XAVIERBECERRA i . FILED Attorney General of California ETATE OF CALEFOHWA M. DAVIS . HEBICAL BOAED CALIFOHW <1 Deputy Attorney General EH 5' (b MARTIN W. HAGAN EVA) *1 1131!? ??133? 'i Deputy Attorney General - State Bar No. 155553, 600 West Broadway, Suite 1800 San Diego, CA 92101 P.O. Box 85266 San Diego, CA 92186?5266 Telephone: (619) 738-9405 Facsimile: (619) 645-2061 Attorneys for Complainant BEFORE THE MEDICAL. BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS San Diego,'California 92101 STATE OF CALIFORNIA In the Matter of the Accusation Against: Case No. 800?2016-022170 FRANK GILMAN, M.D. A US A I 2001 4th Avenue - . Physician?s and Surgeon?s Certi?cate No. G58692 . Respondent. Complainant alleges: PARTIES . 1. Kimberly Kirchmeyer (complainant) brings this Accusation solely in her of?cial capacity as the Executive Director of the MediCal Board of California, Department of Consumer Affairs (Board). . 2. On or about September 22, 1986, the Board issued Physician?s "and S-urgeon?s Certificate No. G58692 to Frank Gilman, M.D. (respondent). The Physician?s and Surgeon?s I Certi?cate was in full force and effect at all times?relevant to the charges and allegations brought herein and Will expire on April 30, 2020, unless renewed. I . 1 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016-022170 laws. JURISDICTION 3. i This Accusation is brought before the Board, under the authority of the following All section references are to the Business and Professions Code (Code) unless. otherwise indicated. 'th?e?Medical Quality Hearing Panel as designated 'in?S?e?ctiorr?l l'371"6f the??w 4. Section 2227 of the Code states: A licensee Whose matterlhas been heard by an administrative law judge Government Code, or Whose default has been entered, and who is found guilty, or who has entered into a stipulation for disciplinary action with the board, may, in accordance with the provisions of this chapter: A his or her license revoked upon order of the board. Have his or her right to practice suspended for a period not to exceed one year upon order of the board. Be placed on probation and be required to pay the costs of probation monitoring upon order of the board. Be publicly reprimanded by the board. The public reprimand may include a requirement that the licensee complete relevant educational courses approved by the board. I Have any other action taken in relation to discipline as part of an order of probation, as the board or an administrative law judge may'deem proper. Any matter heard pursuant to subdivision except for warning letters,- medical review or advisory conferences, professional cempetency examinations, continuing education activities, and cost reimbursement associated therewith that are agreed to with the board and successfully completed by the licensee, or other matters made con?dential or privileged by existing law, is deemed public, and shall be made available to the public by the board pursuant to Section 803.1.? 2 FRANK MD. - ACCUSATION NO. 800-2016-022170 Section 2234 of the Code, states: ?The board shall take action against any licensee who is charged?with unprofessional conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not limited to, the following: Gross negligence. Repeated negligent acts. To be repeated, there must be two or more negligent acts or omissions. An initial negligent act or omission followed by a separate and distinct departure from the applicable standard of care shall constitute repeated negligent acts. An initial negligent diagnosis followed by an act or omission medically appropriate for that negligent diagnosis of the patient shall constitute a single negligent act. When the standard of care requires a change in the diagnosis, act, or omission that constitutes'the negligent act described in paragraph (1), including, but not limited to, a reevaluation of the diagnosis or a change in treatment, and the licensee?s conduct departs from the applicable standard of care, each departure constitutes a separate and distinct breach of the standard of care. Incompetence. 6. Section 2266 of the Code states: ?The failure of a physician and surgeon to maintain adequate and accurate records relating to the provision of services to their patients constitutes I unprofessional conduct.? 7. Section 725 of the Code states: Repeated acts of clearly excessive prescribing, ?lrnishing, dispensing, or administering of drugs or treatment, repeated acts of iclearly excessive use of diagnostic procedures, or repeated acts of clearly excessive use of diagnostic or treatment facilities as determined by the standard of the community of licensees is unprofessional conduct for a physician and surgeon, dentist, podiatrist, 3 FRANK GILMAN, MD. - ACCUSATION NO. 800-2016-022170 physical therapist, chiropractor, optometrist, speech-language pathologist, or audiologist. Any person Who engages in repeated acts of clearly excessive prescribing or administering of drugs or treatment is guilty of amisdemeanor and shall be punished by a ?ne of not less than one hundred dollars ($100) nor more than six hundred dollars or by imprisonment for a term .of not less than 60 days nor more than 180 days, or by both that ?ne and imprisonment. A practitioner who has a medical basis for prescribing, furnishing, dispensing, or administering dangerous drugs or prescription controlled substances shall not be subject to disciplinary action or prosecution under this section. No physician and surgeon shall be subject to disciplinary action pursuant to this section for treating intractable pain in compliance with Section 2241.5.? 4 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016-022170 FIRST CAUSE FOR DISCIPLINE (Gross Negligence) 8. Respondent is subject to disciplinary action under sections 2227 and 2234, as de?ned by section 2234, subdivision of the Code, in that he committed gross negligence in his care and treatment of patients A, 13, and D, as more particularly alleged hereinafter: PATIENT least February 23, 2007, respondent was treating patient a old female with a decumented history of, among other things, neck pain, major depressive disorder, hypothyroidism, gastroesophageal re?ux disease (GERD), and musculoskeletal issues. Respondent treated patient A approximately three more times from February 24, 2007, through the end of 2008. 10. During the period of on or about January 1, 2009,_to December 31, 2009, respondent had ?ve (5) of?ce visits with patient A.2 According to Respondent?s progress notes, the Visits took place on March 31, May 7, June 10, June 29'and October 21, 2009._ Patient A?s problems during this time included, but were not limited to, chronic pain, chest pain, ?bromyalgia, hypothyroidism, and GERD. Patient A was also being followed by her Dr. C.M., for mental health issues. According to the CURES report for patient A, the following prescriptions for controlled substances were ?lled for patient A during 2012: Filled .Drug Name Strength 1 Quantity Priescriber 02-04?2009' Oxycodone/APAP3 =10/325 mg 360 Dr. C.M. 7 1 Patient A is being used in place of the?patient?s name or initials'to maintain patient con?dentiality. The other patients in this Accusation are referred to patients B, C, and D, to also maintain patient con?dentiality. 2 Conduct occurring more than seven (7) years from the ?ling date of this Acousation is for informational purposes only and is not alleged as a basis for disciplinary action. 3 Oxycodone/APAP an opioid analgesic, is a Schedule II controlled substance pursuantto Health and Safety Code section'11055, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, it is used for the management of moderate to moderately severe pain. The Drug Enforcement Administration has identi?ed oxycodone, as a drug of abuse. (Drugs 'of Abuse, A DEA Resource Guide (2011 Edition), at p. 41.) The Federal Drug Administration has issued a (continued. .) 5 FRANK GILMAN, M.D. ACCUSATION NO. 800?2016-022170 .Filled Drug Name Strength Quantity Prescriber 02?23-2009 Temazepam4 30 mg 90 Dr. C.M. 04-10-2009' Lorazepam5 i . 2 mg 90 Dr. C.M. 06?10-2009 Provigil6 200 mg 30 Respondent 06-11-2009 Temazepam 30 mg 90 Dr. C.M. 06-17?2009 Lorazepam 2 mg .90 Dr. C.M. 07-08-2009 Diazepam7 710 mg 1 Other 07?29-2009 Provigil 200 mg 90 Dr. CM. 7 07-30-2009 Oxycodones 5 mg 900 Dr. CLM. (. . .continued) . black box warning for Percocet? which warns about, among other things, addiction, abuse and . misuse, and the possibility of ?life-threatening respiratory distress.? . . 4 Temazepam (Restoril?), a benzodiazepine, is a centrally acting hypnotic-sedative that is a' Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subdivision and a dangerous drug pursuant to Business and Professions Code section 4.022. When properly prescribed and indicated, it is used to treat seizure disorders and panic disorders. Concomitant use of Restoril? with opioids ?may result in profound sedation, respiratory depression, coma, and death.? The Drug Enforcement Administration (DEA) has identi?ed benzodiazepines, such as Restoril?, as drug of abuse. (Drugs of Abuse, DEA Resource Guide (2011 Edition), at p. 53.) - 5 Lorazepam (Ativan?), a benzodiazepine, is a centrally acting hypnotic?sedative that is a Schedule IV centrolled substance pursuant to Health and Safety Code section 1105 7, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, it is used for the management of anxiety disorders or for the short term relief of anxiety or anxiety associated with depressive Concomitant use of Ativan? with opioids ?may result in. profound sedation, respiratory depression, coma, and death.? The DEA. has identi?ed benzodiazepines,? such as Ativan?, as a drugof abuse. (Drugs of Abuse, DEA Resource Guide (2011 Edition), at p. 53.) . 6 Provigil? (moda?nil), is a Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated it is used to improve wakefulness in adult patients with excessive sleepiness associated with narCOIepsy, obstructiVe sleep apnea, or shift work disorder. - 7 Diazepam (Valium?), a benzodiazepine, is a centrally acting hypnotic-sedative that is a Schedule IV controlled substance pursuant to Health and Safety Code "section 11057, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, it is used for the management of anxiety disorders or for short- term relief of anxiety. Concomitant use of Valium? with opioids ?may result in profound sedation, respiratory depression, coma, and death.? The DEA has identified benzodiazepines, such as Valium?, as a drug of abuse. (Drugs of Abuse, Resource Guide (2011 Edition), at p. 53.) . 6 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016-022170 Filled Drug Name Strength Quantity Prescriber 08?31?2009 'Temazepam 30 mg 90 Dr. CM. 09-14?2009 Provigil 200 mg 180 Dr. C.M. 09?14-2009 Lorazepam 2mg 90 Dr. CM. 10-28-2009 Roxicetg 5/325 mg 900 Dr. CM. 11?13?2009 Temazepam 30 mg 90 Dr. CM. 11-20~2009 Lorazepam .2 mg 90 Dr. C.M. 11-23?2009 Oxycodone 5 mg 200 Dr. C.M, 12-30?2009 Alprazolamlo 1 mg . 180 Dr. CM. 11. During the period of on or about January 1, 2010, to December 31, 2010, respondent had seven (7) of?ce visits with patient A. According to Respondent?s progress notes, the visits took place on February 18, May 19, September 2, October 4, October 14, and November 16, 2010. Patient A?s problems during this time included, but were not limited to, chronic pain, . . .co?iitinued) 8 Oxycodone HCL (OxyContin?) is a Schedule II controlled substances pursuant to Health and Safety Code section 11055, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, Oxycodone HCL is used for the management of pain severe enough to require daily, around-the- clock, long term opioid treatment for which alternative treatment options are inadequate. The DEA has identified oxycodone, as a drug of abuse. (Drugs of Abuse, A DEA Resource Guide (2011 Edition), at p. 41.) The risk of respiratory depression and overdose is increased with the concomitant use of benzodiazepines or when prescribed to patients with pre-existing respiratory depression. . 9 Roxicet? (oxycodone and acetaminophen), an opioid analgesic, is a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivision and a dangerous drug pursuant to BuSiness .and Professions Code section 4022. When properly prescribed and indicated, it is used for the management of moderate to moderately severe pain. The Drug Enforcement Administration has identi?ed oxycodone, as a drug of abuse. G)rugs of Abuse, A DEA ReSource Guide (2011 Edition), at p. 41.) The Federal Drug Administration has Issued a black box warning for Percocet? which warns about, among other things, addiction, abuse and misuse, and the possibility of ?life-threatening respiratory. distress.? ?0 Alprazolam (Xanax?), a benzodiazepine, is a centrally acting hypnotic-sedative that is a Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subdivision (d and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, it is used for the management of anxiety disorders. Concomitant use of Xanax? with _0pioids ?may result in profound sedation, respiratory depression, coma, and death.? The DEA has identified benzodiazepines, such as Xanax?, as a drug of abuse. (Drugs of Abuse," DEA Resource Guide (2011 Edition), at p. 53.) 7 FRANK GILMAN, M.D. - ACCUSATION NO. 800?2016-022170 hypertension (HTN), and depression. During 2010, patient A received electroconvulsive therapy (ECT) to treat severe depression and she was also followed by her Dr. C.M. According to the CURES report for patient A, the following prescriptions for- controlled substances were ?lled for patient A during 2010: Filled Drug Name Strength Quantity Prescriber 01-23?2010 Nuvigil? 7 150 mg 30 . Dr. C.M. 02-02?201 0 Temazepam 30 mg 90 Dr. C.M. 02-23-2010 Oxycodone - 5 mg 900 Dr. C.M. 05-11-2010 Oxycodone 5 mg 900 Dr. C.M. 05-11-2010 PrOVigil 100 mg 90 Dr. C.M. 05?26-2010 Temazeparn 30 mg 90 Respondent 06-08-2010 Oxycontin '10 mg 14' Dr. C.M. 06-15-2010 OxyContin 2.0 mg 63 Dr. C.M. 07-02?2011) Oxycodone 20 mg 360, Dr. C.M. 08-03?2010 Temazepam 30 mg 90 Respondent 09-02-2010 QxyContin 10 mg 60 Respondent 09-03-2010 Alprazolam 1 mg 180 Dr. C.M. 09-07?2010 OxyContin 20mg 360 Dr. C.M. 10-11-2010 Oxycodone 5 mg 240 Respondent 10-14-2010 Temazepam 30 mg 30 Respondent 11-09-2010 Alprazolam 1 mg 180 Dr. C.M. 11-23-2010 Oxycodone 5 mg 720 Respondent 11-23-2010 OxyContin 20 mg 60 Respondent ?1 Nuvigi1? (armoda?nil), is a Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated it is used to improve wakefulness in adult patients with excessive sleepiness associated with narcolepsy, obstructive sleep apnea, or shift work disorder. 8 FRANK GILMAN, MD. - ACCUSATION NO. 800-2016?022170 Filled Drug Name Strength Quantity Prescriber 12?17?2010' Temazepam 30 mg 90 Respondent 12. During the period of on or about January 1, 2011, to December 31, 2011, respondent had ?ve (5) of?ce visits with patient A. According to respondent?s progress notes, the visits took place on January 5, March 2, May 4, July 11, and November 2, 2011. .Patient A?s problems during this time included, but were not limited to, chronic pain, ?bromyalgia, and depression. On November 9, 2011, patient A ?lled-a prescription for Oxycodone 5 mg the details of I which are not accurately documented in patient A?s medical record and which respondent could not explain when questioned about the prescription. During this time, patient A was also followed by, a new Dr. C.C., for her mental health issues. According to the CURES report for patient A, the following prescriptions for controlled?substances were ?lled for patient A during 2011: Filled Drug Name Strength Quantity Prescriber 02-18-2011 Temazepam 30 mg 90 7 . Respondent 03-09-2011 OxyContin 20 mg 60 1 Respondent 03-09-2011 Oxycodone I 5 mg 720 Respondent 04-19-2011 5 mg 60 Dr. cc. 05?05?2011 10mg 60 5 Dr. c.c. 12 The progress note for the prior visit of November 2, 2011, indicates ?.Oxycodone HCL 5 MG Oral Tablet; 1?2 TABS HR PRN SEVERE Rx.? There is no indication of the quantity that is being prescribed and respondent had dif?culty explaining the large quantity of oxycodone when asked at his interview before a Department of Consumer Affairs, Health Quality Investigation Unit (HQIU) investigator regarding his care and treatment of patient A. Patient A had previously ?lled prescriptions from respondent for oxycodone 5 mg (#720) on November 23, - 2010, March 9, 20171, and May 9, 2011. 13 (Ritalin? and Methylin?), a central nervous system stimulant, is a Schedule II controlled substance pursuant to Health and Safety Code seetion 11055, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, it is used to treat attention de?cit hyperactivity disorder (ADHD) and narcolepsy. According to the DEA, amphetamines, such as are considered a drug of abuse. ?The effects of amphetamines and methamphetamine are similar to cocaine, but their onSet is slower and their duration is longer.? (Drugs of Abuse A DEA Resource Guide (2011), at p. 44.) . 9 FRANK (GILMAN, MD. - ACCUSATION NO. SOD-20164022170 Filled Drug Name Strength Quantity Prescriber I 05-09-2011 Alprazolam 1 mg 90 Dr. of; 05-09-2011 Oxycodone' 5 mg 720 Respondent 05-09-2011 OxyContin 20 mg 60 Respondent 05711-2011 Methylin 10 mg 180 1 Dr. C.C. 06-01-201 1' "femazepam 30 mg 30 Respondent 06-07-2011 Temazepam 30 mg" 1 9O ReSpondent 06-23-2011 Methylin 20 mg 180 Dr. 00' 07?15?201 1 OxyContin 20 mg 60 Respondent 08-3 0-2011 Temazepam 30 mg 90 Respondent 09?29-2011 20 mg 2 180 Dr. cc 10?19-2011 20 mg . ,270 Dr. C.C. 11-09?201 1 OxyContin . 20 mg 60 Respondent 1 1-09-201 1. Oxycodone 5 mg 720 Respondent 1 1-22-201 1 Temazepam 30 mg 90 Respondent 12?02-2011 Oxycontin 20 mg 6O 4 Respondent 13. During the period of on or about January 1, 2012, to July 1, 2012, respondent had five (5) office visits with patient A. According to respondent?s progress notes, the visits took place on January 5, March 2, May 4, July 11, and November 2, 2011. Patient A?s problems during this time included, but were not limited to, depression, chronic pain, ?bromyalgia, hypothyroidism, and opiate addiction (as noted in her records); During this time, patient A continued to be followed by Dr. 00, for her mental health issues. On January 13, 2012, patient A was admitted to Sharp Grossmont Behavioral Health after a suicide attempt. 14 After consultation, she . 14 According to one of the relevant medical records, .. [t]he patient was transferred here from Sharp Memorial'Medical ?oor for further stabilization and recent suicidality. When I_f1rst contacted the patient I did an extensive history note for treatment of refractory depression, She has overdosed on 7 temazepam '30 mg tablets because she was ?very depressed.? She states she had been thinking about it for weeks and wrote some sort of suicide 10' FRANK GILMAN, MD. - ACCUSATION NO. 800-2016-022170 Alum underwent ECT therapy on January 18, January 20,?and January 23, 2012. Patient A was discharged on January 24, 2012. On February 5, 2012, patient A?s husband reported to respondent that patient A ?took 6 temazepam tablets in suicide gesture,? that she had been . admitted for a mental health evaluation, and that she received three electroconvulsive therapy (ECT) prOcedures which improved her mood but ?increased memory difficulty.? On April 22, - 2012, patient A self-admitted to Sharp Grossmont Behavioral Health, with the recommendation of her treating Dr. C.C., for severe depression and suicidal ideation. According to the relevant medical records, patient A was diagnosed as suffering from, among other things, major depressive disorder, recurrent, severe, without chronic pain affecting condition; hypothyroidism; and chronic low back painwith degenerative disk disease? and was noted to have a ?history of opioiddependence over the last 5 to 6 The treatment plan for Patient A?s care was additional ECT procedures, which had been tried in the past, because her medications were no longer effective in treating her severe depression. Patient A underwent a series of ECT procedures on an outpatient and inpatient basis and was discharged in early May 2012, to be followed by her treating Patient I A?s condition on discharge was documented as ?stable, improved [and] [w]hile continuing to be quite depressed [patient was no longer with acute suicidal ideations.? According to the CURES report for patient A, the following prescriptiOns for controlled substances were ?lled for patient A during 2012: Filled . Drug Name Strength Quantity Prescrib?r 02-22?2012 OxyContin 20 mg 60 Respondent 02?22-2012 Oxycodone 5 mg . . 240 7 Respondent 03-08?2012 30 mg 60 Respondent 04-05?2012 20 mg 270 Dr. C.C. 05-08?2012 OxyContin 20 mg 90 Respondent 05-23-2012 OxyContin A 20 mg 90 . Respondent 06?02?2012 20 mg 180 Dr. C.C. 11 FRANK GILMAN, M.D. ACCUSATION NO. 800-2016-022170 Filled Drug Name Strength Quantity 'Prescriber 06-19-2012 Oxycodone . 5mg 90 Respondent 06-20-2012 OxyContin- 20 mg 90 .Respondent 14. On or about July 3, 2012, patient A was found dead at her home. 'Patient A?s cause of death was listed as ?acute oxycodone, alprazolam, and temazepam intoxication? and the manner - of death was listed as suicide. 15 I i 15. Throughout his course of treatment of patient A, respondent failed to adequately respond to warning signs indicating possible misuse, abuse and/or diversion of controlled substances and did not take adequate risk screening measures to prevent the misuse, abuse and/or the diversion of the controlled, substances that he was prescribing. These warning signs included, but were not limited to, overuse of controlled substances and possible diversion by patient A?s husband, who was also receiving controlled substances from respondent.I6 l6. Respondent committed gross negligence in his care and treatment of patient A which included, but Was not limited to, the following: - Respondent repeatedly increased the risk of harm to. patient A through, among other things, his haphazard prescribing of cOntrolled substances to patient ?5 According the Autopsy Report, ?Toxicological testing detected a markedly elevated level of oxycodone. Additionally, 72 mg of oxycodone, which would be ?fteen 5 mg oxycodone pills, remained in her gastric contents, clearly indicating intentional overdose. Also, detected were alprazolam and temazepam (and its metabolite, oxa?zepam). No alcohol was detected. Based on the autopsy ?ndings and the circumstances surrounding the'death, as currently understood, the cause of death is acute oxycodone, alprazolam, and temazepam intoxicatiOn, and the manner of death is suicide.? . 16 During his interview before a HQIU investigator, respondent admitted that patient A would vary her dose on occasion which was due, in part, to respondent?s failure to have a clear, rationale, and adequately documented treatment plan for the controlled-substances that were being prescribed to patient A. Respondent was also prescribing pain medications to. patient A?s husband. During his interview, respondent was asked whether he was aware that one of patient A?s prescriptions had been ?lled on July 18, 2012, approximately two weeks after patient A had - died. Respondent indicated he was not aware of the prescription that was ?lled on July 18, 2012.. Respondent further admitted during his interview that he was not checking CURES at the time he was treating patient A. - 12 FRANK GILMAN, M.D. - ACCUSATION NO. 800?2016?022170 Respondent repeatedly prescribed controlled substances. to patient A without discussmg and/or documenting adequate informed consent which included, but was not limited to, the risks associated with treating chronic pain with opioids; the risks associated with the, concomitant use of opioids, benzodiazepines, and other drug combinations; and the risks associated with prescribing opioids to. patient A, who had a history of suicidal thoughts or actions; (0) Respondent repeatedly failed to utilize risk screening measures to address possible misuse or diversion of controlled substances which included, but was not limited to, failing to check failing to utilize a pain 1 management Contract; failing to conduct urinalysis or other drug screening; failing to properly coordinate prescribing with other prescribers; and failing to utilize other possible risk screening measures; and (dj Respondent repeatedly failed to maintain accurate and adequate medical - records concerning his care and treatment of patient A which included, but was not limited to, failing to document adequate informed consent, failing to document sufficient and aCcurate information regarding the controlled Substances being prescribed to enable, among other things, validation and continuity of care pertaining to the controlled substances that were being prescribed; failing to document the rationale for continuing opioid treatment with patient A after each of her suicide attempts; and failing to document a rationale and clear treatment plan for the controlled substances that were being prescribed to patient A. PATIENT 17. According to respondent?s progress notes, respondent ?rst started treating patient B, a then-32-year old male, on or about May 16, 2011. Patient B?s documented medical history at the time included chronic lumbar neuritis since high school, depression, hypertension, GERD, and 13 FRANK GILMAN, MD, - ACCUSATION NO. 800-2016-022170 4:qu Patient reported he was reluctant to have surgery. Current medications were Prevacid 30 mg and Prozac 40 mg. At this visit, prescriptions for oxycodone HCL (OxyContin) 30 mg _12 (every 12 hours) and hydrocodone/APAP (Norco)17 q.i.d (fourna day). were re?lled. 18. During the period of on or about May 17, 2011, to December 31, .201 l, respondent had ?ve (5) additional of?ce visits with patient B: According to respondent?s progress notes, the visits took place on June 3, June 24, July 11?, October 11, and November 14, 2011. Patient B?s problems during this time generally included, but were not limited to, alleged chronic pain, depression, elevated liver function test, and dyslipidemia. On June 24, 2011, patient indicated that he was seeing a new Dr. T.L., and was motivated to taper his dosage of oxycodone HCL (OxyContin), which was reduced to 40 mg am (in the morning) and 30 mg . pm (in the evening) [morphine equivalency dose of 105 mg/day] and was eventually switched to hydrocodone APAP (Norco) 10/325 mg (?ve per day) of 50. mg/day] and then oxycodone/APAP (Per-cocet) 7.5/325 mg (up to 5 tablets per day) of56.25 rug/day]. According to the CURES report for patient B, he ?lled multiple prescriptions during the 17 Hydrocodone/APAP (V icodin?, Lortab? and Norco?) is a hydrocodone combination of hydrocodone bitartrate and acetaminophen which was a Schedule controlled substance pursuant to Health and Safety Code section 11056, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. On August 22, 2014, the DEA published a ?nal rule rescheduling hydrocodone combination products (HCPS) to schedule 11 of the Controlled Substances Act, which became effective October 6, 2014. Schedule II controlled substances are substances that have a currently accepted medical use in the United States, but also have a high potential for abuse, and the abuse of which may lead to severe or physical dependence. When properly prescribed and indicated, it is used for the treatment of moderate to severe pain. In addition to the potential for and physical dependence there is also the risk of acute liver failure which has resulted in a black box warning being issued by the Federal Drug Administration (FDA). The FDA black box warning provides that ?Acetaminophen has been associated With cases of acute liver failure, at times resulting in liver . transplant and death. Most of the cases of liver injury are assOciated with use of the - acetaminophen at doses that exceed 4,000 milligrams (4 grams) per day, and often involve more than one acetaminophen containing product.? 18 Morphine equivalency dose (NIED) is a value assigned to opioids to represent their relative potencies. MED is determined by using an equivalency factor to calculate a dose of morphine that is equivalent to the prescribed opioid. Daily MED is the sum total of all opioids, with conversation factors applied, that are being taken within a 24?hour period, which is used to determine if a patient is at risk of addiction, respiratory depression, or other delirious effects associated with Opioids. The process of converting opioid doses to an overall morphine equivalency dose can be accomplished by using a MED calculator or a morphine equivalency table, also known as opioid conversation chart. - l4 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016-022170 0'00 \1'remainder of 201 1? for, among other things, hydrocodone/APAP 10/325 mg (#240) of 80 mg/day], benzodiazepines (some prescribed by respondent and some by patient B?s treating and (Ritalin) prescribed by the treating 19. During the period of on or about January 1, 2012, to December 31, 2012, re3pondent had one (1) of?ce Visit with patient B. According to respondent?s progress note, the Visit took place on June 6, 2012. Patient B?s problems during this time generally included, but were not limited to, alleged chronic pain, depression, anxiety, and ADHD. During 2012, patient was also under the care of his treating T.L., who was also'prescribing controlled substances. According to the CURES report for patient B, the folloWing prescriptions for controlled substances were ?lled for patient during 2012:. Date Filled Drug Name Strength Quantity Days Prescriber 01-02?2012 Lorazepam 1 mg 90 30 - Respondent 01-14-2012 Hydrocodone/APAP 10/325 mg 240 30 Respondent 01-16-2012 Clonazepamlg 0.5 mg 90 30 Dr. T.L. 01-16-2012 54 mg 60 60 Dr. T.L. 02?1 0-2012 Hydrocodone/APAP 10/325 mg 240 7 15 Respondent 02?12?2012 Clonazepam 0.5 mg 90 30 Dr. T.L. . 03?02-20 1 2 Hydrocodone/APAP 10/3 25 mg 240 3 0 Respondent . 03?10?2012 Lorazepam 90 30 Respondent- 03-29-2012 Hydroco?done/APAP 10/325 mg 240 3 0 Respondent 04-02-2012 Lorazepam '1 mg 90 30 Respondent 04-12-2012 54 mg 30 I 30 Dr. T.L. '9 Clonazepam (Klonopin?), a benzodiazepine, is a centrally acting hypnotic-sedative that is a Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, it is used to treat seizure disorders and panic disorders. Concomitant use of Klonopin? with opioids ?may result in profound sedation, reSpiratory depression, coma, and death.? The DEA has identi?ed benzodia?zepines, such as Klonipin?, as a drug of abuse. (Drugs of Abuse, DEA Resource Guide (2011 Edition), at p. 53.) 15 FRANK GILMAN, M.D. ACCUSATION NO. 800-2016-022170 Date Filled Drug Name Strength Quantity Days Prescriber 04-22-2012 Hydrocodone/APAP 10/325 mg 240 3-0 Respondent 05?18?2012 Hydrocodone/APAP 10/325 mg 240 30 Respondent 05-30-2012 Clonazepam 0.5 mg 30 10 Dr. TL. 053 12012 54 mg 60 60 . Dr. T.L. 06?06-2012 Clonazepam 0.5 mg 90 30 Dr. T.L. 06-06-2012 QxyContin 40 mg 60 30 Respondent 06?1 1?20 12 Hydrocodone/APAP 10/325 mg ?240 30 Respondent 06?29-2012 Clonazepam 0.5 mg 90 . 30 Dr. T.L. 06?29-2012 OxyContin 40 mg 8 4 Other 07?03-2012 OxyContin 40 mg 60 30 Respondent . 07-13?2012 Hydrocodone/APAP I 10/325 mg 240 . 30 Respondent . 07-26-2012 Clonazepam 0.5 mg 90 30 Dr. T.L. 08?01-2012 OxyContin 20 mg 60 30 Respondent 08-01-2012 54 mg 60 60 Dr. T.L. 08-07-2012 Hydrocodone/APAP 10/325 mg 240 30 Respondent 08-21-2012 Clonazepam 0.5 mg 90 30 Dr. T.L. 08-31?2012 OxyContin 20 mg 60 30 . Respondent 09?07-20 12 Hydrocodone/APAP 1 0/3 25 mg 240 30 Respondent 09?23?2012 Clonazepam 0.5 mg 90 30 Dr. T.L. 10-02?2012 Hydrocodone/APAP 10/325 mg 240 30 Respondent Adderall XR20 20 mg 30 30 Dr. T.L. 2? Adderall?, a mixture of d-amphetamine and l-amphetamine salts in a ratio of 3:1, is a central stimulant of the amphetamine class, and is a Schedule II controlled Code section 11055, subdivision and a dangerous ction 4022. When properly prescribed and yperactivity disorder and narcolepsy. According to the are considered a drug of abuse. ?The effects of similar to cocaine, but their onset is slower and their . 44.) Adderall and other stimulants are substance pursuant to Health and Safet drug pursuant to Business and Professi indicated, it is used for attention-de?cit DEA, amphetamines, such as Adderall?, amphetamines and methamphetamine are duration is longer.? (Drugs of Abuse A DEA Resource Guide contraindicated for patients with a history of drug abuse. ons Code se 16 (201 1), at FRANK GILMAN, M.D. ACCUSATION NO. 800?2016-022 170 "Date Filled Drug Name Strength Quantity Days I Prescriber 10-04-2012 OxyContin 20 mg 60 3o . Dr. D.B.21 '10?18-2012 Clonazepam 0.5 mg 135 30 Dr. T.L. 11?05?2012 Hydrocedpne/APAP 10/325 mg 240 30 Respondent 11?08-2012 - Adderall XR 30 mg 30 30 11?12?2012 Clonazepam 0.5 mg 135 30 Dr. T.L. 11?21-2012 Oxycontin - 20 mg 60 30 Dr. D.B.- 12-04-2012 Hydrocodone/APAP 10/325 mg i 240 30 Respondent 12?12-2012 Adde'rall XR 30 mg 30 '30 Dr. T.L. 12?22?2012 Clonazepam 0.5 mg 135 30 Dr. TLL. 20. During the period of on or about January 1, 2013, to December 31, 2013, respondent had two (2) of?ce visits with patient B. According to respondent?s progress notes, the visits took place on January 17 and September 13, 2013. Patient B?s problems during this time generally included, but were not limited to, alleged chronic pain, depression, hypertensiOn, and GERD. According to the CURES report for patient B, the following prescriptions for controlled substances Were ?lled for patient during 2013: Date Filled Drug-Name Strength Quantity Days Prescriber 01-02?2013 Hydrocodone/APAP 10/325 mg 240 30 Respondent 01 -03?20 1 3 OxyContin . 20- mg 60 3 0 Respondent 01?14-2013 Clonazepam 06-2013 Adderall -30-2013 OxyContin 20 mg . 3 0 30 Respondent 01-3 0-2013 Hydrocodone/APAP Respondent 02-07?2013 Adderall XR 20 mg 60 30 Other 02-11-2013 Clonazepam 0.5 mg 135 30 Dr. T.L. 21 At his interview before an HQIU investigator, respondent identi?ed Dr. D.B. as one of his partners that would ?share call? and cover for him if he was out of the of?ce. 17' FRANK GILMAN, M.D. ACCUSATION NO. 800-2016-022170 \lox'meoow ?Prescriber Date Filled Drug Name Strength Quantity Days 02-26-2013 OxyContin 20 mg 60 30 Respondent 02-26-2013 Hydrocodone/APAP 10/325 mg 240 30 Respondent 03-07-2013 Adderall Dr'. T.L. 03-09-2013 Clonazepam 0.5 mg 13 5 30 Dr. T.L. 03-25?20 1 3 Hydrocodone/APAP 10/325 mg 240 3 0 Respondent 04-03-2013 OxyContin 20 mg 3 60 3 0 Respondent 0404?201 3 Clonazepam? I 0.5 mg 135 30 Dr. T.L. 04-05-2013 Adderall XR 30 mg. 60 30 Dr. T.L. 04?21?2013 Hydrocodone/APAP 10/325 mg 240 5 30 Respondent~ 7 04?29-20 13 - OxyContin '20 mg 60 3 0 Respondent 04-29-2013 cinnazepam' 0.5 mg 135 ?30 Dr. T.L. 05-09-2013 Adderall XR 30 mg 60 30 Dr. T.L. 05?1 8-2013 HydrocodOne/APAP 10/325 mg 240 30 Respondent 05-31-2013 Clonazepam 0.5 mg - 135 30 Dr. T.L. 06-03-2013 R-OxyContin 20 mg 60 30 Respondent 06-04-2013 Adderall XR 30 mg 60 30 - Dr. T.L. 06-13-2013 Hydrocodone/APAP 10Respondent 06-26-2013 Clonazepam 0.5 mg 13 5 30 Dr. T.L. 07-05-2013 OxyContin 20 mg 60 30 Respondent 07-05?201 3 Adderall- XR 30 mg 60 30 Dr. T.L. 07-15-2013 HydrOcodone/APAP 10/325 mg 240 30' 1 Respondent I 07-22-2013 Clonazepam 0.5 mg 13 5 30 . Dr. T.L. 08-16-2013 Hydrocodone/APAP 10/3 25 mg 240 30 Respondent 08-20-2013 Clonazepam 0.5 mg 135. 30 Dr. T.L. 08-23-2013 Adderall XR 30 mg 60. 30 Dr. T.L. 08-23?20 1 3 OxyContin 20 mg 60 30 Respondent 1 8 FRANK GILMAN, M.D. - ACCUSATION NO. 800?2016-022170 Date 'Filled Drug Name Strength Quantity Days Prescrib er 09-13-2013 Hydrocodone/APAP 1. 0/3 25 mg 240 30 Respondent 09?21-2013 Adderall XR 30 mg 60 30 Dr. T.L. 09-21?2013 Clonazepam 0.5 mg 135 30 Dr. T.L. 09?21-201 3 OxyContin 20 mg 60 30 Respondent I 10-08?201 3 Hydrocodone/APAP 10/325 mg 240 30 Respondent 1091-2013 OxyContin 20 mg 60 30 Respondent 1 1-06-2013 Hydrocodone/APAP Respondent 1 1-06-2013 Clonazepam 0.5 mg 13 5 30 Dr. T.L. 11?12-2013 Adderall 1-20-2013 Oxycontin 20 mg 60 30 Respondent 12-09-2013 Hydrocodone/APAP 10/ 325 mg 240 . 30 Respondent 12?19-2013 Clonazepam 0.5 mg 13 5 30 Dr. T.L. 21. During the period of on or about January 1, 2014, to December 31, 2014, respondent had ?ve (5) of?ce visits with patient B. According to respondent?s progress notes, the visits took place on January 2, April 14, June 9, July 10, and September 12, 2014. Patient B?s problems 7 during this time generally included, but were not limited to, alleged chronic pain, depression, chronic bronchitis, hypertension, hypo gonadism, GERD, and ADHD. On the visit of June 9, .2014, patient reported, among other things, that he had not taken any opiate pain relievers for the last two weeks- and ?he [was] agreeable to staying off oxycontin and trying tramadol/apap for mild to moderate pain instead of hydrocodone 10 mg/325 and also complained of ?low motivation, low energy and low sex drive? that respondent attributed to ?hypo gonadism thought secondary to increased weight and chronic Opiate use.? In response, respondent provided patient 'with a tapering schedule22 with his plan documented as discontinue OxyContin, use 22 The tapering schedule was on an undated handwritten note from respondent, discovered . by patient B?s mother after her son had overdosed. Respondent indicated in his interview before a HQIU investigator, that he believed the note was written in 2014 when patient and respondent discussed ?opioid use [as] a contributor to his hypogonadism and decreased sex drive [a]nd he wanted to taper his opiates.? 19 FRANK GILMAN, MD. - ACCUSATION NO. 800?2016-022170 .hydrocodone 10/325 mg only as needed for severe pain and ?otherwise use of ultracet 37.5 - mg/3 25 one-two tablet'every 4-6 hour for pain? and also?prescribed testosterone. Despite the fact that the OxyContin was to be discontinued per respondent?s chart note for June 9, 2014, a prescription of OxyCont-in was ?lled the same day; and despite that hydrocodone 1-0/325 mg was only to be used ?as needed for severe pain? patient ?lled additional prescriptions for hydrocodone/APAP 10/325 mg (#240) on June 16, July 25, August 26, and September 25, 2014. At the beginning of 2014, patient B?s MED was approximately 140 mg/day and at the end of 2014 was at approximately 80 mg per day. During 2014, patient ?lled his prescriptions at approximately seven (7) different pharmacies. According to the CURES report for patient B, the following prescriptions for Controlled substances were ?lled for patient during 2014: Date Filled Drug Name Strength Quantity Days Prescriber . 0 1-02?20 14 ?OxyContin 20 mg- 60 3O Respondent 01-05?2014 Adderall XR '30 mg 60 30 Dr. T.L. 01 -09-2014 Hydrocodone/APAP 10/ 325 mg 240 30 Respondent 01?27-2014 OxyContin 20 mg 60 30 Respondent 02?03-20 1 4 Hydrocodone/APAP 10Respondent 02?20-20 14 Clonazepam 0. 5 mg 135 30 Dr. T.L.. 02-21-2014 OxyContin 20 mg 60 30 Respondent 02-27-2014 Hydrocodone/APAP 1 0/ 325 mg 240 30 Dr. T.L. 03?19?2014 OxyContin 20 mg 60 30 Respondent 03-24?20 14 Hydrocodone/APAP 10/ 3 25 mg 240 30 Respondent. 04-07?2014 Clonaz?epam 0.5 mg 135 30 Dr. T.L. 04-15-2014 Adderall XR 30 mg 60 30 A Dr. T.L. 04-16-2014 OxyContin 20 mg .60 30 Respondent 04?23-20 14 Hydrocodone/APAP Respondent 05-09-2014 Clonazeparn 0.5 mg i 135 30 Dr. 05-12-2014 OxyContin 20 mg 60 30 ReSpondent 20 FRANK GILMAN, M.D. ACCUSATION NO. 800-2016-022170 \lONUiDate Filled Drug Name Strength Quantity Days Pres crib er 05-15-2014 Adderall 9?20 1 4 Hydrocodone/APAP 10/325 mg 240 30 Respondent 06?03-2014 Clonazepam 1mg 90 . . 30 Dr. T.L. 06?09-2014 Androgel? 1.62% 75 30 Respondent 06-09-2014 OxyContin 20 mg 60 30 Respondent I 06?15?2014 Adderall 06?16-2014 Hydrocodone/APAP Respondent 06?28?20 14 Clonazepam 1 mg 90 i 30 Dr. T.L. 07?07?20 14 Andro gel 1.62% 75 30 Respondent 07-12-2014 Adderall 30 mg 60 30 Dr. T.L. 07-25-2014 . Hydrocodone/APAP 10/ 325 - mg .240 3 0 Respondent 07-31-2014 Clonaiepam 1mg 90? 30 Dr. 11L. 08-10-2014 Andro gel 1.62% 75. 30 5 Respondent 08-19-2014 Adderall 30 mg 60 30 Dr. T.L. 08-26-2014 Hydrocodone/APAP 10/ 325 mg 240 30 Respondent 08-26-2014 Clonazeparn 1 mg 90 30 Dr. T.L. 09-25-2014 Hydrocodone/APAP 10/325 mg 240 30 Respondent 09-25-2014 Adderall 30 mg 60 30 . Dr. T.L. 09-25-2014 Clonazeparn 1mg 90 30 Dr. T.L. 10-1 1?20 14 Andro gel 1.62% 75 30 Respondent 10?29-20 1 4 Clonazepam 1 mg 90 30 Dr. T.L. 10-30-2014 Adderall 30 mg 60 ?30 Dr. T.L. 11?09?2014 Androgel 1.62% 75 30 Respondent 23 Androgel? (testosterone) is a Schedule controlled substance pursuant to Health and Safety Code section 11056, subdivision (1), and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, it is used as a replacement therapy in adult males for conditions associated with a de?ciency or absence of endogenous testosterone. 21 FRANK GILMAN, - ACCUSATION NO. 800-2016-022170 28' Date Filled Drug Name Strength Quantity Days Prescriber 12?04?2014 Androgel 1.62% 75 30 - Respondent 12-04-2014 Clonazepam 1 mg 90 30 Dr. T.L. . 12-09-2014 Adderall 30 mg 60 . 30 Dr. T.L. 22. During the period of on or about January 1, 2015, to December 3-1, 2015, respondent had four (4) of?ce visits with patient B. According to respondent?s progress notes, the visits took place on January 9, May 6, October 28, and December 16, 2015. Patient B?s problems during this time generally included, but were not limited to, alleged chronic pain, depression, chronic bronchitis, hypertension, hypo gonadism, and ADHD. Near the end of 2015, patient B?s MED was between 110 to 140 mg/day. During 2015, patient ?lled his prescriptions at approximately six (6) different pharmacies. According to the CURES report for patient B, the following - prescriptions for controlled substances were ?lled for patient during 2015 Date Filled Drug Name Strength Quantity Days Prescriber '01?03-2015 Clonazepam ?05-20 1 5 Andro gel 1.62% 75 3 0 Respondent 01-08-2015 Lorazepam 2 mg 30 _30 Dr. T.L. 01-08-2015 Vyvanse? 70 mg 30 30 Dr. T.L. 01?09-20 1 5 Hydrocodone/APAP 10/325 mg 180 I 22 Respondent 01-09?2015 Oxyco'done 10 mg 90 22 Respondent 03?27?2015 Lorazepam 2 mg 30 30 Dr. T.L. 24 Vyvanse? (lisdexamfetamine dimesylate), a central nervous system stimulant, is a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, it is used to treat Attention De?cit Hyperactivity Disorder (ADHD) or moderate to Severe binge eating disorder (BED) in adults. According to the DEA, stimulants, such as Vyvanse?, are considered a drug of abuse. ?The effects of amphetamines and methamphetamine are similar to cocaine, but their onset is slower and their duration is longer.? (Drugs of Abuse A DEA ResoUrce Guide (2011), at p. 44.) Stimulants are contraindicated for patients with a history of drug abuse. The FDA has issued the following box warning, ?Warning Abuse and Dependence CNS stimulants (amphetamines and containing products), including Vyvanse?, have a high potential for abuse and dependence. Assess the risk of abuse prior to prescribing and monitor for signs of abuse and dependence while on therapy.? 22 FRANK GILMAN, MD. - ACCUSATION NO. 800-2016-022170 Date Filled Drug Name I Strength Quantity Days Prescriber 04-23-2015 Hydrocodone/APAP 10/325 mg 180 22 Respondent 04?24?20 1 5 'Lorazepam 2 mg 30 30 Dr. T.L. 05-12?201 5 Adderall 30 mg 3 0 3 0 Respondent 05?15?201 5 HYdrocodone/APAP _10/325 mg 240 30 Respondent 0 6-22?20 1 5 - Hydrocodone/APAP 10/3 25 mg 180 3'0 . Respondent . 06-30-2015 Lorazepam '1 mg 60 3 0 Respondent 07-22-2015 Hydrocodone/APAP 10/325 mg 180 30 Dr. D.B. 08?24-20 1 5 Hydrocodone/APAP 10/325 mg . 240 3 0 ReSpondent 09?17?2015 Lorazepam 1mg 60 30 - Dr. 21.13.25 09?22-20 1 5 Hydrocodone/APAP 10/32-5 mg i 240 30 Respondent 10-06-2015 Adderall 1.0 mg 30 30 Respondent 10-12-2015 Oxycodone 10 mg 90 22. - Dr. DB. 10-14-2015 - Lorazepam 1 mg 60 ?30 Dr. DB. 10-20-2015' Hydrocodone/APAP 10/325 .mg 240 30 ReSpondent 11-02?2015 Adderall 10 mg 30 30 Respondent 11-04?2015 OxyContin ?20 mg 60 30 Respondent 1 1?1 1?20-1 5 - Lorazepam 1 mg 60 3'0 Respondent 1 1-16-2015 Hydrocodone/APAP Respondent 1 1-25-2015 4 Zolpidem Tartrate 10 mg 30 3 0 Respondent 12?13-2015 Lorazepam Respondent 12-15-2015 Hydrocodone/APAP 1 0/3 25 mg 240 30 Respondent 12-1 6?20 1 5 Adderall Respondent 12-16-2015 OxyContin 10 mg 60 3 0 Respondent 25 At his interview before an HQIU investigator, respondent identi?ed Dr. A.P. as one of his partners that would ?share call? and cover for him if he was out of the of?ce. 23 FRANK GILMAN, MD. - ACCUSATION NO. 800?2016-022170 hb-23. During the period of on or about January 1, 2016, to December 31, 2016, respondent had nine (9) of?ce visits with patient B. According to respondent?s progresslnotes, the Visits took place on January 22, March 17, May 2, May 11, June 8, June 20, June 27, July 7, and July 28, 2016. Patient B?s problems during this time generally included, but were not limited to, alleged chronic pain, depression, anxiety, hypertension, hypo gonadism, Stevens?Johnson (a rare and serious skin and mucous membrane disorder related to severe reaction 'to medicine), episode with diagnosis of bipolar disorder, renal insuf?ciency, pulmonary embolism with brief hospitalization, and ADHD. Beginning in approximately March 2016, patient was A ?lling prescriptions under two different names, of which respondent was unaware. On May 2, 2016, respondent had a follow up visit with patient B, after patient suffered a bipolar manic episode and was admitted to UCSD for Stevens-Johnson secondary to Tegretol. On . May 10, 2016, unbeknownst to respondent, patient ?lled a prescription for Oxycodone 10 mg that was prescribed hy another prescriber, Dr. M.R. On May 11, 2016, respondent had a follow up Visit with patient B, at which time his plan in regard to pain control was documented as ?pt. [patient] previously dependent on short term opiate pain relievers pt. has #57 tablets left of oxycodone 10 mg which his wife is dispensing tid [three per day] will use fentanyl patch26 50 72 hour [one patch every 72 hours] for one month then discontinue after short hydrocodone taper.? (Emphasis added.) 'On June 20, 2016, respondent documented, among other things, that ?[patient last ?lled clonazepam 1 mg tid #90 on 5/27 I and] [hie has alreadv'run out.? 7 (Emphasis added.) On July 7, 2016, respondent had a follow up appointment with patient B. and documented the following as part of his plan, ?pt. requesting pain relief . .. Prefer to avoid pm [as needed] pain reliever with [patient B?s] past opiate dependence will use fentanyl 25 meg patch 26 Fentanyl transdermal (Duragesic?) patches are a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivision (0), and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated fentanyl transdermal patches are used for the management of pain in opioid-tolerant? patients, severe enough to require daily, around-the?clock, long term opioid treatment and for which alternative treatment options are inadequate. The FDA has issued several black box warnings about fentanyl transdermal patches including, but not limited to, the risks of addiction, abuse and misuse; life threatening respiratory depression; accidental exposure; neonatal opioid withdrawal and the risks associated with the concomitant use with benzodiazepines or Other CNS depressants. - 24 FRANK GILMAN, MD. - ACCUSATION NO. 800-2016-022170 hour with goal ofdiscontinuingmedication in 4 weeks,? which was one-half the dosage of patient B?s prior prescription of 50 meg/hour, with patient ?lling the prescription on the same day. (Emphasis added.) On July 28, 2016, respondent had another follow up visit with patient B, in which he noted patch 25 72 hour has helped some but would like to - increase to 50 mcg? with respondent doubling the fentanyl patch dosage from 25' meg/hour back up to 50 meg/hour,27 in combination with the clonazepam 1 mg t.i.d. and zolpidem tartrate (Ambien) 10 mg that was also being prescribed to him. 24. On or about August 1, 2016, at approximately 3:30 am, patient B?s mother was awakened when she heard her nine-month old granddaughter crying in her son?s room. When she entered her son?s room, she saw her son slumped over his bed andnot breathing. Patient B?s mother called her husband to the room who attempted CPR. 9?1-1 was called. When patient was moved off his bed a syringe fell to the ?oor. The autopsy report for patient lists his cause of death as ?Acute Mixed Drug Interaction?28 and manner of death as ?Accident.? According to the CURES report for patient B, the following prescriptions for controlled substances were ?lled for patient during 2016: Filled Drug Name Strength - Quantity Days Prescriber 01 -08?20 1 6 Lorazepam 2 mg 30 30 Respondent 01-12-2016 Hydrocodone/APAP Dr. D.B. 27 At his interview before an HQIU investigator, respondent was asked why he doubled the strength of the fentanyl patch from 25 meg/hour back up to 50 meg/hour and reSpondent. replied that patient advised him that he had doubled up the dose and was using two of the 25 patches. This was not veri?ed, nor was it documented 1n respondent?s chart note. As a result, respondent increased the dosage of the fentanyl patch from 25 mcg/hour to 50 meg/hour, despite his earlier plan to taper patient off of the fentanyl patches. . 28 Speci?cally, the Autopsy Report for patient states, in pertinent part, ?Toxicology testing of peripheral blood detected a potentially toxic concentration of fentanyl (6.8 ng/ml); supratherapeutic concentra'tiOns 0f (0.13 mg/L), citalopram (0.11 mg/L), and amphetamine (0.14 mg/L); and low concentrations of trazodone (trace), zolpidem (trace) and benzodiazepine metabolite7 7-aminoclonazepam (0.07 mg/L). All of the above may have contributed toward central nervous system depression, all are considered contributory toward the death. Amphetamine IS included as it many contribute toward deleterious cardiorespiratory effects. Also detected were trace naproxen, warfarin and ibuprofen (which are not felt to be contributOry toward the death)? 25 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016?022170 Drug Name Quantity Filled Strength Days Pres crib er 01?20-201 6 OxyContin 10 mg 60 3 0 Respondent 01-22-2016 Clonaaepam 1mg 90 30 Respondent 01-25-2016 Zolpidem Tartrate 10 ?g 30 30 Respondent 02-04-2016 Lorazepam 2 mg 30 30 Respondent 02-18?2016 Clonazepam 1 mg 90 3 0 Respondent 02-22-2016 Hydrocodone/APAP 10/325 mg 240 3 0 Respondent. 02?23-20 1 6 Zolpidem Tartrate Respondent 03?02?20 1 629 Lorazepam . 2 mg 30 30 Respondent? 03 -02-2016 OxyContin 10 mg 60 3 0 Respondent 03?17?2016 Clonazepam 1 mg 90 30 Respondent 03-20-2016 Hydrocodone/APAP 10/325 mg 240 30 03?29-20 1 6 Zolpidem Tartrate 10 mg 3 0 3 0 Respondent 03-31-2016. OxyContin 10 mg 60 30 Respondent 04?1 1?20 1 6 Clonazepam 1 mg 90 3 0 Respondent 7. 04-15?2016 Clonazepam 1 mg 42 14 Other 04-19-2016 Adderall 10 mg 30 30 Respondent 04-2542016 Zolpidem Tartrate 10 mg 30 3 0 Respondent 05?09?20 1 6 . Clonazepam 1 mg 90 30 Respondent 05-10-2016 Oxycodone 10 mg 60 10 Other 05?1 1?20 1 6 Fentanyl Transdermal 5 0 meg/hour 5 1 5 Respondent 05?25 -201 6 Adderall 20 mg 30 30 Respondent 05725-2016 Zolpidem Tartrate 10 mg 30 30 Respondent 05-27-2016 Clonazepam 1 mg . 90 30 Respondent - 29 The prescriptions ?lled from March 2, 2016, through July 19, 2016, were ?lled with patient using a different last name. CURES reports were run on both names and the prescriptions under both names are listed 1n the table above. It IS currently unknown whether the use of a different name was pursuant to a legal name change. 26 FRANK GILMAN, MD. - ACCUSATION NO. 800?2016-022170 Filled Drug Name Strength Quantity Days . Prescriber 06-21-2016 Zolpidem Tartrate 10 mg 3 0 3 0 Respondent 06-24?2016 Clonazepam 1mg 45 15 Respondent 06-27-2016 Adderall 20 mg 60 30 Other 07-06?20 1 6 Clonazepam 1 mg 45 15 Respondent 07-07-2016 Fentanyl Transdermal 25 meg/hour 10 ,3 0 Respondent 07-19-2016 Zolpidem Tartrate 10 I 3 3 0 Respondent 07-19-2016 Clonazepam Respondent 07?23-2016 Dexedrine-??0 20 mg ?60 60 Other 07?28-20 1 6 Fentanyl Transdermal 5 0 meg/hour 10 I 3 I Respondent 25. Throughout his course of treatment of patient B, respondent failed to adequately respond to several warning signs indicating misuse, abuse and/or diversion of controlled substances and did'not take adequate risk screening measures to prevent the misuse, abuse and/or the diversion of the controlled substances that he was prescribing. These warning signs included, but were not limited to, multiple early re?lls and overuse of controlled substances. 26. Respondent committed gross negligence in his care and treatment of patient which included, but was not limited to, the following: Respondent failed to properly evaluate and manage patient B?s chronic nonmalignant pain; 30 The prescription for Dexedrine? is actually described by its generic name, dextroamphetamine, in the CURES report. Dexedrine? (dextroamphetamine sulfate) is a central nervous system stimulant of the amphetamine class. D?exedrine? is a Schedule II controlled substance pursuant to Health and Safety Code section 11055, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022; When properly prescribed. and indicated, it is used for the treatment of attention-de?cit hyperactivity disorder and narcolepsy. The DEA has identi?ed amphetamines, such as Dexedrine?, as drugs of abuse. (Drugs of Abuse, A DEA Resource Guide (2011 Edition), at pp. 42-44.) The Federal Drug Administration has . issued a black box warning for amphetamines whiCh provides that ?Aniphetamines have a high potential for abuse. Administration of amphetamines for prolonged periods of time may lead to drug dependence and must be avoided. Particular attention should be paid to the possibility'of subjects obtaining amphetamines for non-therapeutic use of distribution to others, and the drugs should be prescribed Or dispensed sparingly. Misuse of amphetamines may cause sudden death and serious cardiovascular adverse events.? Dexedrine? and other stimulants are contraindicated for patients with a history of drug abuse. - 127 FRANK GILMAN, MD. - ACCUSATION NO. 800?2016-022170 (6) (0. Respondent repeatedly prescribed controlled substances, primarily opioids, to treat patient B?s chronic nonmalignant pain without, among, other things, sufficiently documenting the effect of patient'B?s pain on his function and quality of life, without folldwing a rational treatment plan with measurable stated objectives including, but not limited to, pain level- and function, and without adjusting treatment pursuant to a rationale and clearly documented treatment plan; Respondent repeatedly prescribed controlled substances, primarily benzodiazepines, to treat patient B?s anxiety without, among other things, a suf?cient and clearly documented history, physical examination and/or rationale treatment plan; Respondent repeatedly prescribed various controlled substances including, but not limited to, opioids, benzodiazepines, and/or other CNS depressants, without providing and documenting adequate informed consent; Respondent repeatedly prescribed controlled substances including, but not limited to, opioids, benzodiazepines and/or other CNS depressants, without being cognizant of aberrant drug behavior and without timely and adequate risk screening measures to address aberrant drug behavior including, but not limited to, effectively using pain management agreements, periodically revietving CURES, obtaining information from pharmacies, and/0r effectively utilizing pill counts; Respondent repeatedly increased the risk of harm to patient B, though his concurrent prescribing of opioids, benzodiazepines and/or other CNS depressants; 7 Respondent excessively prescribed various controlled substances including, but not limited to, opiates, benzodiazepines, and/or other CNS 4 depressants; and 28 FRANK - ACCUSATION NO. 800-2016-022170 Respondent occasionally exceeded the recommended maximum daily dosage for acetaminophen (APAP). -- PATIENT . 7 27. During the period of on or about January 1, 2013, to December 31, 2013, respondent had one 1) known of?ce visit31 on July 8, 2013, with patient C, a then?49?year old male. According to the available problem list in mediCal records, Patient C?s problems included, but were not limited to, adrenal cortical adenoma, anxiety, back and neck pain withneuralgia, chest pain, chronic pulmonary embolism, opioid dependence with secondary constipation, hypo gonadotropic hypo gonadism, hypothyroidism, morbid obesity, osteoarthritis with hip and knee pain, and sleep apnea treated with CPAP, with past surgical history of, among other things, . bariatric surgery in February 2012. The progress note for the visit of July 8, 2013, indicates that respondent was attempting to treat Patient C?s pain by prescribing him Oxycodone 15 mg (3 tabs every 3 hours 360 mg/day) which equated to a MED of 540 mg per day. However, unbeknownst to respondent, because he was not checking CURES, patient was periodically ?lling prescriptions from respondent on the same days at two different pharmacies and, thus, was getting twice the number of tablets of oxycodone 15 mg which equated to 720 mg/day of ?oxycodone for a MED of 1,080 mg/day.32 During the period of June 24 to July 15, 2013 [20 days], patient obtained 1,328 tablets of oxycodone 15 mg which equated to approximately 66 pills per day for a MED of 1,485 mg per day. According to the CURES report for patient C, the 31 As part of its investigation of this matter, the HQIU requested a certi?ed copy of medical records for patient from respondent. According to the executed Certi?cation of Records form, the certi?ed records covered the period of January 1, 2013, to March 10, 2017, the - dates the records were produced. The absence of any progress notes prior to July 8, 2013, was discussed with respondent and his counsel who indicated'that ?we would have to look into that.? No additional records were produced by respondent or his counsel. 32 As an example, patient ?lled prescriptions for oxycodone from different pharmacies on March 25 (total'of 332 tabs), April 1 (total of 332 tabs), July 8 (total of 332 tabs), July 15 (total of 498 tabs), August 12 (total of 332 tabs), August 19 (total of 332 tabs), September 16 (total of 332 tabs), October 21 (total of 332 tabs), October 28 (total of 332 tabs), November 4 (total of 332 tabs), and November 18, 2013 (total of 332 tabs). When asked about this at his interview with a HQIU investigator, respondent stated he was not aware that patient was ?lling prescriptions at two different pharmacies on the same day because, as previously indicated, he was not checking CURES at the time. 29 FRANK GILMAN, MD. ACCUSATION NO. 800-2016-022170 following prescriptions for controlled substances were ?lled for patient during 2013: Date Filled I Drug Name Strength Quantity Days Pres crib er 01-03-2013 Oxycodone 20 mg 282 12 Other 01-07-2013 CarisoprodOlE'3 350 mg 30 10 Respondent 01-07-2013 Oxycodone 15 mg 166 6 Respondent 01-10-2013 Oxycodone 20 mg 176 8_ Other 01-14-2013 Clonazepam 1 mg 30 30 Respondent 01-14?2013 Oxycodone 15 mg - 166 6 "Respondent 01-14-2013 Diazepam 10 mg 60 30 Other 01-17-2013 Oxycodone 20 mg 160 10 Other 01?17-2013 Fentanyl Transdermal 25 meg/hour 10 30 Other 01-21?2013 Oxycodone 1 15 'mg 166 6 Respondent 01-25-2013 :Hydrocodone/APAP 5/325 mg 50 8 Respondent 01-28-2013 Oxycodone 15 mg I 166 6 Respondent 02?01?2013 Oxchdone 20 mg 90 30 - Other 02?04-20 1 3 Oxycodone . 15 mg 166 7 - Respondent 02.1 12013 Alprazolam 0.5 mg 90 30 Respondent 02-11-2013 Carisoprodol 350 mg 90 30 Respondent 02-1 1-2013 Clonazepam 2 mg 3 0 3 0 Respondent 02-11-2013 Oxycodone 15 mg 166 8 Respondent 33 Carisoprodol (Soma?) is a Schedule IV controlled substance pursuant to Health and Safety Code section 11057, subdivision and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, it is used for the short? term treatment of acute and painful musculoskeletal conditions. Soma? is commonly used by those who abuse opioids to potentiate the euphoric effect of Opioids, to create a better ?high?, According to the DEA, Of?ce of Diversion Control, a'riso'prodol abuse has escalated in the last decade in the United States. According to Diversion Drug Trends, published by the DEA on the trends in diversion of controlled and noncontrolled pharmaceuticals, carisoprodol continues to be one Of the most commonly diverted drugs. Diversion and abuse Of carisoprodol is prevalent throughout the country. As of March 2011, street prices for [carisoprodol] Soma? ranged from $1 to $5 per tablet. Diversion methods include doctor shopping for the purposes of obtaining multiple prescriptions and forging prescriptions.? 30 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016-022170 LII-PLUM Date Filled . Drug Name Strength Quantity Days Prescrib er 02-12-2013 Clonazepam 1mg 30 - 30 Respondent 02?12?2013 Diazepam 10 mg 60 30. Othef 02-18-2013 Oxyoodone 15 mg _166 7 Respondent 02-25-2013 Oxycodone 15 mg A 166 7 Respondent 03-04-2013 Oxycodone - 15 mg 166 7 Respondent 03-.1 1-201 3 ?Oxycodone 15 mg 166 7 Respondent I I 03-13-2013 Clonazepam 1 mg 30 30 Respondent 03-18-2013 Oxycodone 15 mg 166 6 Respondent 03 -25-2013 Oxycodone . 15 mg 166 7 Respondent 03-25-2013 Oxycodone 15 mg 166 7 Respondent 03-27?201 3. Alprazolam 0.5 mg 90 30 Respondent 03-31-2013 Diazepam 10 mg ??60 - 30 Other 04?01-20 1 3 Oxycodone 15 mg 166 7 Respondent 04?01?2013 Oxycodone 15 mg' 166 7 Respondent 04-08-2013 - Oxycodone 15 mg 166 7 Respondent 04-15-2013 Oxycodone 15 mg - 166 7 - ReSpondent 04-22-201 3 Oxycodone Respondent 04-24-2013 A Alprazolam 0.5 mg 90 3 0 Respondent 04-26-2013 Carisoprodol 350 mg 90 30 Respondent 04-26-201 3 Clonazepam 2 mg 30 30 I Respondent 04-29-2013 Oxycodone 15 mg 166 30 . Respondent 05-06-2013 Oxycodone 15 mg 166 8 . Respondent. 05-13-2013 Oxycodone 15 mg 166 7 Respondent 05-20-2013 Carisoprodol 350 mg 90 30 Respondent . 05?20?20 1 3 Clonazepam 2 mg 30 30 Respondent 05?20?20 13 Oxyeodone 15 mg 332 14 Respondent 3 1 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016~022170 Date Filled Quantity Drug Name . Strength Days PreScriber 05-22-2013 Testosterone Unknown 10 70 Other 05-22?2013 Compound Unknown 10 70 Other 06-03-2013 Oxycodone 15 mg 166 7 Respondent 06-04-2013 Lunesta '3 mg . 30 30 Respondent 06-10?20 13 Oxyoodone 15 mg 166 7 Respondent 06-17-2013 Oxyoodone 15 mg 166 7 Respondent 06-1 9-201 3 Testosterone: Unknown 1 0 70 Other 06?19-2013 Compound Unknown 10 70 Other 06-20-2013 Clonazepam 27mg 30 30 Respondent 06-20?20 1 3 Carisoprodol Respondent 06?20?20 1 3 Alprazolam 0.5 mg 90 3 1 Respondent 06420-2013 Diazepam 10 mg 100 30 Other 06-24-2013 - OXycodone 15 mg 166 7 Respondent 07-01-2013 Oxycodone '15 mg 166 7 Respondent 07-08-2013 Oxycodone 15 mg 166 7 Respondent 07-08-2013 Oxycodone 15 mg 166 - 7 Respondent 07?15?2013 Oxycodone 15 mg .166 7 . Respondent 07-15-2013 Oxycodone I 15 mg 166 7 . Respondent 07-15-2013 Oxycodone 15 mg 3 32 36 Respondent 07-22-2013 Alprazolam 0.5 mg 90 30 Other 07-22-2013 Oxycodone 15 mg 166 7 Respondent 07-22?20 13 Carisoprodol 3 5 0 mg - 90 3.0 ReSpondent 07-22-2013 - Clonazepam 2 mg 3 0 3 0 Respondent 08-06-2013 Clonazepam 1 mg 30 3 0 Respondent 08-06-2013 Testosterone Unknown 10 70 Other 08?06?2013 Compound Unknown 10 70 Other 32 FRANK GILMAN, MD. - ACCUSATION NO. 800?2016-022170 \Date Filled Drug Name Strength Quantity Days Prescriber 08-12-2013 Oxycodone 15 mg 166 7 Respondent 08-12-2013 Oxycodone 15 mg 166 7 Respondent 08?19?2013 Oxycodone 15 mg 166 7 Respondent 08-19?2013 Oxyeodone 15 mg 166 . 7 Respondent 08-22-2013 Lunesta 3 mg 3 0 3 I Respondent 08-23-2013 Alprazolam 0.5 mg 90 30 Respondent 08-23-2013 Carisoprodol 350 mg 90 30 Respondent 08-23-2013 Clonazep'am 2 mg 30 30 Respondent 08-26-2013 Oxycodone 15 mg '166 - 7 Respondent 09?03-201 3 Oxycodone 15 mg 166 30 Respondent 09-09-2013 OXYCodone 15 mg 166' 7 I Respondent 09-10-2013 Clonazep?Respondent 09?14-20 1 3 Carisoprodo1 350 mg . 90 .30 Respondent 09?1 6-2013 - OXycodone 15 mg . 3 166 7 ReSpondent 09-16-2013 Oxycodone 15 mg 166 7 Respondent 09-17?201 3 Diazepam 10 mg 90 90 Other. 09?23-201 3 Oxycodone 15 mg? 166 7 Respondent 10?07?2013 Compound Unknown 10 70 Other 10-07-2013 Testosterone Unknown 10 70 Other 10-07-2013 OXycodone 15 mg 166 7 Respondent 1.0?13?2013 Clonazepam 1mg 30 30 Respondent 10-21-2013 Clonazepam 2 mg 3 0 3 0 Respondent 10721-2013 Oxycodone 15 mg 166 7 Respondent 10-21-2013 Oxycodone 15 mg I 166 7 . Respondent 10?23-2013 Alprazolam 0.5 mg 90 30 Respondent 10-23-2013 Lnnesta 3 mg 30 30 Respondent 33 FRANK GILMAN, ACCUSATION NO. 800-2016-022170 450310 - Drug Name Da?te Filled Strength Quantity Days Prescrib er 10?28-2013 Oxycodone 15 mg 166 7_ Respondent - 10-28-2013 Oxycodone 15 mg 166 7 Respondent 11?04?2013 . Oxyoodone? 15 mg 166 7 Respondent 1 1?04-20 1 3 Oxycodone 15 mg 166 . 7 Respondent 1 1-06-2013 Testosterone Unknown - 10 70 Other I 1 1-06-2013 Compound Unknown 10 70 Other 1 1-1 1-2013 Oxycodone 15 mg 166 7 Respondent 1 1-12-2013 Carisoprodol 350 mg 90 1 30 Respondent 1 1-15-2013 Clonazepam 1 mg 30 - 30 Respondent 1 1-18-2013 15 mg 166 7 Respondent - 1 1-18-2013 Oxycodone 15 mg 166 7 Respondent 1 1-22-2013 Clonazepam 2 mg 3 0 3 0 Respondent 7 11-22-2013 Lunesta 3 mg 30. 30 Respondent 11-22?2013 .Alprazolam 0.5 mg . 90 30 Respondent- 1 1-25?20 1 3 Oxycodone 15 mg -1 66 7 Respondent 12?02-201 3 Oxycodone 15 mg 166 7 Respondent 12-09-2013 Oxyeodone 15 mg 166 7 Respondent. 12?09-20 1 3 Carisoprodol 350 mg 90 30 Respondent 12-10-2013 Diezepam 10 mg 90 90 Other 12?1 1-2013 Clonazepam 1 mg 3 0 30 4 Respondent 12-16-2013 Oxycodone - 15 mg 166 7 . Respondent 12-18-2013 Alprazolam 0.5 mg 90 30 Respondent 12?23-2013 Clonazepam 2 mg 3 0 3O Respondent 12-23?20 1 3 Oxycodone 15 mg 166 7 I Respondent 12-23?20 1 3 Lunesta 3 mg 30 30 Respondent 12-26-2013 Oxycodone 15 mg 166 7 Respondent 34 FRANK GILMAN, - ACCUSATION NO. SOC-20166022170 Lem28. During the period of on or about January 1, 2014, to December 31, 2014, respondent \had two (2) of?ce Visits with patient C. According to respondent?s progress notes, the visits took place on June 3 (almost eleven months since his last visit with respondent) and September 12, 2014 (pre-operative visit for upcoming cervical surgery). Patient C?s problems during thistime generally included, but were not limited to, obesity, osteoarthritis, spinal stenosis, hypogonadism, hypothyroidism, and GERD. During 2014, patient?C continued his practice of ?lling some of his prescriptions for oxycodone on the same day at two different pharmacies which, Once again, doubled the amount of pills he Was supposed to receive on those dates and increased his MED from 540 mg per day to 1,080 mg per day.34 On September 8, 2014, respondent Was given a phone message from a pharmacist indicating that he was ?concerned with [patient and the recent early re?lls.? _On November 3, 2014, patient undeerent extensive back surgery that was performed by Dr. S.L. at Scripps Memorial Hospital to address severe cervical spondylosis, posterior cervical segmental instability, and severe thoracic stenosis with cord compression and severe thoracic degenerative spondylosis. ?According to the CURES report for patient C, the following prescriptions for controlled substances were ?lled for patient during 2014: Date Filled Drug Name Strength Quantity Days Prescriber 01-02-2014 Pro'methazine 6.25 mg/5 m1 120 2 Other Codeine Syrup to 10 mg/5 m1 01-02-2014 Oxycodone 15 mg 166 7 Respondent 01-06-2014 Oxycodone 15_ mg 166 - 7 Respondent 01-09-2014 OxyCOdone 15 mg 166 7 Respondent 01-10-2014 Carisoprodol 350 mg 90 30 Respondent 01-20-2014 Oxyco done 1 5 mg 166 7 Respondent 34 As an example, patient ?lled prescriptions for oxycodone 15 mg from the Hillcrest and Priority pharmacies on January 2 (total of 332 tabs), March 17 (total of 332 tabs), March 24 (total of 332 tabs), March 31 (total of 332 tabs), April 7 (total of 332 tabs), May 5 (total of 332 tabs), July 10 (total of 498 tabs), November 20 (total of 332 tabs), November 21 (150 tabs of 15 mg and 150 tabs of 30 mg) and November 26,2014 (total of 332 tabs). 35 FRANK GILMAN, M.D. - ACCUSATION NO. 800?2016-022170 Date Filled Drug Name Strength Quantity Days Prescrib er 01?21-2014 Testosterone-M35 Unknown . 10 50 Other 01 -2 1-2014 Testo sterone?P36 Unknown 10 50 7 Other 01?22-201 4 Clonazepam 7 2 mg 30 30 Respondent 01-27?2014 Oxycodone 15 mg 166 7 Respondent 02-03-2014 Oxycodone 15 mg 332' 14 . Respondent 02-03?2014 Alprazolam 0.5 mg 90 30 Respondent 02-03-2014 Oxyeodone - 15 mg 166 7 Respondent 02-04-2014 carisoprodol 350 mg 90 30 Respondent 02-13-2014 Oxycodone 15 mg 166 7 Respondent 02-17-2014 Oxycodone . 15 mg 166 7 Respondent 02?20-20 1 4 Qxycodone 15 mg 166 7 Respondent 02?21?2014 Clonaz'epam '2 mg 30 30 Respondent 02-24-2014 Oxycodone 1 15 mg 166 7 Respondent 02?27?20 14 Oxyeodone 15 mg 166 7 Respondent 03-03-2614 Oxycodone 15 mg 166 7 Respondent 03-03-2014 Carisoprodol 350 mg 90 3O Respondent 03-06-2014 AlpraZolam 0.5 mg 90 30 Respondent 03 ?10?2014 . Oxycodone 15 mg. 166 7 Respondent 03 -17-2014 Oxycodone 15 mg 166 7 Respondent 03-17-2014 Oxycodone 15 mg 166 7 Respondent 03?24?20 14 Oxycodone 15 mg 166 7 Respondent 03 -24?20 1 4 Oxycodone 15 mg 166 7 . . Respondent 03-27-2014 Carisoprodol 350 mg 30 30 Respondent 03-?31-2014 Oxycodone 15 mg 166 7 Respondent 35 Testosterone-M is abbreviated for Testosterone Micronized. 36 Testosterone-P is abbreviated for Testosterone Propionate. 36 FRANK GILMAN, MD. - ACCUSATION NO. 800-2016-022170 Date Filled Drug Name Strength Quantity Days Prescriher 03 ?31-2014 ?OXycodone 15 mg . 166 7 Respondent 04-03-2014 Alprazolam 0.5 mg, - 90 30 Respondent 04-07?20 14 Oxycodon?e 15 mg 166 7 - Respondent 04-07?20 14 Oxycodone 15 mg 166 7 Respondent 04-14-2014 Oxycodone 15 mg 166 7 Respondent 04-21-2014 Carisoprodol 350 mg 90 3O Respondent 04-21-2014 Oxycodone . 15 mg 166 7 Respondent, 04?21-2014 Clonazepam 2 mg 30 30 5 Respondent 04-21-2014 Oxycodone '15 mg 166 7 Respondent 04-28?20 1 4 Oxicodone 1' 5 mg 166 7 Respondent 04-2 8-2014 Oxycodone 15 mg 166 7 Respondent 05 -05-20 14 Oxycodone 15 mg 4 166 7 Respondent 05 -05 1 4 Oxycodone 15 mg 166 7 Respondent 05-06-2014 Alprazolam 0.5 mg 90- 3Q Respondent 05-12-2014 Oxycodone .15 mg 166 7 Respondent 05-16?20 14- Clonazepam 2 mg 30 30 Respondent - 05?1 9-2014 . Oxycodone 15 mg 166? 7 Respondent 05-23?20 14 Carisoprodol 350 mg 90 3O Respondent 05-23-2014 Oxycodone 15 mg 166 7 Dr. 05-27?2014 Oxycodone 15 mg I 166 7 Respondent 06?02?20 1 4 Oxycodone 15 mg I 166 7 Respondent 06?05-20 1 4 Oxycodone 15 mg 166 7 Respondent 06-10-2014 Alprazolam 0.5 mg 90 30 Dr. H.W. 06?10-2014 Hydrocodone/APAP 5/325 mg 25 3 Other 37 At his interview before an investigator, respondent identi?ed Dr. H.W. as One of his partners that would ?share call? and cover for him if he was out of the of?ce. 37 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016?022170 Date Filled Drug Name Strength Quantity Days Prescrib er 06-10-2014 Oxycodone 15 mg 166 7 Respondent 06-12-2014 \Oxycodone 15 mg 166 7 Respondent 06-1 6?20 14 Carisoprodol 350 mg 90 . 3 0 Respondent 06-16?2014 Clonazepam 2 mg -3 0 3O Respondent 06-19-2014 Oxycodone - 15 mg 166 7 Respondent 0640-2014 Diazepam - 10 mg 90 90 Other 06?26-20 1 4 Oxycodone 15 mg 166 6 Respondent 06-27-2014 Testosterone-P Unknown 1 0 5 0 Other 06?27?2014 Testosterone-M Unknown 10 50 Other 07?03-26 14 Oxyoodone 15mg 166 6 Respondent 07-07?2014 Alprazolam 0.5 mg 90 30 Dr. H.W. 07?10?2014 Oxycodone 15 mg 73 32 14 Respondent 07?10?2014 7 Oxycodone 15 mg '166 5 7 Respondent '07?1 1-2014 Carisoprodol 350 mg 90 30 Respondent 07-17-2014 Oxycodone 15 mg 166 3 0 Respondent 07-18-2014 Clonazepam 2 mg - 30 30 Other 07-2 1?20 14 Oxycodone _1 5 mg 332 3 0 Respondent 08-01?2014 OxycodOne 15 mg 166 30 Respondent 08?08-20 14 Testo sterone-M Unknown 10 5 0 Other 08?08?20 14 Testo sterone?P - Unknown 10 5 0 Other 08-09?20 1 4 Carisoprodol 350- mg 90 3O Respondent 08-09?2014 Clonazepam 2mg 30 30 m. H.W. 08-11-2014. Oxycodone 15 mg 166 7 Respondent 08-18-2014 Oxycodone ?15 mg 166 7 . ReSpondent 08-25?20 14 Testosterone?M Unknown 1 0 50 Other 08-25-2014 Te stosterone?P Unknown 1 0 5 Other 38 FRANK GILMAN, MD. ACCUSATION NO. 800-2016?022 170 28? Quantity ?Date Filled Drug Name Strength Days Prescriber 08?29-14 Diazepam 10 mg 90 90 Other 09?22?2014 Oxycodone 7 15 mg 166 7 Respondent 10-03-2014 Oxycodone 15 mg 332 . 14 . Dr. HW. 10-23?2014 Oxycodone 15 mg 166 7 Respondent 10-30-2014 Oxycodone 15 mg - -1 66 7 Respondent 11?06-2014 Alprazolam 1mg 60 30 Respondent 1 1-06?20 1 4 Clonazepam 2 mg 30 30 Respondent 1 1?06-20 14 Oxycodone 15 mg 166 7 Respondent 1 1-09-2014 Diazepam 10 mg 5 6 I . '14 Other 1 1?09-20 1 4 Carisoprodol 350 mg 42 14 Other 11-09-2014 - Oxycodone 30 mg 112 14 Other 1 1-09-2014 OxyContin 10 mg 28 14 Other 1 1-09-2014 Oxycodone 30 mg 1 12 14 Other 1 1?09-2014 OxyContin 20 mg 28 14 Other 1 1-15-2014 Oxycodone 15 mg 166 7 Respondent 11-20?2014 Carisoprodol 350 mg 90 30 Dr. A.P. 11420-2014 Oxycodone 15 mg 166 7 Respondent 1 1-20-2014 Oxyeodone- 15 mg 166 7 - Respondent 11?21-2014 Oxycodone . 15 mg 150 19 Dr. S.L. 11-21?2014 Oxycodone 30 mg 150 19 Dr. S.L. 11-21-2014 Diazepam 10 mg 90 45 Dr. S.L. 11?21?2014 A OxyContin 20 mg 90 30 Dr. S-.L. 11?21-2014 OxyContin 10 mg 90 45 Dr. S.L. 11-21-2014 I Carisoprodol 350 mg 90 30 Dr. SL. 112642014 Oxyeodone 15 mg 166 7 I Respondent, 1 1-26-2014 Oxycodone 15 mg 166 7 Respondent 39 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016-022170 Date Filled Drug Name Strength Quantity Days Prescriber 12-04?20 1 4 Clonazepam 2 mg 30 30 Respondent 12?04?2014 - Alprazolam 1mg 60? 30 Respondent 12?04?20 14 Oxycodone 15 mg 166 7 A 7 Respondent 12-1 1-2014 Oxycodone I 15 mg I 166 7 Respondent 12?1 1-2014 Oxycodone 15 mg 100 12 Other - 12-11-2014 Oxycodone - 30mg 100 12 Other 12-15?2014 CarisoprodolDr. 12?15?2014. Diazepam - 10mg 60 30 Dr. s.L. 12?1 8-2014 Oxycodon'e - 15 mg I 166 21- Respondent 12?18?2014 Carisoprodol 350 mg 90 30 Dr. A.P. 12-22-2014 Testosterone?P Unknown 10 3 0 Other 1 2?22-20 14 Testosterone?M Unknown 1 0 3 0 Other 12?23?20 14 Oxycodone 15 mg 166 7 Respondent 4 12-23-2014 Oxycodone . 30 mg 120 18 Other I 12-23-2014 Oxycodone 15 mg 120 15 Other 29. During the period of on or about January 1, 2015., to December 31, 2015, respondent had two (2) of?ce Visits with patient C. According to respondent?s progress notes, the visits took place on October26 and December 11, 2015. Patient C?s problems during this time generally included, but were not limited to, post-operative recovery from multilevel laminectomy with I stabilization, osteoarthritis (improved with weight loss), hypogonadism, hypothyroidism, and GERD. Respondent continued patient on oxycodone 15 mg (3_tabs every 3 hours) 360 mg/day of 540 mg per day] which he inaccurately documented as ?390 mg of ochodone per day (45 mg taken 3 his progress note of October 26, 2015. On December 11, 2015, reSpondent inaccurately documented ?pt; continued 390 mg of oxycodone per day,? when patient was actually taking 360 mg per day, and also noted ?[c]ontinue to consider taper when ready.? During 2015, respondent was preScribing a combination of opioids, benzodiazepines, and 40 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016-022170 - carisoprodol (Soma), a dangerous drug combination known as the ?holy trinity.?38 According to the CURES reportfor patient C, the following prescriptions for controlled substances were ?lled for patient during. 2015: Date Filled Drug Name Strength Quantity Days Pres criber 01-02-2015 Diazepam 10 mg i 90 45 Other 01?07-20 1 5 Oxycodone 15 mg 166- 7 Respondent 01-07-2015 Oxycodone 30 mg '1 20? 8 Other 01?14?2015 Carisoprodol. 350 mg 90 30 Other 01?14?2015 Oxycodone 15 mg 166 7 Respondent 01-21?20 1 5 Oxycodone 5 mg 166 7 Respondent 01-21-2015 Oxycodone 30 mg 120 20l Other 01-21-2015 Oxycodone 15 mg 120 20 Other 01?27?2015 Carisoprodol 350 mg 90 30 Other 01?28?2015 . Oxycodone 15 mg 166 6 Respondent 01 ?2 8-20 1 5 Clonazepam 2 mg 3 0 3 0 Respondent - 01?28-201 5 Alprazolam 1 mg . '60 30 Respondent 02-02-2015 Testo sterone-M Unknown 10 3 0 Other 02?02?20 15 Testo sterone -P Unknown 10 3 0 Other 02-04-2015 Oxycodone- 15 mg 166 7 Respondent 02-10-2015 Oxycodone - 30 mg 120 20 Other 02-10-2015 OXycodone .15 mg 120 20 Other 02-1 1?-20 1 5 Oxycodone 15 mg 166 7 Respondent 02-11-2015 Carisoprodol 350 mg 90 30 Dr. A.P-. 33 ?Taking these three drugs in combination is typically not medically justi?ed. When - taken together these medications may give users a feeling of euphoria similar to heroin. As a result, this prescription drug combination, which may bereferred to as ?Houston Cocktail,? ?Holy . Trinity,? or ?Trio, is subject to abuse and has resulted in deaths.? (M. Forrester, Ingestions of Hydrocodone, Carisoprodol, and Alprazolam 1n Combination Reported to Texas Poison Centers, Journal of Addictive Diseases, 30: 110- 115, 2011. 41 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016-022170 Drug Name Date Filled Strength Quantity Days Prescriber 02-18-2015 Oxycodone 15 mg 166 7 Respondent 02-24-2015 Diazepam 10 mg 90 30 Other 02-24-2015 Carisoprodol 350 mg 90 30 Other 02?25?201 5 Oxycodone 15 mg 166 7 Respondent 02-25-2015 Clonazepam 2 mg 3 0 3 0 Respondent 02?25?2015 Alprazolam 1mg 1' 6Q 30 Respondent 02-26-2015 Oxycodone 30 mg 120 30 Other 02-26-2015 Oxycodone 15 mg 120 20 Other 03-1 6?20 15 Oxycodone 15 mg 120 1 20 Other 03-16-2015 Oxycodone . 30 mg 120 20 Other 03?17?2015 Oxycodone 15 166 7 Respondent 03-19-2015 Testosterone?P Unknown 10 30 Other 03-19-2015 Testosterone?M Unknown 10 30 Other 03?23-20 1 5 I Clonazepam 1 2 mg 30 30 Respondent 03-24-2015 ?Alprazolam 1' mg 60 30 Respondent 03?24?2015 Oxyoodone 15 mg 166 7 Respondent 03-25-2015 Carisoprodol 350 mg 90 30 Other 03?26?20 1 5 Diazepam 10 mg 90 30 Other 03?31?2015 Oxyeodone . 15 mg 166. 7 Respondent 04-03-2015 Oxycodone 15 mg 70 12 Other 04-03-2015 Oxycodone 30 mg 70 1.2 Other 04?07?20 1 5 Carisoprodol 350 mg 90 30 Other 04?07?20 1 5 Oxycodone 15 mg 166 7 Respondent 04-14?2015 Ox?ycodo?e 15 mg 166 30 Respondent. 04-14-2015 Oxycodone' 15 mg 166 7 Respondent 04-21-2015 Oxycodone 15 mg 166 7 Respondent 42 FRANK GILMAN, MD. - ACCUSATION NO. 800?2016-022170 Date Filled D111 Name Strength Quantity Days Prescrib er 04-21-2015 Clonazepam 2 mg 30 30' Respondent 04-21-2015 A Alprazolam I mg 60 30 Respondent 042112015 Oxycodone 15 mg 1 166 7 Respondent 04-27-201 5 Te stosterone?P Unknown 10 12 Other 04-27-2015 Testosterone-M Unknown 10 12 Other 04?28?20 1 5 Oxyoodone 15 mg 166 7 Respondent 04-28-2015? Oxycodone 15 mg 166 7 Respondent 05-12-2015 Oxycodone 15 mg 16 6 7 Respondent - 05-18-2015 - Alprazolam 1 mg 60 30 Respondent 05-19?201 5 Oxycodone 15 mg 166 7 Respondent 05-19-2015 Clonazepam 2 mg 30 3O Respondent I 05?19-2015 Oxycodone 15 mg 166 7 Respondent I 05 -26i201 5 Oxycodone 15 mg 166 7 Respondent 06?02-20 1 5 CariSOprodol Respondent 06-02-2015 Oxycodone . 15 mg 166 7 Respondent 06-09-2015 Oxycodone 15 mg 166 7? Respondent 06-15?201 5 OXyeodone 15 mg 166 I 7 Respondent 06-17-2015 Alprazolam 1 mg 60 30 Respondent 06-17-2015 Clonazepam 2 mg 30 30 Respondent 06-22-2015 Oxycodone 15 mg 166 7 1 Respondent 06-23-2015 Oxycodone 15 mg 16 6 7 Respondent 06?29-201 5 Oxycodone 15 mg 166 7 Respondent 06-29-2015 CariSOprodol 350 mg 90 30 Respondent - 06-3 0-2015 Oxycodone 15 mg 166 7 Respondent 07-06-2015 I Oxycodone 15 mg 166 7 Respondent 07-07-2015 Oxycodone 15 mg 166 . 7 Respondent 43 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016?022170 Date Filled Drug Name Strength Quantity Days Prescrib er 07?13?2015 C1onazepam' 2 mg 30 30 Respondent 07-13-2015 Oxycodone 15 mg- 166 7 Respondent 07?1 3 -2015 Alprazolam 1 mg 60 3 0 Respondent 07420?20 1 5 Oxycodone 15 mg 166 1 7 - Respondent 07-27-2015 Catisoprodol 350 mg 90 30 - Respondent . 07-27-2015 Oxycodone 15 mg 166 7 Respondent 08-03-2015 Oxycodone 15 mg 166 7 . Respondent 08-03?2015 I Oxycodone - 15 mg - 166 7 Respondent 08-10-2015 - Alprazolam 1 mg _60 3 0 Respondent 08-10?2015 Clonazepem- 2 mg 30 30 Respondent 08-10-2015 Oxycodone 15 mg 166 7 Respondent 08-10-2015 Oxycodone 15 mg 332 7 Respondent 08-21?201 5 Carisoprodol 3 50 mg . 90 3O Respondent 08?24-2015 Oxycodone 15 mg. 166 7 Respondent 08?3 1-2015 Oxycodone 15 mg 166 7 Respondent 09-01-2015 Testo sterone-P Unknown . 10. 12 Other 09-01-2015 "Testosterone-M Unknown 10 12 Other 09-03?20 1 5 Oxycodone 15 mg 166 7 Dr. A.P. 09-09-2015 - c1onozepam 2 mg 30 30 Respondent. 09?08-20 1 5 Alprazolam 1 mg 60 3 0 Respondent 09-08-2015 tOxycodone 15 mg 1 166 7 Respondent 09?14-20 1 5 Oxycodone 15 mg 166 7 Respondent 09-14-2015 Oxycodone 15 mg 166 7_ Respondent 09-16?2015 consoptodol 350 mg 90 . 30 Respondent 09-18-2015 Codeine Syrup 10 mg/5 ml to 240 4 . Dr. DB. 100 mg/5 m1 09-21?2015 Oxycodone 15 mg . 166 7 Respondent 44 FRANK GILMAN, MD. - ACCUSATIQN NO. 8010-2016-022170 Date Filled Drug Name Strength Quantity Days Prescriber 09?21-20 1 5 Oxycodone. 15 mg. 166 7 Respondent 09?28?20 1 5 Oxycodone 15 mg 166 7 Respondent 10-05-2015 Clonazepam 2 mg. 30 30 Respondent 10-05-2015 Oxycodone 15 mg 166 7 Respondent 10-05-2015 Alprazolnm 1 mg 60 30 Respondent 10-12-2015 ?Catisoprodol 350 mg 90 30 Respondent 10?12?2015 Oxycodone 15 mg 166 7 Respondent 10-19-2015 Oxycodone 15 mg 166 7 1 Respondent 1 0-19?20 15 Oxycodone 15 mg 166 7 Respondent 10-26-2015 Oxycodone 15 mg 166 - 7 Respondent 10-26?2015 1 Oxycodone 15 mg 166 21 Respondent 1 1?02?20 1 5 Clonaz'epam 2 mg 3 0 3 0 Respondent . 1 1-02?20 1 5 Oxycodone 15 mg 166 7 Respondent 1 1-02-2015 Alprazolam? 1 mg 60 3 0 Respondent 1 1-02-2015 Oxycodone 15 mg 166* 7 Respondent 1 1-05-201 5 Testosterone?M Unknown 1 70 Other 1 1?05-20 1 5 Testosterone-P Unknown 1 0 70 Other 1 1-09-2015 Carisoprodol 350 mg 90 3Q Respondent 1 1-09-2015 Oxycodone 15 mg 166 . 7 Respondent 11-09?2015 Oxycodone 15 mg 166 7 Respondent 1 1?16-201 5 Oxycodone 15 mg 166 7 Respondent - 11-23?20 1 5 Oxycodone 15 mg 166 7 Respondent 1 1-25-2015 Oxycodone 15 mg 7 166 7 Respondent 1 1-25-2015 Alprazolam 1 mg 60 3 0 Respondent 1 1-3 0?20 1 5 Clonazepam 2 mg 3 0 3 0 Respondent 12-04-2015 Carisoprodol 350 mg 90 30 Respondent 45 FRANK GILMAN, MUD - ACCUSATION NO. 800?2016-022170 U1 \lCh Date Filled Drug Name Strength Quantity Days Prescriber 12-04-2015 Oxycodone 15 mg 166 7 Respondent 12-07-2015 OxycodOne 7 15 mg 166 - 7 Respondent 12-22-2015 Alprazolam 1 mg I 60 30 Respondent 12-29-2015 Clonazepam 2 mg 30 3 0 Respondent 30. During the period of on or about January 1, 2016, to December 31, 2016, respondent had two (3) of?ce visits with patient C. According to respondent?s progress notes, the visits took place on February 25 and August 24, 2016. Patient C?s problems during this time generally included, but were not limited to, hypogonadism, hypothyroidism, GERD, low back pain, and opioid dependence. On January ?2 1 2016, respondent authorized an early re?ll of oxycodone 15 mg DuringMarch and April 201'6, patient was also ?lling preseriptions for opiates written by Dr. a bariatric surgeon, that respondent stated was related to post-surgical pain after patient C?s gastric sleeve was converted to a gastric bypass to address acid reflux.39 As a result, patient received an additional 990 tablets of opiates (oxycodone, oxycodone/APAP, or morphine sulfate) and an additional 120 tablets of diazepam from what was already being prescribed by respondent, further increasing the risk of harm to patient C. On July 22, 2016, patient signed a Pain Management Agreement.? On September 29., 2016, patient asked-for 39 During his interview before a HQIU investigator, respondent was asked if he was aware of the number of prescriptions, primarily for opiates, that were being written by Dr. S.B., a bariatric surgeon. Respondent indicated that he was aware because patient had allegedly told him that Dr. S.B. had prescribed some medications for post-operative pain. However, respondent was not aware ?to? the degree of the number of re?lls? because, in part, he was not using CURES on a regular basis until 2017. 40 Respondent?s use of pain management agreements for patients and in response to their aberrant drug behavior Was an ineffective use of the pain management agreements, which should be used as soon as possible when a physician is prescribing controlled substances on a regular basis. One of the purposes of a pain management agreement is to prevent aberrant drug behavior before it occurs. Pain management agreements are also ineffective if a physician does not take active steps to monitor a patient?s use of controlled substances through periodic reviews of CURES, pill counting, toxicology Screens, etc., to determine if the patient is complying with the terms and conditions of the pain management agreement. The pain management agreement for patient provided, among other things, that patient would not use any illegal drugs, would not sell or trade his medications, would not try to obtain opioids, stimulants or anxiety medications from another doctor, would safeguard his medicine, re?lls would only be made during regular of?ce hours, he wOuld only get his prescriptions ?lled at Hillcrest or 24 [Hour] Rite-Aid, would submit to blood or urine testingto ensure compliance with the agreement, would . (continued. . .) 46 FRANK GILMAN, M.D. ACCUSATION NO. 800-2016-022170 .early re?ll. When asked why he needed an early re?ll, patient replied he had been taking ?about 6 more tabs a day? than originally prescribed, which would have pushed his total up to 30 tabs of oxycodone 15 mg per day (450 mg/day which equates to a MED of 675 mg/day). When M.G. from respondent?s of?ce followed up with patient on September 30, 2016, to discuss his request for an early re?ll, his speech was slurred,41 he was dif?cult to understand, and he was agitated about his re?llrequest not being granted, as had been done in the past. M.G. wrote a detailed and account of her conversation with patient that was electronically signed by respondent on October 10, 2016. According to the CURES report for patient C, the following prescriptions for controlled substances were ?lled for patient during 2016: . patient C, but not by respondent. Date Filled Drug Name Strength Quantity Days ?Prescriber 01 -04-2016 Carisoprodol 350 mg . 90 30 Respondent 01-15-2016 Oxycodone 15 mg 166 7 Respondent 01?21-201 6 Oxycodone . '15 mg - 21 - 2 Respondent 01-22-2016 Oxycodone 15 mg 166 7 Respondent 01 -22-201 6 Oxycodone 15 mg 166 7 Respondent 01-23-2016 Alprazolam . 1 mg 60 30 Respondent 01-27-2016 Clonazepam . 2 mg 30 30 Respondent 01-29-2016 Oxycodone 15 mg I 166 7 Respondent (. . .continued) not take medicine ?at a rate greater than the prescribed rate,? would bring all medications to the of?ce, and could comply with any recommendations made in a pain management program. The copy of patient C?s 'pain management agreement in the certi?ed medical records is signed by 41 At one point during his interview before a HQIU investigator, respondent was asked ell, now, as you sit here today, and [the district medical consultant] has gone over the list of opioids, that was being prescribed by another physician concurrently, with your preScribing, is that of concern to you?? Respondent replied, in pertinent part, that ?it is a concern. . .I am using? the CURES on a regular basis since 2017. And during the conVersations with [patient seeing him in the of?ce I never again got the sense he was having adverse health effects. He wasn?t: slurring his speech. He wasn?t ataXic. He was alert and oriented.? But, in truth and fact, patient had slurred speech, was dif?cult to understand, and was agitated about not getting a re?ll on September 30, 2018, as documented by M.G. on the same date, and electronically signed and. acknowledged by respondent on October 10, 2016. '47 FRANK GILMAN, MD. - ACCUSATION NO. 800-2016?022170 Date Filled Drug Name Strength Quantity Days Prescrib er 02-01-2016. Carisoprodol 350 mg 90 3O Respondent 02-05?2016 Oxycodone 15 mg 166. 7 . Respondent 02-12-2016 OxycodOne 15 mg 166 7 Respondent 02?18-2016 OxycodOne 15 mg 168 7 Respondent 02-22-2016 Alprazolam 1 mg 60 30 Respondent. 02-25-2016 Clonazepam 2 mg 3 0 3 0 Respondent 02?25?2016 Oxycodone 15 mg 168 7 Respondent 02?26-20 1 6 Carisoprodol . 350 mg 90 30 Respondent 02?29?2016 Triazolam- .25 mg 10 7 Other 03-01?2016 Oxycodone/APAP 10/325 mg 30 5 SB. 03-03-2016 Oxycodone 15 mg 168 7 Respondent 03-04-2016 Oxycodone .7 15 mg? 90 30 5.13. 03-04-2016 Diazepam 10 mg 60 - 30 SB. 03-04-2016 Oxycodone 30 mg 90, 30 SB. 03-05-2016 Morphine Sulfate.42 30 mg 30 10 SB. 03-05-2016 Morphine Sulfate 15 mg 30 30 SB. 03 -08-2016 Testosterone-M Unknown 10 70 Other 03-08-2016 Testosterone-P Unknown 10 70 I Other 03-10-2016 Oxycodone 15 mg 168 7 Respondent 03-11-2016 Oxycodone 15 mg 90 11 SB. 42 Morphine sulfate (MS Contin?), an opioid analgesic, is a Schedule II controlled - substance pursuant to Health and Safety Code section 11055, subdivision (6), and a dangerous drug pursuant to Business and Professions Code section 4022. When properly prescribed and indicated, it is used for the management of pain that is Severe enough to require daily, around-the- . clock, long?term opioid treatment and for Which alternative treatment options are inadequate. The DEA has identi?ed oxycodone, as a drug of abuse. (Drugs of Abuse, A DEA Resource Guide (2011 Edition), at p. 39.) The Federal Drug Administration has issued a black box warning for MS Contin? which warns about, among other things, addiction, abuse and misuse, and the possibility of life-threatening respiratory distress. The warning also cautions about the risks associated with concomitant use of MS Contin? with benzodiazepines or other central nervous system (CNS) depressants. 48 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016-022170 xyox Date. Filled Drug Name Strength Quantity Days Prescriber 03-11-2016 Morphine Sulfate 30 mg 30 10 SB. 03?11?2016 Oxycodone 30 mg 90' 11 . S.B. 03-17?2016 ?Oxycodone 15 mg 168 7 Respondent 03?21-2016 Morphine Sulfate 30 mg 90 30 3.13. 03-21-2016 Oxycodone 30 mg. 90 11 SB. 03-21-2016 Oxycodone' 15 mg 90 11 SB. 03-21?20 1 6 Alprazolam 1 mg 60 30 Respondent 03-22-2016 Clonazepam 2 mg 30 30 Respondent 03 -22-2016 Carisoprodol 350 mg 9Q 3 0 Respondent 03?24-201 6 Oxycodone 15 mg 168 7 Respondent 03-30-2016 Oxycodone 30 mg 9O 11 SB. 03-30-2016 Oxycodone 15 mg 90 11 SB. I 03-31-2016 Oxycodone 15 mg 168 7 Respondent 04?0 1-201 6 Morphine Sulfate 10 mg 60 30 - SB. 04-02-2016 Diazepam 10 mg 60 30- .B. 04-07-2016. Oxycodone 15 mg 1681 7 Respondent 04-13-2016 Oxyeodone 15 mg 168 7 Respondent 1 04-20-2016 Oxycodone 15mg 168 7 Respondent 04-20-2016 Clonazepam 2 mg 3 0 3 0 Respondent 04-21-2016 Carisoprodol 3 50 mg 90 30 Respondent 04-21-2016 Alprazolam 1 mg 60 30 Respondent 04?27-201 6 Oxycodone 15 mg 168 7 RespOndent 05-04-2016 Oxycodone 15 mg 168 7 Respondent 05-1 1-2016 Oxycodone- 15 mg 168 7 Respondent 05-18-2016 Oxycodone ?1 5 mg 168 7 Respondent 05-18-2016 Clonazepam '2 mg 30 30 Respondent. 49 FRANK GILMAN, MD. - ACCUSATION NO.I800-2016-022170 Date Filled Drug Name Strength Quantity Days Prescrib er 05-18-2016 Alprazolam 1 mg 60 30 Respondent 05-18?2016 Carisoprodol - 350 mg .90 30 Respondent. 05?1 8-2016 - Oxycodone . 15 mg 168 7 - Respondent 05 -25-2016 Oxycodone 15 mg 168 7 Respondent 06-01-2016 Testosterone?M Unknown 10 5 70 1 Other 06-01-2016 Testosterone?P - Unknown I 10 70 Other 06-01-2016 Oxycodone 15 mg 168 7 Respondent 06?07?2016 OXycodone 15 mg .168 7 Dr. HW 06?14-20 1 6 Carisoprodol 3 50 mg 90 30 Respondent - 06-14-2016 Oxycodone 15 mg - 168 7 Respondent "06?14-2016. Clonazepam 2 mg 30 30 Respondent 06-14-2016 Alprazolam 1 mg i 60 3 0 Respondent 06-21-2016 Oxyeodone 15 mg 168 7 Respondent . 06-28-2016 Oxycodone 15 mg 16 8 7 Respondent 07?05 ?201 6 Oxycodone 15 mg 168 7 Respondent 07-1 1-2016 Carisoprodol 350 mg 90 30 Respondent 67-1 1-2016 Oxycodone 15 mg 336 14 Respondent 07?1 1?20 1 6 Clonazepam 2mg 30 3 0 Respondent 07-11?2016 Alprazolam' 1mg - 60 30 Respondent 08-01-2016 Oxycodone 15 mg 16 8 7 Respondent 16 Carisoprodol 350 mg 90 3 0 Respondent 08-08-2016 Alprazolam- 1mg 60 3o Respondent 08-08-2016 Clonazepam - 2 mg 30 30 Respondent .08-08?20 1 6 'Oxycodone 15 mg - 168 7 Respondent 08-12?2016 Testosterone-M Unknown 10 70 Other 08- 1 2?201 6 Testosterone?P Unknown . 10 70 Other 50 FRANK GILMAN, - ACCUSATION NO. 800-2016-022170 000me Date Filled. Drug Name Strength Quantity Days Prescriber 08?12?2016 Oxycodone - 15 mg 168 7 Respondent 08-17-2016 Clonazepam 2 mg 30 30, Respondent 08-17-2016 Alprazolam 1 mg 60 3 0 Respondent 08-17-2016 Carisoprodol 350mg 90 30 Respondent 08-22-2016 .- Oxyeodone '15 mg 168 7 Respondent 08-29-2016 Oxycodone 15 mg . 168 7 Respondent 09-02-2016 Oxyeodone 15 mg 168 7 Respondent 09-12-2016 Oxycodone 15 mg 16 8 7 . Respondent 09-14-2016 Clondzepam 2 mg 30 . 30 Respondent 09-14-2016 Alprazolam 1 mg 60 30 Respondent 02? 14-201 6 'Carisoprodol 350 mg 90? 30 Respondent 09-19-2016 Oxycodone 15 mg 168 7 Respondent 09-19-2016 Oxycodone 15 mg 4 168 7 Respondent 10-03-2016 Oxyeodone 15 mg . 168 7 Respondent 10-07-2016 ORycodone 15 mg 1 168 7 Dr. A.P. 10-10-2016 Alprazolam 1 mg 60 30 Respondent 10-10-2016 Carisoprodol 350 mg 90 . 30 Respondent 10?1 1-2016 Clonazepam 2 mg 30 30 Respondent 10?17-2016 Testo sterone?M Unknown 10 70 Other 107 1 7-201 6 Testosterone?P Unknown 10 70 Other 10-17?2016 Oxycodone 15 mg . 168 7 Respondent 10-24-2016 Oxyco'done 15 mg 168 7. Respondent 10-31-2016 Oxycodone' 15 mg 168 7 Respondent 1 1-07-2016 Alprazolam 1 mg - 60 30 Respondent A I 1 1-07-2016 Carisoprodol Respondent 1 1-07-2016 Clonazepam 2 mg 3 0 30 Respondent 5 1 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016-022170 27? 28' Date Filled Drug Name Strength Quantity Days Prescrib er 1 1-07-2016 Oxycodone 15 mg _1 68 7 . Respondent 1 1-14-2016 Oxycodone 15 mg 168 7 Respondent 1 1?2 1?201 6 Oxvcodone 15 mg 1 68 7 Respondent 11-22-2016 Oxycodone/APAP . 5/325 mg 20 2 Other 1 1-28-2016 Oxycodone 15 mg 168 7 Respondent 12-02-2016 Alprazolam 1 mg 60 30 Respondent 12-0242016 Carisoprodol 350 mg 90 30 Respondent 12-02-2016 Clonazepam 2 mg 3 0 3O Respondent 12-05-2016 Oxycodone 15 mg 1.68 7 Respondent 12-12-2016 Oxycodone 15 mg 168 7 Respondent 12-19-2016 - Oxycodone 15 mg 168 7 Respondent . 12-23-2016 Oxycodone 15 mg 168 7 Respondent 12-29?20 1 6 Alprazolam 1 mg 60 30 Respondent 12-29-2016 Carisoprodol 350 mg 90 30 Respondent 12?29-20 1 6 Clonazepam 2 mg i 30 30 . Respondent 12-30-2016 Oxycodone 15 mg 168 .7 . Respondent 31. Throughout his course of treatment of patient C, respondent failed to adequately respond to several warning signs indicating misuse, abuse and/or diversion of controlled substances and did not take adequate risk screening measures to prevent the misuse, abuse and/or the diversion of the controlled substances that he was prescribing. :These warning signs included, but were not limited to, requests for early re?lls, drug intoxication, excessive use of controlled substances, a pharmacist voicing concerns over the controlled substances being prescribed to patient C, and obtaining controlled substances from multiple prescribers and pharmacies. 52 FRANK GILMAN, MD. - ACCUSATION NO. 800-2016-022170 32! Respondent committed gross negligence in his care and treatment of patient which included, but was not limited to, the following: I (6) Respondent failed to properly evaluate and manage patient C?s chronic nonmalignant pain; Respondent repeatedly prescribed controlled substances, primarily opioids, to treat patient C?s chronic nonmalignant painwithout, among other things, suf?ciently documenting the effect of patient C?s pain on his function and quality of life, without following a rational treatment plan with measurable stated objectives including, but not limited to, pain level and ?Jnction, and without adjusting treatment pursuant to a rationale and clearly documentedtreatment plan; 7 Respondent repeatedly prescribed controlled substances, primarily . benzodiazepines, to treat patient C?s anxiety without, among other things, - a suf?cient'and clearly documented history, physical examination and/or rationale treatment plan; I Respondent repeatedly prescribed various controlled substances including, but not limited to, opioids, benzodiazepines, and/or other CNS depressants, without providing and documenting adequate informed consent; Respondent repeatedly prescribed-controlled substances including, but not limited to, opioids, benzodiaZepines, and/ or other CNS depressants, without. being cognizant of aberrant drug behavior and without timely and adequate risk screening measures to address aberrant drug behavior I - including, but not limited to, effectively using pain management agreements in a non?reactive manner, periodically reviewing obtaining information from pharmacies, utilizing pill counts, and/or properly c00rdinating care with other physicians and prescribers; 53 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016-022170 Respondent repeatedly increased the risk of harm to patient C, though his. concurrent prescribing of opidids, benzodiazepines, carisoprodol (Soma), and/or other CNS depressants; and Respondent excessively prescribed various controlled substances including, but not limited to, opiates, benzodiazepines, and/or other CNS depressants. PATIENT 33. According to respondent, he had treated Patient D, since approximately 1992. During the period of on or about January 1, 2013, to December 31, 2013, respondent had eleven (1 l) of?Ce visits with patient D, a then-71? year?old male. According to respondent?s progress notes, the visits took plaCe on January 7, February 5, March 12, May 28 (chief complaint of ?follow up from fall? after taking ?a second 5 mg zolpidem tablet?i with assessment of ?frequent falls? with patient ?advised not to increase his norco dosing given his frequent falls?), June 24, August 23, September 19, October 10, November 7, November 18, and December 31, 2017. Patient D?s problems during this time generally included, but were not limited to, rotator cuff repair, hypertension, edema and pain associated shoulder surgeries on January 24 (right rotator cuff repair) and October 17, 2013 (right shoulder reversal). On June 14, 2013, respondent entered a ?chronic care update? indicating ?[n]otice sent to Dr. of?ce to avoid ?lling pain medications unless managing post op pain or on emergency basis when this of?ce cannot be reached.? According?to opiate medications listed on respondent?s ?current meds? list of December-31, 2013, patient D?s NIED at the end of 2013 was at least 184 mg/day.43 A pain management agreement44 was executed by respondent and patient on June 24, 2013. During 43 This computation is based on 120 mg of hydrocodone/APAP per day and 16 mg of hydromorphone per day. This computation does not include opiates that were being prescribed by other health care practitioners. 44 The pain management agreement for patient provided, among other things, that patient would not use any illegal drugs, would not sell or trade his medications, 'would not try to obtain opioids, stimulants or anxiety medications from another doctor, would safeguard his medicine, re?lls would only be made during regular of?ce hours, he would only get his prescriptions ?lled at CVS 1n Mission Valley, would submit to blood or urine testing to ensure compliance with the agreement, would not take medicine? ?at a rate greater than the prescribed (continued. . .) 54 FRANK GILMAN, MD. ACCUSATION NO: 800?2016-022170 2013, patient had his prescriptions ?lled at approximately seven (7) different pharmacies; According to the CURES report for patient D, the following prescriptions for controlled substances were ?lled for patient during 2013: Quantity 1 Date Filled ?Drug Name Strength Days Prescrib er 01-08-2013 Temazepam 15 mg 30 30 Respondent 01-16-2013 Hydrocodone/APAP 10/ 325 mg 60 5 Other I 01-16?2013 Zolpidem Tartrate 5 mg . 60 30 Respondent 01-16?2013 Oxycodone/APAP 10/325 mg 60 5 Other 01-16-2013 Temazepam 15 mg 30 30 Respondent 01-18-2013 Temazepam '15 mg 60 30 Respondent 01-20-2013 Hydrocodone/APAP 10/325 mg 240' 20 Respondent 01?28-2013 Oxycodone/APAP 10/325 mg - 80 13 Other 02-05-2013 Oxycodone/APAP 10/ 325 mg 80 7 Other 02?05-2013 Hydrocodone/APAP 10/325 mg 240 30 Respondent 02?12-2013 Oxycodone/APAP 10/325 mg 80 7 Other 02?19-2013? Oxycodone/APAP 10/325 mg 80 6 iOther 03-02-2013 Temazepam 15 mg 60 3 0 . Respondent 03?04-20 1 3 Hydrocodone/APAP 10/325 mg 240 30 Respondent 03 -13-2013 Zolpidem Tartrate 5 mg 60 3 0 Respondent '03-29-2013 Hydrocodone/APAP 10/325 mg 20 5' Other 03-30-2013 Hydrocodone/APAP 10/325 mg 240 30 Respondent 03 -30-2013 Temazepam 15 mg 60 30 Respondent 04-10-2013 Zolpidem Tartrate 5 mg 7 60 30 Respondent 04-25-2013 Hydrocodone/APAP Respondent (. . .continued) rate,? would bring all medications to the of?ce, and could comply with any recommendations made in a pain management program. 55" FRANK GILMAN, MD. - ACCUSATION NO. 800-2016-022170 10 ?11'28 Date Filled Dru g. Name Strength Quantity . Days Pres eriber 05-06-2013 Temazepam 15 mg 60 60 Respondent 05-11-2013 Zolpidem T-artrate 5 mg 60 30 Respondent 05-22-2013 Hydroeodone/APAP 5/5 00 mg 20 3 Other 05-23-2013 Hydrocodone/APAP 7.5/ 325 mg 120 15 Respondent 05?28-20 1 3 Hydrocodone/APAP 7.5/3 25 mg 120 15 Respondent 06-04-2013 Hydrocodone/APAP 10/325 mg . 80 13 Other 06-11-2013 Temazepam 15 mg 60 30 Respondent 06-24-2013 Hydrocodone/APAP' 10/325 mg 240 30 Respondent 07-16-2013 Temazepem 15 mg 60 3 0 Respondent 07?2 1-201 3 Hydrocodone/APAPV 10/ 3 25 mg 240 30 Respondent 07-3 1-2013 Zolpidem Tartrate 10 mg 30 30 Other 07-31-2013 Oxyeodone/APAP 10/325 mg 19 4 Other 08?1 8-2013 Hydrocodone/APAP 10/325 mg 240 30 Respondent 08-24-2013 - Oxycodone 7.5/325 mg 240 30 Respondent 09-15?2013 Hydrocodone/APAP Respondent 09?19?2013 Oxycodone/APAP 1'0/ 325 mg 120 15 Respondent 10?03-20 1 3 Oxycodone/APAP 1 0/ 325 mg 120 15 Respondent 10-15-2013 Hydrocodone/APAP 10/325 mg 240 3 0 Respondent 10-16-20-13 . Oxyeodone/APAP 10/325 mg 120 I 15 Respondent 10-21-2013 Hydromorphone 2 mg 80 10 Other 10-24-2013 Hydromorphone 4 mg 90 15 . - Other 10-31-2013 Oxycodone/APAP 10/325 mg 120 15 Respondent 1 1-06-2013 Hydrocodone/APAP Respondent 1 1-06-2013 . Hydromorphone 2 mg 120 15 Respondent 1 1-18-2013 Hydromorphone 2 mg 120 _15 Respondent 1 1-19?2013 Hydrocodone/APAP Respondent 56' FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016?022170 Date Filled Drug Name Strength Quantity I Days Prescrib er 12-02-2013 Hydromorphone 2 mg 60 7 Dr. .W. 12-08-2013 . Hydromorphone I 2 mg 60 7 I .Dr. H.W. 12-13-2013 Hydrocodone/APAP 10/325 mg 240 20 Respondent 12-17-2013 Hydromorphone 2 mg 60 . 7 Respondent 12-22-2013 Hydromorphone 2 mg 120 15 Respondent 12-31-2013 Morphine Sulfate 15 mg 90 . . 3 Respondent 34. During the period of on or about January 1, 2014, to December 31, 2014, respondent had siX.(6) of?ce visits with patient D1. According to respondent?s progress notes, the visits took place on March 27, April 29, June 16, July 2, August 15 (chief complaint listed as ?Recent fall caused injury to right side of face? with patient describing fall and then requesting early re?ll ?vacation over-ride? on his Norco with respondent granting ?vacation override on norco for pick up of 37d [days] time 8/day #296?) and November 14, 2014. Patient D?s problems during this time generally included, but were not limited to, HTN, chest pain (which resolved), shoulder pain, opioid dependence, facial abrasion from fall on August 12, chronic recurrent major depressive disorder and anxiety. On January 24, 2014, reSpondent approved an early re?ll because patient was traveling to Paris in a few days with another vacation over?ride on August 15, 2014. During 2014, patient had his prescriptions ?lled at apprOximately ?ve (5) different pharmacies, which was a violatio?nof the pain management agreement he had signed, At the end of 2014, patient D?s MED was at least 170 mg/day. According to the CURES report for patient D, the following prescriptions for controlled substances were ?lled for patient during 2014: Date Filled Drug Name - Strength Quantity Days Prescriber 01?10?2014 Hydrocodone/APAP 10/325 mg 240 20 Respondent 01?24-2014 Morphine Sulfate 15 mg 90 20 Respondent 02-04-2014 Hydrocodone/APAP 10/325 mg 240 20 Respondent 02-18-2014 Hydromorphone 15 mg 90 a 30 Dr. 13.13. 03-04-2014 Hydrocodone/APAP 10/325 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016-022170 Date Filled Drug Name Strength Quantity Days Prescriber 03?17?2014 1 Morphine Sulfate 15mg 90 30 Respondent 03-27-2014 Hydrocodone/APAP 10/325 mg 240 30 Respondent 04-1 5?20 14 Morphine Sulfate 15 mg 90 30 Respondent 04-23?20 14 Hydrocodone/APAP 10/325 mg 240? 30 Respondent 04-29?2014 Morphine Sulfate 30 mg 90 30 Respondent 05-20-2014 HydrocodOne/APAP 10/325 mg 240 20 Respondent 05-26?2014 Morphine Sulfate 30 mg 90 1 30 Respondent. 06-16-2014 Hydrocodone/APAP 10/325 mg 240 20 Respondent 06-20-2014 Morphine Sulfate 30 mg 90 30 Respondent 07?08?2014 Hydrocodone/APAP 10/325 mg 240 20 1 Respondent 07-17-2017 Morphine sulfate 30 mg 90 30 Respondent 07-30-2014 Hydrocodone/APAP- 10/325 mg 240 20 Respondent 08?09?20 14 Morphine Sulfate. 30mg 90 30 Respondent 08?28?2014 Hydrocodone/APAP 10/325 mg 296 37 Respondent 09?04?2014 Morphine Sulfate . 30 mg 90 30 . Respondent 09-26-2014 Hydrocodone/APAP 10/325 mg 240 20 Dr. D.B. 09-27-2014 Morphine Sulfate 30 mg 90 30 Dr. D.B. 10?24?2014 . Hydrocodone/APAP 10/32? mg i 240 20 Respondent 10?25-2014 Morphine Sulfate 30 mg 90 I 30 Respondent 1 1?1 8-2014 Hydrocodone/APAP 10/ 325 mg 240 20 Respondent 11-23-2014 Morphine Sulfate 30 mg 90 - 30 Respondent 12-15-2014 Hydrocodone/APAP 10/325 mg 240 A 20 Dr. A.P. 12?21-2014 Morphine Sulfate 30 mg 90 30 35. During the period of on or about January 2015, to October 30, 2015, respondent had seven (7) of?ce visits with patient D. According to respondent?s progress notes, the visits 58 took place on January 8, February 10, March 19, April 28, July 16, September 30 (patient FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016-022170 LUJN LII \10\ indicating that will be moving to Kentucky with respondent noting ?patient may want to attempt \3 taper pain management after establishing care in Kentucky consider suboxone program vs taper to hydrocodone alone?), and October 26, 2015 (?nal visit before patient left for Kentucky). Patient D?s problems during this time generally included, but were not limited to, shoulder pain, GERD, HTN, major depressive disorder, chest pain associated With pericarditis, and opioid dependence. As of the date of respondent?s last visit with patient on October 26, 2015, patient D?s MED was approximately 210 mg per day. During 2014, patient had his prescriptions filled at approximately ?ve (5) different pharmacies, which was? a Violation of the pain management agreement he had signed. According to the CURES report, the following . prescriptions for controlled substances were filled for patient during 2015: Date Filled I DrugName Strength Quantity Days Prescriber 01-08-2015 Hydrocodone/APAP 10/325 ?mg 240 . 20 Respondent 01-29-2015 Oxycodone/APAP 5/325 mg 10 1 Other 02-19-2015 Oxycodone/APAP 5/ 3 25 mg 10 10 Other 03?05-2015 Hydrocodone/APAP 10/325 mg 240 20 Respondent 03-1 1?2015? Morphine Sulfate 30 mg 90 3 0 Respondent 04-08-2015 Morphine Sulfate 30 mg 90 30 Respondent 04?12?2015 Oxycodone/APAP 5/325 mg ?20 5 Other 04-28?2015 Hydrocodone/APAP 10/325 mg 240 20 Respondent '05?05?2015 Morphine Sulfate 30 mg 90 30 Respondent 05 ?27?20 1 5 Hydrocodone/APAP Respondent 07-16?2015 Hydrocodone/APAP 10/325 mg 240 20 Respondent 1172 1-201 5 Morphine Sulfate 30 mg 90 30 - Respondent 08?13-201 5 Hydrocodone/APAP 10/325 mg 240 20 Respondent 08-17-2015 Morphine?Sulfete 30 mg 90 30 Respondent 08?27-20 1 5 Hydrocodone/APAP 10/ 325 mg 240 20 Respondent 08-27-2015 Morphine Sulfate 30 mg 90 30 Respondent . 59 FRANK GILMAN, MD. - ACCUSATION NO. 800-2016-022170 DateFilled Drug Name Strength Quantity Days Prescriber 09-30-2015 Hydrocodone/APAP 10/325 mg 240 20 Respondent 09-30-2015 Morphine Sulfate 30 mg '90 30 ReSpondent 10-26-?2015? Hydrocodone/APAP 10/325 mg 240 20 7 Respondent 10?26?2015 Morphine Sulfate 30 mg '90 30 . Respondent 10-30-2015 Morphine Sulfate 30 mg 90 30 Respondent 10-30-2015 Hydrocodone/APAP 7 10/325 mg 7 240 20 Respondent 36. Throughout his course of treatment of patient D, respondent failed to adequately respond to several warning signs indicating misuse, abuse and/or diversion of controlled. I substances and did not take adequate risk screening measures to prevent the misuse, abuse and/or the diversion of the controlled substances that he was prescribing. These warning signs included, but Were not limited to, having prescriptions ?lled at multiple pharmacies, obtaining controlled substances from multiple prescribers, overuse of prescribed drugs, and patient D?s history of falls. 37. Respondent committed gross negligence in his care and treatment of patient which included, but was not limited to, the folloWing: Respondent failed to properly evaluate and manage patient D?s chronic nonmalignant pain; i Respondent repeatedly prescribed controlled substances, primarily opioids, to treat patient D?s chronic nonmalignant pain without, among other things, suf?ciently documenting the effect of patient D?s pain on his function and quality of life, without following a rational treatment plan with measurable stated obj ectives including, but not limited to, pain level and function, and without adjusting treatment pursuant to a rationale and clearly documented treatment plan; (0) Respondent repeatedly prescribed controlled substances, primarily I benzodiazepines, to treat patient D?s anxiety without, among other things, a suf?Cient and clearly documented history, physical examination and/0r '60 MD. - ACCUSATION NO. 800-2016-022170 rationale treatment plan; . Respondent repeatedly prescribed various controlled substances including, but not limited to, opioids, benzodiazepines, and/or other CNS depressants, without providing and documenting adequate informed consent; 1 i Respondent repeatedly prescribed controlled, substances including, but not limited to, opioids, benzodiazepines, and/or other CNS depressants, without being cognizant of aberrant. drug behavior and without timely and adequate risk screening measures to address aberrant drug. behavior including, but not limited to, effectively using pain management agreements in a non-reactive manner, periodically reviewing CURES, . obtaining information from pharmacies, utilizing pill counts, and/ or properly coordinating care with other physicians and prescribers; Respondent excessively prescribed various controlled substances including,- but not limited to, opiates, benzodiazepines and/or other CNS depressants; and? Respondent occasionally exceeded the recommended maximum daily dosage for acetaminophen (APAP). SECOND CAUSE FOR DISCIPLINE (Repeated Negligent Acts) 38. Respondent is further subject to disciplinary action under sections 2227 and 2234, as de?ned by. section 2234, subdivision of the Code, in that he committed repeated negligent acts in his care and treatment of patients A, B, C, and D, as more particularly alleged-in I paragraphs 8 through 37, above, which are hereby incorporated by reference and realleged as if fully set forth herein. 1 61 FRANK GILMAN, M.D. - ACCUSATION NO. 800-2016?022170 \10THIRD CAUSE FOR DISCIPLINE (Incompetence) 39. Respondent is further subject to diSciplinary action under sections 2227 and 2234, as de?ned by section 2234, subdivision of the Code, in that he has demonstrated a lack of knowledge regarding opioids and their safe prescription, along with other pharmacological issues, as it pertained to his prescribing of controlled substances to patients B, and D, as more particularly alleged in paragraphs 16 through i 37, above, Which are hereby incorporated by reference and reallegedas if fully set forth herein. FOURTH CAUSE FOR DISCIPLINE (Repeated Acts of Clearly Excessive Prescribing). 40. Respondent is further subject to disciplinary action under sections 2227 and 2234, as de?ned by section 725, of the Code, in that he has committed repeated acts of clearly excessive prescribing drugs or treatment to patients A, B, and D, as determined by the standard of the community of physicians, as more particularly alleged in paragraphs 8 through 37, above, which are hereby incorporated by reference and realleged as if fully set forth herein. - I FIFTH CAUSE FOR DISCIPLINE (Failure to Maintain Adequate and Accurate Medical Record) 41. Respondent is further subject to disciplinary action under sections 2227 and 2234, as de?ned by section 2266, of the Code, in that he failed to maintain adequate and accurate records in his care and treatment of patients A, B, and D, as more particularly alleged in paragraphs 8?through 37, above, which are hereby incorporated by reference and realleged as if fully set forth herein. 62 FRANK GILMAN, MD. - ACCUSATION NO. 800-2016-022170 10 1?2.6. 27 28' PRAYER WHEREFORE, Complainant requests that a hearing be held On thematters herein alleged, and that following the hearing, the MediCal Board of California issue a decision: 1. Revoking or suspending Physician?s and Surgeon?s Certi?cate No. GS 8692, issued to respondent Frank Gilman; 2.. Rekaing, suspending or denying approval of respondent Frank Gilman, authority to supervise physician assistants and advanced practice nurses; . 3. Ordering respondent Frank Gilman, M.D., if placed on probation, to pay the Board thecosts of probation monitoring; and - 4. Taking such other and further action as deemed necess ry and proper. DATED: October 2, 20-18 RCHMEYEW Executive Dig}I ctor '1y . Medical Board of California - Department of Consumer Affairs State of California Complainant SD2014708244 71556284.docx 63 FRANK GILMAN, M.D. ACCUSATION NO. 800-2016-022170