STATE OF FLORIDA DEPARTMENT OF HEALTH

Transcription

1 STATE OF FLORIDA DEPARTMENT OF HEALTH Final Order No. DOH MQA FILED DATE - OCT Depart ant ealth puty Agency Clerk In Re: Emergency Suspension of the License of ; ; ; ORDER OF EMERGENCY SUSPENSION OF LICENSE Celeste Philip, M.D., M.P.H., State Surgeon General, ORDERS the emergency suspension of the license of, (Dr. Katz) to practice medicine in the State of Florida. Dr. Katz holds license number ME Dr. Katz's address of record is 3301 Boynton Beach Boulevard, Suite 12, Boynton Beach, Florida The following Findings of Fact and Conclusions of Law support the emergency suspension of Dr. Katz's license to practice medicine in the State of Florida. FINDINGS OF FACT 1. The Department of Health (Department) is the state agency charged with regulating the practice of medicine pursuant to Chapters 20, 456, and 458, Florida Statutes (2017). Section (8), Florida Statutes (2017), authorizes the State Surgeon General to summarily suspend Dr. Katz's license to practice medicine in the State of Florida, in accordance with Section (6), Florida Statutes (2017). 2. At all times material to this Order, Dr. Katz was licensed to practice

2 medicine in the State of Florida, pursuant to Chapter 458, Florida Statutes. 3. On July 17, 2015, Patient K.C., a 49-year-old female, was transported via emergency services to the hospital after suffering from nausea and vomiting for three days. During transport, Patient K.C. became unresponsive. Patient K.C. was pronounced dead upon arrival at the hospital.' 4. An autopsy revealed that Patient K.C. died from multiple drug intoxication and that she had cocaine,2 temazepam,3 alprazolam,4 heroin,5 oxycodone,6 acetaminophen,' and buprenorphine8 in her system. 1 The facts related to Patient K.C. are contained in Department of Health Case Number According to Section (2), Florida Statutes ( ), cocaine 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 cocaine may lead to severe psychological or physical dependence. 3 Temazepam is prescribed to treat insomnia. According to Section (4), Florida Statutes ( ), temazepam 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 temazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. 4 Alprazolam is prescribed to treat anxiety. According to Section (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 III. 5 According to Section (1), Florida Statutes ( ), heroin is a Schedule I controlled substance that has a high potential for abuse and has no currently accepted medical use in treatment in the United States. Its use under medical supervision does not meet accepted safety standards. 6 Oxycodone is commonly prescribed to treat pain. According to Section (2), Florida Statutes ( ), oxycodone 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 oxycodone may lead to severe psychological or physical dependence. Acetaminophen, or Tylenol, a pain-relieving drug. 8 Buprenorphine, brand name Suboxone, is commonly prescribed to treat pain and opioid dependence. According to Section (5), Florida Statutes ( ), buprenorphine is a Schedule V controlled substance that has a low potential for abuse relative to the substances in Schedule IV and has a currently accepted medical use in treatment in the United States. Abuse of buprenorphine may lead to limited physical or psychological dependence relative to the substances in Schedule IV. 2

3 5. Patient K.C. was known by local law enforcement to engage in prostitution and abuse drugs. The home in which emergency services found Patient K.C. was a known "drug house.h Patient K.C. also had pending criminal charges against her based on her possession of heroin and drug paraphernalia in February Between April 17, 2015, and June 8, 2015, Dr. Katz treated Patient K.C. for "opioid dependence" and prescribed buprenorphine to her. 7. Dr. Katz also treated Patient K.C. for hypertension, or high blood pressure, by prescribing her Lisinopril.9 Patient K.C.'s medical records did not support a diagnosis of, or treatment for, hypertension. 8. Additionally, Dr. Katz prescribed phentermine to Patient K.C. Phenterminel raises blood pressure, and is contraindicated for a patient purportedly suffering from high blood pressure. 9. During the three-month period of treatment, Dr. Katz failed to obtain, or failed to create or keep documentation of, an adequate medical history for Patient K.C. 9 Lisinopril is prescribed to treat high blood pressure. io Phentermine is prescribed as an appetite suppressant. 3

4 10. Additionally, Dr. Katz failed to have, or failed to create or keep documentation of, an adequate medical justification for prescribing phentermine and Lisinopril to Patient K.C. 11. Dr. Katz failed to document prescribing phentermine to Patient K.C. 12. Dr. Katz failed to perform, or failed to create or keep documentation of performing, follow-up related to the course of treatment for Patient K.C.'s opioid dependence and high blood pressure. 13. Despite Patient K.C.'s pending criminal charges and clear history of drug abuse, Dr. Katz's records are devoid of any documentation that he discussed with Patient K.C. her history of illicit drug use and prescription drug abuse. Additionally, Dr. Katz failed to appropriately manage and monitor Patient K.C., a high-risk patient. 14. On December 30, 2015, Patient R.U., a 36-year-old male patient, was found-deceased in his home. The autopsy revealed that Patient R.U. died from heroin overdose Patient R.U. had an extensive criminal history of drug and alcohol related arrests. "The facts related to Patient R.U. are contained in Department of Health Case Number

5 16. Between August 29, 2013, and December 29, 2015, Dr. Katz treated Patient R.U. for general anxiety disorder, cervical disc disease, and neuropathy. R.U. 17. Dr. Katz prescribed alprazolam, Norco,12 and gabapentin13 to Patient 18. During the approximate two-and-a-half-year period of treatment, Dr. Katz failed to obtain, or failed to create or keep documentation of, an adequate medical history for Patient R.U. 19. Dr. Katz failed to perform, or create or keep documentation of performing, an adequate physical examination of Patient R.U. 20. Additionally, Dr. Katz failed to have, or failed to create or keep documentation of, an adequate medical justification for prescribing alprazolam, Norco, and gabapentin to Patient R.U. Dr. Katz failed to obtain, or maintain, imaging studies of Patient R.U.'s cervical disc disease and of Patient R.U.'s neurology consultations. 12 Norco combines hydrocodone and acetaminophen and is prescribed to treat pain. According to Section (3), Florida Statutes ( ), hydrocodone, in the dosages found in hydrocodone/apap is a Schedule III controlled substance that has a potential for abuse less than the substances in Schedules I and II and has a currently accepted medical use in treatment in the United States. Abuse of the substance may lead to moderate or low physical dependence or high psychological dependence. 13 Gabapentin is a legend drug prescribed to treat nerve pain. 5

6 21. Dr. Katz failed to perform, or failed to create or keep documentation of performing, follow-up related to the course of treatment with alprazolam, Norco, and gabapentin. 22. Additionally, Dr. Katz failed to appropriately manage and monitor Patient R.U. During the time that Dr. Katz was treating Patient R.U. with controlled and legend drugs, Patient R.U. was receiving buprenorphine from another physician. Dr. Katz's failure to review Patient R.U.'s prescription records, and ultimate failure to coordinate care for Patient R.U., resulted in the continued prescription of contraindicated medications that were potentially life-threatening when used concurrently. 23. Patient R.U.'s history of drug abuse and treatment with buprenorphine indicated that he was at high-risk for drug abuse. Patient R.U.'s medical records reflect that Dr. Katz failed to appropriately warn Patient R.U. about the dangers associated with combining medications and failed to appropriately monitor Patient R.U. 24. On December 27, 2015, Patient D.G., a 33-year-old male, was found deceased in a parked car. Patient D.G. was first noticed to be missing on December 23, Autopsy reports suggest that Patient D.G. died days before 6

7 he was found. Patient D.G. died from complications caused by multiple drug intoxication. At the time of the autopsy, Patient D.G. had cocaine metabolites and hydromorphone in his system Between June 13, 2014, and December 21, 2015, Dr. Katz treated Patient D.G. for generalized anxiety disorder and attention deficit hyperactivity disorder (ADHD). 26. Dr. Katz prescribed clonazepam15 and Addera1115 to Patient D.G. to treat his anxiety and ADHD. 27. On July 11, 2014, Patient D.G. tested positive foi un-prescribed oxycodone and morphine. Dr. Katz failed to discuss, or document discussing Patient D.G.'s recent use of un-prescribed opiates. 28. On August 7, 2014, Patient D.G. tested positive for un-prescribed buprenorphine and morphine.17 Dr. Katz indicated in Patient D.G.'s patient record 14 The facts related to Patient D.G. are contained in Department of Health Case Number Clonazepam is commonly prescribed to treat anxiety. According to Section (4), Florida Statutes ( ), clonazepam 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 clonazepam may lead to limited physical or psychological dependence relative to the substances in Schedule III. is Adderall is the brand name for a drug that contains amphetamine, commonly prescribed to treat attention deficit disorder. According to Section (2), Florida Statutes ( ), amphetamine 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 amphetamine may lead to severe psychological or physical dependence. 17 Morphine is prescribed to treat pain. According to Section (2), Florida Statutes ( ), morphine is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but 7

8 that Patient D.G. was "not on opioids" except for when he received opioids from the "hospital and friend." This was the extent of Dr. Katz's follow-up related to Patient D.G.'s two positive urine drug screens. 29. On March 2, 2015, Patient D.G. presented to Dr. Katz's office and reported that he was "struggling with drugs from pain issues" and hoping to be prescribed buprenorphine. 30. Patient D.G. also presented Dr. Katz with therapy notes wherein he admitted to a therapist that he was buying buprenorphine "off the street." 31. On March 30, 2015, Dr. Katz diagnosed Patient D.G. with "opioid dependence," after Patient D.G. admitted to illicit use of Dilaudid.18 Dr. Katz prescribed buprenorphine to Patient D.G. 32. Dr. Katz failed to appropriately follow-up on Patient D.G.'s admission to illicitly using Dilaudid and buprenorphine. 33. Dr. Katz waited approximately eight months to request another urine drug screen from Patient D.G. When Patient D.G. submitted to a urine drug severely restricted medical use in treatment in the United States. Abuse of morphine may lead to severe psychological or physical dependence. 18 Dilaudid is the brand name for hydromorphone and is prescribed to treat pain. According to Section (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. 8

9 screen on November 24, 2015, he tested positive for un-prescribed oxycodone. Dr. Katz failed to appropriately follow-up on Patient D.G.'s third urine drug screen that was positive for un-prescribed medications. 34. During the approximate one-and-a-half-year period of treatment, Dr. Katz failed to obtain, or failed to create or keep documentation of, an adequate medical history for Patient D.G. 35. Dr. Katz failed to perform, or failed to create or keep documentation of performing, an adequate physical examination of Patient D.G. 36. Additionally, Dr. Katz failed to have, or failed to create or keep documentation of, an adequate medical justification for prescribing buprenorphine to Patient D.G. 37. Dr. Katz failed to perform, or failed to create or keep documentation of performing, follow-up related to the course of treatment for Patient D.G.'s anxiety, ADHD, and opioid dependence. 38. Dr. Katz failed to adequately respond to Patient D.G.'s multiple urine drug screens that were positive for un-prescribed opiates and buprenorphine. 9

10 39. Additionally, Dr. Katz failed to appropriately manage and monitor Patient D.G. while prescribing a potentially dangerous and addictive combination of opioids, sedatives, and stimulants to Patient D.G., a high-risk patient. 40. On February 4, 2016, Patient M.V.-C., a 27-year-old female, was transported to the hospital via emergency services due to a suspected drug overdose." 41. Patient M.V.-C. was found unconscious in Dr. Katz's home bathroom. A tourniquet and used syringe were lying near Patient M.V.-C. and she had a weak pulse. 42. Several days after being admitted at the hospital, Patient M.V.-C. died. Patient M.V.-C. was found in possession of a small bag containing heroin and cocaine. An autopsy revealed Patient M.V.-C. died as a result of complications from multiple drug overdose. 43. Dr. Katz treated Patient M.V.-C. in 2014 and 2015 for "opioid dependence" and attention deficit/ hyperactivity disorder (ADHD). Dr. Katz failed to create or keep records documenting his treatment of Patient M.V.-C. 19 The facts related to Patient M.V.-C. are contained in Department of Health Case Number

11 44. Patient M.V.-C. told her mother that she went to Dr. Katz for treatment because she would be able to obtain controlled substances from him in exchange for cash. 45. In or around January 2016, Patient M.V.-C. began staying with Dr. Katz at his home because she did not have any money or a place to live. 46. While Patient M.V.-C. stayed with Dr. Katz, Dr. Katz asked Patient M.V.-C. to have sex with him. In January and/or February 2016, Patient M.V.-C. engaged in sexual intercourse with Dr. Katz. 47. After Patient M.V.-C. died, her mother cleaned out her storage unit. Inside the unit, Patient M.V.-C.'s mother found stacks of blank prescription pads, including a pre-signed prescription from Dr. Katz's office. She also found several pill bottles of medications prescribed to Patient M.V.-C. by Dr. Katz. 48. Despite Patient M.V.-C.'s purported discharge from Dr. Katz's care in 2015, Dr. Katz continued prescribing medication to Patient M.V.-C., as indicated by the following prescriptions that Patient M.V.-C. filled shortly before her death: a. Ten strips of buprenorphine 8 mg on January 21, 2016; b. Four strips of buprenorphine 8 mg on January 22, 2016; c. Five strips of buprenorphine 8 mg on January 23, 2016; 11

12 , d. Sixty tablets of clonazepam 0.5 mg on January 25, 2016; e. Ten strips of buprenorphine 8 mg on January 27, 2016; f. Ninety tablets of clonazepam 1 mg on January 27, 2016; and g. Ten strips of buprenorphine 8 mg on February 1, In November 2015, Palm Beach County Sheriff's Office (PBSO) received several complaints that Dr. Katz was selling prescriptions for pain medication to individuals from his residence without obtaining a medical history, conducting appropriate physical examinations, or maintaining patient records. 50. Based on these complaints, PBSO launched an investigation into Dr. Katz's prescribing practices. 51. On the night of February 2, 2016, an undercover officer posing as a Patient J.M. presented to Dr. Katz's office Patient J.M. told Dr. Katz that he "was not feeling good" and suffered from, intermittent and unspecified "pain all over." Patient J.M. told Dr. Katz that he used "blues" before. "Blue" is a slang term for oxycodone. 53. Dr. Katz did not ask Patient J.M. about his history of illicit drug or prescribed drug use. 20 The facts related to Patient J.M. are contained in Department of Health Case Number

13 54. Dr. Katz performed a cursory and inadequate physical examination of Patient J.M Dr. Katz prescribed 30 tablets of Vicoprofen mg to Patient J.M. Dr. Katz failed to have adequate medical justification to prescribe Vicoprofen to Patient J.M. 56. On April 12, 2016, Patient J.M. returned to Dr. Katz's office. 57. When Dr. Katz asked the patient why he was there, Patient J.M. replied that he was "just not feeling right" and that he was used to the "blues." 58. Dr. Katz told Patient J.M. that he was in trouble and that he "didn't even hear those words." Dr. Katz asked the patient to "start again." 59. Patient J.M. again told Dr. Katz that he was not feeling well and wanted "blues." 60. Dr. Katz told the patient that he was not a "pill-pusher." He again asked Patient J.M. why he was there. 21 Vicoprofren contains hydrocodone and ibuprofen and is prescribed to treat pain. According to Section (3), Florida Statutes ( ), hydrocodone, in the dosages found in Vicoprofen, is a Schedule III controlled substance that has a potential for abuse less than the substances in Schedules I and II and has a currently accepted medical use in treatment in the United States. Abuse of the substance may lead to moderate or low physical dependence or high psychological dependence. 13

14 License No,: ME Patient J.M. reiterated that he was not feeling well and had "pain kinda all over." 62. Dr. Katz noted that he previously prescribed Vicoprofen to Patient J.M. Then, despite Patient J.M.'s blatant drug-seeking behavior and unspecified complaint of pain, Dr. Katz wrote Patient J.M. a prescription for 30 tablets of Norco 10/325 mg in exchange for $100 cash. 63. Dr. Katz failed to perform a physical examination of Patient J.M. and failed to obtain an adequate medical history for Patient J.M. 64. Dr. Katz failed to have adequate medical justification to prescribe controlled pain medication to Patient J.M. 65. Dr. Katz did not create, or keep, patient records documenting Patient J.M.'s two visits. 66. Dr. Katz was arrested and charged with trafficking in a controlled substance, a felony. This charge is pending resolution in Palm Beach County Case Number CF On August 7, 2017, a sober home manager referred to as "the Manager" met Dr. Katz at his office. The Manager told Dr. Katz that a "friend" 14

15 told her that she would be able to get a referral from Dr. Katz for urine drug tests for her residents at the sober home The Manager explained that she wanted to pay cash for the referrals and have the results go directly to the sober home. 69. Dr. Katz told the Manager "yes and no." Dr. Katz explained to the Manager that he was dealing with two situations. First, three of his former patients had died from drug overdose. Second, a "DEA agent set him up," and he was currently facing criminal charges for inappropriately prescribing medication to the "agent." 70. Dr. Katz explained that but for the pending criminal case, he did not see that there was anything wrong with providing referrals for urine drug tests for sober home residents. 71. After talking about his pending criminal case and the fact that he had been "put through the gears" by every state and federal agency, he proceeded to write a referral for a 10-panel urine drug test for Resident 1, a female resident at the sober home. 22 The facts related to the sober home are contained in DOH Case

16 72. The Manager asked Dr. Katz to also write a prescription for buprenorphine "just in case" one of her residents needed to undergo detoxification. Dr. Katz wrote the prescription for twelve strips of buprenorphine and wrote Resident l's name on the prescription. 73. The Manager paid Dr. Katz $40 for the urine drug test referral and left. 74. On August 10, 2017, the Manager returned to Dr. Katz with two different sober home residents, Resident 2 and Resident 3. Dr. Katz wrote a prescription for urine drug tests for Resident 2 and Resident 3 after conducting a cursory and incomplete physical evaluation. 75. Dr. Katz advised the Manager to be careful because the DEA is "watching the sober homes for some crazy reason." 76. The Manager paid Dr. Katz $40 for each referral. 77. On August 17, 2017, the Manager returned to Dr. Katz's office with Resident 4, another resident at her sober home. Dr. Katz learned that Resident 4 used drugs while at the sober home. Dr. Katz told the Manager that the patient was a "high-risk" patient and wrote her a referral for a urine drug test. 16

17 78. Resident 4 stepped out of the room and the Manager asked Dr. Katz for a prescription for Adderall. Dr. Katz told the Manager to drink coffee and if that did not work, he recommended she fill out a survey for him to determine whether she suffered from ADD or ADHD. The Manager looked at the form and told Dr. Katz that none of the criteria applied to her. Dr. Katz told the Manager she should take the form home and "think about it." 79. On August 22, 2017, the Manager returned to Dr. Katz's office with Resident 5, another resident at the sober home. Dr. Katz learned that Resident 5 was addicted to huffing chemicals and benzodiazepines.23 Dr. Katz provided the Manager with a referral for a urine drug test for Resident 5 in exchange for $ On August 31, 2017, the Manager returned to Dr. Katz's office with Resident 6 and Resident 7, both residents at her sober home. In exchange for $40, Dr. Katz prescribed lithium24 to Resident 6 without obtaining an adequate medical history or performing a complete physical evaluation. In exchange for 23 Benzodiazepines are a class of drugs that cause sedation and can be habit forming. Benzodiazepines are typically prescribed to treat anxiety or Insomnia. 24 Lithium is prescribed as a psychiatric medication. 17

18 $40, Dr. Katz prescribed Prozac25 to the other resident without obtaining an adequate medical history or performing a complete physical evaluation. 81. Dr. Katz also wrote a prescription for buprenorphine for the sober home manager to keep at the sober home "in case" any of her residents needed to undergo detoxification, in exchange for $ During the aforementioned interactions between Dr. Katz and the Manager, Dr. Katz made it clear to the Manager that the residents that she brought in to see Dr. Katz were not his patients and that he did not want to be involved in their treatment. 83. Dr. Katz's interaction with the residents was solely to write referrals for urine drug tests in exchange for cash. COMPREHENSIVE FINDINGS OF FACT 84. On May 3, 2017, Florida Governor, Rick Scott, signed an Executive Order Number declaring the "Opioid Epidemic" in Florida a state of emergency According to the Executive Order, opioids were responsible for nearly 3,900 deaths in Florida in Prozac is prescribed to treat major depressive disorder. 26 Fla. Exec. Order No (May 3, 2017). 18

19 86. Through the Executive Order, the Governor directed the State Surgeon General to declare a statewide public health emergency and to take any action necessary to protect the public health. 87. In the midst of the Opioid Epidemic, Florida experienced the problematic surge of a "sober home" industry where purported "sober homes" engaged in unlawful activities including receiving kickbacks from treatment facilities, patient brokering, and insurance fraud. 88. Through this industry, individuals addicted to drugs and alcohol have been unable to receive the rehabilitation services that they need, resulting in relapse, overdose, and death. The exploitation of this extraordinarily vulnerable portion of the public is the antithesis of the duty that medical professionals have to protect the public health, safety, and welfare. 89. In light of the Opioid Epidemic and related sober home scheme, medical doctors in the state of Florida have the responsibility to serve the public in a manner that minimizes their patients' risk of drug abuse and addiction. Medical doctors have the responsibility to refrain from engaging in activities that cause harm, or are likely to cause harm to a vulnerable portion of society. 19

20 90. Dr. Katz engaged in a practice that abetted sober homes' fraudulent and exploitive practices by exchanging urine drug test referrals for cash. 91. When Dr. Katz prescribed a controlled substance to a narcoticseeking patient, Dr. Katz showed not only a wanton disregard for that patient's health and safety, but for the laws and rules regulating prescribing of controlled substances in Florida. 92. Even in the simplest interactions with his patients, Dr. Katz failed to meet the standard of care. The medical records for Patients R.U., K.C., and D.G., reveal that Dr. Katz prescribed legend drugs and controlled substances to his patients without adequate medical justification to support the prescriptions and without appropriate follow-up to assess the efficacy of the medication or dosage. Additionally, Dr. Katz prescribed medications that were contraindicated for his patients' purported complaints and in dangerous combinations. 93. Dr. Katz's prescription of legend drugs to patients without an adequate medical justification, his prescription of Schedule II controlled substances to a narcotic-seeking patient, and his prescription of controlled substances and urine drug tests to sober home residents in exchange for cash, indicate that his continued practice of medicine represents an immediate, serious 20

21 danger to the public. Because this behavior has persisted for at least five years, there is a sufficient pattern to show that Dr. Katz is either unable or unwilling to practice medicine in a manner that is safe to the public health, safety, and welfare. Indeed, Dr. Katz's conduct has continued despite the current criminal trafficking charge pending against him. Therefore, Dr. Katz's behavior is likely to continue. 94. Dr. Katz's failure to practice medicine in a manner that is safe to the public is so pervasive, that even in the simplest interactions with his patients, Dr. Katz fails to meet the minimum standard of care. Dr. Katz's misconduct spans such a broad spectrum of violations that there is no less restrictive means than than suspension that can adequately protect the public health, safety, and welfare. CONCLUSIONS OF LAW Based on the foregoing Findings of Fact, the State Surgeon General concludes as follows: 1. The State Surgeon General has jurisdiction over this matter pursuant to Sections and (8), Florida Statutes (2017), and Chapter 458, Florida Statutes (2017), as set forth above. 21

22 2. Section (1)(i), Florida Statutes (2017), authorizes discipline, including suspension, against a medical doctor for paying or receiving any commission, bonus, kickback, or rebate, or engaging in any split-fee arrangement in any form whatsoever with a physician, organization, agency, or person, either directly or indirectly, for patients referred to providers of health care goods and services, including, but not limited to, hospitals, nursing homes, clinical laboratories, ambulatory surgical centers, or pharmacies. The provisions of this paragraph shall not be construed to prevent a physician from receiving a fee for professional consultation services. 3. Dr. Katz violated Section (1)(i), Florida Statutes (2017), by receiving payment from a sober home manager in exchange for writing referrals for Residents 1, 2, 3, 4, and 5 to undergo urine drug tests. 4. Section (1)(m), Florida Statutes ( ), authorizes discipline, including suspension, against a medical doctor 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 22

23 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. 5. Rule (2)1 Florida Administrative Code, provides that a licensed physician shall maintain patient medical records in English, in a legible manner and with sufficient detail to clearly demonstrate why the course of treatment was taken. 6. Rule , Florida Administrative Code, provides that 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 healthcare practitioners at the request of the physician and relied upon by the physician in determining the appropriate treatment of the patient. 23

24 7. Dr. Katz violated Section (1)(m), Florida Statutes (2017), and Rule 64B , Florida Administrative Code, by: a. Failing to create or keep documentation of obtaining an adequate medical history of Patient K.C.; b. Failing to create or keep documentation of performing an adequate physical examination of Patient K.C.; c. Failing to create or keep documentation of following-up on the efficacy of treatment for Patient K.C.'s high blood pressure and opioid dependence; d. Failing to create or keep documentation of obtaining an adequate medical history of Patient R.U.; e. Failing to create or keep documentation of performing an adequate physical examination of Patient R.U.; f. Failing to create or keep documentation of following-up on the efficacy of treatment for Patient R.U.'s anxiety, neuropathy, and cervical disc disease; g. Failing to create or keep documentation of obtaining an adequate medical history of Patient D.G.; 24

25 h. Failing to create or keep documentation of performing an adequate physical examination of Patient D.G.; i. Failing to create or keep documentation of following-up on the efficacy of treatment for Patient D.G.'s anxiety, ADHD, and opioid dependence; j. Failing to create or keep documentation of adequately addressing Patient D.G.'s positive urine drug screens for un-prescribed controlled substances; k. Failing to create or keep medical records for Patient M.C.-V.; and I. Failing to create or keep medical records for Patient J.M. 8. Section (1)(q), Florida Statutes ( ), authorizes discipline, including suspension, against a medical doctor 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 this 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 25

26 is not in the course of the physician's professional practice, without regard to his or her intent. 9. Dr. Katz violated Section (1)(q), Florida Statutes ( ), by inappropriately prescribing: a. Buprenorphine to Patient K.C.; b. Lisinopril to Patient K.C.; c. Phentermine to Patient K.C.; d. Alprazolam to Patient R.U.; e. Norco to Patient R.U.; f. Gabapentin to Patient R.U.; g. Clonazepam to Patient D.G.; h. Adderall to Patient D.G.; i. Buprenorphine to Patient D.G.; j. Buprenorphine to Patient M.C.-V.; k. Clonzepam to Patient M.C.-V.; I. Vicoprofen to Patient J.M.; and m. Norco to Patient J.M. 26

27 10. Section (1)(t), Florida Statutes ( ), authorizes discipline, including suspension, against a medical doctor for committing medical malpractice as defined in Section , Florida Statutes. The board shall give great weight to the provisions of Section 766,102, Florida Statutes, when enforcing this paragraph. Medical malpractice shall not be construed to require more than one instance, event, or act. 11. Section (1)(g), Florida Statutes ( ), defines medical malpractice to mean the failure to practice medicine in accordance with the level of care, skill, and treatment recognized in general law related to health care licensure. 12. Dr. Katz violated Section (1)(t), Florida Statutes ( ), committing medical malpractice in his treatment of Patients K.C., D.G., R.U., M.C.-V., and Patient J.M. by: a. Failing to obtain an adequate medical history of Patient K.C.; b. Failing to perform an adequate physical examination of Patient K.C.' c. Failing to follow-up on the efficacy of treatment for Patient K.C.'s high blood pressure and opioid dependence; 27

28 d. Failing to adequately monitor and manage Patient K.C., a high-risk patient; e. Failing to obtain an adequate medical history of Patient R.U.; f. Failing to perform an adequate physical examination of Patient R.U.; g. Failing to follow-up on the efficacy of treatment for Patient R.U.'s anxiety, neuropathy, and cervical disc disease; h. Failing to adequately monitor and manage Patient R.U., a high-risk patient; i. Failing to obtain an adequate medical history of Patient D.G.; j. Failing to perform an adequate physical examination of Patient D.G.' k. Failing to follow-up on the efficacy of treatment for Patient D.G.'s anxiety, ADHD, and opioid dependence; I. Failing to adequately address Patient D.G.'s positive urine drug screens for un-prescribed controlled substances; m. Failing to adequately monitor and manage Patient D.G., a high-risk patient; n. Failing to obtain an adequate medical history of Patient J.M. prior to prescribing controlled substances to Patient J.M.; 28

29 o. Failing to perform an adequate physical examination of Patient J.M. prior to prescribing controlled substances to Patient 1 M.; p. Failing to have adequate medical justification to prescribe Vicoprofen and Norco to Patient 1M.; and q. Prescribing a controlled pain medication to Patient J.M. despite Patient 3.M.'s drug-seeking behavior. 13. Section (1)(t)3., Florida Statutes ( ), authorizes discipline, including suspension, against a medical doctor for committing repeated medical malpractice as defined in Section , Florida Statutes. 14. Section (1)(h), Florida Statutes ( ), defines repeated medical malpractice to mean three or more incidents of medical malpractice found to have been committed by a medical doctor. 15. Dr. Katz violated Section (1)(t)3., Florida Statutes ( ), by committing three or more incidents of medical malpractice against Patients R.U., K.C., D.G., M.C.-V., and J.M. 16. Section (1)(aa), Florida Statutes ( ), authorizes discipline, including suspension, against a medical doctor for pre-signing blank prescription forms. 29

30 17. Dr. Katz violated Section (1)(aa), Florida Statutes ( ), by pre-signing a blank prescription form. 18. Section (6), Florida Statutes (2017), authorizes the State Surgeon General to summarily suspend a medical doctor's license upon a finding that the nurse presents an immediate, serious danger to the public health, safety, or welfare. 19. Dr. Katz's continued practice as a medical doctor constitutes an immediate, serious danger to the health, safety, or welfare of the citizens of the State of Florida, and this summary procedure is fair under the circumstances to adequately protect the public. WHEREFORE, in accordance with Section (6), Florida Statutes (2017), it is ORDERED THAT: 1. The license of, to practice as a medical doctor, license number ME 37959, is immediately suspended. 2. A proceeding seeking formal discipline of the license of Dr. Peter Stewart Katz, M.D., to practice as a medical doctor in the State of Florida will be promptly instituted and acted upon in compliance with Sections and (6), Florida Statutes (2017). 30

31 DONE and ORDERED this,314 day of O44-61-, In Re: Emergency Suspension of the License of Celest ilip, M.D., M.P.H. Surgeon General and Secretary PREPARED BY: Kristen M. Summers Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL Florida Bar Number (T) (850) (F) (850) (E) 31

32 NOTICE OF RIGHT TO JUDICIAL REVIEW Pursuant to Sections (6), and , Florida Statutes, the Department's findings of immediate danger, necessity, and procedural fairness shall be judicially reviewable. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings are commenced by filing a Petition for Review, in accordance with Florida Rule of Appellate Procedure 9.100, and accompanied by a filing fee prescribed by law with the District Court of Appeal, and providing a copy of that Petition to the Department of Health within thirty (30) days of the date this Order is filed. 32