The Issue The ultimate issue to be resolved is whether the Respondent has committed violations of statutory provisions relating to the practice of medicine, and, if so, what disciplinary action should be taken. The allegations of the complaint relate to prescriptions for controlled substances that the Respondent allegedly wrote for himself or for members of his family other than in the course of his professional practice. The Respondent has denied the allegations of the Administrative Complaint, except allegations that he failed to keep written medical records justifying the course of treatment for several close family members and friends as set out in Count II of the complaint.
Findings Of Fact The Respondent is a physician licensed to practice in Florida. He holds License No. ME0001643 issued by the Board of Medical Examiners. The Respondent has been licensed to practice in Florida since 1935. He has practiced in Jacksonville since January, 1946. He maintains an office practice specializing in obstetrics and gynecology. The Respondent is 73 years old, and he no longer maintains a hospital practice. The Respondent has never previously been the subject of any disciplinary proceedings. The Respondent enjoys a very good reputation for truth and veracity in his community and is well regarded by his peers. During approximately July and August, 1981, the Respondent wrote three prescriptions for the drug Dilaudid for Sarah Goldstein. Dilaudid is a Schedule II controlled substance under the provisions of Section 893.03, Florida Statutes. Sarah Goldstein is the Respondent's daughter. She was visiting the Respondent from out of town at the time that the prescriptions were written. She was suffering from ulcerated colitis. The Respondent wrote the prescriptions to his daughter to treat this condition. No evidence was offered from which it could be concluded that the prescriptions were written other than in good faith in the course of proper medical practice. The Respondent did not keep written medical records justifying the treatment of his daughter. On an uncertain date, the Respondent wrote a prescription for Dilaudid for the patient Agnes Flatley. Agnes Flatley is the Respondent's sister-in-law. She was visiting the Respondent's home and injured her back. Respondent wrote the prescription to assist her with the pain in her back. There is no evidence from which it could be concluded that the prescription was written other than in good faith and in the proper course of the practice of medicine. The Respondent did not keep written medical records justifying the course of his treatment of Agnes Flatley. During approximately November, 1981, the Respondent wrote a prescription for Dilaudid for the patient Ann Ferguson. Ann Ferguson is a close friend of the Respondent and the Respondent's wife. She is over 80 years old. She visits frequently with the Respondent and the Respondent's wife and eats in their home approximately three times per week. On one such occasion, she was suffering from a severe headache. The Respondent prescribed the medication to alleviate the pain. No evidence was offered from which it could be concluded that the prescription was written other than in good faith in the proper course of the practice of medicine. The Respondent did not keep a written medical record justifying his treatment of the patient Ann Ferguson. During approximately November, 1981, the Respondent wrote a prescription for the drug Tuinal for the patient Betty McCall. Betty McCall is the despondent's wife. She was having difficulty in connection with their son, and the Respondent wrote the prescription to assist her. No evidence was offered from which it could be concluded that the prescription was written other than in good faith in the proper course of the practice of medicine. It does not appear that the Respondent kept any written record justifying the course of treatment of his wife. The Respondent has a son whose name is Eugene Franklin McCall, Jr. The son is now 27 years old. Since approximately 1973, the Respondent's son has suffered from a drug problem. He has had a specific problem in connection with the use of the drug Dilaudid. The Respondent's son is presently serving a prison term at the Florida State Prison. He was convicted of forging his father's signature on a prescription for Dilaudid. He was also convicted of forging checks on his father's account. This is the Respondent's son's second imprisonment in connection with drug-related problems. The Respondent has expended considerable money and energy seeking a solution to his son's drug problem, with obvious lack of success. During August, 1980, the Respondent wrote two prescriptions for Dilaudid for his son. His son was suffering severe withdrawal symptoms, and the prescriptions were written in an effort to prevent him from suffering severe repercussions, including possible death. No evidence was offered during the course of the hearing from which it could be concluded that the prescriptions were written other than in good faith in the proper course of the practice of medicine. During the period from April through November, 1981, the Respondent's son forged his father's signature on numerous prescriptions for the drug Dilaudid. The Respondent's son used the names Lesley McCall, Lesley Walker, Betty McCall, and E. F. McCall as the patient's name on the prescription forms. The Respondent's son typically filled these prescriptions by presenting them at drugstores. The Respondent's son occasionally wrote the prescriptions utilizing prescription forms that he had stolen from his father's office. On other occasions, he used forms which he picked up at various drug stores. The Respondent was unaware that his son forged these prescriptions until he was interviewed by the Petitioner's investigator in connection with this proceeding. No evidence was offered at the final hearing from which it could be concluded that the Respondent issued any prescriptions other than in good faith in the proper course of the practice of medicine. There is no evidence from which it could be concluded that the Respondent wrote any prescriptions for a scheduled controlled substance for himself. There is no evidence from which it could be concluded that the Respondent made any deceptive, untrue or fraudulent representations, or employed any trick or scheme in the practice of medicine. There is no evidence from which it could be concluded that the Respondent engaged in gross or repeated malpractice, or that he is unable to practice medicine with reasonable skill and safety to his patients.
The Issue This is a license discipline case in which the Petitioner, by means of a one-count Administrative Complaint, seeks to take disciplinary action against the Respondent on the basis of his alleged violation of Section 458.331(1)(c), Florida Statutes (2002).
Findings Of Fact The Respondent, Eduardo S. Mendez, M.D., was born in Cuba, was reared in Cuba, and was educated in Cuba. His education in Cuba included a degree in Medicine. He came to the United States of America in 1995. Shortly after moving to this country, the Respondent became the owner of a retail pharmacy and medical equipment business in Florida. The Respondent did not have a license to practice pharmacy in Florida. On the basis of conduct which took place between July of 1998 and June of 2000, an Information was issued in Case No. 02-20859 in the United States District Court for the Southern District of Florida charging the Respondent with engaging in a conspiracy to pay and receive health care kickbacks in violation of Title 18, United States Code, Section 371. The basic facts forming the basis for the criminal charge are described as follows in the Information: Medicare was a "Federal health care program" as defined in Title 42, United States Code, Section 1320a-7b(f)(1). Confortec D.M.E., Inc. ("Confortec") was a pharmacy located in Miami, Florida. Confortec was authorized by Medicare to submit claims to Medicare Part B for reimbursement of the cost of certain medications that Confortec dispensed by prescription to Medicare beneficiaries. Defendant EDUARDO S. MENDEZ was a resident of Miami and the sole owner of Confortec. Defendant EDUARDO S. MENDEZ offered to pay kickbacks to various patient recruiters so that they would provide the names and Medicare identification numbers of Medicare beneficiaries, along with prescriptions relating to these beneficiaries. Confortec filled these prescriptions and then filed claims with Medicare for reimbursement of the cost of the prescribed medications. After receiving payment on these claims from Medicare, defendant EDUARDO S. MENDEZ used a portion of the payments to pay kickbacks to the patient recruiters or their associates. * * * 12. Using a portion of the money received from Medicare payments, defendant EDUARDO S. MENDEZ paid or caused to be paid approximately $200,000 in kickbacks to the patient recruiters or their associates so that the recruiters would continue to refer Medicare beneficiaries and related Medicare prescription business to Confortec. Following his arrest, the Respondent cooperated extensively with the Federal Bureau of Investigation (FBI) and assisted the FBI in their investigation of his own activities, as well as in their investigation of similar criminal activities by others. Because of the Respondent's assistance to the FBI, the federal prosecutor recommended a substantial reduction in the sentence that might otherwise have been imposed on the Respondent. On November 14, 2000, the Respondent entered into a plea agreement in which he agreed "to plead guilty to an Information or an Indictment that charges him with the crime of conspiracy to commit an offense against the United States, namely, a violation of Title 42, United States Code, Section 1320a-7b(b)(2)(knowingly and intentionally offering and paying kickbacks and bribes to any person to induce the referral of individuals for the furnishing of services or items for which payment may be made under a Federal health care program), in violation of Title 18, United States Code, Section 371." On or about February 12, 2003, a United States District Judge signed a judgment in which the Respondent was adjudicated guilty of the criminal offense described above. The Respondent's sentence was three years of probation, three months of home confinement (with electronic monitoring), 150 hours of community service, and a fine of $100.00. The Respondent has fulfilled all of the terms of his sentence. Although the recruitment methods described above are prohibited by federal law and are a crime, that criminal activity does not involve any element of fraudulent billing seeking reimbursements from the Medicare program for services or items that were not provided. To the contrary, all of the prescriptions for which Confortec sought Medicare reimbursement were prescriptions that were actually filled for medications that were actually provided to the Medicare beneficiaries. During the period from July of 1998 through June of 2000, the Respondent did not have a license to practice medicine in Florida. Accordingly, the criminal conduct described above was not related to the Respondent's practice of medicine, because the Respondent was not practicing medicine at that time. As discussed in greater detail in the conclusions of law, the criminal conduct described above was directly related to the practice of medicine by the physicians who wrote the prescriptions that were filled in the course of the subject criminal activity. As also discussed in greater detail in the conclusions of law, the criminal conduct described above was directly related to the ability to practice medicine. The Respondent is presently a physician licensed to practice medicine in the State of Florida. He has been so licensed since November of 2001. His license number is 83615. The criminal charges described above are the only criminal charges that have ever been filed against the Respondent. There has never been any prior disciplinary action taken against the Respondent's license to practice medicine.
Recommendation On the basis of all of the foregoing, it is RECOMMENDED that a final order be entered finding the Respondent guilty of violating Section 458.331(1)(c), Florida Statutes (2002), and imposing the following penalties: Suspending the Respondent's license to practice medicine for a period of nine months; Imposing an administrative fine in the amount of five thousand dollars; and When the Respondent is reinstated following the nine- month period of suspension, placing the Respondent on probation for a period of two years subject to such terms of probation as may appear to the Board of Medicine to be necessary and appropriate. DONE AND ENTERED this 16th day of September, 2005, in Tallahassee, Leon County, Florida. S MICHAEL M. PARRISH Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 16th day of September, 2005.
The Issue The issues to be determined here concern disciplinary action to be taken against Respondent for those administrative offenses pertaining to the controlled substances Talwin, Dilaudid and Paregoric dispensed by Scottie Drug Store in Duval County, Florida, during the period April 2, 1981, to March 23, 1982, in violation of various provisions of Chapter 465, Florida Statutes. These contentions made by the State of Florida, Department of Professional Regulation, are more particularly described in the Administrative Complaint, DPR Case No. 0022146.
Findings Of Fact Howard E. Staats is a pharmacist who has been issued a license by the State of Florida, Department of Professional Regulation, Board of Pharmacy. The license number is 0007704. At times relevant to this proceeding, Staats, practiced pharmacy in Jacksonville, Florida. At all times pertinent to the Administrative Complaint, which is the focus of this action, Staats was the managing pharmacist at American Apothecaries, Inc., which does business as Scottie Drug Store at 41 Arlington Road South, Jacksonville, Florida. A copy of Respondent's most recent license may be found as Petitioner's Exhibit No. 1, admitted into evidence. Petitioner's Exhibit No. 2, admitted into evidence, is a copy of the permit for American Apothecaries. Sometime within the period March 23, 1982, through March 29, 1982, an audit was conducted at the Scottie Drug Store. The audit revealed that in the period April 2, 1981, through March 23, 1982, the drug store had purchased 66,900 tablets of Talwin, 50 mg., had sold 29,373 tablets of that drug, had lost by robbery or theft, 1,000 tablets of the drug, leaving 36,527 tablets of Talwin unaccounted for. During that same audit period, the pharmacy purchased 4,000 tablets of Dilaudid, 4 mg., selling 3,025 tablets of that drug, losing by robbery or theft, 200 tablets of the drug and failing to account for 775 tablets of the drug. Finally, during the audit period, 2,064 ounces of Paregoric had been purchased and 699 ounces sold, with the remaining amount of 1,285 ounces being unaccounted for. See Petitioner's Exhibit No. 4. Talwin is a Schedule IV controlled substance within the meaning of Chapter 893, Florida Statutes. Dilaudid is a Schedule II controlled substance within the meaning of Chapter 893, Florida Statutes. Paregoric is a Schedule III controlled substance within the meaning of Chapter 893, Florida Statutes. The audit which was conducted at the Scottie Drug Store revealed numerous prescriptions for the controlled substance Talwin, 50 mg., written on prescription blanks of Drs. W. W. Shell, Jr., and L. T. McCarthy, Jr., which had allegedly been signed by those physicians, when in fact the patients for whom the prescriptions were written were unknown to the physicians and the signatures of the physicians were forgeries. Those prescriptions are depicted in Petitioner's Exhibit No. 5, admitted into evidence. During the period covered by the audit, it was shown that Staats filled a number of prescriptions for various patients for the controlled substance Talwin, which had been written on prescription pads of Methodist Hospital and Baptist Medical Center in Jacksonville, Florida, and signed by individuals who are not physicians having hospital privileges at those medical centers nor practicing as physicians in the Duval County area. Copies of those prescriptions may be found as Petitioner's Exhibit No. 6, admitted into evidence. In the course of the time sequence related to the audit review process, it was discovered that Staats had refilled numerous prescriptions for controlled substances on more occasions than had been authorized by physicians, namely prescription No. 51632 was refilled twice although the physician indicated there were to be no refills; prescription No. 51579 was refilled once although the prescription indicated there should be no refills; prescription No. 51639 was refilled twice although the prescription indicated there should be no refills; prescription No. 51217 was refilled once although the prescription indicated there should be no refills; prescription No. 51238 was refilled once although the prescription indicated that there should be no refills; prescription No. 53010 was refilled once although the prescription indicated that there should be no refills; prescription No. 53597 was refilled four (4) times although the prescription indicated that it should only be refilled once; prescription No. 53537 was refilled once although the prescription indicated that it should not be refilled; and prescription No. 53592 was refilled twice although the prescription indicated that there should be no refills. Petitioner's Exhibit No. 7, admitted into evidence, is copies of prescriptions spoken to in this paragraph. Respondent Staats had operated the Scottie store under a lease arrangement during 1979 and 1980, and in January of 1981, took a position as an active pharmacist in that store. After becoming the principal operating pharmacist in the Scottie store, Staats began to receive prescriptions from doctors Shell and McCarthy for the substance Talwin and when a prescription purportedly written by those physicians was in question, Staats would call the office of the physicians for confirmation, which at times would be given over the phone and at other times an indication was made that a call back from the physician's office to Staats would be necessary. Some of the indications of physicians' prescription authority of the substances in question would be placed on a separate log and not on the back of the prescription and on other occasions, the note of the prescription information would be placed on the back of the prescription form and not in the log. Normally, this information would be reflected both in the log and on the back of the prescription. There were occasional circumstances in which the authority was not stated in either place. At approximately the same time as was covered by the audit, Staats began to ask for identification from customers who were seeking prescriptions for Talwin and noted that the demand for that substance declined with the advent of the request for identification. Staats posted a notice in the window of the pharmacy to the effect that state law imposed a fine of $5,000.00 or might cause incarceration for five (5) years for presenting forged prescriptions or conspiring or agreeing with another to have a forged prescription filled. On two (2) occasions Staats called law enforcement officials on a circumstance involving suspect prescriptions and those persons were apprehended. (Poor record keeping and mistakes in estimating the amount of losses due to a robbery and a larceny which occurred in the period covered by the audit contributed to the unaccounted for controlled substances, but those matters of record keeping and theft reports would cause only a slight differential in the disparity, as opposed to explaining the whereabouts of a substantial portion of the missing controlled substances.) Beginning on March 25, 1982, Staats began to keep a daily inventory log on the substance Talwin and a number of other controlled substances. A copy of that log may be found as Respondent's Exhibit No. 9, admitted into evidence. In addition, certain out-of-date and otherwise undesirable controlled substances, Schedules II, III and IV, have been removed from inventory and turned over to appropriate authorities for destruction.
Recommendation That a final order be entered placing Respondent Staats on probation for a period of two (2) years, with a special requirement that Staats attend continuing education courses dealing with the proper methods for prescribing controlled substances and to the extent possible, courses which emphasize the detrimental effect to the public when those controlled substances are abused and requiring that Respondent work under the supervision of another pharmacist for the first six (6) months of his probationary period. DONE and ENTERED this 17th day of November, 1982, in Tallahassee, Florida. CHARLES C. ADAMS Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 17th day of November, 1982.
