Final Order No.

DOH-11-2505FILED DATE - 10 13 Department of Health

ego MQA

STATE OF FLORIDA DEPARTMENT OF HEALTH

IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

By:

lair\
Deput 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 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

IN RE: The Emergency Suspension of the License of Aiman I. Aryan License 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 fill the oxycodone prescriptions without scrutiny or restriction. From 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

IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

lawfully dispense controlled substances. Mr. Aryan also owns and operates three other pharmacies, Pharmacy One, Inc., Izz & Sons l and RDS Pharmacy Management, Inc., each of which conducts business individually as "Robert's Drug Store." 3. Since 2010, the United States Department of Health and Human Services

(HHS) and DEA conducted an investigation into allegations that Mr. Aryan engaged in a conspiracy with Dr. F.B. to illegally distribute controlled substances. In particular, the investigation revealed that sponsors recruited purported patients to obtain drug prescriptions from Dr. F.B. The sponsor would coach the patient as to what symptoms to allege to Dr. F.B., and Dr. F.B. would then prescribe large amounts of controlled substances, including Oxycontin, oxycodone and/or Opana ER, to the patient. After obtaining the prescription, the sponsor would contact Mr. Aryan, who directed the sponsor and patient to one of his four pharmacies, at which time the pharmacy would dispense the prescribed drugs to the patient. Mr. Aryan would receive cash from the sponsor to process and fill the prescriptions without scrutiny, and the patient would then provide the sponsor with the drugs in exchange for $600. 4. Oxycodone is commonly prescribed to treat pain. Oxycodone is an opioid

drug, which has similar effects as the drug opium. Opioid drugs are synthetically manufactured, while opiate drugs are naturally occurring, but the terms opioid and opiate are often used interchangeably. Opioid drugs are addictive and subject to abuse.
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3454 NW 7th Avenue, Miami, Florida, 33127.

IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

According to Section 893.03(2)(a), Florida Statutes (2009-2011), oxycodone, or any salt, compound, derivative, or preparation of 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. 5. Oxycontin is a brand name of oxycodone hydrochloride and is prescribed

to treat pain. Oxycontin is an extended-release medication used to provide pain relief for extending periods of time, while oxycodone is an immediate-release medication used to provide short-term pain relief. According to Section 893.03(2)(a), Florida Statutes (2009-2010), oxycodone, or any salt, compound, derivative, or preparation of 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. 6. Opana ER is a brand of oxymorphone hydrochloride, a morphine-like

opioid agonist, and is prescribed to treat pain. Opana ER is similar to Oxycontin in that it is an extended-release medication used to provide pain relief over an extended period of time. According to Section 893.03(2), Florida Statutes (2011), oxymorphone 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

IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

oxymorphone may lead to severe psychological or physical 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, Mr. Aryan and Izz & Sons dispensed a combination of Oxycontin 80 mg 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 mg, a combination which Mr. 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. Although the quantities of drugs dispensed Between June 1 2010, and

September 28, 2011, varied, Mr. Aryan and Izz & Sons routinely dispensed a combination of 60-90 tablets of Oxycontin 80 mg / Opana ER 40 mg and 120-180 tablets of oxycodone 30 mg to individual patients. This means that each "patient" received a minimum of 280 mg of oxycodone per day if he or she received the

IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

oxycodone-Oxycontin combination, or a minimum of 200 mg of oxycodone per day if he or she received the oxycodone-Opana ER combination. 10. Between January 1 and June 1, 2011, Mr. Aryan and Izz & Sons purchased

from wholesalers 384,900 medications that contained oxycodone, including Oxycontin, oxycodone, Opana ER, Endocet and Roxicet. As such, Mr. Aryan and Izz & Sons were the fifth-highest wholesale purchaser of oxycodone in Miami-Dade and Monroe counties, combined. In total, Mr. Aryan's four Robert's Drug stores were the first, fifth, ninth and 24th highest wholesale purchasers of oxycodone medications in Miami-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 Department retained an independent pharmacy expert to review Mr.

Aryan's dispensing records at Izz & Sons. Based 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 inappropriate 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 number 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

IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

excessive and inappropriate. Finally, the expert opined that an 80 mg daily dose of oxycodone is potentially lethal for opioid-naive patients, and Mr. Aryan's customers routinely received doses and quantities of oxycodone that greatly exceeded the 80 mg lethal daily dose. 12. On October 12, 2011, Mr. Aryan was indicted and arrested on one count of

conspiracy to possess with intent to distribute controlled substances in violation of Title 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 time period.

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.

IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

14.

In September 2010, the HHS issued the results of a 2009 National Survey

on Drug Use and Health. The HHS report found that there were 7.0 million individuals in the U.S. who used prescription drugs for non-medical reasons within the previous one-month period during 2009. Of those individuals, 55.3% received the prescription drug from a friend or relative; 17.6% reported that they received the drug from one doctor; 4.8 % received the medication from a drug dealer or a stranger; and 0.4 % purchased the drug on the Internet. 15. Pharmacies that liberally fill prescriptions for controlled substances for

patients who have no legitimate medical need for the drugs and often divert and resell the drugs to others, pose a serious danger to the public health, welfare and safety. This is so because such controlled substances are often potentially addictive and because the misuse or abuse of these drugs can cause serious and lasting medical injury and death. 4

CONCLUSIONS OF LAW
Based on the foregoing Findings of Fact, the State Surgeon General concludes as follows: 1. The 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.

IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

2.

Section 120.60(6), Florida Statutes (2009-2011), authorizes the Department

to suspend or restrict a pharmacist's license if the Department finds that the pharmacist presents an immediate, serious danger to the public 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 pharmacy. 4. Mr. Aryan dispensed or distributed controlled substances in excessive or

inappropriate quantities in one or more of the following manners: a. By dispensing excessive or inappropriate dosages and quantities of

oxycodone 30 mg; b. By dispensing excessive or inappropriate dosages and quantities of

Oxycontin 80 mg; c. By dispensing excessive or inappropriate dosages and quantities of

Opana ER 40 mg; d. By dispensing combinations of large quantities of oxycodone 30 mg

IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

and Oxycontin 80 mg; and e. By dispensing combinations of large quantities of oxycodone 30 mg

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. By repeatedly dispensing large doses and quantities of oxycodone

medications prescribed by Dr. F.B.; b. By repeatedly dispensing large doses and quantities of oxycodone 30

mg and Oxycontin 80 mg prescribed by Dr. F.B.; and c. By repeatedly dispensing large doses and quantities of oxycodone 30

mg and Opana ER 40 mg prescribed by Dr. F.B.

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IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

7.

Section 465.016(1)(r), Florida Statutes (2009-2011), allows the Board to

discipline or suspend the license of a pharmacist for violating any provision of Chapters 456 or 465, Florida Statutes (2009-2011), 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 Department of Health. 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 Dr. F.B. to the Department. 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 of the 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 limited. 11. Mr. Aryan violated Rule 64B16-27.104(3), Florida Administrative Code,

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IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

by entering into an arrangement with Dr. F.B. to receive compensation for servicing Dr. F.B.'s patients. 12. Section 120.60(6), Florida Statutes (2011), authorizes the Department to

suspend a pharmacist's license if the Department finds that the pharmacist presents an immediate, serious danger to the public health, safety, or welfare. 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 pharmacy laws and rules, as well as the safety of 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 welfare. 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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IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

and harm to the public. Inappropriate dispensing of highly addictive controlled substances to patients presents a danger to the public health, safety, or welfare, and does not correspond to that level of professional conduct expected of a person licensed to practice pharmacy 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 or 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 RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case 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 and welfare. 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 Mr. 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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IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

pharmacist constitutes an immediate serious danger to the health, safety and welfare of the citizens of the State of Florida. 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

immediately 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).

DONE and ORDERED this

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day of

, 2011.

H. ank Far i er, Jr. State Surgeon General Department of Health PREPARED BY: Gavin D. Burgess Assistant General Counsel DOH, 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

Ph.D., F.A.C.P.

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IN RE: The Emergency Suspension of the License of Aiman I. Aryan License No. PS 33142 Case Number: 2011-15571

NOTICE OF RIGHT TO JUDICIAL REVIEW

Pursuant to Sections 120.60(6), and 120.68, Florida Statutes, the Department's findings of immediate danger, necessity, and procedural fairness shall be judicially reviewable. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings are commenced by filing one copy of a Petition for Review, in accordance with Florida Rule of Appellate Procedure 9.100, with the Department of Health and a second copy of the petition accompanied by a filing fee prescribed by law with the District Court of Appeal within thirty (30) days of the date this Order is filed.

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