The reasons for the Florida action are as follows:
From 1997 through August 27, 2004, Gray provided treatment to a 55-year-old male patient with a history of chronic back pain and depression due to a work-related accident from 1987 which resulted in four crushed vertebrae. The patient was then treated with Prozac and later started on Oxycontin to manage his low back pain.
Gray’s medical records do not contain a record of an initial evaluation or examination or any notes that would indicate a reason why Gray chose the treatment plan that he did. Treatment started monthly until 2002 and moved to every three to four months.
Gray prescribed various psychotropic medications including the antidepressant medications Effexor and Prozac, as well as a benzodiazepine Valium for management of spasms associated with his painful condition. Gray provided prescriptions for Soma, as well as Ambien, a sleep-inducing medication.
The core of the treatment and the only medication taken throughout the entire course was the opiod agonist oxycodone in the long-acting form of Oxycontin. The patient was escalated from an initial 80 mg twice daily to 480 twice daily for several years until his death. The patient also received an antipsychotic medication, Seroquel, given to him for the purpose of treating insomnia as well as “agitation.”
The patient was not asked to sign a controlled substance agreement authorizing Gray to be the only treating physician prescribing antidepressant and pain medications. There was no documentation of urine toxicology screens, pill counts, or pharmacy surveillance having been performed. Gray postdated several prescriptions for schedule II medications, those with a high potential for abuse and severe psychological and physical dependence.
The patient last saw Gray on August 27, 2004 and a follow-up appointment was scheduled for January 7, 2005, however the patient died on October 16, 2004. The coroner found excessively high levels of oxycodone in the patient.
Among other things, Gray failed to:
Prepare any documentation following physical examination of the patient, including instances when the patient reported worsening or other change in the severity of his condition.
Set reasonably frequent follow-up visits given the treatment included the use of opiods. (The patient weighed 120 pounds and was taking over 900 mg of Oxycodone daily. A prudent physician would have considered seeing such a patient at a minimum of every other month.)
Assess the presence of aberrant drug behavior and opiod therapy-related side effects as expected of a prudent physician.
Sufficiently document the process of obtaining informed consent from the patient covering the risk of treatment with controlled substances.
In summary, the Florida Board found that Gray failed to practice medicine with the level of care, skill and treatment of the patient as recognized by a reasonably prudent physician.
The website of the Oklahoma Board of Medical Licensure and Supervision shows that, despite the loss of his Florida and Tennessee licenses, Gray still has an active license in Oklahoma.
Source: Entry on Jack K. Gray in Disciplinary Action Report, Tennessee Department of Health, July 2010, pg. 2 and Final Order, Department of Health, Petitioner vs. Jack K. Gray, Jr., M.D., Respondent, DOH case no. 2004-37880, license no. ME0057877.