11-005692PL Department Of Health, Board Of Medicine vs. Jacinta Irene Gillis, M.D.
 Status: Closed
Recommended Order on Friday, February 3, 2012.


View Dockets  
Summary: Dr. Gillis failed to properly diagnose, treat, and medicate patients; recommend suspension of license and payment of costs and fees.

1STATE OF FLORIDA

4DIVISION OF ADMINISTRATIVE HEARINGS

8DEPARTMENT OF HEALTH, )

12BOARD OF MEDICINE , )

16)

17Petitioner , )

19)

20vs. ) Case Nos. 11 - 5691PL

27) 11 - 5692PL

31JACINTA IRENE GILLIS, M.D. , )

36)

37Respondent . )

40)

41RECOMMENDED ORDER

43Pursuant to notice to all parties, the final hearing was

53conducted in this case on December 5 and 6, 2011, in Ft. Myers,

66Florida, before Administrative Law Judge R. Bruce McKibben of

75the Division of Administrative Heari ngs.

81APPEARANCES

82For Petitioner: Robert J. Bobek, Esquire

88Shirley L. Bates, Esquire

92Department of Heath

95Prosecution Services Unit

984052 Bald Cypress Way, Bin C65

104Tallahassee, Florida 32399 - 3265

109For Respondent: Jacinta I rene Gillis, M.D. , pro se

11812446 Pebble Stone Court

122Fort Myers, Florida 33913

126STATEMENT OF THE ISSUE S

131The issues in this case, as set forth in the Amended

142Administrative Complaints in each respective case, are as

150follows:

151DOH Case No. 2010 - 01 128/DOAH Case No. 11 - 5692

163Count One . Whether Respondent, Jacinta Irene Gillis, M.D.

172(hereinafter referred to herein as " Dr. Gillis " ), violated

181sections 458.331(1)(nn) and 458.326, Florida Statutes (2008 and

1892009), by:

191a. Failing to diagnose patient M.G. w ith intractable

200pain prior to prescribing a controlled substance

207under Schedules II - V, as provided in section

216893.03, from on or about December 19, 2008 through

225December 30, 2009;

228b. By inappropriately or excessively prescribing

234potentially lethal, highly abused, controlled

239substances, to wit: oxycodone, oxycontin,

244Percocet, and Valium, to M.G. without justification

251during the same time period;

256c. By inappropriately or excessively prescribing

262controlled substances to M.G. prior to exploring

269other treatm ent modalities or rehabilitation; and

276d. By failing to order a urine drug screen on M.G. at

288any time during her course of treatment.

295Count Two . Whether Dr. Gillis failed to keep legible

305medical records justifying the course of treatment for M.G. in

315one or more of the following ways:

322a. By failing to document justification for

329inappropriately or excessively prescribing

333controlled substances during her course of

339treatment; and

341b. By failing to document justification for not

349ordering a urine drug screen du ring the course of

359treatment.

360Count Three . Whether Dr. Gillis failed to meet the

370required standard of care in regards to her treatment of M.G. in

382one or more of the following ways:

389a. By inappropriately or excessively prescribing

395controlled substances wi thout justification;

400b. By failing to confirm whether M.G. presented to a

410psychiatrist or psychologist after the initial

416referral by Dr. Gillis;

420c. By failing to order a urine drug screening of M.G.

431during her course of treatment; and

437d. By inappropria tely or excessively prescribing

444controlled substances prior to exploring other

450modalities or rehabilitation.

453Count Four . Whether Dr. Gillis prescribed controlled

461substances , other than in the course of her professional

470practice , by prescribing controlled substances inappropriately

476or excessively in one or more of the following ways:

486a. By inappropriately or excessively prescribing

492controlled substances prior to exploring other

498treatment modalities or rehabilitation for M.G.;

504b. By inappropriately or exce ssively prescribing

511controlled substances without ordering a urine drug

518screening for M.G.; and

522c. By inappropriately or excessively prescribing

528controlled substances to M.G. without

533justification.

534DOH Case No. 2008 - 20661/DOAH Case No. 11 - 5961

545Count One . Whether Dr. Gillis violated section

553458.331(1)(nn), Florida Statutes (2008), 1/ and Florida

560Administrative Code Rule 64B8 - 9.013(3) in one or more of the

572following ways:

574a. By failing to perform or document performing a

583complete physical exam of R.S.;

588b. By failing to explore or document exploring other

597treatment modalities or rehabilitation for R.S.;

603c. By failing to obtain or document obtaining a

612complete medical history of R.S.;

617d. By failing to document the nature or intensity of

627R.S. ' s pain;

631e. By failing to document the current or past

640treatments of R.S. ' s pain;

646f. By failing to document information on the effect of

656pain on R.S. ' s physical or psychological function;

665g. By failing to develop or document developing a

674treatment plan for R.S.; a nd

680h. By failing to determine or document determining if

689there were any underlying or coexisting diseases or

697conditions for R.S.

700Count Two . Whether Dr. Gillis violated sections

708458.331(1)(nn) and 458.326 in one or more of the following ways:

719a. By faili ng to diagnose R.S. with intractable pain

729prior to prescribing controlled substances, i.e.,

735Percocet;

736b. By prescribing 90 tablets of Percocet 10/325 to

745R.S. without justification;

748c. By prescribing Percocet to R.S. without exploring

756other treatment mod alities or rehabilitation; and

763d. By inappropriately prescribing Percocet to R.S.

770after R.S. reported that he was not currently being

779treated for pain.

782Count Three . Whether Dr. Gillis failed to keep legible

792medical records justifying the course of trea tment for R.S. in

803one or more of the following ways:

810a. By failing to document justification for

817prescribing Percocet to R.S.;

821b. By failing to document a complete physical

829examination of R.S. prior to prescribing Percocet;

836c. By failing to document a c omplete medical history

846of R.S. prior to prescribing a controlled

853substance;

854d. By failing to document a urine screen on R.S.; and

865e. By failing to document a diagnosis of intractable

874pain for R.S.

877Count Four . Whether Dr. Gillis violated sections

885458. 331(1)(nn) and 458.326 in one or more of the following ways:

897a. By failing to perform or document performing a

906complete physical examination of D.H. on either of

914two visits;

916b. By failing to obtain or document obtaining a

925complete medical history on D.H. ;

930c. By failing to explore or document exploring other

939treatment modalities or rehabilitation for D.H.;

945d. By failing to document the nature or intensity of

955D.H. ' s pain;

959e. By failing to document the current or past

968treatments of D.H. ' s pain;

974f. By fa iling to document information on the effect

984of pain on D.H. ' s physical or psychological

993function;

994g. By failing to develop or document a treatment plan

1004for D.H.; and

1007h. By failing to determine or document determining if

1016there were any underlying or coexi sting diseases

1024or conditions for D.H.

1028Count Five . Whether Dr. Gillis violated sections

1036458.331(1)(nn) and 458.326 in one or more of the following ways:

1047a. By failing to diagnose D.H. with intractable pain

1056prior to prescribing a controlled substance, i.e .,

1064oxycodone;

1065b. By prescribing 120 tablets of 30 mg oxycodone

1074without justification;

1076c. By prescribing 120 tablets of 30 mg oxycodone prior

1086to exploring other treatment modalities or

1092rehabilitation for D.H.; and

1096d. By prescribing oxycodone to D.H. a fter D.H.

1105reported that he was not experiencing any pain.

1113Count Six . Whether Dr. Gillis failed to keep legible

1123medical records justifying the course of treatment for D.H. in

1133one or more of the following ways:

1140a. By failing to document justification for

1147p rescribing 120 tablets of 30 mg oxycodone;

1155b. By failing to document a complete physical

1163examination of D.H. prior to prescribing a

1170controlled substance;

1172c. By failing to document a complete medical history

1181of D.H.;

1183d. By failing to document urine dru g screening of D.H.

1194prior to prescribing a controlled substance; and

1201e. By failing to document a diagnosis of intractable

1210pain for D.H. prior to prescribing a controlled

1218substance.

1219PRELIMINARY STATEMENT

1221This case was originally opened at the Division of

1230Administrative Hearings ("DOAH") under C ase Nos. 11 - 4058PL and

124311 - 4062PL. Pursuant to a motion filed by Respondent, Department

1254of Health, Board of Medicine (hereinafter the " Department " ),

1263jurisdiction was relinquished to the Department so that the

1272Adminis trative Complaints could be amended and presented to the

1282probable cause board. When the files were reopened at DOAH,

1292they were opened under the style and case numbers appearing

1302above. Dr. Gillis disputes the allegations in the Amended

1311Administrative Comp laints and requested a formal administrative

1319hearing.

1320At the final hearing, the Department presented the

1328testimony of four witnesses: Daniel Negersmith, a deputy with

1337the Pinellas County Sheriff ' s Office (PCSO); Robert Johnson,

1347deputy with PCSO; Robert Osterland, detective with PCSO; and

1356Dr. Marc Gerber, accepted as an expert in p ain m edicine. The

1369Department ' s E xhibits 1 through 3, 6, and 17 were admitted into

1383evidence. Official recognition was taken of the statutes and

1392rules offered in E xhibits 7 thro ugh 16. Dr. Gillis called

1404Negersmith, Johnson and Dr. Gerber as witnesses in her

1413case - in - chief. Dr. Gillis did not testify. Dr. Gillis's

1425E xhibits 8 through 11 were admitted into evidence.

1434The parties advised that a transcript of the final hearing

1444would be ordered. By rule , the parties have ten days from the

1456date the transcript is filed to file proposed recommended

1465orders. The T ranscript was filed on January 9, 2012.

1475Dr. Gillis filed a " Post Order Recommendation " on January 3,

14852012 , which is accepted a s her P roposed R ecommended O rder

1498("PRO") . On January 5, 2012, Dr. Gillis refiled her Post Order

1512Recommendation, stating that the Department refused to provide

1520her a copy of the final hearing T ranscript " as agreed in court. "

1533Dr. Gillis offered to resubmit her Post Order Recommendation

1542with citations to the record if the Department provided her a

1553copy of the T ranscript. The Department filed its PRO on

1564January 19, 2012. Each party ' s PRO was duly considered in the

1577preparation of this Recommended Order. Dr. Gillis filed a

1586response to the Department's PRO on February 1, 2012, but it was

1598not considered in the preparation of the Recommended Order, as

1608there is no provision in the Rules of Procedure for such a

1620response.

1621FINDINGS OF FACT

16241. The Department is th e state agency having

1633responsibility for monitoring health care professionals,

1639including medical doctors. Dr. Gillis is a medical doctor

1648licensed in Florida, North Carolina , and Iowa. She is not

1658board - certified in any area of medicine , but claims to be

" 1670eligible " for board - certification in the field of internal

1680medicine.

16812. Dr. Gillis received her medical degree from Meharry

1690Medical College in Nashville, Tennessee, in 1997. She completed

1699her internal medicine residency in 2003. Her medical career

1708incl udes the following places of employment:

1715Ʊ Medical director/staff physician at Tennessee

1721prison for women: March - August 2003;

1728Ʊ Hospitalist at Hilton Head Regional Medical Center:

1736August 2003 - February 2004;

1741Ʊ Pain management " specialist " in Atlanta, Georgia:

1748March - September 2004;

1752Ʊ Staff phys ician for Illinois Correctional

1759Facilities: September 2004 - January 2005;

1765Ʊ Pain specialist/physician in Rock Island, Illinois:

1772March - September 2005;

1776Ʊ Hospitalist at Brommen Medical Center in

1783Bloomington, Illinois: May - August 2005;

1789Ʊ Hospitalist at Hor izon Medical Center in Dixon,

1798Tennessee: September 2005 - January 2006;

1804Ʊ Pain specialist for National Health Services Clinic

1812in Nashville, Tennessee: June - August 2006;

1819Ʊ Hospitalist at Kedlic Medical Center in Richland,

1827Washington: September 2006 - Janua ry 2007;

1834Ʊ Hospitalist at Auburn Regional Medical Center in

1842Auburn, Washington: January - June 2007;

1848Ʊ Hospitalist at Mercy Medical Center in Sioux City,

1857Iowa: July - August 2007;

1862Ʊ Hospitalist at Albermarle Medical Center in

1869Elizabeth City, North Carolina : September - December

18772007;

1878Ʊ Hospitalist at National Medical Affiliates in Punta

1886Gorda, Florida: January - July 2008;

1892Ʊ Pain management specialist at UR Medical Clinic in

1901St. Petersburg, Florida: July - November, 2008; and

1909Ʊ Pain management specialist a t Dollar Medical Clinic

1918in St. Petersburg, Florida: January 2009 - October

19262010.

19273. The Department is pursuing sanctions against Dr. Gillis

1936based on her provision of medical care to three patients: D.H.,

1947R.S. and M.G. Both D.H. and R.S. are pseudonyms used by

1958D eputies Negersmith and Johnson, respectively, as part of an

1968undercover investigation of the clinic where Dr. Gillis was

1977working in 2008. Their initials are used throughout this order

1987for continuity , because all of the patient records and other

1997e vidence used those initials , rather than patient names. M.G.

2007was a bona fide patient of Dr. Gillis ' s while she was operating

2021another clinic in 2009 - 2010.

20274. In 2008 , Dr. Gillis worked at a clinic operated by

2038UR Medical Group, Inc., located in Pinellas Pa rk, Florida. The

2049clinic (referred to herein as the " UR Clinic " ) was owned by

2061Renee Demasso, a non - physician. Dr. Gillis was the only medical

2073doctor on staff at the clinic when she worked there. Another

2084employee at the clinic was Quinton Knight, a large African -

2095American male , who served as the office receptionist. The

2104clinic had a " recruiter " named Jason Norris. 2 / A recruiter is a

2117person hired by the clinic to find new patients for the clinic ' s

2131medical staff, i.e., for Dr. Gillis.

21375. On August 4, 2008, Negersmith , posing as D.H. , was

2147escorted to the UR Clinic by Norris. Upon arrival , he was given

2159a patient information sheet to fill out. Norris directed him to

2170write " severe lower back pain " on the sheet as the purpose of

2182the visit. D.H. filled out the sheet, providing the following

2192information:

2193Ʊ His pseudonym, address and contact information;

2200Ʊ His gender, marital status, height and weight;

2208Ʊ A fake social security number and date of birth;

2218Ʊ A fake driver ' s license number;

2226Ʊ His supposed occupat ion, i.e., a lineman for a

2236private employer;

2238Ʊ A purported ailment, i.e., " severe lower back pain,

2247weakness in knees " as the purpose for his visit;

2256Ʊ No insurance information;

2260Ʊ Neck/back pain and headaches as his medical

2268history;

2269Ʊ A signature and da te.

22756. All of the information provided was , of course , false.

2285That is, D.H. was a fictitious name for a person pretending to

2297be a patient. After filling out the form, D.H. discussed with

2308Norris the cost of seeing the doctor. Norris said it would be a

2321$350 charge. After approximately 45 minutes, D.H. was escorted

2330to another waiting area, a vestibule separate from the main

2340waiting area.

23427. After a short wait of five to ten minutes, D.H. was

2354shown into an examination room where he met Dr. Gillis. D.H .

2366was told to weigh himself on a floor scale and told Dr. Gillis

2379his weight, 264 pounds. She then took his blood pressure which

2390was 140/80. Dr. Gillis told D.H. that he might want to take

2402some medication to lower his blood pressure.

24098. Dr. Gillis inqu ired as to the history of his present

2421illness. According to the History and Physical Form (referred

2430to herein as the patient chart) filled out by Dr. Gillis as she

2443talked with the patient, D.H. said he had no pain (zero on a

2456one - to - ten scale). Dr. Gillis wrote that D.H. " has difficulty

2469explaining what he is really feeling " and that D.H. said muscle

2480relaxers do not work for him. D.H. then told Dr. Gillis that

2492oxycodone helps him to relax.

24979. Dr. Gillis then had D.H. perform three simple tasks:

2507walking a short distance on his toes, walking on his heels, and

2519raising his arms above his head. D.H. walked as directed, but

2530he could not raise his arms higher than shoulder height because

2541he was concealing a firearm in his waistband and raising his

2552arms any highe r would have revealed the weapon. 3 / So he raised

2566his arms up to shoulder height and then lowered them. D.H.

2577cannot remember whether Dr. Gillis asked him why he could not

2588raise his arms higher. Her notations on the patient chart

2598indicate only that D.H. h as less strength in his right foot

2610(leg) and less range of motion in his left arm.

262010. At the conclusion of the examination, Dr. Gillis

2629listed " chronic back and neck problems, chronic pain symptoms,

2638non - specific " as the assessment and treatment plan for D. H. The

2651lower left corner of the patient chart has an indication saying

" 2662needs records. " D.H. purposefully avoided using the word

" 2670pain " throughout his examination. The only mention of pain was

2680o n the intake sheet he filled out, where he checked a box

2693en titled neck/back pain. D.H. told Dr. Gillis that oxycodone

2703helped him relax. She did not inquire as to whether he was

2715taking any other medications or suggest any other modalities or

2725treatment with D.H.

272811. After the examination, D.H. went back to the fro nt

2739office where he received a prescription for 120 tablets of 30 mg

2751oxycodone and for 90 tablets of 600 mg M otrin. He handed Norris

2764$350 in cash, which Norris then gave to Knight. No receipt was

2776provided for the payment. D.H. then went to a local pharma cy

2788and had the prescription filled. Pursuant to prior

2796arrangements, he gave 60 of the oxycodone tablets to Norris for

2807sale on the street. 4 / The remaining tablets were placed into

2819locked storage. Norris did not know D.H. was a police officer,

2830of course.

283212. On August 27, 2008 (23 days later), D.H. appeared at

2843the UR Clinic again. This time he was accompanied by D eputy

2855Johnson who was posing as patient R.S. The deputies arrived at

2866the clinic and looked for Norris, who was usually hanging around

2877the parki ng lot. However, Norris was not there , and the

2888deputies could not reach him via telephone , so they decided to

2899go into the clinic anyway and see if they could obtain

2910additional drugs. When D.H. and R.S. came into the clinic

2920without Norris accompanying the m, Knight became very upset and

2930agitated. D.H. told Knight that Norris had recently changed his

2940cell phone number , and it was not possible to contact him right

2952then. R.S. started to walk out of the office, but Knight called

2964him back and asked him for $35 0 and a copy of his

2977identification . Knight then gave R.S. a patient information

2986sheet to fill out. D.H. was not asked to fill out any paperwork

2999at that time.

300213. D.H. was then escorted to the examination room where

3012he saw Dr. Gillis again. No tests or p hysical examination were

3024conducted. The only thing Dr. Gillis asked D.H. was whether he

3035had brought his medical records with him. D.H. told her he had

3047not had time to get them from his prior doctor yet. Dr. Gillis

3060instructed D.H. not to come back to the clinic without his

3071medical records. At the foot of the chart, Dr. Gillis wrote

" 3082Dr. Rew, family doctor; 2 weeks records; brought in

3091personally. " The note was not explained by Dr. Gillis.

310014. The patient chart filled out by Dr. Gillis on the

3111second visit was extremely abbreviated in content. Under chief

3120complaint , Dr. Gillis wrote, " patient states treatment plan is

3129working; no complaints. " The chart contains his vital signs:

3138pulse of 142/80 and weight of 268 pounds. The history of

3149present illness sect ion of the form says only that D.H has a

3162zero out of ten level of pain with treatment. She noted that

3174D.H. has " no changes from prior testing " and added a note to

" 3186refill meds. " The assessment and treatment plan section says

" 3195chronic back and neck proble m. " According to D.H., he never

3206mentioned any problem to Dr. Gillis.

321215. Dr. Gillis did not inquire as to whether D.H. was

3223currently taking any medications, but wrote , " oxycodone # 120 "

3232and " Motrin 600 # 90 " on the current medications section of the

3244chart. There was no physical examination of any kind performed

3254on this visit.

325716. D.H. then went out to the office and got his

3268prescription for 120 tablets of 30 mg oxycodone. Dr. Gillis

3278never asked him whether he had taken all of the prior

3289prescription, nor di d she discuss pain with him. As part of his

3302cover, D.H. intentionally avoided the use of the word " pain "

3312when talking to Dr. Gillis.

331717. Meanwhile, R.S. completed his patient information

3324sheet, providing the following information:

3329Ʊ His pseudonym, addres s and contact information;

3337Ʊ His gender, marital status, height and weight;

3345Ʊ A fake social security number and date of birth;

3355Ʊ A fake driver ' s license number;

3363Ʊ His occupation (carpenter work) and employer

3370(unemployed);

3371Ʊ Purpose of visit, which D.H . listed as " stiffness in

3382both shoulders " ;

3384Ʊ No auto accident involved and no insurance available;

3393Ʊ Medical history options of high blood pressure and

3402neck/back pain were checked in the list of various

3411diseases and conditions listed on the sheet;

3418Ʊ An allergy to Keflex;

3423Ʊ Referred to clinic by a friend.

343018. R.S. was then taken back to an examination room where

3441he met Dr. Gillis. He, too, contrived not to mention the word

3453pain in his conversations with Dr. Gillis. He simply said he

3464had a stiff shoul der.

346919. Dr. Gillis took his vital signs and had R.S. do the

3481same physical tests that D.H. had performed in his first visit.

3492R.S. remembers Dr. Gillis listening to his chest with a

3502stethoscope and then examining his shoulder.

350820. The patient chart filled out by Dr. Gillis during

3518R.S. ' s visit contained the following information: " Chief

3527complaint - - Self employed; carpentry; history of surgery on back,

3538shoulder problems one year ago; surgery and thus pain; no

3548history of pain management. " She correctly noted that R.S. was

3558not currently on any medications.

356321. Dr. Gillis ' s assessment and treatment plan for R.S.

3574was listed on the chart as chronic shoulder pain. There is no

3586explanation for that notation. At the bottom corner of the

3596chart, Dr. Gillis wrote " MRI of neck/shoulder; Dr. Wood,

3605Pinellas County Orthopedic. " That notation was not explained

3613further by Dr. Gillis.

361722. R.S. went back to the front office where he was handed

3629a prescription for Percocet 10/325, even though he never asked

3639for medication. The Percocet was at the maximum strength (10

3649mg) for oxycodone content for that medication. R.S. then left

3659the office, identified photographs of Dr. Gillis and Knight for

3669his superiors and had no further involvement with the

3678investigation.

367923. The testimony o f Negersmith and Johnson as to their

3690undercover actions was credible. Each of them had a clear and

3701unambiguous memory of the events and did not appear to have any

3713prejudices or ill intent that might negatively affect their

3722testimony. The truth and veraci ty of their statements is

3732accepted.

373324. At some point in time after the August 27, 2008 ,

3744visit, the P CSO decided they had enough evidence to prosecute

3755the UR Clinic as a " pill mill. " As part of that prosecution,

3767Dr. Gillis was pulled over in a traffic sto p one day as she was

3782leaving the clinic. After detaining her and explaining the

3791charges that were being filed, the deputies advised Dr. Gillis

3801to retain all patient records for patients she had been treating

3812at the clinic. Later, Dr. Gillis cooperated wi th the s heriff ' s

3826o ffice and provided sets of original patient records to them.

3837Dr. Gillis thereafter left her employment with the UR clinic and

3848opened her own clinic.

385225. Patient M.G. presented to Dr. Gillis at her new place

3863of employment, Dollar Medical Clinic, on December 19, 2008.

3872Dr. Gillis was the owner and operator of this new clinic.

388326. M.G. filled out a patient information sheet which

3892garnered the following information about him:

3898Ʊ Name, address and contact information;

3904Ʊ Marital status (married), and emergency contact

3911information;

3912Ʊ Height, weight, and date of birth;

3919Ʊ Purpose of visit, listed as " refill on meds, follow - up

3931on surgery. "

3933Ʊ Auto accident on November 17, 2007;

3940Ʊ Insurance company information; and

3945Ʊ Medical history of neck/back pain, headaches, and

3953arthritis.

395427. M.G. was then examined by Dr. Gillis. She filled out

3965a patient chart for him that listed a history of surgery and

3977treatments for pain. The patient chart lists Dr. Spuza and

3987Dr. Nucci as physicians from whom M.G. had received care in the

3999past.

400028. The patient chart note d that M.G. need ed to be

4012referred to a psychiatrist or psychologist as soon as possible .

4023There wa s also a note indicating that M.G. ' s MRI need ed to be

4039confirmed. Then there wa s a note written by Dr. Gillis saying

" 4051[p] atient is not going to be patient. " There wa s no

4063explanation as to what that note mean t . The assessment and plan

4076of treatment wa s then listed as " pain dependent " (altho ugh the

4088writing on the patient chart is not very clear , and no testimony

4100was elicited from Dr. Gillis to confirm what was written) and

4111that the patient was advised about decreasing his pain

4120medications.

412129. M.G. complained of pain at an eight on the one to ten

4134scale with " treatment with oxycodone times four, " presumably

4142meaning four times per day.

414730. Upon completion of her examination of M.G., Dr. Gillis

4157wrote him a prescription for 240 tablets of 30 mg oxycodone,

4168120 tablets of 40 mg oxycontin, 30 table ts of 10 mg valium, and

418260 tablets of 500 mg naprosyn. According to the prescription,

4192M.G. was supposed to take one of the oxycodone tablets every

4203three hours, 24 hours per day, i.e., eight times per day. That

4215was in addition to the oxycontin, which was to be taken every

4227six hours. According to Dr. Gerber, " no pain doctor in the

4238country would write a prescription like that. " It would also be

4249almost impossible for a patient to take all of those medications

4260as prescribed.

426231. Approximately one month later , on January 16, 2009,

4271M.G. returned to Dr. Gillis for the first of several follow - up

4284visits. The patient chart filled out by Dr. Gillis that day

4295indicates the chief complaint by M.G. to be " pain, top of

4306buttocks radiating down leg to foot on left side. " M.G. said

4317his pain level was an eight out of ten with his medications.

4329Dr. Gillis wrote a note to refill the medications and that there

4341were " no acute changes " to M.G. ' s condition. This time, the

4353assessment and treatment plan was abbreviated as " A/P. " This

4362was the beginning of very cursory notes in the patient charts

4373for M.G. The notes on the chart became shorter and less

4384detailed as time went on. The "A/P" was listed as chronic neck

4396pain and dental issues.

440032. Dr. Gillis then wrote prescriptions for 240 more

4409oxycodone tablets, 120 more oxycontin tablets, 30 valium and

441830 amoxicillin tablets. There is no record in the chart as to

4430why the amoxicillin was added to M.G. ' s medication regimen.

4441There is no justification for providing essentially the same

4450r egimen of treatment when the patient was complaining of pain at

4462a level of eight out of ten .

447033. M.G. came back for another follow - up on February 13,

44822009. At that visit, Dr. Gillis charted the chief complaint as

" 4493thorac lumbar surgery [indecipherable] mo nths ago. " Again M.G.

4502complained of a level of pain at eight out of ten when using his

4516medications. Dr. Gillis noted her intent to refill the

4525medications and that there were no acute changes in M.G. ' s

4537condition. His "A/P" was listed as chronic back pain . A

4548prescription for the same medications, same doses, and same

4557amounts as the previous visit was issued.

456434. M.G. returned on March 12, 2009 , for a follow - up

4576visit. The chief complaint at that time was " patient has

4586difficulty [indecipherable]. " Under h istory of present illness,

4594Dr. Gillis wrote that M.G. has no history of pain prior to

4606surgery and that he gets no relief from valium or Soma. There

4618is no prescription for Soma in the records, so M.G. must have

4630been getting that drug from some other source . There is no

4642indication Dr. Gillis inquired as to where he got the

4652medication, whether he was on any other medications, or how

4662often he was taking the medication.

466835. Dr. Gillis again wrote that there were no acute

4678changes in M.G. ' s condition although he did not present with the

4691same chief complaint. The "A/P" appears to be chronic back

4701pain , although the writing is not clear. Prescriptions for

4710oxycodone and oxycontin were renewed as before, and a

4719prescription for A mbien was added. The valium prescript ion was

4730not refilled. No explanation for the change in the drug regimen

4741was provided by Dr. Gillis.

474636. On April 4, 2009, M.G. returned for another visit.

4756This time his chief complaint was that he ran out of medications

4768and had a seizure. There is no in dication that Dr. Gillis

4780inquired as to the type of seizure or whether M.G. had received

4792any treatment for it. There is no evidence as to when M.G. ran

4805out of his medications or how many pills he had taken since the

4818prior visit. M.G. still complained of pain at a level of eight

4830out of ten with his treatment. There is no indication of his

4842pain level after he ran out of his medications. The "A/P" was

4854listed as chronic back pain. The prescriptions written by

4863Dr. Gillis for this visit were the same as the previous visit.

487537. For his next visit, May 12, 2009, there is no chief

4887complaint listed on the patient chart. Dr. Gillis again wrote

4897that there was no acute change in the patient ' s condition, that

4910M.G. ' s pain level was 6.5 out of ten with his treatment, and

4924that the prescriptions should be refilled. The same oxycodone

4933and oxycontin prescriptions (240 and 120 tablets, respectively)

4941were written, along with the A mbien prescription.

494938. M.G. visited Dr. Gillis again on June 12, 2009. The

4960chief complaint fo r that visit was low back pain caused by

4972tripping over a toy car at his home. M.G. ' s pulse and weight

4986were measured , and there wa s a note on the chart that M.G. ha d

" 5001CBP " (which is presumably chronic back pain) and a toothache.

5011A notation at the bottom o f the chart sa id " 25$ , " but is not

5026explained. Dr. Gillis prescribed the same regimen of 240 pills

5036of oxycodone and 120 pills of oxycontin. In the current

5046medications section of the chart, Dr. Gillis wrote " Meds. " That

5056notation was not explained. As in each of the previous visits,

5067Dr. Gillis did not perform a urine screen to determine whether

5078M.G. had been taking the medications or not.

508639. M.G. came back to see Dr. Gillis on July 6, 2009. The

5099chart for that visit says the chief complaint by M.G. was a

5111surgical procedure called percantaneous distectomy and that M.G.

" 5119had care since the procedure. " There is also a note that

5130indicates " 5 procedures , " but the note is not explained. M.G.

5140reported his pain level as five out of ten , with medications ,

5151and ten out of ten , without. Dr. Gillis prescribed the same ,

5162oxycodone and oxycontin medications as in the previous visits.

5171There is no explanation as to why the medication levels were the

5183same , even though M.G. was reporting less pain than in prior

5194visits and had undergone surgery during the interim.

520240. M.G. ' s next visit to Dr. Gillis was on August 5, 2009.

5216His chief complaint on that day is essentially unreadable , and

5226Dr. Gerber could not decipher it at all. There is a mention of

5239Xanax in the chart, but its purpose is not explained. M.G. ' s

5252pain level is listed as six out of ten , with medications, ten

5264out of ten , without. That is close to the pain levels described

5276in the prior visit. However, without some sort o f physical or

5288functional exam or a psychologi cal assessment, it wa s impossible

5299to determine whether M.G. was functioning, no matter what his

5309pain level. Dr. Gillis refilled the oxycodone and oxycontin

5318prescriptions and added a prescription for ten tablets of

5327Percocet 1/650, a minimal and almost usel ess dose . The "A/P"

5339list ed chronic lower back pain and seizure activities, but there

5350wa s no discussion as to what seizures occurred or when.

536141. On September 9, 2009, M.G. presented with a complaint

5371of a stiff neck. The chart mention ed an MRI, but d id no t

5386explain or elaborate on it. The assessment of the patient wa s

5398listed as " Ch LBP " (presumably chronic lower back pain), but

5408there wa s no explanation of the relationship between the

5418assessment and the presenting problem. There wa s no

5427documentation of car e in treatment on the patient chart.

5437Dr. Gillis refilled the oxycodone and oxycontin and also added a

5448prescription for Mobic, an anti - inflammatory medication.

545642. M.G. came back to visit Dr. Gillis on October 7, 2009.

5468The chief complaint sa id M.G. ha d go od and bad days and that the

5484last surgery did not have good results. His pain level was down

5496to six out of ten , with medications , and ten out of ten ,

5508without. Chronic lower back pain continues to be the assessment

5518and treatment plan notation. Nonetheles s, he was prescribed the

5528exact same levels of oxycodone and oxycontin as all of the other

5540visits.

554143. On November 4, 2009, M.G. returned to see Dr. Gillis.

5552A different patient chart form was utilized by Dr. Gillis at

5563that visit. The form includes a quest ion, " Hello, how are you

5575doing? " to which M.G. responded, " Terrible. " M.G. said the

5584ongoing treatment was working , but that he wa s not sleeping

5595better. His pain level on that day was back up to seven out of

5609ten , with medications. In her notes, Dr. Gilli s said to " refill

5621with adjustment with valium. " There is no explanation as to why

5632valium would be added to M.G. ' s medication regimen.

564244. M.G. then visited Dr. Gillis on December 2, 2009. In

5653response to the question about how he wa s feeling, M.G. said he

5666was " planning for surgery; not doing good. " He said the

5676treatment was working and he was sleeping better. The

5685assessment update on the chart said chronic lower back pain with

5696exacerbations. The exacerbations were not explained. M.G. was

5704prescribed t he same medications as the previous visit.

571345. M.G. ' s thirteenth and last monthly visit to Dr. Gillis

5725occurred on December 20, 2009. When asked how he felt, M.G.

5736answered " Alright. " He said the treatment was working , but that

5746some of his medications had been stolen. He reported not having

5757oxycodone for nine days and oxycontin for seven days (or,

5767possibly, not having nine oxycodone tablets or seven oxycontin

5776tablets , the record is not clear.) He also said he had taken

5788his medications that very day, but t here wa s no indication in

5801the record as to which medications he was talking about. He

5812said his lower back pain was at a level of seven to eight on

5826that day. Dr. Gillis did not inquire about the inconsistent

5836statements and refilled his prescriptions anywa y.

584346. The patient records for M.G. do not discuss whether he

5854was paying for the cost of the prescriptions out - of - pocket or

5868whether insurance was covering some of the cost. The cost of

5879the medications would have been approximately $600.00 per month.

588847. I t is clear that M.G. presented as a complex patient

5900and was obviously receiving medical care elsewhere at the same

5910time he was being treated by Dr. Gillis. He was apparently

5921receiving medications from other sources at the same time

5930Dr. Gillis was treating him. Dr. Gillis was at least somewhat

5941aware of M.G. ' s other medical care, but she never did monitoring

5954or screening of M.G. that would have given her insight into how

5966her treatment plan was interacting with M.G. ' s other treatment.

5977And, once Dr. Gillis s aw that her treatment was not alleviating

5989M.G. ' s pain, she should have referred him to a b oard - certified

6004pain management specialist.

600748. Dr. Marc Gerber was accepted at final hearing as an

6018expert witness for the Department. Dr. Gerber is a b oard -

6030certifie d pain management specialist who currently treats

6038patients with pain management issues. Dr. Gerber ' s testimony

6048was clear, concise, and credible. He did not appear to have any

6060prejudice against Dr. Gillis as a person, but was very concerned

6071about how she was practicing medicine. His testimony forms the

6081basis for the following findings of fact.

608849. Relying upon the patient charts and patient

6096information sheets provided by Dr. Gillis, there does not appear

6106to have been a diagnosis of intractable pain for M. G.

6117Intractable pain is pain for which, in the generally accepted

6127course of medical practice, the cause cannot be removed and

6137otherwise treated. There does not appear to have been an

6147appropriate and complete physical examination of M.G. performed

6155by Dr. G illis.

615950. The oxycodone and oxycontin prescriptions for M.G.

6167over a 13 - month period are excessive. Despite her initial note

6179wherein she advised M.G. that his medication levels must be

6189decreased, Dr. Gillis continued the same regimen of oxycodone

6198and ox ycontin throughout M.G. ' s treatment. There is no

6209indication the medications were working, as M.G. continued to

6218complain about pain for the entire 13 months he was under

6229Dr. Gillis ' care. Other than adding other medications, Valium,

6239Mobic, Percocet, and A mbien for very brief periods, there was no

6251change to M.G. ' s prescription regimen. The patient charts for

6262the visits to Dr. Gillis do not contain any justification for

6273why the medications were prescribed in those quantities.

628151. The amount of oxycodone and oxycontin prescribed was,

6290in itself, excessive. According to the prescriptions, M.G. was

6299supposed to take one oxycontin every six hours. Oxycontin is a

6310time - release medication that should only be taken once every

632112 hours at most. M.G. was prescribed e ight tablets of 30 mg

6334oxycodone per day, i.e., one every four hours or two every eight

6346hours - - in addition to the oxycontin. The totality of those

6358medications could be lethal.

636252. There are no indications in the patient charts that

6372Dr. Gillis was taking vi tal signs and doing a physical

6383evaluation of M.G. at every visit. Nonetheless, she continued

6392to prescribe the high dosages of potentially lethal medications.

640153. Most importantly, Dr. Gillis never had a urine drug

6411screen done on M.G. Such a test would ha ve revealed whether

6423M.G. was actually taking the drugs he was prescribed. It would

6434have provided a determination of the level of drugs or other

6445substances in M.G. ' s body and then how the drugs were affecting

6458him. A urine drug screen done at the time of M .G. ' s earliest

6473visit would have established a baseline for measuring the

6482effectiveness and utility of future prescriptions. For a

6490patient such as M.G., with a history of surgeries, a need for

6502psychiatric evaluation, and a propensity to take large amounts

6511of drugs, a urine drug screen would have been an essential

6522element of the periodic review required for all such patients.

653254. Dr. Gillis erroneously stated that she had rejected

6541D.H. and R.S. as patients after their first and second visits,

6552respectively. The evidence shows that both " patients "

6559voluntarily stopped visiting the clinic after completing their

6567undercover work. Neither of the patients was told by Dr. Gillis

6578not to return (although D.H. was told not to come back without

6590bringing his medical reco rds).

659555. Dr. Gillis did not testify at final hearing and did

6606not provide any credible rebuttal to the facts asserted by the

6617Department ' s witnesses. Dr. Gillis did demonstrate an

6626understanding of the practice of medicine through her

6634questioning of the Dep artment ' s medical expert, but her

6645treatment of patients R.S., D.H. and M.G. was deficient. The

6655Department did not specifically allege, nor was there any

6664evidence to support that Dr. Gillis intentionally practiced

6672medicine in an inappropriate manner. Howe ver, her treatment of

6682the patients in question indicate s serious shortcomings in her

6692ability to effectively and appropriately manage pain for her

6701patients. Furthermore, Dr. Gillis represented herself at final

6709hearing and, without assistance of counsel, wa s not able to

6720effectively present a strong defense to the Department ' s

6730allegations. Although she was given ample opportunity to

6738testify concerning her care and treatment of the patients at

6748issue, she declined to do so. Although the Department ' s

6759perceptio n of Dr. Gillis ' treatment of D.H., R.S. and M.G. was

6772based on its expert ' s review of medical records only,

6783Dr. Gillis ' s refusal to testify left Dr. Gerber ' s perception as

6797the only reliable source of information.

6803CONCLUSIONS OF LAW

680656. The Division of A dministrative Hearings has

6814jurisdiction over the parties to and the subject matter of this

6825proceeding pursuant to s ections 120.57 and 120.569, Florida

6834Statutes (2011).

683657. The burden of proof in this case is on the Department

6848to prove, by clear and convin cing evidence, that sanctions or

6859discipline should be imposed on Dr. Gillis based on the facts

6870presented. Dep ' t of Banking & Fin. V. Osborne Stern & Co. , 670

6884So. 2d 932 (Fla. 1996).

688958. The Department has the right to impose discipline on

6899physicians lice nsed by the State of Florida. Grounds for

6909discipline are found in s ection 458.331. In the 2008 version of

6921Florida Statutes , which are relevant to this proceeding, the

6930following grounds for disciplinary actions are listed:

6937(q) Prescribing, dispensing, or

6941administering, mixing, or otherwise

6945preparing a legend drug, including any

6951controlled substance, other than in the

6957course of the physician ' s professional

6964practice. For the purposes of this

6970paragraph, it shall be legally presumed that

6977prescribing, dispe nsing, administering,

6981mixing, or otherwise preparing legend drugs,

6987including all controlled substances,

6991inappropriately or in excessive or

6996inappropriate quantities is not in the best

7003interest of the patient and is not in the

7012course of the physician ' s profe ssional

7020practice, without regard to his or her

7027intent.

7028* * *

7031(t) Notwithstanding s. 456.072(2) but as

7037specified in s. 456.50(2):

70411. Committing medical malpractice [which]

7046shall not be construed to require more than

7054one instance, event, or act.

70592. Committing gross medical malpractice.

70643. Committing repeated medical

7068malpractice as defined in s. 456.50. . .

7076Nothing in this paragraph shall be construed

7083to require that a physician be incompetent

7090to practice medicine in order to be

7097disciplin ed pursuant to this paragraph. A

7104recommended order by an administrative law

7110judge . . . finding a violation under this

7119paragraph shall specify whether the licensee

7125was found to have committed " gross medical

7132malpractice, " " repeated medical

7135malpractice, " or medical malpractice, " or

7140any combination thereof, and any publication

7146by the board must so specify.

7152* * *

7155(nn) Violating any provi sion of this

7162chapter or chapter 456, or any rules adopted

7170pursuant thereto.

717259. Section 458.326 states:

7176Intract able pain; authorized treatment. Ï -

7183(1) For the purposes of this section, the

7191term " intractable pain " means pain for

7197which, in the generally accepted course of

7204medical practice, the cause cannot be

7210removed and otherwise treated.

7214(2) Intractable pai n must be diagnosed by

7222a physician licensed under this chapter and

7229qualified by experience to render such

7235diagnosis.

7236(3) Notwithstanding any other provision

7241of law, a physician may prescribe or

7248administer any controlled substance under

7253Schedules II - V, as provided for in

7261s. 893.03, to a person for the treatment of

7270intractable pain, provided the physician

7275does so in accordance with that level of

7283care, skill, and treatment recognized by a

7290reasonably prudent physician under similar

7295conditions and circumstan ces.

7299(4) Nothing in this section shall be

7306construed to condone, authorize, or approve

7312mercy killing or euthanasia, and no

7318treatment authorized by this section may be

7325used for such purpose.

732960. Medical malpractice is defined as " the failure to

7338practic e medicine in accordance with the level of care, skill,

7349and treatment recognized in general law related to health care

7359licensure. . . . " § 456.50(1)(g) .

736661. The standards for the use of controlled substances for

7376the treatment of patients with intractable pain are set forth in

7387Florida Administrative Code Rule 64B8 - 9.013 (the " Rule " ). The

7398Rule also directs practicing physicians to the Physicians

7406Manual: An Informational Outline of the Controlled Substances

7414Act of 1970, published by the U.S. Drug Enforceme nt Agency, for

7426specific rules governing controlled substances , as well as

7434applicable state regulations.

743762. The Rule recognizes that controlled substances,

7444including opioid analgesics, may be essential to the treatment

7453of intractable pain. However, the Rule cautions physicians to

7462use such drugs only when relying upon current knowledge.

7471Further, physicians are cautioned to assess patients and adjust

7480dosages according to the intensity and duration of the pain.

749063. Evaluation of the patient is an essentia l standard set

7501forth in the Rule. It includes a complete medical history and

7512physical examination of the patient, including current and past

7521treatments, underlying or co - existing diseases or conditions,

7530and the effect of the pain on the patient ' s psycholo gical and

7544physical functioning. After evaluation, a treatment plan is the

7553next important standard to be met. The treatment plan should be

7564written with objectives that can be used to determine treatment

7574success and shall state whether other diagnostic eva luations or

7584treatments are planned.

758764. Under the standard for medical records in the Rule,

7597the physician is required to keep accurate and complete records

7607which must include at least the following:

76141. The complete medical history and a

7621physical exam ination, including history of

7627drug abuse or dependence, as appropriate;

76332. Diagnostic, therapeutic, and

7637laboratory results;

76393. Evaluations and consultations;

7643eatment objectives;

76455. Discussion of risks and benefits;

7651eatments;

76527. Medications (including date, type,

7657dosage, and quantity prescribed;

76618. Instructions and agreements;

76659. Drug testing results; and

767010. Periodic reviews. Records must

7675remain current, maintained in an accessible

7681manner, readily available fo r review, and

7688must be in full compliance.

769365. Chapter 456 addresses health professions, including

7700physicians. Section 456.072 sets forth the grounds for

7708discipline; section 456.073 outlines the process for

7715disciplinary proceedings.

771766. The Department has established by clear and convincing

7726evidence that Dr. Gillis failed to perform a complete physical

7736examination on R.S. and D.H. The controlled substances

7744prescribed to those two patients were , thus , inappropriate and

7753excessive. There is inadequate e vidence as to the nature of the

7765physical examination for M.G.

776967. The Department has established by clear and convincing

7778evidence that Dr. Gillis failed to diagnose M.G. with

7787intractable pain, but prescribed controlled substances in

7794excessive amounts wi thout proper monitoring, evaluation, or

7802assessments. The failure to order a urine drug screen for M.G.

7813despite prescribing voluminous quantities of opioid analgesics

7820violated the standard of care.

782568. Dr. Gillis violated the standard of care by not

7835docum enting or considering other treatment modalities for

7843patients R.S., D.H., and M.G. Further, Dr. Gillis ' s repeated

7854prescription of controlled substances to M.G. with differing

7862complaints and results was a violation of the standard of care.

787369. Despite not ing the need for psychological evaluation

7882for M.G., Dr. Gillis failed to confirm whether M.G. had received

7893such an evaluation , while continuing to prescribe large

7901quantities of a controlled substance to the patient.

790970. Dr. Gillis prescribed potentially l ethal doses of

7918oxycodone and oxycontin to M.G. without sufficient

7925justification. She also prescribed valium, Percocet and other

7933drugs without sufficiently documented bases.

793871. Dr. Gillis is guilty of committing medical malpractice

7947based on the finding s set forth herein.

795572. In DOAH Case No. 11 - 5692,as to Count One involving

7968patient, M.G., Dr. Gillis:

7972Ʊ Failed to diagnose M.G. with intractable pain prior

7981to prescribing controlled substances;

7985Ʊ Inappropriately and excessively prescribed

7990potentially lethal controlled substances;

7994Ʊ Excessively prescribed controlled substances; and

8000Ʊ Failed to order a u rine drug screen when necessary.

801173. As to Count Two involving M.G., Dr. Gillis:

8020Ʊ Failed to document justification for excessive

8027prescription of controlled substances; and

8032Ʊ Failed to document her rationale for failing to

8041order a urine drug screen.

804674. As to Count Three involving M.G., Dr. Gillis violated

8056the required standard of care by:

8062Ʊ Inappropriately and excessively prescribing

8067controlled substances without justification;

8071Ʊ Failing to confirm whether the patient presented to

8080a psychiatrist or psychologist;

8084Ʊ Failing to order a urine drug screen; and

8093Ʊ In appropriately and excessively prescribing

8099controlled substances prior to exploring other

8105modalities.

810675. As to Count Four involving M.G., Dr. Gillis:

8115Ʊ Inappropriately and excessively prescribed

8120controlled substances prior to exploring other

8126treatment modalities;

8128Ʊ Inappropriately and excessively prescribed

8133controlled substances without ordering a urine

8139screen; and

8141Ʊ Inappropriately and excessively prescribing

8146controlled substances w ithout justification.

815176. In DOAH Case No. 11 - 5961, as to Count One concerning

8164patient R.S., Dr. Gillis violated section 458.331(1)(nn):

8171Ʊ By failing to perform or document performing a

8180complete physical examination;

8183Ʊ Failing to explore or document ex ploring other

8192treatment modalities;

8194Ʊ Failing to obtain or document obtaining a complete

8203medical history;

8205Ʊ Failing to document the nature and intensity of

8214pain;

8215Ʊ Failing to document the current or past treatments;

8224Ʊ Failing to document information on the effect of

8233pain on the patient's physical or psychological

8240function;

8241Ʊ Failing to develop or document developing a

8249treatment plan; and

8252Ʊ Failing to determine or document determining if

8260there were any underlying or coexisting diseases or

8268conditions fo r the patient.

827377. As to Count Two for patient R.S., Dr. Gillis violated

8284sections 458.331(1)(nn) and 458.326 by:

8289Ʊ Failing to diagnose intractable pain;

8295Ʊ Prescribing Percocet without justification; and

8301Ʊ Prescribing Percocet without exploring other

8307t reatment modalities.

831078. As to Count Three for patient R.S., Dr. Gillis failed

8321to keep legible medical records justifying the course of

8330treatment by:

8332Ʊ Failing to document justification for prescribing

8339Percocet;

8340Ʊ Failing to document a complete physica l examination

8349prior to prescribing a controlled substance;

8355Ʊ Failing to document a complete medical history prior to

8365prescribing a controlled substance;

8369Ʊ Failing to document a urine screen; and

8377Ʊ Failing to diagnose intractable pain.

838379. As to Coun t Four for patient D.H., Dr. Gillis violated

8395sections 458.331(1)(nn) and 458.326 by:

8400Ʊ Failing to perform or document performing a

8408complete physical examination on either of his

8415visits;

8416Ʊ Failing to obtain or document obtaining a complete

8425medical history;

8427Ʊ Failing to explore or document exploring other

8435treatment modalities;

8437Ʊ Failing to document the intensity or nature of the

8447pain;

8448Ʊ Failing to document current or past treatments of

8457the pain;

8459Ʊ Failing to document information on the effect of

8468pain on the patient's physical or psychological

8475function;

8476Ʊ Failing to develop or document developing a

8484treatment plan; and

8487Ʊ Failing to determine if there were any underlying

8496or coexisting diseases or conditions.

850180. As to Count Six relating to patient D.H., Dr. Gillis

8512failed to keep legible medical records by:

8519Ʊ Failing to document justification for prescribing

8526120 tablets of 30mg oxycodone;

8531Ʊ Failing to document a complete physical examination

8539prior to prescribing a controlled substance;

8545Ʊ Failing to doc ument a complete medical history;

8554Ʊ Failing to document a urine drug screening; and

8563Ʊ Failing to document a diagnosis of intractable pain

8572prior to prescribing a controlled substance.

8578RECOMMENDATION

8579Based on the foregoing Findings of Fact and Conclusion s of

8590Law, it is

8593RECOMMENDED that a final order be entered by the Department

8603of Health suspending the license of Respondent , Jacinta Irene

8612Gillis, M.D., until such time as Dr. Gillis can demonstrate

8622competency in the practice of medicine, especially as it relates

8632to pain management, to the satisfaction of the Board of

8642Medicine.

8643It is further

8646RECOMMENDED that the final order assess the cost of

8655investigating and prosecuting this case and that payment of such

8665costs be a condition precedent to ending the s uspension of

8676Dr. Gillis ' s license to practice.

8683DONE AND ENT ERED this 3rd day of February , 2012 , in

8694Tallahassee, Leon County, Florida.

8698S

8699R. BRUCE MCKIBBEN

8702Administrative Law Judge

8705Division of Administrative Hearings

8709The D eSoto Building

87131230 Apalachee Parkway

8716Tallahassee, Florida 32399 - 3060

8721(850) 488 - 9675

8725Fax Filing (850) 921 - 6847

8731www.doah.state.fl.us

8732Filed with the Clerk of the

8738Division of Administrative Hearings

8742this 3rd day of February , 2012 .

8749ENDNOTES

87501 / All statut ory references are to Florida Statutes (20 08 ),

8763unless otherwise noted.

87662 / Norris did not testify at the final hearing. He is currently

8779incarcerated in the Pinellas County Jail following his arrest

8788for armed robbery of a pharmacy.

87943 / Negersmith was car rying a firearm because he had been advised

8807that Norris sometimes robbed patients after they picked up their

8817prescription from the pharmacy.

88214 / D.H. observed Norris selling the pills on the street in a

8834drug deal.

8836COPIES FURNISHED :

8839Joy Tootle, Executive Director

8843Board of Medicine

8846Department of Health

88494052 Bald Cypress Way

8853Tallahassee, Florida 32399

8856Nicholas Romanello, General Counsel

8860Department of Health

88634052 Bald Cypress Way, Bin A02

8869Tallahassee, Florida 32399 - 1701

8874Robert J. Bobek, Esquire

8878Shirley L. Bates, Esquire

8882Department of Health

8885Prosecution Services Unit

88884052 Bald Cypress Way, Bin C65

8894Tallahassee, Florida 32399 - 3265

8899Jacinta Irene Gillis , M.D.

890312446 Pebble Stone Court

8907Fort Myers, Florida 33913

8911NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

8917All parti es have the right to submit written exceptions within

892815 days from the date of this Recommended Order. Any exceptions

8939to this Recommended Order should be filed with the agency that

8950will issue the Final Order in this case.

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Date
Proceedings
PDF:
Date: 04/24/2012
Proceedings: (Agency) Final Order filed.
PDF:
Date: 04/23/2012
Proceedings: Agency Final Order
PDF:
Date: 02/03/2012
Proceedings: Recommended Order
PDF:
Date: 02/03/2012
Proceedings: Recommended Order (hearing held December 5-6, 2011). CASE CLOSED.
PDF:
Date: 02/03/2012
Proceedings: Recommended Order cover letter identifying the hearing record referred to the Agency.
PDF:
Date: 02/01/2012
Proceedings: Response to Department of Health's Post Recommendation Order Statement of Facts filed.
PDF:
Date: 01/19/2012
Proceedings: Petitioner's Proposed Recommended Order filed.
Date: 01/09/2012
Proceedings: Transcript of Proceedings Volume I-III (not available for viewing) filed.
PDF:
Date: 01/03/2012
Proceedings: (Respondent's) Post Order Recommendation filed.
Date: 12/15/2011
Proceedings: Undeliverable envelope returned from the Post Office.
Date: 12/08/2011
Proceedings: Respondent's Proposed Exhibits (exhibits not available for viewing)
Date: 12/05/2011
Proceedings: CASE STATUS: Hearing Held.
PDF:
Date: 12/01/2011
Proceedings: Notice of Transfer.
PDF:
Date: 11/29/2011
Proceedings: Joint Pre-hearing Stipulation filed.
PDF:
Date: 11/28/2011
Proceedings: Petitioner's Separate Pre-hearing Statement (filed in Case No. 11-005692PL).
PDF:
Date: 11/22/2011
Proceedings: Amended Notice of Hearing (hearing set for December 5 and 6, 2011; 9:00 a.m.; Fort Myers, FL; amended as to hearing location).
PDF:
Date: 11/21/2011
Proceedings: Order Re-scheduling Hearing (hearing set for December 5 and 6, 2011; 9:00 a.m.; Fort Myers, FL).
PDF:
Date: 11/21/2011
Proceedings: Notice of Ex-parte Communication.
PDF:
Date: 11/17/2011
Proceedings: Petitioner's Motion to Re-schedule Final Hearing (filed in Case No. 11-005692PL).
PDF:
Date: 11/16/2011
Proceedings: Letter to Judge Kirkland from J. Gillis regarding an objection filed.
PDF:
Date: 11/15/2011
Proceedings: Notice of Ex-parte Communication.
PDF:
Date: 11/15/2011
Proceedings: Order of Pre-hearing Instructions.
PDF:
Date: 11/15/2011
Proceedings: Notice of Hearing (hearing set for December 29 and 30, 2011; 9:00 a.m.; Fort Myers, FL).
PDF:
Date: 11/10/2011
Proceedings: Response to Administrative Complaints and Supportive Materials filed.
PDF:
Date: 11/07/2011
Proceedings: Joint Response to Order Re-opening and Consolidating Cases filed.
PDF:
Date: 11/07/2011
Proceedings: Joint Response to Order Re-opening and Consolidating Cases filed.
PDF:
Date: 11/07/2011
Proceedings: Amended Administrative Complaint (filed in Case No. 11-005692PL).
PDF:
Date: 11/07/2011
Proceedings: Amended Administrative Complaint filed.
PDF:
Date: 11/03/2011
Proceedings: Order Re-opening and Consolidating Cases (DOAH Case Nos. 11-5691PL, 11-5692PL).
PDF:
Date: 11/03/2011
Proceedings: Motion to Re-open DOAH Case filed. (FORMERLY DOAH CASE NO. 11-4062PL)
PDF:
Date: 10/04/2011
Proceedings: Order Relinquishing Jurisdiction and Closing Files.
PDF:
Date: 09/27/2011
Proceedings: Motion for Denial of Postponement filed.
PDF:
Date: 09/27/2011
Proceedings: Motion to Relinquish Jurisdiction filed.
PDF:
Date: 09/08/2011
Proceedings: Notice of Taking Deposition Duces Tecum in Lieu of Live Testimony (Detective R. Osterland) filed.
PDF:
Date: 09/08/2011
Proceedings: Notice of Taking Deposition Duces Tecum in Lieu of Live Testimony (Special Agent J. Beuth) filed.
PDF:
Date: 09/08/2011
Proceedings: Amended Notice of Taking Duces Tecum (as to location only) filed.
PDF:
Date: 08/31/2011
Proceedings: Subpoena Duces Tecum (J. Gillis, M.D.) filed.
PDF:
Date: 08/24/2011
Proceedings: Notice of Serving Petitioner's First Request for Production, First Request for Interrogatories, and First Request for Admissions to Respondent filed.
PDF:
Date: 08/22/2011
Proceedings: Order of Consolidation (DOAH Case Nos. 11-4058PL and 11-4062PL).
PDF:
Date: 08/22/2011
Proceedings: Order of Pre-hearing Instructions.
PDF:
Date: 08/22/2011
Proceedings: Notice of Hearing (hearing set for October 17 through 19, 2011; 9:00 a.m.; Fort Myers, FL).
PDF:
Date: 08/18/2011
Proceedings: Joint Response to Initial Order filed.
PDF:
Date: 08/12/2011
Proceedings: Notice of Appearance as Co-counsel (filed by S. Bates).
PDF:
Date: 08/12/2011
Proceedings: Notice of Appearance (filed by R. Bobek).
PDF:
Date: 08/11/2011
Proceedings: Election of Rights filed.
PDF:
Date: 08/11/2011
Proceedings: Administrative Complaint filed.
PDF:
Date: 08/11/2011
Proceedings: Agency referral filed.

Case Information

Judge:
R. BRUCE MCKIBBEN
Date Filed:
11/03/2011
Date Assignment:
12/01/2011
Last Docket Entry:
04/24/2012
Location:
Fort Myers, Florida
District:
Middle
Agency:
ADOPTED IN TOTO
Suffix:
PL
 

Counsels

Related DOAH Cases(s) (6):

Related Florida Statute(s) (15):

Related Florida Rule(s) (3):