Upload
sergio8023
View
222
Download
0
Embed Size (px)
Citation preview
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 1/16
STATE OF FLORIDA
DEPARTMENT OF HEALTH
B y: lair\
Deput Agency Clerk
egoFinal Order No. DOH-11-2505-Q A
FILED DATE - 1 0 • 1 3 •Department of Health
IN RE: The Emergency Suspension of the License of
Aiman I. Aryan
License No. PS 33142
Case Num ber: 2011-15571
ORDER OF EMERG ENCY SUSPENSION OF LICENSE
H. Frank Farmer, Jr., M.D., Ph.D., F.A.C.P., State Surgeon General, ORDERS
the Emergency Suspension of the license of Aiman I. Aryan, (Mr. Aryan), to practice as
a pharmacist in the State of Florida. Mr. Aryan holds license number PS 33142. His
address of record is 590 West Flagler Street, Miami, Florida, 33130. The following
Findings of Fact and Conclusions of Law support the Emergency Suspension of Mr.
Aryan's license to practice as a pharmacist in the State of Florida.
INTRODUCTION
Beginning in March 2010, the United States Drug Enforcement Agency (DEA)
commenced an undercover investigation of an alleged criminal conspiracy between
Mr. Aryan and Dr. F.B. to defraud Medicare and traffic large amounts of oxycodone.
Mr. Aryan owns and operates four pharmacies, including Izz & Sons, Inc. (Izz & Sons),
all which did business as "Robert's Drug Store." The DEA investigation revealed an
operation whereby individuals (sponsors) would pick up recruits (patients) and drive
them to the office of Dr. F.B. The sponsors instructed patients as to what symptoms to
allege to Dr. F.B., and Dr. F.B. would then prescribe oxycodone medications without a
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 2/16
IN RE: The Emergency Suspension of the License of
Ai ma n I . Ar y a nLicense No. PS 33142
Case Number: 2011-15571
legitimate medical purpose. The sponsors then arranged with Mr. Aryan which
particular Robert's Drug store to transport the patients to in order to fill the
prescriptions. Generally, the patients received the same combinations, quantities and
dosages of oxycodone prescriptions from the pharmacy and received $600 from the
sponsors for the medications. Mr. Aryan received cash payments from the sponsors in
order to fil l the oxy codone prescriptions without scrutiny or restriction. Fro m about June
2010, through August 2011, Mr. Aryan dispensed excessive and inappropriate quantities
of oxycodone medications other than in the course of the professional practice of
pharmacy.
FINDINGS OF FACT
1. The Department of Health (Department) is the state agency charged with
regulating the practice of pharmacy pursuant to Chapters 20, 456 and 465, Florida
Statutes. Section 456.073(8), Florida Statutes (2011), empowers the State Surgeon
General to summarily suspend the license of Mr. Aryan to practice as a pharmacist in
the State of Florida in accordance with Section 120 .60(6), Florida Statutes (2011).
2. At all times material to this Order, Mr. Aryan was a pharmacist practicing
within the State of Florida pursuant to Chapter 465, Florida Statutes, and practiced at
the Izz & Sons, Inc., pharmacy (Izz & Sons), which he owned and operated. Izz & Sons
holds DEA pharmacy registration number BI5793395, which allows the pharmacy to
2
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 3/16
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 4/16
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 5/16
IN RE: The Emergency Suspension of the License of
Ai ma n I . Ar y a nLicense No. PS 33142
Case Number: 2011-15571
oxym orphone m ay lead to severe psychological or phy sical dependence.
7. Between June 1 and December 1, 2010, Mr. Aryan and Izz & Sons
dispensed 28,880 tablets of Oxycontin 80 mg, 4,260 tablets of Opana ER 40 mg and
67,968 tablets of oxycodone 30 mg, all of which were prescribed by Dr. F.B. Of those
prescriptions, M r. Aryan and Izz & Sons dispensed a com bination of Oxy contin 80 m g
and oxycodone 30 mg on 303 occasions.
8. In early September 2010, Dr. F.B. ceased prescribing, and therefore
Mr. Aryan and Izz & Sons ceased dispensing, the combination of Oxycontin 80 mg and
oxycodone 30. However, beginning on October 7, 2010, and continuing until October
25, 2010, Dr. F.B. began prescribing a combination of Opana ER 40 mg and oxycodone
30 m g, a combination which M r. Aryan and Izz & Sons dispensed on 71 occasions
during that time period. Similarly, between March 9 and September 28, 2011,
Mr. Aryan and Izz & Sons dispensed a combination of Opana ER 40 mg and oxycodone
30 mg on 221 occasions.
9 . A lthough the quantities of drugs dispensed B etween June 1 201 0, and
September 28, 2011, varied, Mr. Aryan and Izz & Sons routinely dispensed a
combination of 60-90 tablets of Oxy contin 80 m g / Opana E R 40 m g and 1 20-180
tablets of oxycod one 3 0 m g to individual patients. This means that each "patient"
received a minimum of 280 mg of oxycodone per day if he or she received the
5
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 6/16
IN RE: The Emergency Suspension of the License of
Ai ma n I . Ar y a nLicense No. PS 33142
Case Number: 2011-15571
oxycodone-Oxy contin combination, or a minimum of 200 mg o f oxycodone per day if
he or she received the oxycodone-Op ana ER combination.
10. B etween January 1 and June 1, 2011, M r. Aryan and Izz & Sons purchased
from wh olesalers 384,900 m edications that contained oxy codone, including O xycontin,
oxycodone, Op ana ER , Endocet and Roxicet. As such, Mr. Ary an and Izz & Sons were
the fifth-highest wholesale purchaser of oxycodone in Miami-Dade and Monroe
counties, com bined. In total, Mr. A ry an's four Robert's Drug stores were the first, fifth,
ninth and 24 t h highest wholesale purchasers of oxycodone med ications in M iami-Dade
and Monroe counties, combining for a total of 1,692,700 units of oxycodone
medications purchased between January 1 and June 1, 2011.
11. The D epartment retained an independent pharmacy expert to review M r.
A ryan 's dispensing records at Izz & Sons. B ased on his review of the records, the
Department's expert opined that Izz & Sons was operating below the standard of care
expected of a licensed pharmacy. The expert determined that Izz & Sons customers
received excessive and inapp ropriate quantities of controlled substances that were not in
patients' best interest or in the normal course of the practice of pharmacy. The expert
also opined that the large n umber of patients receiving nearly identical prescriptions for
large quantities of oxycodone from the same physician indicated that the pharmacists,
including Mr. Aryan, either knew or should have known that the prescriptions were
6
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 7/16
IN RE: The Emergency Suspension of the License of
Ai ma n I . Ar y a nLicense No. PS 33142
Case Number: 2011-15571
excessive and inappropriate. Finally, the expert opined that an 80 mg daily dose of
oxycodone is potentially lethal for opioid-naive patients, and Mr. Aryan's customers
routinely received doses and quantities of oxycodone that greatly exceeded the 80 mg
lethal daily dose.
12. On October 12, 2011, Mr. Aryan was indicted and arrested on one count of
conspiracy to possess with intent to distribute controlled substances in violation o f T itle 21
U.S.C. Section 846 and one count of health care fraud conspiracy in violation of Title
18 U.S.C. Section 1349.
13. Since 2005, the State of Florida has experienced a surge of pill mills 2 and a
resulting widespread abuse of prescription drugs among its citizens. 3 In 2010,
prescription drugs were responsible for more deaths in Florida than illicit drugs.
Oxycodone was the first leading cause of drug-related deaths, and the incidence of
Oxycodone identified in toxicology reports increased by 10.9% in January through June
2010 when compared to July through December 2009. Benzodiazepines were the
second leading cause of drug-related deaths in the State of Florida from January 2010
through June 2010, and the incidence of benzodiazepines identified in toxicology
reports increased by 3 % during that t ime period.
2 The term "pill mill" is commonly used by law enforcement to identify a pain management clinic that issues prescriptions for controlled
substances illegally and without medical necessity.3
Th i s health emergency is not restricted to the State of Florida. Indeed, the United States Centers for Disease Control and Prevention has
declared prescription drug overdose a public health epidemic.
7
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 8/16
IN RE: The Emergency Suspension of the License of
Aiman I . AryanLicense No. PS 33142
Case Number: 2011-15571
14. In September 2010, the HHS issued the results of a 2009 National Survey
on Drug Use and Health. The HHS report found that there were 7.0 million individuals
in the U.S. who used prescription drugs for non-medical reasons within the previous
one-month period during 2009. Of those individuals, 55.3% received the prescription
drug from a friend or relative; 17.6% reported that they received the drug from one
doctor; 4.8 % received the medication from a drug dealer or a stranger; and 0.4 %
purchased the drug on the Internet.
15. Pharmacies that liberally fill prescriptions for controlled substances for
patients who have no legitimate medical need for the drugs and often divert and resell
the drugs to others, pose a serious danger to the public health, welfare and safety. T his is
so because such controlled substances are often potentially addictive and because the
m isuse or abuse of these d rugs can cause serious and lasting m edical injury and d eath. 4
CONCLUSIONS OF LAW
Based on the foregoing Findings of Fact, the State Surgeon General concludes as
follows:
1 .he State Surgeon General has jurisdiction over this matter pursuant to
Sections 20.43 and 456.073(8), Florida Statutes (2009-2011), and Chapter 465, Florida
Statutes (2011).
'The Proliferation of Pain Clinics in South Florida, November 19, 2009, Broward County Grand Jury report.
8
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 9/16
IN RE: The Emergency Suspension of the License of
Ai ma n I . Ar y a nLicense No. PS 33142
Case Number: 2011-15571
2. Section 120.60(6), Florida Statutes (2009-2011), authorizes the Department
to suspend or restrict a pharmacist's license if the Department finds that the pharmacist
presents an imm ediate, serious danger to the p ublic health, safety or welfare.
3. Section 465.016(1)(i), Florida Statutes (2009-2011), allows the Board of
Pharmacy (Board) to discipline or suspend the license of a pharmacist for compounding,
dispensing or distributing a legend drug, including any controlled substance, other than
in the course of the professional practice of pharmacy. For purposes of this paragraph, it
shall be legally presumed that the compounding, dispensing or distributing of legend
drugs in excessive or inappropriate quantities is not in the best interests of the patient
and is not in the course of the professional practice of pharm acy.
4. Mr. Aryan dispensed or distributed controlled substances in excessive or
inappropriate quantities in one or m ore of the following ma nners:
a. By dispensing excessive or inappropriate dosages and quantities of
o xy co d on e 30 m g;
b. By dispensing excessive or inappropriate dosages and quantities of
O xy co n t in 80 m g;
c. By dispensing excessive or inappropriate dosages and quantities of
O p a n a E R 4 0 m g ;
d. By dispensing combinations of large quantities of oxycodone 30 mg
9
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 10/16
IN RE: The Emergency Suspension of the License of
Aiman I . AryanLicense No. PS 33142
Case Number: 2011-15571
and Oxycontin 80 mg; and
e.y dispensing combinations of large quantities of oxycodone 3 0 m g
and Opana 40 mg.
5. Section 465.016(1)(s), Florida Statutes (2009-2011), allows the Board to
discipline or suspend the license of a pharmacist for dispensing any medicinal drug
based upon a communication that purports to be a prescription as defined by Sections
465.003(14) and 893.02, Florida Statutes (2009-2011), when the pharmacist knows or
has reason to believe that the purported prescription is not based upon a valid
practitioner-patient relationship.
6. Mr. Aryan violated Section 465.016(1)(s), Florida Statutes (2009-2011), by
dispensing controlled substances based upon purported prescriptions when he knew or
had reason to believe that the purported prescriptions were not based upon a valid
practitioner-patient relationship, in one or more of the following manners:
a. B y repeatedly dispensing large doses and quantities of oxycodone
medications prescribed by Dr. F.B.;
b. B y repeatedly dispensing large doses and quantities of oxycodone 30
mg and Oxycontin 80 mg prescribed by Dr. F.B.; and
c. B y repeatedly dispensing large doses and quantities of oxycodone 30
mg and Opana ER 40 m g prescribed by Dr. F.B .
10
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 11/16
IN RE: The Emergency Suspension of the License of
Ai ma n I . Ar y a nLicense No. PS 33142
Case Number: 2011-15571
7. Section 465.016(1)(r), Florida Statutes (2009-2011), allows the Board to
discipline or suspend the license of a pharmacist for violating any provision of Chapters
456 o r 465, Florida Statutes (2009-201 1), or any rules adopted pursuant thereto.
8. Rule 64B16-27.831, Florida Administrative Code, sets forth the standards
of practice for the dispensing of controlled substances for treatment of pain, in part, as
follows:
* (5) Any pharmacist who has reason to believe that a prescriber of controlled
substances is involved in the diversion of controlled substances shall report
such prescriber to the D epartme nt of Hea lth.
9. Mr. Aryan violated Rule 64B16-27.831, Florida Administrative Code, as
he had had reason to believe Dr. F.B. was involved in the diversion of controlled
substances but failed to report D r. F.B . to the Departm ent.
10. Rule 64B16-27.104(3), Florida Administrative Code, sets forth the conduct
governing pharmacists and pharmacy permittees as follows:
No pharmacist or pharmacy, or employee or agent thereof, shall enter into
or engage in any agreement or arrangement with any physician or other
practitioner or nursing home or extended care facility for the payment or
acceptance of compensation in any form or type for the recommending ofthe professional services of either; or enter into a rebate or percentage rental
agreement of any kind, whereby in any way a patient's free choice of a
pharmacist or pharmacy is or may be l im ited.
11. Mr. Aryan violated Rule 64B16-27.104(3), Florida Administrative Code,
11
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 12/16
IN RE: The Emergency Suspension of the License of
Aiman I . AryanLicense No. PS 33142
Case Number: 2011-15571
by entering into an arrangement with Dr. F.B. to receive compensation for servicing
Dr. F.B.'s patients.
12. Section 120.60(6), Florida Statutes (2011), authorizes the Department to
suspend a pharmacist's license if the Department finds that the pharmacist presents an
imm ediate, serious danger to the p ublic health, safety, or w elfare.
13. Mr. Aryan dispensed excessive or inappropriate quantities of Oxycontin,
Opana and oxycodone based upon prescriptions that he knew or had reason to believe
were not valid. Mr. Aryan's dispensing and distribution of excessive or inappropriate
quantities of Oxycontin, Opana and oxycodone demonstrate a reckless disregard for
pharm acy laws an d rules, as well as the safety o f the public.
14. The facts recited above support the conclusion that Mr. Aryan is using his
pharmacy license to illegally dispense or distribute controlled substances to his
customers without any regard for the health, safety or well-being of the individuals
receiving these potentially addictive and lethal drugs. Mr. Aryan's acts manifest such a
pattern and propensity to practice below the appropriate standard of care that a
continuation of this practice poses an immediate serious danger to the public health,
safety and w elfare.
15. The Legislature has vested a trust and confidence in pharmacists by
permitting them to purchase, store and dispense drugs with a high potential for abuse
12
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 13/16
IN RE: The Emergency Suspension of the License of
Ai ma n I . Ar y a nLicense No. PS 33142
Case Number: 2011-15571
and harm to the public. Inappropriate dispensing of highly addictive controlled
substances to patients presents a danger to the public health, safety, or welfare, and does
not correspond to that level of professional conduct expected of a person licensed to
practice pharm acy in this state.
16. Mr. Aryan consistently acted with indifference to the health of his
customers and the public by dispensing highly addictive and potentially harmful drugs
based upon prescriptions that he knew o r had reason to believe were not valid.
17. Illegal or dishonest activity by a pharmacy necessarily affects that
pharmacy's ability to operate. A pharmacist's integrity and trustworthiness is necessary
for delivery of health care services. The prevention of breaches of trust is vital to
maintain the integrity of the pharmacy profession and, thereby, insures the care given to
medical patients and customers is justifiable and proper. This is particularly true where
the breach of trust involves the use of a license to conduct illegal activity. Mr. Aryan's
repeated illegal distribution of controlled substances manifests a lack of the professional
judgment and ethical standards that are necessary to conduct business as a pharmacist in
the State of Florida. Mr. Aryan's willingness to use his license to illegally dispense
medication and, thereby, endanger the lives of his customers and of members of the
public also demonstrates a lack of the good moral character required to operate a
pharmacy in the State of Florida.
13
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 14/16
IN R E: The E mergency Suspension of the License ofAiman I. AryanLicense No. PS 33 142Case Number: 2011-15571
18. Mr. Aryan's propensity to illegally distribute drugs in violation of state law
and his indifference to the safety of its patrons and of the public, when taken together,
plainly demonstrate that he is incapable of, or unwilling to, practice pharmacy safely
and that his continued practice of pharmacy poses an immediate serious danger to the
public health, safety an d we lfare.
19. Mr. Aryan's repeated illegal distribution of addictive and potentially lethal
drugs makes obvious that a less restrictive sanction, such as an emergency restriction
order preventing him from dispensing controlled substances, would not be sufficient to
protect the public from the immediate serious danger posed by Mr. Aryan's continued
practice as a pharmacist. Mr. Aryan's actions in this case are not the result of
carelessness or ignorance on his part; instead Mr. Aryan's actions demonstrate its
willingness to violate the laws, regulations and standards that govern the practice of
pharmacy in the State of Florida. Nothing short of the immediate suspension of Mr.
Aryan's license to practice as a pharmacist would be sufficient to protect the public
from the danger of harm presented by M r. Aryan.
20. Mr. Aryan's propensity to operate outside the law and his indifference to
the safety of his customers and of the public demonstrate a likelihood that Mr. Aryan's
unsafe practice of pharmacy is likely to recur. The continued practice of Mr. Aryan as a
14
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 15/16
DONE and ORDERED this 13 day of , 2011.
H. ank Far i er, Jr.State Surgeon General
Department of H ealth
Ph.D., F.A.C.P.
IN RE: The Emergency Suspension of the License of
Aiman I. AryanLicense No. PS 33142
Case Number: 2011-15571
pharmacist constitutes an immediate serious danger to the health, safety and welfare of
the citizens of the State of F lorida.
In accordance with Section 120.60(6), Florida Statutes (2011), it is ORDERED
THAT:
1. The license of Aiman I. Aryan, license number PS 33142, is hereby
imm ediately suspended.
2.A proceeding seeking formal suspension or discipline Mr. Aryan's license
to practice as a pharmacist will be promptly instituted and acted upon in compliance
with Sections 120.569 and 120.60(6), Florida Statutes (2011).
P R E P A R E D B Y :Gavin D. B urgessAssistant General CounselDOH, Prosecution Services Unit
4052 Bald Cypress Way, Bin C-65
Tallahassee, Florida 32399-3265(850) 245-4640 — Telephone(850) 245-4662 — Facsimile
Florida Bar No. 0013311
15
8/3/2019 DOH 11-2505 ESO 201115571
http://slidepdf.com/reader/full/doh-11-2505-eso-201115571 16/16
IN RE: The Emergency Suspension of the License of
Ai ma n I . Ar y a nLicense No. PS 33142
Case Number: 2011-15571
NOTICE OF RIGHT TO JUDICIAL REVIEW
Pursuant to Sections 120.60(6), and 120.68, Florida Statutes, the Department's
findings of immediate danger, necessity, and procedural fairness shall be judicially
reviewable. Review proceedings are governed by the Florida Rules of Appellate
Procedure. Such proceedings are commenced by filing one copy of a Petition for
Review, in accordance with Florida Rule of Appellate Procedure 9.100, with the
Department of Health and a second copy of the petition accompanied by a filing fee
prescribed by law with the District Court of Appeal within thirty (30) days of the date
this Order is filed.