Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Notices 17505 

Square, Room 2E–508, 145 N Street NE., 

Washington, DC 20530. 

Jerri Murray, 

Department Clearance Officer, PRA, United 

States Department of Justice. 

[FR Doc. 2012–7190 Filed 3–23–12; 8:45 am] 

BILLING CODE 4410–FY–P 

DEPARTMENT OF JUSTICE 

Drug Enforcement Administration 

[Docket No. 11–1] 

Morris W. Cochran, M.D.: Revocation 

of Registration 

On September 22, 2010, I, the thenDeputy Administrator of the Drug 

Enforcement Administration, issued an 

Order to Show Cause and Immediate 

Suspension of Registration to Morris W. 

Cochran, M.D. (Respondent), of 

Birmingham, Alabama. The Order 

proposed the revocation of 

Respondent’s DEA Certificate of 

Registration BC1701184, and the denial 

of any pending applications to renew or 

modify his registration, on the ground 

that his ‘‘continued registration is 

inconsistent with the public interest.’’ 

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

More specifically, the Order alleged 

that while Respondent is authorized to 

prescribe Suboxone and Subutex ‘‘for 

maintenance or detoxification treatment 

pursuant to 21 U.S.C. 823(g)(2) under 

DEA identification number 

XC1701184,’’ he had ‘‘prescribed 

methadone,’’ a schedule II controlled 

substance, ‘‘to patients for the purpose 

of drug addiction treatment’’ without 

the registration required under 21 U.S.C. 

823(g)(1). ALJ Ex.1, at 1–2. 

Next, the Order alleged that 

Respondent had prescribed both 

methadone and Suboxone, the latter 

being a Schedule III controlled 

substance, to numerous patients whose 

charts show that he ‘‘did not obtain a 

prior medical history,’’ that he ‘‘did not 

perform an initial physical exam,’’ that 

he ‘‘established little or no basis for the 

diagnoses,’’ and that he ‘‘offered no 

other treatment other than prescribing 

controlled substances.’’ Id. at 2. The 

Order further alleged that ‘‘[s]uch 

prescribing was not for a legitimate 

medical purpose in the usual course of 

professional practice in violation of 21 

CFR 1306.04(a), and in violation of 

Alabama Administrative Code 540–X– 

11)(1), which requires that a physician 

personally obtain an appropriate 

history, perform a physical exam, make 

a diagnosis and formulate a therapeutic 

plan before prescribing drugs to a 

patient.’’ Id. Finally, the Order alleged 

that Respondent had ‘‘continue to 

prescribe alprazolam, a schedule IV 

controlled substances depressant, to a 

patient after [the] patient file explicitly 

noted that the patient abused this drug.’’ 

Id. 

Based on the above, I concluded that 

Respondent’s continued registration 

during the pendency of the proceeding 

‘‘constitute[d] an imminent danger to 

the public health and safety.’’ Id. I 

therefore invoked my authority under 

21 U.S.C. 824(d) and immediately 

suspended Respondent’s registration. 

Respondent requested a hearing on 

the allegations and the matter was 

placed on the docket of the Agency’s 

Administrative Law Judges (ALJs). On 

November 2–4, 2010, an ALJ conducted 

a hearing in Birmingham, Alabama. ALJ 

Decision (also ALJ), at 3. 

On January 5, 2011, the ALJ issued 

her decision which recommended that 

Respondent’s registration be revoked. 

Id. at 51. Therein, the ALJ found that the 

Alabama Medical Board had not made 

a recommendation in the matter (factor 

one) and that Respondent has not been 

convicted of an offense related to the 

manufacture and distribution of 

controlled substances (factor three). Id. 

at 43, 48. 

With respect to factors two 

(Respondent’s experience in dispensing 

controlled substances) and four 

(Respondent’s compliance with 

applicable laws related to controlled 

substances), the ALJ made extensive 

findings. First, the ALJ found that 

Respondent violated DEA regulations 

because he prescribed drugs other than 

Suboxone or Subutex on prescription 

forms that used only his Data Waiver (or 

X) number. ALJ at 43. The ALJ also 

found that Respondent ‘‘improperly 

prescribed Suboxone for substance 

abuse using his regular DEA registration 

number rather than the required ‘‘X’’ 

number.’’ Id. 

Next, the ALJ found that Respondent 

prescribed methadone for detoxification 

and maintenance treatment without 

holding the separate registration 

required to do so under Federal law. 

ALJ at 43–45. The ALJ specifically 

rejected Respondent’s testimony that he 

had prescribed methadone to nine 

patients to treat pain (which does not 

require a separate registration), noting 

that Respondent had initially told a 

DEA Investigator that he was 

prescribing methadone for 

detoxification purposes, that several 

patients who had received methadone 

had told the Investigator that they were 

being treated for substance abuse, and 

that several of the patients had come to 

Respondent’s clinic ‘‘directly after’’ 

being treated by a methadone clinic 

‘‘where the prescription of methadone 

for pain is prohibited’’ and had been 

diagnosed by Respondent as being 

substance abusers. Id. at 44–45. The ALJ 

also found that Respondent had violated 

the limitation imposed under Federal 

law and regulations which limit to 100, 

the number of patients who can be 

treated for substance abuse with 

Suboxone. ALJ at 46–47 (citing 21 

U.S.C. 823(g)(2)(B)(iii) and 21 CFR 

1301.28(b)(1)(iii)). 

Next, the ALJ found that Respondent 

violated both Federal and State 

regulations because his medical charts 

‘‘fail[ed] to list the source and severity 

of pain when chronic pain [wa]s the 

diagnosis. ALJ at 47 (citing Ala. Admin. 

Code 540–X–4.08; 21 CFR 1306.04(a) 

and 1306.07(c)). The ALJ further found 

that Respondent’s charts ‘‘fail[ed] to 

record when medical examinations were 

conducted and the specific results of 

those examinations in support of 

diagnoses,’’ and that ‘‘[i]n some 

instances, patients actually reported that 

no examination was conducted.’’ Id. 

The ALJ also found that the ‘‘charts 

failed to show the use of any treatment 

options besides the prescribing of 

controlled substances,’’ and that the 

‘‘lack of attempts of alternative 

treatment modalities prior to 

determining that the patient suffers from 

chronic pain violates 21 CFR 

1306.07(c).’’ Id. 

The ALJ further found that 

Respondent had post-dated 

prescriptions for schedule II controlled 

substances in violation of Federal 

regulations. Id. at 47–48 (citing 21 CFR 

1306.05(a) and 1306.12(b)). In addition, 

the ALJ found that Respondent had 

admitted to having issued a controlled 

substance prescription after he was 

served with the Immediate Suspension 

Order. Id. at 48. The ALJ then found that 

‘‘Respondent testified, and the record 

contains no expert evidence to the 

contrary, that his treatment of his 

patients met the standard of care.’’ Id. 

However, based on Respondent’s 

improper use of his data-waiver number 

on prescriptions, his unauthorized 

prescribing of methadone for 

maintenance and detoxification 

purposes, his incomplete records, his 

failure to recommend any treatment 

options for his chronic pain patients 

besides the prescribing of controlled 

substances, and his issuance of a 

controlled substance prescription after 

his registration was suspended, the ALJ 

concluded that these factors supported 

the revocation of his registration. Id. 

With respect to factor five—such 

other conduct which may threaten 

public health or safety—the ALJ found 

that Respondent lacked candor. More 


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1Respondent also was practicing at offices in Red 

Bay and Russellville, Alabama. ALJ at 4–5 

(Stipulated Facts at para. 4); Tr. 35. 

specifically, the ALJ noted that 

‘‘[p]ractically all of the patient charts in 

this record had the same diagnoses: 

Chronic pain and substance abuse. 

However, when most of the patients 

were asked about their treatment by the 

Respondent, they stated that they were 

being treated for substance abuse.’’ Id. at 

49. While the ALJ acknowledged ‘‘that 

it may be difficult to accurately 

diagnose chronic pain or substance 

abuse,’’ she found Respondent’s 

testimony that the patients did not 

know that they were being treated for 

chronic pain to ‘‘lack[] credibility.’’ Id. 

The ALJ thus concluded that 

Respondent’s ‘‘lack of candor also 

threatens public health and safety.’’ Id. 

at 49. 

The ALJ then turned to Respondent’s 

evidence as to his remedial measures. 

The ALJ noted that Respondent had 

stopped using his X number improperly 

(to prescribe drugs other than Suboxone 

and for purposes other than substance 

abuse treatment), that he had stopped 

prescribing methadone, and that at the 

hearing, he had ‘‘apologized for the 

issuance of prescriptions for controlled 

substances without a proper DEA 

registration.’’ Id. at 50. However, noting 

that upon being served with the 

Immediate Suspension Order, 

Respondent had stated that he did not 

intend to comply with it, as well as his 

testimony that while he currently lacks 

‘‘authority to handle controlled 

substances, he continues to ‘help’ with 

the Suboxone at [another] clinic,’’ the 

ALJ found that Respondent’s ‘‘actions 

do not indicate remorse, but, rather, are 

more indicative of a failure to appreciate 

the seriousness of the allegations against 

him and the responsibility with which 

he was charged.’’ Id. The ALJ further 

found that ‘‘Respondent, through his 

actions, likely facilitated’’ drug abuse. 

Id. 

The ALJ thus concluded that 

Respondent had failed to rebut the 

Government’s prima facie case. Id. at 51. 

She further recommended that 

Respondent’s registration be revoked 

and that any pending applications be 

denied. Id. 

Neither party filed exceptions to the 

ALJ’s decision. Thereafter, the record 

was forwarded to this Office for Final 

Agency Action. Having considered the 

record as a whole, I adopt the ALJ’s 

findings of fact and conclusions of law 

except as otherwise noted herein. I 

further adopt the ALJ’s recommendation 

that Respondent’s registration be 

revoked and that any pending 

application be denied. I make the 

following findings. 

Findings 

Respondent is a physician licensed by 

the Alabama State Board of Medical 

Examiners (hereinafter, State Board or 

Medical Board) and is board certified in 

family practice. As of the date of the 

hearing, Respondent’s state license 

remains current and unrestricted. Tr. 

259. The State Board, however, has an 

open investigation of Respondent. Id. at 

257–58. 

Respondent is also the holder of DEA 

Certificate of Registration BC1701184, 

which prior to the issuance of the 

Immediate Suspension Order, 

authorized him to dispense controlled 

substances as a practitioner in schedules 

II through V, with the registered 

location of Narrows Health & Wellness, 

151 Narrows Parkway, Suite 110, 

Birmingham, Alabama.1 ALJ at 4 

(stipulated facts). Respondent’s 

registration does not expire until August 

31, 2012. Id. 

Respondent is also authorized to 

dispense Suboxone and Subutex, under 

the Drug Addiction Treatment Act of 

2000 (DATA), for the purpose of treating 

opiate addicted patients and is 

authorized to treat up to 100 patients; 

Respondent has been assigned 

identification number XC1701184 for 

this purpose. Id.; see 21 U.S.C. 823(g)(2). 

Suboxone and Subutex are schedule III 

controlled substances (and are the only 

schedule III through V drugs) which 

have been approved by the Food and 

Drug Administration for the treatment of 

opiate addiction by a DATA Waiver 

physician. 

Respondent is not, however, 

authorized to dispense methadone, a 

schedule II narcotic, for the purpose of 

treating opiate addiction as he does not 

have the registration required by 21 

U.S.C. 823(g)(1). GXs 1 & 2. Respondent 

can, however, lawfully dispense 

methadone for the purpose of treating 

pain. 

The Investigation 

Respondent first came to the attention 

of the authorities when several 

pharmacies complained to a State Board 

Investigator that he was prescribing 

large amounts of methadone using his X 

number. Tr. 35–36. The State 

Investigator passed this information on 

to a DEA Diversion Investigator (DI); on 

February 28, 2010, which was a Sunday 

morning, the two Investigators went to 

Respondent’s Red Bay Clinic and 

arrived there at 6:30 a.m. Id. at 37. 

While the Investigators were in the 

parking lot taking photographs, they 

were approached by TS, who said ‘‘[h]e 

was waiting to get his methadone from’’ 

Respondent. Id. at 38. TS also stated 

that he paid cash for his visits, that he 

was seeing Respondent for an old 

football injury, that he did not provide 

any medical records to Respondent, and 

that he was not asked for identification 

when he first registered as a patient. Id. 

at 39–40. 

Respondent did not arrive at the office 

until shortly before 11 a.m., by which 

time ‘‘close to 50 people’’ were waiting 

to see him. Id. The State Investigator 

then went inside to register in an 

attempt to see Respondent. Id. However, 

when the State Investigator was told 

that he would have to wait five to six 

hours to see Respondent, the 

Investigators decided to identify 

themselves and interview him. Id. at 42. 

Respondent initially told the 

Investigators that ‘‘he was operating a 

detox clinic where he was using 

methadone to get his patients onto 

Suboxone.’’ Id. at 43. Respondent also 

said that he accepted cash only, that he 

saw an average of 80 patients on 

Sundays at the Red Bay clinic, and that 

he also treated chronic pain patients on 

whom he performed ‘‘range of motion 

tests.’’ Id. at 43–44. 

With respect to his chronic pain 

patients, Respondent told the State 

Investigator that he would look for 

surgical scars on the patient’s body and 

that he sent some of his patients for 

X–Rays and MRIs. Id. at 218–19. 

Respondent admitted to the State 

Investigator that ‘‘he did not’’ follow the 

Board’s guidelines for the use of 

controlled substances in treating pain. 

Id. at 220. In the interview, Respondent 

also stated that he would require his 

substance abuse patients to undergo 

drug screens ‘‘if he felt that they needed 

one.’’ Id. at 219. 

Respondent also maintained that he 

knew the requirements for using his X 

number and that he was not prescribing 

any other drugs under this number. Id. 

at 44–45. The State Investigator then 

showed Respondent a methadone 

prescription he had written under his X 

number; Respondent said that the 

‘‘prescription was a mistake.’’ Id. at 45. 

The DI then told Respondent that he 

had found ‘‘close to 200 prescriptions 

* * * written under his X number for’’ 

drugs other than Suboxone and 

Subutex, including Xanax (a schedule 

IV depressant) and Adderall (a schedule 

II stimulant). Id.; see also id. at 221 

(testimony of State Investigator). 

The DI then asked Respondent how 

many patients he was treating under his 

X number. Id. at 46. Respondent said 

that he had 60 patients at his Red Bay 

clinic and another 50 patients at his 


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2Twenty-six of the patient files were entered into 

evidence as Government Exhibit 5; the two 

remaining files were entered into evidence as 

Government Exhibits 22–23. Respondent also 

introduced copies of the same files. See RXS 2, 4– 

28. I have carefully reviewed both sets of files and 

conclude that there are no material differences 

between the two sets. 

Birmingham office. Id. When told by the 

DI that this exceeded the 100 patient 

limit, Respondent claimed that ten of 

the patients were actually being treated 

with Suboxone for pain. Id. at 46. 

During the visit, the DI encountered 

JKB in Respondent’s waiting room and 

asked to speak with him. Id. at 51. The 

DI asked JKB what Respondent was 

treating him for; JKB stated that he was 

treating him for an addiction to opiates 

with methadone. Id. at 52. JKB also told 

the DI that he had previously gone to a 

narcotic treatment program which used 

methadone and that he was going to 

Respondent because it was cheaper. Id. 

at 53. JKB also stated that he was not 

seeing Respondent for chronic pain. Id. 

Following this interview, the DI 

resumed his interview of Respondent. 

Respondent now maintained that he 

was prescribing methadone for pain. Id. 

When the DI told Respondent that he 

had just interviewed a patient who said 

he was being treated for opiate 

addiction with methadone, Respondent 

stated that the patient was mistaken. Id. 

at 54. When the DI reminded 

Respondent that he had earlier stated 

that he was using methadone to transfer 

patients onto Suboxone, he stated that 

he had previously misspoken and 

‘‘[t]hat he was only using methadone for 

pain’’ and not to treat addiction. Id. at 

55. When the DI asked Respondent 

whether it was possible to see eighty 

patients in a day and ‘‘provide the kind 

of treatment that was necessary for’’ 

them, Respondent stated that ‘‘he was 

overwhelmed and . . . needed some 

guidance.’’ Id. at 56–57. 

Upon leaving the clinic, the 

Investigators observed ‘‘approximately 

50 patients inside of [the] office and 

probably another 50 to 60 . . . in the 

parking lot.’’ Id. at 57. The Investigators 

then went to a local CVS pharmacy and 

interviewed its pharmacist, who stated 

that since the opening of Respondent’s 

Red Bay clinic, he had ‘‘seen a 

tremendous spiking in the amount of 

prescriptions for methadone.’’ Id. at 58. 

The pharmacist further stated that 

Respondent was writing methadone 

prescriptions to treat addiction and that 

he would not fill these prescriptions. Id. 

at 59; see also GX 7. 

On May 17, 2010, the Investigators 

(along with a Supervisory DI) went to 

Respondent’s Russellville office and 

obtained various patients’ files through 

either an administrative subpoena or a 

warrant. Tr. 48–50, 62–63. The 

Investigators again interviewed 

Respondent who stated that he was 

mainly seeing pain patients. Id. at 63. 

The DI then asked Respondent if he had 

made any changes to his practice; 

Respondent states that ‘‘he had 

switched pretty much everybody from 

methadone to Suboxone and that out of 

the 85 percent [of his] patients that he 

was seeing for pain, 95 percent . . . were 

being treated with Suboxone.’’ Id. at 64. 

Respondent also stated that he had 

stopped prescribing methadone for pain 

because he was having more success 

using Suboxone. Id. at 65. 

During the interview, Respondent 

identified AK as a chronic pain patient 

who he was treating with Suboxone and 

who was waiting to see him. Id. at 65– 

66. The DI proceeded to interview AK, 

who had yet to see Respondent that day; 

AK stated that Respondent ‘‘was treating 

her for an addiction to opiates,’’ and 

that after the February visit by the 

Investigators, he had stopped writing 

methadone prescriptions. Id. at 66. 

The DI also interviewed another 

patient, SH, who was in the parking lot. 

Id. at 73–74. SH stated that Respondent 

was treating him for opiate addiction 

and not for chronic pain. Id. at 74. 

The DIs seized 114 patient files which 

were selected on the basis of pharmacy 

records showing that Respondent had 

prescribed either Suboxone or 

methadone to the patients. Id. at 171– 

72, 174. The files were taken to the DIs’ 

office where they were reviewed. Id. at 

68. Thereafter, the DIs focused their 

investigation on approximately 28 

patients, whose files were introduced 

into evidence.2 During the course of the 

investigation, the DIs interviewed most 

of these patients by telephone to 

determine why they were seeing 

Respondent. Id. at 172. 

The Patient Files and Interviews 

Respondent’s Methadone Patients 

TP 

On June 1, 2010, the DI spoke with 

TP. TP told him that Respondent did 

not physically examine her, that she 

paid $100.00 for the visit and that he 

prescribed methadone to her. Tr. 103– 

105; GX 5X. TP went to Respondent 

because she had heard that he was using 

methadone to treat addiction. Tr. 105. 

TP saw Respondent on three 

occasions (Feb. 7 and 21, and Mar. 7, 

2010). GX 5X. TP completed an intake 

form on which she listed her 

medications as ‘‘methadone 12 10s a 

day’’ and wrote that her pharmacy was 

the ‘‘methadone clinic.’’ Id. at 2. At her 

first visit, Respondent checked ‘‘YES’’ 

for whether TP had pain and listed her 

legs and back as the location. Id. at 3. 

Respondent diagnosed TP as having 

chronic pain, substance abuse and 

anxiety. Id. 

However, Respondent did not 

document the nature and intensity of 

the pain, current and past treatments for 

the pain, and its effect on TP’s physical 

and psychological functioning. Id. at 3, 

5. No vital signs were recorded at any 

of her visits. Id. In addition, the chart 

contains no medical history. See 

generally GX 5X. 

Moreover, while TP indicated that she 

had previously gone to a methadone 

clinic, Respondent did not know the 

name of the clinic and did not even 

attempt to obtain her treatment records. 

See generally GX 5X; Tr. 727–28. In 

addition, the progress note for TP’s third 

visit contains no information other than 

her name, date of birth and the date of 

the visit. 

At each of TP’s three visits, 

Respondent prescribed a daily dose of 

eleven tablets of methadone 10 mg, with 

the first two prescriptions being written 

under his X number for 154 tablets each. 

See GX 5X. While TP told the DI that 

after DEA’s February 28, 2010 visit, 

Respondent told her that he was no 

longer prescribing methadone, Tr. 105; 

on March 7, Respondent again 

prescribed 88 tablets of methadone 10 

mg to her. GX 5X, at 1. When 

Respondent offered TP alternative 

medications to methadone, she elected 

to return to a methadone treatment 

program. Tr. 501, 728. 

When asked on cross-examination if 

the methadone clinic which TP had 

previously gone to was treating her for 

abusing narcotics, Respondent testified 

that while the only purpose of a 

methadone clinic is to treat ‘‘substance 

abuse,’’ she was ‘‘going for pain.’’ Id. at 

728. While Respondent also diagnosed 

TP as having substance abuse, he did 

not document the substances that she 

was abusing. GX 5X. 

DG 

DG first saw Respondent on January 3, 

2010. GX 5O. On the intake form, DG 

listed his medications as ‘‘methadone.’’ 

Respondent made a diagnosis of chronic 

pain even though he checked ‘‘NO’’ for 

whether DG had pain and the progress 

note for the visit does not document the 

nature and intensity of the pain, 

whether any treatments had been 

previously tried, and the pain’s effect on 

his psychological and physical function. 

GX 5O, at 4. While Respondent noted 

that he performed a physical exam, he 

found each of the areas of the 

examination to be normal. Id. 

Respondent prescribed methadone to 


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3Respondent issued MB a total of six methadone 

prescriptions between January 5 and March 14, 

2010. GX 5A, at 2. Some of the prescriptions 

indicated that they were ‘‘for pain.’’ Id. at 4, 6. 

DG at this visit, as well as on January 

12, 19, and February 1, 14, and 28, 2010. 

Id. at 5, 7, 9, 11. 

On July 9, 2010, the lead DI 

interviewed DG. Tr. 106. DG stated that 

Respondent had told him on February 

28, 2010, that he would no longer 

prescribe methadone, but that he would 

prescribe Suboxone to DG if he was 

having trouble getting off of the 

methadone. Id. at 107–08, 386. 

Respondent testified that on January 

19, 2010, he diagnosed DG as having a 

substance abuse problem, yet the 

medical chart does not document the 

basis for that diagnosis. Id. at 701–02. 

Respondent testified that his diagnosis 

was based on DG’s demeanor and 

‘‘probably . . . also a drug screen.’’ Id. 

However, there is no drug screen in the 

file. See GX 5O. 

DG testified at the hearing. The ALJ 

found credible his testimony that he 

was also seeing the Respondent for pain 

in his shoulder and lower back. ALJ at 

23. While DG believed this pain was a 

result of masonry work he had done 

since he was a teenager, as well as a 

snowboarding accident he had when he 

had lived in Utah, DG’s chart does not 

reflect any of this information. Tr. 367, 

374; GX 5O. 

According to DG, Respondent 

examined him and would spend about 

7 to 10 minutes with him during his 

visits. Tr. 370. DG also denied having 

told the DI that Respondent did not 

perform a physical exam on him and 

that he was seeing Respondent for 

substance abuse. Tr. 371. 

Respondent used his X number to 

prescribe methadone for DG. GX 5O, at 

5, 7, 9, 11. The methadone prescriptions 

were for lesser and lesser amounts. GX 

5O, at 1. In March of 2010, Respondent 

proposed to offer DG an alternative 

medication treatment plan. Id. at 11; Tr. 

386–87. The medical chart stops at that 

point. GX 5O. Respondent stated that he 

believed his treatment of DG was 

appropriate. Tr. 488. 

MB 

On July 20, 2010, the lead DI 

interviewed MB. Tr. 108; GX 5A. MB 

stated that she was seeing Respondent 

for an addiction to Lorcet and not for 

chronic pain, that she paid cash for her 

prescriptions, and that Respondent did 

not perform any physical examinations. 

Tr. 109–110. MB also commented that 

she thought there were too many people 

waiting inside and outside the office to 

see Respondent. Id. at 109. 

On the progress note for MB’s first 

visit, Respondent circled ‘‘YES’’ for 

whether she had pain and diagnosed her 

as having chronic pain due to 

headaches. GX 5A, at 7. At the hearing, 

Respondent testified that MB was being 

treated for both periodic headaches and 

substance abuse. Respondent did not, 

however, further document the nature 

and intensity of the pain, how it affected 

MB’s ability to function, and any prior 

treatments for her pain. See id. Nor did 

he document the history of MB’s 

substance abuse. Tr. 533–37. 

Respondent did not obtain information 

from MB’s prior physicians. Tr. 533–34. 

While Respondent indicated that the 

physical examination was normal, he 

did not take MB’s vital signs. Tr. 532– 

33; GX 5A, at 7. 

Respondent described his treatment of 

MB as tapering her down on her 

methadone prescriptions, and the 

prescriptions show that Respondent was 

gradually reducing her daily dosage 

from 150 mg to 130 mg over the course 

of the slightly more than two months in 

which he treated her.3 Tr. 463, 545, 550; 

GX 5A, at 5–6. At MB’s last visit (Mar. 

14), Respondent offered her the option 

of using different medication to control 

any potential withdrawal symptoms she 

may have from the lack of methadone. 

Tr. 464–65. However, MB chose to seek 

treatment elsewhere. Tr. 551. 

Respondent issued MB two 

methadone prescriptions on his X 

prescription pad. Tr. 541–42; GX 5A, at 

6. MB’s file has no entry for her visits 

of February 28 and March 14, even 

though MB’s drug log notes that a 

methadone prescription was issued on 

each date for 182 and 106 dosage units 

of methadone respectively. GX 5A, at 2– 

3. 

JC1 

Respondent saw JC1 three times in 

February and March of 2010. GX 5N. On 

his intake form, JC1 listed his 

medications as methadone and Xanax. 

GX 5N, at 2. On the progress note for 

JC1’s first visit (Feb. 9), Respondent 

noted that he had been in an automobile 

accident and wrote ‘‘back’’ on the chart. 

Id. at 4. However, Respondent also 

noted that JC1 had ‘‘NO’’ pain and did 

not document the nature and intensity 

of the pain, details regarding the 

accident such as when it occurred, what 

treatments had been used, and the 

pain’s effect on his physical and 

psychological functioning. Id. The 

progress note indicated that Respondent 

did a physical exam, during which he 

did not find any area to be abnormal. Id. 

Respondent did not document having 

taken JC1’s vital signs. Id. At this visit, 

Respondent gave JC1 prescriptions for 

210 tablets of methadone 10 mg, with a 

daily dose of 15 tablets, and 60 tablets 

of Valium, even though he noted that 

JC1 was not agitated or moody and did 

not have insomnia. Id. at 4–5. These 

prescriptions were written under his X 

number. Id. at 5. 

At JC1’s next visit (Feb. 23), 

Respondent again indicated that he had 

‘‘NO’’ pain and did a physical exam at 

which he found all areas normal. Id. at 

4. At this visit, Respondent noted 

diagnoses of both chronic pain and 

substance abuse. Id. Respondent issued 

JC1 a prescription for 210 tablets of 

methadone 10 mg, with a daily dose of 

15 tablets ‘‘for pain.’’ Id. Respondent 

wrote the prescription under his X 

number. Id. at 5. 

On March 9, Respondent wrote JC1 

two more prescriptions, one for another 

210 tablets of methadone with the same 

daily dose ‘‘for pain’’ as before, and one 

for twenty-eight tablets of Valium. Id. at 

1, 7. Respondent wrote the prescriptions 

under his X number. Id. at 7. 

Respondent did not, however, create a 

progress note to document the issuance 

of the prescriptions. See generally GX 

5N. 

Respondent testified that JC1 had 

been in an automobile accident and had 

fractured his back, that he had 

developed a tolerance for pain medicine 

and was taking more and more, and thus 

went to a methadone clinic. Tr. 486. 

Respondent further testified that JC1 

had come from either the Shoal’s clinic 

or a narcotic treatment program in 

Hamilton because he ‘‘wanted to take a 

cleaner medicine for his pain.’’ Id. at 

486, 699. Respondent denied that JC1 

had gone to the narcotic treatment 

program ‘‘to be treated for addiction’’ 

and maintained that ‘‘he was going there 

to be treated for pain from a fractured 

back.’’ Id. at 699. 

As for the basis of the substance abuse 

diagnosis which he made at JC1’s 

second visit, Respondent testified that 

‘‘we probably got our February 9 drug 

screen back. And he probably had some 

[illicit] drug in there.’’ Id. at 700. 

However, Respondent acknowledged 

that he was speculating about this 

because JC1’s chart did not contain any 

drug test results. Id. 

Respondent prescribed methadone at 

a lower dosage amount than the dosage 

JC1 reported he had been on. Id. at 486; 

GX 5N at 1, 5, 7. However, while 

Respondent maintained that JC1 

‘‘wanted to take a cleaner medicine for 

his pain,’’ Respondent did not taper the 

methadone prescriptions for JC1, but 

rather prescribed the same daily dose of 

150 mg in each prescription between 

February 9, 2010, and March 9, 2010. 

Tr. 486; GX 5N, at 1, 5, 7. When in 


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4 It is unclear whether JB is the same person as 

JKB, who was interviewed in the waiting room on 

February 28, 2010, and who told Investigators that 

he had previously gone to a methadone clinic and 

that Respondent was treating him for opiate 

addiction, as the Government did not establish that 

this chart (GX 5L) was JKB’s. 

March, Respondent offered him 

alternative medications, JC1 elected to 

go to another treatment facility. Tr. 486. 

Respondent maintained that his care of 

JC1 was appropriate. Id. at 487. 

JB 

Respondent treated JB in February 

and March of 2010.4 GX 5L. On the 

intake form, JB listed his medications as 

‘‘methadone,’’ and on the progress note 

for his visit, Respondent wrote that JB 

had been a patient at the Shoals 

Treatment Center, that he had been on 

230 mg. of methadone, but that he ‘‘was 

kicked out.’’ GX 5L, at 5. Respondent 

further wrote that JB ‘‘desires to get off 

methadone.’’ Id. In addition, 

Respondent noted that JB had foot pain, 

back pain and knee pain which had 

been caused by ‘‘a four-wheeler 

accident.’’ Id.; Tr. 696. Respondent 

performed a physical examination and 

took JB’s blood pressure and heart rate. 

GX 5L, at 5. Respondent also noted that 

JB had withdrawal, was agitated/moody, 

had insomnia, and had a positive MDQ 

(Mood Disorder Questionnaire). Id. 

Respondent then issued JB a 

prescription for a fourteen-day supply of 

methadone 10 mg, at a daily dose of 18 

tablets, id., and noted that his plan 

included placing JB on his alternative 

medication (KCZZU) program. Id. 

Respondent issued JB a prescription for 

methadone, which was written under 

his X number, and wrote on it ‘‘for 

pain.’’ Id. at 6. Respondent also wrote JB 

a prescription for Ultram, a noncontrolled drug, on the same form, 

which listed only his X number. Id. 

On February 28, 2010, JB again saw 

Respondent. Respondent circled ‘‘YES’’ 

for whether JB had pain and insomnia, 

and made a further notation that his 

pain was worse, although the precise 

area is illegible. Id. at 5. Respondent 

again noted a diagnosis of chronic pain 

and issued JB another prescription for 

252 methadone 10 mg, with a daily dose 

of 18 tablets ‘‘for pain.’’ Id. at 6. This 

prescription was also issued under his 

X number. 

At JB’s final visit (Mar. 14), 

Respondent noted that his ‘‘pain 

persists’’ and that he was ‘‘anxious 

about stopping methadone.’’ Id. at 3. 

Respondent issued him a prescription 

for 156 tablets of methadone 10 mg with 

a daily dose of 17 tablets ‘‘for pain.’’ Id. 

at 4. Respondent wrote the prescription 

on a form, which contained both his X 

number and regular DEA number. Id. 

Respondent testified that JB had been 

asked to leave a drug treatment program 

before he saw the Respondent. Tr. 482. 

Respondent testified that he had done a 

drug screen on JB and that he did not 

‘‘see anything that bothered [him], such 

as cocaine * * * or marijuana at that 

time.’’ Id. at 483. However, JB’s file does 

not contain the results of a drug screen. 

GX 5L. 

According to Respondent, JB had been 

in a four-wheeler accident, took 

narcotics, and went to the drug 

treatment program because his other 

physician would not write anymore 

prescriptions for narcotics. Tr. 696. 

Respondent did not, however obtain 

JB’s records from the drug treatment 

program and Respondent maintained 

that the fact that JB was being treated at 

a methadone clinic did not tell him that 

JB was being treated for opiate 

addiction. Id. at 695–96. Respondent 

stated that he prescribed methadone in 

a tapered amount to prevent JB from 

going into withdrawal. Id. at 483; GX 

5L, at 1. 

Respondent also testified that he had 

provided JB with the option of other 

treatment medications, but that he 

elected to go to another methadone 

clinic. Tr. 483. Respondent annotated in 

the medical chart that he was treating JB 

for back and knee pain. GX 5L, at 5–6. 

Respondent did not document the 

severity of the pain. GX 5L. Respondent 

stated that his treatment of JB was 

appropriate. Tr. 483–84. 

NB 

Respondent saw NB three times in 

February and March of 2010. GX 5M. At 

her first visit (Feb. 7), Respondent 

diagnosed her as having chronic pain 

even though he indicated that she had 

‘‘NO’’ pain. GX 5M, at 3. Respondent 

did not document any further 

information regarding NB’s condition 

(such as the nature and intensity of the 

pain, its history, whether any treatments 

had been previously tried, and the 

pain’s effect on her psychological and 

physical functioning) at any of her three 

visits. Id. at 3, 5. 

The progress note for NB’s first visit 

indicates that Respondent performed a 

physical exam. Id. at 3. However, 

Respondent noted that all areas were 

normal. Id. Respondent did not 

document having taken NB’s vital signs. 

Id. At this visit, Respondent issued NB 

prescriptions under his X number, for 

210 tablets of methadone 10 mg (with a 

daily dose of 15 tablets) and 30 Xanax. 

Id. at 4. Respondent did not diagnose 

NB as having anxiety; indeed, he noted 

that she was not agitated/moody and 

did not have insomnia. Id. at 3. 

On Feb. 21, Respondent issued NB 

additional prescriptions for methadone 

and Xanax under his X number. Id. at 

4. The progress note for this visit, 

however, contains no information 

regarding her medical condition. Id. at 

3. On the progress note for NB’s final 

visit (Mar. 7), Respondent circled 

‘‘CHRONIC PAIN’’ but made no other 

findings. Id. at 5. At this visit, 

Respondent issued her prescriptions for 

112 tablets of methadone 10 mg, with a 

daily dose of 14 tablets ‘‘For Pain,’’ and 

for 20 tablets of Klonopin ‘‘for anxiety.’’ 

Id. at 6. Respondent wrote the 

prescriptions on a form which listed 

both his X number and his regular 

registration number. Id. 

Respondent testified that NB told her 

at the initial visit that she had been on 

180 mg of methadone and that ‘‘she was 

taking it for pain.’’ Tr. 484. He then 

testified that ‘‘she also had some 

anxiety’’ and that she was a ‘‘troubling 

patient’’ because she was ‘‘on a 

combination of methadone and Xanax’’ 

which caused him great concern, 

especially if ‘‘those two drugs get mixed 

with alcohol.’’ Id. at 485. None of this 

was documented. 

Respondent also testified that he gave 

her ‘‘150 methadone,’’ which was 

‘‘much less methadone than she was 

on,’’ and that he ‘‘gave her 28 tablets of 

the Xanax in fear of seizure potential if 

we went below that.’’ Id. At her last 

visit, Respondent offered NB the option 

of alternative medications, after which 

she did not return to his clinic. Id. 485; 

GX 5M. Respondent believed his care of 

NB was appropriate. Tr. 485–86. 

KI 

Respondent saw KI four times in 

February and March of 2010. GX 5T. On 

the intake form, KI noted that her 

medications included ‘‘methadone, 

Xanex[sic], [and] Ambien.’’ Id. at 2. 

According to Respondent, KI was 

being treated at Shoals, a narcotic 

treatment facility, and she wanted out of 

the clinic. Tr. 494. Respondent testified 

that KI had back pain; however, 

Respondent indicated that she had 

‘‘NO’’ pain on the progress note for her 

first visit. Tr. 494, GX 5T, at 3. Although 

Respondent wrote ‘‘Back’’ as the 

location, once again, he did not 

document the nature and intensity of 

the pain, the history of the pain, what 

treatments had been used, and the 

pain’s effect on KI’s physical and 

psychological functioning. GX 5T, at 3; 

Tr. 494, 718. 

Respondent performed a physical 

examination but did not note any 

abnormalities; he also did not document 


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5At LM’s second visit, Respondent listed 

substance abuse as a diagnosis; however, at two 

subsequent visits, he no longer listed substance 

abuse as a diagnosis. See GX 5V. 

having taken KI’s vital signs. GX 5T, at 

3. Respondent noted the diagnoses of 

both chronic pain and substance abuse 

and prescribed a lesser dose of 

methadone (130 mg per day) than what 

KI reported she had been receiving at 

Shoals (150 mg). Tr. 494; GX 5T, at 3– 

4. However, Respondent did not taper 

KI’s methadone prescriptions; rather, he 

prescribed 130 mg per day of 

methadone to her three times between 

February 7, 2010, and March 7, 2010, 

with the first two prescriptions being 

written under his X number. GX 5T, at 

1, 4, 6. 

Respondent did not obtain treatment 

records from the narcotic treatment 

facility and did not know what 

substance KI was abusing; he also did 

not obtain any records related to her 

back pain. Tr. 715–16. Respondent 

testified that KI began taking narcotics 

to treat her pain, became addicted to 

those narcotics, but then denied that she 

had told him that she then entered the 

methadone clinic to treat her addiction. 

Id. at 716–17. Respondent testified that 

he offered alternative medications to KI, 

that on March 21, 2010, he refused to 

prescribe methadone to her, and that 

she then ‘‘went to another facility.’’ Id. 

at 494–95. Respondent maintained that 

his care of KI was appropriate. Id. at 

495. 

Respondent’s Suboxone Patients 

SS 

On June 1, 2010, the DI spoke with SS 

by phone. Tr. 96. SS said that he was 

being treated for opiate addiction, that 

he received a Suboxone prescription 

from Respondent, and that he was not 

being treated for chronic pain. He also 

stated that he paid $100.00 cash directly 

to Respondent for his prescription and 

that Respondent did not conduct any 

examination on him. Tr. 95–98; GX 5H. 

SS saw Respondent only on May 2, 

2010. GX 5H, at 2–3. On the intake form, 

SS listed methadone as his medication 

and Respondent noted on the progress 

note that he was on 120 mg. Id. at 3. 

Respondent diagnosed SS as having 

both chronic pain and methadone use; 

while Respondent checked ‘‘NO’’ for 

SS’s pain, he indicated that SS had disc 

surgery at L5S1. Id. at 3; Tr. 475. While 

Respondent recalled, and the chart 

reflects, that SS had back surgery, SS’s 

chart does not contain any copies of 

records related to his back surgery and 

does not document the date of the 

surgery. Tr. 475, 673; GX 5H. SS’s chart 

does not document the nature and 

intensity of the pain, current and past 

treatments for it other than the surgery, 

and the pain’s effect on his physical and 

psychological functioning. GX 5H, at 3. 

No vital signs were recorded at SS’s 

visit. Id. 

Respondent testified that SS was on 

methadone, which he was getting ‘‘off 

the street,’’ but that fact is not annotated 

in his chart. Tr. 672. Respondent, 

however, refused to prescribe 

methadone to SS. Instead, he prescribed 

Suboxone and offered SS the choice of 

an alternative medical treatment 

program for getting off of methadone. Id. 

at 475–76, 674. Respondent believed 

that he gave SS appropriate care. Id. at 

476. 

AG 

On May 17, 2010, the DI interviewed 

AG. Id. at 80. AG stated that she was 

seeing Respondent for treatment of her 

addiction to Lortab, a schedule III 

narcotic containing hydrocodone. Id. at 

80–81. AG further explained that she 

was not being treated for chronic pain, 

although such treatment was indicated 

in her chart. AG stated she did not know 

why her chart listed this condition. Id. 

at 81; see also GX 5P. 

According to her chart, Respondent 

diagnosed AG as having chronic pain 

and substance abuse as a secondary 

condition. GX 5P, at 3; Tr. 488–89. 

However, the chart does not specify the 

basis for this diagnosis and Respondent 

checked ‘‘NO’’ for whether AG had 

pain. Tr. 704; GX 5P, at 3. In addition, 

Respondent did not record any vital 

signs at this or any subsequent visit. 

Respondent prescribed Suboxone to 

AG at both the initial and several 

subsequent visits. Tr. 488; GX 5P, at 1, 

4, 6, 8, 9. Moreover, at subsequent visits, 

Respondent continued to diagnose AG 

as having both chronic pain and 

substances abuse while checking ‘‘NO’’ 

for whether she had pain. See id. In 

other instances, the progress notes 

indicate that AG visited on a certain 

date but are otherwise blank even 

though Respondent issued AG a 

prescription. GX 5P, at 5. At AG’s final 

visit, Respondent circled ‘‘YES’’ for 

whether she had pain but provided no 

further documentation as to the location 

of the pain, the nature and intensity of 

the pain, current and past treatment for 

pain, and its effect on her physical and 

psychological functioning. Id. at 7. In 

addition, the chart contains no medical 

history. See generally GX 5P. 

Respondent nonetheless maintained 

that he met the standard of care with 

respect to AG. Tr. 489. 

LM 

On June 1, 2010, DI Michael Jones 

interviewed LM by telephone. Id. at 82. 

LM stated that the Respondent was 

treating her for an addiction to pain 

killers. Id. at 83. Respondent had been 

treating LM since December 27, 2009, at 

the Red Bay clinic. LM confirmed that 

she was not being treated for chronic 

pain. Tr. 82–83. 

LM completed a form in which she 

listed her medications as Adderall and 

Oxycontin, the latter being a schedule II 

narcotic. Tr. 193; GX 5V, at 2. At LM’s 

first visit, Respondent diagnosed LM as 

having chronic pain, substance abuse, 

and bipolar disorder. GX 5, at 3. While 

Respondent checked ‘‘YES’’ for whether 

LM had pain and listed her ‘‘back’’ as 

the location, the chart does not 

document the nature and intensity of 

the pain, current and past treatments for 

pain, and its effect on her physical and 

psychological functioning. Id. In 

addition, the chart contains no medical 

history. See generally id. Respondent 

prescribed Suboxone and Adderall on 

an X prescription pad. GX 5V, at 4, 6. 

Subsequently, he prescribed both 

controlled substances using his regular 

DEA registration number. GX 5V, 

at 6–7. 

At subsequent visits, Respondent 

continued to list chronic pain as a 

diagnosis while checking ‘‘NO’’ for 

whether LM had pain.5 Id. at 3. 

Respondent testified that he was 

treating LM for back pain and for 

bipolar disorder. He further stated that 

LM was on Oxycontin and wanted to get 

‘‘onto a better pain medicine.’’ Tr. 498. 

However, when asked on crossexamination as to whether his diagnosis 

of substance abuse was ‘‘based on her 

abuse of Oxycontin,’’ Respondent 

stated: ‘‘I think it had to do with—she 

had multiple things. She had stimulants 

* * * such as Adderall,’’ and ‘‘I think 

she had taken periodically Xanax.’’ Id. 

at 723. 

LM’s progress notes do not, however, 

indicate what substance(s) she was 

abusing. GX 5V, at 3 & 5. Moreover, 

notwithstanding his testimony that her 

substance abuse was based in part on 

her use of Adderall, Respondent 

prescribed this drug to LM at four of her 

subsequent visits. Id. at 4, 6, 7. 

Respondent believed his treatment of 

LM was within the standard of care. Tr. 

498–99. 

ET 

On June 1, 2010, the DI interviewed 

ET by telephone. ET explained that the 

Respondent was treating him for an 

addiction to pain killers. Tr. 83–84. 

Respondent prescribed Suboxone to ET 

on an X pad on four occasions between 

December 2009 and March 2010; in 


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6For this reason, I conclude that the undated note 

was for ET visit of December 8, 2009, at which 

Respondent issued him a prescription for 

Suboxone. See GX 5Z, at 1 & 4. 

7Respondent also diagnosed KP as having 

anxiety, for which he prescribed Xanax. GX 5W, at 

5. 

April, he prescribed Suboxone to ET on 

a prescription pad which listed both his 

X number and his practitioner’s 

registration number. GX 5Z, at 4, 6, 8. 

ET told the DI that he was not being 

treated for chronic pain. Tr. 83–84. 

The first two progress notes (one of 

which is undated but which is above the 

note for January 5, 2010 6) indicate a 

diagnosis of chronic pain but not 

substance abuse, the latter not being 

listed as a diagnosis until ET’s third 

visit (Feb. 2, 2010). GX 5Z, at 3, 7. Here 

again, Respondent noted on the chart 

that ET had ‘‘NO’’ pain and the chart 

does not indicate the location of the 

pain, the nature and intensity of the 

pain, current and past treatments for the 

pain, and its effect on his physical and 

psychological functioning. Id. at 3, 5, 7. 

No vital signs were recorded at any of 

ET’s visits. Id. In addition, the chart 

contains no medical history. See 

generally GX 5Z. Respondent 

maintained that his care of ET was 

appropriate. Tr. 503. 

CT 

On June 2, 2010, a DI spoke with CT. 

CT stated that Respondent was treating 

her for opiate addiction with Suboxone. 

Tr. 87–88. On the intake form, CT listed 

her medications as ‘‘Suboxone, 

methadone, and Zanex [sic].’’ GX 5Y, 

at 2. 

At CT’s first visit, Respondent 

diagnosed her as having both substance 

abuse and chronic pain. GX 5Y, at 3. 

However, Respondent did not indicate 

in the chart what substance she was 

abusing. Id. Moreover, Respondent 

indicated that she had ‘‘NO’’ pain. Id. 

Respondent did not indicate a location 

of CT’s pain until the third visit 

(approximately two months later) when 

he noted its location as her ‘‘back,’’ but 

once again checked that she had ‘‘NO’’ 

pain. Id. at 5. While Respondent listed 

a diagnosis of chronic pain at each of 

CT’s four visits, he never checked 

‘‘YES’’ for pain on any of the progress 

notes. Id. at 3, 5. Respondent did not 

document the nature and intensity of 

the pain, current and past treatments for 

the pain, and its effect on CT’s physical 

and psychological functioning. Id. Nor 

did he record vital signs at any of CT’s 

visits. Id. 

In his testimony, Respondent 

admitted that he did not know what 

substance(s) CT was abusing, but added 

that ‘‘usually they’re on multiple 

medicines to get whatever desired effect 

they want.’’ Tr. 729–30. Respondent did 

not obtain any prior treatment records 

for CT, whether for pain or substance 

abuse. Id. at 731. 

Respondent wrote CT prescriptions 

for Suboxone on a pad which contained 

only his X number, as well as on a pad 

which contained both his X number and 

his regular DEA registration number. GX 

5Y, at 4, 6. Respondent believed his 

treatment of CT was within the standard 

of care. Tr. 502. 

JH 

On June 2, 2010, the lead DI spoke 

with JH. JH stated that Respondent was 

treating him for ‘‘a bad addiction to 

Oxycontin’’ with Suboxone and that he 

was not being treated for chronic pain. 

Tr. 89–90; GX 5R. JH listed his 

medications as ‘‘OXY 80 mg x4.’’ GX 5R, 

at 9. According to Respondent, JH was 

taking ‘‘four [Oxycontin] a day for his 

pain,’’ which he was getting off the 

street because ‘‘his doctors fired him.’’ 

Tr. 710. 

At JH’s first visit, Respondent 

diagnosed him as having substance 

abuse, attention deficit disorder and 

chronic pain. GX 5R, at 10. While in his 

testimony, Respondent maintained that 

JH had told him that he needed 

OxyContin ‘‘to get by with his pain,’’ on 

JH’s chart, Respondent indicated that JH 

had ‘‘NO’’ pain and did not document 

a cause of the pain. Id. Moreover, while 

JH saw Respondent multiple times 

thereafter and diagnosed him as having 

chronic pain at each visit, Respondent 

never checked ‘‘YES’’ in the pain entry 

of the progress notes and never 

provided a description and location of 

the pain. See generally GX 5R. 

Moreover, Respondent never recorded 

vital signs for any of JH’s visits. See 

generally id. Nor does JH’s chart include 

a medical history. See generally id. 

Respondent obtained a printout of 

JH’s prescriptions from the State’s 

prescription monitoring program. Id. at 

2–8. While the report showed that JH 

had also obtained Suboxone from 

another physician (Dr. H.), Respondent 

neither obtained JH’s records from 

Dr. H. nor conferred with him. Tr. 711– 

12; GX 5. Respondent wrote JH 

prescriptions for both Suboxone and 

Adderall under his X number. GX 5R, at 

11, 15. However, Respondent required 

JH to undergo a drug test; while this test 

showed that JH was taking Suboxone 

(buprenorphine) and amphetamine 

(Adderall), he also tested positive for 

marijuana use. GX 5R, at 12. 

Respondent believed his care of JH was 

appropriate. Tr. 492. 

KP 

On June 2, 2010, the lead DI spoke 

with KP. KP stated that Respondent was 

prescribing Suboxone to treat her opiate 

addiction and that she was not being 

treated for chronic pain. Tr. 92–94. 

While Respondent testified that KP was 

on a narcotic which she wanted off of, 

KP did not list any medications she was 

on. GX 5W, at 2. Moreover, Respondent 

did not document the name of the 

narcotic in KP’s record. Tr. 499. 

Respondent testified that KP had ‘‘a 

complaint of pain.’’ Id. At KP’s first two 

visits (Dec. 6, 2009 and January 3, 2010), 

Respondent diagnosed her as having 

only chronic pain. GX 5W, at 3. 

However, for both visits, Respondent 

checked ‘‘NO’’ for whether KP had pain 

and did not list a cause or location of 

any such pain. Id. 

Respondent did not make a diagnosis 

of substance abuse until her third visit 

(Jan. 19, 2010); however, none of the 

progress notes for KP’s subsequent visits 

list a diagnosis of substance abuse.7 See 

id. at 5, 7, 9, 11. Moreover, while 

Respondent continued to diagnose KP 

as having chronic pain, he did not check 

‘‘YES’’ for whether she was having pain 

on any of the progress notes. See id. Nor 

did he document the cause, location or 

severity of her pain, or record her vital 

signs, at any of her visits. See id. 

KP stated that she had to pay cash for 

her prescriptions as Respondent would 

not file a claim with Medicare for her. 

Tr. 94. She also stated that the 

Respondent did not perform any 

medical examinations on her, although 

Respondent indicated on the progress 

notes that he had done so and noted that 

the various parts of the examinations 

were normal (by either checking or 

lining through them). Tr. 95, see also GX 

5W, at 3, 5, 9. 

Respondent prescribed Suboxone and 

Xanax for KP on an X prescription pad. 

Id. at 499; see also GX 5W, at 4, 6. 

Respondent believed his treatment of 

KP was within the standard of care. Tr. 

500. 

TB 

On June 10, 2010, the lead DI spoke 

with TB. TB stated that Respondent was 

prescribing Suboxone to him for both 

pain and addiction. Tr. 98–99; GX 5B. 

TB wrote on the intake sheet that he had 

used Suboxone, but Respondent did not 

know who prescribed it, and he 

commented that he could not tell from 

TB’s chart if the Suboxone had been 

prescribed for substance abuse. GX 5B, 

at 1; Tr. 580–81. 

At the first visit (Dec. 20, 2009), 

Respondent diagnosed TB as having 

chronic pain and substance abuse. Tr. 


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8 In the progress note for this visit, Respondent 

indicated that TB had ‘‘NO’’ pain while continuing 

to indicate that he had chronic pain. GX 5B, at 4. 

In his testimony, Respondent explained he ‘‘marked 

off that [TB’s] pain was controlled under the no 

part.’’ Tr. 588. The ALJ did not, however, credit this 

testimony. See ALJ at 21–22. Nor do I. 

9The ALJ noted that the testimony of the lead DI 

and SW conflicted on this point. ALJ at 22 n.3. The 

DI testified that SW told him that Respondent was 

not treating him for chronic pain and had not 

performed a physical examination on him; SW 

testified to the contrary. Compare Tr. 102–03, with 

id. at 348–49. The ALJ found, however, that the DI 

had difficulty recalling the conversation that he had 

with SW and his memory had to be refreshed by 

the use of his notes, id. at 101–102, but that SW’s 

memory required no similar refreshment. Id. at 

345–65. I therefore adopt the ALJ credibility finding 

that SW’s testimony is a more reliable account of 

the conversation that took place between SW and 

the DI. 

10SW testified that he saw Respondent four or 

five times. Tr. 364. However, SW’s patient file 

documents only three visits. 

466. Respondent checked ‘‘YES’’ for 

whether TB had pain and indicated the 

location as the lumbar area. GX 5B, at 

6. While Respondent testified that ‘‘[w]e 

got him to tell us about his back 

problems,’’ if he had undergone any 

surgeries and how ‘‘it affect[ed] his 

everyday activity,’’ Respondent did not 

document the nature and intensity of 

the pain, whether any treatments had 

been previously tried, and the pain’s 

effect on his psychological and physical 

function. Id.; Tr. 578–79. Moreover, 

Respondent did not know if TB’s back 

pain was caused by an injury or a 

degenerative condition. Tr. 578–79. 

The chart indicates that Respondent 

performed an examination at which all 

areas including TB’s back were found to 

be normal. GX 5B, at 6. However, no 

vital signs were recorded. Id. at 6–7. 

Respondent prescribed Suboxone to TB, 

as well as Ambien. Id. While 

Respondent testified that he prescribed 

the Suboxone for TB’s back pain, he 

issued the prescription under his X 

number; he also issued the Ambien 

prescription on the same form. Id. at 7. 

Respondent also saw TB on January 

19, February 16,8 and May 2, 2010. Id. 

at 4–7. At both the January and February 

visits, Respondent prescribed both 

Suboxone and Ambien to TB using his 

X number. Id. at 5, 7; Tr. 466–67, 587– 

88. Respondent did not obtain TB’s 

records from other doctors even though 

TB listed Suboxone as one of his 

medications. Tr. 578–580; GX 5B. When 

asked if he knew the name of the doctor 

who had previously prescribed 

Suboxone to TB, Respondent testified 

‘‘We might have found it out—I just 

didn’t document it * * *. It could be a 

local doctor there.’’ Tr. 581. When asked 

why TB had previously gotten 

Suboxone, Respondent could not 

definitively answer if it had been for 

pain or substance abuse. Id. at 582. With 

respect to the Ambien prescriptions, 

Respondent admitted that he did not 

document an insomnia diagnosis. Id. at 

583. 

SW 

SW’s chart indicates that he was being 

treated for chronic pain and substance 

abuse. While the chart for SW’s first 

visit indicates that he was on Oxy 160 

mg, Respondent checked ‘‘NO’’ for 

whether SW had pain and did not 

document the cause or severity of SW’s 

pain. GX 5J at 3, 5. Respondent did not 

identify a potential source of SW’s pain 

until his third and final visit, when he 

noted that SW had a herniated disc in 

his back and had undergone surgery. Id. 

at 3. 

SW testified at the hearing and the 

ALJ found credible his testimony that he 

had a herniated disc in his back, that he 

had been taking Oxycontin for the pain, 

and that he had begun treatment with 

the Respondent in order to get a 

different pain medication. Tr. 346. The 

ALJ also found credible SW’s testimony 

that he told a DI that Respondent was 

treating him for chronic pain and that 

the Respondent had performed a 

physical examination on him.9

However, the ALJ also found credible 

SW’s subsequent testimony that he had 

told the DI that he was being treated for 

substance abuse because ‘‘it was better 

being on Suboxone than it was 

Oxycontin.’’ Tr. 363. 

Respondent did not know who had 

prescribed Oxycontin to SW, and SW’s 

chart does not contain any prior medical 

records. Tr. 684–85; GX 5J. SW testified 

that he was addicted to his pain 

medications. Tr. 355. Respondent spent 

15 to 20 minutes with SW and 

prescribed Suboxone to him. Id. at 351– 

52; GX 5J. SW testified that he had an 

MRI in 2005 or 2006, and a bone scan 

in 2001 or 2002, but these test results 

were not part of his patient chart in 

evidence. Tr. 346, 349, 353, 357; GX 5J. 

SW saw Respondent three times. See 

GX 5J.10 At the time of the hearing, SW 

was still taking Suboxone, but he was 

not getting it from Respondent. Tr. at 

364–65. Respondent refused to file an 

insurance claim for SW., and required 

that he pay $100 cash for the visits. Id. 

at 102–103. 

CL 

CL first saw Respondent on December 

20, 2009. See GX 22, at 6. Respondent 

made a diagnosis of both chronic pain 

and bipolar disorder; however, 

Respondent did not document the 

nature and intensity of the pain (he did 

not check either ‘‘YES’’ or ‘‘NO’’ for 

whether CL had pain), the history of the 

pain, whether any treatments had been 

previously tried, and the pain’s effect on 

her psychological and physical 

function. Id. While Respondent noted 

that he had performed a physical exam 

and found all areas normal, he did not 

record any vital signs. Id. Respondent 

did not make a substance abuse 

diagnosis at this visit and yet prescribed 

Suboxone to CL under his X number. Id. 

at 7. 

Respondent saw CL again on January 

17, 2010. Id. at 6. At this visit, 

Respondent again diagnosed CL as 

having pain even though he noted that 

she had ‘‘NO’’ pain and made none of 

the findings as explained above. Id. He 

also diagnosed her as having substance 

abuse and required that CL undergo a 

drug screen, the results of which are not 

in her chart. Tr. 127–28, 153–54; GX 22. 

Respondent did not, however, 

document CL’s history of substance 

abuse. GX 22, at 6. Respondent again 

provided CL with a prescription for 

Suboxone. Id. at 7. 

Respondent provided CL with 

prescriptions for Suboxone on February 

14, March 14, April 10, and May 9, 

2010. Id. at 2–3, 5. However, the 

progress notes for both February 14 and 

March 14 contain no information 

besides CL’s name, date of birth and the 

date of the visit. Id. at 4. The progress 

note for April 10 indicates that CL had 

chronic pain even though Respondent 

checked ‘‘NO’’ for her pain and no 

longer listed substance abuse as a 

diagnosis. Id. at 1. Finally, the progress 

note for CL’s last visit (May 9) again lists 

chronic pain as one of three diagnoses 

even though Respondent checked that 

she had ‘‘NO’’ pain. Id. While the notes 

for both the April 10 and May 9 visits 

indicate that CL’s physical exam was 

normal, Respondent did not document 

having taken any vital signs as either 

visit. Id. 

CP 

The earliest progress note for CP is 

dated December 20, 2009, which also 

corresponds with the earliest date listed 

on the record of CP’s Suboxone 

prescriptions. GX 23, at 5, 10. The 

progress note indicates a diagnosis of 

chronic pain, even though Respondent 

checked that CP had ‘‘NO’’ pain and 

contains no other documentation (such 

as the nature and intensity of the pain, 

its history, and its effect on CP’s 

functioning) to support this diagnosis. 

Id. at 5. Respondent also diagnosed CP 

as having substance abuse (with no 

supporting findings) and anxiety. Id. 

While Respondent performed a physical 

exam and found all areas normal, he did 

not document having taken CP’s vital 


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11SJW’s file includes an intake form in which she 

listed her medications as ‘‘Suboxin.’’ GX 5I, at 1. 

signs. Id. Respondent prescribed 

Suboxone and Xanax at this visit using 

his X number. 

At the next visit, Respondent again 

noted that CP had chronic pain while 

indicating that he had ‘‘NO’’ pain. Id. 

Respondent, however, made an entry in 

the blank for ‘‘EXT’’ and for the 

‘‘Location,’’ both of which are illegible. 

Id. Respondent did not, however, note 

a diagnosis of substance abuse at this or 

any subsequent visit. See generally id. at 

1,3,5. 

At CP’s next visit (Feb. 16), 

Respondent again diagnosed him as 

having chronic pain while noting that 

he had ‘‘NO’’ pain. Id. at 3. 

Subsequently, at CP’s April 10 visit, 

Respondent again checked that CP had 

‘‘NO’’ pain while writing ‘‘knee pain’’ in 

the ‘‘Review of Systems’’ section; he 

also made a note next to the ‘‘EXT’’ 

section of the Examination which is 

illegible but was not asked about this 

during his testimony. Id. Finally, at CP’s 

final visit, Respondent again diagnosed 

him as having chronic pain but noted 

that he had ‘‘NO’’ pain and did not 

otherwise document any other findings 

regarding CP’s pain. Id. at 1. Moreover, 

the Government did not offer any 

testimony as to whether it had 

interviewed CP. 

Respondent issued CP prescriptions 

for Suboxone on Dec. 20, 2009, Jan. 17, 

Feb. 16, Mar. 16, April 10, and May 9, 

2010; he also wrote CP prescriptions for 

Xanax on each of these dates except for 

April 10. GX 23. Respondent wrote both 

the Suboxone and Xanax prescriptions 

on Dec. 20, 2009, as well as the Jan. 17, 

Feb. 16, and March 16, under his X 

number. Id. He also wrote the April 10 

Suboxone prescription under his X 

number even though he did not list a 

diagnosis of substance abuse on any of 

CP’s visits after the first visit. Id; Tr. 

130–31. 

CML 

On June 23, 2010, another DI 

interviewed CML and asked whether 

she was ‘‘being treated for pain or 

addiction.’’ Tr. 266–67. CML stated that 

she was being treated for addiction to 

controlled substances and that the 

Respondent was prescribing Suboxone 

to her. Id. at 267–68. She paid $100.00 

cash for her visits. Id. at 268. 

On the progress note for CML’s first 

visit (Dec. 8, 2009), Respondent checked 

that she had both pain and chronic pain, 

as well as insomnia. GX 5F, at 7. While 

Respondent noted that her physical 

exam was normal in all areas, he did not 

record any vital signs and did not 

document the nature and intensity of 

the pain, the history of the pain, 

whether any treatments had been 

previously tried, and the pain’s effect on 

her psychological and physical function 

at any of her subsequent visits. See GX 

5F. Respondent did not document that 

CML had back pain until her sixth and 

final visit (April 27, 2010), while on the 

same note checking that she had ‘‘NO’’ 

pain. Id. at 3. 

Indeed, several of the progress notes 

for CML’s visits contain no medical 

information whatsoever. With respect to 

this, Respondent testified, ‘‘In fact, 

there’s some entries I didn’t even put in 

on February and March of 2010 and I 

don’t know why that’s the case.’’ Tr. 

472. 

At CML’s second visit, Respondent 

noted a diagnosis of substance abuse. 

GX 5F, at 7. However, Respondent did 

not note this diagnosis at any of CML’s 

subsequent visits. See GX 5F. Moreover, 

the chart contains no information about 

what substances CML was abusing and 

her history of substance abuse. GX 5F, 

at 7; Tr. 666. 

Respondent admitted that the chart 

fails to adequately document CML’s 

pain. Tr. 472. Respondent also testified 

that he was tapering CML’s dosages of 

Suboxone to find the appropriate levels 

to treat her chronic pain. Id. at 473. 

Respondent maintained that his care of 

CML was within the standard of care. 

Id. Respondent prescribed Suboxone 

(and Ambien at the first visit) to CML 

under his X number at several of the 

visits even though he did not document 

that he was treating her for substance 

abuse at those visits. See GX 5F. 

SJW 

On December 29, 2009, SJW made her 

initial visit to Respondent.11 GX 5I, at 7. 

At the visit, Respondent diagnosed SJW 

as having both chronic pain and 

substance abuse, although he noted that 

she had ‘‘NO’’ pain and did not 

document the nature and intensity of 

the pain, the history of the pain, 

whether any treatments had been 

previously tried, and the pain’s effect on 

her psychological and physical function 

at this or any of her subsequent visits. 

Id. While Respondent indicated that all 

areas of her physical examination were 

normal, he did not record any vital signs 

at this visit. Id. Nor did Respondent 

make any notes regarding SJW’s history 

of substance abuse. There is, however, 

no evidence that Respondent prescribed 

to SJW at this visit. 

Respondent did, however, prescribe 

Suboxone (and Xanax) to SJW at her 

second visit, which occurred one week 

later. Id. at 7–8. On the progress note for 

this visit, Respondent listed the 

diagnoses as chronic pain (while 

indicating that she had ‘‘NO’’ pain and 

failing to document any other 

information regarding her condition) 

and substance abuse, again without any 

documentation. Id. at 7. Moreover, he 

again documented that SJW’s physical 

exam was normal but did not record any 

vital signs. Id. Nor did Respondent 

document that SJW had anxiety, the 

condition for which Xanax is typically 

prescribed, and, in fact, Respondent 

indicated ‘‘NO’’ for whether she was 

agitated/moody. Id. 

While SJW’s chart shows that she 

received prescriptions for Suboxone 

(and Xanax) in February and March, the 

progress notes for this period contain no 

information regarding her medical 

condition(s). Id. at 2,—5–6. Regarding 

these incidents, Respondent stated: ‘‘I 

don’t have an explanation for it unless 

I had to zip over and take care of 

another patient and I just took care of 

her and then took off. I don’t know the 

situation.’’ Tr. 681. 

On May 9, 2010, SJW made her final 

visit to Respondent. GX 5I, at 3. At this 

visit, Respondent again diagnosed her as 

having chronic pain while indicating 

that she had ‘‘NO’’ pain and that her 

physical examination was normal in all 

areas. Id. at 3. Respondent also 

diagnosed her as having anxiety, even 

though he indicated ‘‘NO’’ for whether 

she was agitated or moody. Id. 

Respondent issued her prescriptions for 

both Suboxone and Xanax. Id. at 4. 

On June 23, 2010, a DI phoned SJW 

and interviewed her. SJW told the DI 

that Respondent was treating her for her 

addiction to controlled substances and 

that she paid $100 cash for each visit. 

Tr. 268–69. On two occasions (Jan. 5 

and Feb. 2), Respondent prescribed both 

Suboxone and Xanax to SJW under his 

X number. Tr. 269; GX 5I, at 6, 8. 

Respondent testified that he was 

treating SJW for pain and anxiety. Tr. 

477, 679. 

As for how he made his diagnosis of 

substance abuse, Respondent testified 

that ‘‘[i]t could be in her history with 

me; it could be a drug screen.’’ Id. at 

679. There is, however, no evidence in 

SJW’s chart establishing that 

Respondent took a history or that he 

required her to undergo a drug screen. 

See generally GX 5I. Moreover, when 

asked ‘‘do we see an indication that 

[SJW] complained of pain?,’’ 

Respondent answered: ‘‘No. I did not fill 

that out.’’ TR. at 679–80. As for 

Respondent’s failure to note why he 

prescribed Xanax, Respondent testified: 

‘‘No, I did not put an anxiety there. And 

there was a good chance that she was on 

Xanax already. Did not give it to her in 

the December because she probably 


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12The ALJ found credible Respondent’s 

testimony that he had also diagnosed MR with 

bipolar disorder, but that he had failed to annotate 

that in the patient’s chart as well. Tr. 474. 

13Respondent also diagnosed SHY as having 

major depression. 

already had an active prescription for it. 

And we probably got that from the drug 

monitoring system.’’ Id. at 680. 

Respondent believed his treatment of 

SJW was appropriate, but that his 

documentation was ‘‘terrible.’’ Tr. 478. 

LMJ 

On her intake form, LMJ listed her 

medications as ‘‘Loricets’’ [sic]. GX 5E. 

At her first visit (Feb. 16, 2010), 

Respondent made diagnoses of both 

chronic pain and substance abuse. Id. at 

4. However, Respondent noted that LMJ 

had ‘‘NO’’ pain, that her physical 

examination was normal and did not 

document the nature and intensity of 

the pain, the history of the pain, 

whether any treatments had been 

previously tried, and the pain’s effect on 

her psychological and physical function 

at this visit or her next two visits. Id. at 

2 & 4. Respondent did not note a 

location of any pain LMJ had until her 

final visit; even then, however, he did 

not document any information other 

than that the pain was in her ‘‘back & 

arms.’’ Id. at 2. Respondent did not 

document having taken LMJ’s vital signs 

at any of her visits. Id. at 2, 4. Moreover, 

while at LMJ’s first three visits, 

Respondent listed a diagnosis of 

substance abuse, the chart contains no 

information as to her history of 

substance abuse. Id. at 2, 4. At each of 

LMJ’s visits, Respondent prescribed 

Suboxone to her. Id. at 3, 5. 

On June 24, 2010, a DI interviewed 

LMJ by phone. Tr. 270. The DI asked 

LMJ whether she was seeing 

Respondent for pain or for addiction to 

controlled substances; LMJ said that she 

was seeing Respondent for addiction for 

which he was prescribing Suboxone. Id. 

LMJ also stated that she paid $100.00 

cash for each visit. Id. 

The ALJ found that Respondent 

credibly testified that he did not ‘‘have 

a good grasp on her history and physical 

as to, is this chronic pain or substance 

abuse, so we put the differential as both 

of these right now.’’ Id. at 470. She also 

found credible Respondent’s testimony 

that LMJ was a patient ‘‘who wanted to 

get off Lorcet because she was building 

such a tolerance having to take more 

and more of this for her pain, but I 

could not totally rule out that she had 

a substance abuse problem.’’ Id. at 471. 

While Respondent testified that he 

could sometimes rule out a substance 

abuse diagnosis ‘‘later on as [I] get a 

grasp on these patients, and periodic 

random drug screens help me with this 

also,’’ there is no evidence that 

Respondent required LMJ to undergo a 

drug test. Id. Respondent thought his 

treatment of LMJ was within the 

standard of care. Id. 

MR 

MR first saw Respondent on 

December 15, 2009. GX 5G, at 7. 

Respondent diagnosed MR as having 

chronic pain even though he noted that 

MR had ‘‘NO’’ pain. Id. Respondent 

documented the pain’s location as MR’s 

‘‘Teeth’’ and prescribed Suboxone to 

him. Id. at 7–8. Respondent testified 

that MR’s pain was in his mouth and 

jaw, but the chart does not contain any 

other information regarding this 

condition. Tr. 474, 668; GX 5G. 

Moreover, Respondent continued to list 

a diagnosis of chronic pain at MR’s 

visits of Jan. 17, Feb. 14, and Mar. 30, 

even though on the respective progress 

notes, he checked ‘‘NO’’ for whether MR 

had pain, did not list a location of the 

pain, noted that the physical exam was 

normal in all areas, and did not 

document having taken any vital signs 

Id. at 5, 7. Nor is there any evidence that 

Respondent referred MR to a dentist. 

On both the January 17 and March 30 

progress notes, Respondent also listed a 

diagnosis of substance abuse. Id. at 5, 7. 

However, Respondent did not document 

the basis for his diagnosis. Id. At MR’s 

final visit, Respondent no longer listed 

a diagnosis of substance abuse. 

However, he now documented that MR 

had right shoulder pain as the result of 

a motor vehicle accident. Id. at 3; Tr. 

671. Respondent testified that MR had 

gone to the emergency room, but that he 

had not obtained those records. Tr. 671. 

When asked whether MR’s tooth pain 

‘‘was no longer an issue in the 

subsequent visits’’; Respondent 

maintained that ‘‘I just didn’t enter it.’’ 

Id. at 672. As for the diagnosis of 

substance abuse, Respondent did not 

note in MR’s chart the substances he 

abused, and Respondent could not 

remember during his testimony.12 Id. at 

668–69; GX 5G. 

On June 24, 2010, a DI phoned MR 

and interviewed him. Id. at 271. The DI 

asked MR whether he was seeing 

Respondent for chronic pain or for 

addiction; MR stated that ‘‘he was 

addicted.’’ Id. at 271–72. MR also said 

that he paid $100.00 cash for each visit. 

Id. at 272. MR was treated with 

Suboxone, which was written on an X 

prescription pad. Tr. 474; GX 5G, at 6, 

8. Respondent believed his treatment of 

MR was appropriate. Tr. 475. 

SHY 

SHY first saw Respondent on 

December 13, 2009. GX 5D, at 8. On the 

intake form, SHY listed his medications 

as Suboxone and Zyprexa. Id. at 1. 

Respondent diagnosed SHY as having 

chronic pain even though he circled 

‘‘NO’’ for whether SHY had pain, did 

not note the location of the pain, and 

did a physical examination during 

which he found all areas normal. Id. at 

8. Moreover, Respondent did not 

document a history of the pain, whether 

any treatments had been previously 

tried, and the pain’s effect on his 

psychological and physical function at 

this visit. Id. Respondent also did not 

document having taken SHY’s vital 

signs.13 Id. 

At SHY’s subsequent visits, 

Respondent continued to document that 

SHY had chronic pain even though he 

repeatedly noted that he had ‘‘NO’’ 

pain, never found anything that was not 

normal during the physical exams, and 

never listed a location of any pain. Id. 

at 4, 6. Respondent also noted a 

diagnosis of substance abuse on two 

separate occasions, but did not 

document SHY’s history of substance 

abuse and what substances he was 

abusing. Id. He did, however, require 

SHY to undergo a drug screen at the first 

visit, the results of which were negative 

with the exception of the test for 

synthetic opioids, which was consistent 

with SHY having indicated that his 

medications included Suboxone. Id. at 

1, 10–11. 

On June 22, 2010, a DI called SHY, 

and asked him why he was seeing 

Respondent. Tr. 288. SHY said that he 

was being treated for opiate addiction 

and that he was not being treated for 

chronic pain. Id. at 288–89. 

At the hearing, Respondent testified 

that he thought SHY was probably 

abusing either Lorcet or Oxycontin. Id. 

at 659. However, he then admitted that 

he did not document this. Id. 

Respondent then claimed that SHY 

‘‘probably had a little marijuana or 

something like that in a drug screen, 

and that’s where we probably gave him 

a substance abuse diagnosis.’’ Id. at 660. 

SHY did not, however, test positive for 

THC. See GX 5D, at 10–11. Respondent 

also admitted that he ‘‘did not 

document * * * any details of the 

pain,’’ but then stated that ‘‘[a] lot of 

these people with major depression 

have pain from the depression, but we 

still put a diagnosis of potential chronic 

pain.’’ Id. at 468, see also id. at 655–56. 

Respondent acknowledged that he 

inappropriately prescribed other 

medications than Suboxone using his X 

number to SHY. Id. at 468. Respondent 

believed his care of SHY was within the 

standard of care. Id. 469–70. 


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JC2 

Respondent treated JC2 for chronic 

pain, substance abuse, attention deficit 

disorder, and extreme anxiety. Tr. 458; 

GX 5C. Respondent acknowledged that 

JC2 was ‘‘a tough patient,’’ who had 

been ‘‘fired’’ by other doctors and had 

abused Xanax. Tr. 458–60. A note in 

JC2’s chart dated ‘‘9–1–09’’ indicates 

that a friend of JC2 had stated that he 

was taking twelve Xanax pills at a time. 

GX 5C, at 3. 

Respondent noted in the chart that 

JC2 was abusing Xanax and ‘‘MUST 

STOP XANAX.’’ Id. at 2, 12; see also Tr. 

459–60, 628. In his testimony, 

Respondent stated that his treatment 

plan was to gradually taper JC2 off 

Xanax, which could take up to a year, 

or to manage JC2’s intake. Tr. 460–62, 

630. The chart also notes that in 

November 2009, JC2 missed two 

appointments and was jailed for 

distribution. GX 5C, at 8. The chart also 

again notes ‘‘Reported taking [greater 

than] #12 Xanax @ a time.’’ Id. 

Respondent also testified that he knew 

‘‘for a fact in this young man’s history 

[that] he has been jailed before’’ for 

‘‘doing things [that were] 

inappropriate.’’ Tr. 631. 

The ALJ found that Respondent 

credibly testified that he could not just 

cease prescribing Xanax to JC2 because 

he could have seizures. Id. at 460–61. 

However, the patient file shows that 

notwithstanding Respondent’s 

testimony that he planned to taper JC2 

off of Xanax, he actually increased the 

daily doses of the prescriptions. 

Compare GX 5C, at 11 (Aug. 30, 2009 

RX for 30 tablets of Xanax 1.0 mg, c BID 

(for daily dose of 1 mg)), with id. at 10 

(Oct. 25, 2009 RX for 90 tablet of Xanax 

1.0 mg., 1 TID (for daily dose of 3 mg)), 

with id. at 5 (Apr. 17, 2010 RX for 60 

tablets of Xanax 2.0 mg, 1q12, with 2 

refills (for daily dose of 4 mg)). The 

chart also demonstrates that Respondent 

wrote multiple Xanax and Suboxone 

prescriptions under his X number prior 

to February 28, 2010. GX 5C, at 7, 9–11, 

13. Respondent testified that he 

conducted drug screens on JC2, but the 

results of these tests were not in JC2’s 

medical record. Tr. 633–34. 

Respondent testified that he 

prescribed Suboxone to treat JC2’s 

substance abuse and that substance 

abuse was JC2’s primary diagnosis. Id. at 

643, 645. Moreover, a note for a visit of 

April 5, 2009, states ‘‘Desires To Get 

OFF Narcotics.’’ GX 5C, at 15. 

Respondent also testified that JC2 was 

being seen for chronic pain caused by a 

football injury when he was a teenager, 

but he then admitted that JC2’s chart 

does not document the source or 

severity of that pain. Tr. 654–55. Nor 

did Respondent document the history of 

the pain, any prior treatments for it and 

its effect on JC2’s functioning. See GX 

5C. Respondent maintained, however, 

that he knew JC2’s history and ‘‘that 

he’s had a lot of problems.’’ Tr. 655. 

Respondent also testified that JC2 had 

been in a narcotic treatment program in 

2007 or 2008 and had left against 

medical advice. Id. at 631–632. Yet 

Respondent did not document this in 

JC2’s chart and did not obtain his 

treatment records from the narcotic 

treatment facility. GX 5C. Respondent 

believed he treated JC2 within the 

standard of care. Tr. 461. 

DA 

DA saw Respondent three times: in 

December 2009, and in January and 

February of 2010. GX 5K. According to 

the progress note for the first visit, 

Respondent diagnosed DA with chronic 

pain and anxiety. Id. at 3. Respondent 

circled ‘‘YES’’ for whether DA had pain 

and noted that the location was his back 

and both legs. Id. Respondent did not, 

however, document the nature and 

intensity of the pain, its history, 

whether any treatments had been 

previously tried, and the pain’s effect on 

his psychological and physical function 

at either this visit or his next visit. Id. 

at 3. Moreover, the progress notes for 

DA’s first two visits (there is no note for 

a third visit on Feb. 21, 2010, even 

though there is a prescription for this 

date), indicate that Respondent 

performed a physical examination and 

found all areas normal. Id. Respondent 

did not document DA’s vital signs for 

either visit. Id. Respondent also noted a 

diagnosis of substance abuse at DA’s 

second visit but did not document the 

basis for this diagnosis. Id. Respondent 

issued DA prescriptions for both 

Suboxone and Xanax at all three visits, 

including on the second visit when he 

noted that DA had ‘‘NO’’ pain; on each 

occasion, Respondent issued the 

prescriptions under his X number. Id. at 

4–5. 

On June 1, 2010, the lead DI 

interviewed DA by phone. Tr. 85. DA 

told the DI that he was addicted to pain 

killers and that Respondent was treating 

him for this condition and not for 

chronic pain. Id. at 85–87. In his 

testimony, Respondent admitted that he 

did not get DA’s medical records for his 

pain condition but maintained that he 

was familiar with this patient from 

treating him in the emergency 

department of the Red Bay Hospital. Tr. 

693; see generally GX 5K. Respondent 

believed that his care was appropriate 

for DA. Tr. 482. 

AH 

Respondent saw AH four times 

beginning on December 13, 2009, and 

ending on March 28, 2010. GX 5S. 

Respondent noted that AH was taking 

12 Lortab 10 mg a day, which she was 

getting ‘‘from doctors, friends, [and] off 

the street.’’ Tr. 493. Respondent 

diagnosed AH with both substance 

abuse and chronic pain as a secondary 

diagnosis. GX 5S, at 3. While 

Respondent noted ‘‘YES’’ for whether 

AH had pain, he did not document the 

nature, intensity and location of the 

pain; the history of the pain; what 

treatments had been used; and the 

pain’s effect on her physical and 

psychological functioning. Id. at 3. 

Respondent also noted that AH was 

undergoing withdrawal, was agitated/ 

moody, had insomnia and a positive 

MDQ. Id. AH’s physical exam was 

normal and Respondent did not 

document having taken her vital signs. 

Id. At this visit, Respondent prescribed 

Suboxone to her under his X number. 

GX 5S, at 4. 

At AH’s second visit (Feb. 1), 

Respondent noted that she had ‘‘NO’’ 

pain and did not make any other 

findings about her pain; he also 

indicated that she did not demonstrate 

withdrawal, that she was not agitated or 

moody and did not have insomnia or a 

positive MDQ. GX 5S, at 7. Respondent 

did not note any abnormalities in the 

physical exam and did not document 

having taken AH’s vital signs. Id. 

Respondent noted his diagnosis as 

Suboxone 16 mg. and gave AH a 

prescription for Suboxone which he 

wrote under his X number. Id. at 8. 

On Feb. 28, Respondent issued AH a 

third prescription for Suboxone, again 

using his X number. Id. at 8. The 

progress note for this visit, however, 

lists AH’s name, date of birth and a visit 

date but contains no medical 

information. Id. at 7. 

On March 28, AH again saw 

Respondent. Id. at 5. At this visit, 

Respondent circled ‘‘YES’’ for whether 

she had pain and noted its location as 

her neck and back. Id. Once again, he 

did not document the nature and 

intensity of the pain, the history of the 

pain, what treatments had been used, 

and the pain’s effect on her physical and 

psychological functioning. Id. Again, 

Respondent performed a physical exam 

but found no abnormalities; he also did 

not document having taken AH’s vital 

signs. Id. Respondent made diagnoses of 

both chronic pain and substance abuse. 

Id. Respondent issued AH a new 

prescription for Suboxone, which was 

written on a prescription form that 

contained both of his numbers. Id. at 6. 


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14 DH’s previous visit was on August 4, 2010. RX 

31, at 30. 

Respondent testified that AH had 

some neck and back pain, but ‘‘appeared 

to be functional.’’ Tr. 493. He was also 

‘‘not convinced that [he] could not add 

the substance abuse potential to her.’’ 

Id. Respondent stated that his treatment 

of AH was within the standard of care. 

Id. at 494. 

NK 

NK saw Respondent three times 

during February and March 2010. GX 

5U. On the intake form, NK listed his 

medications as Suboxone and Xanax. Id. 

at 2. On the progress note for NK’s first 

visit, Respondent noted that he had 

‘‘NO’’ pain and did not indicate a 

location for any pain. Id. at 3. 

Respondent noted that he had 

performed a physical examination, but 

found no abnormalities; Respondent 

also did not document having taken 

NK’s vital signs. Id. Respondent 

nonetheless diagnosed NK as having 

both chronic pain and anxiety (but not 

substance abuse) and gave him 

prescriptions for Suboxone and Xanax, 

both of which were written under his X 

number. Id. at 5. 

On March 9, Respondent issued NK a 

second prescription for Suboxone, and 

on March 21, he issued NK 

prescriptions for both Suboxone and 

Xanax. Id. at 4–5. However, the progress 

note dated Mar. 9 contains no medical 

information and there is no note for 

Mar. 21. See generally GX 5U. 

On May 25, 2010, the lead DI 

interviewed NK. Tr. 78. NK stated that 

Respondent was treating him for opiate 

addiction, and not for any other medical 

problem including chronic pain. Id. at 

79. NK also told the DI that he was no 

longer seeing Respondent and that ‘‘he 

would kick the habit himself.’’ Id. at 78. 

NK’s chart also contains a prescription 

for Suboxone dated April 17, 2010, even 

though NK did not see Respondent on 

that date. GX 5U, at 6. Respondent 

explained that he had prepared the 

prescription in advance of NK’s visit, 

but that ‘‘no one gets that prescription 

unless I hand it to them.’’ Tr. 497. 

Respondent’s Post-Suspension Conduct 

On September 27, 2010, Respondent 

was personally served with the Order to 

Show Cause and Immediate Suspension 

of Registration. At that time, the lead DI 

explained to Respondent that, as of that 

date, he was no longer authorized to 

prescribe or handle any controlled 

substances. Tr. 112–13. Respondent told 

the DI that ‘‘he was not going to abide 

by this order and that (the DI) didn’t 

have the authority to tell him that he 

couldn’t prescribe any controlled 

substances.’’ Id. at 113. 

Thereafter, the lead DI discovered that 

Respondent had issued controlledsubstance prescriptions which were 

dated September 29, October 3 and 

October 4, 2010. Tr. 114; GX 6. While 

the ALJ found that there were a total of 

four post-suspension prescriptions, two 

of the prescription forms contained 

prescriptions for two controlled 

substances. ALJ at 34; but see GX 6, at 

3–4. 

The first prescription, which was 

issued to CW and dated September 29, 

2010, was for the drug Adderall, a 

schedule II controlled substance. GX 6, 

at 1. CW told the lead DI that 

Respondent wrote the prescription after 

she had been seen by Respondent’s 

Physician’s Assistant, CC. CW picked 

up the prescription the next day, 

September 30. Tr. 115–118; GX 6, at 1. 

Respondent admitted to signing this 

prescription. Tr. 506–07; see also RX 29, 

at 17–19 (CW’s chart for Sept. 29, 2010 

visit). 

The second prescription, which was 

issued to JB and dated October 3, 2010, 

was also for Adderall. Tr. 118–19, 200– 

01; GX 6, at 2. However, the evidence 

showed that Respondent had issued the 

prescription on September 3, 2010. Tr. 

119–20, 508, 733–34. This prescription 

did not, however, include Respondent’s 

registration number and listed only his 

X number. GX 6, at 2. 

The lead DI contacted the pharmacist 

who filled the prescription, and was 

told that the pharmacy would not accept 

a post-dated prescription for a 

scheduled drug. Tr. 123. The pharmacist 

remembered this prescription and 

further stated that it had actually been 

presented for filling on October 3, 2010. 

Tr. 123–24, 158–59. The lead DI 

testified that while it would have been 

permissible to write a prescription and 

sign it on September 3, 2010, with the 

annotation of ‘‘do not fill until October 

3, 2010,’’ it was not permissible for 

Respondent to sign a schedule II 

prescription on September 3 but date 

the prescription for October 3rd. Tr. 

124. 

The evidence also included two 

prescriptions issued (on a single 

prescription form) to MK and dated 

October 4, 2010; the prescriptions were 

for 60 Adderall and 90 Lortab 10 mg, 

another schedule III narcotic. GX 6, at 

3. The lead DI contacted MK about the 

prescriptions; MK confirmed that the 

prescriptions were written and received 

on October 4, 2010. Tr. 124–25. While 

Respondent testified that the 

prescriptions had been post-dated, he 

admitted to having written the 

prescriptions on September 29, two 

days after he was served with the 

Immediate Suspension Order. Tr. 508– 

09; 740–41. Respondent maintained that 

the prescription was given to MK by 

mistake. Id. at 741. MK’s patient file 

includes a progress note which 

establishes that she saw Respondent on 

September 29, 2010. RX 32, at 28. 

Notwithstanding the testimony 

regarding MK’s statement as to the date 

the prescriptions were written, I find 

that the prescriptions were written on 

September 29. 

The evidence also included two 

prescriptions which were issued to DH 

and also dated October 4, 2010. GX 6, 

at 4. The prescriptions were for 90 

Lortab 10 mg and 90 Xanax 1 mg. Tr. 

126, 509; GX 6, at 4. 

Respondent testified that he thought 

that he had seen DH in September but 

that he did not know ‘‘exactly which 

day I saw him.’’ Tr. 509. Respondent 

admitted, however, that the prescription 

was in his handwriting and that he 

‘‘signed it.’’ Continuing, he maintained 

that he did not have an explanation for 

it, that ‘‘[t]his was an accident,’’ and 

that he ‘‘would never do anything to 

violate an order.’’ Id. at 509. 

According to DH’s patient file, DH 

saw Respondent on September 29, 

2010.14 RX 31, at 28. The chart for the 

visit noted that DH was ‘‘Here for med 

refills’’ and that he was ‘‘here for Dr. 

Cochran,’’ and that his ‘‘Current Meds’’ 

were Lortab and Xanax. Id. In addition, 

Respondent signed the chart. Id. I 

therefore find that Respondent wrote the 

prescriptions on September 29. 

Respondent’s Testimony 

Respondent maintained that some of 

the patients did not know what they 

were being treated for. Tr. 743–44. 

However, Respondent did not document 

any patient’s lack of understanding of 

his diagnosis in the patient files. Tr. 

745. Moreover, the ALJ did not find this 

testimony credible. ALJ at 49. 

As noted above, Respondent provided 

evidence that he had stopped 

prescribing methadone to his patients. 

Moreover, Respondent established that 

he had stopped using his X number to 

write prescriptions for drugs other than 

Suboxone and when prescribing 

Suboxone to treat pain. However, on 

September 3, 2010, Respondent wrote a 

further controlled substance 

prescription for Adderall (which was 

post-dated) under his X number. GX 6, 

at 2. 

Respondent also testified that he 

maintained the drugs screens he ordered 

on his patients in a separate file which 

he called the ‘‘Drug Screen Book.’’ Tr. 

687. Respondent testified that when the 


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15An applicant for registration under this 

provision must meet three requirements: (1) The 

applicant must be ‘‘determined by the Secretary [of 

HHS] to be qualified * * * to engage in the 

treatment with respect to which registration is 

sought; (2) the Attorney General must ‘‘determine[] 

that the applicant will comply with standards 

* * * respecting (i) security of stocks of narcotic 

drugs for such treatment, and (ii) the maintenance 

of records * * *. on such drugs,’’ and (3) ‘‘if the 

Secretary determines that the applicant will comply 

with standards * * * respecting the quantities of 

narcotic drugs which may be provided for 

unsupervised use by individuals in such 

treatment.’’ 21 U.S.C. 823(g)(1). 

DIs obtained the patient files, they did 

not take the Drug Screen Book.’’ Id. 

Respondent did not, however, submit 

the Drug Screen Book for the record. 

Respondent agreed that his patient 

charts were incomplete. Tr. 452. In one 

case Respondent testified that his record 

keeping was incorrect and he had 

mistakenly written the wrong primary 

diagnosis for the patient. Id. at 654. 

Respondent, however, offered no 

evidence that he was prepared to 

comply with the Alabama Board’s 

Guidelines For The Use Of Controlled 

Substances For The Treatment Of Pain. 

See Ala. Admin Code r.540–x–4–.08. 

Discussion 

Section 304(a) of the Controlled 

Substances Act provides that a 

‘‘registration pursuant to section 823 of 

this title 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 

his registration under section 823 of this 

title inconsistent with the public 

interest as determined under such 

section.’’ 21 U.S.C. 824(a)(4). In 

determining the public interest, 

Congress directed that the following 

factors be considered: 

(1) The recommendation of the 

appropriate State licensing board or 

professional disciplinary authority. 

(2) The applicant’s experience in 

dispensing * * * controlled substances. 

(3) The applicant’s conviction record 

under Federal or State laws relating to 

the manufacture, distribution, or 

dispensing of controlled substances. 

(4) Compliance with applicable State, 

Federal, or local laws relating to 

controlled substances. 

(5) Such other conduct which may 

threaten the public health and safety. 

21 U.S.C. 823(f). In addition, pursuant 

to 21 U.S.C. 824(d), ‘‘[t]he Attorney 

General may, in his discretion, suspend 

any registration simultaneously with the 

institution of proceedings under this 

section, in cases where he finds that 

there is an imminent danger to public 

health or safety.’’ 

The public interest factors are 

considered in the disjunctive. Robert A. 

Leslie, 68 FR 15227, 15230 (2003). I may 

rely on any one or a combination of 

factors and may give each factor the 

weight I deem appropriate in 

determining whether to revoke an 

existing registration or to deny an 

application for a registration. Id. 

Moreover, I am ‘‘not required to make 

findings as to all of the factors.’’ Hoxie 

v. DEA, 419 F.3d 477, 482 (6th Cir. 

2005); see also Morall v. DEA, 412 F.3d 

165, 173–74 (DC Cir. 2005). 

The Government has ‘‘the burden of 

proving that the requirements for * * * 

revocation or suspension pursuant to 

section 304(a) * * * are satisfied.’’ 21 

CFR 1301.44(e); see also 21 CFR 

1301.44(d) (Government has ‘‘the 

burden of proving that the requirements 

for [a] registration pursuant to section 

303 * * * are not satisfied’’). However, 

where the Government satisfies its 

prima facie burden, the burden then 

shifts to the registrant to demonstrate 

why he can be entrusted with a new 

registration. Medicine ShoppeJonesborough, 73 FR 364, 380 (2008). 

Having considered all of the factors, I 

conclude that the Government’s 

evidence pertinent to factors two 

(Respondent’s experience in dispensing 

controlled substances) and four 

(Respondent’s compliance with 

applicable laws related to controlled 

substances), establishes that Respondent 

has committed acts which render his 

registration ‘‘inconsistent with the 

public interest.’’ 21 U.S.C. 824(a)(4). I 

further conclude that Respondent has 

not rebutted the Government’s prima 

facie case. 

Factors One and Three—The 

Recommendation of the State Board 

and Respondent’s Record of 

Convictions Under Laws Relating to the 

Manufacture, Distribution and 

Dispensing of Controlled Substances 

The record establishes that the State 

Board has an open investigation of 

Respondent. However, the Board has 

not made a recommendation in this 

matter, and it is undisputed that 

Respondent’s medical license remains 

active and unrestricted. Accordingly, 

this factor does not support a finding 

either for, or against, the continuation of 

Respondent’s registration. See Joseph 

Gaudio, 74 FR 10083, 10090 n.25 

(2009); Mortimer B. Levin, 55 FR 8209, 

8210 (1990). 

There is also no evidence in the 

record that Respondent has been 

convicted of an offense related to the 

manufacture, distribution or dispensing 

of controlled substances. While this 

factor supports the continuation of 

Respondent’s registration, DEA has long 

held that this factor is not dispositive. 

See, e.g., Edmund Chein, 72 FR 6580, 

6593 n.22 (2007). 

Factors Two and Four—Respondent’s 

Experience in Dispensing Controlled 

Substances and Compliance With 

Applicable Laws Related to Controlled 

Substances 

The record establishes that 

Respondent violated numerous 

provisions of Federal law and DEA 

regulations. These include: (1) The 

prescribing of methadone for substance 

abuse treatment without being 

registered to do so under 21 U.S.C. 

823(g)(1), in violation of 21 U.S.C. 

841(a)(1); (2) the prescribing of 

methadone for substance abuse 

treatment, in violation of 21 CFR 

1306.04(c) and 1306.07; (3) prescribing 

controlled substances without a 

legitimate medical purpose, in violation 

of 21 CFR 1306.04(a); (4) the post-dating 

of prescriptions, in violation of 21 CFR 

1306.05(a); and (5) prescribing 

controlled substances when his 

registration had been suspended, in 

violation of 21 U.S.C. 843(a)(2). 

The Methadone Prescriptions 

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

‘‘practitioners who dispense narcotic 

drugs to individuals for maintenance 

treatment or detoxification treatment 

shall obtain annually a separate 

registration [from their practitioner’s 

registration] for that purpose.’’15 In the 

Drug Addiction Treatment Act of 2000, 

Congress provided that the requirement 

to obtain a separate registration is 

‘‘waived in the case of the dispensing 

(including the prescribing), by a 

practitioner, of narcotic drugs in 

schedule III, IV, or V or combinations of 

such drugs if the practitioner meets the 

conditions specified in [section 

823(g)(2)(B)] and the narcotic drugs or 

combinations of such drugs meet the 

conditions specified in [section 

823(g)(2)(C)].’’ Id. § 823(g)(2)(A) 

(emphasis added). 

Methadone is, however, a schedule II 

narcotic, and thus, except for where a 

patient presents with acute withdrawal 

symptoms (and then for no more than a 

total of three days), cannot be lawfully 

dispensed for the purpose of 

maintenance or detoxification treatment 

absent the practitioner’s holding a 

registration under section 823(g)(1). See 

21 U.S.C. 812(c) (Schedule II (b)(11)); 21 

CFR 1308.12(c)(15). Moreover, under 

DEA’s regulations, ‘‘[a] prescription may 

not be issued for ‘detoxification 

treatment’ or ‘maintenance treatment,’ 

unless the prescription is for a Schedule 

III, IV, or V narcotic drug approved by 

the Food and Drug Administration 


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16See also 21 CFR 1306.07(d) (‘‘A practitioner 

may administer or dispense (including prescribe) 

any Schedule III, IV, or V narcotic drug approved 

specifically by the Food and Drug Administration 

specifically for use in maintenance or detoxification 

treatment to a drug dependent person if the 

practitioner complies with the requirements of [21 

CFR 1301.28].’’ 21 CFR 1301.28 is the provision 

which implements the DATA Waiver Act. 

17The CSA also defines the term ‘‘detoxification 

treatment.’’ 21 U.S.C. 802(30). The term ‘‘means the 

dispensing, for a period not in excess of one 

hundred and eighty days, of a narcotic drug in 

decreasing doses to an individual in order to 

alleviate adverse physiological or psychological 

effects incident to withdrawal from the continuous 

or sustained use of a narcotic drug and as a method 

of bringing the individual to a narcotic drug-free 

state within such period.’’ Id. 

18See also Ala. Admin. Code r. 540–X–4.08(2)(b) 

(‘‘The written treatment plan should state objectives 

that will be used to determine treatment success, 

such as pain relief and improved physical and 

psychosocial function, and should indicate if any 

further diagnostic evaluations or other treatments 

are planned.’’). 

The Guidelines also provide that: 

The physician should keep accurate and 

complete records to include 

1. The medical history and physical examination; 

2. Diagnostic, therapeutic and laboratory results; 

3. Evaluations and consultations; 

4. Treatment objectives; 

5. Discussion of risks and benefits; 

6. Treatments; 

7. Medications (including date, type, dosage and 

quantity prescribed); 

8. Instructions and agreements; 

9. Periodic reviews. 

Id. 2(f). 

specifically for use in maintenance or 

detoxification treatment.’’ 21 CFR 

1306.04(c).16 See also id. 1306.07(a) (‘‘A 

practitioner may administer or dispense 

directly (but not prescribe) a narcotic 

drug listed in any schedule * * * for 

the purpose of maintenance or 

detoxification treatment if the 

practitioner * * * is separately 

registered with DEA as a narcotic 

treatment program [and] is in 

compliance with DEA regulations 

regarding treatment qualifications, 

security, records, and unsupervised use 

of the drugs pursuant to the [CSA].’’) 

(emphasis added); id. 1306.07(b) 

(‘‘Nothing in this section shall prohibit 

a physician * * * from administering 

(but not prescribing) narcotic drugs to a 

person for the purpose of relieving acute 

withdrawal symptoms when necessary 

while arrangements are being made for 

referral for treatment. Not more than one 

day’s medication may be administered 

to the person or for the person’s use at 

one time. Such emergency treatment 

may be carried out for not more than 

three days and may not be renewed or 

extended.’’) (emphasis added). 

Also relevant here is the definition of 

the term ‘‘maintenance treatment.’’ 21 

U.S.C. 802(29). Under the CSA, the term 

‘‘means the dispensing, for a period in 

excess of twenty-one days, of a narcotic 

drug in the treatment of an individual 

for dependence upon heroin or other 

morphine-like drugs.’’ Id.17

Finally, Respondent claimed that 

most of the patients whose files were 

introduced into evidence (including 

some of the methadone patients) were 

chronic pain patients. Under a 

longstanding DEA regulation, to be 

effective, ‘‘[a] prescription for a 

controlled substance * * * must be 

issued for a legitimate medical purpose 

by an individual practitioner acting in 

the usual course of his professional 

practice.’’ 21 CFR 1306.04(a). As the 

Supreme Court has explained, ‘‘the 

prescription requirement * * * ensures 

patients use controlled substances 

under the supervision of a doctor so as 

to prevent addiction and recreational 

abuse. As a corollary, [it] also bars 

doctors from peddling to patients who 

crave the drugs for those prohibited 

uses.’’ Gonzales v. Oregon, 546 U.S. 

243, 274 (2006) (citing United States v. 

Moore, 423 U.S. 122, 135, 143 (1975)). 

Under the CSA, it is fundamental that 

a practitioner must establish and 

maintain a bonafide doctor-patient 

relationship in order to act ‘‘in the usual 

course of * * * professional practice’’ 

and to issue a prescription for a 

‘‘legitimate medical purpose.’’ Laurence 

T. McKinney, 73 FR 43260, 43265 n.22 

(2008); see also Moore, 423 U.S. at 142– 

43 (noting that evidence established that 

physician ‘‘exceeded the bounds of 

‘professional practice,’’’ when ‘‘he gave 

inadequate physical examinations or 

none at all,’’ ‘‘ignored the results of the 

tests he did make,’’ and ‘‘took no 

precautions against * * * misuse and 

diversion’’). The CSA, however, 

generally looks to state law to determine 

whether a doctor and patient have 

established a bonafide doctor-patient 

relationship. See Kamir Garces-Mejias, 

72 FR 54931, 54935 (2007); United 

Prescription Services, Inc., 72 FR 50397, 

50407 (2007). 

By regulation, the Alabama Board of 

Medical Examiners has adopted 

Guidelines For The Use of Controlled 

Substances For The Treatment of Pain. 

See Ala. Admin. Code r. 540–X–4-.08. 

According to the Board, the ‘‘guidelines 

are not intended to define complete or 

best practice, but rather to communicate 

what the Board considers to be within 

the boundaries of professional practice.’’ 

Id. (1)(g). Guideline (2)(a), which is 

captioned ‘‘Evaluation of the Patient,’’ 

states: 

A complete medical history and physical 

examination must be conducted and 

documented in the medical record. The 

medical record should document the nature 

and intensity of the pain, current and past 

treatments for pain, underlying or coexisting 

diseases or conditions, the effect of the pain 

on physical and psychological function, and 

history of substance abuse. The medical 

record also should document the presence of 

one or more recognized medical indications 

for the use of a controlled substance. 

Id. (2)(a).18

The record contains substantial 

evidence that Respondent prescribed 

methadone to opiate addicted patients 

for the purpose of providing 

maintenance treatment. During his 

initial interview (on Feb. 28, 2010) with 

the Investigators, Respondent told them 

that ‘‘he was operating a detox clinic 

where he was using methadone to get 

his patients onto Suboxone.’’ Tr. 43. It 

was not until later that day, when the 

Investigators interviewed Respondent 

for the second time, that he claimed that 

he prescribed methadone for pain and 

that he had previously misspoken. Id. at 

55. 

Other evidence supports the 

conclusion that Respondent was 

prescribing methadone to provide 

maintenance or detoxification treatment 

to opiate addicted patients. On the date 

of the visit, Investigators interviewed 

JKB, who told them that he was being 

treated by Respondent with methadone 

for opiate addiction. Id. at 52. JKB 

further stated that he had previously 

gone to a narcotic treatment program, 

which used methadone, and that he was 

seeing Respondent because the latter 

charged less. Id. at 52–53. JKB also 

stated that Respondent was not treating 

him for chronic pain. Id. at 53. 

The Government introduced into 

evidence seven files of patients who 

received methadone prescriptions from 

Respondent. GXs 5X; 5O; 5A; 5N; 5L; 

5M; and 5T. The Government also 

elicited the testimony of the DIs to the 

effect that they had interviewed several 

of the patients to determine what 

condition they were being treated for. 

Patient TP related that she had gone 

to Respondent because she had heard 

that he was using methadone to treat 

addiction; TP also noted on her intake 

form that she had previously gone to a 

methadone clinic and was taking twelve 

tablets of methadone 10 mg strength a 

day. Respondent issued her 

prescriptions for methadone on three 

separate dates over the course of a 

month, and ultimately TP returned to a 

methadone clinic. 

While Respondent maintained that TP 

had been going to the methadone clinic 

for pain, he conceded that the purpose 

of a methadone clinic is to treat 

addiction. Moreover, while Respondent 

noted diagnoses of both chronic pain 

and substance abuse on TP’s progress 


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19As explained above, if Respondent was treating 

MB for substance abuse, the methadone 

prescriptions were illegal because methadone 

cannot be prescribed for this purpose and because 

he did not hold the required registration. See 21 

U.S.C. 823(g)(1); 21 CFR 1306.07(a) & (b). 

notes, he did not document having 

taken a medical history, the nature and 

intensity of any pain, current and past 

treatments for paint, and its effect on 

her physical and psychological 

functioning. 

I thus conclude that Respondent 

prescribed methadone to TP for 

maintenance or detoxification purposes 

and not to treat chronic pain. In doing 

so, he violated the CSA because he did 

not have the registration required under 

section 823(g)(1) to dispense methadone 

for this purpose; he also violated DEA 

regulations which prohibit the 

prescribing of narcotic drugs for this 

purpose except for those drugs in 

schedules III through V which have 

been specifically approved by the FDA 

to provide maintenance or 

detoxification treatment. 21 CFR 

1306.04(c). 

The DIs also interviewed MB, who 

stated that she was being treated by 

Respondent for an addiction to Lorcet 

and not for chronic pain. Respondent 

testified, however, that he was treating 

MB both for chronic pain cause by 

headaches and substance abuse. 

Respondent prescribed methadone to 

her on six different dates. 

Notably, the Government did not 

produce any evidence corroborating 

MB’s statement that she was not being 

treated for chronic pain. See 

Consolidated Edison Co. v. NLRB, 305 

U.S. 197, 230 (1938) (‘‘Mere 

uncorroborated hearsay * * * does not 

constitute substantial evidence.). 

However, even if this evidence is not 

sufficient to establish that Respondent 

was treating her only for substance 

abuse and crediting his testimony that 

he was also treating her for chronic 

pain, I conclude that the prescriptions 

were unlawful. 

Notably, Respondent did not 

document the nature and intensity of 

her pain, its effect on both her physical 

and psychological function, any prior or 

current treatment for it, and her history 

of substance abuse. See Ala. Admin 

Code r.540–X–4.08(2)(a). Accordingly, 

because Respondent did not make any 

of the findings required under the 

Alabama guidelines, I conclude that he 

did not have a basis for his diagnosis of 

chronic pain. I thus conclude that 

Respondent acted outside of ‘‘the usual 

course of * * * professional practice’’ 

and lacked a ‘‘legitimate medical 

purpose’’ in issuing the methadone 

prescriptions to MB and violated 

Federal law. 21 CFR 1306.04(a).19

Respondent issued three methadone 

prescriptions (on Feb. 9, 23, and Mar. 9) 

to JC1 (GX 5N), each of which was for 

210 tablets with a daily dose of 150 mg. 

Respondent admitted that JC1 had come 

from another methadone clinic even 

though he denied that JC1 had gone to 

the clinic to be treated for addiction and 

maintained that he had gone there for 

pain management. Moreover, while 

Respondent also maintained that JC1 

had come to him because ‘‘he wanted to 

take a cleaner medicine for his pain,’’ 

when Respondent stopped writing 

methadone prescriptions, JC1 decided to 

go to another treatment facility. 

In addition, notwithstanding 

Respondent’s claim that he was treating 

JC1 for pain, at his first two visits (and 

at which Respondent prescribed 

methadone), Respondent noted that JC1 

had ‘‘NO’’ pain; and at the third visit, 

where he issued a further methadone 

prescription, Respondent did not even 

make a progress note. Respondent also 

failed to document any of the findings 

set forth in Alabama’s Guideline 2(a). 

Accordingly, I conclude that 

Respondent prescribed methadone to 

JC1 for maintenance/detoxification 

purposes without the required 

registration and violated DEA 

regulations which prohibit the 

prescribing of schedule II narcotics for 

this purpose. 21 U.S.C. 823(g)(1); 21 

CFR 1306.04(c). 

JB also came to Respondent from a 

narcotic treatment program, which he 

had been kicked out of. Respondent 

noted this in the chart and that JB 

‘‘desire[d] to get off methadone.’’ 

Respondent asserted that the fact that JB 

had been treated at a methadone clinic 

did not mean that the clinic was treating 

him for addiction, even though that is 

the purpose of a methadone clinic; 

moreover, he admitted that he did not 

obtain JB’s records from the clinic. After 

Respondent stopped prescribing 

methadone to JB, the latter went to 

another methadone clinic. 

While Respondent documented that 

JB had foot and knee pain, and the 

progress notes include a few additional 

statements regarding his pain such as 

the location and that JB had been in an 

accident, the notes do not document the 

nature and intensity of pain, any prior 

treatments for it, and its effect on JB’s 

functioning. Moreover, Respondent 

noted that he planned to put JB on his 

alternative medication program. Given 

JB’s prior history of substance abuse 

treatment and his express ‘‘desire to get 

off methadone,’’ I conclude that 

Respondent’s primary purpose in 

prescribing methadone to him (which 

he did on three occasions over a month) 

was to provide maintenance/ 

detoxification treatment. I thus 

conclude that Respondent violated the 

CSA and DEA regulations in doing so. 

21 U.S.C. 823(g)(1); 21 CFR 1306.04(c). 

Respondent testified that NB told him 

at the initial visit that she had been on 

180 mg of methadone which she was 

taking for pain. He also testified that she 

was a ‘‘troubling patient’’ because she 

was on both methadone and Xanax and 

that this was a great concern, especially 

if she mixed the drugs with alcohol. 

Respondent diagnosed NB as having 

chronic pain even though he noted on 

her chart that she had ‘‘NO’’ pain, and 

he did not document any further 

findings to support a diagnosis of 

chronic pain. Moreover, 

notwithstanding his express concern 

that NB was on both methadone and 

Xanax, Respondent prescribed Xanax to 

her and did not document that she had 

anxiety, although he maintained in his 

testimony that she ‘‘had some anxiety.’’ 

The evidence is insufficient to 

support the conclusion that NB sought 

treatment from Respondent for a 

substance abuse problem. However, the 

evidence does support the conclusion 

that Respondent acted outside of the 

usual course of professional practice 

and lacked a legitimate medical purpose 

in prescribing methadone to her. 21 CFR 

1306.04(a). Having noted on NB’s chart 

that she had ‘‘NO’’ pain, and having 

failed to document any further findings 

as required by the Guidelines to support 

his chronic pain diagnosis (and to 

explain the inconsistency between his 

diagnosis and his notation that she had 

no pain), it is clear that Respondent 

lacked a legitimate medical purpose in 

prescribing methadone to her. 

KI noted on her intake form that she 

was using three controlled substances: 

methadone, Xanax and Ambien. 

Respondent also acknowledged that KI 

had previously been treated at a narcotic 

treatment facility and that she had taken 

narcotics and become addicted to them. 

However, he denied that KI had told her 

that she had gone to the methadone 

clinic to treat her addiction—as if there 

was any other reason a person would 

seek treatment from a methadone clinic. 

While Respondent maintained that KI 

had diagnoses of both substance abuse 

and chronic pain, on the progress note 

for her initial visit, he noted that she 

had ‘‘NO’’ pain although he wrote 

‘‘Back’’ as the location. Respondent did 

not document any findings that would 

explain the inconsistency between his 

diagnosis and his having noted that KI 

had ‘‘NO’’ pain; he also did not 

document the history of any pain, what 


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20 Given the conflicting evidence regarding DG, I 

decline to make any legal conclusions regarding 

Respondent’s prescribing of methadone to him. 

21While the Government introduced the Alabama 

Guidelines on using controlled substances to treat 

pain, it offered no evidence establishing that these 

standards apply to the treatment of substance abuse 

patients. 

22While Respondent’s charts included a Plan 

section, none of them included the ‘‘objectives that 

will be used to determine treatment success.’’ Ala. 

Admin. Code r.540–X–4-.08(2)(b). 

treatment had been used, and the pain’s 

effect on her physical and psychological 

functioning. 

Respondent issued three methadone 

prescriptions to KI. I conclude that 

Respondent’s purpose in doing so was 

not to treat pain, but to provide 

maintenance/detoxification treatment to 

her. I thus conclude that Respondent 

violated Federal law by prescribing 

methadone to KI for maintenance/ 

detoxification treatment without the 

required registration and violated DEA 

regulations which prohibit the 

prescribing of schedule II narcotics for 

this purpose. 21 U.S.C. 823(g)(1); 21 

CFR 1306.04(c).20

The Suboxone Prescriptions 

As found above, Respondent also 

prescribed Suboxone, a schedule III 

controlled substance, to numerous 

patients. The Government elicited the 

testimony of the DIs as to phone 

interviews they conducted with sixteen 

of these patients, the majority of whom 

said that Respondent was treating them 

for substance abuse and not chronic 

pain. See Tr. at 78 (NK); id. at 80–81 

(AG); id. at 82–83 (LM); id. at 83–84 

(ET); id. at 85–87 (DA); id. at 87–88 

(CT); id. at 89–90 (JH); id. at 92–94 (KP); 

id. at 95–98 (SS); id. at 266–67 (CML); 

id. at 268–69 (SJW); id. at 270 (LMJ); id. 

at 271 (MR); id. at 288–89 (SHY). 

As found above, Respondent testified 

that many of these patients were 

actually being treated for chronic pain 

in addition to substance abuse, or were 

just being treated for chronic pain. 

Moreover, Respondent frequently noted 

both diagnoses on the patient’s charts, 

although in some instances he did not 

note a substance abuse diagnosis until 

after the first visit (and sometimes not 

until after several visits). See, e.g., GX 

5P (AG); GX 5V (LM); GX 5Y (CT); GX 

5R (JH); GX 5B (TB); GX 5J (SW); GX 5I 

(SJW); GX 5E (LMJ); GX 5D (SHY); GX 

5K (DA). 

However, even if it is the case that 

most of the Suboxone patients were 

being treated only for substance abuse, 

the Government did not offer any 

evidence (whether in the form of 

clinical standards or expert testimony) 

establishing what the appropriate course 

of professional practice requires of a 

physician treating patients for substance 

abuse.21 In short, while in its brief, the 

Government repeatedly argues that 

Respondent lacked a medical 

justification to support his diagnosis of 

substance abuse for the various patients 

and his issuance of the Suboxone 

prescriptions, the Government’s failure 

to offer any probative evidence as to the 

standards of medical practice for 

diagnosing and treating a substance 

abuse patient precludes a finding that 

Respondent lacked a legitimate medical 

purpose when he prescribed Suboxone 

to these patients. 

Respondent, however, testified that 

many of the Suboxone patients were 

actually being treated for chronic pain, 

and he noted this as his primary 

diagnosis in many of their charts. As 

explained above, the Alabama 

Guidelines require that a physician who 

prescribes controlled substances to treat 

pain, obtain ‘‘[a] complete medical 

history’’ and document this in the 

patient’s medical record. Moreover, the 

Guidelines state that the record ‘‘should 

document the nature and intensity of 

the pain, current and past treatments for 

pain, underlying or coexisting diseases 

or conditions, the effect of the pain on 

physical and psychological function, 

and history of substance abuse.’’ Ala. 

Admin. Code r. 540–X–4–.08(2)(A). 

As found above, at the initial visits of 

nine of the Suboxone patients, 

Respondent diagnosed them as having 

chronic pain but not substance abuse. 

See supra Findings for Patients SS, ET, 

KP, CL, CML, MR, SHY, DA, and NK. 

Notwithstanding his diagnosis, 

Respondent typically did not even list a 

location of a patient’s purported pain 

and/or did not list a location until after 

the patient had made several visits. See 

supra Findings for ET, KP, CL, CML, 

SHY, NK. Moreover, Respondent did 

not document the nature and intensity 

of the patient’s pain, the pain’s effect on 

the patient’s ability to function, and 

rarely documented any past treatments 

for the pain, and the patient’s substance 

abuse history at either the initial visit or 

follow-up visits.22

Tellingly, in the charts, Respondent 

frequently noted that the patients had 

‘‘NO’’ pain, yet nonetheless diagnosed 

them as having chronic pain. See 

Findings for SS, ET, KP, CL, MR, SHY, 

and NK. Respondent offered no 

explanation for the inconsistency 

between his findings and his diagnosis 

with respect to any of these patients. 

Based on Respondent’s having noted 

that these patients had no pain and his 

failure to offer any explanation for why 

he nonetheless diagnosed the patients as 

having chronic pain, I conclude that 

Respondent lacked a legitimate medical 

purpose and acted outside of the usual 

course of professional practice in 

violation of 21 CFR 1306.04(a) when he 

prescribed Suboxone to these patients 

for the purpose of treating chronic pain. 

The Government further argues, and 

the ALJ agreed, that Respondent 

violated 21 CFR 1306.07(c), because his 

‘‘charts failed to show the use of any 

treatment options besides the 

prescribing of controlled substances.’’ 

ALJ at 47. The ALJ further explained 

that ‘‘[s]uch lack of attempts of 

alternative modalities prior to 

determining that the patient suffers from 

chronic pain violates’’ this regulation. 

Id. 

Both the Government and the ALJ 

clearly misread the regulation. This 

provision, which is part of the 

regulation setting forth the requirements 

for dispensing narcotic controlled 

substances ‘‘to a narcotic dependant[sic] 

person for the purpose of maintenance 

or detoxification treatment’’ states: 

This section is not intended to impose any 

limitations on a physician or authorized 

hospital staff to administer or dispense 

narcotic drugs in a hospital to maintain or 

detoxify a person as an incidental adjunct to 

medical or surgical treatment of conditions 

other than addiction, or to administer or 

dispense narcotic drugs to persons with 

intractable pain in which no relief or cure is 

possible or none had been found after 

reasonable efforts. 

21 CFR 1306.07(c). 

The Government’s and the ALJ’s 

construction of this regulation as 

imposing—by implication no less—an 

affirmative obligation for a physician to 

engage in alternative treatment 

modalities cannot be squared with the 

purpose of the CSA, which ‘‘manifests 

no intent to regulate the practice of 

medicine generally,’’ an authority which 

remains vested in the States. Gonzales v. 

Oregon, 546 U.S. 243, 270 (2006). 

Rather, in any case, whether a physician 

has an adequate basis for concluding 

that ‘‘no relief or cure is possible’’ for 

a patient’s pain, or that alternative 

treatments should be tried, is a clinical 

judgment which must be assessed by 

reference to the standards of medical 

practice as set by the state medical 

boards and the profession itself. While 

a practitioner’s failure to recommend 

alternative treatments may provide 

some evidence as to whether a 

prescription complies with 21 CFR 

1306.04(a), the Government produced 

no expert testimony establishing with 

respect to any patient, that under the 

standards of medical practice, 


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23The ALJ noted that ‘‘Respondent testified, and 

the record contains no expert evidence to the 

contrary, that his treatment of his patients met the 

standard of care.’’ ALJ at 48. While evidence as to 

the standard of care is admissible in criminal 

prosecutions under 21 U.S.C. 841(a)(1), I conclude 

that the Alabama Guidelines provide substantial 

evidence as to accepted boundaries of professional 

practice in prescribing controlled substances for the 

treatment of pain. See Ala. Admin. Code r. 540–X– 

4–.08(1)(g) (guidelines are intended ‘‘to 

communicate what the Boards considers to be 

within the boundaries of professional practice’’). 

Respondent was required to recommend 

alternative treatments.23

Other Allegations 

The ALJ found that ‘‘[t]he parties do 

not dispute that Respondent improperly 

used his ‘X’ prescription registration to 

prescribe controlled and non-controlled 

substances other than Suboxone or 

Subutex.’’ ALJ at 43. The problem with 

the ALJ’s reasoning is that an X number 

is not a registration at all, but only an 

identification number. 

As the statute states: ‘‘Upon receiving 

a notification under subparagraph (B) 

[of a practitioner’s intent to prescribe 

narcotic drugs in schedules III through 

V for maintenance or detoxification 

treatment], the Attorney General shall 

assign the practitioner involved an 

identification number under this 

paragraph for inclusion with the 

registration issued for the practitioner 

pursuant to subsection (f) of this 

section.’’ 21 U.S.C. 823(g)(2)(D)(ii) 

(emphasis added). See also 21 CFR 

1301.28(a) (‘‘An individual practitioner 

may dispense or prescribe Schedule III, 

IV, or V narcotic controlled drugs * * * 

which have been approved by the Food 

and Drug Administration (FDA) 

specifically for use in maintenance or 

detoxification treatment without 

obtaining the separate registration 

required by § 1301.13(e). * * *’’); id. 

§ 1301.28(d)(1) (‘‘If the individual 

practitioner has the appropriate 

registration under § 1301.13, then the 

Administrator will issue the practitioner 

an identification number. * * * ’’) 

(emphasis added). 

Moreover, under DEA’s regulations, 

[a]ll prescriptions for controlled substances 

shall be dated as of, and signed on, the day 

when issued and shall bear the full name and 

address of the patient, the drug name, 

strength, dosage form, quantity prescribed, 

directions for use and the name, address and 

registration number of the practitioner. In 

addition, a prescription for a Schedule III, IV, 

or V narcotic drug approved by FDA 

specifically for ‘detoxification treatment’ or 

‘maintenance treatment’ must include the 

identification number issued by the 

Administrator under § 1301.28(d) of this 

chapter or a written notice stating that the 

practitioner is acting under the good faith 

exception of § 1301.28(e). 

21 CFR 1306.05(a). See also 21 CFR 

1301.28(d)(3) (‘‘The individual 

practitioner must include the 

identification number on all records 

when dispensing and on all 

prescriptions when prescribing narcotic 

drugs under this section.’’). 

As found above, Respondent issued 

numerous controlled substance 

prescriptions (for both Suboxone and 

other drugs) on forms that listed only 

his X number. The Suboxone 

prescriptions issued in this manner 

violated DEA’s regulation because 

Respondent was required to include 

both his X number and his practitioner’s 

registration number on them. See 21 

CFR 1306.05(a). Moreover, because he 

did not include his practitioner’s 

registration number, the non-Suboxone 

controlled substance prescriptions 

violated this provision as well. 

The ALJ also concluded that 

‘‘Respondent improperly prescribe 

Suboxone for substance abuse using his 

regular DEA registration number rather 

than the required X number.’’ ALJ at 43. 

Apparently, this was because 

Respondent eventually started listing 

both numbers on his prescription 

blanks. However, as set forth above, 

DEA’s regulation expressly requires that 

a practitioner include both his 

registration number and his X number 

when issuing a prescription for 

Suboxone for maintenance or 

detoxification treatment under the 

authority of 21 CFR 1301.28. See 21 CFR 

1306.05(a). 

Moreover, while a ‘‘practitioner must 

include the identification number * * * 

on all prescriptions when prescribing 

narcotic drugs’’ for the purpose of 

providing maintenance or detoxification 

treatment, id. 1301.28(d), nothing in 

DEA regulations prohibits a practitioner 

from including both his practitioner’s 

registration number and his X 

identification number on his 

prescription blanks. Nor does any DEA 

regulation require that a practitioner 

cross-out his X number when writing a 

prescription for controlled substances 

other than Suboxone (or Subutex) on a 

prescription blank that includes both 

numbers. 

The evidence also shows that 

Respondent violated the Immediate 

Suspension Order by issuing multiple 

prescriptions after he was served with 

the Order. Under 21 U.S.C. 843(a)(2), it 

is ‘‘unlawful for any person knowingly 

or intentionally * * * to use in the 

course of the distribution[] or 

dispensing of a controlled substance, a 

registration number which is * * * 

suspended[.]’’ 

The evidence clearly shows that 

Respondent was personally served with 

the Immediate Suspension Order on 

September 27, 2010, at which time he 

told the Investigator that ‘‘he was not 

going to abide by this order and that [the 

DI] didn’t have the authority to tell him 

that he couldn’t prescribe any 

controlled substances.’’ Tr. 113. True to 

his word, two days later, however, he 

issued prescriptions to CW for Adderall, 

to MK for Adderall and Lortab, and to 

DH for Lortab and Xanax. Respondent’s 

explanation that these prescriptions 

were just mistakes or accidents is totally 

unpersuasive. 

The prescriptions to MK and DH, as 

well as a further Adderall prescription 

which was issued to JB, were unlawful 

for the further reason that they were 

post-dated. As set forth above, under 21 

CFR 1306.05(a), ‘‘[a]ll prescriptions for 

controlled substances shall be dated as 

of, and signed on, the day when 

issued.’’ Respondent admitted that on 

September 3, 2010, he issued CW a 

prescription for Adderall, a schedule II 

controlled substance which he dated 

October 3, 2010. Moreover, both 

Respondent’s testimony and 

documentary evidence establish that 

Respondent wrote the prescription to 

MK and DH on September 29, while 

post-dating them to October 4. 

Accordingly, I also find that Respondent 

violated DEA regulations in writing 

these prescriptions. 

I further find that Respondent lacked 

a legitimate medical purpose in 

prescribing Xanax to JC2. The evidence 

shows that Respondent knew that JC2 

was abusing Xanax and that he had been 

jailed for distribution. While 

Respondent testified that he could not 

simply stop prescribing the drug to JC2 

because JC2 could have seizures, and 

that he planned to taper JC2 off the 

drug, Respondent actually increased the 

daily dose of JC2’s Xanax prescriptions. 

Given the inconsistency between the 

medical justification Respondent offered 

for his continuing to prescribe Xanax to 

JC2 and the actual prescriptions he 

issued, I conclude that Respondent 

lacked a legitimate medical purpose and 

acted outside the usual course of 

professional practice in prescribing 

Xanax to JC2. 21 CFR 1306.04(a). 

The record thus establishes that 

Respondent’s experience in dispensing 

controlled substances (factor two) and 

his record of compliance with 

applicable laws related to controlled 

substances (factor four) is characterized 

by his multiple violations of Federal 

law. These include his prescribing of 

methadone for maintenance or 

detoxification purposes without being 

registered to do so and in violation of 

DEA regulations prohibiting the 

prescribing of methadone for this 


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24With respect to factor five, the ALJ found that 

Respondent’s ‘‘lack of candor * * * threatens 

public health and safety.’’ ALJ at 49. As support for 

this conclusion, the ALJ noted that most of the 

patients who were interviewed by the Investigators 

had stated that Respondent was treating them for 

substance abuse, yet Respondent testified that they 

were being treated for chronic pain but did not 

realize this. Id. 

While I agree with the ALJ that Respondent 

lacked candor, and appreciate that she personally 

observed his testimony, I do so based on different 

evidence. First, during the initial interview on Feb. 

28, 2010, Respondent told the investigators that he 

was operating a detox clinic and was using 

methadone to transfer his patients to Suboxone. Tr. 

43. Yet later that day, he claimed that he was 

prescribing methadone only for pain and had 

previously misspoken. Id. at 54–55. Second, when 

confronted with evidence that several of his 

methadone patients had come to him from 

methadone clinics, he attempted to justify his 

unlawful prescribing of methadone to them by 

claiming that the patients had actually gone to these 

clinics to treat their pain. See Tr. 695–96 (testimony 

regarding JB); id. at 699 (testimony regarding JC); id. 

at 716–17 (testimony regarding KI); id. at 728 

(testimony regarding TP). This factor thus also 

supports revocation. 

purpose; his prescribing of controlled 

substances to treat chronic pain without 

a legitimate medical purpose; his 

prescribing of Xanax to JC2; his issuance 

of prescriptions which lacked his 

practitioner’s registration number; his 

issuance of post-dated prescriptions; 

and his issuance of multiple 

prescriptions after his registration had 

been suspended. I further conclude that 

the Government has made a prima facie 

showing that Respondent has 

committed acts which render his 

registration ‘‘inconsistent with the 

public interest,’’ 21 U.S.C. 824(a)(4), and 

that this conduct is sufficiently 

egregious to warrant the revocation of 

his registration.24

Sanction 

Under Agency precedent, where, as 

here, the Government has made out a 

prima facie case that a registrant has 

committed acts which render his 

‘‘registration inconsistent with the 

public interest,’’ he must ‘‘ ‘present[] 

sufficient mitigating evidence to assure 

the Administrator that [he] can be 

entrusted with the responsibility carried 

by such a registration.’ ’’ Samuel S. 

Jackson, 72 FR 23848, 23853 (2007) 

(quoting Leo R. Miller, 53 FR 21931, 

21932 (1988)). ‘‘Moreover, because ‘past 

performance is the best predictor of 

future performance,’ ALRA Labs., Inc. v. 

DEA, 54 F.3d 450, 452 (7th Cir. 1995), 

this Agency has repeatedly held that 

where a registrant has committed acts 

inconsistent with the public interest, the 

registrant must accept responsibility for 

[his] actions and demonstrate that [he] 

will not engage in future misconduct.’’ 

Medicine Shoppe-Jonesborough, 73 FR 

364 (2008). As the Sixth Circuit has 

recognized, this Agency also ‘‘properly 

consider[s]’’ a registrant’s admission of 

fault and his candor during the 

investigation and hearing to be 

‘‘important factors’’ in the public 

interest determination. See Hoxie, 419 

F.3d at 483. 

The ALJ found, and the record 

supports the conclusion, that 

Respondent eventually ceased 

prescribing methadone for maintenance 

and detoxification purposes. ALJ at 49– 

50. The record generally supports the 

conclusion that Respondent stopped 

writing controlled substance 

prescriptions which did not include his 

registration number, as required by DEA 

regulations. However, as found above, 

in September 2010, Respondent issued 

a further Adderall prescription to JB and 

did not include his registration number. 

The ALJ further noted that 

Respondent expressed remorse for some 

of his wrongdoing. ALJ at 50. However, 

while Respondent maintained that he 

had mistakenly issued the postsuspension prescriptions, and ‘‘would 

never do anything to violate an order,’’ 

Tr. 509, his testimony is belied by the 

evidence that upon being served with 

the Immediate Suspension Order, he 

stated his intention not to comply with 

it. Indeed, his testimony is patently 

disingenuous, given that he wrote the 

prescriptions only two days after he was 

served with the Order. In short, 

Respondent’s conduct manifests a 

deliberate and egregious disregard for 

his obligations as a DEA registrant. 

Finally, while the ALJ noted that 

‘‘Respondent testified passionately 

about the prevalence of narcotic abuse 

in Red Bay and his want to eliminate 

it,’’ she further concluded that he 

‘‘likely facilitated some of that abuse.’’ 

Id. The ALJ’s conclusion is well 

supported. Indeed, as found above, in 

numerous instances, Respondent issued 

controlled-substance prescriptions for 

the purported purpose of treating a 

patient’s pain, even though he recorded 

in the patient’s chart that the patient 

had ‘‘NO’’ pain and/or failed to make 

the findings required under the State’s 

Guidelines to properly diagnose the 

patient. Moreover, during one of the 

interviews by the Investigators, 

Respondent admitted that he did not 

follow the State’s Guidelines. Tr. 220. 

Respondent, however, offered no 

evidence that he now intends to comply 

with the Guidelines. 

Accordingly, I hold that Respondent 

has not rebutted the Government’s 

prima facie case. I will therefore order 

that Respondent’s registration be 

revoked and that any pending 

application be denied. For the same 

reasons that led me to order the 

Immediate Suspension of Respondent’s 

registration, I conclude that the public 

interest requires that this Order be 

effective immediately. 

Order 

Pursuant to the authority vested in me 

by 21 U.S.C. 823(f) & 824(a)(4), as well 

as by 28 CFR 0.100(b) & 0.104, I order 

that DEA Certificate of Registration, 

BC1701184, and Identification Number 

XC1701184, issued to Morris W. 

Cochran, M.D., be, and they hereby are, 

revoked. I further order that any 

application for renewal or modification 

of such registration be, and it hereby is, 

denied. This Order is effective 

immediately. 

Dated: March 16, 2012. 

Michele M. Leonhart, 

Administrator. 

[FR Doc. 2012–7107 Filed 3–23–12; 8:45 am] 

BILLING CODE 4410–09–P 

DEPARTMENT OF JUSTICE 

Office of Justice Programs 

[OMB Number 1121–NEW] 

Agency Information Collection 

Agencies: New Collection; Comments 

Requested 

ACTION: 60-Day notice of information 

collection under review. 

The Department of Justice, Office of 

Justice Programs, Bureau of Justice 

Statistics, will be submitting the 

following information collection request 

for review and approval in accordance 

with the Paperwork Reduction Act of 

1995. The proposed information 

collection is published to obtain 

comments from the public and affected 

agencies. Comments are encouraged and 

will be accepted for ‘‘sixty days’’ until 

May 25, 2012. This process is conducted 

in accordance with 5 CFR 1320.10. 

If you have additional comments, 

especially on the estimated public 

burden or associated response time, 

suggestions, or need a copy of the 

proposed information collection 

instrument with instructions or 

additional information, please contact: 

Ron Malega, 202–353–0487, Bureau of 

Justice Statistics, Office of Justice 

Programs, Department of Justice, 810 

Seventh Street NW., Washington DC 

20531 or Ronald.Malega@usdoj.gov. 

Written comments and suggestions 

from the public and affected agencies 

concerning the proposed collection of 

information are encouraged. Your 

comments should address one or more 

of the following four points: 


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