STATE OF FLORIDA DEPARTMENT OF HEALTH ORDER OF EMERGENCY SUSPENSION OF LICENSE

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1 IN RE: STATE OF FLORIDA DEPARTMENT OF HEALTH The Emergency Suspension of the License of Final Order No. DOH L - FILED DATE - Department of Health By:6-) Dep Agency Clerk ORDER OF EMERGENCY 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 (Dr. Scarborough) to practice as a physician in the State of Florida. Dr. Scarborough holds license number ME His address of record is 31 South Fifth Street, Maclenny, Florida The following Findings of Fact and Conclusions of Law support the Emergency Suspension of Dr. Scarborough's license to practice as a physician in the State of Florida. INTRODUCTION Dr. Scarborough operates a family-practice medical clinic in Maclenny, Florida. He encourages unlicensed staff, consisting of individuals with little-to-no medical training, to evaluate his patients, make treatment recommendations, prescribe medications and administer injections on a regular basis. Furthermore, Dr. Scarborough utilized this unlicensed staff to fabricate a medical record and a steroid prescription for an individual who had been arrested for illegal possession of steroids. Dr. Scarborough's intent was to make it appear that he had treated the individual and prescribed the steroids to him so that the criminal charges against him would be

2 dropped. FINDINGS OF FACT 1. The Department is the state agency charged with regulating the practice of medicine, pursuant to Chapters 20, 456, and 458, Florida Statutes ( ). Section (8), Florida Statutes ( ), empowers the State Surgeon General to summarily suspend Dr. Scarborough's license to practice as a physician in the State of Florida in accordance with Section (6), Florida Statutes ( ). 2. At all times material to this Order, Dr. Scarborough was licensed to practice as a physician in the State of Florida, pursuant to Chapter 458, Florida Statutes ( ). He was not board certified in any specialty and was not a dispensing practitioner. 3. At all times material to this Order, Dr. Scarborough has owned and operated a family practice medical clinic (the clinic) in Maclenny, Florida. Dr. Scarborough employs both licensed registered nurses and untrained staff at the clinic. This staff includes: A.S. and T.D., who possess licenses to practice as registered nurses in the State of Florida, and L.D., V.A. and C.A., who possess no healthcare licenses and little-to-no medical training. 2

3 Treatment of Patients by A.S. 4. A.S. has worked for Dr. Scarborough for about one year. She is a registered nurse in the State of Florida and has been for approximately 15 years. A.S.'s duties at the clinic include documenting patients' vitals signs and chief' complaints, reviewing patients' medical histories and addressing any problems they may have. A.S. determines which medications should be prescribed to patients and enters this information in the computer system before Dr. Scarborough sees patients in certain situations, including those situations when patients have no changes in their conditions. A.S. spends approximately ten-to-twenty minutes with each patient she sees, while Dr. Scarborough spends five to ten minutes with each patient. She typically sees patients per day. A.S. also obtains refills of her husband's medication without her husband seeing Dr. Scarborough and sometimes without generating medical records for the refills. Treatment of Patients by L.D. 5. L.D. worked for Dr. Scarborough from January 2010 through August 2011 as a "medical technician," but possessed no type of healthcare licensure. L.D. has an Associate of Arts degree and an Associate of Science degree in legal studies. She claims to have completed a two-week classroom program to become a certified nursing assistant (CNA) and worked under supervision at St. Luke's Hospital in 3

4 Jacksonville, Florida, but left the program before she earned her licensure. According to L.D., Dr. Scarborough treated his unlicensed staff as nurse practitioners working under his direction, referred to them as "nurses" and the patients believed the employees were all licensed nurses. 6. L.D. was assigned her own exam room at Dr. Scarborough's clinic. Her duties primarily consisted of checking patients' blood pressure and pulse, documenting patients' complaints or reasons for their visits, reviewing patients' current medications and test results and recommending treatment, dosages and medication adjustments based on test results. L.D. typically entered prescriptions into the clinic's electronic database, after she made prescribing decisions, so that the staff could print the prescriptions and have Dr. Scarborough sign them. Sometimes L.D. saw multiple patients, including sets of friends or family members, at the same time. Dr. Scarborough met with patients in L.D.'s examination room, but only examined about half of the patients. It was especially common for Dr. Scarborough not to examine all of the patients when multiple patients were present in L.D.'s exam room at the same time. 7. On some occasions, L.D. prescribed medications without Dr. Scarborough examining patients or Dr. Scarborough took action based only on La's interpretation of lab results or her summary of the patients' complaints. In a sworn 4

5 interview with Florida Department of Law Enforcement (FDLE) agents, L.D. referred to Dr. Scarborough "seeing [her] patients" as though she had her own set of patients. L.D. also described Dr. Scarborough as "slow" in his treatment of patients and stated that he would "skip a few corners." The length of time that Dr. Scarborough spent with "L.D.'s patients" depended on each patient's situation. 8. L.D. administered injections, including Vitamin B 12 injections, to patients at the clinic. Dr. Scarborough instructed L.D. and other employees to inject the patients as required. However, L.D. admitted that her CNA training never included instructions on how to administer injections and Dr. Scarborough never taught her how to do so either. Treatment of Patients by V.A. 9. V.A. began working for Dr. Scarborough in October 2003 as a receptionist. Since then, she has also worked as the office manager and as a medical assistant. V.A. had no medical training other than an at-home medical assistant course through Penn and Foster, for which she received no certificate or licensure. However, Dr. Scarborough refers to V.A. as a nurse practitioner and tells the patient that she is a nurse. 10. Shortly after V.A. began working at the clinic, Dr. Scarborough began having her work with patients in an exam room. V.A.'s duties included taking 5

6 patients' blood pressure, reviewing patients' current medications and writing out orders for X-rays and lab work. V.A. also reviewed and interpreted lab results and patients' statements regarding their medical conditions and made recommendations based on those interpretations. For example, if V.A. saw that a patient's lab results reflected high cholesterol, she would enter a prescription for cholesterol-lowering medication into the computer system so that Dr. Scarborough only had to print it and sign it. Dr. Scarborough sometimes reviewed the lab data himself, but often made treatment and prescribing decisions based on V.A.'s interpretations alone. V.A. also administered intramuscular injections, including Vitamin B 12 and testosterone injections, to patients at the clinic. 11. V.A. saw between 12 and 20 patients per day. In a sworn interview with FDLE Agents, V.A. stated that she did not make recommendations for medication adjustments for patients that Dr. Scarborough failed to see at all, but she regularly was the only person who saw recurring patients who only needed refills on their routine medications. Dr. Scarborough would simply sign prescriptions for these patients without seeing them. V.A. stated that many of these patients were taking Lortab and Percocet as "just about everyone of [Dr. Scarborough's] patients" took pain medication. According to V.A., Dr. Scarborough routinely failed to see about 25% of the patients. However, on a particular day just prior to Christmas 2009, V.A. 6

7 saw 40 patients, all of whom needed refills on pain medications and none of whom saw Dr. Scarborough. 12. Lortab is the brand name for a drug that contains hydrocodone and is prescribed to treat pain. According to Section (3), Florida Statutes ( ), hydrocodone, in the dosages found in Lortab, is a Schedule III controlled substance that has a potential for abuse less than the substances in Schedules I and II and has a currently accepted medical use in treatment in the United States. Abuse of hydrocodone may lead to moderate or low physical dependence or high psychological dependence. 13. Percocet is the brand name for a drug that contains oxycodone and is prescribed to treat pain. According to Section (2), Florida Statutes ( ), oxycodone is a Schedule II controlled substance that has a high potential for abuse and has a currently accepted but severely restricted medical use in treatment in the United States. Abuse of oxycodone may lead to severe psychological or physical dependence. 14. Starting in approximately January 2011, Dr. Scarborough instructed V.A. to start seeing his patients at Maclenny Nursing and Rehabilitation (Maclenny Nursing), a nursing home, as he stated that he did not always have time to see them. On most weekday afternoons, V.A. went to Maclenny Nursing to review patients' 7

8 charts and lab results and to speak to the patients about any medical complaints they had. If patients needed medication adjustments, V.A. would sometimes call Dr. Scarborough from Maclenny Nursing. However, the course of treatment Dr. Scarborough implemented was based on her examination of the patients, her evaluation of the patients' lab results and records and, often, her recommendations. If V.A. did not speak to Dr. Scarborough about a particular patient while at Maclenny Nursing, she typed up a medical record, briefed the doctor and made recommendations for treatment upon her return to the clinic. On average, V.A. saw four to five patients per day at Maclenny Nursing. Dr. Scarborough went to Maclenny Nursing to see his patients within 24 hours of V.A. seeing them because Maclenny Nursing had a strict requirement that the patients be seen by a doctor. However, during a sworn interview with FDLE agents, V.A. could not recall any instances where Dr. Scarborough disagreed with her "diagnosis or treatment" recommendations. 15. According to V.A., staff at Maclenny Nursing or a home health agency sometimes called the clinic regarding the results of a patient's PT/INR test (a test to determine the clotting levels of blood). In those instances, V.A. took the phone call and made the determination to adjust the patients' Coumadin prescriptions and only told Dr. Scarborough she had done so after the fact. Initially, when these calls came 8

9 in to the clinic, V.A. took the call, consulted with Dr. Scarborough, and relayed the information to caller. On one occasion, staff at Maclenny Nursing called the clinic regarding Patient M.R., who was experiencing a urinary tract infection. Dr. Scarborough instructed V.A. to "just prescribe something" and V.A. prescribed Cipro. On another occasion, staff at Maclenny Nursing called to report that a patient's Coumadin level was low. V.A. instructed the staff to increase the dosage and only later informed Dr. Scarborough of the conversation. Dr. Scarborough told her that she had made the right decision, and, from that point on, he allowed her to adjust medications on her own. 16. Coumadin is a brand name for warfarin and is a drug used to prevent blood clots from forming or worsening. Coumadin is a legend drug, but not a controlled substance. 17. Cipro is a brand name for ciproflaxin and is an antibiotic used to treat infections, including urinary tract infections. Cipro is a legend drug, but not a controlled substance. Treatment of Patients by C.A. 18. C.A. is V.A.'s twenty-one-year-old daughter. She began working at Dr. Scarborough's clinic when she was thirteen and worked there until September C.A. only completed school through tenth grade, does not have a GED and has no 9

10 medical training whatsoever. However, Dr. Scarborough referred to her as a "nurse," just as he did with his other unlicensed staff. 19. C.A.'s duties included taking patients' vitals, reading patients' lab results and talking to patients about their complaints. When patients came to the clinic for refills on their medications, C.A. entered the prescriptions into the computer database and Dr. Scarborough would sign the prescriptions once staff printed them. According to C.A., Dr. Scarborough changed prescriptions that C.A. wrote about twice per day. C.A. saw approximately 15 to 30 patients per day, which amounted to approximately half of the total patients seen at the clinic each day. Dr. Scarborough did not always examine all of these patients. Sometimes, he would simply enter C.A.'s exam room, make "small talk" with the patients and then leave. C.A. also administered intramuscular injections, including B 12 and testosterone, approximately three days per week. Comprehensive Findings of Fact 20. According to C.A., patients often come to the clinic 30 to 45 minutes before Dr. Scarborough arrives so that they can be evaluated and waiting for him upon his arrival. On some occasions, patients enter the clinic through the back door of the building, instead of entering through the patient entrance, and see 1)r. Scarborough without a record to document their visits. Other patients have their 10

11 family members see Dr. Scarborough on their behalf. Dr. Scarborough regularly receives calls on his cell phone and instructs employees to contact pharmacies and order prescriptions for patients. For some of these instances, Dr. Scarborough instructs staff to generate medical records for patients who did not visit the office as though they had presented to the office for examinations. In those instances, staff enters artificial blood pressure readings and other information for the patients into fictitious medical records so that the patients' insurance companies can be billed for visits that did not occur. 21. It is especially common for Dr. Scarborough to write prescriptions or give samples to employees' family members without requiring them to present for an office visit. For example, Dr. Scaborough prescribed medications for L.D.'s sister-inlaw, M.D., or L.D.'s husband, M.B.D., without seeing them. L.D. would simply ask Dr. Scarborough to prescribe medications for them without having them come to the clinic. On one instance, M.D. was suffering from dental pain and L.D. spoke to Dr. Scarborough, who prescribed Lortab for M.D. without any contact with M.D. and without generating any medical record for the incident. 22. On another instance, L.D. asked Dr. Scarborough for a prescription for Xanax for M.B.D. Dr. Scarborough approved it, even though it had been several months since M.B.D.'s last visit with Dr. Scarborough, and L.D. had it filled at a 11

12 local pharmacy. 23. Xanax is the brand name for alprazolam and is prescribed to treat anxiety. According to Section (4), Florida Statutes ( ), alprazolam is a Schedule IV controlled substance that has a low potential for abuse relative to the substances in Schedule III and has a currently accepted medical use in treatment in the United States. Abuse of alprazolam may lead to limited physical or psychological dependence relative to the substances in Schedule III. 24. Dr. Scarborough pushes his staff to move through patient visits extremely quickly. He used to tell his staff that he needed to see 40 patients per day to "make payroll." After he hired T.D., he began stating that he needed to see 60 patients per day to "make payroll." He also told staff that treating the patients was not "rocket science." During a sworn interview with FDLE agents, V.A. stated that when she asked Dr. Scarborough to see patients for whom he already signed prescriptions he said, "I've already signed your patient's scripts, get 'em out and get another one in there." Several times, V.A. told the clinic receptionists not to schedule new patients due to the large volume of patients in the clinic, but Dr. Scarborough countermanded her each time. Instead, he instructed the receptionists that they were definitely seeing new patients with the "good insurance." 25. On a particular day in early 2011, Dr. Scarborough was ill and unable to 12

13 see any patients at all. He spent the entire day lying down in his office. V.A. and A.S. saw all of the patients on that date and only consulted with Dr. Scarborough to have him sign the prescriptions for the patients. According to V.A., Dr. Scarborough did not know what he was signing. On that date, V.A. also saw one patient with a new complaint that consisted of an ulcerated leg wound for which V.A. recommended treatment and prescribed antibiotics. 26. On or about April 5, 2011, Baker County Sheriff's Deputy R.S. (Deputy R.S.) initiated a traffic stop on C.L. 1, a twenty-year-old male, who was driving recklessly. Upon stopping the vehicle, Deputy R.S. asked C.L. for consent to search the vehicle, but C.L. refused consent. Shortly thereafter, C.K., a K-9 officer with the Florida Department of Transportation, arrived and utilized his K-9 to perform an exterior search of C.L.'s vehicle. The K-9 alerted on the driver's door of C.L.'s vehicle and a subsequent search of the interior of the vehicle revealed small bag containing approximately four grams of marijuana, a ten ml vial labeled "testosterone" 2 and approximately seven smaller vials labeled "Omnadren." C.L. told Deputy R.S. that he had a prescription for the "testosterone," but stated that he purchased the "Omnadren" on the internet. Deputy R.S. arrested C.L. for possession of the "testosterone" and "Omnadren" without a prescription and possession of 1 C.L.'s mother is a former employee of Dr. Scarborough. 2 The contents of the this vial were later identified as "Sustanon," which is a trade name for a combination of four testosterone-based compounds that is not legally available in the United States and is not approved by the United States Food and Drug Administration for treatment of any conditions. 13

14 marijuana and booked him into the Baker County Detention Center (BCDC). According to Deputy R.S., the labels on the vials of "testosterone" and "Omnadren" did not contain the information typically found on prescription medication, including the name and birthday of the individual who received the prescription, the name of the prescribing physician and the name of the dispensing pharmacy. 27. Testerone and Omnadren are anabolic-androgenic steroids. Anabol icandrogenic steroids are steroid compounds, including testosterone and its synthetic relatives that possess anabolic and androgenic effects. Anabolics have the effect of building lean muscle mass, and androgens express male secondary sexual characteristics. Steroid users consume anabolic-androgenic steroids for their anabolic effects, but the androgenic effects are generally responsible for adverse reactions. Common adverse reactions include profound effects on the cardiovascular system, the liver, the musculoskeletal system, the hematological system, and the male and female reproductive systems. Several studies have also reported an association between anabolic-androgenic steroids and serious psychological problems, including psychosis, mania, hyperaggressiveness, and dependency. 28. According to Section (3), Florida Statutes ( ), anabolic steroids are Schedule III controlled substances that have a potential for abuse less than the substances contained in Schedules I and II. However, abuse of Schedule III 14

15 substances may lead to moderate or low physical dependence or high psychological dependence, or, in the case of anabolic steroids, may lead to physical damage. 29. Upon his release from BCDC, C.L. went to the home of V.A., advised her that he had been arrested for possession of steroids and asked her for assistance in having the charges dismissed and having the steroids released from the Sheriff's Department. V.A. spoke with Dr. Scarborough and then directed C.L. to go to Dr. Scarborough's office. Upon arriving at Dr. Scarborough's office, C.L. entered the exam room used by L.D. L.D., A.S. and Dr. Scarborough entered the room and C.L. explained to Dr. Scarborough that he had been arrested for possession of steroids, including Sustanon. C.L. lied to Dr. Scarborough and stated that Sustanon was legal to possess and utilize. C.L. also stated that if he could show the State Attorney that he had a prescription for Sustanon, then the State Attorney would dismiss the possession charge. 30. Dr. Scarborough initially instructed V.A. to research a medical condition called gynecomastia (benign enlargement of the male breast) and to research Sustanon, including what it is, what it does, and how it is to be prescribed. However, V.A. had to leave the clinic to see patients at Maclenny Nursing and Dr. Scarborough instructed L.D. to complete the research. Dr. Scarborough also instructed L.D. to generate a medical record for C.L. pertaining to treatment for gynecomastia and 15

16 backdate that record so that it appeared that Dr. Scarborough had been treating C.L. on an ongoing basis. 31. L.D. researched Sustanon for a couple of days and determined that it is used as an estrogen blocker and is commonly utilized by weightlifters. L.D. subsequently created a medical record that indicated C.L. was seen at Dr. Scarborough's clinic on Saturday, January 8, 2011, a date on which the clinic was closed. The contents of the medical record stated that C.L. came into the clinic and explained that he was "growing breasts" as a result of working out. The medical record also contains a lengthy explanation regarding gyencomastia and the use of tamoxifen (an estrogen blocker) and Sustanon to treat that condition. L.D. cut-andpasted this explanation from the internet. The medical record further states that Dr. Scarborough prescribed Sustanon 300 mg/1 cc, injected intramuscularly once per week, to C.L. Dr. Scarborough reviewed the medical record and advised L.D. what information to add or delete from it. 32. Dr. Scarborough also directed his staff to generate a prescription for Sustanon as though he had prescribed it to C.L. Dr. Scarborough normally issued electronically-generated prescriptions, but A.S. handwrote the Sustanon prescription because she could not locate Sustanon in any of the drug databases at the clinic. Dr. Scarborough signed the prescription. 16

17 33. C.L. returned to Dr. Scarborough's office on or about April 7, 2011, and L.D. handed him the handwritten prescription for Sustanon, which was dated April 5, 2011, and a patient record that fraudulently documented treatment that never occurred. V.A. and other staff overheard Dr. Scarborough tell C.L. that he could "get into trouble" or lose his medical license if anyone found out what he had done. C.L. provided copies of these documents to his attorney who provided them to the State Attorney. The State Attorney dropped the steroid possession charges against C.L. and had the Baker County Sheriff's Department release the Sustanon to C.L. 34. On or about September 30, 2011, C.L. stated, under oath, to FDLE Agents that he was not seen at the clinic on January 8, 2011, that Dr. Scarborough never prescribed Sustanon for him and that he purchased the Sustanon from "someone in Georgia." 35. The Department retained an independent medical expert who is a medical doctor board certified in Family Medicine. The Department's expert reviewed the evidence regarding the activities of Dr. Scarborough's unlicensed staff. He opined that Dr. Scarborough delegated duties to unlicensed individuals he knew were not qualified to perform those duties and allowed unlicensed individuals to practice medicine. The improperly-delegated duties included allowing the stall to make treatment recommendations regarding patients, to prescribe medications to 17

18 patients and to administer injections to patients. The expert opined that it was improper for Dr. Scarborough to have V.A. give orders to Maclenny Nursing stall' regarding the dosages of patients' Coumadin and other medications. 36. The Department's expert also reviewed the available evidence substantiating Dr. Scarborough's prescription of Sustanon to C.L. The expert opined that, at the very least, prescribing Sustanon was beyond Dr. Scarborough's legal scope of practice. 37. Dr. Scarborough consistently acted with indifference to the health of his patients by allowing unlicensed staff to provide the vast majority of care to his patients on a repeated basis. Dr. Scarborough has demonstrated a flagrant disregard for the duties and responsibilities imposed upon a physician practicing in the State of Florida and for the health and welfare of his patients. Furthermore, Dr. Scarborough's instructions to his staff to fabricate medical records and a prescription for Sustanon for C.L. demonstrate his willingness to practice beyond the scope permitted by law and engage in misrepresentations related to the practice of medicine. Dr Scarborough's egregious conduct constitutes a breach of the trust and confidence that the Legislature placed in him by issuing him a license to practice medicine. 18

19 38. Illegal or dishonest activity by a physician necessarily affects that physician's ability to practice medicine as a physician's professional judgment and ethical standards are all implicated in these activities. A physician's integrity and trustworthiness is a necessity for our system of delivery of healthcare services to function properly. The prevention of breaches of trust is vital to maintain the integrity of the medical profession, and thereby insure the care given to patients is justifiable and proper. Dr. Scarborough's improper delegation of duties and fabrication of medical records manifest a lack of the professional judgment and ethical standards necessary to practice medicine in the State of Florida. Dr. Scarborough's willingness to endanger the lives of his patients also demonstrates a lack of the good moral character required for licensure as a physician in the State of Florida. 39. Dr. Scarborough's actions in this case are not the result of carelessness or ignorance on his part; instead Dr. Scarborough's actions demonstrate his willingness to violate the laws, regulations and standards that govern the practice of medicine in the State of Florida. Dr. Scarborough's acts manifest a pattern and propensity to violate the laws governing the practice of medicine. An emergency order restricting Dr. Scarborough' license is not sufficient to protect the public because the level of improper delegation of duties in which Dr. Scarborough engaged 19

20 demonstrates an inability to make decisions that are in the best interest of his patients. Nothing short of the suspension of Dr. Scarborough's license will protect the public from this danger. as follows: CONCLUSIONS OF LAW Based on the foregoing Findings of Fact, the State Surgeon General concludes 1. The State Surgeon General has jurisdiction over this matter pursuant to Sections and (8), Florida Statutes ( ), and Chapter 458, Florida Statutes ( ). 2. Section (1)(f), Florida Statutes ( ), subjects a licensee to discipline, including suspension, for aiding, assisting, procuring, or advising any unlicensed person to practice medicine contrary to this chapter or to a rule of the department of the board. 3. Dr. Scarborough violated Section (1)(f), Florida Statutes ( ), in one or more of the following manners: a. By allowing or encouraging unlicensed staff, including L.D., V.A. and C.A. to make recommendations for treatment of patients; b. By allowing or encouraging unlicensed staff, including L.D., V.A. and C.A. to prescribe medications to patients; and/or c. By allowing or encouraging unlicensed staff, including L.D., V.A. and C.A. to administer injections to patients. 20

21 4. Section (1)(w), Florida Statutes ( ), subjects a licensee to discipline, including suspension, for delegating professional responsibilities to a person when the licensee delegating such responsibilities knows or has reason to know that such person is not qualified by training, experience, or licensure to perform them. 5. Dr. Scarborough violated Section (1)(w), Florida Statutes ( ), in one or more of the following manners: a. By allowing or encouraging unlicensed staff, including L.D., V.A. and C.A. to make recommendations for treatment of patients; b. By allowing or encouraging unlicensed staff, including L.D., V.A. and C.A. to prescribe medications to patients; and/or c. By allowing or encouraging unlicensed staff, including L.D., V.A. and C.A. to administer injections to patients. 6. Section (1)(k), Florida Statutes ( ), subjects a licensee to discipline, including suspension, for making deceptive, untrue, or fraudulent representations in or related to the practice of medicine or employing a trick or scheme in the practice of medicine. 7. Dr. Scarborough violated Section (1)(k), Florida Statutes ( ), in one or more of the following manners: a. By directing his office staff, including L.D., V.A. and A.S. to fabricate a medical record to make it appear that Dr. Scarborough treated C.L. for gynecomastia and prescribed Sustanon to him; and/or 21

22 b. By directing his office staff, including L.D., V.A. and A.S. to fabricate a prescription for Sustanon to make it appear that Dr. Scarborough prescribed Sustanon to C.L. 8. Section (1)(q), Florida Statutes ( ), subjects a licensee to discipline, including suspension, for prescribing, dispensing, administering, mixing, or otherwise preparing a legend drug, including any controlled substance, other than in the course of the physician's professional practice. There is a legal presumption that prescribing, dispensing, administering, mixing, or otherwise preparing legend drugs, including all controlled substances, inappropriately or in excessive or inappropriate quantities is not in the best interest of the patient and is not in the course of the physician's professional practice, without regard to his or her intent. 9. Dr. Scarborough violated Section (1)(q), Florida Statutes ( ), by prescribing Sustanon, an anabolic-androgenic steroid which is illegal in the United States, to C.L. 10. Section (1)(u), Florida Statutes ( ), subjects a licensee to discipline, including suspension, for performing any procedure or prescribing any therapy which, by the prevailing standards of medical practice in the community, would constitute experimentation on a human subject, without first obtaining full, informed, and written consent. 22

23 Case Number: Dr. Scarborough violated Section (1)(u), Florida Statutes ( ), by prescribing Sustanon, a therapy which is illegal in the United States, to C.L. 12. Section (1)(v), Florida Statutes ( ), subjects a licensee to discipline, including suspension, for practicing or offering to practice beyond the scope permitted by law or accepting and performing responsibilities which the licensee knows or had reason to know that her or she is not competent to perform. 13. Dr. Scarborough violated Section (1)(v), Florida Statutes ( ), by prescribing Sustanon, an anabolic-androgenic steroid which is illegal in the United States, to C.L. 14. Section (6), Florida Statutes ( ), authorizes the State Surgeon General to summarily suspend Dr. Scarborough's license to practice medicine upon a finding that the physician presents an immediate serious danger to the public health, safety or welfare. 15. Based on the foregoing, Dr. Scarborough's continued practice as a physician constitutes an immediate serious danger to the health, safety, or welfare of the public, and this summary procedure is fair under the circumstances to adequately protect the public. 23

24 In accordance with Section (6), Florida Statutes ( ), it is ORDERED THAT: 1. The license of, license number ME is hereby immediately suspended. 2. A proceeding seeking formal suspension or discipline of the license of, to practice as a physician will be promptly instituted and acted upon in compliance with Sections and (6), Florida Statutes ( ). d DONE and ORDERED this day of October, PREPARED BY: Jenifer L. Friedberg Florida Bar No Assistant General Counsel DOH, Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida (850) Telephone (850) Facsimile? H. Frank Farmer, Jr., M.D., P. D., F.A.C.P. State Surgeon General Department of Health 24

25 NOTICE OF RIGHT TO JUDICIAL REVIEW Pursuant to Sections (6), and , Florida Statutes, the Department's findings of immediate danger, necessity, and procedural fairness shall be judicially reviewable. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings are commenced by filing 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 fil ing lee prescribed by law with the District Court of Appeal within thirty (30) days of the date this Order is filed. 25