63126 Federal Register / Vol. 88, No. 177 / Thursday, September 14, 2023 / Notices 

823(g)(1)(A). Nonetheless, an absence of such 

evidence ‘‘does not weigh for or against a 

determination as to whether continuation of [or 

granting of a] DEA certification is consistent with 

the public interest.’’ Roni Dreszer, M.D., 76 FR 

19434, 19444 (2011). As to Factor C, there is no 

evidence in the record that Applicant has been 

convicted of an offense under either federal or state 

law ‘‘relating to the manufacture, distribution, or 

dispensing of controlled substances.’’ 21 U.S.C. 

823(g)(1)(C). Likewise to Factor A, Agency cases 

have found that ‘‘the absence of such a conviction 

is of considerably less consequence in the public 

interest inquiry’’ and is therefore not dispositive. 

Dewey C. MacKay, M.D., 75 FR 49956, 49973 (2010). 

Finally, as to Factor E, the Government’s evidence 

fits squarely within the parameters of Factors B and 

D and does not raise ‘‘other conduct which may 

threaten the public health and safety.’’ 21 U.S.C. 

823(g)(1)(E). Accordingly, Factor E does not weigh 

for or against Applicant. 

10The Agency need not adjudicate the criminal 

violations alleged in the instant Order to Show 

Cause. Ruan v. United States, 142 S. Ct. 2370 (2022) 

(decided in the context of criminal proceedings). 

in support of its prima facie case for 

denial of Applicant’s application is 

confined to Factors B and D. See RFAA, 

at 6–9. Moreover, the Government has 

the burden of proof in this proceeding. 

21 CFR 1301.44. 

Here, the Agency finds that the 

Government’s evidence satisfies its 

prima facie burden of showing that 

Applicant’s registration would be 

‘‘inconsistent with the public interest.’’ 

21 U.S.C. 824(a)(4). 

1. Factors B and D 

Evidence is considered under Public 

Interest Factors B and D when it reflects 

compliance (or non-compliance) with 

laws related to controlled substances 

and experience dispensing controlled 

substances. See Kareem Hubbard, M.D., 

87 FR 21156, 21162 (2022). In the 

current matter, the Government has 

alleged that Applicant has violated both 

federal and California state law 

regulating controlled substances. 

RFAAX 10, at 1–5.10

Under federal law, those engaged in 

chemical analysis are required to be 

registered with the DEA. 21 CFR 

1301.13(e)(1)(x). Regarding 

recordkeeping, the CSA requires that 

DEA registrants maintain complete and 

accurate records of the manufacture, 

receipt, sale, delivery, or disposal of 

controlled substances. 21 U.S.C. 

827(a)(3). Additional relevant 

recordkeeping requirements can be 

found at 21 CFR 1304.03(a) (all 

registrants shall maintain required 

records), 1304.04(a) (records must be 

retained and available for DEA 

inspection for at least two years), 

1304.21(a) (records must be complete 

and accurate), 1304.23(a) (registrants 

registered for chemical analysis with 

controlled substances must maintain 

records for each controlled substance). 

Here, the record demonstrates that 

prior to the expiration of its previous 

registration on September 30, 2020, 

Applicant failed to maintain necessary 

records as required by the CSA despite 

receiving and possessing controlled 

substances. Further, the record 

demonstrates that following the 

expiration of its previous registration on 

September 30, 2020, Applicant 

unlawfully continued to receive and 

possess large quantities of controlled 

substances without maintaining 

necessary records for two years as 

required by the CSA. As Applicant’s 

conduct displays clear violations of 

federal law relating to controlled 

substances, the Agency hereby finds 

that Applicant violated 21 U.S.C. 

827(a)(3) and 21 CFR 1301.13(e)(1)(x), 

1304.03(a), 1304.04(a), 1304.21(a), 

1304.23(a). 

Accordingly, the Agency finds that 

Factors B and D weigh in favor of denial 

of Applicant’s application and thus 

finds Applicant’s registration to be 

inconsistent with the public interest in 

balancing the factors of 21 U.S.C. 

823(g)(1). The Agency further finds that 

Applicant failed to provide sufficient 

evidence to rebut the Government’s 

prima facie case. 

III. Sanction 

Where, as here, the Government has 

established grounds to deny Applicant’s 

application, the burden shifts to the 

registrant to show why it can be 

entrusted with the responsibility carried 

by a registration. Garret Howard Smith, 

M.D., 83 FR 18882, 18910 (2018). When 

a registrant has committed acts 

inconsistent with the public interest, it 

must both accept responsibility and 

demonstrate that it has undertaken 

corrective measures. Holiday CVS, 

L.L.C., dba CVS Pharmacy Nos 219 and 

5195, 77 FR 62316, 62339 (2012) 

(internal quotations omitted). Trust is 

necessarily a fact-dependent 

determination based on individual 

circumstances; therefore, the Agency 

looks at factors such as the acceptance 

of responsibility, the credibility of that 

acceptance as it relates to the 

probability of repeat violations or 

behavior, the nature of the misconduct 

that forms the basis for sanction, and the 

Agency’s interest in deterring similar 

acts. See, e.g., Robert Wayne Locklear, 

M.D., 86 FR 33746. 

Here, Applicant did not request a 

hearing, submit a corrective action plan, 

respond to the OSC, or otherwise avail 

itself of the opportunity to refute the 

Government’s case. As such, Applicant 

has made no representations as to its 

future compliance with the CSA nor 

demonstrated that it can be entrusted 

with registration. Moreover, the 

evidence presented by the Government 

clearly shows that Applicant violated 

the CSA and the Agency has found that 

Applicant is ineligible for DEA 

registration. See supra at II.1. 

Accordingly, the Agency will order the 

denial of Applicant’s application. 

Order 

Pursuant to 28 CFR 0.100(b) and the 

authority vested in me by 21 U.S.C. 

823(g)(1) and 21 U.S.C. 824(a), I hereby 

deny the pending application for a 

Certificate of Registration, Control No. 

W21055614H, submitted by Green Wave 

Analytical, as well as any other pending 

application of Green Wave Analytical 

for additional registration in California. 

This Order is effective October 16, 2023. 

Signing Authority 

This document of the Drug 

Enforcement Administration was signed 

on September 5, 2023, by Administrator 

Anne Milgram. That document with the 

original signature and date is 

maintained by DEA. For administrative 

purposes only, and in compliance with 

requirements of the Office of the Federal 

Register, the undersigned DEA Federal 

Register Liaison Officer has been 

authorized to sign and submit the 

document in electronic format for 

publication, as an official document of 

DEA. This administrative process in no 

way alters the legal effect of this 

document upon publication in the 

Federal Register. 

Scott Brinks, 

Federal Register Liaison Officer, Drug 

Enforcement Administration. 

[FR Doc. 2023–19820 Filed 9–13–23; 8:45 am] 

BILLING CODE 4410–09–P 

DEPARTMENT OF JUSTICE 

Drug Enforcement Administration 

[Docket No. 23–7] 

Rachel Pittala, APRN; Decision and 

Order 

On October 18, 2022, the Drug 

Enforcement Administration (DEA or 

Government) issued an Order to Show 

Cause and Immediate Suspension of 

Registration (OSC/ISO) to Rachel Pittala, 

APRN (Respondent) of Orlando, Florida. 

OSC/ISO, at 1. The OSC/ISO informed 

Respondent of the immediate 

suspension of her DEA Certificate of 

Registration, Control No. MP4600791, 

pursuant to 21 U.S.C. 824(d), alleging 

that Respondent’s continued registration 

constitutes ‘‘‘an imminent danger to the 

public health or safety.’ ’’ OSC/ISO, at 1 

(quoting 21 U.S.C. 824(d)). The OSC/ 


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1Effective December 2, 2022, the Medical 

Marijuana and Cannabidiol Research Expansion 

Act, Public Law 117–215, 136 Stat. 2257 (2022) 

(Marijuana Research Amendments or MRA), 

amended the Controlled Substances Act (CSA) and 

other statutes. Relevant to this matter, the MRA 

redesignated 21 U.S.C. 823(f), cited in the OSC/ISO, 

as 21 U.S.C. 823(g)(1). Accordingly, this Decision 

cites to the current designation, 21 U.S.C. 823(g)(1), 

and to the MRA-amended CSA throughout. 

2The Agency adopts the ALJ’s summary of each 

of the witnesses’ testimonies as well as the ALJ’s 

assessment of each of the witnesses’ credibility. See 

RD, at 3–13. The Agency agrees with the ALJ that 

the Diversion Investigator’s testimony, which was 

focused on the uncontroversial introduction of 

documentary evidence and the Diversion 

Investigator’s contact with the case, was credible in 

that it was sufficiently detailed, plausible, and 

internally consistent. Id. at 4. The Agency also 

agrees with the ALJ that the undercover detective’s 

testimony, which was focused on the recorded 

phone conversation that the detective had with 

Respondent to obtain controlled substances, was 

credible in that it was internally consistent as well 

as consistent with both the Diversion Investigator’s 

testimony and the recording of the detective’s 

conversation with Respondent. Id. Further, the 

Agency agrees with the ALJ that the testimony from 

the Government’s expert witness, which was 

focused on Respondent’s treatment of the 

undercover detective, was credible and reliable 

given the expert’s knowledge of the Florida 

standard of care and Florida state law underlying 

the standard of care. Id. at 5. Finally, the Agency 

agrees with the ALJ that Respondent’s testimony 

was not fully credible in that it was unclear, 

evasive, and both internally contradictory and 

contradictory with the recording of the detective’s 

conversation with Respondent. Id. at 12–13. 

Specifically, Respondent contradicted herself 

multiple times regarding her reasoning for 

prescribing Adderall, her reasoning for prescribing 

Adderall and Klonopin together, and the extent of 

her autonomy in treating patients. Id. 

3 Xanax is a brand name for alprazolam. RD, at 

6. 

4 Klonopin is a brand name for clonazepam. RD, 

at 6. 

5Under the collaborative agreement, Respondent 

had the authority to, among other things, determine 

if a patient should receive treatment; examine and 

initiate treatment of a patient’s mental health and 

psychiatric conditions; prescribe controlled and 

non-controlled substances; and ultimately manage 

the patient’s care and make her own decisions 

regarding the proper diagnosis and treatment. RD, 

at 8; Tr. 305–310; RX 2. 

6Respondent viewed S.H. as a mentor and expert 

in addiction due to his experience at the Betty Ford 

Clinic and his success in treating patients abusing 

methamphetamine, cocaine, and other substances 

by prescribing Adderall. RD, at 9; Tr. 233–234, 244– 

245, 299, 388–389, 406, 411. Respondent testified 

that although she now recognizes that Adderall 

should not be prescribed to treat drug abuse, she 

had previously ‘‘felt confident and comfortable’’ 

trusting S.H.’s opinion and S.H. had ‘‘felt that it was 

a good practice’’ despite a lack of published studies 

regarding the use of Adderall for managing drug 

abuse. RD, at 9; Tr. 244–245, 249. 

ISO also proposed the revocation of 

Respondent’s registration, alleging that 

Respondent has ‘‘committed such acts 

as would render [her] registration 

inconsistent with the public interest.’’ 

Id. at 1, 4 (citing 21 U.S.C. 823(g)(1),1

824(a)(4)). 

A hearing was held before DEA 

Administrative Law Judge Teresa A. 

Wallbaum (the ALJ) who, on May 15, 

2023, issued her Recommended Rulings, 

Findings of Fact, Conclusions of Law, 

and Decision (Recommended Decision 

or RD), which recommended revocation 

of Respondent’s registration. RD, at 27. 

Respondent did not file exceptions to 

the RD. Having reviewed the entire 

record, the Agency adopts and hereby 

incorporates by reference the entirety of 

the ALJ’s rulings, credibility findings,2

findings of fact, conclusions of law, 

sanctions analysis, and recommended 

sanction as found in the RD. 

I. Findings of Fact 

Investigation and Undercover Phone 

Call 

Respondent was a mid-level 

practitioner at Sawgrass Health of 

Florida (Sawgrass Health), a practice 

operated by physician S.H. RD, at 5; Tr. 

37, 44. On April 4, 2022, an undercover 

detective (UC) posing as a patient went 

to Sawgrass Health and recorded his 

visit with S.H. and his attempt to obtain 

prescriptions. RD, at 5; Tr. 46–47, 74. 

Respondent was not present during the 

visit. RD, at 5; Tr. 66. UC testified that 

during the visit, S.H. did not perform a 

physical examination, take vital signs, 

or obtain a medical history; further, S.H. 

indicated that he would not be issuing 

any prescriptions and that Respondent 

would follow up with UC to issue him 

prescriptions. RD, at 5–6; Tr. 83, 92, 

112. On April 5, 2022, Respondent and 

UC had a phone call. RD, at 6; Tr. 92, 

94–95; GX 6–7. 

At the beginning of the call, 

Respondent stated to UC, ‘‘[S.H.] sent 

me a message and . . . asked me to give 

you a call so we can . . . see whatcha 

need,’’ and then immediately asked UC 

‘‘what medication [he was] needing.’’ 

RD, at 6; GX 8, at 1. UC stated that he 

wanted Adderall, to which Respondent 

asked UC if he had attention-deficit/ 

hyperactivity disorder (ADHD) and UC 

replied, ‘‘No I don’t I just . . . like 

taking it[.] I don’t . . . have any medical 

stuff.’’ Id. UC told Respondent that he 

was buying 30 mg tablets of Adderall, 

the highest strength of Adderall tablets, 

from a friend but that he did not want 

to continue purchasing them from his 

friend. Id.; Tr. 161. Then, Respondent 

stated, ‘‘[S]o I do have to put[,] in order 

to legally prescribe this medication for 

you[,] [ ] I have to document that you 

have a diagnosis of ADHD.’’ RD, at 6; 

GX 8, at 4. When UC was nonresponsive, Respondent reiterated, ‘‘I 

have to document that otherwise I can’t 

prescribe it,’’ to which UC replied, ‘‘Ok 

well I mean whatever you gotta put 

down.’’ Id. Respondent asked UC if he 

was ever told as a child that he had 

ADHD to which UC said no twice; then 

Respondent stated, ‘‘Oh ok so . . . a 

friend just let you try it out and it just 

gives you energy and helps you 

concentrate better,’’ to which UC 

replied, ‘‘Yeah.’’ Id. 

Following Respondent’s indication 

that she would send a prescription for 

Adderall to UC’s pharmacy, UC also 

asked Respondent for a Xanax 3

prescription. RD, at 6; GX 8, at 4. 

Respondent then stated that Sawgrass 

Health did not issue Xanax 

prescriptions, to which UC replied that 

he would ‘‘keep getting that from [his] 

friend then.’’ RD, at 6; GX 8, at 5. 

Respondent discouraged UC from 

buying Xanax from friends because the 

pills could be dangerous and 

illegitimate; Respondent and UC also 

briefly discussed the dangers of fentanyl 

and Respondent said that she could give 

UC Klonopin 4 instead of Xanax, but UC 

would need to choose between the 

Klonopin and Adderall prescriptions 

because Respondent was ‘‘trying not to 

do too much combinations’’ and she 

would need to check with S.H. RD, at 

6; GX 8, at 5–6. Respondent told UC that 

he had to promise that he would not be 

‘‘using anything on the street’’ if she 

gave him the prescriptions. RD, at 7; GX 

8, at 7; Tr. 114. Respondent stated to 

UC, ‘‘[y]ou have a lot of anxiety,’’ to 

which UC responded, ‘‘[n]o . . . I just 

started taking it when they . . . gave it 

to me and I was like alright I’ll try it.’’ 

RD, at 7; GX 8, at 7–8. When 

Respondent asked UC if he took Xanax 

for anxiety or to relax, UC said that it 

was ‘‘[m]ore of a relax’’ and said that he 

either took Xanax or ‘‘smoke[d] weed’’ 

to relax. RD, at 7; GX 8, at 8. 

Respondent and UC again discussed 

the dangers of fentanyl; Respondent told 

UC that he did the right thing by coming 

to see S.H. and asked that UC not 

purchase anything illicitly. RD, at 7; GX 

8, at 8–10. At the conclusion of the 

phone call, Respondent told UC that she 

would issue him prescriptions for 30 mg 

tablets of Adderall and 1 mg tablets of 

Klonopin. RD, at 7; GX 8, at 5–6, 10–11. 

After his call with Respondent, UC went 

to the pharmacy where Respondent had 

sent his prescriptions, filled the 

prescriptions, and obtained the 

controlled substances. RD, at 7; Tr. 106– 

108; GX 9a; GX 9b; GX 11. 

Respondent 

Respondent worked at Sawgrass 

Health and signed a collaborative 

agreement with S.H. for him to be her 

supervising physician. RD, at 8; Tr. 221– 

222, 225–226, 230; RX 2.5 6 When 

treating patients at Sawgrass Health, 

S.H. would establish care with new 


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7Respondent exclusively provided care via 

telemedicine and never went to Sawgrass Health. 

RD, at 8; Tr. 232, 351. Following an in-person visit 

with a new patient, S.H. would contact Respondent 

to assign her the patient, give Respondent 

background on the patient, state a diagnosis, and 

make recommendations about treatment. RD, at 8; 

Tr. 251–252, 356. 

8Respondent testified that UC ‘‘didn’t have an 

extensive history’’ compared to other mental health 

patients that she treated and that she had no 

medical records for UC, so her conversation with 

S.H. was the only information she had besides what 

UC told her during their phone call. RD, at 9; Tr. 

253–254, 372, 395. 

9Respondent testified that ICD codes are codes 

that represent a diagnosis and are attached to 

medications that are prescribed to treat the 

diagnosis. RD, at 10 n.9; Tr. 387–388. 

10On cross-examination, Respondent admitted 

that if a patient is not receiving controlled 

substances pursuant to a prescription, ‘‘then that 

would be illicit drug use.’’ RD, at 11; Tr. 300–301. 

11Respondent stated that, at the time she 

prescribed Adderall, she ‘‘did not willingly violate 

the Nurse Practice Act.’’ RD, at 11; Tr. 246. 

Respondent also stated that she should have done 

a further assessment, assigned diagnostic criteria 

more appropriately, and used the ADHD and GAD 

screening questionnaires before prescribing 

Adderall and Klonopin. RD, at 11; Tr. 412. 

Respondent admitted that even when a patient 

reports having a particular condition, a practitioner 

must still evaluate the patient and confirm the 

diagnosis before prescribing controlled substances, 

and it was inappropriate for her to document a 

diagnosis or ICD code for a condition that a patient 

did not have. RD, at 11; Tr. 285–286, 291–292, 294– 

295, 394–395. 

12For Dr. Kennedy’s qualifications, see RD, at 4– 

5; Tr. 119, 124–129, 132–133, 135, 188. Dr. 

Kennedy testified that Florida statutes and Florida 

medical board regulations form the Florida standard 

of care. RD, at 13; Tr. 130–131. 

13When treating a patient for a psychiatric 

condition, the physical examination may be a 

mental status examination or diagnostic interview 

without physical contact. RD, at 14; Tr. 182. 

14 Dr. Kennedy noted that it would be outside of 

the standard of care to prescribe controlled 

substances solely for the purpose of preventing a 

patient from obtaining controlled substances 

illicitly and that such a situation would more likely 

warrant ‘‘a very strong reason not to prescribe that 

medication.’’ RD, at 14; Tr. 422, 424. 15 Dr. Kennedy defined red flags as ‘‘cautionary 

things’’ that should raise a practitioner’s attention 

and indicated that a patient stating that he or she 

obtains controlled substances from an illicit source 

‘‘would be a big red flag.’’ RD, at 14; Tr. 154–155. 

Moreover, a history of drug abuse would also 

constitute a red flag. RD, at 14; Tr. 153–154. 

16The three categories include: (1) patients with 

narcolepsy, patients with ADHD, or children with 

behavioral syndrome; (2) patients receiving a 

differential diagnostic psychiatric evaluation of 

depression or treatment of depression that has been 

refractory to other therapies; and (3) patients 

participating in clinical investigations. RD, at 14; 

Tr. 169. 

17The ‘‘Black Box’’ warning for Adderall states 

that Adderall has a high potential for abuse and 

diversion and should not be prescribed to patients 

with a history of drug abuse. RD, at 14; Tr. 151– 

154; GX 12, at 1. 

patients and then assign patients to 

Respondent. RD, at 8; Tr. 229.7 When 

Respondent began treatment of a 

patient, she became independently 

responsible for deciding the course of 

treatment including what, if any, 

medications to prescribe, with 

recommendations from S.H. RD, at 8–9; 

Tr. 358–359. 

Regarding the current matter, 

Respondent testified that prior to the 

phone call with UC, S.H. had provided 

her with a verbal history and indicated 

that UC had a substance use disorder, 

but S.H. specifically stated that he did 

not diagnose UC with ADHD or anxiety. 

RD, at 9; Tr. 371–373, 393, 395–397.8

Respondent testified that she issued the 

Adderall prescription to UC because of 

S.H.’s recommendation that Adderall 

was an effective treatment for patients 

with substance use disorder, and 

Respondent documented a diagnosis of 

ADHD because there were no ICD 

codes 9 that allowed for Adderall to be 

prescribed for substance use disorder. 

RD, at 10; Tr. 380–381. Respondent also 

stated that she prescribed the Adderall 

because she was concerned that UC was 

illicitly purchasing it and could 

potentially take something laced with 

fentanyl. RD, at 10; Tr. 374–375, 380– 

382. 

Regarding the Klonopin prescription, 

Respondent testified that she prescribed 

Klonopin to UC because she wanted to 

keep him safe and further explore a plan 

of care with follow-up visits. RD, at 10; 

Tr. 385–386.10 Respondent testified that 

although UC stated multiple times that 

he did not have anxiety, she believed 

that his statements about wanting a 

benzodiazepine to relax were an 

indicator of generalized anxiety disorder 

(GAD); however, Respondent 

acknowledged that UC’s statements 

about wanting to relax were not enough 

to establish a diagnosis of GAD and S.H. 

had not provided any diagnosis 

justifying a benzodiazepine 

prescription. RD, at 10–11; Tr. 378, 385, 

397, 399–400. 

In the time since her call with UC and 

since leaving Sawgrass Health, 

Respondent has obtained her postmaster’s certification to treat psychiatric 

and mental health conditions as well as 

completed two additional courses, one 

regarding safely and effectively 

prescribing controlled substances in 

Florida and the other regarding the laws 

and rules governing nursing in Florida. 

RD, at 11; Tr. 248–249; RX 8–9. 

Respondent testified that this training 

‘‘really clarified some things for [her].’’ 

RD, at 11; Tr. 247. Respondent also 

testified that she now understands that 

S.H.’s opinion on Adderall was wrong 

and that she violated the CSA. RD, at 11; 

Tr. 249, 299.11

Florida Standard of Care 

DEA hired Dr. Kennedy to testify as 

an expert in the standard of care in 

prescribing controlled substances in 

Florida, including for the management 

of pain and addiction and including 

prescribing by nurse practitioners. RD, 

at 4; Tr. 136–137.12 Dr. Kennedy 

testified that a nurse practitioner is 

independently responsible for the 

controlled substance prescriptions that 

he or she issues and remains subject to 

any obligations under the Florida 

standard of care even if he or she has 

a collaborative agreement with a 

physician. RD, at 13; Tr. 186, 189, 204. 

According to Dr. Kennedy, the Florida 

standard of care requires that a nurse 

practitioner perform a physical 

examination,13 obtain a medical history, 

create an individualized treatment plan, 

and maintain accurate and complete 

records. RD, at 13; Tr. 147. Further, a 

nurse practitioner may only prescribe 

controlled substances for a legitimate 

medical purpose and cannot provide 

treatment beyond his or her training. 

RD, at 14; Tr. 140–141.14 Dr. Kennedy 

also testified that a nurse practitioner 

must monitor for red flags,15 and to 

resolve a red flag, a nurse practitioner 

must, at a minimum, discuss and define 

the red flag with the patient and 

document it. RD, at 14; Tr. 154–155. 

Regarding the prescribing of Adderall by 

a nurse practitioner, Dr. Kennedy 

testified that under the Florida standard 

of care, a nurse practitioner can only 

prescribe Adderall for patients falling 

into one of three categories 16 and must 

consider the FDA ‘‘Black Box’’ warning 

for Adderall before prescribing it to a 

patient.17 RD, at 14; Tr. 169, 419–420. 

In reviewing the current matter, Dr. 

Kennedy determined, and the Agency 

agrees, that Respondent issued both 

prescriptions to UC beneath the Florida 

standard of care because, as detailed 

above, Respondent failed to make a 

diagnosis justifying either prescription, 

failed to take a medical history, failed to 

perform a physical examination, and 

failed to accurately document her 

treatment. RD, at 15; Tr. 170–172. 

Respondent’s diagnostic procedure 

consisted of asking UC if he had ADHD 

and anxiety, to which UC repeatedly 

stated that he did not have either 

condition and wanted to take Adderall 

and Klonopin because he liked them 

and wanted to relax; and, Respondent 

ultimately failed to diagnose UC with 

any condition justifying either 

prescription, as well as ignored the FDA 

‘‘Black Box’’ warning for Adderall in 

particular. RD, at 15–16; 159, 163–164, 

166–169, 171–172, 419–420; GX 8, at 4, 

8. Moreover, Respondent did not take a 

medical history for either prescription, 

did not perform any diagnostic 

interview for either prescription, failed 


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18Legitimate purposes are as authorized by Fla. 

Stat. § 464.001–464.027 (the Nurse Practice Act). 

to properly address clear red flags of 

diversion and abuse, and knowingly 

documented false diagnoses of ADHD 

and GAD. RD, at 15–16; Tr. 161–162, 

164, 167–168, 170, 172–173, 180–182, 

197–200, 202, 400–401, 422–423; GX 8 

at 4–5, 7–8. 

II. Discussion 

A. The Five Public Interest Factors 

Under the CSA, ‘‘[a] registration . . . 

to . . . dispense a controlled substance 

. . . may be suspended or revoked by 

the Attorney General upon a finding 

that the registrant . . . has committed 

such acts as would render her 

registration under section 823 of this 

title inconsistent with the public 

interest as determined under such 

section.’’ 21 U.S.C. 824(a). In making the 

public interest determination, the CSA 

requires consideration of the following 

factors: 

(A) The recommendation of the 

appropriate State licensing board or 

professional disciplinary authority. 

(B) The [registrant’s] experience in 

dispensing, or conducting research with 

respect to controlled substances. 

(C) The [registrant’s] conviction record 

under Federal or State laws relating to the 

manufacture, distribution, or dispensing of 

controlled substances. 

(D) Compliance with applicable State, 

Federal, or local laws relating to controlled 

substances. 

(E) Such other conduct which may threaten 

the public health and safety. 

21 U.S.C. 823(g)(1). 

The DEA considers these public 

interest factors in the disjunctive. Robert 

A. Leslie, M.D., 68 FR 15,227, 15,230 

(2003). Each factor is weighed on a caseby-case basis. Morall v. Drug Enf’t 

Admin., 412 F.3d 165, 173–74 (D.C. Cir. 

2005). Any one factor, or combination of 

factors, may be decisive. David H. Gillis, 

M.D., 58 FR 37,507, 37,508 (1993). 

The Government has the burden of 

proof in this proceeding. 21 CFR 

1301.44. While the Agency has 

considered all of the public interest 

factors in 21 U.S.C. 823(g)(1), the 

Government’s evidence in support of its 

prima facie case for revocation of 

Respondent’s registration is confined to 

Factors B and D. RD, at 18; see also RD, 

at 18. n.16 (finding that Factors A, C, 

and E do not weigh for or against 

revocation). 

Having reviewed the record and the 

RD, the Agency agrees with the ALJ, 

adopts the ALJ’s analysis, and finds that 

the Government’s evidence satisfies its 

prima facie burden of showing that 

Respondent’s continued registration 

would be ‘‘inconsistent with the public 

interest.’’ 21 U.S.C. 824(a)(4). RD, at 18– 

23. 

B. Factors B and D 

Evidence is considered under Public 

Interest Factors B and D when it reflects 

compliance (or non-compliance) with 

laws related to controlled substances 

and experience dispensing controlled 

substances. See Sualeh Ashraf, M.D., 88 

FR 1095, 1097 (2023); Kareem Hubbard, 

M.D., 87 FR 21156, 21162 (2022). DEA 

regulations require that for a 

prescription for a controlled substance 

to be effective, it must be issued for a 

legitimate medical purpose by an 

individual practitioner acting in the 

usual course of professional practice. 21 

CFR 1306.04(a); see also 21 U.S.C. 829. 

Further, Florida state law provides that 

a practitioner, including an advanced 

practice registered nurse, may only 

prescribe controlled substances when 

acting in good faith and in the course of 

professional practice. Fla. Stat. 

893.02(3), 893.05(1)(a). Florida state law 

also provides that a nurse practitioner 

may be subject to discipline for, among 

other things, prescribing controlled 

substances for any purpose other than 

legitimate purposes 18 and for ‘‘[f]ailing 

to meet minimal standards of acceptable 

and prevailing nursing practice, 

including engaging in acts for which the 

nurse is not qualified by training or 

experience.’’ Id. 464.018(1)(i), (n). 

Under Florida state law, it is ‘‘legally 

presumed that prescribing . . . 

controlled substances[ ] inappropriately 

. . . is not in the best interest of the 

patient and is not in the course of the 

advanced practice registered nurse’s 

professional practice, without regard to 

his or her intent.’’ Id. 464.018(1)(p)(6). 

Finally, Florida state law only 

authorizes the prescribing of 

amphetamines by a nurse practitioner 

for three specific purposes: (1) to treat 

patients with narcolepsy, patients with 

ADHD, or children with behavioral 

syndrome; (2) to treat patients receiving 

a differential diagnostic psychiatric 

evaluation of depression or treatment of 

depression that has been refractory to 

other therapies; and (3) to patients 

participating in clinical investigations. 

Id. 464.018(1)(p)(3). 

In the current matter, the Agency 

agrees with the ALJ’s analysis that 

Respondent issued prescriptions for 

Adderall and Klonopin to UC beneath 

the Florida standard of care and thus 

violated Federal and State Law because, 

as detailed above, Respondent failed to 

make a diagnosis justifying either 

prescription, failed to take a medical 

history, failed to perform a physical 

examination (conduct a diagnostic 

interview), and failed to accurately 

document her treatment. RD, at 20. 

Instead, Respondent ‘‘prescribed two 

controlled substances to a person who 

repeatedly denied having any medical 

justification for those medications, 

repeatedly admitted that he was 

obtaining controlled substances 

illegally, and admitted that he wanted 

the controlled substances for 

recreational use.’’ Id. Moreover, 

Respondent knowingly created and 

documented false diagnoses to issue the 

prescriptions for an improper purpose, 

that is, to prevent UC from illicitly 

obtaining controlled substances. Id. at 

20, 21. 

As Respondent’s conduct displays 

clear violations of the federal and state 

regulations described above, the Agency 

agrees with the ALJ and hereby finds 

that Respondent violated 21 CFR 

1306.04(a) and Fla. Stat. 464.018(1)(i), 

464.018(1)(n), 464.018(1)(p)(3), 

464.018(1)(p)(6), 893.02(3), 893.05(1)(a). 

RD, at 23. Accordingly, the Agency 

agrees with the ALJ and finds that 

Factors B and D weigh in favor of 

revocation of Respondent’s registration 

and thus finds Respondent’s continued 

registration to be inconsistent with the 

public interest in balancing the factors 

of 21 U.S.C. 823(g)(1). Id. 

III. Sanction 

Where, as here, the Government has 

established sufficient grounds to revoke 

Respondent’s registration, the burden 

shifts to the registrant to show why she 

can be entrusted with the responsibility 

carried by a registration. Garret Howard 

Smith, M.D., 83 FR 18882, 18910 (2018). 

When a registrant has committed acts 

inconsistent with the public interest, 

she must both accept responsibility and 

demonstrate that she has undertaken 

corrective measures. Holiday CVS, 

L.L.C., dba CVS Pharmacy Nos 219 and 

5195, 77 FR 62316, 62339 (2012) 

(internal quotations omitted). Trust is 

necessarily a fact-dependent 

determination based on individual 

circumstances; therefore, the Agency 

looks at factors such as the acceptance 

of responsibility, the credibility of that 

acceptance as it relates to the 

probability of repeat violations or 

behavior, the nature of the misconduct 

that forms the basis for sanction, and the 

Agency’s interest in deterring similar 

acts. See, e.g., Robert Wayne Locklear, 

M.D., 86 FR 33738, 33746 (2021). 

Here, the Agency agrees with the ALJ 

that Respondent failed to accept 

responsibility because ‘‘[w]hile [she] 

acknowledged that she made mistakes 

with [UC] and would do things 

differently if she had the opportunity, 

she made excuses and shifted blame,’’ 


lotter on DSK11XQN23PROD with NOTICES1
63130 Federal Register / Vol. 88, No. 177 / Thursday, September 14, 2023 / Notices 

such as repeatedly emphasizing that she 

had been trying to prevent UC from 

taking illicit controlled substances. RD, 

at 24–25. 

When a registrant fails to make the 

threshold showing of acceptance of 

responsibility, the Agency need not 

address the registrant’s remedial 

measures. Ajay S. Ahuja, M.D., 84 FR 

5479, 5498 n.33 (2019) (citing Jones 

Total Health Care Pharmacy, L.L.C. & 

SND Health Care, L.L.C., 81 FR 79188, 

79202–03 (2016)); Daniel A. Glick, 

D.D.S., 80 FR 74800, 74801, 74810 

(2015). Even so, in the current matter, 

the Agency agrees with the ALJ that 

although Respondent indicated that she 

has obtained her post-master’s 

certification to treat psychiatric and 

mental health conditions as well as 

completed two additional courses, one 

regarding safely and effectively 

prescribing controlled substances in 

Florida and the other regarding the laws 

and rules governing nursing in Florida, 

‘‘these measures are inadequate in the 

face of her actions.’’ RD, at 25. 

In addition to acceptance of 

responsibility, the Agency considers 

both specific and general deterrence 

when determining an appropriate 

sanction. Daniel A. Glick, D.D.S., 80 FR 

74810. In this case, the Agency agrees 

with the ALJ that revocation will 

remind practitioners that a prescriber is 

independently responsible for the 

prescriptions that he or she issues. RD, 

at 27. Regarding Respondent in 

particular, ‘‘[a]ny sanction short of 

revocation would fail to deter 

Respondent from ignoring red flags of 

diversion and prescribing controlled 

substances for other than legitimate 

medical purposes.’’ Id. Moreover, the 

Agency agrees with the ALJ that 

Respondent’s actions were egregious 

because Respondent knowingly 

recorded two false diagnoses when she 

documented ADHD and GAD to justify 

prescribing UC Adderall and Klonopin 

despite no medical justification for 

issuing the two prescriptions and in the 

face of obvious signs of diversion. RD, 

at 26–27. 

In sum, Respondent has not offered 

any credible evidence on the record to 

rebut the Government’s case for 

revocation of her registration and 

Respondent has not demonstrated that 

she can be entrusted with the 

responsibility of registration. RD, at 27. 

Accordingly, the Agency will order that 

Respondent’s registration be revoked. 

Order 

Pursuant to 28 CFR 0.100(b) and the 

authority vested in me by 21 U.S.C. 

824(a), I hereby revoke DEA Certificate 

of Registration No. MP4600791 issued to 

Rachel Pittala, APRN. Further, pursuant 

to 28 CFR 0.100(b) and the authority 

vested in me by 21 U.S.C. 823(g)(1), I 

hereby deny any pending applications 

of Rachel Pittala, APRN, to renew or 

modify this registration, as well as any 

other pending application of Rachel 

Pittala, APRN, for additional registration 

in Florida. This Order is effective 

October 16, 2023. 

Signing Authority 

This document of the Drug 

Enforcement Administration was signed 

on September 5, 2023, by Administrator 

Anne Milgram. That document with the 

original signature and date is 

maintained by DEA. For administrative 

purposes only, and in compliance with 

requirements of the Office of the Federal 

Register, the undersigned DEA Federal 

Register Liaison Officer has been 

authorized to sign and submit the 

document in electronic format for 

publication, as an official document of 

DEA. This administrative process in no 

way alters the legal effect of this 

document upon publication in the 

Federal Register. 

Scott Brinks, 

Federal Register Liaison Officer, Drug 

Enforcement Administration. 

[FR Doc. 2023–19819 Filed 9–13–23; 8:45 am] 

BILLING CODE 4410–09–P 

DEPARTMENT OF JUSTICE 

Office of Justice Programs 

[OJP (BJA) Docket No. 1815] 

Meeting of the Public Safety Officer 

Medal of Valor Review Board 

AGENCY: Office of Justice Programs 

(OJP), Bureau of Justice Assistance 

(BJA). 

ACTION: Notice of meeting. 

SUMMARY: This is an announcement of a 

meeting (via WebEx/conference call-in) 

of the Public Safety Officer Medal of 

Valor Review Board to consider 

nominations for the 2022–2023 Medal of 

Valor, and to make a limited number of 

recommendations for submission to the 

U.S. Attorney General to be cited. 

Additional issues of importance to the 

Board may also be discussed. 

DATES: October 12, 2023, 12:30 p.m. to 

3:00 p.m. EDT. 

ADDRESSES: This meeting will be held 

virtually using web conferencing 

technology. The public may hear the 

proceedings of this virtual meeting/ 

conference call by registering with 

Gregory Joy at last seven (7) days in 

advance with Gregory Joy (contact 

information below). 

FOR FURTHER INFORMATION CONTACT: 

Gregory Joy, Policy Advisor, Bureau of 

Justice Assistance, Office of Justice 

Programs, by telephone at (202) 514– 

1369, or by email at Gregory.joy@

usdoj.gov. 

SUPPLEMENTARY INFORMATION: The 

Public Safety Officer Medal of Valor 

Review Board carries out those advisory 

functions specified in 42 U.S.C. 15202. 

Pursuant to 42 U.S.C. 15201, the 

President of the United States is 

authorized to award the Public Safety 

Officer Medal of Valor, the highest 

national award for valor by a public 

safety officer. 

This virtual meeting/conference call 

is open to the public to participate 

remotely. For security purposes, 

members of the public who wish to 

participate must register at least seven 

(7) days in advance of the meeting/ 

conference call by contacting Mr. Joy. 

Access to the virtual meeting/ 

conference call will not be allowed 

without prior registration. Please submit 

any comments or written statements for 

consideration by the Review Board in 

writing at least seven (7) days in 

advance of the meeting date. 

Gregory Joy, 

Policy Advisor/Designated Federal Officer, 

Bureau of Justice Assistance. 

[FR Doc. 2023–19918 Filed 9–13–23; 8:45 am] 

BILLING CODE 4410–18–P 

DEPARTMENT OF JUSTICE 

Office of Justice Programs 

[OJP (BJA) Docket No. 1816] 

Meeting of the Public Safety Officer 

Medal of Valor Review Board 

AGENCY: Office of Justice Programs 

(OJP), Bureau of Justice Assistance 

(BJA). 

ACTION: Notice of meeting. 

SUMMARY: This is an announcement of a 

meeting (via WebEx/conference call-in) 

of the Public Safety Officer Medal of 

Valor Review Board to cover a range of 

issues of importance to the Board, to 

include but not limited to: Membership/ 

terms; Board Bylaws; program 

marketing and outreach. 

DATES: November 15, 2023, 1:00 p.m. to 

2:00 p.m. EST. 

ADDRESSES: This meeting will be held 

virtually using web conferencing 

technology. The public may hear the 

proceedings of this virtual meeting/ 

conference call by registering at last 


lotter on DSK11XQN23PROD with NOTICES1