ARTICLE XIV PAIN MANAGEMENT CLINICS AND CASH ONLY PHARMACIES

ARTICLE XIV PAIN MANAGEMENT CLINICS AND CASH ONLY PHARMACIES Sec. 11-650. Purpose and Intent: The purpose and intent of this Ordinance is to promote the health, safety and general welfare of the residents of the City of Titusville through the regulation of certain Pain Management Clinics and Cash Only Pharmacies (as defined below) currently in operation and to provide for regulation of any additional Pain Management Clinics and Cash Only Pharmacies. Sec. 11-651. Definitions: a. Applicant means the owner or a person or person(s) authorized by the owner to complete an application for a license to operate a Pain Management Clinic or Cash Only Pharmacy. b. Chronic Nonmalignant Pain means pain unrelated to cancer, which persists beyond the usual course of the disease or injury that is the cause of the pain, for more than ninety (90) days after surgery. c. Code Enforcement Officer means any employee designated as a code enforcement officer pursuant to Florida Statutes Sections 166 or 162.21. d. Department shall mean the Department designated by the City Manager to administer the mandates of this Ordinance. e. Pain Clinics and Pain Management Clinics - Pain Management Clinic- All privately owned pain-management clinics, facilities, or offices hereinafter referred to as clinics which advertise in any medium for any type of pain-management services or employ a physician who is primarily engaged in the treatment of pain by prescribing or dispensing controlled substance medications except as follows: 1. The clinic is licensed as a facility pursuant to Chapter 395; 2. The majority of the physicians who provide services in the clinic primarily provide surgical services; 3. The clinic is owned by a publicly held corporation whose shares are traded on a national exchange or on the over-the-counter market and whose total assets at the end of the corporation s most recent fiscal quarter exceeded $50 million; 4. The clinic is affiliated with an accredited medical school at which training is provided for medical students, residents or fellows; 5. The clinic does not prescribe or dispense controlled substances for the treatment of pain; or 6. The clinic is owned by a corporate entity exempt from federal taxation under 26 U.S.C. 501(c) 3. 7. Hospice. Registration with the Florida Department of Health, pursuant to Florida Statutes 458.3265 or Florida Statutes 459.0137 shall be prima facia evidence of operating as a pain management clinic pursuant to this definition. f. Cash Only Pharmacy- Cash Only Pharmacy shall mean a pharmacy that primarily dispenses medication designated as Schedule II, III, and IV by Sections 893.03, 893.035, and 893.0355, Florida Statutes, including but not limited to opiods, including fentanyl, hydrocodone, morphine, and oxycodone, to individuals for cash, money order only and/or is not classified as a retail pharmacy and/or is not generally open and accessible to the general

public and/or does not accept medical insurance from an insurance carrier authorized to do business in the State of Florida. For purposes of this definition a pharmacy_that primarily dispenses medication_means more than 40% of its prescriptions or more than 40% of its revenues are medication listed as Schedule II, III and IV in Section 893.03, 893.035 and 893.0355 Florida Statutes. g. Retail Pharmacy Retail Pharmacy is defined as a pharmacy that fills prescriptions for medications by a licensed physician or person or entity authorized to prescribe medications in the State of Florida. A Retail Pharmacy shall have at least 50% of its floor area available or open for retail sale of merchandise. Said pharmacy shall accept cash, credit or debit cards, and medical insurance from a carrier or such other form of payment and less than 40% of its revenues are derived from medication listed as Schedule II, III and IV in Section 893.03, 893.035 and 893.0355 Florida Statutes. h. License shall mean a certificate issued pursuant to this Ordinance by the Department, on an annual basis, authorizing the operation of a specific Pain Management Clinic location in Titusville or Cash Only Pharmacy. Each license shall at a minimum identify on its face, the clinic s or pharmacy name and physical address, the responsible physician s or pharmacist s name, the clinic owner s name or pharmacy and address and the property owner s name or pharmacy and address. Each license shall have a unique number identification on its face. i. Person means an individual, partnership, corporation, association or other legal entity. Sec. 11-652. License Required: Beginning March 1, 2011, no Pain Management Clinic or Cash Only Pharmacy as defined in this Ordinance, may operate in the City of Titusville without first obtaining a license issued by the Department; except that any Pain Management Clinic or Cash Only Pharmacy who has filed an application and paid the application fee may continue operating until the Department renders a decision to either grant or deny the license and notifies the applicant of the decision. Licenses shall be granted only for new clinics or pharmacy that satisfy the requirements of this Ordinance, or were open and operational prior to July 13, 2010, and have satisfied all other requirements of this Ordinance including the payment of the applicable application and license fees. Sec. 11-653. License Application Process and Requirements: a. Application required Any Pain Management Clinic or Cash Only Pharmacy, as defined in Section 11-651 above, must complete an application available from the Department which shall, at a minimum, as applicable, require the applicant to provide the following: 1. The registration number from the State Department of Health as required by Florida Statutes Section 458.3265 or 459.0137, if the clinic must be registered in accordance with state law or state pharmacy registration number; 2. Proof satisfactory to the Department that the applicant is or has been conducting business in the City of Titusville as a Pain Management Clinic or Cash Only Pharmacy at the registered location for which the applicant is seeking a City of Titusville license that was issued prior to July 13, 2010 and continued in business through March 1, 2011.

3. Designation of the physician who shall be responsible for complying with all requirements related to registration and operation of the clinic and the physician s DEA number. The designated physician must have a full, active and unencumbered license under Florida Statutes Chapters 456, 458 or 459 and shall practice at the clinic location for which the physician has assumed responsibility. Within ten (10) days after termination or absence of a designated physician, the clinic must notify the Department of the identity of another designated physician for the clinic or forfeit the clinic s license. 4. Designation of the pharmacist who shall be responsible for complying with all requirements related to registration and operation of the pharmacy and the pharmacist s DEA number. The designated pharmacist must have a full, active and unencumbered license under Florida Statutes Chapters 456 or 465 and shall practice at the location for which the pharmacists has assumed responsibility. Within ten (10) days after termination or absence of a designated pharmacists, the clinic must notify the Department of the identity of another designated pharmacists for the clinic or forfeit the clinic s license. 5. A list of all persons associated with the management or operation of the clinic or pharmacy, whether paid or unpaid, part-time or full time, including all contract labor and independent contractors. This list includes, but is not limited to all owners, operators, employees and volunteers. For persons listed, the following additional information must be provided. A. The person s title; B. current home address, telephone number and date of birth; C. list of all criminal convictions whether misdemeanor or felony; that are drug related. D. A copy of a current Florida driver s license or a government issued photo I.D.; and E. A set of fingerprints. This list shall be required to be updated within ten (10) days of any new person becoming associated with the clinic or pharmacy. 6. The property owner s name, address, telephone number and a copy of a Florida driver s license or a government issued photo I.D., if the property owner is different than the clinic owner or pharmacy. 7. A copy of a valid business tax receipt required pursuant to Florida Statutes Chapter 205, Florida Statutes and the Code of Ordinances issued before July 13, 2010, if applicable. 8. Whether the Pain Management Clinic or Cash Only Pharmacy dispenses controlled substances at the Pain Management Clinic or pharmacy site; 9. A floor plan of the Pain Management Clinic showing the location and size of the waiting area, location and size of the patient rooms and location of any type of diagnostic equipment. In addition, if any controlled substances are dispensed at the site or are stored at the site and the location and method of security for any controlled substances kept on the clinic s premises. For Cash Only Pharmacies the same information as applicable. 10. Any other information the Department Director deems necessary; and

11. A sworn notarized statement from both the designated physician or pharmacist and the clinic or pharmacy owner attesting to the veracity and accuracy of the information provided in the application. 12. In the event that any information provided in the application changes, a new updated application must be filed with the Department within ten (10) days of the change. 13. A separate permit is required for each clinic or pharmacy location. 14. Provide an affidavit by the Medical Director or pharmacist attesting to the fact that no employees, full-time, part-time, contract, independent or volunteers have been convicted of or who has pled guilty or nolo contender at any time to an offense constituting a felony in this state or in any other state involving the prescribing, dispensing, supplying, selling or possession of any controlled substance prior to the adoption date of this ordinance and that the business shall not employ any such persons thereafter. 15. Provide a disclosure of interest affidavit to identify the natural persons having the ultimate ownership interest in the business. The disclosure of interest affidavit shall provide in detail as applicable all principal stockholders and percent of stock owned by each, or a list of the trust beneficiaries and the percent of interest held by each, or a list of the principals including general and limited partners. Where principal officers, stockholders, beneficiaries or partners consist of other corporations, trusts, partnerships or other similar entities, further disclosure shall be made to identify the natural persons having the ultimate ownership interests. Said disclosure shall be updated within ten (10) days of any change. b. Application Fee and Requirements Each application for a Pain Management Clinic or Cash Only Pharmacy license shall be accompanied by a nonrefundable application fee in the amount of Five Hundred ($500.00) Dollars. The application fee is in addition to the applicable business tax receipt fee. Any changes to the application or license fees authorized by this Ordinance may be accomplished by Resolution of the City Council without the need to revise this ordinance. It is the applicant s sole responsibility to provide accurate contact information when submitting the application to the Department. If the application for a Pain Management Clinic or Cash Only Pharmacy license is not completed, the Department shall notify the designated contact person listed in the application. A completed application must be received by the Department within fifteen (15) business days of receipt of the deficiency notice from the Department in order to avoid assessment of another application fee. Failure to timely respond within the fifteen (15) days shall result in a denial of the application as incomplete. A new application must then be submitted that is accompanied by the full nonrefundable application fee, in order to request a license. c. The Department shall perform inspections(s) of the facility as necessary to determine whether or not the application submitted is accurate in all respects and to verify a physician licensed under Florida Statutes Chapter 456, 458 or 459 is on the premises during all times medications are dispensed or prescribed or a pharmacist is on duty supervising the dispensing of controlled substances. d. Beginning March 1, 2011, no Pain Management Clinic or Cash Only Pharmacy may operate in the City of Titusville without a valid City of Titusville License (as defined herein). In addition, it shall be a violation of this ordinance for the property owner

where the clinic is situated to allow an unlicensed Pain Management Clinic or Cash Only Pharmacy to open or operate without a valid Pain Management or Cash Only Pharmacy clinic license. e. A completed application with no missing information shall be acted upon within twenty (20) days of receipt of the completed application. Sec. 11-654. Grounds For License Denial Or Revocation: The City Manager or designee shall deny or revoke a Pain Management Clinic or Cash Only Pharmacy license upon the occurrence of one or more of the following: a. An application contains material false information or missing information; b. The clinic or pharmacy is not registered, if required, with the State in accordance with Florida Statutes Chapter 458.3265 or Chapter 459.0137 or Chapter 465 Florida Statutes or other applicable law or has had its registration suspended or revoked by the State; c. A copy of a valid business tax receipt issued prior to July 13, 2010, is not submitted with the application for each clinic location existing prior to July 13, 2010; d. The clinic was not open and fully operational immediately prior to July 13, 2010; or has not received approval for a new clinic or pharmacy pursuant to this Ordinance and Chapter 59 of the Land Development regulations. e. Failure to allow for inspection of the clinic or pharmacy at any time by a code enforcement officer, law enforcement officer, or any other person authorized to enforce ordinance violations in the City of Titusville at any time the clinic is open or occupied; f. Failure to abide by any provision of this Ordinance; g. Allowing any person to work or volunteer at the clinic or pharmacy, whether paid or unpaid, who has been convicted of or pled guilty or nolo contendere to, (even if sealed or expunged)an offense that constitutes a felony for receipt of illicit and diverted drugs, including any controlled substance listed in Schedule I, Schedule II, Schedule III, Schedule IV or Schedule V of Florida Statutes Section 893.03 or any other state or the United States; h. The facility is owned by or has any contractual or employment relationship with a physician or pharmacist: 1. Whose Drug Enforcement Administration number has ever been revoked; 2. Whose application for a license to prescribe, dispense or administer a controlled substance has been denied or revoked by any jurisdiction; 3. Who has been convicted of or pled guilty or nolo contendere to (even if sealed or expunged) an offense that constitutes a felony for receipt of illicit and/or diverted drugs, including any controlled substance listed in Schedule I, Schedule II, Schedule III, Schedule IV or Schedule V of Florida Statutes Section 893.03 or any other state or the United States; 4. Whose license has been suspended or revoked or has had other action taken as a result of physician s personal abuse of drugs or alcohol. The City Manager or designee may grant an exception to sub-sections G and H above, if more than ten (10) years have elapsed since the adjudication date. i. The fact that an appeal is pending for any items listed in G and H above has no effect on the City Manager or designee s obligation to deny or revoke a Pain Management Clinic or Cash Only Pharmacy license.

j. If the payment for the application fee or license fee is invalid or uncollectible for any reason. Sec. 11-655. Additional License Compliance Requirements: a. A valid City of Titusville Pain Management Clinic or Cash Only Pharmacy license issued pursuant to this ordinance must be prominently displayed in a common public area of the Pain Management Clinic no later than March 1, 2011. b. In the event any information contained in the license application changes, a new updated application must be filed with the Department within ten (10) days of the change. Failure to do so will result in license revocation and penalty as provided for in Section 11-654 above. c. A Pain Management Clinic or Cash Only Pharmacy license is non-transferable and cannot be assigned. Whenever ownership or management of a Pain Management Clinic or Cash Only Pharmacy changes, a new application must be filed for a new license and all applicable fees paid. d. A valid business tax receipt must be maintained by the Pain Management Clinic or Cash Only Pharmacy. e. The designated physician shall secure all prescription pads so that only authorized persons may access them. Beginning on March 1, 2011, every written prescription must include the clinic s name, address and City of Titusville s license number. f. The hours of operation of the Pain Management Clinic or Cash Only Pharmacy shall be limited to 9:00 a.m. to 7:00 p.m. Monday through Friday and 9:00 a.m. to 5:00 p.m. on Saturday. g. No Pain Management Clinic or Cash Only Pharmacy shall be wholly or partially owned by, or have any contractual relationship (whether as a principal, partner, officer, member managing member, employee, independent contractor, or otherwise) with any physician, pharmacist, or any other person who prescribes drugs and who, within five years prior to the receipt of any application for a business tax receipt, (i) has been suspended, had his or her license revoked, or been subject to disciplinary action for prescribing, dispensing administering, providing, supplying or selling any controlled substance in violation of any state, federal or similar law where such person is licensed to practice; (ii) has been convicted or, pled nolo contendere to, or violated any plea agreement regarding an arrest for, a violation of any state, federal, or similar law where such person is licensed to practice related to drugs or alcohol, specifically including but not limited to, prescribing, dispensing, administering, providing supplying, or selling any controlled substance; (iii) has been suspended, had his or her license revoked or been subject to disciplinary action by any state, federal or other governmental entity where such person is licensed to practice; (iv) has had any state, federal or other governmental entity where such person is licensed to practice take any action against such person s license as a result of dependency on drugs or alcohol; or (v) has been convicted of, pled nolo contendere to, or violated any plea agreement regarding an arrest for, any felony or crime involving moral turpitude. h. No Pain Management Clinic or Cash Only Pharmacy shall be wholly or partially owned by or have as a principal, partner, officer, member, managing member or otherwise where the owner is an entity, any person who (i) has been convicted of, pled nolo contendere to,

or violated any plea agreement regarding an arrest for, a violation of any state, federal or similar law where related to drugs or alcohol, or (ii) has been convicted of, pled nolo contendere to, or violated any plea agreement regarding an arrest for, any felony or crime involving moral turpitude. i. No Pain Management Clinic or Cash Only Pharmacy shall have employees fulltime, part-time, contract, independent or volunteers or any person who has been convicted of, pled nolo contendere to, or violated any plea agreement regarding an arrest for, any felony or crime involving moral turpitude within any five-year period before any application for a certificate of occupancy or business tax receipt. Any application for a certificate of occupancy or business tax receipt shall include an affidavit, under oath, by the medical director, attesting that neither the medical director nor any other person employed in any capacity by the Pain Management Clinic, whether an employee, independent contractor or otherwise, (i) has been convicted of, pled nolo contendere to, or violated any plea agreement regarding an arrest for, a violation of any state, federal or similar law related to drugs or alcohol, specifically including but not limited to prescribing, dispensing, administering, providing, supplying or selling any controlled substance; or (ii) has been convicted of, pled nolo contendere to, or violated any plea agreement regarding an arrest for, any felony or crime involving moral turpitude. The failure to provide the required affidavit shall result in the automatic revocation of the Pain Management Clinic s right to operate in the City. j. A Pain Management Clinic shall be operated by a medical director who is a Floridalicensed physician, board-certified in pain medicine. A Cash Only Pharmacy shall be operated by a Florida licensed pharmacists. k. In order to obtain a certificate of occupancy or business tax receipt, a Pain Management Clinic or Cash Only Pharmacy shall provide with its application (i) an inventory of diagnostic equipment to be located at the clinic, (ii) a natural disaster management plan, and (iii) a floor plan showing the location and nature of adequate security measures, including those required by the State of Florida for controlled substances, to safeguard all drugs to be dispensed in the course of its business. l. If the registration of a Pain Management Clinic is revoked or suspended by the Florida Department of Health, the Pain Management Clinic permit shall be revoked automatically and shall not be subject to provisions of subsection J of this ordinance. m. The Pain Management Clinic shall be fully owned by a physician or a group of physicians each of whom are Florida licensed physicians in good standing; or must be licensed clinic under part X of Chapter 400 in the Florida Statutes as, amended from time to time. n. The Pain Management Clinic or Cash Only Pharmacy is prohibited from having any outdoor seating areas, queues or customer waiting areas. All activities of the Pain Management Clinic and pharmacy including sale, display, preparation and storage shall be conducted entirely within a completely enclosed building. The Pain Management Clinic is prohibited from having an on-site prescription drug dispensary for controlled substances listed in Schedule II of the Florida Statutes 893.03. Within thirty (30) days of the removal of a Pain Management Clinic from a building, site or parcel of land for any reason, the property owner shall be responsible for removing all signs, symbols, or vehicles identifying the premises as a Pain Management Clinic.

o. The Pain Management Clinic shall be in compliance with all federal, state, county and municipal laws and ordinances, as amended from time to time. p. There shall be a one-half (1/2) mile separation between each Pain Management Clinic or Cash Only Pharmacy as defined by this section regardless of the municipal boundaries. Sec. 11-656. Review of License Denial Or Revocation: a. The City Manager or designee shall provide written notice of the denial of any new or renewed application specifying in writing the grounds therefore. The owner of the clinic or pharmacy whose application has been denied (except for an incomplete application) or revoked may request a review before the City Council in writing. The request must be received by the City Clerk within fifteen (15) calendar days of the date of the notice. The decision of the City Council shall be final. Any clinic or pharmacy that has a license denied or non-renewed (except for an incomplete license), may not reapply for a period of six (6) months. b. Any license that has been denied or revoked may not be reissued to any of the owner(s) or the physicians(s) listed on the application regardless of the clinic s name for five (5) years except, that when the denial is solely based on an incomplete application, there is no prohibition against reapplying. Sec. 11-657. License Renewals: Licenses required for Pain Management Clinics or Cash Only Pharmacy shall be valid for only one (1) year. At least thirty (30) days prior to expiration of the license, a renewal application must be submitted along with a non-refundable renewal application fee of Five Hundred ($500.00) Dollars. Provided the Pain Management Clinic or Cash Only Pharmacy named in the renewal application and all information on the application are in compliance with this ordinance, and other applicable City Codes, a renewal license shall be issued by the Department. Renewal licenses shall only be issued to businesses that were previously licensed and who timely file a renewal application. Sec. 11-658. Violation and Inspections: It shall be unlawful for any person to violate any provision of this ordinance or to operate a Pain Management Clinic or Cash Only Pharmacy without a valid City issued Pain Management Clinic or Cash Only Pharmacy license. Any code enforcement officer, law enforcement officer, or any other persons authorized to enforce City ordinances may enter the clinic or pharmacy premises and conduct an inspection to determine compliance with this ordinance at any time someone is present on the premises. Sec. 11-659. Service of Notice; Public Records: a. Any notice required by this ordinance shall be in writing and sent by certified mail or hand delivery to the mailing address set forth on the application for the Pain Management Clinic or Cash Only Pharmacy license, except that notices for code violations shall be provided in the manner prescribed by the City of Titusville Ordinance Section 31-68.

The mailing address set forth in the application shall be considered the correct mailing address. b. Any information contained in an application under this ordinance is subject to the public records law, Florida Statutes Chapter 119, unless specifically exempted by law. Sec. 11-660. Enforcement and Penalties: The City s code enforcement officers, law enforcement or any other person authorized to enforce City ordinances may enforce the provisions of this ordinance. Any enforcement action or legal remedy available under controlling state law, including but not limited to, prosecution as a misdemeanor with a fine not exceeding Five Hundred ($500.00) Dollars or by imprisonment for a term not exceeding sixty (60) days or by both fine and imprisonment, may be imposed as a penalty. When enforced by a code enforcement officer, the enforcement provisions and procedures contained in the Code of Ordinances as may be amended, are incorporated herein by reference and will apply. Nothing contained herein shall prevent the City from taking such other lawful action in law and equity as may be necessary to remedy any violation of, or refusal to comply with, any part of this ordinance, including but not limited to: a. Pursuit of injunctive and/or declaratory relief in a court of competent jurisdiction; or b. Initiating any action to recover any and all damages that may result from a violation of or refusal to comply with any part of this ordinance; or c. Utilizing any other action or enforcement method allowable by law. Sec. 11-661. Allocation of Fees and Fines: Fees collected pursuant to this ordinance shall be used exclusively to pay for the City s administrative costs including but not limited to the application process, inspections and enforcement activities. Sec. 11-662. Severability: If any section, subsection, sentence, clause, phrase or provision of this ordinance is for any reason held invalid or unconstitutional by any court of competent jurisdiction, such holding shall not be construed to render the remaining provisions of this ordinance invalid or unconstitutional.