DOH 11-2505 ESO 201115571

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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

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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

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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

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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

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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.

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Aiman I . AryanLicense No. PS 33142


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.

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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

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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 .

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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,

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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

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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.

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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

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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.


Aiman I. AryanLicense No. PS 33142


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

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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.

Documents

DOH 11-2505 ESO 201115571