.
Section 458.331(1)(m), Florida Statutes (2011-2012), provides that 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 professiona!
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
8
DCH v. Steven Ernest Rahman, MD
Case #2012-00762
29.
30.
31.
histories; examination results; test results; records of drugs prescribed,
dispensed, or administered; and reports of consultations and
hospitalizations, is grounds for disciplinary action by the Board and/or
Department.
Respondent failed to maintain complete and adequate medical records
that justified the course of treatment provided for Patient F.C. in one or
more of the following ways: .
a. By failing to document adequate physical examinations of Patient
F.C.; and/or
b. By failing to document a medical justification for the care and
treatment provided to Patient F.C.
Based on the foregoing, Respondent violated Section 458.331(1)(m),
Florida Statutes (2011-2012).
FACTS SPECIFIC TO PATIENT R.K.
On or about April 19, 2012, Patient R.K., a thirty-four (34) year old male,
sent a facsimile to Progressive which included a completed medical history
questionnaire, a high school pre-participation physical fitness evaluation
form dated April 12, 2012, laboratory results dated April 12, 2012, and
documentation regarding Patient R.K.’s prior microdiskectomy.
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
32.
33."
From about April 19, 2012 to April 23, 2012, Respondent treated Patient
R.K. for decreased concentration, increased stress levels, difficulty
sleeping, decreased energy, decreased muscle strength, decreased libido,
increased fatigue, stiff joints, and muscle aches and pains.
On or about April 23, 2012, Respondent prescribed the following legend
drugs, supplements, and supplies to Patient R.K.: anastrozole, HCG,
testosterone cypionate, nandrolone®, danazol®, B-12 cyanocobalamin,
MIC Injectable, MIC Capsule, testosterone suspension'!, GAC!2, and
needles and syringes in various sizes.
34, Respondent did not perform, or did not create or maintain documentation
of performing, a physical examination of Patient R.K. at any point during
his treatment of Patient R.K.
35. The standard of care for prescribing anabolic steroids and growth
hormone compounds required Respondent to physically examine Patient
® Nandrolone is an anabolic steroid that promotes muscle growth. According to Section 893.03(3\(d), Florida Statutes,
nandrolone is a Schedule III controlled substance that has a high potential for abuse and has a currently accepted by
severely restricted medical use in treatment in the United States. Abuse of nandrolone may lead to severe psychological
or physical dependence.
° Danazol, synthetic steroid derived from ethisterone and is primarily used to treat endometriosis. That suppresses the
production of gonadotrophins and has some weak androgenic effects.
‘© MIC injections contain methionine, inositol and choline and are generally utilized in medically supervised weight
loss.
"| Testosterone suspension is an anabolic steroid in an injectable form: According to Section 893.03(3)(d). Florida
Statutes, testosterone is a Schedule II] controlled substance that has a high potential for abuse and has a-currently
accepted by severely restricted medical use in treatment in the United States. Abuse of testosterone may lead to severe
psychological or physical dependence.
GAC is a supplement containing glutamine, arginine, and carnitine and is generally used for weight loss and
muscle building.
10
DOH v, Steven Ernest Rahman, MD
Case #2012-00762
36.
37.
38.
39.
RK. and take a complete history, with special attention paid to possible
contraindications such as breast and prostate cancer. Additionally, a
diagnosis of low serum testosterone “must be established before
prescribing hormone therapy. The laboratory tests should be current and
should be measured with a morning sample and an additional
confirmation sample.
Respondent did not perform an adequate physical examination of Patient
R.K. prior to prescribing steroids and growth hormone compounds.
Respondent did not order adequate laboratory tests to establish Patient
R.K.'s baseline hormone levels.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing steroids and growth hormone
compounds to Patient R.K. without evidence of hypogonadism or any
other hormonal abnormality or deficiency.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing anastrozole, an estrogen inhibitor that
may be prescribed to increase the effectiveness of testosterone, to Patient
F.C,
Count IV — Patient R.K.
Violation of Section 458.331(1)(t)
DOH v. Steven Emest Rahman, MD
Case #2012-00762
40.
41.
42.
Petitioner re-alleges and incorporates paragraphs thirty-one (31) through
thirty-nine (39) as if fully set forth herein.
Section 458.331(1)(t), Florida Statutes (2011), subjects a licensee to
discipline for committing medical malpractice as defined in Section
456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2011),
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 fleersores Section 766.102, Florida
Statutes (2011), provides that the prevailing standard of care for a given
healthcare 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.
Respondent fell below the minimum standard of care in his treatment of
Patient R.K. in one or more of the following ways:
a. By failing to perform adequate physical examinations of Patient
R.K.;
b. By failing to order current laboratory tests to establish Patient
ow
R.K.'s baseline hormone levels; and/or
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
43.
45.
¢. By inappropriately prescribing steroids, growth hormone
compounds, and anastrozole.
Based on the foregoing, Respondent violated Section 458.331(1)(t),
Florida Statutes (2011).
Count V — Patient R.K.
Violation of Section 458.331(1)(q)
Petitioner re-alleges and incorporates paragraphs thirty-one (31) through
thirty-nine (39) as if fully set forth herein.
Section 458.331(1)(q), Florida Statutes (2011), 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. For the purposes of
the paragraph, it shall be legally presumed that prescribing, dispensing,
administering, mixing, or otherwise preparing legend — including all
controlied 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.
Respondent inappropriately prescribed legend drugs, including controlled
substances, other than in the course of his professional practice by
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
47.
48.
49.
prescribing steroids and growth hormone compounds to Patient R.K-
without performing the proper evaluation for treatment.
Based on the foregoing, Respondent violated Section 458.331(1)(q),
Florida Statutes (2011).
Count VI — Patient R.K.
Violation of Section 458.331(1)(m)
Petitioner re-alleges and incorporates paragraphs thirty-one (31) through
thirty-nine (39) as if fully set forth herein., ,
Section 458.331(1)(m), Florida Statutes (2011), provides that 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, is
grounds for disciplinary action by the Board and/or Department.
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
50.
- SL.
52.
53.
54.
Respondent failed to maintain complete and adequate medical records
that justified the course of treatment provided for Patient R.K. in one or
more of the following ways:
a. By failing to document adequate physical examinations of Patient
R.K.; and/or
b. By failing to document a medical justification for prescribing
Patient R.K. the aforementioned legend drugs.
Based on the foregoing, Respondent violated Section 458.331(1)(m),
Florida Statutes (2011).
FACTS SPECIFIC TO PATIENT C.B.
On or about March 3, 2012, Patient C.B., a thirty-five (35) year old male,
completed a medical history questionnaire and therapy management
agreement for treatment at Progressive.
Patient C.B. provided Progressive with medical records from a surgery he
had in 2005, documentation of blood analysis results dated May 20, 2010
and July 7, 2011, documentation of a physical examination conducted on
October 12, 2011, and a copy of his driver's license.
Patient C.B.’s driver's license was issued by New Jersey and he listed his
residential address as California.
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
55.
56.
57.
58.
From about April 11, 2012 to July 27, 2012, Respondent treated Patient
C.B. for decreased concentration, increased stress levels, decreased
energy, decreased muscle strength, decreased skin elasticity, decreased
libido, thinning or loss of hair, decreased long and short term memory,
decreased testicle size, increased muscle deterioration, thinning and dry
skin, and increased joint pain.
On or about April 11, 2012, Respondent prescribed the following
medications to Patient C.B.: anastrozole, HCG, sildenafil'?, testosterone
cypionate, methylcobalamin"*, and nandrolone.
Respondent did not perform, or did not create or maintain documentation
of performing, an adequate physical examination of Patient C.B. at any
point during Respondent's treatment of Patient C.B.
The standard of care for prescribing anabolic steroids, hormones, and
growth hormone compounds required Respondent to physically examine
Patient C.B. and take a complete history, with special attention paid to
possible contraindications such as breast and prostate cancer.
Additionally, a diagnosis of low serum testosterone must be established
before prescribing hormone therapy. The laboratory tests should be
13 Sildenafil, otherwise known as Viagra, is a legend drug commonly prescribed to treat erectile dysfunction.
14 Methylcobalamin is a form of vitamin B12.
DOH v. Steven Emest Rahman, MD
Case #2012-00762
59.
60.
61.
62.
63.
current and should be measured with a morning sample and an additional
confirmation sample.
Respondent did not perform an adequate physical examination of Patient
C.B. prior to prescribing steroids and growth hormone compounds.
Respondent did not order current and adequate laboratory tests to
establish Patient C.B.’s baseline hormone levels.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing growth hormone compounds to Patient
C.B. without laboratory test results indicating a growth hormone
deficiency.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing steroids and hormone therapy to Patient
C.B. without laboratory test results indicating hypogonadism or any other
hormonal abnormality or deficiency.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing anastrozole, an estrogen inhibitor that
may be prescribed to increase the effectiveness of testosterone, to Patient
C.B.
Count VII — Patient C.B.
Violation of Section 458.331(1)(t)
DOH v, Steven Ernest Rahman, MD
Case #2012-00762
64.
65.
66.
Petitioner re-alleges and incorporates paragraphs fifty-two (52) through
sixty-three (63) as if fully set forth herein.
Section 458.331(1)(t), Florida Statutes (2011-2012), subjects a licensee
to discipline for committing medical malpractice as defined in Section
456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2011-
2012), 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. Section 766.102, Florida
Statutes (2011-2012), provides that the prevailing standard of care for a
given healthcare 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.
Respondent fell below the minimum standard of care in his treatment of
Patient C.B. in one or more of the following ways:
a. By failing to perform adequate physical examinations of Patient
C.B.;
b. By failing to order current laboratory tests to establish Patient
”
C.B.'s baseline hormone levels; and/or
DOH ’v, Steven Ernest Rahman, MD
Case #2012-00762
67.
68.
69.
¢. By inappropriately prescribing steroids, growth hormone
compounds, and anastrozole in the absence of hypogonadism or
any other hormone deficiency.
Based on the foregoing, Respondent violated Section 458.331(1)(t),
Florida Statutes (2011-2012). .
Count VIII — Patient C.B.
Violation of Section 458.331(1)(q)
Petitioner re-alleges and incorporates paragraphs fifty-two (52) through
sixty-three (63) as if fully set forth herein.
Section 458.331(1)(q), Florida Statutes (2011-2012), 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. For the
purposes of the 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.
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
70. Respondent prescribed legend drugs, including controlled substances,
other than in the course of his professional practice by inappropriately
prescribing anabolic steroids, HCG, anastrozole, and testosterone to
Patient C.B. in the absence of a hormonal imbalance or any other medical
justification.
71. Based on the foregoing, Respondent violated Section 458.331(1)(q),
Florida Statutes (2011-2012).
Count IX — Patient C.B.
Violation of Section 458.331(1)(m)
72. Petitioner re-alleges and incorporates paragraphs fifty-two (52) through
sixty-three (63) as if fully set forth herein.
73. Section 458.331(1)(m), Florida Statutes (2011-2012), provides that 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 preseribed,
dispensed, or administered; and reports of consultations and
20
DOH v. Steven Emest Rahman, MD
Case #2012-00762
74.
75.
76.
77.
hospitalizations, is grounds for disciplinary action by the Board and/or
Department.
Respondent failed to maintain complete and adequate medical records
that justified the course of treatment provided for Patient C.B. in one or
more of the following ways:
a. By failing to document adequate physical examinations of Patient
C.B.; and/or
b. By failing to document a diagnosis or medical justification for
prescribing Patient C.B. the aforementioned medications.
Based on the foregoing, Respondent violated Section 458.331(1)(m),
Florida Statutes (2011-2012).
. FACTS SPECIFIC TO R.W.
From about June 15, 2012 to August 29, 2012, Respondent treated
Patient R.W. for decreased concentration, increased stress levels,
difficulty sleeping, increased wrinkles, thinning and loss of hair, decreased
sex drive, decreased endurance, increased fat deposits, and increased
joint pain.
Ove the course of Respondent’s treatment of Patient RW., the
Respondent prescribed the following medications and supplies at various
21
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
78.
79.
80.
times in various combinations, doses, and quantities: anastrozole,
testosterone cypionate, HCG, sildenafil, glucosamine’, amino blend with
lidocaine injection**, nandrolone, needles, and syringes.
Respondent did not perform, or did not create or maintain documentation
of performing, an adequate physical examination prior to prescribing
steroids, growth hormone compounds, and hormone therapy.
The standard of care for prescribing anabolic steroids, growth hormone
compounds, and hormone therapy required Respondent to physically
examine Patient R.W. and take a complete history, with special attention
paid to possible contraindications such as breast and prostate cancer.
Additionally, a diagnosis of low serum testosterone must be established
before prescribing hormone therapy. The laboratory tests should be
current and should be measured with a morning sample and an additional
confirmation sample.
Respondent did not document physical examinations of Patient R.W. at
any point during his treatment of Patient R.W.
5 Glucosamine is a dietary supplement believed by some to relieve symptoms of osteoarthritis.
'S An amino blend is‘a dietary supplement consisting of several amino acids believed by some to assist with weight
loss. Lidocaine. an anesthetic, is included in the injections as well.
: 22
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
81.
82.
83.
84.
85.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing growth hormone compounds to Patient
R.W. without laboratory test results indicating a growth hormone
deficiency.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing steroids and hormone therapy to Patient
R.W. without laboratory test results indicating hypogonadism or any other
hormonal abnormality or deficiency.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing anastrozole, an estrogen inhibitor that
may be prescribed to increase the effectiveness of testosterone, to Patient
R.W without laboratory test results indicating a hormonal deficiency.
Count X — Patient R.W.
Violation of Section 458.331(1)(t)
Petitioner re-alleges and incorporates paragraphs seventy-six (76)
through eighty-three (83) as if fully set forth herein.
Section 458.331(1)(t), Florida Statutes (2011-2012), subjects a licensee
to discipline for committing medical malpractice as defined in Section
456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2011-
2012), defines medical malpractice as the failure to practice medicine in
23
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
accordance with the level of care, skill, and treatment recognized in
general law related to health care licensure. Section 766.102, Florida
Statutes (2011-2012), provides that the prevailing standard of care for a
given healthcare 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.
86. Respondent fell below the minimum standard of care in his treatment of
Patient R.W. in one or — of the following ways:
a. By failing to perform adequate physical examinations of Patient
R.W.; |
b. By failing to order current laboratory tests to establish Patient
R.W/s baseline hormone levels; and/or
c. By inappropriately prescribing steroids, growth hormone
compounds, and anastrozole in the absence of hypogonadism or
any other hormone deficiency.
87. Based on the foregoing, Respondent violated Section 458.331(1)(t),
Florida Statutes (2011-2012).
Count XI — Patient R.W.
Violation of Section 458.331(1)(q)
24
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
88.
89.
90.
91.
Petitioner re-alleges and incorporates paragraphs seventy-six (76)
through eighty-three (83) as if fully set forth herein.
Section 458.331(1)(q), Florida Statutes (2011-2012), 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. For the
purposes of the 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.
Respondent prescribed legend drugs, including controlled substances,
other than in the course of his professional practice by inappropriately
prescribing anabolic steroids, HCG, anastrozole, and testosterone to
Patient R.W. in the absence of any hormonal imbalance or any other
medical justification.
Based on the foregoing, Respondent violated Section 458.331(1)(q),
Florida Statutes (2011-2012).
25
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
92.
93.
94.
Count XII — Patient R.W.
Violation of Section 458.331(1)(m)
Petitioner re-alleges and incorporates paragraphs seventy-six (76)
through eighty-three (83) as if fully set forth herein.
Section 458.331(1)(m), Florida Statutes (2011-2012), provides that 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, is grounds for disciplinary action by the Board and/or
Department.
Respondent failed to maintain complete and adequate medical records
that justified the course of treatment provided for Patient R.W. in one or
more of the following ways:
a. By failing to document adequate physical examinations of Patient
R.W.; and/or
26
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
b, By failing to document a diagnosis or medical justification for
prescribing Patient R.W. the aforementioned medications.
95. Based on the foregoing, Respondent violated Section 458.331(1)(m),
Florida Statutes (2011-2012).
FACTS SPECIFIC TO D.A.
96. From on or about February 15, 2012 to July 2, 2012, Respondent
prescribed Patient D.A. the following legend drugs, supplements, and
equipment in various quantities and dosages: anastrozole, HCG, Lipo
Max!?, testosterone cypionate, L-arginine!®, L-glutamine’, danazol,
triamtereme”, phentermine2!, testosterone propionate2, needles, and
syringes.
97. There is no documentation of any health complaints or issues reported by
Patient D.A. that would indicate Respondent's justification for his
treatment of Patient D.A.
" Lipo Max is a weight loss supplement.
'8 L-arginine is an amino acid used for improving athletic performance.
19 L-glutamine is an amino acid used for improving exercise performance.
° Triamtereme is a diuretic used to treat fluid retention. Diuretics are used by some people to assist in weight loss.
2) Phentermine is an appetite suppressant drug and is medically prescribed as a diet pill. According to Section
893.03(4), phentermine is a Schedule IV controlled substance which has a low potential for abuse and is currently
accepted for medical use in the United States. Abuse of the substance may lead to limited physical or psychological
dependence. o”
® Testosterone propionate is an anabolic steroid. According to Section 893.03(3)(d), Florida Statutes, testosterone is
a Schedule HI controlled substance that has a high potential for abuse and has a currently accepted by severely
restricted medical use in treatment in the United States. Abuse of testosterone may lead to severe psychological or
physical dependence.
27
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
98.
99.
100.
101.
102.
Respondent did not perform, or did not create or maintain documentation
of performing, physical examinations of Patient D.A. at any point during
his treatment of Patient D.A.
The standard of care for prescribing anabolic steroids, growth hormone
compounds, and hormone therapy required Respondent to physically
examine Patient D.A. and take a complete history, with special attention
paid to possible contraindications such as breast and prostate cancer.
Additionally, a diagnosis of low serum testosterone must be established
before prescribing hormone therapy. The laboratory tests should be
current and should be measured with a morning sample and an additional
confirmation sample.
Respondent did not perform an adequate physical examination prior to
prescribing steroids, growth hormone compounds, and hormone therapy.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing growth hormone compounds to Patient
D.A. without laboratory test results indicating a growth hormone
deficiency.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing steroids and hormone therapy to Patient
28
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
103.
104.
105.
D.A. without laboratory test results indicating hypogonadism or any other
hormonal abnormality or deficiency.
Respondent did not justify, or did not create or maintain documentation
adequately justifying, prescribing anastrozole, an estrogen inhibitor that
may be prescribed to increase the effectiveness of testosterone, to Patient
D.A. without laboratory test results indicating a hormonal deficiency.
Count XIII — Patient D.A.
Violation of Section 458.331(1)(t)
Petitioner re-alleges and incorporates paragraphs ninety-six (96) through
one hundred three (103) as if fully set forth herein.
Section 458.331(1)(t), Florida Statutes (2011), subjects a licensee to
discipline for committing medical malpractice as defined in Section
456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2011),
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. Section 766.102, Florida
Statutes (2011), provides that the prevailing standard of care for a given
healthcare provider shall be that level of care, skill, and treatment which,
in light of all relevant surrounding circumstances, is recognized as
Pa
29
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
106.
107.
108.
109.
acceptable and appropriate by reasonably prudent similar health care
providers.
Respondent fell below the minimum standard of care in his treatment of
Patient D.A. in one or more of the following ways:
a. By failing to perform adequate physical examinations of Patient
D.A.;
b. By failing to order current laboratory tests to establish Patient
D.A.’s baseline hormone levels; and/or
c. By inappropriately prescribing steroids, growth hormone
compounds, and anastrozole in the absence of hypogonadism or
any other hormone deficiency.
Based on the foregoing, Respondent violated Section 458.331(1)(t),
Florida Statutes (2011).
Count XIV — Patient D.A.
Violation of Section 458.331(1)(q)
Petitioner re-alleges and incorporates paragraphs ninety-six (96) through
one hundred three (103) as if fully set forth herein.
Section 458.331(1)(q), Florida Statutes (2011), subjects a licensee to
discipline for prescribing, dispensing, administering, mixing, or otherwise
preparing a legend drug, including any controlled substance, other than
30
DOH v. Steven Ernest Rahman, MD
Case #2012-00762 A
110.
111.
112.
113.
in the course of the physician’s professional practice. For the purposes of
the 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.
Respondent prescribed legend drugs, including controlled substances,
other than in the course of his professional practice by inappropriately
prescribing anabolic steroids, HCG, anastrozole, and testosterone to
Patient D.A. in the absence of a hormonal imbalance or any other medical
justification.
Based on the foregoing, Respondent violated Section 458.331(1)(q),
Florida Statutes (2011).
Count XV — Patient D.A.
Violation of Section 458.331(1)(m)
Petitioner re-alleges and incorporates paragraphs ninety-six (96) through
one hundred three (103) as if fully set forth herein.
Section 458.331(1)(m), Florida Statutes (2011), provides that failing to
keep legible, as defined by department rule in consultation with the board,
medical records that identify the licensed physician or the physician
31
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
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, is
grounds for disciplinary action by the Board and/or Department.
114. Respondent failed to maintain complete ‘and adequate medical records
that justified the course of treatment provided for Patient D.A. in one or
more of the following ways:
a, By failing to document adequate physical examinations of Patient
D.A.; and/or
b. By failing to document a diagnosis or medical justification for
prescribing Patient D.A. the aforementioned medications.
115. Based on the foregoing, Respondent violated Section 458.331(1)(m),
Florida Statutes (2011).
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,
32:
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
impositign 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_29 — day of Jannae| , 2016.
John H. Armstrong, MD, FACS
State Surgeon General and Secretary of Health
Assistant General CouriSel
DOH Prosecution Services Unit
FILED 4052 Bald Cypress Way, Bin C-65
Depeenat Of He Tallahassee, Florida 32399-3265
Deputy Florida Bar Number 0085797
ome . MAK —— (850) 245 - 4444 Telephone
a ee (850) 245 - 4683 Facsimile
SEC/
PCP: 1/22/2016
PCP Members: G. El-Bahri, M.D., S. Terkonda, M.D., Ms. B. Goersch
33
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
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. A request or petition
for an administrative hearing must be in writing and must be
received by the Department within 21 days from the day
Respondent received the Administrative Complaint, pursuant to
Rule 28-106.111(2), Florida Administrative Code. If Respondent
fails to request a hearing within 21 days of receipt of this
Administrative Complaint, Respondent waives the right to request
a hearing on the facts alleged in this Administrative Complaint
pursuant to Rule 28-106.111(4), Florida Administrative Code. Any
request for an administrative proceeding to challenge or contest
the material facts or charges contained in the Administrative
Complaint must conform to Rule 28-106.2015(5), Florida
Administrative Code.
Please be advised that mediation under Section 120.573,
Florida Statutes, is not available for administrative disputes
involving this agency action.
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 any other discipline imposed.
34
DOH v. Steven Ernest Rahman, MD
Case #2012-00762
Docket for Case No: 20-000699PL
Issue Date |
Proceedings |
Feb. 02, 2021 |
Order Closing File and Relinquishing Jurisdiction. CASE CLOSED.
|
Feb. 02, 2021 |
Joint Motion to Relinquish Jurisdiction filed.
|
Jan. 29, 2021 |
Notice of Cancellation of Continuation of Deposition Duces Tecum of Jose M. Mandry, M.D. filed.
|
Jan. 27, 2021 |
Petitioner's Notice of Intent to Admit Medical Records filed.
|
Jan. 27, 2021 |
Respondent's Notice of Serving First Request for Production of Documents filed.
|
Jan. 26, 2021 |
Order Granting Motion to Amend Petition for Formal Administrative Hearing.
|
Jan. 26, 2021 |
Notice of Court Reporter filed.
|
Jan. 26, 2021 |
Respondent's Response to Order to Show Cause and Motion for Leave to File an Amended Petition for Formal Administrative Hearing filed.
|
Jan. 25, 2021 |
Petitioner's Response to Order to Show Cause filed.
|
Jan. 21, 2021 |
Notice of Continuation of Deposition Duces Tecum of Jose M. Mandry, M.D. filed.
|
Jan. 12, 2021 |
Order to Show Cause.
|
Jan. 12, 2021 |
Amended Petition for Formal Administrative Hearing filed.
|
Dec. 18, 2020 |
Notice of Appearance (Kimberly Shapiro) filed.
|
Dec. 03, 2020 |
Notice of Taking Deposition Duces Tecum (Jose Mandry, MD) filed.
|
Nov. 19, 2020 |
Order Rescheduling Hearing by Zoom Conference (hearing set for February 8 through 10, 2021; 9:00 a.m., Eastern Time).
|
Nov. 16, 2020 |
Joint Status Conference Report filed.
|
Nov. 06, 2020 |
Order Granting Continuance (parties to advise status by November 16, 2020).
|
Nov. 06, 2020 |
Unopposed Motion to Continue Final Hearing and Enlarge Deadlines per Initial Order filed.
|
Oct. 02, 2020 |
Defense Counsel's Notice of Unavailability filed.
|
Sep. 18, 2020 |
Order Rescheduling Hearing (hearing set for November 16 through 18, 2020; 9:00 a.m.; Tallahassee).
|
Sep. 17, 2020 |
Joint Response to Order Granting Continuance filed.
|
Sep. 17, 2020 |
Notice of Court Reporter filed.
|
Sep. 17, 2020 |
Notice of Taking Telephonic Deposition Duces Tecum filed.
|
Sep. 10, 2020 |
Order Granting Continuance (parties to advise status by September 17, 2020).
|
Sep. 09, 2020 |
Unopposed Motion to Continue Final Hearing and Enlarge Deadlines per Initial Order filed.
|
Sep. 02, 2020 |
Notice of Taking Deposition Duces Tecum (Rahman, MD) filed.
|
Sep. 02, 2020 |
Notice of Taking Deposition Duces Tecum (Gaines, MD) filed.
|
Sep. 02, 2020 |
Notice of Court Reporter filed.
|
Aug. 14, 2020 |
Petitioner's Motion for Official Recognition filed.
|
Jul. 09, 2020 |
Notice of Court Reporter filed.
|
Jul. 07, 2020 |
Order Rescheduling Hearing (hearing set for September 23 through 25, 2020; 9:00 a.m.; Tallahassee).
|
Jul. 02, 2020 |
Joint Status Conference Report filed.
|
Jun. 25, 2020 |
Notice of Cancellation of Deposition Duces Tecum via Zoom Conference (Rahman, MD) filed.
|
Jun. 25, 2020 |
Notice of Cancellation of Deposition Duces Tecum via Zoom Conference (Gaines, MD) filed.
|
Jun. 25, 2020 |
Order Granting Continuance (parties to advise status by July 2, 2020).
|
Jun. 25, 2020 |
Unopposed Motion to Continue Final Hearing and Enlarge Deadlines per Initial Order filed.
|
Jun. 24, 2020 |
Notice of Court Reporter filed.
|
Jun. 24, 2020 |
Notice of Taking Deposition Duces Tecum (Gaines, MD) filed.
|
Jun. 24, 2020 |
Notice of Taking Deposition Duces Tecum (Rahman, MD) filed.
|
Jun. 24, 2020 |
Notice of Appearance of Co-Counsel (Corynn Alberto) filed.
|
Apr. 29, 2020 |
Notice of Court Reporter filed.
|
Apr. 27, 2020 |
Order Rescheduling Hearing (hearing set for July 13 through 15, 2020; 9:00 a.m.; Tallahassee).
|
Apr. 24, 2020 |
Joint Status Conference Report filed.
|
Mar. 24, 2020 |
Order Granting Continuance (parties to advise status by April 24, 2020).
|
Mar. 23, 2020 |
Joint Motion to Continue Final Hearing and Enlarge Deadlines Per Initial Order filed.
|
Mar. 20, 2020 |
Notice of Service of Responses To Petitioner's Discovery Requests filed.
|
Mar. 09, 2020 |
Notice of Court Reporter filed.
|
Feb. 25, 2020 |
Order of Pre-hearing Instructions.
|
Feb. 25, 2020 |
Notice of Hearing (hearing set for April 30 and May 1, 2020; 9:00 a.m.; Tallahassee).
|
Feb. 19, 2020 |
Joint Response to Initial Order filed.
|
Feb. 11, 2020 |
Petitioner's Notice of Serving Petitioner's First Set of Requests for Admission, First Set of Interrogatories, and First Set of Requests for Production of Documents filed.
|
Feb. 11, 2020 |
Initial Order.
|
Feb. 11, 2020 |
Notice of Appearance (of Co-Counsel; Alejandro Camacho) filed.
|
Feb. 10, 2020 |
Notice of Appearance (Sarah Corrigan).
|
Feb. 10, 2020 |
Election of Rights filed.
|
Feb. 10, 2020 |
Administrative Complaint filed.
|
Feb. 10, 2020 |
Agency referral filed.
|