82-000799 Board Of Medical Examiners vs. Teotimo D. Bonzon Status: Closed Recommended Order on Friday, November 18, 1983.

Summary: Respondent prescribed controlled substances other than in the course of his practice.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

STATE OF FLORIDA, DEPARTMENT OF )

PROFESSIONAL REGULATION (BOARD )

OF MEDICAL EXAMINERS), )

)

Petitioner, )

)

vs. ) CASE NO. 82-799

)

TEOTIMO D. BONZON, M.D., )

)

Respondent. )

_________________________________)

RECOMMENDED ORDER

Pursuant to notice, a formal hearing was held before Charles C. Adams,

Hearing Officer with the Division of Administrative Hearings. This hearing was

conducted on August 9 and 10, 1983, in Jacksonville, Florida.

APPEARANCES

For Petitioner: Henry M. Coxe, III, Esquire

204 Washington Street

Jacksonville, Florida 32302

For Respondent: J. Clark Hamilton, Jr., Esquire

801 Blackstone Building

233 East Bay Street

Jacksonville, Florida 32202

ISSUES

The matters presented for consideration in this case concern an

administrative complaint brought by the Petitioner against the Respondent. That

complaint alleges violations of various provisions of Chapter 458, Florida

Statutes. Those sections of law are more particularly described in the

conclusions of law in this Recommended Order. In summary, Respondent is

alleged, in the course of his relationship with patients under his care, to have

prescribed numerous controlled substances which were in excessive amounts, and

were not appropriate prescriptions for the medical problems experienced by the

patients, and were not prescribed in the course of the Respondent's professional

practice. In the face of these circumstances, Respondent is accused of having

committed gross or repeated malpractice in failing to recognized by reasonably

prudent similar physicians in his community. Respondent is also accused of

having failed to keep written medical records justifying the course of

treatment.

FINDINGS OF FACT

1. Teotimo D. Bonzon, M.D., is a physician licensed to practice medicine

in Florida through licensure by the State of Florida, Department of Professional

Regulation, Board of Medical Examiners, license No. MF0016786. He has held this

license at all times relevant to this inquiry and during this period has

practiced medicine at 830 Gary Street, Jacksonville, Florida, and 6229 Merrill

Road, Jacksonville, Florida. At present, Respondent does general surgery

approximately three times a week and sees 30-35 patients a day in his general

office practice.

2. Dr. Bonzon is a graduate of the medical school, Far Eastern University,

Manila, the Philippines. The date of his graduation was 1961. In 1962, he took

his internship at St. Francis Hospital in Jersey City, New Jersey. There

followed five years of general surgery training at Booth Medical Center in

Flushing, New York, and York Hospital in York, Pennsylvania. Respondent then

took a year of surgical fellowship at the Community General Hospital of

Syracuse, New York. Following this practice, Respondent stood examination for

medical license to practice in the State of Florida, and in the States of

Pennsylvania and Indiana. Having passed those examinations, the decision was

made to move to Florida. Respondent arrived in Florida in June of 1971 and has

been involved in the practice of general surgery and general office practice

since that time. The initial two years in practice in Florida were primarily

concerned with general surgery and industrial medicine, which relates to

provision of care for those persons who have been injured in industrial

accidents.

3. The administrative complaint, which is the subject of this controversy,

dates from March 10, 1982, and is the result of a survey made by the State of

Florida, Department of number of Schedule II controlled substances per Chapter

893, Florida Statutes, which had been prescribed by physicians who practice in

the Jacksonville, Florida, area. This survey transpired over a period of

approximately six months, beginning in the fall of 1981. After being properly

served with the administrative complaint, Respondent made a timely request for a

formal hearing pursuant to Subsection 120.57(1), Florida Statutes.

ARTHUR LEE SCHEIDER

(Counts I, II, IV, V)

4. Dr. Bonzon first saw Arthur Scheider in his office on May 29, 1979. At

that time, the chief complaints of the patient had to do with "nerves, that the

patient could not sleep, that he itched and broke out in a rash." These matters

are reflected on the copy of the patient's records, which are admitted as

Petitioner's Exhibit C. Additionally, it was noted that the patient had been

utilizing methaqualone or Quaaludes for one year prior to being seen by Dr.

Bonzon. Scheider had also been receiving Valium in 10 milligram amounts. On

this date, Dr. Bonzon prescribed 100, 300-milligram Quaaludes to assist the

patient in sleeping and 100, 10-milligram Valium tablets related to the nervous

problem being experienced by the patient. Both of these drugs are Schedule II

controlled substances with a potential for abuse by those persons for whom the

prescription has been given. Methaqualone is a sleep producer. Valium is a

muscle relaxer.

5. Scheider was again seen on August 20, 1979, still complaining of

nervousness and problems with sleep together with a rash condition on his torso

and extremities. At that time, a further prescription of Quaaludes in the

amount of 100 at 300-milligram each and Valium in the amount of 100 at 10-

milligram each were prescribed for the patient with the opportunity for one

refill related to the Valium.

6. On November 1, 1979, the patient returned and based upon a diagnostic

note in the patient's records to the effect that the patient needed nerve

medicine, a further prescription Valium with opportunity for one refill was

prescribed. These prescriptions were given on November 1, 1979, before the

amounts related to the August 20, 1979, prescription for Quaaludes and Valium

had been exhausted. This is based upon Dr. Bonzon's appropriate recommendation

that no more than one Valium and one Quaalude tablet be taken per day.

7. On January 7, 1980, a brother of the patient Scheider asked for

Quaalude medication and was denied. The request for medication is reflected in

the aforementioned exhibit related to patient records of Scheider.

8. Scheider was again seen on March 14, 1980, complaining of laryngitis,

cough, and of a fever in the range of 100 degrees. On that date, in addition to

other medication, 100, 300-milligram Quaaludes and 100, 10-milligram Valium were

prescribed for the patient. No explanation is made as to why Quaaludes and

Valium were prescribed.

9. On May 19, 1980, the patient record reflects that 50, 10-milligram

Valium were prescribed for the patient Scheider; no indication is made as to the

reason for this prescription. The Valium prescription was given at a time prior

to the exhaustion of the March 14, 1980, prescription for Valium based upon a

utilization rate of one Valium tablet per day.

10. On June 11, 1980, a sister of Arthur Lee Scheider's called and spoke

to the Respondent and told the Respondent that Arthur Lee Scheider had been

selling Valium to Scheider's mother. As a consequence, Dr. Bonzon noted in the

patient record that he would not prescribe Valium for Scheider in the future and

in fact abided by this choice. Respondent did prescribe 100, 300-milligram

strength methaqualone tablets on this date.

11. On September 12, 1980, Scheider was again seen by the Respondent

reference an examination which led to the conclusion that the patient needed an

operation related to a circumcision. At that time, 100 additional 300-milligram

Quaaludes were prescribed for the patient. Prescribed methaqualone or Quaaludes

for the patient Scheider, it was always on the basis that Dr. Bonzon felt that

the patient needed assistance in sleeping. Although not reflected in the

medical record, Bonzon had suggested to Scheider that he see a psychiatrist in

trying to combat his problem with sleep; however, Scheider declined this

suggestion and the Respondent continued to prescribe methaqualone or Quaaludes.

These prescriptions of 100 were made, notwithstanding the fact that the

Physicians' Desk Reference indicated that methaqualone or Quaaludes should be

prescribed in "small quantities." Respondent believes that this suggestion is a

relative matter and really intends that the patients not be allowed to take more

than one methaqualone tablet per day, an erroneous assumption.

12. Respondent learned of Scheider's trafficking in the controlled

substance, methaqualone, on November 25, 1980, and made a note in the patient's

file that the patient had been arrested for this activity and that no more

medication should be prescribed for this patient for drugs which were under

"narcotic control." It was also indicated that appointments for this patient

should pertain to other medical problems unrelated to controlled substances.

13. Dr. Ensor R. Dunsford practices medicine in Jacksonville, Florida. He

has, during his career, practiced in general surgery and is board certified in

that field. His present practice involves emergency treatment in a freestanding

emergency care facility. Upon examination of the patient records related to

Arthur Lee Scheider, involving the prescription of methaqualone and Valium over

the period May 19, 1979, through September 12, 1980, Dr. Dunsford was of the

opinion that the act of prescribing was "grossly overdone." Further, Dr.

Dunsford felt that this amount prescribed was risky for a patient because of the

potential for abuse. If the patient has an emotional need for the substance,

then the risk is there that a physical need might be created. In summary, Dr.

Dunsford felt that the number of Valium and methaqualone tablets which were in

the best interest of the patient. Moreover, Dr. Dunsford felt that the amounts

of methaqualone and Valium which Respondent prescribed for Scheider over the

period of time were not acts of a "reasonably prudent physician" related to

practicing medicine with a level of care, skill and treatment performed by a

similar physician in the community. Dr. Dunsford also expressed the opinion

that the decision to prescribe the additional methaqualone or Quaaludes on June

11, 1980, and September 12, 1980, after receiving information that the patient

was selling a controlled substance (the information of June 11, 1980, from

patient's sister related to Valium) was inappropriate and a reflection of

substandard medical judgment. To Dr. Dunsford, the information that was given

by the sister of patient Scheider was a "red flag" waving in the face of the

practitioner, Dr. Bonzon. Dr. Dunsford also states that the September 12, 1980,

medical record does not establish a basis for prescribing Quaaludes related to

symptomology of the patient. The record makes no reference to the problem with

sleeping and pertains only to scrotal erythema, parietitis and the need for

circumcision. Finally, given the facts of the prescriptions from May 29, 1979,

through September 12, 1980, with emphasis on the information related to

suspected drug sales which was imparted on June 11, 1980, Dr. Dunsford feels

that a reasonably prudent physician would not want to be involved with that type

of situation, i.e. prescribing the drugs on June 11, 1980, and September 12,

1980. All opinions, as expressed by Dr. Dunsford found above are accepted.

14. Dr. Apolinar C. Ilano gave testimony. Dr. Ilano practices in

Jacksonville, Florida, as a general surgeon. Dr. Ilano agrees with Dr. Dunsford

that methaqualone has a potential for abuse. Following review of the patient

records of Arthur Lee Scheider, Dr. Ilano's opinion was that some record had

been made which justified the prescription of methaqualone for the sleep problem

of Scheider and Valium related to the nervous problem of that patient. The

justification found by Dr. Ilano does not satifactorily explain the lack of

explanation for prescribing methaqualone on September 12, 1980, as referred to

by Dr. Dunsford. Dr. Ilano did not feel that the amounts of methaqualone and

Valium that were prescribed to Scheider were excessive or inappropriate or

contrary to good judgment by reasonably prudent similar physicians in that there

was some justification for prescribing the medication to be found in the record;

no indication in the record that the patient was abusing Valium, as opposed to

sticking to the amount or dosage prescribed, and the rationalization that Dr.

Bonzon was attempting to limit the number of office visits by prescribing the

high amounts of methaqualone and Valium. The opinion expressed in the prior

sentence is not compelling in the face of facts presented and the more

acceptable explanation offered by Dr. Dunsford. Even Dr. Ilano was concerned

about prescribing methaqualone after learning that the patient was possibly

selling Valium, although his opinion did not reach the level of finding fault

with the quality of care offered by Dr. Bonzon in prescribing methaqualone after

being informed of the possible sale of Valium, as Dr. Dunsford had. Again, Dr.

Dunsford's opinion is accepted on this topic. Dr. Ilano correctly states that

if the patient is selling Valium he might in turn sell methaqualone.

15. Dr. Osbey L. Sayler gave testimony related to the care and treatment

of Arthur Lee Scheider. Dr. Sayler practices in Orange Park, Florida, and is a

board-certified general surgeon. The sum and substance of Dr. Saylor's opinion

of Dr. Bonzon's care and treatment of Arthur Lee Scheider was to the effect that

Dr. Bonzon had done nothing inappropriate as alleged in the various counts

pertaining to that patient. After considering this opinion testimony and that

of the other physicians, Dr. Saylor's opinions are accepted to the extent that

they describe methaqualone as being an addictive or habit-forming drug which has

been resorted to by persons attempting suicide and which is sold on the street

as a "downer" and his opinion that Valium has a potential for abuse and can be

addictive. Otherwise Dr. Sayler's opinions are rejected.

GLADYS KNIGHT

(Counts VI, XII, and XIII)

16. Respondent treated the patient Gladys Knight over a period of years.

During that time, the patient was seen on April 28, 1981, and was prescribed 30,

10-milligram Ritalin tablets. Ritalin is a Schedule II controlled substance. A

notation of the prescription may be found in Petitioner's Exhibit D admitted

into evidence, a copy of the patient records kept by the Respondent related to

Gladys Knight. As established through the testimony of Dr. Dunsford, no

indication is made in those records of an acceptable reason for prescribing

Ritalin which is in the category of amphetamine or sympathomimetic amine drugs,

spoke to in Section 458.331(1)(cc) , Florida Statutes. The underlying

diagnostic impression upon the April 28, 1981, visit, according to the patient

records related to complaints of the inability to get out of bed because of

fatigue and insomnia. Remarks are also made in that entry that the patient is

without energy and is complaining of arthritis pain in her right shoulder. None

of these matters comport with a justifiable basis for prescribing ritalin as

allowed in Section 458.331(1)(cc), Florida Statutes.

17. In discussing the prescription of Ritalin, Dr. Bonzon indicated in the

course of the hearing that he recognized Ritalin to be a central nervous system

stimulant, which it is, and that he prescribed it for Mrs. Knight on April 28,

1981, because of his perception of signs of depression in that patient. More

particularly, Dr. Bonzon indicated that she had claimed she didn't have energy,

didn't want to get out of bed and was recalling a time when her husband was

still alive. As a consequence, Bonzon felt that on this one occasion, in his

medical judgment, Knight would benefit from a short term use of Ritalin. This

was the only prescription of that substance for the patient. No mention was

made in the patient record of the depressed condition; however, this impression

which was given of the patient's condition in the course of the hearing is not

sufficient justification for the prescription of Ritalin, "depressed state" not

being one of the accepted bases for prescribing Ritalin as related in Section

458.331(1)(cc), Florida Statutes.

18. Respondent also prescribed Preludin to the patient, Gladys Knight,

commencing February 22, 1979. Preludin is a Schedule II controlled substance.

This drug was prescribed for purposes of weight control. On the initial date,

the patient was provided with 30 tablets with the opportunity for three refills.

At that time, the patient weighed 148 pounds. The patient was seen again on

August 14, 1979, for weight control and 50 Preludin tables were prescribed with

the opportunity for one refill. This visit was made with a Dr. Lagman. At that

time, the patient weighed 145 pounds. On September 27, 1979, the patient was

seen by the Respondent and was given a further prescription of Preludin to

control her weight. She weighed 143 pounds upon that visit. On December 3,

1979, the Respondent saw the patient again and prescribed Preludin in the amount

of 100 tablets for weight control. At that time, the patient weighed 146

pounds. Finally, the patient was seen by the Respondent on February 14, 1980,

her weight was shown to be 143 pounds and she was given a further prescription

of Preludin in the amount of 100 tablets. This was on prescription by

Respondent. Knight had been instructed by the Respondent on the occasion of

prescribing Preludin on the question of how to utilize the Preludin tablets. At

the time Respondent prescribed Preludin for patient Knight, he was unaware that

the drug was an amphetamine or sympathomimetic amine drug. Respondent also

discovered that Preludin prescriptions could not be refilled when a pharmacist

contacted him in August of 1979 reference an effort by Knight to refill a

prescription.

19. Dr. Dunsford had reviewed the patient records related to Gladys

Knight, particularly as it related to the prescription of Preludin. He

identified that Preludin has been prescribed to assist obese people in weight

control through the devise of suppressing the appetite of those patients.

Because of a potential for abuse, Preludin is only prescribed for utilization

over a period approximating a few weeks, per Dr. Dunsford. His testimony about

Preludin, related to utilization, appropriate limits of its use, and potential

for abuse is accepted.

20. Dr. Dunsford felt that the Preludin had been over prescribed in the

sense of amounts being too large on each prescription and over too long a period

of time. Dr. Dunsford placed particular emphasis on the lack of wisdom in

prescribing 100 tablets of Preludin on one occasion and felt that would be

excessive and inappropriate. These opinions are accepted. Moreover, the

opinion by Dr. Dunsford that the pattern of prescribing Preludin for Knight were

not the actions of a reasonably prudent physician, under similar conditions and

circumstances, is found to be correct.

21. Dr. Ilano did not feel that the amount of Preludin was excessive nor

did he feel that the actions of the Respondent constituted a failure to practice

medicine with the care and skill that a reasonably prudent physician, under

similar conditions and circumstances, would pursue. Dr. Ilano's opinion is not

accepted. Nor is the opinion of Dr. Saylor related to the treatment of Mrs.

Knight utilizing Preludin found to be compelling when he speaks favorably to

treatment choices by the Respondent.

JOHN BROUGHTON

(Counts VIII, IX, X and XI)

22. John Broughton was a patient of the Respondent in the time period

August 13, 1979, through February 16, 1981. Records related to the treatment of

Broughton are found as part of the Petitioner's Exhibit E admitted into

evidence. During the treatment of Broughton, beginning on August 13, 1979, 40

Preludin, 75-milligram tablets were provided for weight control. Preludin, 75-

milligrams was again prescribed for control on September 21, 1979, following

examination by Respondent. On October 31, 1979, Dr. Bonzon saw Broughton and

prescribed Preludin 75-milligram in the amount of 60 tablets related to weight

control. On December 31, 1979, an additional 80 tablets of 75-milligrams

Preludin was prescribed by Respondent for the benefit of Broughton. On March

13, 1980, 100, 75-milligram preludin tablets were given to Broughton on

prescription issued by Respondent. On June 4, 1980, 50, 75-milligram Preludin

tablets were prescribed by Respondent for Broughton. Respondent denied

Broughton a request for Preludin upon an office visit on July 28, 1980, to see

how the patient would react without the drug. On November 3, 1980, Preludin,

75-milligrams in the amount of 40 tablets was prescribed by Respondent for

Broughton for weight control and a notation made that no further prescription

would be written unless 40 days had transpired. On December 11, 1980, without

examining the patient, Preludin was prescribed for an unidentified condition.

The strength of the Preludin was 75-milligrams and 50 tablets were authorized by

the prescription issued by Respondent for the benefit of Broughton. Other

evidence in the hearing demonstrates that this Preludin was prescribed for

weight control on that visit.

23. During the course of the treatment, Broughton lost approximately 20

pounds in weight. In the interval of treatment, Broughton had requested

Respondent to prescribe additional Preludin tablets and had been advised by

Respondent that they would not be forthcoming based upon the fact that

sufficient time had not transpired to have utilized one tablet per day on the

previous prescription. In addition, the Preludin was not prescribed for

Broughton if his blood pressure was too high upon examination by Dr. Bonzon. At

the time Dr. Bonzon prescribed Preludin in November and December, 1980, as

identified before, he was unaware that Preludin, an amphetamine or

simpathomimetic amine drug, could not be prescribed for weight control after

July 3, 1980. 1/

24. On August 13, 1979, Talwin was prescribed for Broughton by the

Respondent upon an office visit. The explanation for this prescription says for

"hip." In particular, it related to the provision of pain medication. Talwin,

as with the case of Preludin, is a Chapter 893, Florida Statutes, controlled

substance with addictive qualities. Talwin is, in effect, a pain medication.

On September 21, 1979, a further prescription of Talwin was prescribed by

Respondent for Broughton upon an office visit. This Talwin in 15-milligram

strength, 40 tablets with opportunity for a single refill. No indication was

made in the record as to the basis for prescribing this pain medication.

Between August 13, 1979, and September 21, 1979, there is a notation in the

patient records effective August 28, 1979, of a refill of Talwin in 50-milligram

strength, 30 tablets and a further indication of Talwin being prescribed, 50-

milligram strength, 30 tablets on September 13, 1979. On November 8, 1979, the

patient record shows a refill of Talwin in the amount of 50 tablets. On

November 16, 1979, the file establishes that the patient said he had been caught

in the rain and his bottle got wet and that the Talwin turned to mush and a

prescription was written in the amount of 50 Talwins to replenish Broughton.

Broughton verified this story in the course of his testimony at hearing. The

pills had not been destroyed but the Respondent did not know this at the time

the prescription was written on November 16, 1979. The records reflect a

notation on that date that no refills of Talwin should be given until November

28, 1979. On December 31, 1979, the patient was seen by Respondent for a

problem he was experiencing with a hernia condition and a cough, congestion, and

headaches. On that date, Talwin in, the 50-milligram strength, 50 tablets was

prescribed. On the dates January 22, 1980; February 10, 1980; and February 28,

1980, patient records show prescription of Talwin in the 50-milligram strength,

50 tablets on each of those dates. The patient was seen by Dr. Bonzon on March

30, 1980, complaining of the hernia condition and a prescription was written for

50 Talwin, 50-milligram tablets. On June 4, 1980, the Respondent saw Broughton

and prescribed 50 Talwin in 50-milligram strength. On July 28, 1980, Respondent

saw Broughton and discussion was made of establishing surgery for hernia repair.

Talwin was prescribed in a 50-milligram strength, 50 tablets with an indication

of no refill, as established in the patient records. On August 25, 1980, an

indication is made in the patient records that Talwin, 50-milligram strength in

the amount of 40 tablets was prescribed for the patient. On October 10, 1980,

patient records show that Talwin was refilled. On November 10, 1980, patient

records reflect that a Pic N Save Drug Store had received a request for refill

of Talwin in the amount of 40 tablets and this request was denied by the

doctor's office based upon the fact that a refill had just been given on

November 3, 1980. On November 20, 1980, the records reflect that the Pic N Save

at Sandlewood was given a prescription of Talwin, 50-milligram strength in the

amount of 40 tablets for benefit of Broughton. On December 8, 1980, the patient

was seen by Respondent. It was noted in the record that Talwin in the strength

of 50-milligrams, 20 tablets had been prescribed two days before. Other

evidence does not clarify whether that prescription was indeed written. On

December 19, 1980, the patient records reflect that Talwin in the strength of

50-milligrams, 50 tablets was prescribed. On January 9, 1981, the records

reflect Talwin, 50-milligram strength, 40 tablets was prescribed. On January 19,

1981, the record reflects Talwin, 50-milligram strength, 40 tablets was

prescribed. On February 2, 1981, a notation is given that the patient has

injured his leg and had received a night appointment and has reported using all

the Talwin due to intense pain. Further indication is that Talwin in the amount

of 50-milligram strength, 10 tablets was prescribed. A second entry related to

February 2, 1981, is made having to do with a visit in which Respondent examined

Broughton. He found the leg on the right calf highly inflamed and two large

hemotomas and that the patient was experiencing pain and for this condition,

Talwin in the amount of 50-milligram strength, 50 tablets was prescribed. On

February 11, 1981, a final notation indicates a refill of Talwin and the

establishment of an appointment for the following day. That appointment was not

kept. On February 16, 1981, the Talwin was ordered refilled. A notation was

made at that time that the patient had not been keeping his appointments because

of money owed and an expression of the importance to come in even if he could

only pay a portion of the bill and a notation that the patient was using too

much Talwin. All record notations are accepted as accurate depictions of events

reported.

25. Eventually, Broughton was picked up for criminal offenses related to

controlled substances and was imprisoned. Unknown to Respondent, Broughton had

given Talwin and Preludin which had been prescribed for him through Respondent

to other persons. Following his release from incarceration, Respondent has

refused to see Broughton.

26. Although the records do not reflect the specific basis for prescribing

Talwin in the questioned period, August 13, 1979, through February 16, 1981,

other than the occasions of the hip and leg injury to his calf, it has been

extrinsically established that Talwin was prescribed for pain related to a

hernia condition, at times beginning December 31, 1979, and forward. There is

other indication that the patient Broughton had sustained an injury to his

coccyx and had some sacro coccygeal pain; however, it is unclear whether the

Talwin was prescribed for that condition in the questioned period. Moreover, by

May 20, 1980, Dr. Bonzon is expressing the opinion that physical examination of

Broughton was negative regarding sacro coccygeal pain. The patient's records do

indicate on March 11, 1977, complaints of Broughton with his tail bone or coccyx

because of a fall in a Pantry Pride store in San Diego, California.

27. On the subject of Broughton's involvement with drugs, in an interview

held in November 1981, Respondent told John E. Danson, an investigator with the

Department of Professional Regulation, that he thought Broughton was a drug

addict because on one occasion, Broughton had offered him $50 to prescribe

Dilaudid, a Schedule II controlled substance, at which time Broughton had been

asked to leave Bonzon's office.

28. Dr. Dunsford examined the records of treatment received by Broughton

found in Petitioner's Exhibit E and gave the opinion that the amounts of

Preludin and Talwin prescribed to Broughton in the time frame described were

excessive and inappropriate. The prescription of those drugs over this period

of time was not in the best interests of the patient according to Dr. Dunsford

and not the actions of a reasonably prudent similar physician dealing with a

patient under similar circumstances and conditions, on the subject of the skill

and treatment afforded to this patient. As described by Dr. Dunsford, both

Talwin and Preludin have addictive qualities. Dr. Dunsford did not feel that

the pain the patient Broughton had experienced was sufficiently severe to

warrant the number of Talwin tablets received. Continued response to the

patient's request for more Talwin was in the words of Dr. Dunsford "bad." Dr.

Dunsford also observed that the prescription of Preludin in November and

December 1980, was not based upon any of the health conditions described in

Section 458.331(1)(cc), Florida Statutes. The overall records of Dr. Bonzon

related to the prescriptions of Talwin and Preludin, with particular emphasis on

the December 11, 1980, prescription were deficient as it relates to a

justification of continuing the regimen of prescribing these substances,

according to Dr. Dunsford. The observations and opinions of Dr. Dunsford found

in this paragraph are accepted.

29. Dr. Ilano examined the records related to Broughton and did not find

that Respondent's treatment was unacceptable. Likewise, Dr. Saylor did not find

the treatment of Broughton to be unacceptable. The opinions by these doctors

are not accepted.

COUNTS XIV and XV

30. Between July 1, 1980, and December 31, 1980, Respondent prescribed

approximately 15,260 controlled substances constituted of Percodan, Percocet,

Tuinal, Preludin, Tylox, Quaalude, Ritalin, Demerol, Merperganfortis,

Biphetamine, Sopar, Eskatrol and Dilaudid. With the exception of these

substances related to the patients Scheider, Knight, and Broughton, no notation

has been made that these drugs were prescribed, dispensed or administered in

excessive or inappropriate amounts i.e., the 15,000 number is not excessive and

inappropriate "on its face," nor is this raw number an indication that

Respondent has failed to practice medicine with a level of care, skill and

treatment which is recognized by a reasonably prudent, similar physician as

being acceptable under similar conditions and circumstances.

CONCLUSIONS OF LAW

31. The Division of Administrative Hearings has jurisdiction over the

subject matter and the parties to this action. See Subsection 120.57 (1),

Florida Statutes.

32. Count I in the administrative complaint alleges that Respondent

prescribed methaqualone and Valium to Arthur Lee Scheider other than in the

course of his professional practice in violation of Section 458.331(1)(q),

Florida Statutes. This violation has been proven in that the controlled

substances prescribed were inappropriate and in excessive quantities. As a

consequence, Respondent is subject to the penalties set forth in Section

458.331(2), Florida Statutes.

33. Count II accuses Respondent of gross or repeated malpractice or the

failure to practice medicine with the level of care, skill and treatment which

is recognized by a reasonably prudent, similar physician as being acceptable

under similar conditions and circumstances, related to the treatment afforded

Scheider in prescribing methaqualone and Valium in violation of Section

458.331(1)(t), Florida Statutes. The evidence establishes this violation. As a

consequence, Respondent is subject to the penalties set forth in Section

458.331(2), Florida Statutes.

34. Count III of the administrative complaint has been voluntarily

dismissed.

35. Count IV of the administrative complaint relates to the prescription

of Quaaludes on June 11, 1980, and September 12, 1980, after the Respondent had

been advised by Scheider's sister that he was selling Valium, such advice being

made on June 11, 1980. In particular, it is alleged that the Respondent

prescribed, dispensed or administered a controlled substance other than in the

course of his professional practice. It was inappropriate for Respondent to

prescribe on the dates in question after receiving the information from his

sister and that action constitutes a violation of Section 458.331(1)(q) Florida

Statutes. As a consequence, Respondent is subject to the penalties set forth in

Section 458.331(2), Florida Statutes. This penalty should be concurrent with

any penalty associated with Count I.

36. Count V relates to those facts in Count IV having to do with

prescribing Quaaludes to Scheider after learning of the possible sale of Valium,

and alleges that Respondent has engaged in gross or repeated malpractice or the

failure to practice medicine with that level of care, skill and treatment which

is recognized by reasonably prudent similar physicians as being acceptable under

similar circumstances and conditions, per Section 458.331(1)(t), Florida

Statutes. A violation of that provision has been shown related to this count.

As a consequence, Respondent is subject to the penalties set forth in Section

458.331(2), Florida Statutes.

37. Count VI in its operative terms found at paragraph 15 has been

dismissed.

38. Count VII accuses the Respondent on April 28, 1981, of prescribing

Ritalin for the patient Gladys Knight which is an amphetamine or sympathomimetic

amine drug or a compound designated as a Schedule II controlled substance under

Chapter 893, Florida Statutes. Ritalin falls into the category of amphetamine

or sympathomimetic amine drug and is designated as a Schedule II drug within

Chapter 893, Florida Statutes. The drug was prescribed after July 3, 1980, at

which time only select conditions could be treated by that type of drug and not

violate Section 458.331(1)(cc), Florida Statutes. The purpose of the

prescription of the drug for Ms. Knight did not fit one of the acceptable

categories. Therefore, Respondent has violated that provision. As a

consequence, Respondent is subject to the penalties set forth in Section

458.331(2), Florida Statutes.

39. Count VIII relates to the treatment of the patient John Broughton

related to a weight condition, hernia, and leg injury with the substances

Preludin related to weight and Talwin related to the other conditions. It is

alleged that excessive and inappropriate amounts of those substances were

prescribed for John Broughton and as a result, Respondent is accused of

violating Section 458.331(1)(q) , Florida Statutes, by prescribing, dispensing,

or administering a controlled substance other than in the course of his

professional practice. Those drugs were prescribed in excessive and

inappropriate amounts in violation of of the questioned provision. As a

consequence, Respondent is subject to the penalties set forth in Section

458.331(2), Florida Statutes.

40. Count IX restates facts related in Count VIII pertaining to the

patient Broughton and accuses Respondent of violating Section 458.331(1)(t) ,

Florida Statutes, in that Respondent has engaged in gross or repeated

malpractice or the failure to practice medicine with that level of care, skill

and treatment which is recognized by a reasonably prudent similar physician as

being acceptable on similar conditions and circumstances. This violation has

been shown. As a consequence, Respondent is subject to the penalties set forth

in Section 458.331(2), Florida Statutes.

41. Count X to the administrative complaint accuses Respondent of issuing

a prescription of Preludin to Broughton on December 12, 1980, in an instance in

which there is no justification in the records of the Respondent for that

prescription. For this action, Respondent is alleged to have violated Section

458.331(1)(n) , Florida Statutes, in that he failed to keep written medical

records justifying the course of treatment. This violation has been shown. As

a consequence, Respondent is subject to the penalties set forth in Section

458.331(2), Florida Statutes.

42. Count XI accuses the Respondent on November 3, 1980, and December 12,

1980, of issuing Preludin to Broughton for weight control. Further, it is

indicated that Preludin is an amphetamine or sympathomimetic amine drug or

compound designated as a Schedule II controlled substance pursuant to Chapter

893, Florida Statutes. Based upon these actions, Respondent is said to have

violated Section 458.331(1)(cc), Florida Statutes in that the Preludin was not

prescribed for any of the conditions set forth in that section before July 3,

1980, which is the effective date of the subject section. Respondent has

violated that provision by issuing the prescriptions on the questioned dates for

unauthorized purposes and in view of the fact that Preludin falls within the

category of amphetamine or sympathomimetic amine drug or is a compound

designated as a Schedule II controlled substance in Chapter 893, Florida

Statutes. As a consequence, Respondent is subject to the penalties set forth in

Section 458.331(2), Florida Statutes.

43. Count XII accuses Repondent of prescribing Preludin for weight control

for the patient Gladys Knight in excessive or inappropriate amounts and by that

action violating Section 458.331(1)(q), Florida Statutes, by prescribing,

dispensing, or administering a controlled substance other than in the course of

his professional practice. This violation has been proven. As a consequence,

Respondent is subject to the penalties set forth in Section 458.331(2), Florida

Statutes.

44. Count XIII sets out those factual allegations in Count XII and based

upon that pleading, accuses the Respondent of a violation of Section

458.331(1)(t), Florida Statutes, by engaging in gross or repeated malpractice

with a failure to practice medicine with that level of care, skill and treatment

which is recognized by a reasonably prudent similar physician as being

acceptable under similar conditions and circumstances. This violation has been

proven. As a consequence, Respondent is subject to the penalties set forth in

Section 458.331(2), Florida Statutes.

45. Count XIV accuses the Respondent of prescribing in excess of

approximately 15,000 controlled substances under Chapter 893, Florida Statutes,

namely Percodan, Percocet, Tuinal, Preludin, Tylox, Quaalude, Ritalin, Demerol,

Merperganfortis, Biphetamine, Sopar, Eskatrol and Dilaudid. Based upon the

amounts, in and of themselves, Respondent is accused of violating Section

458.331(1)(q), Florida Statutes, by prescribing, dispensing, or administering a

controlled substance other than in the course of his professional practice.

This general violation has not been shown. Violations related to some of these

controlled substances have been demonstrated in previous counts. Likewise, the

accusation that based upon those total amounts of the prescribed materials, as

alleged in Count XV, the Respondent is in violation of Section 458.331(1)(t) ,

Florida Statutes, by engaging in gross or repeated malpractice or the failure to

practice medicine with that level of care, skill and treatment which is

recognized by a reasonably prudent similar physician as being acceptable under

similar conditions and circumstances, has not been established.

Based upon a full consideration with the facts and conclusions of law

reached, it is

RECOMMENDED:

That a final order be entered dismissing Counts III, VI, XIV and XV and

imposes the following disciplinary action for violations found in Counts I, II,

IV, V, VII, VIII, IX, X, XI, XII and XIII:

1. Respondent's license is suspended for 3 years.

2. Service of the last 2 years of the suspension is stayed, provided the

Respondent successfully meets conditions of a 2-year probation which runs

concurrent with the last 2 years of the suspension term. Violation of the

probation will bring about the imposition of the entire 3 years of the

suspension.

3. The conditions related to probation include attendance and successful

completion of a course selected by the Board of Medical Examiners related to

treatment by use of controlled substances. Furthermore, Respondent shall not

violate any statute or rule during the course of his probation.

DONE and ENTERED this 15th day of November, 1983, in Tallahassee, Florida.

___________________________________

CHARLES C. ADAMS, Hearing Officer

Division of Administrative Hearings

The Oakland Building

2009 Apalachee Parkway

Tallahassee, Florida 32301

[phone]

Filed with the Clerk of the

Division of Administrative Hearings

this 15th day of November, 1983.

ENDNOTE

1/ After that date only those matters set forth in Section 458.331(I)(cc),

Florida Statutes, could be treated by Preludin and weight control was not in

those categories.

COPIES FURNISHED:

Henry M. Coxe, III, Esquire Fred Roche, Secretary

204 Washington Street Old Courthouse Square Building

Jacksonville, Florida 32202 130 North Monroe Street

Tallahassee, Florida 32301

J. Clark Hamilton, Jr., Esquire

801 Blackstone Building

233 East Bay Street

Jacksonville, Florida 32202

Dorothy Faircloth, Executive Director

Board of Medical Examiners

Old Courthouse Square Building

130 North Monroe Street

Tallahassee, Florida 32301