STATE OF FLORIDA DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH, Petitioner, . v. CASE NO.: 2017-13684 DAVID P. PURPORA, M.D., | Respondent. ee ADMINISTRATIVE COMPLAINT Petitioner, Department of Health, files this Administrative Complaint before the Board of Medicine against Respondent, David P. Purpora, M.D., and in support thereof alleges: 1. 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. . 2. At all times material to this Complaint, Respondent was a licensed medical doctor within the state of Florida, having been issued license number ME 119149. 3. Respondent's address of record is 211 186" Street, Sunny Isles Beach, Florida 33160. 4. At all times relevant to this complaint, Respondent treated Patients F.G., R.H., W.C., R.M., and M.A. at Summerlin Medical Centre, a pain management clinic i in Lee County, Florida. 5. While practicing at Summerlin Medical Centre, Respondent prescribed controlled substances, namely hydromorphone!, MS Contin2, alprazolam?, and cyclobenzaprine’, to Patients FG., R.H., W.C., R.M., and M.A. Facts Related to Patient F.G. 6. Respondent treated Patient F.G., a thirty-four (34) year old male, from on or about July 2016 until June 2017, at Summerlin Medical Centre. 7. Onor about July 5, 2016, Patient FG. presented to Respondent for his initial visit to Summerlin Medical Centre with the chief complaint of lower back pain. 1 Hydromorphone is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes, hydromorphone 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 hydromorphone may lead to severe psychological or physical dependence. Hydromorphone is classified as an opioid. ?MS Contin is the brand name for a drug that contains morphine and is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, morphine 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 morphine may lead to severe psychological or physical dependence. MS Contin is classified as an opioid. 3 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 II. Alprazolam is classified as a benzodiazepine. 4 Cyclobenzaprine is a central nervous system (CNS) muscle relaxant intended for short-term use in the treatment of pain, tenderness, and limitation of motion caused by muscle spasms. Cyclobenzaprine may enhance the effects of other CNS depressants including alcohol, barbiturates, benzodiazepines and narcotics and anecdotal reports indicated it is used non-medically to induce euphoria and relaxation. Cyclobenzaprine is not controlled under the Controlled Substances Act. 8. Respondent treated Patient F.G. for chronic jower back pain. 9. . Respondent prescribed Patient FG. hydromorphone, MS Contin, alprazolam, and cyclobenzaprine for the management of his lower back pain. | 10. Respondent prescribed Patient F.G. hydromorphone, MS Contin, alprazolam, and cyclobenzaprine in excessive quantities. 11. Respondent failed to create a treatment plan with treatment goals, or failed to create or keep documentation of creating a treatment plan with treatment goals, for Patient FG. 12. Respondent failed to create or keep’ documentation of the medications that Patient FG. was taking and why Patient F.G. was taking those medications. 13. Respondent failed to monitor, or failed to create or keep documentation of -monitoring, Patient F.G.s compliance with controlled substance prescriptions. 14. Respondent did not perform, or did not create or keep documentation of performing, a thorough medical history of Patient F.G. 15. Respondent did not refer, or did not create or keep documentation of referring, Patient F.G. to ancillary medical providers to co-manage his chronic lower back pain. 16. Respondent did not create or keep documentation of adequate justification for continuing to prescribe large quantities of Schedule II controlled substances to Patient F.G. 17. Respondent did not communicate, or did not create or keep documentation of communicating, with Patient EG!s primary care physician or any of his other treating medical providers. | Facts Related to Patient R.H. 18. Respondent treated R.H., a thirty-three (33) year old male, from on or about September 2015 to June 2017 at Summerlin Medical Centre. 19. Respondent treated Patient R.H. for chronic hip, lower back, and knee pain along with mild anxiety resulting from chronic pain. 20. Respondent prescribed Patient R.H. hydromorphone, MS Contin, methadone5, alprazolam, and cyclobenzaprine for management of his hip, lower back, and knee pain and mild anxiety. 21. Respondent prescribed Patient R.H. hydromorphone, MS Contin, methadone, alprazolam, and cyclobenzaprine in excessive quantities. 5 Methadone 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 peychological or physical dependence. It is classified as an opioid. . 4 22. Respondent failed to create a treatment plan with treatment goals, or failed to create or keep documentation of creating a treatment plan with treatment goals, for Patient R.H. 23. Respondent failed to create or keep documentation of the medications that Patient R.H. was taking and why Patient R.H. was taking those medications. 24. Respondent failed to monitor, or failed to create or keep documentation of monitoring, Patient R.H.’s compliance with controlled substance prescriptions. 25. Respondent did not perform, or did not create or keep documentation of performing, a thorough medical history of Patient R.H. 26. Respondent did not refer, or did not create or keep documentation of referring, Patient R.H. to ancillary medical providers to co-manage his chronic hip, lower back, and knee pain. 27. Respondent did not create or keep documentation of adequate justification for continuing to prescribe large quantities of Schedule II controlled substances to Patient R.H. 28. -Respondent did not create or keep documentation of his justification for taking Patient R.H. off methadone and prescribing MS Contin instead. 29. Respondent did not communicate, or did not create or keep documentation of communicating, with Patient R.H.’s primary care physician or any of his other treating medical providers. 30. On or about December 7, 2016, Respondent was made aware via fax transmission from Operation PAR, a methadone clinic, that Patient R.H. was presenting to the methadone clinic and receiving 50 mg of methadone daily from September 6, 2016 to December 7, 2016. Patient R.H. was also receiving prescriptions for hydromorphone and MS Contin from Respondent during that time period. 31. Respondent failed to address the issue, or did not create or keep documentation of addressing the issue, of Patient R.H. obtaining pain medications from two separate sources. 32. On or about December 7, 2016, Respondent was made aware via fax transmission from Operation PAR that Patient R.H. tested positive for unprescribed amphetamines on or about: November 14, 2016. 33. Respondent failed to address, -or- did: not create or keep documentation of addressing, the fact that Patient R.H. tested positive for unprescribed amphetamines. 34. On or about June 16, 2017, Patient R.H. was found deceased. The medical examiner’s report listed acute combined effects of methadone and alprazolam toxicity as the cause of death: Facts Related to Patient W.C. 35. Respondent treated Patient W.C., a thirty-six (36) year old male, from on or about September 2016 to May 2018. 36. Respondent treated Patient W.C. for chronic lower back pain. 37. Respondent prescribed Patient W.C. hydromorphone, MS Contin, Percocet®, alprazolam, and cyclobenzaprine for management of his chronic lower back pain. 38. Respondent prescribed Patient W.C.. hydromorphone, MS Contin, Percocet, alprazolam, and cyclobenzaprine in excessive quantities. 39. Respondent failed to create a treatment plan with treatment goals, or failed to create or keep documentation of creating a treatment plan with treatment goals, for Patient W.C. 40. Respondent failed to create or keep documentation of the medications that Patient W.C. was taking and why Patient W.C. was taking those medications. - 6 Percocet is the brand name for a drug that contains oxycodone and is prescribed to treat pain. According to Section 893.03(2), Florida Statutes, oxycodone is a Schedule II controlled substarice 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. Percocet is classified as an opioid. 7 41. Respondent failed to monitor, or failed to create or keep documentation of monitoring, Patient W.C’s compliance with controlled substance prescriptions. 42. Respondent noted several times that Patient W.C. was drug tested and tested positive only for prescribed medications; however, Respondent did not include any of Patient W.C’s drug test results in his medical records. 43. Respondent did not perform, or did not create or keep _ documentation of performing, a thorough medical history of Patient W.C. 44. Respondent did not refer, or did- not create or keep documentation of referring, Patient W.C. to ancillary medical providers to co-manage his chronic lower back pain. 45. Respondent did not create or keep documentation of adequate justification for continuing to prescribe large quantities of Schedule II controlled substances to Patient W.C. 46. Respondent did not communicate, or did not create or keep documentation of communicating, with Patient W.C’s primary care physician or any of his other treating medical providers. Facts Related to Patient R.M. 47. Respondent treated Patient R.M., a fifty-six (56) year old male, from on about December 2016 to January 2017. 48. Respondent treated Patient R.M. for chronic lower back pain. 49. Respondent prescribed Patient R.M. MS Contin, oxycodone’, hydrocodone, and clonazepam? for management of his chronic lower back pain. 50. Respondent prescribed Patient R.M. MS Contin, oxycodone, hydrocodone, and clonazepam in excessive quantities. 51. Respondent failed to create a treatment plan with treatment goals, or failed to create or keep documentation of creating a treatment plan with treatment goals, for Patient R.M. 52. Respondent failed to create or keep documentation of the medications that Patient R.M. was taking and why Patient R.M. was taking those medications. 7 Oxycodone is commonly prescribed to treat pain. According to Section 893.03(2), Florida Statutes, oxycodone is a 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 oxycodone may lead to severe psychological or physical dependence. Oxycodone is classified as an opioid. 8 Clonazepam is commonly prescribed to treat anxiety. According to Section 893.03(2), Florida Statutes, clonazepam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule HI and has a currently accepted medical use in treatment in the United States. Abuse of clonazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. Clonazepam is classified as a benzodiazepine. 9 53. Respondent failed to monitor, or failed to create or keep documentation of monitoring, Patient R.M.’s compliance with controlled substance prescriptions. 54. Respondent did not perform, or did not create or keep documentation of performing, a thorough medical history of R.M. 55. Respondent did not refer, or did not create or keep documentation of referring, Patient R.M., to ancillary medical providers to co-manage his chronic lower back pain. 56. Respondent did not create or keep documentation of adequate justification for continuing to prescribe large quantities of Schedule II controlled substances to Patient R.M. 57. Respondent did not communicate, or did not create or keep documentation of- communicating, with Patient R.M.’s primary care physician or any of his other treating medical providers. Facts Related to Patient M.A. 58. Respondent treated Patient M.A., a sixty-seven (67) year old male, from on or about June 5, 2016 to May 8, 2018. 59. Respondent treated Patient M.A. for chronic lower back pain. 60. Respondent. prescribed Patient M.A. hydromorphone and MS Contin for management of his lower back pain. 10 61. Respondent prescribed Patient M.A. hydromorphone and MS Contin in excessive quantities. 62. Respondent failed to create a treatment plan with treatment goals, or failed to create or keep documentation of creating a treatment plan with treatment goals, for Patient M.A. 63. Respondent failed to create or keep documentation of the medications that Patient M.A. was taking and why Patient M.A. was taking those medications. 64. Respondent failed to monitor, or failed to create or keep documentation of monitoring, Patient M.A’s compliance with controlled substance prescriptions. 65. Respondent did not perform, or did not create or keep documentation of performing, a thorough medical history of M.A. 66. Respondent did not refer, or did not create or keep documentation of referring, Patient M.A., to ancillary medical providers to co-manage his chronic lower back pain. 67. Respondent did not create or keep documentation of adequate justification for continuing to prescribe large quantities of Schedule II controlled substances to Patient M.A. 11 68. Respondent did not communicate, or did not create or keep documentation of communicating, with Patient M.A.’s primary care physician or any of his other treating medical providers. 69. is treating Standard of Care The prevailing professional standard of care for a physician who a patient for complaints including but not limited to chronic pain in the lower back, neck, shoulder, knee, and headaches requires a physician to: a b. . Prescribe controlled substances in-non-excessive quantities to . Perform a thorough medical history of the patient; Refer the patient to ancillary medical providers to co-manage chronic pain; the patient; . Monitor the patient’s compliance with controlled substance prescriptions; . Communicate with the patient’s primary care physician and other medical providers; and Create a treatment plan with treatment goals. 12 70. The Florida Board of Medicine has also adopted rule 64B8- 9.013(3), Standards for the Use of Controlled Substances for the Treatment of Pain, which requires a physician to do the following: a. Obtain a complete medical history and physical examination conducted and documented in the medical record; and b. Develop a written treatment pian that states objectives that will be used to determine treatment success; and c. Be willing to refer the patient as necessary for additional evaluation and treatment in order to achieve treatment objectives; and d. Keep accurate and complete records such as treatment objectives, discussion of risks and- benefits of treatments, medications, and drug testing results. Count I — Patient FG Violation of Section 458.331(1)(t) 71. Petitioner realleges and incorporates paragraphs one (1) through seventeen (17) and paragraphs sixty-nine (69) and seventy (70) as if fully set forth herein. 72. Section 458.331(1)(t), Florida Statutes (2015-2017), subjects a licensee to discipline for committing medical malpractice as defined in section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes 13 (2015-2017), states medical malpractice means 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 (2015-2017), 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. 73. Respondent fell below the minimum standard of care in his treatment of Patient F.G. in one or more of the following ways: a. By failing to perform a thorough medical history of Patient F.G.; and/or . b. By failing to create a treatment plan with treatment goals for Patient F.G.; and/or c. By failing to refer Patient F.G. to ancillary medical providers to co-manage chronic pain; and/or d. By prescribing controlled substances in excessive quantities to Patient FG.; and/or e. By failing to monitor Patient F.G.'s compliance with controlled substance prescriptions; and/or 14 f. By failing to communicate with Patient FG's primary care physician and other medical providers. 74. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2015-2017), by committing medical malpractice. | Count II — Patient R.H. Violation of Section 458.331(1)(t) 75. Petitioner realleges and incorporates paragraphs one (1) through five (5), paragraphs eighteen (18) through thirty-four (34) and, paragraphs sixty-nine (69) and seventy (70) as if fully set forth herein. 76. Section 458.331(1)(t), Florida Statutes (2015-2017), subjects a licensee to discipline for committing medical malpractice as defined in section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2015-2017), states medical malpractice means 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 (2015-2017), 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. 77, Respondent fell below the standard of care in his treatment of Patient R.H. in one or more of the following ways: a. By failing to perform a thorough medical history of Patient R.H.; and/or . By failing to create a treatment plan with treatment goals for Patient R.H.; and/or . By failing to refer Patient R.H. to ancillary medical providers to co-manage chronic pain; and/or . By prescribing controlled substances in excessive quantities to Patient -R.H.; and/or . By failing to monitor Patient R.H.’s compliance with controlled substance prescriptions; and/or By failing to address the fact that Patient R.H. tested positive for unprescribed amphetamines; and/or . By failing to address the issue of Patient R.H. obtaining pain medications from two separate sources.; and/or . By failing to communicate with Patient R.H.’s primary care physician or any of his other treating medical providers. 16 78. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2015-2017), .by committing medical malpractice. Count III — Patient W.C, . Violation of Section 458.331(1)(0) 79. Petitioner realleges and incorporates paragraphs one (1) through five (5), paragraphs thirty-five (35) through forty-six (46) and, paragraphs sixty-nine (69) and seventy (70) as if fully set forth herein. 80. Section 458.331(1)(t), Florida Statutes (2015-2017), subjects a licensee to discipline for committing medical malpractice as defined in section 456.50, Florida Statutes. Section 456.50(1)(g), Florida ‘Statutes (2015-2017), states medical malpractice means 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 (2015-2017), 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. 81. Respondent fell below the standard of care in his treatment of Patient W.C. in one or more of the following ways: 17 82. . By failing to perform a thorough medical history of Patient W.C.; and/or . By failing to create a treatment plan with treatment goals for Patient W.C:; and/or . By failing to refer Patient W.C. to ancillary medical providers to co-manage chronic pain; and/or . By failing to monitor Patient W.C’s compliance with controlled substance prescriptions; and/or . By prescribing controlled substances in excessive quantities to Patient W.C.; and/or . By failing to communicate with Patient W.C’s primary care physician or any of his other treating medical providers. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2015-2017), by committing medical malpractice. 83. Count IV. — Patient R.M. Violation of Section 458.331(1)(t) Petitioner realleges and incorporates paragraphs one (1) through five (5), paragraphs forty-seven (47) through fifty-seven (57) and, paragraphs sixty-nine (69) and seventy (70) as if fully set forth herein. 84. Section 458.331(1)(0), Florida Statutes (2015-2017), subjects a licensee to discipline for committing medical malpractice as defined in section 456.50, Florida Statutes. Section 456.50(1)(9), Florida Statutes (2015-2017), states medical malpractice means 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 (2015-2017), 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. 85. Respondent fell below the standard of care in his treatment of Patient R.M. in one or more-of the following ways: a. By failing to perform a thorough medical history of Patient R.M.; and/or -b. By failing to create a treatment plan with treatment goals for Patient R.M.; and/or c. By failing to refer Patient R.M. to ancillary medical providers to co-manage chronic pain; and/or d. By prescribing controlled substances in excessive quantities to Patient R.M.; and/or e. By failing to monitor Patient R.M.’s compliance with controlled substances; and/or f. By failing to communicate with Patient R.M.’s primary care physician or any of his other treating medical providers. 86. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2015-2017), by committing medical malpractice. Count V — Patient M.A. Violation of Section 458.331(1)(t) 87. Petitioner realleges and incorporates paragraphs one (1) through five (5) and paragraphs fifty-eight (58) through seventy (70) as if fully set forth herein. _ a 88. Section 458.331(1)(t), Florida Statutes (2015-2017), subjects a licensee to discipline for committing medical malpractice as defined in section 456.50, Florida Statutes. Section 456.50(1)(g), Florida Statutes (2015-2017), states medical malpractice means 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 (2015-2017), provides that the prevailing standard of care 20 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. 89. Respondent fell below the standard of care in his treatment of Patient M.A. in one or more of the following ways: a. By failing to perform a thorough medical history of Patient M.A; and/or . By failing to create a treatment plan with treatment goals for Patient M.A.; and/or . By failing to refer Patient M.A. to ancillary medical providers to co-manage chronic pain; and/or - . By prescribing controlled substances in excessive quantities to Patient M.A.; and/or . By failing to monitor Patient M.A.'s compliance with controlled substances; and/or By failing to communicate with Patient M.A.’s primary care physician or any of his other treating medical providers. 21 90. Based on the foregoing, Respondent violated Section 458.331(1)(t), Florida Statutes (2015-2017), by committing medical malpractice. Count VI - Patient F.G. Violation of Section 458.331(1)(m) 91. Petitioner realleges and incorporates paragraphs one (1) through seventeen (17) as if fully set forth herein. 92. Section 458.331(1)(m), Florida Statutes (2015-2017), 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. 93. Section 458.331(1)(nn), Florida Statutes (2015-2017), provides that violating any provision of this chapter or chapter 456, or any rules adopted pursuant thereto constitutes grounds for disciplinary action by the Board of Medicine. 22 94. Rule 64B8-9.003, FA.C., the board’s rule, states in relevant part, regarding medical records provides in subsection (3): 95. 64B8-9.003 Standards for Adequacy of Medical Records. (3) The- medical record shall contain sufficient information to identify the patient, support the.diagnosis, justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; reports of consultations and hospitalizations; and copies of records or reports or other documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient. In the alternative to Count I, Respondent failed to create or keep medical records during Patient F.G.'s treatment period in one or more of the following ways: a. By failing to create or keep documentation of performing a thorough medical history of Patient FG.; and/or b. By failing to create or keep documentation of what medications Patient F.G. was taking and why Patient FG. was taking those medications; and/or c. By failing to create or keep documentation of creating a treatment plan with treatment goals for Patient F.G.; and/or 23 d. By failing to create or keep documentation of referring Patient FG. to ancillary medical providers to co-manage chronic pain; and/or. e. By failing to create or keep documentation of adequate justification for prescribing F.G. large quantities of Schedule IT controlled substances; and/or . f. By failing to create or keep documentation of communication with Patient FG's primary care physician and other medical providers. 96. Based on the foregoing, Respondent has violated Section 458.331(1)(m), Florida Statutes (2015-2017), and/or Section 458.331(1)(nn), Florida Statutes (2015-2017), by violating Rule 64B8-9.003 FA.C. | 7 Count VII — Patient R.H. Violation of Section 458.331(1)(m) 97. Petitioner realleges and incorporates: paragraphs one (1) through five (5) and paragraphs eighteen (18) through thirty-four (34) as if fully set forth herein. 98. Section 458.331(1)(m), Florida Statutes (2015-2017), subjects a licensee to discipline for failing to keep legible, as defined by department 24 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. 99. Section 458.331(1)(nn), Florida Statutes (2015-2017), provides that violating any provision of this chapter or chapter 456, or any rules adopted pursuant thereto constitutes grounds for disciplinary action by the Board of Medicine. 100. Rule 64B8-9.003, FA.C., the board’s rule, states in relevant part, regarding medical records provides in subsection (3): 64B8-9.003 Standards for Adequacy of Medical Records. (3) The medical record shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; reports of consultations and hospitalizations; and copies of records or reports or other- documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient. 25 101. In the alternative to Count II, Respondent failed to create or keep medical records during Patient R.H.’s treatment period in one or more of the following ways: a. By failing to create or keep documentation of performing a thorough medical history of Patient R.H.; and/or . By failing to create or keep documentation of what medications Patient R.H. was taking and why Patient R.H. was taking those medications; and/or . By failing to create or keep documentation of creating a treatment plan with treatment goals for Patient R.H.; and/or . By failing to create or keep documentation of referring Patient R.H. to ancillary medical providers to co-manage chronic pain; and/or . By failing to create or keep documentation of adequate justification for prescribing R.H. large quantities of Schedule II controlled substances; and/or By failing to create or keep documentation of monitoring Patient R.H.’s compliance of controlled substance prescriptions; and/or 26 g. By failing to create or keep documentation of communication with Patient R.H.’s primary care physician and other medical providers. 102. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida - Statutes (2015-2017), and/or Section 458.331(1)(nn), Florida Statutes (2015-2017), by violating Rule 64B8-9.003 FA.C. Count VITI — Patient W.C. Violation of Section 458.331(1)(m) 103. Petitioner realleges and incorporates paragraphs one (1) through five (5) and paragraphs thirty-five (35) through forty-six (46) as if fully set forth herein. 104. Section 458.331(1)(m), Florida Statutes (2015-2017), 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 27 drugs prescribed, dispensed, or administered; and reports of consultations and hospitalizations. 105. Section 458.331(1)(nn), Florida Statutes (2015-2017), provides that violating any provision of this chapter or chapter 456, or any rules adopted pursuant thereto constitutes grounds for disciplinary action by the Board of Medicine. 106. Rule 64B8-9.003, FA.C., the board’s rule, states in relevant part, regarding medical records provides in subsection (3): 64B8-9.003 Standards for Adequacy of Medical Records. (3) The medical record shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; reports of consultations and hospitalizations; and copies of records or reports or other documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient. 107. In the alternative to Count ITI, Respondent failed to create or keep medical records during Patient W.C.’s treatment period in one or more of the following ways: . a. By failing to create or keep documentation of performing a thorough medical history of Patient W.C.; and/or 28 . By failing to create or keep documentation of what medications Patient W.C. was taking and why Patient W.C. was taking those medications; and/or . By failing to create or keep documentation of creating a treatment plan with treatment goals for Patient W.C.; and/or . By failing to create or keep documentation of referring Patient W.C. to ancillary medical providers to co-manage chronic pain; and/or . By failing to create or keep documentation of adequate justification for prescribing W.C. large quantities of Schedule I controlled substances; and/or . By failing to create or keep documentation of monitoring Patient W.C.’s compliance of controlled substance prescriptions; and/or . . By failing to include Patient Wo's drug test results in his medical records; and/or ; | . By failing to create or keep documentation of communication with Patient W.C’s primary care physician and other medical providers. 29 108. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2015-2017), and/or Section 458.331(1)(nn), Florida Statutes (2015-2017), by violating Rule 64B8-9.003 FAC. Count IX — Patient R.M. Violation of Section 458.331(1)(m) 109. Petitioner realleges and incorporates paragraphs one (1) through five (5) and paragraphs forty-seven (47) through fifty-seven (57) as if fully set forth herein. 110. Section 458.331(1)(m), Florida Statutes (2015-2017), 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. 111. Section 458.331(1)(nn), Florida Statutes (2015-2017); provides that violating any provision of this chapter or chapter 456, or any rules 30 adopted pursuant thereto constitutes grounds for disciplinary action by the Board of Medicine. - 112. Rule 6488-9.003, FAC, the board's rule, states in relevant part, regarding medical records provides in subsection (3): 64B8-9.003 Standards for Adequacy of Medical Records. (3) The medical record shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; reports of consultations and hospitalizations; and copies of records or reports or other documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient. 113. In the alternative to Count IV, Respondent failed to create or keep medical records during Patient R.M.’s treatment period in one or more of the following ways: . . a. By failing to create or keep documentation of performing a thorough medical history of Patient R.M.; and/or b. By failing to create or keep documentation of what medications Patient R.M. was taking and why: Patient R.M. was taking those medications; and/or 31 fo) . By failing to create or keep documentation of creating a treatment plan with treatment goals for Patient R.M.; and/or a . By failing to create or keep documentation of referring Patient R.M. to ancillary medical providers to co-manage chronic pain; and/or @ By failing to create or keep documentation of adequate justification for prescribing R.M. large quantities of Schedule II controlled substances; and/or Saal . By failing to create or keep documentation of monitoring Patient R.M.’s compliance of controlled substance prescriptions; and/or a . By failing to create or keep documentation of communication with Patient RIM'S primary care physician and other medical providers. 114. Based. on the foregoing, Respondent violated Section 458.331(1)(m), Florida “Statutes (2015-2017), and/or Section 458.331(1)(nn), Florida Statutes (2015-2017), by violating Rule 64B8-9.003 FA.C. . Count X — Patient M.A. Violation of Section 458.331(1)(m) 32 115. Petitioner realleges and incorporates paragraphs one (1) through five (5) and paragraphs fifty-eight (58) through sixty-eight (68) as if fully set forth herein. - 116. Section 458.331(1)(m), Florida Statutes (2015-2017), 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. 117. Section 458.331(1)(nn), Florida Statutes (2015-2017), provides that violating any provision of this chapter or chapter 456, or any rules adopted pursuant thereto constitutes grounds for disciplinary action by the Board of Medicine. 118. Rule 64B8-9.003, FA.C., the board’s rule, states in relevant part, regarding medical records provides in subsection (3): 64B8-9.003 Standards for Adequacy of Medical Records. 33 (3) The medical record shall contain sufficient information to identify the patient, support the diagnosis, justify the treatment and document the course and results of treatment accurately, by including, at a minimum, patient histories; examination results; test results; records of drugs prescribed, dispensed, or administered; reports of consultations and hospitalizations; and copies of records or reports or other documentation obtained from other health care practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient. 119. In the alternative to Count V, Respondent failed to create or keep medical records during Patient M.A.’s treatment period in one or more of the following ways: a. By failing to create or keep documentation of performing a thorough medical history of Patient M.A.; and/or b. By failing to create or keep documentation of what medications Patient M.A. was taking and why Patient M.A. was taking those medications; and/or c. By failing to create or keep documentation of creating a treatment plan with treatment goals for Patient M.A.; and/or d. By failing to create or keep documentation of referring Patient M.A. to ancillary medical providers to co-manage chronic pain; and/or 34 e. By failing to create or keep documentation of adequate justification for prescribing M.A. large quantities of Schedule II controlled substances; and/or . f. By failing to create or keep documentation of communication with Patient M.A’s primary care physician and other medical providers. 120. Based on the foregoing, Respondent violated Section 458.331(1)(m), Florida Statutes (2015-2017), and/or Section 458.331(1)(nn), Florida Statutes (2015-2017), by violating Rule 64B8-9.003 FAC. 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, restriction of practice, 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. | Signature appears on the following page.] 35 SIGNED this %o%?day of Poel _, 2019. CA Cynthia Nash-Early Assistant General Counsel Florida Bar Number 20554 DEPARTMENT OF HEALTH DOH-Prosecution Services Unit DEPUTY CLERK 4052 Bald Cypress Way-Bin C-65 CLERK: Angel Senders Tallahassee, Florida 32399-3265 paTEY JAPR 308 (850) 558-9872 oS (850) 245-4684 FAX E-Mail: Cynthia.NashEarly@flhealth.gov CNE/sdr PCP: April 26, 2019 PCP Members: Georges El-Bahri, M.D. and Brigitte Goersch 36 NOTICE OF RIGHTS Respondent has the right to request 2 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. Mediation under Section 120.573, Florida Statutes, is not available to resolve this Administrative Complaint. 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. 37

Docket for Case No: 21-001143PL