Federal Register / Vol. 89, No. 179 / Monday, September 16, 2024 / Notices 75567 

1The restrictions that the ALJ recommends 

imposing on Respondent’s registration require her 

to: (1) limit her controlled substance administering, 

prescribing, and dispensing to the practice of 

anesthesiology; (2) comply with the terms of the 

Medical Board of California’s (MBC’s) Stipulated 

Interim Order imposing restrictions on her 

Registration; (3) comply with the terms of her 

probation with the MBC and refrain from seeking 

early termination of her probation; (4) notify DEA’s 

Los Angeles Field Division of any action taken 

against her license and immediately surrender her 

Registration if her California medical license is 

suspended or revoked; (5) remain in monitoring for 

substance abuse and submit to regular urine drug 

screens; (6) provide DEA with copies of all 

quarterly reports issued by her practice monitor; (7) 

maintain a detailed record of controlled substances 

prescribed, administered, or dispensed; (8) report 

all activity involving Schedule II controlled 

substances to DEA on a monthly basis; (9) allow 

DEA personnel to enter her registered location 

during normal business hours without prior notice 

or a warrant. RD, at 42–43. 

2The Agency adopts the ALJ’s summary of each 

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

assessment with respect to each of the witnesses’ 

credibility. RD, at 4–23. 

3The Agency agrees with the ALJ that 

Respondent’s testimony was ‘‘genuine and 

generally consistent,’’ despite Respondent having a 

significant personal interest in the outcome of these 

proceedings. RD, at 23. The ALJ found that ‘‘to the 

extent that [Respondent’s testimony] differs from 

the testimony of other testifying witnesses, [he 

would] consider her personal interest in this case, 

and [he would] give her testimony the weight that 

it deserves in light of other evidence and testimony 

presented during the hearing.’’ Id. The Agency 

agrees with the amount of weight that the ALJ 

afforded Respondent’s testimony. 

4Zolpidem is a Schedule IV controlled substance 

sold under the brand name Ambien. The generic 

name (zolpidem) is used in this decision. 

5 Diazepam is a Schedule IV controlled substance 

sold under the brand name Valium. The generic 

name (diazepam) is used in this decision. 

Trade and Investment Queensland, San 

Francisco, CA; TruGenomix Health, 

Inc., dba Polaris Genomics, 

Gaithersburg, MD; Unveil LLC, 

Cincinnati, OH; Ursus Medical Designs 

LLC, Pittsburgh, PA; and Vaxxas Pty, 

Ltd., Hamilton, AUSTRALIA, have been 

added as parties to this venture. 

Also, ImmersiveTouch, Inc., Chicago, 

IL; Neuromersive, Inc., Fort Worth, TX; 

Precisio Biotix Technologies, Dover, DE; 

and Sepsis Scout, Inc., San Francisco, 

CA, have withdrawn as parties to this 

venture. 

No other changes have been made in 

either the membership or planned 

activity of the group research project. 

Membership in this group research 

project remains open, and MTEC 

intends to file additional written 

notifications disclosing all changes in 

membership. 

On May 9, 2014, MTEC filed its 

original notification pursuant to section 

6(a) of the Act. The Department of 

Justice published a notice in the Federal 

Register pursuant to section 6(b) of the 

Act on June 9, 2014(79 FR 32999). 

The last notification was filed with 

the Department on April 2, 2024. A 

notice was published in the Federal 

Register pursuant to section 6(b) of the 

Act on June 21, 2024(89 FR 52090). 

Suzanne Morris, 

Deputy Director Civil Enforcement 

Operations, Antitrust Division. 

[FR Doc. 2024–20967 Filed 9–13–24; 8:45 am] 

BILLING CODE P 

DEPARTMENT OF JUSTICE 

Antitrust Division 

Notice Pursuant to the National 

Cooperative Research and Production 

Act of 1993—America’s DataHub 

Consortium 

Notice is hereby given that, on June 

28, 2024, pursuant to section 6(a) of the 

National Cooperative Research and 

Production Act of 1993, 15 U.S.C. 4301 

et seq. (‘‘the Act’’), America’s DataHub 

Consortium (‘‘ADC’’) has filed written 

notifications simultaneously with the 

Attorney General and the Federal Trade 

Commission disclosing changes in its 

membership. The notifications were 

filed for the purpose of extending the 

Act’s provisions limiting the recovery of 

antitrust plaintiffs to actual damages 

under specified circumstances. 

Specifically, ADACEN FEDERAL LLC, 

Albuquerque, NM; AT Worthy 

Technology, Fairfax, VA; Brightquery, 

Inc., Irvine, CA; Careplots, Inc., 

Malvern, PA; CAS a division of 

American Chemical Society, Columbus, 

OH; Data Point LLC, Orange, NJ; Data 

Products LLC, Chicago, IL; Generative 

Medical, Inc., Palo Alto, CA; K8R 

Applications, Inc. dba Future Perfect 

Engineering, Seattle, WA; Node.Digital, 

Leesburg, VA; Omnicom Consulting 

Group, Inc., Tarrytown, NY; Polaron 

Technologies, Inc., Miamisburg, OH; 

Prism Lab at Cornell University, Ithaca, 

NY; and Vistra Communications LLC, 

Lutz, FL, have been added as parties to 

this venture. 

No other changes have been made in 

either the membership or planned 

activity of the group research project. 

Membership in this group research 

project remains open, and ADC intends 

to file additional written notifications 

disclosing all changes in membership. 

On November 11, 2021, ADC filed its 

original notification pursuant to section 

6(a) of the Act. The Department of 

Justice published a notice in the Federal 

Register pursuant to section 6(b) of the 

Act on December 22, 2021 (86 FR 

72628). 

The last notification was filed with 

the Department on April 4, 2024. A 

notice was published in the Federal 

Register pursuant to section 6(b) of the 

Act on June 21, 2024 (89 FR 52092). 

Suzanne Morris, 

Deputy Director Civil Enforcement 

Operations, Antitrust Division. 

[FR Doc. 2024–20968 Filed 9–13–24; 8:45 am] 

BILLING CODE P 

DEPARTMENT OF JUSTICE 

Drug Enforcement Administration 

[Docket No. 23–31] 

Mary A. Vreeke, M.D.; Decision and 

Order 

On February 13, 2023, the Drug 

Enforcement Administration (DEA or 

Government) issued an Order to Show 

Cause (OSC) to Mary A. Vreeke, M.D. 

(Respondent), of Oxnard, CA. OSC, at 1, 

5. The OSC proposed the revocation of 

Respondent’s DEA Certificate of 

Registration (Registration) No. 

FV3660037, alleging that Respondent’s 

continued registration is inconsistent 

with the public interest. Id. at 1 (citing 

21 U.S.C. 823(g)(1), 824(a)(4)). 

A hearing was held before DEA 

Administrative Law Judge Paul E. 

Soeffing (the ALJ), who, on October 19, 

2023, issued his Recommended Rulings, 

Findings of Fact, Conclusions of Law, 

and Decision (Recommended Decision 

or RD). The RD recommended that 

Respondent’s Registration be suspended 

for six months, and then reinstated with 

restrictions to ensure that Respondent 

remains sober and continues with her 

current treatment program.1 RD, at 27. 

Neither party filed Exceptions to the RD. 

Having reviewed the entire record, the 

Agency adopts and hereby incorporates 

by reference the ALJ’s credibility 

findings,2 findings of fact, and 

conclusions of law, and clarifies and 

expands upon portions thereof herein. 

However, the Agency has determined 

that revocation is the appropriate 

sanction based on the egregiousness of 

Respondent’s conduct, her recidivism, 

and the Agency’s interests in deterring 

intentional violations of the Controlled 

Substances Act (CSA). 

I. Findings of Fact 

Respondent is an anesthesiologist 

currently practicing at St. John’s 

Hospital in Oxnard, California. 

Respondent testified that she has a 

substance abuse disorder that began 

with abusing alcohol in her mid-30s. 

RD, at 18; Tr. 234–35.3 Respondent later 

began abusing zolpidem 4 and 

diazepam 5 which she obtained without 

a prescription either from a friend or by 

going into Mexico. Tr. 235. Respondent 

was arrested and convicted in 2009 for 


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6PAG is a support group for ‘‘impaired healthcare 

professionals’’ that is ‘‘designed to help healthcare 

professionals provide treatment that is safe for the 

public [and] that is ethical and within the bounds 

of each of their practices.’’ RD, at 6; Tr. 55–56. 

7Respondent testified that the circumstances that 

precipitated her relapse included stress related to 

the second wave of the COVID–19 pandemic, 

wanting to spend more time with her family, 

sporadic shifts, and mounting anger and resentment 

towards her boss relating to his scheduling 

decisions. RD, at 20; Tr. 258–59, 296–97. 

Respondent also testified that around the time of 

her relapse, she was attending AA meetings via 

Zoom video teleconferencing, not in person, due to 

COVID-related stress. RD, at 20; Tr. 259. 

Respondent testified that she ‘‘basically had no 

accountability’’ with the lack of a ‘‘solid’’ AA 

program. RD, at 20; Tr. 259–60. Respondent 

testified that on the day of her overdose, she 

received a text message from her boss that he would 

not give her future shifts if she did not cancel a 

long-scheduled vacation. RD, at 20–21; Tr. 260–61, 

298. Additionally, her last case of the day involved 

a ‘‘code crimson,’’ where hospital staff must engage 

in a hasty blood transfusion. RD, at 21; Tr. 299. 

8Respondent testified that she never took 

medication that was necessary to treat a patient. RD, 

at 19; Tr. 300. 

9Respondent admitted that overprescribing 

controlled substances to a patient and diverting the 

excess could have an impact on the actions of 

another doctor reviewing the patient’s file at a later 

time. RD, at 20; Tr. 335–36. However, she testified 

that it is standard practice for anesthesiologists to 

titrate the dose until the desired respiratory rate is 

achieved, which would mitigate the potential harms 

of overprescribing. Id. 

10 DEA Diversion Investigator Yekaterina Blissard 

(DI) testified that DEA received an anonymous tip 

in August of 2022 alleging that Respondent was 

found unconscious in a hospital bathroom in March 

of 2021 ‘‘with an IV still attached to her hand’’ and 

controlled substances on her person. RD, at 4; Tr. 

16. 

DI’s testimony primarily focused on the 

introduction of the Government’s documentary 

evidence and her interactions with Respondent 

following the anonymous tip. RD, at 5. The Agency 

agrees that DI’s testimony was ‘‘generally 

consistent,’’ that ‘‘there was no indication that she 

harbors any animosity towards the Respondent,’’ 

and that she has no personal stake in this 

proceeding. Id. 

transporting zolpidem and diazepam 

across the United States border with 

Mexico. RD, at 18; Tr. 235–36. 

Respondent testified that she 

transported drugs across the border on 

approximately ten occasions. RD, at 18 

n.25; Tr. 237. In 2013, Respondent was 

confronted by her employer regarding 

diversion of controlled substances, and 

she admitted to diverting fentanyl and 

midazolam for personal use. RD, at 18; 

Tr. 239–40. 

After admitting to diversion in 2013, 

Respondent entered treatment at the 

Loma Linda behavioral unit, and then 

moved to a 95-day inpatient program at 

the Betty Ford Center. RD, at 18; Tr. 240. 

The Medical Board of California (MBC) 

required Respondent to participate in a 

recovery program for one year before 

formally putting her on probation. RD, 

at 18; Tr. 241–42. This program 

included undergoing monitoring with 

the Pacific Assistance Group (PAG),6

attending PAG support meetings twice 

weekly, attending Alcoholics 

Anonymous (AA) meetings, getting an 

AA sponsor, engaging in individual 

therapy, and attending meetings and 

programing through Betty Ford. RD, at 

18; Tr. 240–41. 

After a year of monitoring, the MBC 

and Respondent reached an agreement 

that resulted in restrictions being placed 

on Respondent’s medical license for 

seven years. RD, at 18; Tr. 242–43. The 

conditions included ‘‘all of the 

conditions that [she] was currently 

doing and then a few more.’’ RD, at 18; 

Tr. 243, 246–47; RX 2. Respondent 

testified that she was ‘‘100 percent’’ 

compliant with the terms of her 

probation. RD, at 19; Tr. 247–48. After 

approximately four years on probation, 

her probation agent suggested that she 

apply for early termination. Id. 

Respondent testified that she delayed 

her application for early termination 

because she was very comfortable in the 

routine that she had developed with 

PAG and AA, and she felt safe having 

their support. RD, at 19; Tr. 250–51. 

However, Respondent eventually 

applied for early termination, and her 

probation terminated on December 31, 

2020. RD, at 19; Tr. 249, 252; RX 4. 

During the time that Respondent was 

on probation with the MBC, she also 

entered into a Memorandum of 

Agreement (MOA) with DEA that 

allowed her to retain authority in 

Schedules II–V as long as she abided by 

the MBC’s restrictions, which included 

limiting her registration to prescribing 

and administering controlled substances 

in a perioperative or obstetric setting. 

RD, at 19; Tr. 252–53; RX 3. Respondent 

testified that she fully complied with 

the DEA restrictions, which terminated 

in December of 2020 along with her 

MBC probation. RD, at 19; Tr. 254–56. 

In January of 2021, less than 30 days 

after the MBC’s and DEA’s restrictions 

were lifted, Respondent relapsed and 

resumed diverting controlled substances 

from her employer for personal use.7

RD, at 19; Tr. 256–57. Respondent’s 

relapse lasted from January 2021 to 

March 2021, and she recalled diverting 

fentanyl, midazolam, and 

hydromorphone on at least ten 

occasions for intravenous use. RD, at 19; 

Tr. 257–58. Respondent testified that 

she diverted mostly ‘‘waste’’ controlled 

substances that were not used during a 

procedure and should have been 

discarded.8 Id. Respondent deceived the 

nurses by telling them that she was 

disposing of the ‘‘waste’’ substances, 

when instead she was disposing of 

saline. Id. On other occasions, 

Respondent overprescribed controlled 

substances to patients, or falsely 

documented that she had administered 

a controlled substance to a patient, and 

retained the excess for herself.9 RD, at 

19–20; Tr. 300. Respondent used the 

diverted controlled substances at home 

or in the call room where she worked at 

St. John’s hospital. RD, at 20; Tr. 258. 

On March 26, 2021, Respondent was 

found unconscious in the hospital 

bathroom after having unintentionally 

overdosed on fentanyl, midazolam, and 

propofol that she had falsely 

documented that she had given to a 

patient during her shift.10 RD, at 20–21; 

Tr. 298–300. 

Respondent’s testimony about the 

restrictions that the MBC placed on her 

registration after her 2021 relapse is 

summarized below. See infra III.B. 

II. Discussion 

A. The Five Public Interest Factors 

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

to . . . dispense a controlled substance 

. . . may be suspended or revoked by 

the Attorney General upon a finding 

that the registrant . . . has committed 

such acts as would render his 

registration under section 823 of this 

title inconsistent with the public 

interest as determined under such 

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

public interest determination, the CSA 

requires consideration of the following 

factors: 

(A) The recommendation of the 

appropriate State licensing board or 

professional disciplinary authority. 

(B) The [registrant’s] experience in 

dispensing, or conducting research with 

respect to controlled substances. 

(C) The [registrant’s] conviction record 

under Federal or State laws relating to the 

manufacture, distribution, or dispensing of 

controlled substances. 

(D) Compliance with applicable State, 

Federal, or local laws relating to controlled 

substances. 

(E) Such other conduct which may threaten 

the public health and safety. 

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

The Agency considers these public 

interest factors in the disjunctive. Robert 

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

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

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

2005). Any one factor, or combination of 

factors, may be decisive. David H. Gillis, 

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

The Government has the burden of 

proof in this proceeding. 21 CFR 

1301.44. While the Agency has 

considered all of the public interest 

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

Government’s evidence in support of its 

prima facie case for revocation of 


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11Respondent argues that Factor A weighs in her 

favor because the MBC considered her misconduct 

and put her on probation rather than revoking her 

state medical license. ALJ Exhibit (ALJX) 29, at 29. 

Prior Agency decisions have considered two forms 

of recommendations from state licensing entities: 

‘‘(1) A recommendation to DEA directly from a state 

licensing board or professional disciplinary 

authority . . . , which explicitly addresses the 

granting or retention of a [Registration]; and (2) the 

appropriate state entity’s action regarding the 

licensure under its jurisdiction on the same matter 

that is the basis for the DEA OSC.’’ John O. Dimowo, 

M.D., 85 FR 15,800, 15,810 (2020). Here, the MBC 

has not made a direct recommendation to DEA, but 

the MBC has considered the same misconduct 

alleged in the OSC and entered into a Stipulated 

Interim Order (Interim Order) with Respondent 

substantially restricting her registration. The 

Interim Order is not a final decision by the MBC, 

it does not contain final legal conclusions or factual 

findings, and it clarifies that any admissions 

regarding Respondent’s conduct are not admissible 

in administrative proceedings. RX 12, at 3 (‘‘The 

parties stipulate that the admissions made by 

Respondent as to the alleged conduct . . . are solely 

for the purpose of this stipulated Interim Order 

Imposing License Restrictions only, and shall not be 

used in any other proceeding before the [MBC], and 

shall not be admissible in any other criminal, civil, 

and/or administrative proceeding.’’). Moreover, the 

Order does not analyze whether Respondent’s 

continued registration is consistent with the public 

interest under the CSA, which is a determination 

that the Agency must make in deciding whether to 

sanction a registrant. Id. at 15,810 (citing Ajay S. 

Ahuja, M.D., 84 FR 5479, 5490 (2019)). Thus, the 

Agency finds that this Order is not determinative. 

Regarding Factor C, the Agency does not consider 

Respondent’s 2009 felony conviction as part of the 

public interest analysis because the Government 

did not allege that the conviction was a basis for 

revocation. RD, at 26 n.33. Finally, regarding Factor 

E, the absence of evidence of ‘‘other conduct which 

may threaten the public health and safety’’ does not 

militate for or against a finding that Respondent’s 

registration is inconsistent with the public interest. 

Id. 

12The Agency need not adjudicate the criminal 

violations alleged in the instant OSC. Ruan v. 

United States, 142 S. Ct. 2370 (2022) (decided in 

the context of criminal proceedings). 

13RD, at 2; Stipulation 3, 4 (‘‘[Respondent] 

acknowledges that her conduct reflects negative 

experience in dispensing with respect to controlled 

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

5 (‘‘[Respondent] failed to comply with applicable 

federal and state laws relating to controlled 

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

6. 

Respondent’s registration is confined to 

Factors B and D. RD, at 26–31; see also 

id. at 26 n.33 (finding that Factors A, C, 

and E do not weigh for or against 

revocation).11 Having reviewed the 

record and the RD, the Agency adopts 

the ALJ’s analysis, and agrees that the 

Government’s evidence satisfies its 

prima facie burden of showing that 

Respondent’s continued registration 

would be ‘‘inconsistent with the public 

interest.’’ 21 U.S.C. 824(a)(4); RD, at 25– 

31. 

B. Factors B and D 

Evidence is considered under Public 

Interest Factors B and D when it reflects 

compliance (or non-compliance) with 

laws related to controlled substances 

and experience dispensing controlled 

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

FR 1095, 1097 (2023); Kareem Hubbard, 

M.D., 87 FR 21,156, 21,162 (2022). In 

the current matter, the Government has 

alleged that Respondent violated 

numerous federal and state laws 

regulating controlled substances. OSC, 

at 1–2. Specifically, federal law requires 

that ‘‘[a] prescription for a controlled 

substance to be effective 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).12

California law provides that ‘‘no person 

shall knowingly prescribe, administer, 

dispense, or furnish a controlled 

substance to or for any person . . . not 

under his or her treatment for a 

pathology or condition.’’ Cal. Health & 

Safety Code § 11154(a). California law 

also provides that ‘‘no person shall 

prescribe, administer, or furnish a 

controlled substance for himself.’’ Id. at 

§ 11170. Further, California law defines 

unprofessional conduct to include 

‘‘[p]rescribing, dispensing, or furnishing 

[controlled substances] without an 

appropriate prior examination and a 

medical indication’’ and ‘‘commi[ting] 

[ ] any act involving dishonesty or 

corruption that is substantially related 

to the qualifications, functions, or duties 

of a physician and surgeon.’’ Cal. Bus. 

& Prof. Code §§ 2242(a), 2234. 

In the current matter, Respondent 

admitted that she diverted controlled 

substances for her own personal use on 

at least ten occasions between January 

2021 and March 2021. The parties 

stipulated that these acts of diversion 

occurred and that Respondent’s conduct 

weighs against her under Factors B and 

D.13 As Respondent’s conduct displays 

clear violations of the federal and state 

regulations described above, the Agency 

agrees with the ALJ and finds that 

Respondent repeatedly violated federal 

and state law relating to controlled 

substances. RD, at 41. Accordingly, the 

Agency agrees with the ALJ and finds 

that Factors B and D weigh in favor of 

revoking Respondent’s registration, and 

thus finds Respondent’s continued 

registration to be inconsistent with the 

public interest in balancing the factors 

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

III. Sanction 

Where, as here, the Government has 

established sufficient grounds to revoke 

Respondent’s registration, the burden 

shifts to Respondent to show why she 

can be entrusted with the responsibility 

carried by a registration. Garret Howard 

Smith, M.D., 83 FR 18,882, 18,904 

(2018). When a registrant has committed 

acts inconsistent with the public 

interest, she must both accept 

responsibility and demonstrate that she 

has undertaken remedial measures. 

Holiday CVS, L.L.C., dba CVS Pharmacy 

Nos 219 and 5195, 77 FR 62,316, 62,339 

(2012). Trust is necessarily a factdependent determination based on 

individual circumstances; therefore, the 

Agency looks at factors such as the 

acceptance of responsibility, the 

credibility of that acceptance as it 

relates to the probability of repeat 

violations, the nature of the misconduct 

that forms the basis for sanction, and the 

Agency’s interest in deterring similar 

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

M.D., 86 FR 33,738, 33,746 (2021). 

A. Acceptance of Responsibility 

Here, the Agency agrees with the ALJ 

that Respondent unequivocally accepted 

responsibility for her conduct and 

expressed genuine remorse for her 

actions. RD, at 31–35. Respondent fully 

accepted responsibility for the 

allegations outlined in the OSC, as well 

as her misconduct in 2009 and 2013, 

and agreed that she violated state and 

federal law. Id. at 22, 33; Tr. 332, 327. 

Respondent testified that, for her, 

accepting responsibility means making 

‘‘living amends’’ and not ‘‘minimizing’’ 

her actions. RD, at 33; Tr. 345–46. She 

feels ‘‘profound regret’’ for her relapse, 

but she is ‘‘trying to use [that regret] as 

a tool for good.’’ RD, at 22; Tr. 326–27. 

Respondent testified that her actions 

were egregious because she was 

dishonest, she ‘‘violated the trust of 

patients and nurses,’’ she ‘‘potentially’’ 

hurt patients, she knew better, and she 

failed to use her available resources to 

get help. RD, at 23; Tr. 346. 

Respondent’s willingness to reflect on 

her battle with addiction in a public 

forum is admirable, and the Agency 

agrees with the ALJ that Respondent 

unequivocally accepted responsibility 

for her misconduct. RD, at 31–35. 

B. Remedial Measures 

Having found that Respondent has 

unequivocally accepted responsibility 

for her conduct, the Agency considers 

whether Respondent has implemented 

sufficient remedial measures to 

demonstrate that she will not engage in 

future misconduct and can be trusted 

with a registration. Jayam Krishna-Iyer, 

M.D., 74 FR 459, 463 (2009). The 

Agency has acknowledged that ‘‘[i]n 

self-abuse cases, . . . successful 

rehabilitation efforts are an important 

consideration in determining whether a 

respondent can be trusted with a 

registration.’’ Trenton F. Horst, D.O., 80 

FR 41,079, 41,091 (2015); see also Abbas 

E. Sina, M.D., 80 FR 53,191, 53,201 


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14The Agency has held that remedial measures 

are given ‘‘limited-to-no-weight’’ when they are 

implemented after enforcement begins. See, e.g., 

Morris & Dickson Co., LLC, 88 FR 34,523 (2023) 

(citing Mireille Lalanne, M.D., 78 FR 47,750, 47,777 

(2013) (‘‘The Agency has recognized that a cessation 

of illegal behavior only when ‘DEA comes knocking 

at one’s door,’ can be afforded a diminished weight 

borne of its own opportunistic timing.’’); 

Southwood Pharmaceuticals, Inc., 72 FR 36,487, 

36,503 (2007) (giving no weight to respondent’s 

‘‘stroke-of-midnight decision’’ to cease supplying 

suspect pharmacies with controlled substances and 

to employ a compliance officer). This principle 

applies in even greater force here, where the 

remedial measures that Respondent has 

implemented appear to be mandatory under an 

agreement with the state medical board rather than 

voluntary. 

15Respondent described the ‘‘maintenance steps’’ 

as steps to avoid complacency by focusing on 

recognition of present feelings and emotions, faith 

and meditation, and outreach to others in recovery 

and service. RD, at 21; Tr. 309–10. 

16The Medical Director of UrgentMed, Dr. Peter 

Chung, testified that there were no complaints 

about Respondent’s treatment of patients and she 

received only positive feedback from patients and 

colleagues. RD, at 14; Tr. 175. The Agency agrees 

with the ALJ that Dr. Chung’s testimony was 

‘‘genuine and generally consistent, though the 

subject matter of his testimony is of limited 

relevance to these proceedings.’’ RD, at 13. The ALJ 

stated that ‘‘where relevant[,] [he would] give [Dr. 

Chung’s] testimony the weight that it deserves in 

light of other evidence and testimony presented 

during the hearing.’’ Id. The Agency agrees with the 

amount of weight that the ALJ afforded Dr. Chung’s 

testimony. 

17 Dr. James Golden, a California-licensed 

physician who is Board certified in addiction 

medicine, evaluated Respondent following her 

relapse in 2021. RD, at 11–12; Tr. 124–26. Dr. 

Golden testified that he initially determined that 

Respondent was fit to work twenty or thirty hours 

a week, because she has a ‘‘propensity to have 

problems when she [feels] overwhelmed.’’ RD, at 

12; Tr. 124–29. After additional meetings with 

Respondent, Dr. Golden has increased his 

recommended limitation to forty hours per week. 

RD, at 12; Tr. 130. Dr. Golden agreed that even 

physicians being monitored can relapse, but 

testified that relapse is less likely the longer a 

physician is in recovery and subject to monitoring. 

RD, at 12; Tr. 132–33. Dr. Golden further testified 

that Respondent ‘‘stands out [to him] as someone 

who is very committed’’ to her recovery program 

with a ‘‘willingness to continue with recovery.’’ RD, 

at 12; Tr. 135–36. Dr. Golden expressed support for 

the Respondent’s continued DEA registration and 

medical practice ‘‘so long as she is being monitored 

under the terms imposed by the Medical Board of 

California.’’ RD, at 12; Tr. 137. 

The Agency agrees with the ALJ that Dr. Golden’s 

testimony was ‘‘was genuine and generally 

consistent, though the bases for his 

recommendations and conclusions were not 

addressed in much detail.’’ RD, at 12. The ALJ 

determined that Dr. Golden’s testimony was 

‘‘credible and [he would] give it appropriate 

weight.’’ Id. The Agency agrees with the amount of 

weight that the ALJ afforded Dr. Golden’s 

testimony. 

18The Agency agrees with the ALJ that Dr. 

Zemansky ‘‘presented credible testimony that was 

internally consistent and generally logically 

persuasive’’ and that she ‘‘presented an objective 

analysis’’ despite her ‘‘close therapeutic 

relationship with the Respondent.’’ RD, at 11. The 

Agency also agrees with the ALJ that Dr. 

Zemansky’s testimony is entitled to significant 

weight. Id. 

(2015) (‘‘[T]he risk of relapse becomes 

critical in determining what steps are 

warranted when determining the public 

interest.’’) 

Respondent testified at length about 

the measures that she has taken, and 

will continue to take, to remain sober. 

These measures were implemented after 

Respondent was caught diverting from 

her employer in 2021, and they are 

mandatory under the terms of her 

agreements with the MBC and/or St. 

John’s Hospital (her current employer), 

which diminishes their weight as 

remedial evidence.14 However, the 

Agency appreciates that the measures 

that Respondent is required to take 

under her agreements with the MBC and 

St. John’s hospital are extensive, leaving 

little room for Respondent to implement 

additional voluntary measures. The 

Agency also appreciates that 

Respondent has made a sincere 

commitment to remaining sober for 

herself, and not just for her employer. 

Tr. 341. Thus, the Agency considers 

Respondent’s remedial measures in 

determining whether Respondent can be 

trusted with a DEA registration. 

Summary of Respondent’s Remedial 

Measures 

After her overdose in March of 2021, 

Respondent was put on a medical leave 

of absence and began a new 30-day 

inpatient treatment program at the Betty 

Ford Center. RD, at 21; Tr. 302–04. 

Following her discharge from Betty Ford 

in May of 2021, she completed another 

three-month outpatient addiction 

program. RD, at 21; Tr. 304–05, 307–09. 

On August 2, 2023, Respondent 

entered into a restrictive agreement with 

the MBC (the 2023 MBC Agreement) 

that allows her to continue practicing 

anesthesia as long as she: (1) abstains 

from using drugs and alcohol, (2) enlists 

a licensed physician to monitor her at 

work, (3) remains enrolled in the PAG 

program, (4) attends weekly substance 

abuse support group meetings, (5) 

receives psychotherapy, (6) submits to 

regular biological fluid testing (drug 

testing), and (7) notifies all of her 

employers about the MBC Agreement. 

RD, at 21–22; Tr. 323–24; RX 12, at 4– 

10. The MBC agreement allows 

Respondent to order, prescribe, and 

dispense controlled substances in a 

perioperative setting. RD, at 22; Tr. 324; 

RX 12 at 4. 

Respondent testified that she 

currently attends AA meetings five 

times per week and PAG meetings twice 

per week (more than is required by the 

MBC Agreement). RD, at 21; Tr. 309. 

Respondent has completed the AA 12- 

Step Program and remains in the 

‘‘maintenance steps,’’ 10, 11, and 12.15

RD, at 21; Tr. 309. 

Respondent’s return to work 

following her relapse began in 

November of 2021 at UrgentMed urgent 

care, where she worked through the 

spring of 2023.16 RD, at 21; Tr. 168, 315. 

In August of 2022, Respondent resumed 

practicing as an anesthesiologist at St. 

John’s Hospital, where her continued 

employment is conditioned upon 

compliance with a Return to Practice 

Agreement (the St. John’s Practice 

Agreement). RD, at 21; Tr. 315–18; RX 

9. In addition to the requirements 

outlined above in the 2023 MBC 

Agreement, the St. John’s Practice 

Agreement also requires Respondent to 

continue treatment with naltrexone (or 

an equivalent medication), to notify the 

hospital of any outside employment, 

and to maintain records of controlled 

substances ordered, prescribed, 

dispensed, administered, or possessed. 

RX 9, at 1–3. The St. John’s Practice 

Agreement also included restrictions 

that remained in place for a limited 

period of time, including proctoring for 

at least three cases, limitations on the 

number of shifts and hours worked, and 

evaluation by a board-certified 

addiction physician.17 Id. Respondent is 

currently working a full 40-hour per 

week schedule. RD, at 21; Tr. 318–19. 

Respondent offered eight witnesses to 

testify about Respondent’s commitment 

to remaining sober, her success in 

remaining sober from 2013 to 2020 

while being monitored by PAG, and 

their belief that there is a high 

likelihood that Respondent will remain 

sober under her current monitoring 

program. RD, at 6–17; Tr. 50–217. 

Tracy Zemansky, Ph.D., is a clinical 

psychologist and one of seven 

practitioners who owns and operates 

PAG.18 RD, at 6; Tr. 50, 55–56. Dr. 

Zemansky was accepted as an expert in 

psychology, specializing in the field of 

physician impairment, evaluation, and 

recovery. RD, at 6; Tr. 57–58. Dr. 

Zemansky has known Respondent since 

November of 2013, when Respondent 

initially enrolled in PAG after being 

caught diverting drugs from her 

employer the first time. RD, at 6; Tr. 58, 

61. Dr. Zemansky has also been 

involved in monitoring Respondent 

since her relapse in 2021. 

Dr. Zemansky testified that, in her 

expert opinion, Respondent remains 

safe to practice as a physician and safe 

to prescribe controlled substances. RD, 

at 9; Tr. 84–85, 94, 107–08. Dr. 

Zemansky testified that the stressors 

that led to Respondent’s relapse in 2021 

are a new focus of her recovery plan, 

and that her commitment to recovery is 


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19The Agency agrees with the ALJ that Dr. Wan’s 

testimony was ‘‘generally credible and consistent.’’ 

RD, at 17. The ALJ found that, ‘‘where relevant [he 

would] give his testimony the weight that it 

deserves in light of other evidence and testimony 

presented during the hearing.’’ Id. The Agency 

agrees with the amount of weight that the ALJ 

afforded Dr. Wan’s testimony. 

20 Dr. Wan testified that Respondent was not 

being formally monitored by the Well-Being 

Committee when she relapsed in 2021. RD, at 16; 

Tr. 206–07. Dr. Wan is not aware of any patient 

complaints or other issues in the seven or eight 

years that Respondent worked at St. John’s prior to 

relapsing. Id. 

21Respondent offered the testimony of four 

additional colleagues and friends who support the 

continuation of her registration: Kathleen Van 

Daalen Wetter, Kimrae McDonald, Dr. Karen Simon, 

and Dr. Bahram Namdari. Ms. Wetter has been 

Respondent’s AA sponsor for the past two years and 

interacts with her daily. RD, at 13. Ms. Wetter 

believes that Respondent has the ‘‘perfect attitude 

needed to continue to stay clean and sober,’’ and 

‘‘[s]he remains open, willing, and honest about her 

recovery.’’ Id.; Tr. 147. Ms. McDonald, a nurse who 

works with Respondent at St. John’s, testified that 

Respondent has a stellar reputation and she 

unequivocally supports Respondent’s ability to 

continue practicing as an anesthesiologist. RD, at 

13; Tr. 150–159. Dr. Simon, another colleague at St. 

John’s, testified that she has known Respondent for 

15 years, but was unaware of Respondent’s 

substance abuse history until these proceedings. 

RD, at 15; Tr. 193–97. Dr. Simon testified that since 

2021 she has not observed Respondent appear 

impaired while at work, and that she and 

Respondent have ‘‘an excellent working 

relationship.’’ RD, at 15; Tr. 198. Dr. Simon testified 

that Respondent’s practice at St. John’s is very busy 

and regularly involves emergency care, and that 

Respondent’s performance is ‘‘excellent’’ under 

those stressful conditions. RD, at 15–16; Tr. 199. Dr. 

Namdari, a California-licensed anesthesiologist, 

testified that he has worked with Respondent at St. 

John’s since 2015 and interacts with her nearly 

every workday as her workplace monitor. RD, at 15; 

Tr. 183–89. Dr. Namdari testified that since 

returning to work at St. John’s following her 

relapse, Respondent has had no issues, she is 

‘‘doing a great job,’’ and ‘‘patients are happy.’’ RD, 

at 15; Tr. 188. Dr. Namdari supported Respondent’s 

ability to continue administering controlled 

substances with monitoring in place. RD, at 15; Tr. 

189. 

The Agency agrees with the ALJ that the 

testimony of Ms. Wetters, Ms. McDonald, Dr. 

Simon, and Dr. Namdari was ‘‘genuine and 

generally consistent[,] though the subject matter of 

[their] testimony is of minimal relevance to these 

proceedings.’’ RD, at 13–16. The Agency agrees 

with the amount of weight that the ALJ afforded 

these witnesses’ testimony. 

22Several of Respondent’s witnesses 

acknowledged that relapse is possible (although 

rare) when physicians are being monitored for 

substance abuse. See RD, at 9–10; Tr. 87–88, 106– 

07 (Dr. Zemansky’s testimony); see also RD, at 12; 

Tr. 132–33 (Dr. Golden’s testimony); RD, at 17; Tr. 

217–18 (Dr. Wan’s testimony). 

sincere. RD, at 7–8, 11; Tr. 80, 101–04. 

Although Dr. Zemansky agreed that new 

and unforeseen stressors could cause a 

future relapse, she opined that having 

already gone through an extremely 

stressful situation resulting in relapse, 

Respondent now has additional tools 

that will help her remain sober. RD, at 

11; Tr. 104–05. Dr. Zemansky testified 

that Respondent is being monitored 

closely by St. John’s well-being 

committee, and that PAG provides St. 

John’s with monthly compliance 

reports. RD, at 9; Tr. 81–82. Dr. 

Zemansky testified that Respondent has 

not had any positive drug tests or 

missed any appointments since 

resuming monitoring with PAG, and 

that Respondent has been sober since 

March of 2021. RD, at 7–8; Tr. 69–72, 

74. Dr. Zemansky also highlighted that 

Respondent was fully compliant with 

her probation during her initial eight 

years of monitoring with PAG from 2013 

to 2020, and that she ‘‘went above and 

beyond what was required in terms of 

her attitude . . . [and] involvement in 

outside recovery.’’ RD, at 6–7, 9; Tr. 62– 

64; Tr. 84–85, 99–100. 

Dr. Zemansky opined that physicians 

in monitoring are ‘‘actually safer than 

physicians’’ who are not being 

monitored, because ‘‘we don’t know 

what [the unmonitored physicians] are 

doing.’’ RD, at 9; Tr. 81–82. However, 

Dr. Zemansky acknowledged that there 

is ‘‘always’’ a chance for relapse, and 

that relapse can occur even with 

monitoring, though rare. RD, at 9; Tr. 

87–88. 

Dr. Zemansky testified that she 

supported Respondent’s request for 

early termination of her probation in 

December of 2020. RD, at 9–10; Tr. 86– 

87, 105–06. At that time, Dr. Zemansky 

offered testimony on Respondent’s 

behalf in front of the MBC stating that 

she believed that Respondent had an 

excellent prognosis for continued 

success and that she had no reservations 

about terminating Respondent’s 

probation. Tr. 86–87. At the DEA 

hearing, Dr. Zemansky acknowledged 

that she regrets her decision to support 

the removal of all monitoring 

requirements in December of 2020, and 

she characterized Respondent’s relapse 

in January of 2021 as ‘‘brief but quite 

severe.’’ Tr. 87, 106–07. Dr. Zemansky 

testified that she ‘‘wish[es] that [she] 

had been able to foresee differently.’’ Tr. 

107. 

Dr. W. Lee Wan,19 a Californialicensed ophthalmologist and Chair of 

the Well-Being Committee at St. John’s, 

testified that the Well-Being Committee 

has assumed an active role in 

monitoring Respondent since her 2021 

relapse.20 RD, at 16; Tr. 205–06. Dr. Wan 

testified that Respondent has remained 

compliant with the St. John’s Practice 

Agreement. RD, at 17; Tr. 215. Dr. Wan 

supports Respondent’s continued ability 

to practice as an anesthesiologist and 

continued DEA registration, and 

testified that he believes Respondent 

remains fit for duty. RD, at 17; Tr. 217, 

221–22. However, Dr. Wan agreed that 

there is always a chance that an 

‘‘addicted physician’’ will relapse. Tr. 

217–18.21

Based on this evidence, the ALJ found 

that Respondent had ‘‘produced 

significant, unrebutted evidence 

showing that she is capable of 

complying with the terms of licensing 

restrictions and monitoring,’’ and 

concluded that the Agency can trust 

Respondent to handle controlled 

substances as long as these 

rehabilitative measures remain in place. 

RD, at 35, 38–39. The ALJ did observe, 

however, that the length of time 

between the end of Respondent’s 

probation in December of 2020 and her 

relapse in January of 2021 was 

‘‘especially concerning.’’ Id. at 39. 

The Agency agrees with the ALJ that 

the likelihood of Respondent relapsing 

is reduced if Respondent remains under 

strict monitoring. However, the record 

in this case establishes that relapse is 

always possible.22 Respondent’s expert 

witness, Dr. Zemansky, acknowledged 

this, and even admitted that she did not 

foresee Respondent’s severe relapse in 

2021. Thus, in assessing the adequacy of 

Respondent’s remedial measures, the 

Agency must weigh the reduced risk of 

relapse against the serious and 

unmitigable risk that Respondent poses 

to the public if she relapses on the job 

again. Respondent works with patients 

while they are heavily sedated or 

unconscious—in their most vulnerable 

state. The practice of anesthesia requires 

careful focus and continuous 

monitoring, as Respondent testified that 

medication is titrated during a 

procedure in small doses until the 

desired respiratory rate is achieved. RD, 

at 20 n.30; Tr. 335–39. During 

Respondent’s previous episodes of 

abuse and diversion, she treated 

patients for months at a time while 

under the influence, deceiving her 

colleagues and falsifying patient records 

to obtain more drugs. Although there 

was no evidence demonstrating that 

Respondent harmed any patients during 

her previous relapses, Respondent 

concedes that her conduct put patients 

at risk and could have caused harm. RD, 

at 20; Tr. 327–28, 337. 

The Agency finds that Respondent 

has presented substantial evidence of 

remedial measures and acknowledges 

that Respondent has taken admirable 

steps towards continued sobriety; but 

continued sobriety is not guaranteed. 

Moreover, the agency has long held that 

‘‘past performance is the best predictor 

of future performance.’’ ALRA Labs, Inc. 

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

Here, where Respondent had a ‘‘severe’’ 

relapse one month after the prior 


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23The ALJ concluded that Respondent’s conduct 

was egregious, but found that there were two factors 

that mitigated the egregiousness: first, that 

Respondent’s addiction problems ‘‘greatly impacted 

her decision-making leading to her deceptive 

actions,’’ and second, that the record is devoid of 

evidence that Respondent directly harmed her 

patients. RD, at 37–38. The Agency agrees that the 

first factor could be mitigating in certain 

circumstances, but finds that the weight of the 

evidence supports a sanction of revocation, as 

discussed throughout this Order. Regarding the 

second factor, the Agency does not consider the 

lack of evidence of harm to be a mitigating factor 

because of the significant risk to public health and 

safety that Respondent posed while treating 

patients under the influence. The Agency has 

repeatedly held that it is not necessary for the 

Agency to find patient harm to revoke a registration 

and has declined to consider a lack of harm as 

evidence of positive prescribing experience. See, 

e.g., Larry C. Daniels, M.D., 86 FR 61630, 61660– 

61 (2021) (‘‘Waiting for a controlled substance to be 

found coursing through a person’s bloodstream 

before holding the registrant accountable is wholly 

at odds with the DEA’s responsibility to protect the 

public interest under 21 U.S.C. 823(f).’’); Jeanne E. 

Germeil, M.D., 85 FR 73786, 73799 n.32 (2020) (‘‘I 

decline to consider that ‘no reported overdoses or 

deaths’ is an indicator of positive dispensing 

experience and there is no legal authority for the 

proposition that I must find death or an overdose 

before I may suspend or revoke a registration.’’). 

24See ALJX 29, at 34–36 (citing Judy L. 

Henderson, D.V.M., 65 FR 5672 (2000); Theodore 

Neujahr, D.V.M., 65 FR 5680 (2000); Jimmy H. 

Conway, Jr., M.D., 64 FR 32271 (DEA 1999); Robert 

G. Hallermeier, M.D., 62 FR 26,818 (1997); Karen A. 

Kruger, M.D., 69 FR 7016 (2004) Jeffrey Martin Ford, 

D.D.S., 68 FR 10750 (2003)). 

25See, e.g., Abbas E. Sina, M.D., 80 FR 53191 

(2015) (physician with a long history of abusing 

alcohol, controlled substances, and illicit drugs 

allowed to retain a restricted registration, despite 

repeated acts of issuing unlawful prescriptions, 

because he unequivocally accepted responsibility 

for his misconduct and demonstrated that he had 

successfully complied with substance abuse 

monitoring for four years); Trenton F. Horst, D.O., 

80 FR 41079 (2015) (physician with a history of 

self-abuse granted a restricted registration, despite 

repeatedly issuing unlawful prescriptions and 

possessing methamphetamine without a 

prescription, after expressing true remorse for his 

actions and demonstrating compliance with a 

substance abuse treatment plan for seven months). 

restrictions to her controlled substances 

authority were lifted, the Agency is not 

confident that it can trust Respondent 

with the continuation of her registration 

even with the remedial measures in 

place. 

C. Deterrent Effect and Egregiousness 

Acceptance of responsibility and 

remedial measures are assessed in the 

context of the ‘‘egregiousness of the 

violations and the [DEA’s] interest in 

deterring similar misconduct by [the] 

Respondent in the future as well as on 

the part of others.’’ Daniel A. Glick, 

D.D.S., 80 FR 74,800, 74,810 (2015); 

OakmontScript Limited Partnership, 87 

FR 21,546, 21,545 (2022). Here, 

although Respondent accepted 

responsibility and expressed a genuine 

commitment to ensuring that she does 

not relapse again, she has a long history 

of violating federal and state laws 

related to controlled substances. DEA 

has shown leniency in the past by 

allowing Respondent to retain her 

registration after her previous offenses, 

but Respondent reverted back to 

intentionally diverting from her 

employer less than 30 days after DEA’s 

and the MBC’s restrictions were lifted, 

and she continued diverting for several 

months until she was caught. Thus, the 

Agency finds that considerations of 

specific deterrence weigh in favor of 

revocation. The Agency also finds that 

the interests of general deterrence 

support revocation. A decision to 

maintain Respondent’s registration after 

repeated behavior of intentionally 

diverting from her employer and 

violating other controlled substance 

laws would send a message to the 

registrant community that repeated acts 

of intentional diversion can be 

overlooked or excused as long as the 

Respondent accepts responsibility when 

confronted. 

The egregiousness of Respondent’s 

conduct also supports a sanction of 

revocation.23 Respondent engaged in 

prolonged and repeated acts of 

intentional diversion, involving 

deception, theft, and falsifying patient 

records, that ‘‘strike[] at the CSA’s core 

purpose.’’ Samuel Mintlow, M.D., 80 FR 

3630, 3653 (2015). In this case, the 

Agency believes that revocation of 

Respondent’s registration would 

encourage the general registrant 

community to seek help as soon as 

possible upon experiencing substance 

abuse problems, in order to avoid 

violating the Agency’s trust by engaging 

in repeated and intentional diversion. 

Respondent agrees that her 

misconduct was egregious, but she cites 

in her Post-Hearing Brief to several 

cases where the Agency has allowed 

physicians to retain restricted 

registrations despite intentional and 

egregious violations of the CSA. ALJX 

29, at 34–36. However, most of the cases 

that Respondent cites were decided 

more than 20 years ago, before the 

opioid epidemic surged.24 The Agency 

has since departed from some of its 

more lenient sanction policies, citing 

the need to protect the public from 

abuse and diversion. For example, in 

Jayam Krishna-Iyer, the Agency noted 

that ‘‘[b]ecause of the grave and 

increasing harm to public health and 

safety caused by the diversion of 

prescription controlled substances,’’ it 

would no longer allow registrants who 

intentionally diverted controlled 

substances to retain their registrations if 

they declined to accept responsibility. 

Jayam Krishna-Iyer, M.D., 74 FR 459, 

463 (2009). In Southwood and Gaudio, 

the Agency further clarified that it 

would consider the deterrent effect of a 

potential sanction, in addition to 

requiring registrants to accept 

responsibility and demonstrate that they 

could be trusted with a registration. 

Southwood Pharmaceuticals, Inc., 72 FR 

36487, 36504 (2007); Joseph Gaudio, 

M.D., 74 FR 10083, 10094 (2009). 

Although the Agency has issued 

decisions within the past decade 

maintaining or granting restricted 

registrations notwithstanding 

intentional and egregious violations of 

the CSA,25 the Agency considers the 

unique facts of each case in determining 

the appropriate sanction. In this case, 

there are significant factors weighing 

against continuing Respondent’s 

registration, including the recurrent 

nature of her misconduct, the severity of 

her relapse, the substantial danger that 

she will pose to the public if she 

relapses again, the high level of 

deception involved in her diversion, 

and the speed with which Respondent 

resumed her unlawful behavior after 

DEA and the MBC lifted their 

restrictions in December of 2020. 

Respondent also argues that 

revocation is not necessary for purposes 

of deterrence, and that revoking 

Respondent’s registration would 

‘‘send[ ] the wrong message to impaired 

physicians’’ that ‘‘if you are open, 

honest, and admit to abusing or 

diverting controlled substances and seek 

help, you may have your DEA 

registration revoked.’’ ALJX 29, at 36. 

However, this record establishes that 

DEA did show leniency to Respondent 

previously, in 2013, which should give 

addicted registrants hope that by 

accepting responsibility and 

remediating their actions they too may 

be shown leniency for CSA violations. 

Rather, this decision is meant to 

encourage recovering registrants to 

continue to follow the CSA and avoid 

diversion even after DEA lifts any 

restrictions. Moreover, Respondent did 

not admit to abusing or diverting 

controlled substances and seek help 

until after she was confronted by her 

employer in both 2013 and 2021. If she 

had immediately sought help after 

relapsing in January of 2021, rather than 

diverting from her employer for several 

months until getting caught, 

Respondent’s argument regarding 

deterrence may have been more 

persuasive. 

In sum, Respondent has not offered 

sufficient credible evidence on the 

record to rebut the Government’s case 

for revocation and Respondent has not 

demonstrated that she can be entrusted 


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1Respondent argues in its Exceptions to the 

Recommended Decision (Exceptions) that the ISO 

‘‘led to the ‘wrongful takings’ of its DEA license’’ 

because the hearing established that no diversion 

occurred and there was ‘‘no imminent harm, no 

harm, and no damage, threat or harm to the ‘public 

interest.’ ’’ Exceptions, at 1 (citing Tr. 8, 14, 52–53, 

55, 69, 179–81, 192). However in this case, the 

evidence showed that Respondent repeatedly 

dispensed dangerous combinations of controlled 

substances that posed serious risks to patients 

without first resolving blatant red flags of drug 

abuse and diversion. Respondent’s repeated 

dispensing of controlled substances outside the 

usual course of the professional practice and in 

violation of federal and state law established ‘‘a 

substantial likelihood of an immediate threat that 

death, serious bodily harm, or abuse of a controlled 

substance . . . [would] occur in the absence of the 

immediate suspension’’ of Respondent’s 

registration. 21 U.S.C. 824(d). Thus, the Agency 

finds that at the time the Government issued the 

OSC/ISO, there was clear evidence of imminent 

danger. Moreover, the immediate suspension aspect 

of the Government’s case was final as of the date 

the OSC/ISO was issued by the Administrator, and 

is not the subject of these proceedings. 21 U.S.C. 

824(d)(1) (‘‘A[n immediate] suspension . . . shall 

continue in effect until the conclusion of 

[administrative enforcement] proceedings, 

including judicial review thereof, unless sooner 

withdrawn by the Attorney General or dissolved by 

a court of competent jurisdiction.’’); 21 CFR 

1301.36(h) (‘‘Any suspension shall continue in 

effect until the conclusion of all proceedings upon 

the revocation or suspension, including any judicial 

review thereof, unless sooner withdrawn by the 

Administrator or dissolved by a court of competent 

jurisdiction.’’). 

2The Agency has reviewed and considered the 

Respondent’s exceptions and addresses them 

herein, but ultimately agrees with the ALJ’s 

recommendation. 

3The Agency adopts the ALJ’s summary of each 

witness’ testimony, as well as the ALJ’s assessment 

of each witness’ credibility, except as clarified 

herein. See RD, at 4–53. 

4Respondent argues in its Exceptions that the ALJ 

was biased towards the Government. Respondent’s 

only record support for this assertion is a citation 

to the transcript where the ALJ thanks the 

Government for printing certain documents in large 

enough font for him to read. Exceptions, at 3 (citing 

Tr. 46–47). Respondent cites no authority 

suggesting that the ALJ’s expression of appreciation 

for a chosen font size reflects bias especially where, 

as here, the ALJ thanked both parties at the end of 

the hearing for their zealous advocacy. Tr. 522. 

5For Ms. Salinas’s full qualifications, see RD, at 

6–7, Government Exhibit (GX) 10. 

6The Agency incorporates herein the entire 

summary of Dr. Okpala’s testimony. RD, at 19–24. 

7The ALJ found Dr. Okpala’s testimony to be 

‘‘generally credible,’’ while noting that Dr. Okpala 

failed to lay an adequate foundation for his 

testimony that the patients in this case suffered 

from chronic pain. RD, at 24. The ALJ determined 

that ‘‘[t]o the extent that [Dr. Okpala’s] testimony 

differs from the testimony of other testifying 

witnesses, I will consider his personal interest in 

this case, and I will give his testimony the weight 

it deserves in light of other evidence and testimony 

presenting during the hearing.’’ Id. The Agency 

agrees with the amount of weight that the ALJ 

afforded Dr. Okpala’s testimony, except as clarified 

herein. 

with the responsibility of registration. 

Accordingly, the Agency will order that 

Respondent’s registration be revoked. 

Order 

Pursuant to 28 CFR 0.100(b) and the 

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

824(a), I hereby revoke DEA Certificate 

of Registration No. FV3660037 issued to 

Mary A. Vreeke, M.D. Further, pursuant 

to 28 CFR 0.100(b) and the authority 

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

hereby deny any pending applications 

of Mary A. Vreeke, M.D. to renew or 

modify this registration, as well as any 

other pending application of Mary A. 

Vreeke, M.D., for additional registration 

in California. This Order is effective 

October 16, 2024. 

Signing Authority 

This document of the Drug 

Enforcement Administration was signed 

on September 10, 2024, by 

Administrator Anne Milgram. That 

document with the original signature 

and date is maintained by DEA. For 

administrative purposes only, and in 

compliance with requirements of the 

Office of the Federal Register, the 

undersigned DEA Federal Register 

Liaison Officer has been authorized to 

sign and submit the document in 

electronic format for publication, as an 

official document of DEA. This 

administrative process in no way alters 

the legal effect of this document upon 

publication in the Federal Register. 

Heather Achbach, 

Federal Register Liaison Officer, Drug 

Enforcement Administration. 

[FR Doc. 2024–20939 Filed 9–13–24; 8:45 am] 

BILLING CODE 4410–09–P 

DEPARTMENT OF JUSTICE 

Drug Enforcement Administration 

[Docket No. 23–48] 

Awesome Care Pharmacy, Inc.; 

Decision and Order 

On June 1, 2023, the Drug 

Enforcement Administration (DEA or 

Government) issued an Order to Show 

Cause and Immediate Suspension of 

Registration (OSC/ISO) to Awesome 

Care Pharmacy, Inc., (Respondent) of 

Houston, Texas. OSC/ISO, at 1. The 

OSC/ISO informed Respondent of the 

immediate suspension of its DEA 

Certificate of Registration Number 

FA2332346 (registration), pursuant to 21 

U.S.C. 824(d), alleging that 

Respondent’s continued registration 

constitutes ‘‘an imminent danger to the 

public health or safety.’’ Id. at 1 (quoting 

21 U.S.C. 824(d)).1 The OSC/ISO also 

proposed the revocation of 

Respondent’s registration, alleging that 

Respondent’s continued registration is 

inconsistent with the public interest. Id. 

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

A hearing was held before DEA 

Administrative Law Judge Paul E. 

Soeffing (the ALJ), who, on February 6, 

2024, issued his Recommended Rulings, 

Findings of Fact, Conclusions of Law, 

and Decision (Recommended Decision 

or RD), which recommended revocation 

of Respondent’s registration. RD, at 59. 

Following the issuance of the RD, 

Respondent filed exceptions.2 Having 

reviewed the entire record, the Agency 

adopts and hereby incorporates by 

reference the entirety of the ALJ’s 

rulings, credibility findings,3 findings of 

fact, conclusions of law, sanctions 

analysis, and recommended sanction as 

found in the RD and summarizes and 

clarifies portions thereof herein.4

I. Findings of Fact 

Texas Standard of Care 

Katherine Salinas testified as the 

Government’s expert regarding the 

standard of care for pharmacy practice 

in the State of Texas. RD, at 6; Tr. 96– 

97. Ms. Salinas has been licensed as a 

pharmacist in Texas for over thirty years 

and has dispensed medications in retail 

pharmacies since 1992. RD, at 6; Tr. 89– 

91, 167. Ms. Salinas served as a 

Compliance Officer with the Texas 

Board for approximately nine years, 

where she inspected approximately 

2,700 pharmacies, and she currently 

works as the Medication Safety and 

Drug Diversion Supervisor for the 

University of Texas Medical Branch. 

RD, at 6–7; Tr. 93–95.5

Dr. Okpala, Respondent’s owner and 

Pharmacist-in-Charge (PIC), testified on 

Respondent’s behalf. Dr. Okpala 

testified that he has been licensed as a 

pharmacist in Texas since 1993. RD, at 

20; Tr. 373, 376–77; RX 2, at 2.6 The 

Agency agrees with the ALJ that Dr. 

Okpala has a significant personal 

interest in the outcome of these 

proceedings. RD, at 24. Additionally, 

the Agency finds that Dr. Okpala’s 

testimony at times contradicted the 

language of Texas’s regulations. 

Therefore, to the extent that Dr. 

Okpala’s testimony diverges from the 

Texas regulations and the testimony of 

Ms. Salinas, the Agency will credit Ms. 

Salinas’s testimony.7

Ms. Salinas testified that the standard 

of care in Texas is informed by DEA 

regulations and Texas laws and 

regulations, including Texas 

Administrative Code § 291.29(b), which 

requires pharmacists to ‘‘make every 

reasonable effort to ensure that any 

prescription drug order . . . has been 

issued for a legitimate medical purpose 

by a practitioner in the course of 

medical practice.’’ 22 Tex. Admin. Code 

§ 291.29(b); RD, at 7–8; Tr. 98–100. Ms. 


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