STATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS c BUREAU OF PROFESSIONAL LICENSING BOARD OF MEDICINE DISCIPLINARY SUBCOMMITTEE

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1 STATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS c BUREAU OF PROFESSIONAL LICENSING BOARD OF MEDICINE DISCIPLINARY SUBCOMMITTEE In the Matter of KEITH RAYMOND HOFFMANN, M.D. License No Complaint No ADMINISTRATIVE COMPLAINT Attorney General Bill Schuette, through Assistant Attorney General Andrew J. Hudson, on behalf of the Department of Licensing & Regulatory Affairs, Bureau of Professional Licensing, Complainant, files this complaint against Keith Raymond Hoffmann, M.D., Respondent, alleging upon information and belief as follows: 1. The Board of Medicine, an administrative agency established by the Public Health Code, 1978 PA 368, as amended, MCL et seq, is empowered to discipline licensees under the Code through its Disciplinary Subcommittee. 2. Respondent is currently licensed to practice medicine pursuant to the Public Health Code and at all times relevant to this complaint, practiced as a family physician in Roseville, MI. 3. Ritalin (methylphenidate hydrochloride) is a schedule 2 controlled substance used in the treatment of attention deficit hyperactivity disorder. It is a central nervous system stimulant.

2 4. Adderall (amphetamine-dextroamphetamine) is a schedule 2 controlled substance used in the treatment of attention deficit hyperactivity disorder and narcolepsy. It is a central nervous system stimulant. 5. Oxycodone products, such as Percodan and Roxicodone, are schedule 2 controlled substances used for the treatment of pain. They are classified as opioids. 6. Hydrocodone products, such as Norco and Dilaudid, are schedule 2 controlled substances used for the treatment of pain. They are classified as opioids. 7. Valium (diazepam) is a schedule 4 controlled substance used for the treatment of anxiety and muscle spasms. It is classified as a benzodiazepine. 8. Xanax (alprazolam) is a schedule 4 controlled substance used in the treatment of anxiety. It is classified as a benzodiazepine. 9. Section 16221(a) of the Code provides the disciplinary subcommittee with authority to take disciplinary action against Respondent for a violation of general duty, consisting of negligence or failure to exercise due care,. including negligent delegation to, or supervision of employees or other individuals, whether or not injury results, or any conduct, practice, or condition which impairs, or may impair, the ability to safely and skillfully practice medicine. 10. Section 16621(b)(i) of the Code provides the disciplinary subcommittee with authority to take disciplinary action against Respondent for incompetence, defined at section 16106(1) to mean a "departure from, or failure to conform to, minimal standards of acceptable and prevailing practice for a health profession whether or not actual injury to an individual occurs." 2

3 11. Section 16221(c)(iv) of the Code provides the disciplinary subcommittee with authority to take disciplinary action against Respondent for selling, prescribing, giving away, or administering drugs for other than lawful, diagnostic, or therapeutic purposes. 12. Section of the Code authorizes the disciplinary subcommittee to impose sanctions against persons licensed by the Board, if after opportunity for a hearing, the DSC determines that a licensee violated one or more of the subdivisions contained in section of the Code. FACTUAL ALLEGATIONS 13. In the course of investigating Respondent's prescribing practices, a Bureau investigator obtained patient charts for D.K. (female), P.G. (male), C.N. (male) and K.N. (female). Respondent's practice shows a failure to comply with the applicable standards of practice in the following ways: Patient D.K. a. Failure to adequately monitor patients for abuse and diversion of controlled substances b. Prescribing medications in contraindicated combinations c. Prescribing controlled substances to patients, including those with known histories of substance abuse and addiction, without proper monitoring and follow-up d. Prescribing short acting, high dose benzodiazepines for longterm use without documented justification. 14. On or about March 2008, Respondent began treating D.K. for knee pain, stress, and anxiety. 3

4 15. Over the next sev~n years, Respondent provided prescription combinations for D.K. that generally consisted of Xanax, various opioid pain medications, and"a muscle relaxant. Prescribing Xanax, a short-acting, highly addictive benzodiazepine, over a long term is not standard treatment for anxiety, particularly without an adequate assessment for anxiety in D.K.'s medical record. 16. On April 24, 2012, Respondent saw D.K. for an office visit. At that time, D.K. had prescriptions from Respondent for 1mg Xanax 4 times per day and 325/10 mg No~co 10 times per day, along with Labetalol and Naproxen. D.K. reported that she was passing out at night and had fallen asleep in her car at the store. Respondent did not change her medication dosages; instead, he added Flexeril and Lisinopril. 17. On April 6, 2013, Respondent increased D.K.'s Xanax dosage to 2mg _. tablets, 4 times per day. 18. On October 29, 2013, a local pharmacy contacted Respondent's office and reported D.K. had obtained Roxicodone through another provider on August 9, September 20, and October 25, On April 1, 2014, Respondent saw D.K. for an office visit. D.K. reported feeling down, depressed, and hopeless. She reported little interest or pleasure in doing things along with tiredness and a lack of energy. 20. Qn November 21, 2014, Respondent's office received word that an endocrinologist who examined D.K. was surprised D.K. was still alive given her lab results. 4

5 21. On February 4, 2015, Respondent saw D.K. for an office visit. D.K. reported that she could not find her Percodan pills. Also, she indicated that "oxycodone makes her sick" and "[m]orphine makes her more sick." 22. Despite the above reports and the combination of commonly abused and diverted medications, Respondent did not documept ordering any urine drug screens for D.K. to ensure safety and compliance with her medicatioi;i regimen. He also failed to document any consultation with a pain specialist or psychiatrist. 23. On March 21, 2015, D.K. was found dead at her home at the age of The Oakland County Medical Examiner determined the cause of D.K.'s death was medication intoxication. Patient P.G. 25. On July 13, 2011, Respondent saw P.G. for an office visit. P.G. indicated that he wanted to start his own business and asked for Ritalin. 26. Respondent issued a prescription for Ritalin but failed to document an evaluation for attention deficit disorder or obtain old medical records to confirm a prior diagnosis. 27. On September 6, 2011, Respondent increased the dosage of Ritalin for P.G. without any documented medical reason. 28. Over the next four years, Respondent issued prescriptions for 40mg Ritalin 2 times per day and later added a prescription for 2mg Xanax 3 times per day. 5

6 29. Despite issuing prescriptions for commonly abused and diverted drugs, Respondent failed to order any urine drug screens, review reports from the Michigan Automated Prescription System, or otherwise monitor for diversion or medication efficacy. Patient C.N. 30. Respondent has provided primary care to C.N. since C.N. received treatment for chronic pain, attention deficit disorder, depression, and anxiety. C.N. has a history of alcohol abuse. 31. Throughout his time under Respondent's care, C.N. received regular prescriptions for opioid pain medications, such as MS Contin and Oxycodone; benzodiazepines, such as Valium and Xanax; and amphetamines, such as Adderall. 32. On November 1, 2010, C.N. reported his medications were stolen from his vehicle. 33. On September 16, 2011, Respondent ordered a urine drug screen of C.N: The test was positive for THC, a metabolite of marijuana, and negative for benzodiazepines and amphetamines. Despite this concerning result, Respondent continued to prescribe controlled substances to C.N. Additionally, this is the only urine drug screen documented in C.N.'s patient chart. 34. On June 3, 2013, C.N. again reported that his medications were stolen from his vehicle. Respondent continued prescribing controlled substances to C.N. 35. On October 28, 2013, C.N. reported that his wife K.N. stole his medications. Respondent continued prescribing controlled substances to C.N. 6

7 36. On September 23, 2014, C.N. reported that his medications were stolen. Respondent continued prescribing controlled substances to C.N. 37. On January 28, 2015, Respondent received a call from the mother of patient J.H., a male. She told Respondent that J.H. was obtaining Xanax from C.N. and was buying marijuana and c9caine. She indicated that J.H. was now at a drug rehabilitation facility. 38. Respondent continued issuing prescriptions to C.N. for 120 tablets of 2mg Xanax; 60 tablets of 30mg Adderall; 90 tablets of 10mg Valium; 150 tablets of 100mg MS Contin; and 180 tablets of 30mg Roxicodone. 39. On May 7, 2015, Respondent received a call from the mother of patient K.N. She told Respondent that K.N. and C.N. were selling drugs and that she believed C.N. had played a role in K.N.'s overdose death On May 13, 2015, Respondent discussed the report from K.N.'s mother with C.N., who denied selling prescription drugs and claimed he was taking his medication as prescribed. 41. Respondent failed to order a urine drug screen tq verify C.N.'s account or otherwise monitor C.N. for diversion activities. 42. On May 14, 2015, despite the ample evidence that C.N. was diverting controlled substances, Respondent issued prescriptions to C.N. for 180 tablets of 30mg Roxicodone; 60 tablets of 30mg Adderall; and 150 tablets of 100mg MS r Con tin. 7

8 Patient K.N. 43. On June 6, 2013, Respondent saw K.N. for an initial office visit. She was referred to Respondent by her husband, C.N. She had a history of anxiety, nausea, and struggles with her weight. 44. On July 5, 2013, K.N. presented with complaints of back and shoulder pain due to her job at a factory. K.N. reported that she was using some of C.N.'s pain medication. 45_ Respondent_ assessed K.N. as having a shoulder/upper arm injury, lumbago, and attention deficit disorder. He increased her Valium dosage from 2mg to 5mg and issued prescriptions for 90 tablets of 30 mg Roxicodone and 30 tablets of 10mg Adderall, citing "attention deficit disorder of childhood." 46. On August 22, 2013, K.N. reported that her Roxicodone tablets were stolen. 47. On August 29, 2013, Respondent issued a replacement prescription, but the pharmacy would not fill it. Respondent indicated to staff that "she can use some of [C.N.'s] in the meantime ifhe will share." 48. On October 16, 2013, Respondent saw K.N. for a.follow-up visit. Respondent documented that K.N. had right hip pain and was positive in a straight leg test. However, Respondent also documented that K.N. had normal muscle strength in her upper and lower extremities. 8

9 49. On October 28, 2013, C.N. reported to Respondent that KN. stole his medications. Despite this report, Respondent failed to institute proper monitoring of KN. 50. On April 17, 2014, Respondent saw KN. to follow-up on her back spasms. K.N. admitted that "she got drunk, did some cocaine, and her mom found her and took her to Brighton." KN. reported that she spent "some time" at Brighton and that "her therapist wants her off all pain meds." Despite this report, Respondent issued prescriptions to KN. for 120 tablets of 15mg Roxicodone and 30 tablets of 20mg Adderall. 51. On November 7, 2014, KN. called Respondent regarding a medication refill. Respondent noted "[prescriptions] written- no more pain meds until apt- she had gone through treatment and needs to flu with me to determine if she is still on m:eds." 52. On November 10, 2014, Respondent issued prescriptions to K.N. for 90 tablets of 10 mg Valium and 60 tablets of 20 mg Adderall. 53. On November 11, 2014, KN. called Respondent again regarding a medication refill. Respondent did not document any notes from that conversation. Respondent issued a prescription to KN. for 120 tablets of 15 mg Roxicodone.. 54: On February 23, 2015, Respondent noted that KN. was recently hospitalized for elevated blood pressure, possibly due to her medication. 55. On March 17, 2015, a local pharmacy called Respondent's office and informed his staff that it would not fill K.N.'s prescription for 20mg Adderall. 9

10 Medicaid required a diagnosis by a psychologist or psychiatrist of attention deficit disorder after the age of 18. At this time, KN. was 34 years old, and Respondent had never referred KN. for an evaluation. 56. On April 6, 2015, Respondent saw K.N. for a re-check. KN. reported that she just attended a Narcotics Anonymous meeting. She also complained of back and neck discomfort and that "she wants to ramp up pain meds to 90 30mg tabs." Respondent issued prescriptions to K.N. for 90 tablets of 10 mg Valium and 90 tablets of 30 mg Roxicodone. 57. On May 4, 2015, Respondent saw K.N. for an office visit for treatment for injuries suffered in an assault. Respondent noted that KN. went to an emergency room for treatment and tested positive for cocaine. Respondent issued prescriptions to KN. for 90 tablets of 10 mg Valium; 60 tablets of 20 mg Adderall; and 180 tablets of 15 mg Roxicodone. 58. On May 5, 2015, KN. was found dead in her home. 59. The Wayne County, MI medical examiner determined that K.N. died of citalopram, diazepam, morphine toxicity. COUNT I 60. Respondent's conduct as described above constitutes negligence or failure to exercise due care in violation of section 16221(a) of the Code. COUNT II 61. Respondent's conduct as described above constitutes incompetence in violation of section 16221(b)(i) of the Code. 10

11 .COUNTIII 62. Respondent's conduct as described above constitutes selling, prestribing, giving away, or administering drugs for other than lawful diagnostic or therapeutic purposes in violation of section 1622l(c)(iv) of the Code. THEREFORE, Complainant requests that this Complaint be served upon Respondent and that Respondent be offered an opportunity to show compliance with all lawful requirements for retention of the aforesaid license. If.compliance is not shown, Complainant further requests that formal proceedings be commenced pursuant to the Public Health Code, rules promulgated pursuant to it, and the Administrative Procedures Act of 1969, 1969 PA 306, as amended; MCL et seq. RESPONDENT IS HEREBY NOTIFIED that, pursuant to section 16231(8) of the Public Health Code, Respondent has 30 days from the receipt of this Complaint to submit a written response to the allegations contained in it. The written response shall be submitted to the Bureau of Professional Licensing, Department of Licensing and Regulatory Affairs, P.O. Box 30670, Lansing, Michigan, 48909, with a copy to the undersigned assistant attorney general. Further, pursuant to section 16231(9), failure to submit a written response within 30 days shall be treated as an admission of the allegations contained in the Complaint and shall result in the 11

12 transmittal of the complaint dire,ctly to the Board's Disciplinary Subcommittee for imposition of an appropriate sanction. Respectfully submitted, Dated: June 27, 2016 BILL SCHUETTE Attorney General /7~/f)/?fttx4&d L/ Andrew J. Hu~ (P7692) Assistant Attorney General Licensing & Regulation Division P.O. Box Lansing, MI (517) LF: B/Hoffmann, Keith Raymond, M.D., /C.omplaint-Administrative