li|ay. 1. 2012 l0:0lAM IIJ BOARD [,IIOICAL IXAMiNIRS lllo.37l6 P. 2 JEFFREY S. CHIESA ATTORNEY GENERAL OF NEII JERSEY Division Law 12'l Halsey Street P. of FILED OF MEDICAL EXAMINERS Box 45029 Newark, Ne$, Jersey 07101 o, By: Calla M. Sil.va (973) 648-47 4L Deputy Attorney General I STATE OF NEW JERSEY DEPARTMENT OF I,AW C PUBTTC SAFETY DIVISION OF CONSI'MER AEFAIRS STATE BOARD OF }'EDICAL EXAMINERS IN THE MATTER OF THE SOSPETISION OR REVOqATION OF TIIE LICENSB OF KtcEB, I.Ar.r,nAD, OB, , U.DI.rGENSE rO. 21qo7185000 TO PRACTICE UEDICINE AND SURGERY IN THE STATE OF NEI{ JERSEY Laid! tratlvEUR ActLon oBm, Io sEog cNrsE IIOtrICE OF EEIf,IXIG .'ID IIO|EICE lrlo ErIiE ArISin, TO: Roger Lallemand, u. Dc./o ,John R. orlovskyr Esq. Orl,ovsky, Moody, schaaff t conlon' Lr,c 187 Htghway 35 ltest Irong Branch' New .tersey 07?54 Thls matter was opened to the New .lersey State Board of Medical Exarniners (helelnafter the "Board") by Verified Adnlnlstrative colrPlaint, supportlng docunents and Exhibits, copy attached, of Jeffrey chlesa, Attorney General of New Jersey, by Carla M. Silva, Eteputy Attorney General, on notice to ResPondent, Roger Lalleloand, M.D. (herel,nafte! oRespondent-), seeking the temporary suspension of the Respondent's license to practice -1- Mav. l. 2012 l0:01AM |tlJ B0ARD [4t0lCAt tXA[4l|,rlERS l{o.1716 ? ) medicine and surgery and.for such other rellef deemed approprlate, . pursuant to the authority conferred on the Board by N.J'SJ. 45:9-1 et seo. and N.,t.S.A. tl5:1-14 et sec. and related administrative regu).ations. It betng alleged ln the verlfied conplaint that Respondent has cor[nitted serious vLo].atlons of the statutes and regulations governing the practice of medl-clne' and lt belng furthera1Iegedthatthecont'inuedpract1ceofrned1c1neby Respondent pending final disposition of the verified complaint represents a clear and irminent danger to the public health, safety, and welfare, j.n accordance with N-J-S.A- 45:1-22, according.Iy, therefore, and for good cause shown' rr IIt qc rEtrs IsE DAX Or rYhy , 2oL2 . : Jr', M'D', either in peraon or by attorney, shol, cause before a connittee of the NeH Jersey state Boald of Medlcal Exa:niners at a scheduled onDEnED that the ResPondent, Roger LalLeroand' ,, . Beeting on wednesday' vlay 9, zoLZ, at 9i00an or soon thereafter, to :' be heLd at the Hughes Justice co[U)le8, 5th Floor, Trenton, New Jersey, nhy an order should not be enteled tenporarily susPending hj.s.license to practice medicine and sulgery in this state, and I|! Ia FctIurER qRDBD that a coPy of this Order, together sith th6 varified Complaint, Exhibits and matelials in support therEURof, be sorved uPon ReaPondent and his attorney forthwith' and fI IS titnIIEEn oRDEnED that Respondent shall file a response to the Order to Show Cause by lilay 7, 20L2, said responsive Papers to I -2- Mav l. 2012 10:02AM trlJ B0ARD MtDICAL [XA|l{II{ERS lio.3716 9t lnclude a list of all potential reitnesses to be presented by Respondent. said responsive papers are to be deJ-ivered to the Nex Jelsey Sate Board of M6dical Exarniners, P.O. Boa 183, Trenton, lTersey 08625-0183r New with a copy delivered on that sane date to Carla New ,Jersey 0?101, and M- Silwa, Deputy Attoxney General, Division of Law, 124 Halsey Street, sth Flooi, P.o. Box 45029, Newark, M Ia FI'RIER onDIRtD that separate frorn the response to the Order To Show Cauae, Respi:ndent shall flle an Anstter to the charges contained within the Verlfied Conplalnt not late! than 35 days frorn leceipt; said Answer to be dellvered to thB New Jorsey state Board of lledical Examiners, P.o. Box 183, Trenton, New Jersey C8625-0183, with a copy delivered on that same date and Ei$e to carla !{- Siiva, Deputy Attorney Genelal, Divisj.on of Lasr, '124 Halsey street, 5th Floor, P.O. Box 45029, Newark, ff Is t(ltrIG!, aIRDERED Neht JerseY 07L01, and that faliure to resPond to this Order to an Angwer to the Verified cot0Plaint Netr 'shot{ cause or fallure to file or failure to appear.before the Jelsey State Board of MedicaL Er.anlnels in person or through an attorneyr as ls. hereln required, wlll lesult fui this natte! being consideted in Respondent's absence on the proofs presented and an Order may be entered agaj.nst Respondent for any and aII relief denanded in the Verlfled complaLnt, and, IT Is tgRTER OBDfnfD that an adrnission of the charges wlll indicate that ResPondent does not Hlsh to contest the charqes -3- May. i.2012 l0:02AM IIJ BOARD MEOICAL EXAli4il'/IRS l{o.3716 P. , atated, renderlng unnecessary hearings ln this lllatte!. sill then be presentEURd to ths State Boald of Medical The case Examinexs withl-n thlrty (30) days of the receipt of Respondent's Answer or on an adjournEURd date, together with any wrLtten matter that RespondEURnt may wish to subnit uith the Answer in alleged mitlgatlon of penalty, for a determination as Lo rrhether dlsciplinary sanctlons, includi.ng guspension or revocation of Respondent's license to .practice rnedicine and surgery or other sanctions, should be and whether nonetary lmpoaed penalties and costs 6hou1d be assessed and, if so, the amount thereof, pursuant to the authorlty conferred on the Board by N-,t-s-A- 45:9-L et sed. and N-J.s.A. 45t!-I4 gE-ssq., and r! Ia FUR:EEER oEDtAD that a denial of the charges will result in a fornal hearLng which rnay be conducted by the Boald or by an adninistrative l-au Judge, who, upon notlce to Respondent' will hear the Verifled complaint and consider the imPosition of disciplinary at the hearing either in petson or by attorney or both, and shall be afforded an opportunl,ty at that tlme to make a defense to any and aII charges sanctions. Respondent may. apPear '*t?., President EXAMINERS t -.) -a- May. 1.2012 10:02AM NJ BOARD MIDICAI. EXAMIiIERS lt^ 2?1( i,EFFREI S. CIIESI I:ETIORET CtrEXAL q' Newark, New .fersey 07101 Divielon of Law 124 Halsey Street P.o. Box 45029 TII| ''IRSET FILED ffi l4ae l. 2OlZ OF MEDICAL EXAMINERS By: Carla M. Silva Deputy Attorney GenEURral 1973', 648-47 4L STATE 08 NEW .'ERSEY DEPTRN'ENT OF TAII I PUBLIC SAF'ETY 'DTVISION OE CONSUHER AFFAIRS STATE BOARD OF UEDTCAI- EXAI{INERS Docket No" , i THE UATTER OE THE SUSPENSION : OR REVOCATION OF TIIE LICENSE OF : a IN AdRinlstlative Actlon COISIAIF I'IRIEHD TE !O odltE8. I, II t III KrcB LDrir.mI|D, itR., l.D. LrcNsE No. 2$n07185000 '. TO PRACTICE IIEDICINE AND SURGERY : : TN.THE STATE OF NEW JERSEY : Jeffrey S. ChiEURsa, Attorney General of the State of New ,Jersey, by carla M. silva, Deputy Attorney General, with offices located aE L24 Halsey StrEURet, Fifth Floo!, Newark, New Jersey 0710L, by way of Verifisd Conplaint as to Counts I, II and IIf says : @lrntL lLrrqarrss of New Jersey, is charged yith enforcing the laws in the State of NehI Jersey pursuant to 1complainant, Attorney General N..f.S.A. 52:1"1A-4 (h) and j-s empowered to initiate administrative disciplinary proceedings against persons l-icensed by the State Board of MedicaL Examiners (the "Board") pursuant to N.J.S.A. 45:L-L4, et seq. 2. The Board is charged with the duty and responsibility of regul-ating the practice of medicine and surgery in the State of New ,Jersey pursuant to N-J,S.A. 45:9-I, et seq. Roger Lal-l-emand, M.D., ("Respondent") is l-icensed to 3. practice medicine and surgery in the State of New Jersey and is the holder of license No. 25MA07l-85000. - Respondent obtained his medical degree from Duke University in 7999 and completed two years of an orthopedic residency at Robert Wood Johnson Universj,ty Hospital in 2001. (Exhibit Z, Respondent's Curricul-um Vitae) 4 5. During all- tirnes relevant to this Complaint, Respondent 516 rnaintained offices for the practj-ce of medicine at 59 Route and 200 Perrine Road in Ol-d Bridge, New Jersey. coulql r as 6. The General Allegations are repeated and real.Ieged if set forth at length herein , 7. On Tuesday, December 6, 20L'Ll D.rug Enforcement ( *TFO Administration (*DEA") Task Eorce Officer, aPPea.red for h j.s initiaf appointment at Respondent' s madi r-al nrarl- i.a -l ef 59 Route 516 2 in Old Bridge, New .Tersey, in an undercover capacity as patient "- seeking medicaf I" care for alleged lower back "discomfort". (See Exhibit it (DEA Report of Investigation for Decer Jer 6, 20Ll)lprovided Respondent's staff with a completed 8. TFo It fictitious medical background questionnaire, urine sample and an MRI report which he represented was prepared in Florida on May f2, 20L0. (Exhibit T, T3:8-19r a 2-7:8-I0 (December 6, 2012 Transcript)t see Exhibit J (December 6, 2012 cD recording Undercover Investigation2); Exhibit H) . additional medicaf 9. Respondent's staff asked TFO F background questions and took his blood pressure. (Exhibit I, T2:22-3:1; Exhibit J; Exhibit H). was then seen by Respondent for approximately 10. TFo Il two (2) minutes and forty (40) seconds' (Exhibit J, 16:l-3:00- 16:15:40) . 11. TFO Il informed Respondent that the "discomfort" rdas in hi-s lower back and buttocks. (Exhibit I' Tll:15-15:6; Exhibit ' J, 76:13:00-15:15:40; Exhibit H) . 12- RespondenL's only physical examination consisted of if he had f eeling on the outer area of h j-s knee as king TFo Il when Respondent touched it. (Exhibit I' T13:7'7-74:2; Exhibit J, 16:13:00-15:15:40; Exhibit H) . r Transcript (page) : (l-ine) 2 AJ-l referenced cDs and DVDS wiLl- be made avaiLable Board. 3 to the l-3. Respondent noted in TFo l's patient record that his general- appearance was "wel-l-nourished, well-developed, and in no acute distress." (Exhibit W iPatierit ' reciiid for with w) Fr Ilrr. L4. Respondent diagnosed TFO radiculopathy and chronic pain. (Exhibit l-umbar informed Respondent that he never received l-5. TFo If formal- physical therapy for his condition and was not currentl-y taking any medication for his lower back issues, though he had taken Oxycodone in the past. (Exhibit f, TL3 : L2-L4 : 15,- Exhibit ; Exhibit H). then requested a prescription for Oxycodone 16. TFO lD from Respondent. (Exhibit l, T]-4:11-15:6; Exhibit .T, 16:13:00,I, 16:13 :00 - 16:15 :40 t-b: t5:4u; t;xnlD.rE HJ . 17. Respondent, or someone on his behalf, issued TFO I a prescription for a total of 56 pills of 30mg Roxicodone at the concl-usion of his fj-rst appointment. (Exhibit H; Exhibit !t; (MRI Report, Prescription Cl-aims Detail and Exhibit w). Prescriprionr ror f *; 1e a^ht- rr rv l-.\ Respondent's December 6, 2071 patient Exhibj.t X TEo hras not prescribed Motrin, record for Inl ll, -l Lorzone or Vimovo. (Exhibit W; Exhibit H; Exhibit I; Exhibit J). L9. TFo I appeared for subsequent appointments with Respondent at 200 Perrine Road in O1d Bridge, Nerar Jersey, on ,fanuary 3, 2072, January 3I, 2012, February 27, 2OI2 and March 19, 2012. (Exhibit K (DEA Report of fnvestigation for January 3, 2OI2); Exhibit N (DEA Report of Investigation for January 31, 2072); Exhibit Q (DEA Rei?ort of Investigation fo.r February 27, 2012); Exhibit T (DEA Report of Investigation for March 19, 20L2t ) . was seen by Respondent 20. on January 3, 20L2, TFo j for approximatefy three (3) minutes. (Exhibit M (January 3, 201,2 DVD recording Undercover Investigation), 22:24-25:I7) . provj-ded Respondent with a fabricated 2I. Tro I prescription claims Detail ror ! which detailed that ||| he last filled prescriptions for 60 piffs of 30mg Oxycodone on ,fune 28, 2011 and l'4ay 29, 2011. (Exhibit K; Exhibit L (,fanuary 3, 2Ol2 Transcxipt), T3:5-14; Exhibit 14, 22:24-25:17; Exhibit X). 22. When asked how the nedication helped, TFo I that "Itfs good" and then proceeded to ask for a higher dosage. (Exhibit L, 13:20-25; Exhibit M, 22:24-25:L'7) . 23. With no medicaf justification, Respondent increased the prescription to L20 pil1s of Roxicodone. (Exhibit K; Exhibit L, responded T5:2L-24; Exhibit l"I, 22:24-25:17; Exhibit X) 24. Neither Respondent nor his staff conducted a physical examination of TFo I on .fanuary 3, 2AL2, other than that Respondent briefly touched his back and checked his knee reflexes. (Exhibit K; Exhibit I; Exhibit M, 22:24-25:17). f, 25. Respondent de]eted or fai]-ed to make any note of TFO s January 3, 2012 appointment in his patient record for llf (Exhibir w) . FF was seen by Respondent 26. on January 3!, 2O!2, TFo I for approximately four (4t minutes and seven (7) seconds. (Exhibit P (January 31, 2012 DVD recording Undercover Investigation) , 19:28-23:35) . 27. TFo lD provided a urine sample on January 3!, 2012. (Exhibit W; Exhibit Nr. by Respondent how his pain was, Tr'O responded, "Good. Just - I mean rnaintain the same. " (Exhibit O (January 31, 201.2 Transcript), T3:10-12). 29. Contrary to Respondent's patient record for ll:l never .repo.rted on January 31. 2012 that the TFo I "symptoms of pain in back [were] worse than feg pain, " that "pain -, pattern is more referred than radicufar", that he experienced "pain with movementr " or that he experienced "muscle spasms." (Exhibit W; Exhibit A, T4:20-23; Exhibit P, 19:28-23:35) a 30. on ,fanuary 31, 2012, Respondent gave rfo I prescription for Xanax with no medicaL justification. (Exhibit N; 28. When asked E Exhibit A, T4:20-23; Exhibit P, 19:28-23:35) . 31. Contrary to Respondent's patient record for |I1 never complained on January 3I, 2OL2 "of TFo Il feeling anxious, tense, and worried, " b Nor did TFO lll stale that he felt "irritable, agitated, restless and Ihad] trouble sleeping." Nor did Respondent ask any guestions regarding was al-so not "medication side ef fects or drug abuse. " TfO I, instructed to "el-iminate use of caffeine and other stimulants" or "encouraged to seek a psychiatrist if s )rmptoms do not improve. " anger, memory loss, ideation, hallucinations [or] drug abuse." (Exhibit W; Exhibit O; Exhibit suicidaf D\ lf fearfulness, Respondent was also not questioned regarding "nervousness, with lhree prescriptions ll on January 3I, 2012, one for 120 pills of 30ng Roxicodone, the (Exhibit second for 60 piffs of Xanax, and a third for Flexaril. 32. Respondent provided TFO Exhibit O, I4i 16-23; Exhibi|L P, 19:28-23:35; Exhibit X) . 33. Contrary to Respondent's January 31, 20L2 patient record for lp Respondent never provided TFo F I with Cymbalta samples or a prescription for Motrin. Nor did he N,' provide rEo If with any instructions regarding daily rni-irritia< n^l-6hf exercises, proper posture and Iifting technique, or sleeping posture. Nor was there any discussj-on regarding "paj-n med.ication side effects and any addiction potential" or the "risks and benefi r c af hrac^?j h+ ion medications." (Exhibit N; Exhibit O; Exhibit P) 34. Neither Respondent nor his staff conducted a physical examinatj.on of TFo t on January 31, 2QL2, other than that 7 Respondent briefly pinched TFo f s neck. (Exhibit K; Exhibit L; Exhibit M). 35. On or about February 3, 2012, AEGIS Pain Medication Compliance Testing ('AEGIS") reported to Respondent that the on ,ranuary 31, urine specimen collected from "-f fl} 2012 was negative for the presence of the prescribed Oxycodone. tE;xn.rDat wl. 36. On February 27 , 20L2, TEo ;\ was seen by Respondent for approximately nine (9) minutes. Five (5) minutes and thirty (30) seconds were spent discussing non-medical topics including p.rostitution and spo.rts tickets. (Exhibit S (February 27, 201,2 DVD recording Undercover Investigation), 14 226-23:23) . provided a urine sample on Februaly 27 | 2OI2 . 37 . TFo lll) (Exhibit W,' Exhibit Q) . 38. With no prompting, Respondent suggested that ffO J begin a testosterone regime because "the l-onger ...you take pain meds, it fucks your hormones." Respondent asserted that he (Exhibit Q; Exhibit R " [does] it for aIJ- lhis] patients. " , 20L2 Transcript) , TII:5-2I7 Exhibit S) . 39. TFO lf asked that Respondent give hirn two prescrj-ptions for 120 pi1ls of 30ng Oxycodone though he did not provide any explanation for the need for an additional prescription. Respondent complied. (Exhibit Q; Exhibit R, (February 21 T12:L6-24; Exhibit S, t4:26-23:23). 8 40. Contrary to Respondent's February 27 , 20L2 patient never stated he would be TEo record for .{ |} -t traveling on vacation and would be unable to return to the clinic in twenty (20) days. Nor was a chronic care handout provided and as the record indicates. (Exhibit R; d.iscussed with TFo F Exhibit S; Exhibit W). with four prescriptions, 4L. Respondent provided TFo F one for 120 pills of 30mg Roxicodone dated February 27, 20L2, one for !20 pills of 30mg Roxicodone dated !4arch 16, 2012, one for 90 pill-s of xanax, and one for l'l-exaril. (Exhibit Q; Exhibit D' Exhibit S; Exhibit X). 42. Contrary to Respondent's February 27, 20L2 patient Respondent never provided rFo I record fot _with a prescription for Motrin or even recommended that. he try (Exhibj-t W; Exhibit R; Exhibit S) . it. 43. Neither Respondent nor his staff conducted a physical o. February 27, 20'J.2, other than that examination of TFo I Respondent briefly pinched TfO - I 's neck and pressed on his l-ower back. (Exhibit Q; Exhibit R; Exhibit S). 44. Contrary to Respondent's February 21 , 20L2 patient never reported that he had record for f rro D fI "morning stiffness with decreased mobility due to pain" and he never denied having "depression and anxiety associated with this Nor did TE'O Il discuss the natuxe, severity or location of his alleged pain on that date. Respond.ent also dj-d not review "motivational techniques,,, the ..target pain leveI management of 3 to 4 in scale of 10,,, .'pain medicine managemenE agreements, " or any other actions listed under ..plan,, in the patient record. (Exhibit R; Exhibit s, Exhibit v{). 45. On or about March 3, 2012, AEGIS reported to Respondent that the urine specimen coLlected fron {!on February 27, 20J,2 was negative for the presence of the prescrlbed the lab described as ..non_ compliant" with his treatment pfan. (Exhibit W). 46. On March L9, 2012, TFO I was seen by Respondent for approximately six (6) minutes. (Exhibit V (March 19, 2OI2 DVD recording Undercover Investigation) , 2:40-g:30) 47. Contrary to Respondent's undated finaf entry in the patient record ror e Respondent did not discharge E, Oxycodone and Cyclobenzaprine which at hie 1ast appointment. (Exhibit U (March L9, 2OL2 I, Transcript), Exhibit V, Exhibit W) . 48- TFOI scheduted another appointment with Respondent and also made an appointment for his girlfriend. (Exhibit U, TFO T10:11-T12:5; Exhibit v) . 49. Respondent Xanax. (Exhiblt U, T10:8-10; Exhibit V; Exhibit X). 50, Throughout his appointnents wirh TFo III made also issued TFo Il a prescription for Respondent multipl-e unprofessional conments. 10 Tnroijgnour rne DacrerrE recoro ror I!I Respondent inserted or caused to be inserted fabricated 5i. and inaccurate inf ormat.ion. 52. Respondent's medical practice as evidenced by his treatment of TFo Il medicaL deviates from the accepted standards of conduct practice. The deviatj-ons are demonstrated by the al-leged herein. 53. Respondent's conduct as alleged herein constitutes gross mal-practice, gross negligence, and/or gross incompetence and thus constitutes a basis for disciplinary sanction pursuant to N.J.S.A. 45:L-2I(c) and constitutes repeated acts of negligence, malpractice, and/or incompetence .in violation of N. J. S.A. 54 45:. L-27 (d\ . - ResDondent's conduct as alleged herein constitute dishonesty, fraud, deception or misreprebentation in vio.l-ation of N.J.S.A- 45:!-2! (b) and a fail-ure to conform to the recordkeepj-ng requirements set forth in N.J.A.C. 13:35-6-5(b) (2) and are thus a viotation of N.,f.S.A. 45:1-21(h) . 55. Respondent's conduct as al-Leged herein further constitutes professional misconduct and thus constitutes a basis for disciplinary sanction pursuant to N.J.S.A. 4511-21(e) . 55. Respondent's conduct as alleged herein further constitutes the prescribing of cDS indiscriminately or without good cause in violat.ion of N..J.S.A. 11 45:1-21(m) . 57. Respondent's conduct as alleged herein palpably demonstrates that his continued practice of medicine and/or surge.ry in New Jersey presents a clear and inminent danger to the public health, safety, and welfare warranting the immediate temporary suspension of his license pursuant to N.J.S.A. 45:\-22. coItlIT rI 58. The General Allegations and Count I are repeated and realleged as if set forth at length herein, 59. Respondent's routine pain management treatment of his patients C.P., P.B., M.R.J., A.E., M.J. (P. ), T.Y. and D.E. deviated repeatedfy from accepted slandards of medical care. 60. Respondent failed to maintain patient medication contract agreements with each patient as recommended by the standard of care and under N.,I.A.C. l-3:35-7.6(f ) . (e.9., Exhibit , 2248-2353; Exhibit D (Patient Record for D.E.), p. S0L826-S02093; Exhibit CC (Patient Record for T.Y.), p. S01774-S01775) ; Exhibit C (Expert Report of Gerard A. Malanga, M.D.), p. 3); Exhibit BB (Transcript of Respondent's April 6, A (Patient Record for P.8.',) 2011 Prelimj-nary Evaluation Conunittee Appearance), T23.20-25 T24:3-21-). & 61. Respondent failed to adequateLy document the effectiveness of the prescribed pain medication or, otherwise, adequalefy monitor whether there nas improvement in pain, improvement in function or adverse effects from the pain 12 medications he prescribed to his patients. pR. An example of this fail-ure includes, but is not fimited to, his treatment of patient (59) Patient P.8., at age fifty-nine ' commenced treatment with Respondent for complaints of low back, feet and hand pain on or about February 6, 2009. (Exhibit A (Patient Record for P.B.1' p.02269). Respondent was aware through a prior January L4, 2009 h letter that P.B. had a history of diabetes and suffered from peripheral- neuropathy in his hands and feet. (Exhibit At p.231'l-23L9) Beginning on February 5, 2009, Respondent prescribed tablet of Oxycontin twice a day and 30ng tablets of Roxicodone for breakthrough pain. (Exhibit P.B, one 80mg A, p.02269-02277 & 02348t, . .l Beginning March I1 , 2009, Respondent increased the dosage to 80mg tablets of Oxycontin four times a day. (Exhibit A, p.02264-02266 & 02348). e. Between March 17, 2009 and October 2, 2009, Respondent prescribed P.B. 960 tablets of 80ng Oxycontin and 960 tablets of 30mg Roxicodone. (Exhibit A, p.0225002266t . f. Patient P.B- notified Respondent on Decerdcer 16, 2009 that at some point since his l-ast apPointment on 13 October 2, 2009 he was hospitalized for jaundice. (Exhibit A, p.02248-02249 & 02348\. also aware that P.B. had a history of liver disease refated to alcohof use and jaundice through an october I, 2009 consuftation report. (Exhibit A, p.02345-02346) . Respondent was h While RespondenL knew or should have known that P.B.'s liver would be less able to metabolize medication' Respondent made no appropriate adjustment to the prescriptions for high-dose oxycontin and Roxicodone. lnstead, on Decenber f6, 2009, Respondent again prescribed P.B. 120 tabfets of 80mg Oxycontin and tabl-ets of 3Omg Roxicodone. 120 (Exhi.bit A, p .022 48 , 02346,02348 & 02289,02327-02322; Exhibit B' P.4; Exhibit c, p.3 & 6) . i. Respondent refilled P.B.'s prescriptions for high-dose OxyContin and Roxicodone without learning more about the cause of the iaundice or whether the narcotics -1 -,,^..r Pl.qlEu ,^1 ^ +tarrq fi nnraaei rrY nn rrelsqDf l- he riSk Of harm tO Oxycontin and Roxicodone can cause P.B.'s liver. "spasm in the biliary system resulting in more .Iiver AIso, "in a impairment and increasing jaundice. " patient that has significant liver disease along with renal impairrnent, there would likely an accumulation of L4 these medications that can result in resplratory suppressr-on and death." (Exhibit B (Expert Repor! of Louis F. Anorosa, MD) ' p.4; Exhibit C, P'6) 62. Respondent continued to provide Controlled Dangerous Substances to patients even though urine drug testing resul-ts repeatedlyindicatedimpropermedicationuseolsubstanceabuse. An exampl,e of this deviation from accepted standards of medical practice includes, but is not finited to, his treatment of patient D-8.: a. Patient D.8., at age forty-four (44'), commenced treatmen! with Respondent for knee pain on or about October 15, 200'7. (Exhibit D (Patient Record for D.E. ) p. S01826-502093) ' . b. Toxicology tests performed on specimens collected from D.E. between May 1, 2008 and December 22, 2008 yielded six positive lab results for the presence of cocaine which were indicative of cocaine abuse or consurnption of medications not prescribed by the Respondent' (Exhibit D, S02003, S02006, 502016, S02018, s02O2I, & 502026; Exhibit c' P.3) . c. Toxicology tests performed on specimens c.olLected from D,E. between May 1, 2008 and December 22' 2008 reveal-ed negative 15 results for benzodiazepine' prox!4)hene, Oxycodone, and tramadol which indicated she was not consuming her prescribed medications. (Exhibit D, p.502002-502028; Exhibit C' P'3) ' d. The absence of prescribed medications in the toxicology results "suggest Is] the potential for diversion" of these "powerful opioid medications"' (Exhibit C, p.3) . 63. Respondent fail-ed to timely refer patients to addiction An example of this deviation from accepted speciaLists. standards of medical practice includes, but is not l-imited to, his treatment of patient T.Y.: e. Patient T.Y., at age forty-six (46) , colnnenced treatment with Respondent for low back pains, knee pains and an evafuation of vertigo on or about August f6, 2006. (Exhibit CC, p . S 0 1 7 7 4 - 0 1 7 7 5 ) ' f. Toxicol-ogy tests performed on a specimen collected from T.Y. on May 25, 2007 yielded a positive lab result for the p.resence of cocaine and a positive S lab resuft for the presence of opiates. (Exhibit CC, p.S01808). g. Respondent continued to prescribe T.Y. increasing narcotic pain medications; in March of 2008, Respondent documented lhree prescriptions of LO in T.Y.'s patient record, totaling 200 tabfets. (Exhibit CC, p.S01513-S01510). h. Respondent prescribed T.Y. Suboxone from April 16, Roxicodone 30nq until Septenber of 2008 whereupon he resumed prescribing T.Y. Roxicodone and other narcotic medications. (Exhibit CC, p.501510-501508). 2008 i. The next toxicology test was performed on a specimen colfected from T.Y. on November 23, 2009 and reported on November 30, 2009. It again revea]ed positive resu.Its for the presence of a metabolite of Cocaine. ft al,so revealed negative results for the presence of benzodiazepines indicating he was not consumj.ng his prescribed medications. (Exhj,bit CC, p.01795-01796) . j. A toxicology test was performed on a specimen collected from T.Y. on December 2L, 2OO9 and reported on December 29, 2009. It reveafed negative resul-ts for the presence of morphine and benzodj-a zepines vrhich indicated he $ras not consuming his prescribed medications. It afso reveal-ed a positive resul-t for the presence of Gabapentin !{hich indicated consumption of medications not currently prescribed by the Respondent. (Exhibit CC, p. 501793-1794) . I1 k. According to his patient record, Respondent issued Y, prescriptions for 405 tabfets of 3Omg Roxicodone, among other medications, between T. Novenber 23, 2009 and ,January 26, 20L0. (Exhibit CC, p.s01505). 1. Though Respondent noted on January 26t 201,0 t}!at T.Y. was discharged due to the Novenber 30, 20L2 positive cocaine resuft, there was no documentation of a referraf to an addiction specialist as woufd be appropriate under the standard of care. (Exhibit CC, p.501505; Exhibit C, p.3-4) 64. Respondent's medical practice as evidenced by his treatment of patients C,P., p.8., M.R.J., A.8., M.,J. (p.), T.y. and D.E. deviates fram t-ha .^^6h+^^ standards of medical practice. The deviations are demonstrated by the conduct alleged herein and as anal-yzed in Exhibits B and C. 55. Respondent, s conduct as alleged herein constitutes gross rnalpractice, gross negligence, and/or gross incompetence and thus constitutes a basis for discipllnary sanction pursuant to N.J.S.A, 45:1-21 (c) and constitutes repeated acts of negligence, mal-practice, and/or incompetence in viofation of N. J. S.A. 45:1-21(d) . 18 66. Respondent's conduct as alleged herein further constitutes professional misconduct and thus constitutes a basis for disciplinary sanction pursuant to N..I.S-A. 45:1-21(e) ' Respondent's conduct as alleged herein further 6'7 . constitutes a violation of the Board's record keeping regulation and thus constitutes a basi,s for disciplinary sanction pursuant to N. J. S.A. 45:1-21(h) . 68, Respondent's conduct as alleged herein further constitutes the prescribing of CDS indiscrj-minately or without good cause in viol-ation of N.J.S.A. 45: l-21 (n) . 59. Respondent's conduct as alleged herein palpably demonstrates that his continued practice of medicine and/or surgery in New ,fersey presents a cl-ear and imminent danger to the public heal-th, safety, and vrelfare warranting the immediate temporary suspension of his license pursuant to N.J.S.A. 45zI-22. COT'NT III 70. The ceneral All-egations, count I and count II are repeated and reall-eged as if set forth at length herein. 17. Respondent's treatment of his patients with testosterone devj.ates from accepted standards of medical- practice as demonstrated by his treatment of patients C.G., C.P. and S.G. (Exhibit E (Patient Profi.Ie for C.P.), p.S0030-S0035; Exhibit F (Office Prescription Record for C.P.), p.50050-S00057; Exhibit c (Patient Record for C.P.), p . S 0 0 0 5 I - 0 0 1 8 3 ; Exhibit DD (Patient S 19 RecordforC.G.),p.02095-02246);ExhibitEE(Patientrecordfor S.G.), p. SO26O8-S02660; Exhibit B, p.3-7). 72. A female patient' c.P., commenced treatment at age thirty-four (34) with Respondent on or about VraY 4, 2006 for low back pain, Ieg pain and anxj-ety. On or about August 1l'' p. S00181-S00183 2006 Respondent a.Iso assessed C.P. as having hypogonadism. (Exhibit G' c S0015-S001-56; Exhibit AA (Transcript of Respondent's November 3, 201-0 Prel-iminajry Evaluation committee , T46:22-T47:41 . Appearance) 13. Between August of 2008 and October 2010, Respondent treated C.P. with 24 prescriptions for the Androgel pump at two pumps per day. (Exhibit E, p.S0030-50035; Exhibit F, p.S0050s00057; Exhibit G, p . S 0 0 0 5 8 - 0 0 1 I 3 ) Exhibit B, p.3-4). C.G, , commenced treatment at age 7 4. A male patient, S thirty-four (34) with Respondent on or about November 8, 2007 for low back pain. On or about May 8, 2008 Respondent assessed c.G. as having hypogonadism. C.G. had a history of chronic opiate abuse. (Exhibit DD, p.02205-02207 & 02L75-021'17). 1q r\vryvrruerrL Rasrton.lcnf also exhibited "marked " with testosterone between May of 2008 and May of 2009 with prescriptions for 1cc of 200m9 testosterone cl4)ionate every seven days, (Exhibit DD, P. 02L25-02L17; Exhibit psychiatric symptoms, El ^ (\ 20 76. A mafe patient, S.G., commenced treatment at age thirty-three (33) with Respondent on or about June 23' 2009 for fatigue, hypogonadism, insomnia and anxiety among other conditions. (Exhibit EE, S02608 & 502644) . 77. Respondent treated S.G. with Lestosterone between ,tufy of 2009 and February of 20L\ with prescriptions for 1cc to l-.6cc of 200m9 testosterone cypionate every seven days. 78, Respondent's patient records fail- to reffect .relevant differential diagnoses and/or careful consideration of less risky or potentially harmful treatments. Testosterone t.reatment can .lead to aggressive behavior, polycythenia (which can lead to strokes), Liver damage and/or prostate cancer. fnstead, it is Respondent's routine practice to prescribe testosterone to hrtiante r'l ca haina nraenriF6.l .prescribed -rr^^{-i narcotic pain medication or have ^ experienced chronic narcotic use. (e.9., Exhibit c, p.S00058S00183, Exhibit DD, 02094-02246; Exhibit EE, S02608-S02660; Exhibit B, p.2-7; Exhibit BB, T36:3-38:19; Exhibit R, 4T11:5-21-). 79. Respondent routinely prescribes testosterone to hrs patients in dosages which are excessively high and at a l-evel l-hrt ic mo.linr] 1rr !.Ii^h t-. unnecessary. High testosterone fevels can exacerbate psychiatric disease, cause male breast enLargement, clitormegaly j-n women, personality changes and/or aggressive behavior. (e.9., Exhibit G, S00058-S00183; Exhibit DD, 0209402246; Exhibit B, p.2-7). For example: 2L a. C.P.'s testosterone j umped dangerously from 37ngld1 in August of 2008 to 551ng/dl in November of 2008 aird 434ng/dl in November of femaLes 2OO9 where the upper l-imit for is approximately 82. (Exhibit G, 500229t s00243, and 500253, Exhibit B, p.3-4). b. C.G.'s testosterone j urnped dangerously fron 97ngld1 in April of 2008 to 968n9./d1 in August of 2008 and 1010n9,/dt in November of 2008 where the upper limit for males is approximately 800. This increased the estradiol levef to 54pg/ml with an upper linit of 42 in rnen. (Exhibit DD, 50225, 502234, and 502239; Exhibit B, p. s) . c. S.G.'s testosterone j umped dangerously from 748n9/d1 in August 2009 to 1435n9,/d1 j-n January 2010 and t257ng / dI in August 2010 $rhere the upper linit for males ls approximately 800. (Exhibit EE, p. 502625, 502630, 502535: Exhibit B, p.5) i. 80. Respondent fail-ed to adequateLy monitor improvement in function or adverse effects experienced by his patients receiving testosterone treatment. This fail-ure is demonstrated by the missing and/or paltly entrj-es in the patient records refLecting such indj-cators, including but not linited to, the presence or absence of acne, lost body fat, body weight or impact on libido 22 or mood. (Exhibit G, p.S00058-S00183; Exhibit DD, p'02095-02246; Exhibit EE, p' sO26O8-502650; Exhibit B, p'3-4)' 81. Respondent prescribed testosterone to patients taking otherhormone-impactinqmedicationswithnodiscussionor monitoring of the potential drug interactions' Specifically' Respondent prescribed testoste.rone to patients receiving arimidex and/ortriphasal2Ebirthcontrol.(ExhibitE,p'S0030-50035; ExhibitF,p'S0050-S00057;ExhibitG,p'S00058-S00183;Exhibit EE, p.S02608-S02560; Exhibit DD, P.02095-02246' Exhibit B' p'57). 82. RespondenL's patient records faif to reffect that he hasadequatelyinformedhispatientsoftheseriousrisksof testosterone treatment' (e.g., Exhibit G, S00058-S00183; Exhibit EE, p.S02608-502660; Exhibit DD, p'02095-02246' Exhibi-t B)' 83. Respondent's medical practlce as evidenced by his treatnentofpatientC.G-,C'P'andS'G'deviatesfromthe The deviations are accepted standards of medical- practice' demonstrated by the conduct alleged herein and as analyzed in Exhibit B and Exhibit C. 84. Respondent's conduct as alleged herein constitutes gross malpractice, gross negligence, and/or gross incompetence and thus constitutes a basis for disciplinary sanction Pursuanf to N. J. S.A. 45:]-2L(c) and constitutes repeated acts of , 23 neg.Ligence' malpractj-ce, N. J. :. and/ or incompetence in violation of alleged herein further constitutes professional misconduct and thus constitutes a basis for disciplinary sanction pursuant to N.'-l'S-A. 45:1-21(e) . 96. Respondent's conduct as alleged herein further constitutes a violation of the Board's record keeping regufation and thus constitutes a basis for disciplinary sanction pursuant to N. J. 87 S.A. 45:1-21(d) Rq Rcsnondent's conduct as S.A. 45:1-21(hl . . Respondent's conduct as alleged herein palpably demonstrates that his contj-nued practice of rnedicine and/or surgery in New Jersey presents a clear and iruninent danger to the public health, safety, and wel-fare warranting the immediate temporary suspension of his l-icense pursuant to N.J.S.A. 45:t-22cot NT rv 88. The General A1legat.ions, Count I, Count II and Count III are repeated and realleged as if set forth at length herej-n. 89. Respondent improperly performed electrodiagnostic testing on patients P.B'' D.8., A.E. and R-J. 90. Respondent made unsupported and unsubstantiated diagnoses based on his improperly performed nerve conduction studies. g1-. Respondent failed to provide a suunary in the patlent records of the observational findings of nerve conduction testing 24 resufting in a risk of rnedical-ly unnecessary treatment such as spinal injections or surgical intervention. 92. Respondent's medical practice as evidenced by his treatment of patients P.8., D.E., A.E. and R.J. deYiates from the ?he deviations are demonstrated by the conduct alleged herein and as analyzed in Exhibil C. 93. Respondent's conduct as alleged herein constitutes gross malpractice, gross negligence' and/or gross incompetence and thus constitutes a basis for disciplinary sanction pursuant accepted standards of medical practice. to N.,J.S.A. 45:L-2L(c) and constitutes repeated acts of negligence, malpractice, and/or incompetence in violation of N. J. S.A. 45:1-21(d) . 94. Respondent's conduct as alleged herein further constitutes professional nisconduct and thus const.itutes a basis for disciplinary sanction pursuant to N.J.S-A. 45:1-21(e). 95. Respondent's conduct as alleged herein further constitutes a violation of the Board's record keeping regulation and thus constitutes a basis for disciplinary sanction pursuant to N.J.S.A. 45: l--21(h) ' couNT v 96. The Generaf Allegations, Count I, Count II, Count III and Count IV are repeated and realleged as if set forth at length herein . 25 97. Respondent improperly performed manipulation anesthesia (*MUA") on patients A.S., D.R. and P.H. unde.r 98. Respondent failed to re-assess each patient on each day following the MUA treatments and prior to performing another session of MUA. 99. Respondent performed MUA with no medica.l necessity generic manipu.Iation perforrned on each patient. as demonstrated by the fack of specific physical- exam findings and 100, Patient records indicate that Respondent fail-ed to have an anesthesiologist present when he performed anesthesia. 1nl rvr, pac6^.Aahf, r\qo},vr.ssrrL c r ma^i nr'l h.i^l-i l/lqeLree -a MUA using general l-'rr ey h.- arzi^anaoA treatment of patients A.S., D.R. and P.H. deviates from the The deviations are accepted standards of medical practice, demonstrated by the conduct alleged herein and as analyzed in Exhibit 1^1 C. Da6^^hAa-f, S COnduCt aS alleOed herei n const i frrtes gross malpractice, gross negligence, and/or gross incompetence and thus constitutes a basis for disciplinary sanction pursuant to N.J.S.A. 45:I-2L(c) and constitutes repeated acts of negligence, malpractice, and/or incompetence in violation of N. J. S.A. 45:1-21 (d) . 26 103. Respondent's conduct as alLeged herein further constitutes professional misconduct and thus constitutes a basis for disciplinary sanction pursuant to N.J.S,A. 45:1-21(e) . 104. Respondent's conduct as alleged herein further constitutes a viol-atj-on of the Boardrs record keeping regulation and thus constj-tutes a basis for disciplinary sanction pursuant to N. J. S.A. 45:1-21(h) . cot Nrr vr 105, The General- AJ.legations, count I/ count rI, count III, Count IV and Count V are repeated and realleged as if set forth at length herein. 106. Respondent's treatment of patients C.P., M.R.J., A.E., M.J.(P.), T.Y., D.8., C.D., P.8., M.G., P.H.' W.1., D.R. and A.S. demonstrates that he lacks adequate training to perform services psychiatry, anesthesiology, pain rel-ated to neurology, management, physical medicine and rehabilitation, spinal manipulative therapy, Manipulation Under Anesthesia, peripheral neuromuscular anatomy, physiology, testosterone treatment and/or ic testing. 107. Respondent's patient records for patients c.P., M.R.J., A.E., M.J. (P.), T.Y., D.E., C.D., P.B., M.G., P.H., W.L., D.R. e Lect rodiagno st and A.S. contain contradictory and inaccurate information, are deficient as to patient hi-stories and physical- exams and lack Respondent's signature at the end of each entry. 27 108. Respondent's conduct as alleged herein constitutes gross malpractice, gross negligence' and/or gross incompetence and thus constitutes a basis for disciplinary sanction Pursuant to N.,f.S.A. 45:.L'2I(c'l and constitutes repeated acts of negligence, malpractice, and/or incompetence in v.iofa!ion of N. ,f . s. A. 45: l--21 (d) . alleged herein further constitutes professional misconduct and thus constilutes a basis for disciplinary sanction pursuant to N.J.S.A' 45:1-21(e) 11-0. Respondent's conduct as alleged herein further 109. Respondent's conduct as constitutes a viofation of the Board's record keeping regulation and thus constitutes a basis for disciplinary sanction pursuant to N. J. S.A. 45:l--21(h) . the Attorney General of New Jersey demands the entry of an Order against the Respondent Roger Lallemand, M.D-: 1. For the immediate temporary suspension of Respondent's license to practice medicine and surgery in the State of New WHEREEORE, Jersey pending a fulf plenary hearing pursuant to N.J.S-A- 45:1zz; For the suspension or revocation of Respondent's license to practice medicine, and surgery pursuant to N.'J.S-A' 45: I-2I; 2. 28 Directing Respondent to cease and desist the practice of medicine and surgery in the State of New Jersey, pursuant to N. J. S.A. 45:. l-22 (c) ; 4. Imposing such l-initations on Respondent, s CDS registration as would be required by the Board or the Office of nrrr^ a^h+ F^ I . 3. 5. Imposing penalties upon the Respondent for each sepaiate offense set forth herein, pursuant to N. J. S.A. 45:L22(b) and N.,f . S.A. 45:l-25; 6. Imposi-ng costs upon the Respondent, includrng investigative costs, fees for expert r"/itnesses, attorney's fees and costs of hearing, such as transcript costs, pursuant to N.J.S.A. 45:7-25 (d) ; and 7. For such other and further relief as the Board shatl deem just and appropriate. 'JEEFREY S. CHIESA ATTORNEY GENERAL OF NEW JERSEY By: Deputy Attorney General Date: April 30, ZOLZ 29 May. l. 2012 10:02A[4 NJ EOARD MIO]CAL EXAMJNERS " 1t11 D 7 CbskaG cowlpi KDrO{raDroo It, @wts Orfi c or rEAnotrurt CtrEBrL DEPARnd*Tor L^t aD Puluc S|lrtfr DrvEoNor LAfl State of New Jereey JEwrS.CbsA Mtqtud I,lttc&r NsrrL NI (t7r0l PO l.r(,i50tS Grrslott r.s. Po$r{o AptiI 30, 2OL2 FILED State Board of tledical Enarnlners Trenton, P.O, Box 183 New NEW JERSEY STATE BOARD Jersey 08625-018 3 Re: Roger tallenand, Jr., M.D. of ths Board: PLease accept this letter brief in iieu of a more formal brief ln support of, the Attorney GenelaL'9 emergent application for the imediate ter[porary suspension of Ehe license of Roger L,allesrand, Jr., M,D. (hereinafter "the Respondentz or "DrLa1lenand-) to practice medicine and surgely in the state of New Jersey- the Attolney General's application is premised upon the allegationa in the verifled Counts of the AdniniEtlative Conplaint, the supporting Exhiblts thereto, the order to shos Cause, and the Certification of Counsel that accompany thLg Ietter brief. Honolable I'lenbels PRET,IMINARY STATEMENT Respondent's conduct demonstraLes that nothing short of a tentl)olary suspension will protect the publ-ic- As described in the detailed expert reports rendered by Dr- Gerard A, Malanga and Dr. Louis F. Araoroaa, Respondent engages in numerous dangerous devj.ations fron the standald of cale in his nedical plactice. Specific to the appLication fo! the teBpolary suspensJ-on of hls License are his deficj.ent ControLlod Dangelous Substances (*cDS") and testostelone prescliblng plactlces as flauduLent nedical recordkeeping, Iihen inltlally l2a Edr' Sh.t. lEJtaoG (t?S) . FrE (gf$ E tpbt t. hin|rd ot fud t/cc.bq LA4 E6IW fua od E46bL April 30, page 2 012 2 questj-oned by a Preliminary Evaluation Committee ("PEC") of the Board regarding his prescribing practices, Respondent asserted that any deficlencies and inaccuracies were due to his transition to electronic medicaf records. He also claimed that his pain management practj-ce was evolvi-ng and that he had begun to institute additional safequards such as cain manaqement contracts , Yet, the DEA's undercover investigation which occurred after the Respondent's PEC testimony demonstrated that Respondent continues to prescribe CDS and testosterone to his patients in an indiscriminate and reckless manner. Respondent's subsequent suppl-ementation and alteration of lll (the fictitious name used by the DEA agent) patient record reveafs that he is aware of his deficient practices but chooses nol to correct them, Respondent's conduct in the DEA's undercover investigation and subsequent supplementation and alteration of the patient record demonstrates that Respondent can not be trusted to abide by any limitations that this Board may impose on his practice of rnedj-cine. Respondent's unfettered ability to practice medicine poses a danger to both his current patients and the public at farge. Thus, his continued practice as a physician poses a clear and imminent danger to the public's health, safety, and weffare. STATEMENT OF FACTS testosterone treatments though he received no significant formal education in these 3ag6<