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7The Government has also alleged that Registrant 

violated Cal. Bus. & Prof. Code § 2241.5. Section 

2241.5 permits California physicians to treat pain, 

including intractable pain, but requires them, 

among other requirements, to ‘‘exercise reasonable 

care in determining whether a particular patient or 

condition, or the complexity of a patient’s 

treatment, . . . requires consultation with, or 

referral to, a more qualified specialist.’’ Dr. 

Munzing’s expert report did not address whether 

Registrant failed to exercise reasonable care in 

determining whether the subject patients’ treatment 

required consultation with, or referral to, a more 

qualified specialist. Accordingly, I find that the 

Government has not met its burden to prove by 

substantial evidence that Registrant violated Cal. 

Bus. & Prof. Code § 2241.5. 

1Registration No. BR0869719 is assigned to 

Respondent. Registration No. BA7661564 is 

assigned to Aurora Surgery Center. OSC, at 2. 

Nothing in the record transmitted to me challenges 

Respondent’s responsibility for both of these 

registrations. See also infra section III.A. 

sustaining the Government’s allegation 

that Registrant violated 21 CFR 1306.04. 

ii. Allegations of Violations of California 

Law 

The Government has also alleged that 

Registrant’s prescribing practices in 

regards to the subject patients violated 

state law. OSC, at 4–7. Echoing the 

federal regulations, California law 

requires that a ‘‘prescription for a 

controlled substance shall only be 

issued for a medical purpose by an 

individual practitioner acting in the 

usual course of his or her professional 

practice.’’ Cal. Health & Safety Code 

11153(a). Therefore, I find that, 

similarly to 21 CFR 1306.04(a), the 

record contains substantial evidence 

that Registrant violated this provision 

with respect to the controlled substance 

prescriptions for Patients K.K., G.K., 

T.L., J.P., and Y.P. I also find based on 

the uncontroverted evidence that 

Registrant issued these same controlled 

substance prescriptions without ‘‘an 

appropriate prior examination and a 

medical indication,’’ which is a 

violation of Cal. Bus. & Prof. Code 

2242(a).7

In sum, I find that the record contains 

substantial evidence that Registrant 

issued a multitude of prescriptions for 

controlled substances, including high 

dosages of opioids, to multiple patients 

beneath the applicable standard of care, 

outside the usual course of the 

professional practice, and in violation of 

federal and state law. I, therefore, find 

that Factors Two and Four weigh in 

favor of revocation. See Mark A. 

Wimbley, M.D., 86 FR 20713, 20726 

(2021). 

III. Sanction 

Where, as here, the Government has 

met its prima facie burden of showing 

that Registrant’s registration should be 

revoked because his continued 

registration is inconsistent with the 

public interest, the burden shifts to the 

Registrant to show why he can be 

entrusted with a registration. Garrett 

Howard Smith, M.D., 83 FR 18882, 

18910 (2018) (collecting cases). 

The CSA authorizes the Attorney 

General to ‘‘promulgate and enforce any 

rules, regulations, and procedures 

which he may deem necessary and 

appropriate for the efficient execution of 

his functions under this subchapter.’’ 21 

U.S.C. 871(b). This authority 

specifically relates ‘‘to ‘registration’ and 

‘control,’ and ‘for the efficient execution 

of his functions’ under the statute.’’ 

Gonzales, 546 U.S. at 259. ‘‘Because 

‘past performance is the best predictor 

of future performance, ALRA Labs, Inc. 

v. Drug Enf’t Admin., 54 F.3d 450, 452 

(7th Cir. 1995), [the Agency] has 

repeatedly held that where a registrant 

has committed acts inconsistent with 

the public interest, the registrant must 

accept responsibility for [the 

registrant’s] actions and demonstrate 

that [registrant] will not engage in future 

misconduct.’ ’’ Jayam Krishna-Iyer, 74 

FR at 463 (quoting Medicine Shoppe, 73 

FR 364, 387 (2008)); see also Jackson, 72 

FR at 23853; John H. Kennnedy, M.D., 

71 FR 35705, 35709 (2006); Prince 

George Daniels, D.D.S., 60 FR 62884, 

62887 (1995). The issue of trust is 

necessarily a fact-dependent 

determination based on the 

circumstances presented by the 

individual registrant; therefore, the 

Agency looks at factors, such as the 

acceptance of responsibility, and the 

credibility of that acceptance as it 

relates to the probability of repeat 

violations or behavior, and the nature of 

the misconduct that forms the basis for 

sanction, while also considering the 

Agency’s interest in deterring similar 

acts. See Arvinder Singh, M.D., 81 FR 

8247, 8248 (2016). 

In this matter, Registrant did not avail 

himself of the opportunity to refute the 

Government’s case. As such, Registrant 

has made no representations as to his 

future compliance with the CSA or 

made any demonstration that he can be 

trusted with a registration. The evidence 

presented by the Government of 

Registrant’s conduct clearly indicates 

that he cannot be so entrusted. 

Accordingly, I shall order the 

sanctions the Government requested, as 

contained in the Order below. 

Order 

Pursuant to 28 CFR 0.100(b) and the 

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

824(a) and § 823(f), I hereby revoke DEA 

Certificate of Registration No. 

BB0500365. Further, pursuant to 28 CFR 

0.100(b) and the authority vested in me 

by 21 U.S.C. 823(f), I hereby deny any 

pending application of David H. Betat, 

M.D. to renew or modify this 

registration, as well as any other 

pending application of David H. Betat, 

M.D. for registration in California. This 

Order is effective May 11, 2022. 

Anne Milgram, 

Administrator. 

[FR Doc. 2022–07685 Filed 4–8–22; 8:45 am] 

BILLING CODE 4410–09–P 

DEPARTMENT OF JUSTICE 

Drug Enforcement Administration 

[Docket No. 19–38] 

Craig S. Rosenblum, M.D.; Decision 

and Order 

I. Introduction 

On August 8, 2019, a former Acting 

Administrator of the Drug Enforcement 

Administration (hereinafter, DEA or 

Government), issued an Order to Show 

Cause and Immediate Suspension of 

Registration to Craig S. Rosenblum, 

M.D. (hereinafter, Respondent), of Palm 

Desert, California. Administrative Law 

Judge Exhibit (hereinafter, ALJX) 1 

(Order to Show Cause and Immediate 

Suspension of Registration (hereinafter 

collectively, OSC)), at 1. The OSC 

informed Respondent of the immediate 

suspension of his DEA Certificates of 

Registration BR0869719, BA7661564, 

and DATA-Waiver No. XR0869719 

‘‘because . . . [his] continued 

registration constitute[d] ‘an imminent 

danger to the public health and 

safety.’ ’’ 1 Id. 

The substantive ground for the 

proceeding, as alleged in the OSC, is 

that Respondent ‘‘committed such acts 

as would render . . . [his] registration 

under 21 U.S.C. 823(f) inconsistent with 

the public interest. See 21 U.S.C. 

824(a)(4).’’ Id. at 2. Specifically, the OSC 

alleges that Respondent issued unlawful 

controlled substance prescriptions, that 

this ‘‘conduct reflects negative 

experience in prescribing with respect 

to controlled substances in violation of 

21 U.S.C. 823(f)(2),’’ and that 

Respondent ‘‘failed to comply with 

applicable federal and state laws 

relating to controlled substances in 

violation of 21 U.S.C. 823(f)(4).’’ Id. The 

OSC also alleges that a California 

medical expert reviewed Respondent’s 

medical files and Controlled Substance 

Utilization Review and Evaluation 

System (hereinafter, CURES) reports and 

concluded that Respondent’s ‘‘issuance 

of each prescription fell below minimal 


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medical standards applicable to the 

practice of medicine in California.’’ Id. 

at 3. The OSC sets out specifics of 

Respondent’s alleged prescribing for six 

individuals to support its allegations. Id. 

at 4–10. 

According to the OSC, in view of the 

information before the DEA at the time, 

the former Acting Administrator 

preliminarily found that Respondent’s 

continued registration was ‘‘inconsistent 

with the public interest,’’ that 

Respondent’s issuance of multiple 

controlled substance prescriptions was 

‘‘without any legitimate medical 

purpose,’’ and that his ‘‘continued 

registration during the pendency of 

these proceedings would constitute ‘an 

imminent danger to the public health or 

safety’ because of the substantial 

likelihood of an imminent threat that 

death, serious bodily harm, or abuse of 

a controlled substance will occur in the 

absence of . . . suspension.’’ Id. at 10– 

11. Citing 21 U.S.C. 824(d), 21 CFR 

1301.36(e), and other authorities, the 

former Acting Administrator suspended, 

‘‘effective immediately’’ and ‘‘until a 

final determination is reached in these 

proceedings,’’ BR0869719, BA7661564, 

and DATA-Waiver No. XR0869719, and 

directed the DEA Special Agents and 

Diversion Investigators serving the OSC 

to take possession of those certificates. 

Id. at 11. 

The OSC notified Respondent of his 

right to request a hearing on the 

allegations or to submit a written 

statement while waiving his right to a 

hearing, the procedures for electing each 

option, and the consequences for failing 

to elect either option. Id. (citing 21 CFR 

1301.43). According to the 

Government’s Notice of Service, a 

member of the DEA Riverside District 

Office personally served the OSC on 

Respondent on August 9, 2019. ALJX 2 

(Government’s Notice of Service of 

Order to Show Cause and Immediate 

Suspension of Registration dated August 

12, 2019), at 1. 

By letter dated August 20, 2019, 

Respondent timely requested a hearing. 

ALJX 3, at 1. The matter was placed on 

the docket of the Office of 

Administrative Law Judges and assigned 

to Administrative Law Judge Charles 

Wm. Dorman (hereinafter, ALJ). During 

the pre-hearing phase of this 

proceeding, the parties agreed to and 

submitted 116 joint stipulations 

(hereinafter, Jt. Stip.) that, at the 

hearing, the parties accepted as 

‘‘binding facts in these proceedings.’’ 

Prehearing Ruling dated September 20, 

2019, at 2–10; Parties’ Additional Joint 

Stipulations dated October 28, 2019, at 

1–13; Transcript page number 

(hereinafter, Tr.) 9. The final, agreed-to 

Stipulations as set out by the ALJ are: 

Controlled Substances 

1. Tetrahydrocannabinol (hereinafter, 

THC) is an illicit Schedule I Controlled 

Substance pursuant to 21 CFR 

1308.11(d)(31). 

2. Amphetamine salts (Adderall) are 

Schedule II Controlled Substances 

pursuant to 21 CFR 1308.12(d)(1). 

3. Fentanyl (Duragesic patch) is a 

Schedule II Controlled Substance 

pursuant to 21 CFR 1308.12(c)(9). 

4. Hydrocodone (Norco) is a Schedule 

II Controlled Substance pursuant to 21 

CFR 1308.12(b)(1)(vi). 

5. Hydromorphone (Dilaudid) is a 

Schedule II Controlled Substance 

pursuant to 21 CFR 1308.12(b)(1)(vii). 

6. Methadone is a Schedule II 

Controlled Substance pursuant to 21 

CFR 1308.12(c)(15). 

7. Oxycodone (Oxycontin or 

Roxicodone) is a Schedule II Controlled 

Substance pursuant to 21 CFR 

1308.12(b)(1)(xiii). 

8. Oxycodone-acetaminophen 

(Percocet) is a Schedule II Controlled 

Substance pursuant to 21 CFR 

1308.12(b)(1)(xiii). 

9. Alprazolam (Xanax) is a Schedule 

IV Controlled Substance pursuant to 21 

CFR 1308.14(c)(2). 

10. Carisoprodol (Soma) is a Schedule 

IV Controlled Substance pursuant to 21 

CFR 1308.14(c)(6). 

11. Clonazepam (Klonopin) is a 

Schedule IV Controlled Substance 

pursuant to 21 CFR 1308.14(c)(11). 

12. Diazepam (Valium) is a Schedule 

IV Controlled Substance pursuant to 21 

CFR 1308.14(c)(16). 

13. Promethazine with codeine is a 

Schedule V Controlled Substance 

pursuant to 21 CFR 1308.15(c)(1). 

Registrations Associated With 

Respondent 

14. Respondent is registered as a 

practitioner with the DEA to handle 

controlled substances in Schedules II 

through V under DEA COR number 

BR0869719 at 73–950 Alessandro Drive, 

Suite 4, Palm Desert, California 92260. 

15. Respondent’s DEA COR expires by 

its terms on April 30, 2021. 

16. Government Exhibit 1 contains a 

true and correct copy of Respondent’s 

DEA COR number BR0869719. 

17. Respondent operates Aurora 

Surgery Center LP. 

18. Aurora Surgery Center LP is 

organized in the State of California as a 

Limited Partnership. 

19. Respondent is listed as the one 

and only General Partner on Aurora 

Surgery Center LP’s Certificate of 

Limited Partnership. 

20. Government Exhibit 2 contains a 

true and correct copy of the Certificate 

of Limited Partnership for Aurora 

Surgery Center LP. 

21. Aurora Surgery Center LP is 

registered as a hospital/clinic with the 

DEA to handle controlled substances in 

Schedules II through V under DEA COR 

number BA7661564 at 73–950 

Alessandro Drive, Palm Desert, 

California 92260. 

22. Aurora Surgery Center LP’s DEA 

COR expires by its terms on June 30, 

2020. 

23. Government Exhibit 1 contains a 

true and correct copy of Aurora Surgery 

Center LP’s DEA COR number 

BA7661564. 

24. Respondent is a DATA-waived 

(Drug Addiction Treatment Act) 

physician certified to treat 100 patients 

for substance abuse. 

25. Respondent’s DATA-Waiver 

Identification number is XR0869719. 

26. Respondent is licensed in the 

State of California to practice medicine 

pursuant to state license number 

G59060. 

27. Respondent’s state medical license 

expires by its terms on February 29, 

2020. 

Investigation 

28. Government Exhibit 3 contains 

true and correct copies of the 

administrative subpoenas issued to 

Respondent, dated January 16, 2019. 

29. Government Exhibit 4 contains 

true and correct copies of the 

administrative subpoenas issued to 

various pharmacies, dated April 19, 

2019. 

30. Government Exhibit 6 is a true 

and correct copy of the ‘‘Guide to the 

Laws Governing the Practice of 

Medicine by Physicians and Surgeons’’ 

published by the Medical Board of 

California in 2013. 

31. Government Exhibit 7 is a true 

and correct copy of the ‘‘Guidelines for 

Prescribing Controlled Substances for 

Pain’’ published by the Medical Board 

of California in November 2014. 

32. Government Exhibit 8 is a true 

and correct copy of ‘‘Calculating Total 

Daily Dose of Opioids for Safer Dosage’’ 

published by the Centers for Disease 

Control and Prevention (CDC). 

33. Government Exhibit 9 contains a 

true and correct copy of ‘‘New Safety 

Measures Announced for Opioid 

Analgesics, Prescription Opioid Cough 

Products, and Benzodiazepines’’ 

published by the Food and Drug 

Administration (FDA). 

34. Government Exhibit 9 contains 

true and correct copies of the FDA 

labels for Klonopin, Valium, and Xanax. 

35. Government Exhibits 10A and 10B 

contain true and correct copies of the 


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CURES reports for Respondent’s 

prescribing behavior between January 1, 

2018 and August 20, 2019. 

Patient A.A. 

36. Government Exhibits 12A and 12B 

contain true and correct copies of 

Respondent’s patient medical file for 

Patient A.A. 

37. On the following 16 occasions, 

Respondent issued a prescription for 

180 tablets of Percocet 10–325 mg, a 

prescription for 60 tablets of Xanax 2 

mg, and a prescription for 180 tablets of 

methadone 10 mg for Patient A.A.: 

a. December 26, 2017 

b. February 2, 2018 

c. March 7, 2018 

d. April 3, 2018 

e. May 1, 2018 

f. June 1, 2018 

g. July 2, 2018 

h. August 1, 2018 

i. August 31, 2018 

j. September 28, 2018 

k. October 31, 2018 

l. November 30, 2018 

m. January 3, 2019 

n. January 28, 2019 

o. February 27, 2019 

p. March 25, 2019 

38. Government Exhibit 11 contains 

true and correct copies of the 

prescriptions listed in Stipulation 37. 

Patient R.B. 

39. Government Exhibits 14A and 14B 

contain true and correct copies of 

Respondent’s patient medical file for 

Patient R.B. 

40. Respondent issued the following 

44 prescriptions for Patient R.B.: 

a. January 10, 2018: 120 tablets of 

oxycodone 30 mg and 90 tablets of 

ibuprofen 800 mg 

b. February 7, 2018: 120 tablets of 

oxycodone 30 mg, 120 ml 

promethazine with codeine 6.25–10 

mg syrup, and 90 tablets of ibuprofen 

800 mg 

c. March 7, 2018: 120 tablets of 

oxycodone 30 mg, 120 ml 

promethazine with codeine 6.25–10 

mg syrup, and 90 tablets of ibuprofen 

800 mg 

d. April 4, 2018: 120 tablets of 

oxycodone 30 mg, 120 ml 

promethazine with codeine 6.25–10 

mg syrup, and 90 tablets of ibuprofen 

800 mg 

e. May 1, 2018: 120 tablets of oxycodone 

30 mg, 120 ml promethazine with 

codeine 6.25–10 mg syrup, and 90 

tablets of ibuprofen 800 mg 

f. May 31, 2018: 120 tablets of 

oxycodone 30 mg, 120 ml 

promethazine with codeine 6.25–10 

mg syrup, and 90 tablets of ibuprofen 

800 mg 

g. June 27, 2018: 120 tablets of 

oxycodone 30 mg, 120 ml 

promethazine with codeine 6.25–10 

mg syrup, and 90 tablets of ibuprofen 

800 mg 

h. July 25, 2018: 120 tablets of 

oxycodone 30 mg, 120 ml 

promethazine with codeine 6.25–10 

mg syrup, and 90 tablets of ibuprofen 

800 mg 

i. August 22, 2018: 120 tablets of 

oxycodone 30 mg, 120 ml 

promethazine with codeine 6.25–10 

mg syrup, and 90 tablets of ibuprofen 

800 mg 

j. September 17, 2018: 120 tablets of 

oxycodone 30 mg and 90 tablets of 

ibuprofen 800 mg 

k. October 12, 2018: 120 tablets of 

oxycodone 30 mg and 90 tablets of 

ibuprofen 800 mg 

l. November 9, 2018: 120 tablets of 

oxycodone 30 mg and 90 tablets of 

ibuprofen 800 mg 

m. December 10, 2018: 120 tablets of 

oxycodone 30 mg, 120 ml 

promethazine with codeine 6.25–10 

mg syrup, and 90 tablets of ibuprofen 

800 mg 

n. January 9, 2019: 120 tablets of 

oxycodone 30 mg and 90 tablets of 

ibuprofen 800 mg 

o. February 8, 2019: 120 tablets of 

oxycodone 30 mg, 120 ml 

promethazine with codeine 6.25–10 

mg syrup, and 90 tablets of ibuprofen 

800 mg 

p. March 8, 2019: 120 tablets of 

oxycodone 30 mg and 90 tablets of 

ibuprofen 800 mg 

q. April 5, 2019: 120 tablets of 

oxycodone 30 mg and 60 tablets of 

ibuprofen 800 mg 

41. Government Exhibit 13 contains 

true and correct copies of the 

prescriptions listed in Stipulation 40. 

Patient S.D. 

42. Government Exhibits 16A, 16B, 

16C, and 16D contain true and correct 

copies of Respondent’s patient medical 

file for Patient S.D. 

43. Respondent issued the following 

41 prescriptions for Patient S.D.: 

a. January 16, 2018: 180 tablets of 

methadone 10 mg, 180 tablets of 

Roxicodone 15 mg, and 60 tablets of 

Soma 350 mg 

b. February 14, 2018: 180 tablets of 

methadone 10 mg, 180 tablets of 

Roxicodone 15 mg, and 60 tablets of 

Soma 350 mg 

c. March 21, 2018: 180 tablets of 

methadone 10 mg, 180 tablets of 

Roxicodone 15 mg, and 60 tablets of 

Soma 350 mg 

d. April 20, 2018: 270 tablets of 

methadone 10 mg, 180 tablets of 

Roxicodone 15 mg, and 60 tablets of 

Soma 350 mg 

e. May 18, 2018: 270 tablets of 

methadone 10 mg, 180 tablets of 

Roxicodone 15 mg, and 60 tablets of 

Soma 350 mg 

f. June 14, 2018: 270 tablets of 

methadone 10 mg, 180 tablets of 

Roxicodone 15 mg, and 60 tablets of 

Soma 350 mg 

g. July 18, 2018: 270 tablets of 

methadone 10 mg, 180 tablets of 

Roxicodone 15 mg, and 60 tablets of 

Soma 350 mg 

h. August 15, 2018: 270 tablets of 

methadone 10 mg, 180 tablets of 

Roxicodone 15 mg, and 60 tablets of 

Soma 350 mg 

i. September 18, 2018: 270 tablets of 

methadone 10 mg, 180 tablets of 

Roxicodone 15 mg, and 60 tablets of 

Soma 350 mg 

j. October 19, 2018: 270 tablets of 

methadone 10 mg, 180 tablets of 

Roxicodone 15 mg, and 60 tablets of 

Soma 350 mg 

k. November 19, 2018: 270 tablets of 

methadone 10 mg, 180 tablets of 

Roxicodone 15 mg, and 60 tablets of 

Soma 350 mg 

l. January 2, 2019: 270 tablets of 

methadone 10 mg, 180 tablets of 

Roxicodone 15 mg, and 120 tablets of 

Soma 350 mg 

m. February 4, 2019: 180 tablets of 

Roxicodone 15 mg and 120 tablets of 

Soma 350 mg 

n. March 1, 2019: 180 tablets of 

Roxicodone 15 mg and 120 tablets of 

Soma 350 mg 

o. April 2, 2019: 180 tablets of 

Roxicodone 15 mg 

44. Government Exhibit 15 contains 

true and correct copies of the 

prescriptions listed in Stipulation 43. 

Patient L.D. 

45. Government Exhibits 18A and 18B 

contain true and correct copies of 

Respondent’s patient medical file for 

Patient L.D. 

46. Respondent issued the following 

28 prescriptions for Patient L.D.: 

a. January 8, 2018: 120 tablets of Valium 

5 mg, 360 tablets of Dilaudid 8 mg, 60 

tablets of amphetamine salts 30 mg, 

and 30 Duragesic patches 100 mcg/ 

hour 

b. March 5, 2018: 120 tablets of Valium 

5 mg, 360 tablets of Dilaudid 8 mg, 60 

tablets of amphetamine salts 30 mg, 

and 30 Duragesic patches 100 mcg/ 

hour 

c. May 4, 2018: 120 tablets of Valium 5 

mg, 360 tablets of Dilaudid 8 mg, 60 

tablets of amphetamine salts 30 mg, 

and 30 Duragesic patches 100 mcg/ 

hour 


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d. July 5, 2018: 120 tablets of Valium 5 

mg, 360 tablets of Dilaudid 8 mg, 60 

tablets of amphetamine salts 30 mg, 

and 30 Duragesic patches 100 mcg/ 

hour 

e. September 5, 2018: 120 tablets of 

Valium 5 mg, 360 tablets of Dilaudid 

8 mg, and 30 Duragesic patches 100 

mcg/hour 

f. November 5, 2018: 120 tablets of 

Valium 5 mg, 360 tablets of Dilaudid 

8 mg, and 30 Duragesic patches 100 

mcg/hour 

g. January 4, 2019: 120 tablets of Valium 

5 mg, 360 tablets of Dilaudid 8 mg, 

and 30 Duragesic patches 100 mcg/ 

hour 

h. March 4, 2019: 120 tablets of Valium 

5 mg, 360 tablets of Dilaudid 8 mg, 

and 20 Duragesic patches 100 mcg/ 

hour 

47. Government Exhibit 17 contains 

true and correct copies of the 

prescriptions listed in Stipulation 46. 

Patient S.H. 

48. Government Exhibit 20A and 20B 

contains true and correct copies of 

Respondent’s patient medical file for 

Patient S.H. 

49. On the following 17 occasions, 

Respondent issued a prescription for 90 

tablets of Roxicodone 30 mg, a 

prescription for 90 tablets of Dilaudid 8 

mg, and a prescription for 60 tablets of 

methadone 10 mg for Patient S.H. 

a. December 26, 2017 

b. January 29, 2018 

c. February 20, 2018 

d. March 23, 2018 

e. April 23, 2018 

f. May 21, 2018 

g. June 18, 2018 

h. July 18, 2018 

i. August 15, 2018 

j. September 12, 2018 

k. October 10, 2018 

l. November 7, 2018 

m. December 5, 2018 

n. January 2, 2019 

o. January 30, 2019 

p. February 27, 2019 

q. March 27, 2019 

50. Government Exhibit 19 contains 

true and correct copies of the 

prescriptions listed in Stipulation 49. 

Patient J.M. 

51. Government Exhibits 22A, 22B, 

22C, and 22D contain true and correct 

copies of Respondent’s patient medical 

file for Patient J.M. 

52. Respondent issued the following 

33 prescriptions for Patient J.M. 

a. January 26, 2018: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

b. February 23, 2018: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

c. March 22, 2018: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

d. April 19, 2018: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

e. May 16, 2018: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

f. June 13, 2018: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

g. July 13, 2018: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

h. August 9, 2018: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

i. September 6, 2018: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

j. September 27, 2018: 90 tablets of 

alprazolam 2 mg 

k. October 5, 2018: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

l. November 5, 2018: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

m. November 26, 2018: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

n. January 4, 2019: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

o. January 31, 2019: 180 tablets of 

OxyContin 80 mg and 240 tablets of 

Roxicodone 30 mg 

p. February 26, 2019: 180 tablets of 

OxyContin 80 mg and 150 tablets of 

Roxicodone 30 mg 

q. March 28, 2019: 180 tablets of 

OxyContin 80 mg and 150 tablets of 

Roxicodone 30 mg 

53. Government Exhibit 21 contains 

true and correct copies of the 

prescriptions listed in Stipulation 52. 

Exhibits 

54. Respondent stipulates to the 

admissibility of Government Exhibits 

1–4 and 6–22. 

55. Xanax (alprazolam) is a 

benzodiazepine. 

56. Valium (diazepam) is a 

benzodiazepine. 

57. Klonopin (clonazepam) is a 

benzodiazepine. 

Patient A.A. 

58. On the following 16 occasions, 

Respondent prescribed for Patient A.A. 

oxycodone for 60 mg a day and 

methadone for 60 mg a day: 

a. December 26, 2017 

b. February 2, 2018 

c. March 7, 2018 

d. April 3, 2018 

e. May 1, 2018 

f. June 1, 2018 

g. July 2, 2018 

h. August 1, 2018 

i. August 31, 2018 

j. September 28, 2018 

k. October 31, 2018 

l. November 30, 2018 

m. January 3, 2019 

n. January 28, 2019 

o. February 27, 2019 

p. March 25, 2019 

59. On June 5, 2013, Respondent 

increased Patient A.A.’s dosage of 

Percocet (oxycodone-acetaminophen) 

10–325 from 90 tablets to 120 tablets. 

60. On July 23, 2013, Respondent 

increased Patient A.A.’s dosage of 

Percocet (oxycodone-acetaminophen) 

10–325 from 120 tablets to 180 tablets. 

61. On January 11, 2013, Respondent 

increased Patient A.A.’s dosage of 

methadone 10 mg from 90 tablets to 120 

tablets. 

62. On June 2, 2014, Respondent 

increased Patient A.A.’s dosage of 

methadone 10 mg from 120 tablets to 

180 tablets. 

Patient R.B. 

63. Respondent’s first documented 

visit with Patient R.B. occurred on 

January 8, 2016. 

64. During Respondent’s January 8, 

2016 initial visit with Patient R.B., 

Patient R.B. reported to Respondent that 

he was constantly in pain and had 

previously taken oxycodone and was 

then currently taking six tablets of 

Norco (hydrocodone-acetaminophen) 

10–325 mg a day. 

65. During Respondent’s January 8, 

2016 initial visit with Patient R.B., 

Patient R.B. tested positive for THC in 

a urine drug screen. 

66. On January 8, 2016, Respondent 

issued a prescription for 90 tablets of 

oxycodone 30 mg to Patient R.B. 

67. On February 8, 2016, Respondent 

had a second visit with Patient R.B. 

68. On Respondent’s February 8, 2016 

second visit with Patient R.B., Patient 

R.B. reported to Respondent feeling 

much improved, with a pain level of 

one or two out of 10. 

69. On Respondent’s February 8, 2016 

second visit with Patient R.B., Patient 

R.B. tested positive for THC and for a 

benzodiazepine. 

70. On Respondent’s February 8, 2016 

second visit with Patient R.B., 

Respondent issued a prescription for 90 

tablets of oxycodone 30 mg. 

71. On the following occasions, 

Patient R.B. tested positive for THC in 

a urine drug screen: 

a. January 8, 2016 

b. February 8, 2016 


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c. April 6, 2016 

d. May 4, 2016 

e. June 7, 2016 

f. July 11, 2016 

g. August 8, 2016 

h. September 7, 2016 

i. October 5, 2016 

j. November 2, 2016 

k. December 2, 2016 

l. January 2, 2017 

m. January 30, 2017 

n. March 1, 2017 

o. March 29, 2017 

p. April 26, 2017 

q. May 24, 2017 

r. June 26, 2017 

s. July 24, 2017 

t. August 23, 2017 

u. September 18, 2017 

v. October 16, 2017 

w. November 15, 2017 

x. December 13, 2017 

y. February 7, 2018 

72. Respondent did not document in 

Patient R.B.’s patient file any urine drug 

screens performed for Patient R.B. on 

January 10, 2018 and between March 7, 

2018 and February 8, 2019. 

73. On the following 17 occasions, 

Respondent prescribed Patient R.B. 

oxycodone of 120 mg a day: 

a. January 10, 2018 

b. February 7, 2018 

c. March 7, 2018 

d. April 4, 2018 

e. May 1, 2018 

f. May 31, 2018 

g. June 27, 2018 

h. July 25, 2018 

i. August 22, 2018 

j. September 17, 2018 

k. October 12, 2018 

l. November 9, 2018 

m. December 10, 2018 

n. January 9, 2019 

o. February 8, 2019 

p. March 8, 2019 

q. April 5, 2019 

74. On an April 6, 2016 visit with 

Patient R.B., Respondent increased 

Patient R.B.’s oxycodone 30 mg 

prescription from 90 tablets to 120 

tablets. 

75. On an April 6, 2016 visit with 

Respondent, Respondent documented in 

R.B.’s medical file that Patient R.B. 

reported feeling improved. 

Patient S.D. 

76. On the following occasions, 

Patient S.D. tested positive for THC: 

a. June 19, 2012 

b. October 10, 2012 

c. December 13, 2012 

d. January 11, 2013 

e. February 8, 2013 

f. March 8, 2013 

g. July 12, 2013 

h. August 9, 2013 

i. September 9, 2013 

j. October 7, 2013 

k. March 18, 2014 

l. April 15, 2014 

m. May 14, 2014 

n. August 8, 2014 

o. October 7, 2014 

p. December 9, 2014 

q. February 6, 2015 

r. March 6, 2015 

s. April 29, 2015 

t. June 5, 2015 

u. July 1, 2015 

v. July 29, 2015 

w. September 29, 2015 

x. December 23, 2015 

y. February 24, 2016 

z. March 21, 2016 

aa. May 23, 2016 

bb. July 20, 2016 

cc. August 17, 2016 

dd. September 16, 2016 

ee. October 17, 2016 

ff. January 13, 2017 

gg. February 13, 2017 

hh. March 13, 2017 

ii. April 10, 2017 

jj. July 5, 2017 

kk. August 28, 2017 

ll. September 27, 2017 

mm. November 22, 2017 

nn. December 19, 2017 

oo. February 14, 2018 

pp. March 21, 2018 

qq. April 20, 2018 

rr. May 21, 2018 

ss. June 14, 2018 

tt. August 15, 2018 

uu. November 19, 2018 

77. On the following three occasions, 

Respondent prescribed Patient S.D. 

methadone at 60 mg a day and 

oxycodone at 90 mg a day: 

a. January 16, 2018 

b. February 14, 2018 

c. March 21, 2018 

78. On the following nine occasions, 

Respondent prescribed Patient S.D. 

methadone for 90 mg a day and 

oxycodone for 90 mg a day: 

a. April 20, 2018 

b. May 18, 2018 

c. June 14, 2018 

d. July 18, 2018 

e. August 15, 2018 

f. September 18, 2018 

g. October 19, 2018 

h. November 19, 2018 

i. January 2, 2019 

79. On the following three occasions, 

Respondent prescribed Patient S.D. 

oxycodone at 90 mg a day: 

a. February 4, 2019 

b. March 1, 2019 

c. April 2, 2019 

80. On February 24, 2016, Respondent 

increased Patient S.D.’s methadone 10 

mg prescription from 120 tablets to 180 

tablets. 

81. On April 20, 2018, Respondent 

increased Patient S.D.’s methadone 10 

mg prescription from 180 tablets to 270 

tablets. 

Patient L.D. 

82. Respondent’s first documented 

visit with Patient L.D. occurred on June 

20, 2011. 

83. On Respondent’s initial June 20, 

2011 visit with Patient L.D., Respondent 

documented in Patient L.D.’s patient file 

that Patient L.D. was taking 

amphetamine. 

84. During a September 23, 2011 visit, 

L.D. tested positive for amphetamine on 

a urine drug screen. 

85. As of the September 23, 2011 visit, 

Respondent had prescribed Patient L.D. 

amphetamine, hydromorphone, 

fentanyl, and clonazepam. 

86. On the following eight occasions, 

Respondent prescribed Patient L.D. 

Duragesic patches at 100 mcg per hour 

every two days and Dilaudid for 48 mg 

a day: 

a. January 8, 2018 

b. March 5, 2018 

c. May 4, 2018 

d. July 5, 2018 

e. September 5, 2018 

f. November 5, 2018 

g. January 4, 2019 

h. March 4, 2019 

87. On January 16, 2012, Respondent 

increased Patient L.D.’s prescription for 

Dilaudid 8 mg from 90 tablets to 180 

tablets. 

88. On July 14, 2015, Respondent 

increased Patient L.D.’s prescription for 

Duragesic patches 100 mcg/hour from 

10 patches (1 patch every 72 hours) to 

15 patches (1 patch every 48 hours) for 

a thirty day supply. 

89. In May and July 2014, Respondent 

documented in Patient L.D.’s patient file 

that Patient L.D. and her husband had 

been criminally convicted. 

Patient S.H. 

90. Respondent’s first documented 

visit with Patient S.H. occurred on 

August 24, 2010. 

91. On Respondent’s visit with Patient 

S.H. on August 4, 2015, Patient S.H. 

tested positive only for oxycodone. 

92. On Respondent’s visit with Patient 

S.H. on August 4, 2015, Patient S.H. 

reported to Respondent that he was 

taking Adderall, hydromorphone, 

methadone, and oxycodone. 

93. An X-Ray taken for Patient S.H. on 

October 7, 2010 reported normal results 

for neck and spine. 

94. An MRI taken for Patient S.H. on 

April 26, 2011 reported normal results 

for the spine. 


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2The ALJ ‘‘note[d] that . . . [his] 

Recommendation would be the same had . . . [he] 

sustained all of the allegations to which the 

Government presented expert testimony.’’ RD, at 

161. 

95. An MRI taken for Patient S.H. on 

January 17, 2012 reported normal 

results for the neck. 

96. On the following occasions, 

Patient S.H. had been prescribed 

methadone by Respondent: 

a. August 4, 2015 

b. September 1, 2015 

c. April 24, 2017 

d. December 4, 2017 

Patient J.M. 

97. Respondent’s first documented 

visit with Patient J.M. occurred on May 

17, 2011. 

98. On Respondent’s initial visit with 

Patient J.M. on May 17, 2011, Patient 

J.M. reported to Respondent that he had 

difficulty getting OxyContin authorized 

and wanted to try oxycodone instead. 

99. During a June 17, 2011 visit with 

Patient J.M., Respondent documented in 

Patient J.M.’s patient file that Patient 

J.M. came to the office with his mother. 

100. During a June 17, 2011 visit with 

Patient J.M., Respondent documented in 

Patient J.M.’s patient file that Patient 

J.M. came to ‘‘plead mercy’’ and ask for 

a second chance at being treated. 

101. During a June 17, 2011 visit with 

Patient J.M., Respondent issued Patient 

J.M. a prescription for 180 tablets of 

oxycodone 30 mg 

102. During a June 17, 2011 visit with 

Patient J.M., Respondent noted in 

Patient J.M.’s patient file that he would 

give Patient J.M. ‘‘[o]ne final chance.’’ 

103. On the following occasions, 

Respondent checked the CURES 

database for Patient J.M.: 

a. May 17, 2011 

b. June 13, 2011 

c. July 15, 2011 

d. September 9, 2011 

e. August 10, 2012 

f. October 12, 2012 

g. March 4, 2013 

h. June 28, 2013 

i. February 28, 2014 

j. November 10, 2014 

k. May 4, 2016 

l. September 6, 2018 

104. On March 23, 2012, Respondent 

increased Patient J.M.’s oxycodone 30 

mg prescription from 180 tablets to 240 

tablets. 

105. On September 4, 2012, 

Respondent decreased Patient J.M.’s 

oxycodone 30 mg prescription from 240 

tablets to 180 tablets. 

106. On September 21, 2012, 

Respondent increased Patient J.M.’s 

oxycodone 30 mg prescription from 180 

tablets to 240 tablets. 

107. Between August and September 

2012, Respondent increased Patient 

J.M.’s prescription for 90 tablets of 

OxyContin 60 mg to 180 tablets of 

OxyContin 80 mg. 

108. On the following occasions, 

Patient J.M. tested positive for the 

following controlled substances in a 

urine drug screen: 

a. July 15, 2011: benzodiazepine 

b. August 12, 2011: THC 

c. September 9, 2011: THC 

d. December 2, 2011: THC and 

benzodiazepine 

e. January 27, 2012: benzodiazepine 

f. March 23, 2012: THC and 

benzodiazepine 

g. May 18, 2012: THC 

h. July 12, 2012: THC and 

benzodiazepine 

i. August 10, 2012: THC 

j. September 21, 2012: THC and 

benzodiazepine 

k. November 7, 2012: THC and 

benzodiazepine 

l. December 7, 2012: THC 

m. January 7, 2013: THC 

n. March 4, 2013: THC 

o. March 29, 2013: THC and 

benzodiazepine 

p. May 3, 2013: THC 

q. June 28, 2013: THC 

r. August 27, 2013: THC 

s. November 5, 2013: THC 

t. December 3, 2013: THC and 

benzodiazepine 

u. December 27, 2013: THC and 

benzodiazepine 

v. January 30, 2014: THC and 

benzodiazepine 

w. February 28, 2014: THC and 

benzodiazepine 

x. April 1, 2014: THC 

y. April 30, 2014: THC and 

benzodiazepine 

z. July 23, 2014: THC and 

benzodiazepine 

aa. August 14, 2014: THC and 

benzodiazepine 

bb. October 13, 2014: THC and 

benzodiazepine 

cc. December 8, 2014: THC and 

benzodiazepine 

dd. March 31, 2015: benzodiazepine 

ee. April 29, 2015: THC 

ff. June 24, 2015: benzodiazepine 

gg. August 21, 2015: THC 

hh. November 12, 2015: THC and 

benzodiazepine 

ii. April 4, 2016: THC and 

benzodiazepine 

jj. May 4, 2016: benzodiazepine 

kk. September 16, 2016: THC and 

benzodiazepine 

ll. October 13, 2016: THC and 

benzodiazepine 

mm. December 12, 2016: 

benzodiazepine 

nn. May 5, 2017: THC and 

benzodiazepine 

oo. August 4, 2017: THC and 

benzodiazepine 

pp. September 29, 2017: THC and 

benzodiazepine 

qq. October 27, 2017: THC and 

benzodiazepine 

rr. November 27, 2017: THC and 

benzodiazepine 

ss. December 21, 2017: THC and 

benzodiazepine 

tt. January 26, 2018: THC and 

benzodiazepine 

uu. September 6, 2018: THC and 

benzodiazepine 

109. During the periods referenced in 

Paragraph 108, Respondent had not 

prescribed Patient J.M. a 

benzodiazepine. 

110. On a May 5, 2017 visit with 

Respondent, Respondent documented in 

Patient J.M.’s patient file that Patient 

J.M. had taken a ‘‘headache pill’’ from 

his mother. 

111. On a May 5, 2017 visit with 

Respondent, Patient J.M. tested positive 

for morphine. 

112. As of the May 5, 2017 visit with 

Respondent, Respondent had not 

prescribed Patient J.M. any morphine. 

113. Respondent’s Exhibit 1 is a true 

and correct copy of the New England 

Journal of Medicine article ‘‘No 

Shortcuts to Safer Opioid Prescribing.’’ 

114. Respondent’s Exhibit 2 is a true 

and correct copy of an April 10, 2019 

letter from the Center for Disease 

Control and Prevention to Dr. Alford. 

115. Respondent’s Exhibit 3 is a true 

and correct copy of a media statement 

from the Center for Disease Control and 

Prevention titled ‘‘CDC Advises Against 

Misapplication of the Guidelines for 

Prescribing Opioids for Chronic Pain.’’ 

116. Respondent’s Exhibit 4 is a true 

and correct copy of the American 

Medical Association Resolution 235 

‘‘Inappropriate Use of CDC Guidelines 

for Prescribing Opioids D–120.932.’’ 

ALJ’s Recommended Rulings, 

Findings of Fact, Conclusions of Law 

and Decision dated February 25, 2020 

(hereinafter, RD), at 24–40. 

The hearing in this matter was held in 

Los Angeles, California, and, although 

originally scheduled for four days, 

lasted five days, November 18–22, 2019. 

Notice of Hearing dated October 28, 

2019, at 1; Transcripts Received dated 

November 18–22, 2019, at 1–5. The RD 

is dated February 25, 2020. It 

recommends that the three registrations 

at issue be suspended until August 8, 

2021, ‘‘but that . . . [the] suspensions 

not be lifted until . . . [Respondent] has 

met . . . [two] conditions.’’ 2 RD, at 161. 

The two conditions are (1) completion 

of courses, other than courses used to 


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3The RD ‘‘further recommended that if the 

Administrator has not issued a Final Order . . . 

prior to the dates that . . . [Respondent’s] current 

. . . [registrations] expire by their own terms, that 

if . . . [Respondent] has submitted renewal 

applications, that those renewal applications be 

approved[,] . . . subject [also] to the two conditions 

. . . and subject to the condition that . . . 

[Respondent] not commit any further violations of 

the . . . [Controlled Substances Act (hereinafter, 

CSA)] between now and the date of the Final 

Order.’’ RD, at 161. 

4See Gonzales v. Oregon, 546 U.S. 243, 269–71 

(2006); see also OSC, at 2–3. 

5The California statutory definition of 

‘‘dangerous drug’’ includes any drug whose 

dispensing without a prescription is prohibited by 

federal law. Cal. Bus. & Prof. Code § 4022 (Effective 

Jan. 1, 2004 to the present). 

6Section 2241.5 of the California Business & 

Professions Code, during the time at issue in this 

proceeding, concerned a physician’s prescribing of 

controlled substances for the treatment of pain or 

a condition causing pain, including intractable 

pain. Cal. Bus. & Prof. Code § 2241.5(a) (Effective 

Jan. 1, 2007 to the present). According to that 

provision, ‘‘[n]o physician . . . shall be subject to 

disciplinary action for prescribing dangerous drugs 

or prescription controlled substances in accordance 

with this section,’’ among other things. Cal. Bus. & 

Prof. Code § 2241.5(b) (Effective Jan. 1, 2007 to the 

present). The provision explicitly excepts from its 

disciplinary action prohibition violations of section 

2234 (regarding gross negligence, repeated negligent 

acts, or incompetence), section 2241 (regarding 

treatment of an addict), and 2242 (regarding 

performing an appropriate prior examination and 

the existence of a medical indication for prescribing 

dangerous drugs), among others. Cal. Bus. & Prof. 

Code § 2241.5(c) (Effective Jan. 1, 2007 to the 

present). 

7 GX 6. Respondent did not object to the 

admission into evidence of the MBC Guide to the 

Laws. Tr. 29–30. California law assigns the MBC the 

responsibilities of, among other things, enforcing 

the disciplinary and criminal provisions of the 

California Medical Practice Act, revoking or 

otherwise limiting certificates after the conclusions 

of disciplinary actions, reviewing the quality of 

medical practice carried out by physician and 

surgeon certificate holders under its jurisdiction, 

and issuing licenses and certificates under its 

jurisdiction. Cal. Bus. & Prof. Code § 2004 (Current 

with urgency legislation through Ch. 145 of 2021 

Reg.Sess). Accordingly, the MBC Guide to the Laws 

informs my understanding of the standard of care 

applicable in this matter. 

meet any continuing medical education 

requirement, approved in advance by 

DEA in prescribing controlled 

substances and in preparing and 

maintaining patient medical records, 

and (2) submission to DEA of a signed 

‘‘consent[ ] to inspections by DEA 

personnel of . . . [Respondent’s] 

medical practice without the need for 

DEA personnel to obtain an 

administrative inspection warrant prior 

to conducting an inspection’’ that ‘‘shall 

be valid for three years from the date 

. . . [Respondent’s registrations] are 

restored or renewed, whichever occurs 

latest in time.’’ 3 Id. The Government 

filed exceptions to the RD, dated March 

16, 2020 (hereinafter, Govt Exceptions). 

Having considered the record in its 

entirety, I conclude that the record 

establishes, by substantial evidence, that 

Respondent committed acts rendering 

his continued registration inconsistent 

with the public interest. I further 

conclude that Respondent did not 

unequivocally accept responsibility for 

the founded violations and that, even if 

he had, Respondent did not offer 

adequate remedial measures. 

Accordingly, I conclude that the 

appropriate sanctions are (1) the 

revocation of BR0869719 and 

BA7661564, along with DATA–Waiver 

No. XR0869719; (2) the denial of any 

pending application(s) to renew or 

modify these registrations; (3) the denial 

of any other pending application(s) by 

Respondent or by Respondent on behalf 

of Aurora Surgery Center LP for 

registration in California; and (4) 

affirmance of the already issued Order 

of Immediate Suspension of 

Registrations. I make the following 

findings. 

II. California Physicians’ and Surgeons’ 

Standard of Care 

According to the Controlled 

Substances Act (hereinafter, CSA), 

‘‘Except as authorized by this 

subchapter, it shall be unlawful for any 

person knowingly or intentionally . . . 

to . . . distribute, . . . dispense, or 

possess with intent to . . . distribute[ ] 

or dispense, a controlled substance.’’ 21 

U.S.C. 841(a)(1). The CSA’s 

implementing regulations state that a 

lawful controlled substance order or 

prescription is one that is ‘‘issued for a 

legitimate medical purpose by an 

individual practitioner acting in the 

usual course of his professional 

practice.’’ 21 CFR 1306.04(a). 

The OSC is addressed to Respondent 

at his registered medical practice in 

California. Therefore, I also evaluate 

Respondent’s actions according to 

California law and the applicable 

California standard of care.4 California, 

similar to the CSA, requires, during the 

time period at issue in this adjudication 

through to the present, that a 

‘‘prescription for a controlled substance 

shall only be issued for a legitimate 

medical purpose by an individual 

practitioner acting in the usual course of 

his or her professional practice.’’ Cal. 

Health & Safety Code § 11153(a) 

(Effective April 4, 2011, operative Oct. 

1, 2011). This statute explicitly includes 

two examples of prescriptions that are 

not legal. First, in salient part, ‘‘an order 

purporting to be a prescription which is 

issued not in the usual course of 

professional treatment’’ and, second, 

‘‘an order for an addict or habitual user 

of controlled substances, which is 

issued not in the course of professional 

treatment or as part of an authorized 

narcotic treatment program, for the 

purpose of providing the user with 

controlled substances, sufficient to keep 

him or her comfortable by maintaining 

customary use.’’ Id. California makes the 

violation of this provision a criminal 

offense punishable by imprisonment, 

fine, or both. Id. 

Other provisions of the California 

Code further address the characteristics 

of a lawful controlled substance 

prescription. For example, the Health 

and Safety Code prohibits the knowing 

prescribing of a controlled substance ‘‘to 

or for any person’’ ‘‘[e]xcept in the 

regular practice of his or her 

profession.’’ Cal. Health & Safety Code 

§ 11154(a) (Current with urgency 

legislation through Ch. 145 of 2021 

Reg.Sess.). Another example is a 

provision of the Business and 

Professions Code, in effect during the 

period of the violations alleged in the 

OSC, which stated that ‘‘[p]rescribing 

. . . dangerous drugs . . . without an 

appropriate prior examination and a 

medical indication, constitutes 

unprofessional conduct.’’ 5 Cal. Bus. and 

Prof. Code § 2242(a) (Effective Jan. 1, 

2007 to Oct. 10, 2019). By way of further 

example, section 725(a) of the Business 

and Professions Code states that 

‘‘[r]epeated acts of clearly excessive 

prescribing . . . of drugs or treatment 

. . . is unprofessional conduct for a 

physician.’’ Cal. Bus. & Prof. Code 

§ 725(a) (Effective Jan. 1, 2008 to the 

present). Section 725 makes such clearly 

excessive prescribing a misdemeanor 

punishable by fine, imprisonment, or 

both. The provision explicitly states that 

a ‘‘practitioner who has a medical basis 

for prescribing, furnishing, dispensing, 

or administering dangerous drugs or 

prescription controlled substances shall 

not be subject to disciplinary action or 

prosecution,’’ and ‘‘[n]o physician and 

surgeon shall be subject to disciplinary 

action pursuant to this section for 

treating intractable pain in compliance 

with section 2241.5.’’ 6 Id. 

The ‘‘Guide to the Laws Governing 

the Practice of Medicine by Physicians 

and Surgeons’’ published by the 

Medical Board of California (hereinafter, 

MBC) (7th ed. 2013) (hereinafter, MBC 

Guide to the Laws), informs my 

interpretation of these California 

statutes and the applicable California 

standard of care.7 According to the MBC 

Guide to the Laws, ‘‘[o]nly physicians 

. . . are authorized to write 

prescriptions under California law’’ and 

‘‘may prescribe only in the regular 

practice of their profession, after an 

appropriate prior examination, and may 

not furnish any controlled substance to 

persons not under their care.’’ MBC 


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Guide to the Laws, at 53. The MBC 

Guide to the Laws explains that the 

‘‘[i]nappropriate prescribing of 

controlled substances, including 

opioids, can lead to drug abuse or 

diversion and can also lead to 

ineffective management of pain, 

unnecessary suffering of patients, and 

increased health costs.’’ Id. at 55. It 

reiterates the statutory permission, 

supra, that a ‘‘physician and surgeon 

. . . may prescribe for . . . a person 

under his or her treatment for a medical 

condition dangerous drugs or 

prescription controlled substances for 

the treatment of pain or a condition 

causing pain, including, but not limited 

to, intractable pain.’’ Id. at 56. 

The MBC Guide to the Laws sets out 

the California Medical Board’s 

expectation that ‘‘physicians . . . follow 

the standard of care in managing pain 

patients.’’ Id. at 57. The MBC Guide to 

the Laws states that the standard of care 

includes the ‘‘accomplish[ment] of a 

medical history and physical 

examination,’’ meaning ‘‘an assessment 

of the pain, physical and psychological 

function; a substance abuse history; 

history of prior pain treatment; an 

assessment of underlying or coexisting 

diseases or conditions and 

documentation of the presence of a 

recognized medical indication for the 

use of a controlled substance.’’ Id. It 

explains, among other things, that the 

‘‘complexity of the history and physical 

examination may vary based on the 

practice location. . . . In continuing 

care situations for chronic pain 

management, the physician and surgeon 

should have a more extensive 

evaluation of the history, past treatment, 

diagnostic tests, and physical exam.’’ Id. 

The MBC Guide to the Laws discusses 

the treatment plan, advising that it 

‘‘should state objectives by which the 

treatment plan can be evaluated, such as 

pain relief and/or improved physical 

and psychosocial function, and indicate 

if any further diagnostic evaluations or 

other treatments are planned.’’ Id. It 

explicitly points out that ‘‘the physician 

and surgeon should tailor 

pharmacological therapy to the 

individual medical needs of each 

patient’’ and that ‘‘[m]ultiple treatment 

modalities and/or a rehabilitation 

program may be necessary if the pain is 

complex or is associated with physical 

and psychosocial impairment.’’ Id. The 

‘‘annotations’’ associated with this 

section of the MBC Guide to the Laws 

state that ‘‘[p]hysicians and surgeons 

may use control of pain, increase in 

function, and improved quality of life as 

criteria to evaluate the treatment plan’’ 

and ‘‘[w]hen the patient is requesting 

opioid medications for his or her pain 

and inconsistencies are identified in the 

history, presentation, behaviors or 

physical findings, physicians and 

surgeons who make a clinical decision 

to withhold opioid medications should 

document the basis for their decision.’’ 

Id. 

The next section of the MBC Guide to 

the Laws concerns ‘‘informed consent.’’ 

Id. at 58. This section states that the 

‘‘physician and surgeon should discuss 

the risks and benefits of the use of 

controlled substances and other 

treatment modalities with the patient, 

caregiver, or guardian.’’ Id. The 

annotation for this section states, in 

part, that a ‘‘written consent or pain 

agreement for chronic use is not 

required but may make it easier for the 

physician and surgeon to document 

patient education, the treatment plan, 

and the informed consent.’’ Id. 

The MBC Guide to the Laws next 

addresses the matter of ‘‘periodic 

review.’’ Id. It makes three points. First, 

it states that the ‘‘physician and surgeon 

should periodically review the course of 

pain treatment of the patient and any 

new information about the etiology of 

the pain or the patient’s state of health.’’ 

Id. Second, it explains that 

‘‘[c]ontinuation or modification of 

controlled substances for pain 

management therapy depends on the 

physician’s evaluation of progress 

toward treatment objectives.’’ Id. Third, 

it elaborates by stating that, ‘‘[i]f the 

patient’s progress is unsatisfactory, the 

physician and surgeon should assess the 

appropriateness of continued use of the 

current treatment plan and consider the 

use of other therapeutic modalities.’’ Id. 

Regarding the process of determining 

whether the response to treatment is 

satisfactory, the MBC Guide to the Laws 

states that satisfactory response to 

treatment ‘‘may be indicated by the 

patient’s decreased pain, increased level 

of function, or improved quality of life.’’ 

Id. It also notes that physicians and 

surgeons ‘‘should . . . consider[ ]’’ 

‘‘[i]nformation from family members or 

other caregivers . . . in determining the 

patient’s response to treatment.’’ Id. 

The next part of the MBC Guide to the 

Laws is about consultation. Id. It states 

that physicians and surgeons ‘‘should 

consider referring the patient as 

necessary for additional evaluation and 

treatment in order to achieve treatment 

objectives.’’ Id. It addresses abuse and 

diversion by stating that ‘‘physicians 

should give special attention to those 

pain patients who are at risk for 

misusing their medications including 

those whose living arrangements pose a 

risk for medication misuse or 

diversion.’’ Id. It also warns that the 

‘‘management of pain in patients with a 

history of substance abuse requires extra 

care, monitoring, documentation, and 

consultation with addiction medicine 

specialists, and may entail the use of 

agreements between the provider and 

the patient that specify the rules for 

medication use and consequences for 

misuse.’’ Id. 

The last section in this part of the 

MBC Guide to the Laws is entitled, 

‘‘Records.’’ Id. at 59. It states that 

physicians and surgeons ‘‘should keep 

accurate and complete records 

according to items above, including the 

medical history and physical 

examination, other evaluations and 

consultations, treatment plan objectives, 

informed consent, treatments, 

medications, rationale for changes in the 

treatment plan or medications, 

agreements with the patient, and 

periodic reviews of the treatment plan.’’ 

Id. The MBC Guide to the Laws also 

states that ‘‘[t]here is not a minimum or 

maximum number of medications 

which can be prescribed to the patient 

under either federal or California law.’’ 

Id. 

In compiling the California standard 

of care applicable to this matter, I 

looked for, but did not find, any 

relevant exceptions to the applicable 

California standard of care I set out 

above, such as those suggested by 

Respondent’s Case. Infra sections III.E. 

and III.F. 

The record that the ALJ transmitted to 

me includes opposing interpretations of 

the applicable California standard of 

care. See, e.g., RD, at 16–17. My 

adjudication of these differences begins 

with the appropriate scope of the 

testimony of the Government’s expert 

witness, includes comparing the 

testimony of the parties’ experts with 

the applicable California standard of 

care I set out above, and concludes with 

my determinations of which expert’s 

testimony to credit. Infra sections III.D., 

III.E., and III.F. 

III. Findings 

A. Respondent’s DEA Registrations 

The parties stipulated that 

Respondent was registered as a 

practitioner in schedules II through V 

under DEA Certificate of Registration 

No. BR0869719 at 73–950 Alessandro 

Drive, Suite 4, Palm Desert, California 

92260. Jt. Stip. Nos. 14, 16; see also 

Government Exhibit (hereinafter, GX) 1, 

at 3–4. The parties stipulated that 

Respondent was also registered as a 

DATA-waived (Drug Addiction 

Treatment Act) physician certified to 

treat 100 patients for substance abuse 

under DATA–Waiver No. XR0869719. 

Jt. Stip. Nos. 24–25; see also GX 1, at 3– 


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8 ‘‘Dispense,’’ among other things, means ‘‘to 

deliver a controlled substance to an ultimate user 

. . . by, or pursuant to the lawful order of, a 

practitioner, including the prescribing . . . of a 

controlled substance.’’ 21 U.S.C. 802(10). 

9Although he stated that he ‘‘would normally 

accept stipulations between the parties without 

question,’’ the ALJ ‘‘cannot accept’’ Stipulation 52j 

because ‘‘[a]ll parties apparently missed the fact 

that the actual prescription for alprazolam in 

September 2018, that is contained in the 

administrative record, was [not] written by . . . 

[Respondent]. RD, at 148. I agree with the ALJ, 

although I note that Stipulation 52j is irrelevant to 

my Decision/Order given the magnitude and 

seriousness of the unlawful controlled substance 

prescribing evidenced elsewhere in the record. 

10 During Dr. Munzing’s direct testimony and 

during Respondent’s cross examination of Dr. 

Munzing, Respondent moved to strike portions of 

Dr. Munzing’s testimony. I do not always agree with 

the ALJ’s decisions to sustain Respondent’s 

objections and to strike Dr. Munzing’s testimony. 

See, e.g., Tr. 305–06 (Respondent’s interruption of 

Dr. Munzing’s response to Respondent’s question 

with his motion to strike Dr. Munzing’s in-process 

answer as non-responsive and the ALJ sustaining 

the motion); id. at 384–85; id. at 562–63; but see 

id. at 387–88. Other times, I agree with the ALJ’s 

handling of Respondent’s motions to strike Dr. 

Munzing’s testimony. See, e.g. id. at 334–35 (ALJ’s 

second and third rulings during a line of 

questioning denying motions to strike because the 

ALJ ‘‘ha[s]n’t heard the rest of the answer yet’’ and 

because the ALJ ‘‘think[s] it’s not as responsive as 

. . . [Respondent] wanted’’). To benefit 

Respondent, despite my disagreement, I accept all 

of the ALJ’s rulings on Respondent’s objections and 

I do not consider any of Dr. Munzing’s stricken 

testimony in my Decision/Order. 

4. This registration expired on April 30, 

2021. Jt. Stip. 15; GX 1, at 3–4. 

The parties stipulated that 

Respondent operated Aurora Surgery 

Center LP and that Aurora Surgery 

Center LP was registered as a hospital/ 

clinic in schedules II through V under 

DEA Certificate of Registration No. 

BA7661564 at 73–950 Alessandro Drive, 

Palm Desert, California 92260. Jt. Stip. 

Nos. 17–21; see also GX 1, at 1–2. This 

registration expired on June 30, 2020. Jt. 

Stip. 22; GX 1, at 1–2. 

The OSC suspended all of these 

authorities. OSC, at 11. While 

Respondent disputes the immediate 

suspensions of these authorities and the 

allegations in the OSC, he did not 

submit arguments challenging the 

propriety of the OSC’s inclusion of 

registration No. BA7661564 in its 

requested relief. See, e.g. Tr. 5; id. at 43– 

47; id. at Tr. 47–61; supra n.1. 

B. The Investigation of Respondent 

The Diversion Investigator 

(hereinafter, DI) began investigating 

Respondent in March 2018 after several 

databases flagged Respondent as a 

‘‘high-risk opioid prescriber.’’ Tr. 27; see 

also, e.g., Jt. Stip. Nos. 37, 40, 43, 46, 49, 

52, 58–62, 76–81, 91–95, 98–102, 104, 

106–112. The DI’s investigative work 

regarding Respondent, among other 

things, showed a ‘‘high volume of 

[opioid] prescriptions, in the thousands, 

. . . at maximum dosages with little or 

no change and several months at a 

time[,] . . . a lot of drug combinations, 

opioids with benzodiazepines and 

opioids with stimulants[, and] . . . the 

holy trinity of an opioid, . . . a muscle 

relaxer and a benzodiazepine.’’ Tr. 33. 

The DI testified that ‘‘those stood out 

immediately. . . . [T]hose are the 

things that we’ve been trained to look 

for in analyzing . . . possible diversion 

or misuse of controlled substances.’’ Id. 

C. The Allegations of Dispensing 

Violations 8

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

823(f)(2) and (4), the OSC alleges that 

Respondent’s continued registration is 

inconsistent with the public interest due 

to his having issued multiple controlled 

substance prescriptions outside the 

usual course of professional practice 

and without any legitimate medical 

purpose. OSC, at 2, 3, 10. As already 

discussed, the parties agreed to and 

submitted 116 joint stipulations. Supra 

section I. Accordingly, there is factual 

agreement on a significant number of 

matters.9 When there is legally relevant 

factual disagreement, my resolution of 

the disagreement involves the 

applicable law and my credibility 

assessments. 

D. The Government’s Case 

The Government stated its case as 

being that Respondent ‘‘churn[ed] out 

dangerously high dosages of controlled 

substances month after month without 

any medical justification.’’ 

Government’s Proposed Findings of Fact 

and Conclusions of Law dated January 

24, 2020 (hereinafter, Govt Posthearing), 

at 1. The Government’s arguments 

include that Respondent prescribed 

dangerously high dosages of controlled 

substances for years without performing 

initial physical examinations and 

evaluations, without performing 

periodic urine drug screens (hereinafter, 

UDSes), without addressing aberrant 

UDSes, without justifying increased 

dosages, without justifying dangerous 

controlled substance combination 

prescribing, and without adequately 

resolving indicia of abuse and diversion. 

Id. The Government presented its case 

with two witness, the DI and its expert 

witness, Timothy Munzing, M.D., and 

with about 1,750 pages from 

Respondent’s medical records. See id. at 

43. According to the Government, 

Respondent’s ‘‘insistence that he simply 

did not document his reasoning or 

actions was not credible,’’ his 

‘‘recollection was faulty,’’ he 

‘‘essentially admitted that he knew and 

was okay with his patient’s drug abuse,’’ 

and was ‘‘nowhere near contrite.’’ Id. at 

1. 

Regarding its expert, the Government 

offered Dr. Munzing ‘‘as a medical 

expert in the treatment of pain with 

controlled substances in the State of 

California.’’ Tr. 68. According to the RD, 

Dr. Munzing ‘‘is not listed as a pain 

specialist’’ on Kaiser’s roster of pain 

specialists, ‘‘does not have fellowship 

training in pain management,’’ and was 

accepted ‘‘as a medical expert in the 

treatment of pain with controlled 

substances in the State of California’’ 

over Respondent’s objection. RD, at 12. 

According to the RD’s third footnote, 

‘‘[s]ignificantly, Dr. Munzing was not 

proffered as an expert in the standard of 

care in California, or as an expert 

concerning the usual course of 

professional practice in California.’’ Id. 

at 12, n.3; see also id. at 13 (‘‘Although 

not proffered as an expert in such, Dr. 

Munzing provided extensive testimony 

in general terms about the standard of 

care in California.’’); id. at 17 (‘‘I find Dr. 

Munzing’s testimony concerning the 

general standard of care to be credible. 

Since he was not proffered as an expert 

in the standard of care in California, or 

in the usual course of professional 

practice in California, I give limited 

weight to that testimony.’’). The RD’s 

third footnote also records the ALJ’s 

awareness that the ‘‘Acting 

Administrator previously accepted Dr. 

Munzing as an ‘expert in standard of 

care for prescribing controlled 

substances in California,’ in a 

previously published Agency decision.’’ 

Id. at 12, n.3. The footnote elaborates by 

stating that ‘‘[t]here was no hearing in 

that case, however, and the Acting 

Administrator relied on Dr. Munzing’s 

declaration, with no expert evidence 

presented by the respondent.’’ Id. 

As the RD also notes, Respondent 

objected to the Government’s proffer of 

Dr. Munzing and the ALJ determined 

that Respondent wanted to voir dire Dr. 

Munzing. Tr. 68. Voir dire ensued.10 Id. 

at 69–83. Respondent’s voir dire 

addressed Dr. Munzing’s exposure to, 

and knowledge of, the applicable 

standard of care. See, e.g., id. at 71 

(Respondent during voir dire: ‘‘Now you 

mentioned that you took a couple of 

courses on pain management and that’s 

how you began to get your exposure to 

pain . . . standards of care?’’); id. at 72 

(Dr. Munzing during voir dire: ‘‘I am 

considered to be a specialist in the 

prescribing of opiates as far as for 

pain.’’); id. at 81 (Respondent during 

voir dire: ‘‘Do you believe as a physician 

. . . that a physician who’s treating 30 

patients for a particular condition over 


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11See also United States v. Diaz, 876 F.3d 1194, 

1199 (9th Cir. 2017) (citing United States v. Chube, 

538 F.3d 693, 698 (7th Cir. 2008) (‘‘When all is said 

and done, we agree with the Government that it is 

impossible sensibly to discuss the question whether 

a physician was acting outside the usual course of 

professional practice and without a legitimate 

medical purpose without mentioning the usual 

standard of care.’’)). 

12Regarding ‘‘not seem[ing] as familiar with the 

facts or the law as he should have been as an expert 

witness,’’ the RD states ‘‘[f]or example, Dr. Munzing 

relied on the . . . [Centers for Disease Control and 

Prevention’s Guideline for Prescribing Opioids for 

Chronic Pain—United States (2016) (hereinafter, 

CDC Guidelines)] when formulating his opinions in 

this case’’ and ‘‘[i]t is obvious that he did not learn 

that those Guidelines did not apply to . . . 

[Respondent] until after he began to testify.’’ RD, at 

16. On these points, I note several occasions during 

voir dire when Dr. Munzing provided his view of 

the CDC Guidelines, Respondent objected as ‘‘not 

responsive,’’ and the ALJ sustained the objection. 

For example, on voir dire, Respondent asked Dr. 

Munzing: ‘‘With respect to the CDC guidelines, is 

it your opinion they apply to pain specialists or 

not?’’ Tr. 82. Dr. Munzing responded by stating that 

‘‘these are guidelines. These are not required. But 

the general principles, I think, are good principles 

for everyone who is prescribing controlled 

substances. Again, they’re not required.’’ Id. When 

Respondent moved to strike ‘‘as not responsive,’’ 

the ALJ sustained his motion. Id.; see also id. at 77 

(Respondent’s questioning of Dr. Munging: ‘‘Q: Are 

you aware that the CDC guidelines in 2016 applied 

to primary care and to family medicine but are not 

intended to apply to pain specialists? A: Well, the 

CDC guidelines are guidelines strictly. They’re not 

standard of care. And so the intent is to protect 

patients and patient safety.’’ Respondent: ‘‘Move to 

strike as not responsive, Your Honor. Judge 

Dorman: Granted.’’). These struck responses of Dr. 

Munzing concerning the CDC Guidelines do state 

that the CDC Guidelines are not the standard of 

care, that there is no requirement for Respondent 

to have followed them, and, nevertheless, that they 

are ‘‘good principles’’ commended to ‘‘everyone 

who is prescribing controlled substances.’’ Id. at 77, 

82. Accordingly, I disagree with the RD that Dr. 

Munzing is ‘‘not . . . as familiar with the facts or 

the law as he should have been as an expert 

witness,’’ impacting Dr. Munzing’s ‘‘overall 

credibility.’’ RD, at 16; see also, e.g., Tr. 532 (Dr. 

Munzing’s testimony that his opinion does not 

depend on the strict application of the CDC 

guidelines); id. at 533 (Dr. Munzing’s testimony that 

CDC is only one of many entities that issue 

controlled substance related guidelines, along with 

the American Academy of Pain Medicine, the 

American Pain Society, and the Agency Directors in 

Washington, and noting that only one aspect of his 

report dealt with the CDC’s perspective on 

Morphine Milligram Equivalents). 

13 I note that ‘‘appropriate pain management’’ and 

‘‘appropriate care’’ are relevant to my adjudication 

of the OSC. 

14The question Respondent asked that the RD 

quotes Dr. Munzing as answering was: ‘‘Do you 

believe as a physician that a patient—that a 

physician who’s treating 30 patients for a particular 

condition over 10 years and a patient [sic] who has 

treated 3,000 patients, that the person who treated 

the 3,000 patients might have a better 

understanding of the medications and the impacts 

and the standard of care?’’ Tr. 81. In other words, 

contrary to what the RD suggests, Respondent did 

ask Dr. Munzing about Respondent’s 

‘‘understanding of . . . the standard of care,’’ as 

well as Respondent’s ‘‘understanding of’’ controlled 

substances and the impact of controlled substances. 

Id. According to the transcript, I also note, Dr. 

Munzing did not state that he treated ‘‘30 patients 

for a particular condition over 10 years.’’ Instead, 

after Respondent asked Dr. Munzing, ‘‘Since 2011, 

approximately how many patients have you 

managed for chronic pain,’’ Dr. Munzing responded 

‘‘[p]robably in the neighborhood of 30 to 50 on an 

ongoing basis.’’ Id. at 71. Respondent followed up, 

asking, ‘‘With respect to, I think you said between 

30 and 50 patients total that you’ve managed in the 

last 10 years with chronic pain, what percentage of 

those were you prescribing medications to?’’ Id. at 

72 (emphasis added). Dr. Munzing responded that, 

‘‘I should probably rephrase that, is [sic] those are 

the ones who probably were being prescribed 

probably about 30 opiates on an ongoing basis. If 

you want to know total patients with chronic pain 

at any time, that would be hundreds.’’ Id. 

15 In Carlos Gonzalez, M.D., 76 FR 63118 (2011), 

the then-Administrator adopted the Recommended 

Decision of the Chief Administrative Law Judge, 

John J. Mulrooney, II, ‘‘except as discussed below.’’ 

76 FR at 63118. 

10 years and a patient [sic] who has 

treated 3,000 patients, that the person 

who treated the 3,000 patients might 

have a better understanding of the 

medications and the impacts and the 

standard of care?’’). After the conclusion 

of Respondent’s voir dire, the 

Government again offered Dr. Munzing 

‘‘as an expert on the treatment of pain 

with controlled substances in 

California.’’ Id. at 83. The ALJ ruled 

immediately, stating that he 

‘‘recognize[d] Dr. Munzing as an expert, 

relying upon the Gonzalez case, 76 FR 

[63118], a 2011 case from DEA’’ and 

ordered the Government to proceed 

with questioning. Id. at 83–84. I find 

substantial evidence in Respondent’s 

voir dire of Dr. Munzing that it was 

clear to Respondent that the 

Government was offering Dr. Munzing 

as an expert in the applicable standard 

of care.11

While the RD finds ‘‘Dr. Munzing’s 

testimony to be thorough, detailed, and 

internally consistent,’’ it is also critical 

of it and lists ‘‘several aspects’’ of Dr. 

Munzing’s ‘‘testimony and 

qualifications’’ that ‘‘detract from his 

overall credibility.’’ RD, at 14; see also 

id. at 15–17. For example, the RD states 

that Dr. Munzing ‘‘was going out of his 

way to assist the Government in 

presenting its case,’’ ‘‘was not simply 

stating his professional expert opinion 

in an unbiased manner,’’ ‘‘refused to 

concede rather obvious points,’’ 

‘‘frequently volunteered testimony 

beyond a pending question, testimony 

beneficial to the Government . . . [that] 

was distracting and unnecessarily 

extended the hearing,’’ and ‘‘did not 

seem as familiar with the facts or the 

law as he should have been as an expert 

witness.’’ Id. at 14–16. 

I do not share all of the RD’s 

perspectives and conclusions about Dr. 

Munzing.12 Regarding the ‘‘rather 

obvious points’’ that the RD states Dr. 

Munzing ‘‘refused to concede,’’ the RD 

cites Dr. Munzing’s refusal to state that 

Respondent ‘‘had more experience 

treating chronic pain patients than he 

did.’’ Id. The RD correctly characterizes 

Dr. Munzing’s testimony to be that 

Respondent ‘‘may have more experience 

in the procedural end of it, but ‘in the 

area of appropriate pain management, I, 

not sure I would say that.’ ’’ Id. The RD 

criticizes Dr. Munzing by stating that 

‘‘the questions asked nothing about 

appropriate care.’’ 13 Id. 

By way of further example, the RD 

states that, ‘‘when asked the general 

question of whether a doctor 

[Respondent] who had treated 3,000 

patients for a particular condition might 

have a better understanding of how to 

treat those patients than a doctor who 

had only treated 30, Dr. Munzing would 

not agree.’’ Id. at 14–15. ‘‘Rather,’’ the 

RD criticizes Dr. Munzing, stating ‘‘he 

answered another question. ‘Having 

reviewed some of those patients I have 

great concern . . . .’ It was a general 

question, but even during voir dire Dr. 

Munzing was testifying about how bad 

of a doctor he believed . . . 

[Respondent] to be.’’ 14 Id. at 15. 

I do not share these RD criticisms. For 

example, when Respondent asked Dr. 

Munzing whether Respondent ‘‘has 

significantly more experience treating 

chronic pain patients than you do,’’ Dr. 

Munzing’s response agreed, in part, 

when he said that Respondent did have 

more experience ‘‘especially in the 

procedural end of it.’’ Tr. 80. I credit Dr. 

Munzing because he gave an honest 

answer, even admitting the dearth of his 

experience ‘‘in the procedural end of 

it.’’ Id. In the context of this proceeding, 

I further note Dr. Munzing’s obvious 

appreciation that my responsibilities 

under the CSA do not call for me to 

rubber stamp a registrant’s controlled 

substance prescribing based on the 

‘‘significantly more experience’’ he 

might have ‘‘treating chronic pain 

patients than’’ the Government’s expert 

witness. Id. Instead, Dr. Munzing’s 

responses to Respondent’s voir dire 

show me that Dr. Munzing knows to 

distinguish between the number of 

individuals a registrant has seen in his 

practice and the registrant’s compliance 

with the applicable standard of care 

when ‘‘treating’’ those individuals. See 

id. 

As already discussed, when the ALJ 

recognized Dr. Munzing as an expert, he 

stated that he was doing so ‘‘relying 

upon the Gonzalez case.’’ 15 Id. at 84. He 

did not, however, identify the relevant 

portion of Gonzalez upon which he was 

relying. Id. My review of the Chief ALJ’s 

(adopted) Recommended Decision in 

Gonzalez, as I endeavor to understand 

the ALJ’s thought process, indicates that 


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16 In addition, I note that the ALJ explicitly 

allowed Dr. Munzing to give his opinion about the 

standard of care and the usual course of 

professional practice, without raising the scope of 

Dr. Munzing’s expert testimony. See, e.g., Tr. 206 

(ALJ overruling Respondent’s ‘‘vague and 

ambiguous as to time, and asked and answered’’ 

objection to the Government’s question to Dr. 

Munzing of whether ‘‘[i]n . . . [his] opinion, did 

that combination of prescriptions [methadone, 

Roxicodone, and Soma] issued by . . . 

[Respondent] meet the standard of care or was 

issued in the usual course of professional 

practice?’’). 

17The RD continues, ‘‘[t]hat being said, I find Dr. 

Munzing’s testimony concerning the general 

standard of care to be credible. Since he was not 

proffered as an expert in the standard of care in 

California, or in the usual course of professional 

practice in California, I give limited weight to that 

testimony.’’ RD, at 17. 

the Government expert ‘‘was offered and 

accepted as an expert in the area of pain 

management.’’ 76 FR at 63125. I note 

that the Government, in this matter, 

similarly offered Dr. Munzing ‘‘as an 

expert in the treatment of pain with 

controlled substances in California.’’ Tr. 

68. 

In Gonzalez, the Chief ALJ criticized 

the report of the Government’s expert 

witness as being ‘‘confusing and 

singularly unhelpful,’’ and 

‘‘disorganized, unfocused, and written 

in a manner that bespeaks a free 

association narration of documents and 

other items provided to him by the 

Government in no particular order.’’ 76 

FR at 63125. The Chief ALJ was also 

critical that the Government’s expert in 

Gonzalez was ‘‘asked to review a mass 

of paper wherein patient charts that 

were eventually properly admitted into 

evidence are interspersed with DEA 

investigative reports and other 

documents that were not.’’ Id. The RD 

in this matter gives no indication that 

the ALJ has these, or similar, criticisms. 

At the same time, the Chief ALJ’s 

(adopted) Recommended Decision in 

Gonzales attributes to the Government’s 

expert witness, and relies on, input 

regarding the applicable standard of 

care and whether the respondent 

prescribed and dispensed controlled 

substances other than for a legitimate 

medical purpose or outside the usual 

course of professional practice. See, e.g., 

76 FR at 63145–46 (‘‘The 

uncontroverted and persuasive 

testimony of the Government’s expert 

. . . established, by a preponderance of 

the evidence, that the Respondent’s 

prescribing practices fell well below the 

applicable standard in Florida regarding 

the controlled substances prescribed 

and dispensed to the undercover agents, 

as well as to the patients whose charts 

he reviewed. On this record, the 

Government has established that the 

Respondent employed his . . . 

[registration] and/or allowed/enabled 

others to do so in a manner where 

controlled substances were prescribed 

and dispensed for other than a 

legitimate medical purpose or outside 

the usual course of professional 

practice, based on the absence of 

acceptable physician-patient 

relationships and even minimal due 

care in documentation as those concepts 

are dealt with under federal and Florida 

state law.’’). In other words, despite 

concerning issues, such as with the 

expert’s report, the Chief ALJ, in 

Gonzalez, credited the testimony of the 

Government’s expert witness in his 

(adopted) Recommended Decision. 

In sum, the meaning of the ALJ’s 

statement, that he admitted Dr. Munzing 

as an expert witness ‘‘relying upon the 

Gonzalez case,’’ is not apparent from the 

RD. It is clear, though, that the words 

the Government used at this and the 

Gonzalez hearings to proffer its expert 

witnesses are strikingly similar. It is also 

clear that the Chief ALJ relied on the 

testimony of the Government’s expert 

witness in Gonzalez about the 

applicable standard of care, 

respondent’s compliance with the 

applicable standard of care, and 

whether respondent’s controlled 

substance prescribing and dispensing 

were for other than a legitimate medical 

purpose or outside the usual course of 

professional practice. Supra. The RD’s 

third footnote and other statements 

about the scope of Dr. Munzing’s 

proffered expertise, therefore, do not 

appear to be consistent with the ALJ’s 

reliance on Gonzalez when accepting 

Dr. Munzing as an expert 

witness.16 Supra. I conclude and find, 

including based on the Government’s 

proffer of Dr. Munzing as ‘‘an expert in 

the treatment of pain with controlled 

substances in California’’ and on the 

ALJ’s identification of Gonzalez, that 

the appropriate scope of Dr. Munzing’s 

expert witness testimony includes the 

applicable standard of care for 

Respondent’s controlled substance 

prescribing in California, whether 

Respondent’s controlled substance 

prescribing complied with the 

applicable standard of care, and 

whether Respondent’s controlled 

substance prescribing was outside the 

usual course of professional practice. 

The RD further minimizes Dr. 

Munzing as an expert witness by 

concluding that the ‘‘expert 

qualifications’’ of Respondent’s expert 

witness, Dr. Standiford Helm, II, are 

‘‘superior qualifications to testify 

concerning pain management’’ and that, 

‘‘[i]n fact, . . . [Respondent’s] 

credentials, based upon experience and 

training, surpass Dr. Munzing’s 

credentials with respect to pain 

management.’’ RD, at 16. The RD, 

adding the ‘‘standard of care’’ to these 

‘‘pain management’’ conclusions, then 

states that, ‘‘Thus, on issues of pain 

management, and the standard of care 

concerning pain patients, I will give 

greater weight to the testimonies of Dr. 

Helm and to that of . . . [Respondent]’’ 

than to Dr. Munzing.17 Id. at 16–17. 

Based on my analysis of the applicable 

standard of care, supra, and my review 

of the entire record transmitted to me, 

I reach a different conclusion. 

My responsibilities under the CSA 

and the content of the OSC issued to 

Respondent mean that the focuses of my 

adjudication of this matter include the 

applicable standard of care for 

controlled substance prescribing, 

whether Respondent issued controlled 

substance prescriptions in compliance 

with the applicable standard of care, 

and whether Respondent issued 

controlled substance prescriptions 

outside the usual course of professional 

practice. While the experience of an 

expert is important in my assessment of 

the weight to give the expert’s 

testimony, the reliability of that 

testimony is paramount. According to 

the Supreme Court, evidence and expert 

testimony must ‘‘ ‘assist the trier of fact 

to understand the evidence or to 

determine a fact in issue.’ This 

condition goes primarily to relevance,’’ 

and ‘‘any and all scientific testimony or 

evidence admitted . . . [must] not only 

[be] relevant, but reliable.’’ Daubert v. 

Merrell Dow Pharmaceuticals, Inc., 509 

U.S. 579, 589, 591 (1993). In assessing 

reliability, an expert’s experience, 

standing alone, is not a sufficient 

foundation for rendering reliable any 

conceivable opinion an expert may 

express. See, e.g., United States v. 

Frazier, 387 F.3d 1244, 1261 (11th Cir. 

2004). Further, an expert’s 

overwhelming qualifications may bear 

on the reliability of his testimony, but 

they are by no means a guarantor of 

reliability. See, e.g., Quiet Technology 

DC–8, Inc. v. Hurel-Dubois UK Ltd., 326 

F.3d 1333, 1341 (11th Cir. 2003). 

Accordingly, I use ‘‘what is known,’’ in 

this situation, the applicable standard of 

care drawn from California law and 

issuances of the MBC, supra section II, 

to evaluate the reliability of the record 

expert witness testimony, not merely 

each expert’s experience and training. 

See, e.g., United States v. Frazier, 387 

F.3d at 1261. 

Dr. Munzing testified that the MBC 

Guide to the Laws ‘‘informed . . . [his] 

opinion on what the standard of care is 

in California and what is done in the 

usual course of professional practice.’’ 


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18 Dr. Munzing defined ‘‘chronic pain’’ as 

‘‘probably over three months in nature . . . 

[although] [s]ome may use a shorter time frame or 

longer, but . . . three months is a time frame that 

many people will utilize. And so acute pain is what 

suddenly happens. It usually gets better, but 

sometimes it reverts into an ongoing, . . . chronic 

pain, and that’s for a longer period of time.’’ Tr. 89. 19The Medical Board of California ‘‘expects 

physicians and surgeons to follow the standard of 

care in managing pain patients.’’ MBC Guide to the 

Laws, at 59 (emphases added). I see nothing in the 

MBC Guide to the Laws that states, allows, or 

suggests a different application of its contents based 

on the prescriber’s medical specialty. 

In the second annotation to the section entitled 

‘‘History/Physical Examination,’’ the MBC Guide to 

the Laws notes a differentiation based on where the 

medical treatment is provided. Id. That 

differentiation concerns the complexity of the 

history and physical examination ‘‘based on the 

practice location,’’ not based on the specialty of the 

physician or surgeon. Id. (emphasis added). ‘‘In the 

emergency department, the operating room, at night 

or on the week-ends,’’ the MBC Guide to the Laws 

states, ‘‘the physician and surgeon may not always 

be able to verify the patient’s history and past 

medical treatment.’’ Id. This annotation in the MBC 

Guide to the Laws elaborates, without making a 

distinction based on the specialty of the treating 

physician/surgeon, stating ‘‘[i]n continuing care 

situations for chronic pain management, the 

physician and surgeon should have a more 

extensive evaluation of the history, past treatment, 

diagnostic tests, and physical exam.’’ Id.; see also 

supra section II. 

20When the ALJ asked Dr. Munzing whether, if 

a doctor fails to document informed consent to a 

controlled substance prescription, that prescription 

is issued outside the usual course of professional 

practice and for no legitimate medical purpose, Dr. 

Munzing responded that he ‘‘would say that if that’s 

the only thing that’s missing, . . . [he] would 

probably not call it outside—. . . [he] would be 

concerned, but . . [he] wouldn’t strictly—and also 

it depends on the dosages. . . . [I]f we’re on huge 

amounts, then yes. . . . [I]f we’re on large amounts, 

combination, things like that, but if someone is on 

again, hydrocodone five milligrams twice a day, no, 

I wouldn’t say that if everything else looks fine, but 

if you’re on high dosages, which are defined 

whether it be 90, 120, 200, if you’re on dangerous 

combinations, then yes, you must have, like 

anything else that is potentially hazardous, even 

taking off a mole off your arm which is pretty 

minimal, you must have some informed consent.’’ 

Tr. 594–95. 

Tr. 85. He also testified that the ‘‘main 

categories’’ of the MBC Guide to the 

Laws are ‘‘very consistent with the 

general practice of medicine . . . even 

though the fine details may pertain to 

controlled substances.’’ Id. at 87–88. Dr. 

Munzing testified about the main 

categories of the applicable standard of 

care as addressed in the MBC Guide to 

the Laws and the ‘‘fine details.’’ Id. at 

528 (Dr. Munzing’s testimony 

identifying history, physical 

examination, evaluation, minimizing 

risk, and the dangers of combination of 

medicines); see also, e.g., id. at 87–89 

(Dr. Munzing specifically agreeing with 

the Annotation in the MBC Guide to the 

Laws that ‘‘[i]n continuing care 

situations for chronic pain management, 

the physician and surgeon should have 

a more extensive evaluation of the 

history, past treatment, diagnostic tests 

and physical exam’’).18

Dr. Munzing’s testimony in response 

to questions about whether the 

applicable standard of care or the usual 

course of professional practice in 

California for the treatment of pain with 

controlled substances depends on the 

specialty of the prescribing physician is 

consistent with the MBC Guide to the 

Laws.19 Dr. Munzing testified that the 

applicable standard of care and usual 

course of professional practice in 

California apply equally to any 

physician prescribing controlled 

substances for chronic pain over a long 

period of time regardless of the 

physician’s specialty. Id. at 123–25. He 

specifically testified that ‘‘taking 

history, do[ing] an exam, trying to 

mitigate risk, informed consent, those 

key aspects are really whether you’re in 

family medicine, internal medicine, 

pain management, whoever is doing 

that, whoever’s prescribing those 

medications.’’ Id. at 124; see also id. at 

124–25 (‘‘[W]hen I’m working hand in 

hand with our pain management 

specialist, . . . we basically are 

following the same standards.’’); id. at 

528 (Dr. Munzing’s testimony that the 

basic elements of the applicable 

standard of care are the same regardless 

of prescriber’s medical specialty). 

Dr. Munzing testified that the 

applicable standard of care addresses 

taking history, doing a physical 

examination, developing a treatment 

plan and objectives, obtaining informed 

consent, conducting periodic reviews, 

consulting, and record documentation. 

Id. at 531, citing MBC Guide to the 

Laws, at 57–61; see also Tr. 575–80 (Dr. 

Munzing responding to the ALJ’s 

questions about what a doctor is 

required to do when issuing a new 

controlled substance prescription and 

what, if anything, a doctor is required to 

document when increasing the strength 

or the quantity of a previously 

prescribed controlled substance). 

Regarding the applicable standard of 

care first prong of ‘‘History/Physical 

Examination,’’ Dr. Munzing’s testimony 

tracked and elaborated on the MBC 

Guide to the Laws. He testified that 

‘‘certainly one would do a general exam 

looking at are the medications affecting 

you in general,’’ specifically mentioning 

an exam of the heart and lung. Tr. 361. 

Regarding the specifics of the 

musculoskeletal exam, Dr. Munzing 

testified that the physician looks at the 

patient ‘‘at rest and seeing certain 

movement, flexion, extension, lateral 

extension, rotation, straight leg raising 

test.’’ Id. Dr. Munzing testified that 

neurological function is also part of the 

requisite examination to inform the 

physician about how the patient is 

doing, specifically mentioning sensory 

motor and deep tendon reflexes. Id. Dr. 

Munzing specifically testified that part 

of the physician’s physical examination 

is ‘‘actually touch[ing]’’ the patient to 

discern abnormalities and areas of 

tenderness, and the change in those 

abnormalities and tender areas over 

time. Id. at 362. I find that Dr. 

Munzing’s testimony is consistent with, 

and usefully and helpfully elaborates 

on, the ‘‘History/Physical Examination’’ 

section of the MBC Guide to the Laws. 

MBC Guide to the Laws, at 59. 

Regarding the applicable standard of 

care third prong of Informed Consent, 

Dr. Munzing explained that ‘‘for most of 

us, the most dangerous thing that we do 

is write a prescription for a controlled 

substance.’’ Tr. 89. He testified that 

‘‘consistent with the practice of 

medicine, . . . we need to inform the 

patient about . . . the potential risks, 

the potential benefits, the alternatives.’’ 

Id. at 89–90. He stated that, for 

controlled substances, an informed 

consent includes why the controlled 

substance is being prescribed, what the 

potential risks are, what the side effects, 

from mild to addiction, overdose, and 

death, could include, and that there are 

potential complications. Id. at 90–91. 

Dr. Munzing also testified that it is 

insufficient only to give a patient a 

document that says these are the 

potential hazards or benefits and risks of 

taking this particular drug and to 

maintain that document in the medical 

record. Id. at 596 (Dr. Munzing’s 

testimony that if a doctor documents 

that he gave the patient the informed 

consent and they discussed it, that 

‘‘shows that you actually did that rather 

than someone at the front desk just 

saying sign this, it’s one of 10 forms you 

find when you come to the office’’ and 

the doctor need not write down 

everything discussed).20

Dr. Munzing testified about the fourth 

prong of the applicable standard of care, 

Periodic Review, describing it as how to 

see ‘‘whether or not . . . our [chronic 

pain] management [is] working . . .[,] 

[a]re they getting better?’’ Id. at 91. He 

explained that the Periodic Review 

involves determining whether there are 

ways to decrease pain, to improve 

function, to mitigate the risk, and to 

assess compliance. Id. He also testified 

that urine drug tests and checking 

CURES are part of Periodic Reviews. Id. 

When the pain improves, Dr. Munzing 

testified, ‘‘many times we can then, and 

really should, try to decrease the risk by 

decreasing the medication and looking 

for safer alternatives.’’ Id. 

Regarding the meaning of the fifth 

prong of the applicable standard of care, 


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21 Dr. Munzing testified that, with electronic 

medical records, ‘‘it’s sometimes easy to get things 

in the records that didn’t really happen.’’ Tr. 115. 

22 Dr. Munzing also testified that there is no 

‘‘maximum MME . . . that a physician can no 

longer prescribe,’’ that ‘‘there are medically 

necessary reasons for why a physician might 

prescribe more than 90 MME to treat pain,’’ but that 

‘‘[n]inety is certainly recognizing that the risks kind 

of continue going up, and so one constantly needs 

to look at the potential risks and potential benefits.’’ 

Tr. 118–19. 

23A non-controlled substance example that Dr. 

Munzing offered is the use of chemotherapy. Tr. 

113. While chemotherapy has risks, he stated, it is 

given to cancer patients. Id. As soon as possible, he 

added, the patient is taken off chemotherapy to 

discontinue those risks. Id. ‘‘[S]o that really pertains 

to medicine in general, not only to controlled 

substances,’’ Dr. Munzing testified. Id. 

24The Government asked Dr. Munzing whether 

‘‘Calculating Total Daily Dose of Opioids for Safer 

Dosage,’’ GX 8, a two-page CDC document, 

‘‘inform[ed] . . . [his] opinion on what the standard 

of care is for what physicians should do in the 

usual course of professional practice in California.’’ 

Tr. 116. Dr. Munzing answered that ‘‘I don’t know 

that this document does, but the general concepts 

do because they’re consistent with a lot of other— 

the CDC guidelines and others. And so I don’t know 

that this sheet of paper did, but the concepts 

certainly do.’’ Id. This and other testimony show 

that Dr. Munzing familiarizes himself with relevant 

published literature and uses material in that 

literature that is consistent with the applicable 

standard of care to assist his implementation of the 

applicable standard of care. See, e.g., id. at 110 (Dr. 

Munzing’s testimony referring to published 

literature, in this instance, about the frequency of 

conducting UDSes based on the dosage of the 

prescribed controlled substance); id. at 112–13 (Dr. 

Munzing’s reference to studies showing that opiates 

increase the risk for overdose and death and that 

twice the MME per day of those opiates increases 

that risk about 8.9 times); id. at 113–14 (Dr. 

Munzing’s reference to two entities’ definitions of 

‘‘high’’ opiate ranges, analysis of those ranges, and 

use of that authoritative input to implement the 

applicable standard of care to reduce the risk to, 

and benefit, patients); id. at 119–20 (Dr. Munzing’s 

reference to organizations and agencies that are now 

recommending more frequent urine drug tests when 

high dosages of opiates are being prescribed); id. at 

335. Dr. Munzing’s practice of familiarizing himself 

with relevant published literature and using 

material in that literature that is consistent with the 

applicable standard of care to assist his 

implementation of that standard of care contributes 

to the value of his testimony to my adjudication of 

the OSC. Accordingly, as already discussed, I 

disagree with the RD’s conclusion that Dr. Munzing 

‘‘did not seem as familiar with the facts or the law 

as he should have been as an expert witness,’’ 

citing, as an example, Dr. Munzing’s statements 

about the CDC Guidelines. RD, at 16. 

Consultation, Dr. Munzing’s testimony 

described it as ‘‘if people are not getting 

better . . . or they’re getting worse,’’ 

then there is a consultation with the 

appropriate specialist. Id. at 92–93. In 

addition to giving examples of a need 

for a cardiology, pain management, and 

interventionalist consultation, he 

testified that ‘‘it may very well be an 

addiction medicine specialist to see 

whether or not they feel there’s 

evidence that this person may have, in 

addition to a pain issue, . . . an opioid 

use disorder or addictive . . . issue.’’ Id. 

at 93. Concerning the ‘‘special 

attention’’ called for by the Consultation 

prong of the applicable standard of care 

‘‘to those pain patients who are at risk 

for misusing their medications 

including those whose living 

arrangements pose a risk for medication 

misuse or diversion,’’ Dr. Munzing 

testified that ‘‘[w]hen you’re looking at 

patients, you also have to look at their 

social situation and who they’re living 

with or they’re being around.’’ Id. He 

elaborated by testifying that there are 

‘‘certain situations where someone may 

be at risk for having medications stolen 

. . . whether it be family members or 

someone in their social milieu.’’ Id. Dr. 

Munzing further elaborated by stating 

that being around ‘‘people who 

potentially have legal issues, unless you 

know the specifics, it may be that they 

may be congregating with people who 

are putting the medications at higher 

risk for being diverted from a legitimate 

to an illegitimate basis.’’ Id. at 93–94. 

Concerning records, the sixth prong of 

the applicable standard of care, Dr. 

Munzing testified that ‘‘[i]t’s vitally 

important to have accurate, complete 

medical records.’’ Id. at 115. ‘‘This is 

not an area where you want to skimp,’’ 

he stated. Id. Specifically, according to 

Dr. Munzing, ‘‘at every visit one needs 

to make sure that they document what 

they do and don’t document things that 

weren’t done.’’ 21 Id. Dr. Munzing 

highlighted two areas for medical record 

documentation. First, he testified that 

‘‘it’s important to document what you 

do when you have that variances [sic] to 

explain those so people can look at it 

and go, okay, the doctor paid attention 

to it, whether it be an abnormal lab test, 

imaging test, urine drug test, CURES 

that doesn’t look right, and so the doctor 

paid attention to it, addressed it.’’ Id. 

Second, Dr. Munzing identified 

addressing the pain management plan 

and the management of the patient in 

the records, testifying that the records 

need to show that the physician is ‘‘not 

just throwing [a] controlled substance at 

it but in the great scheme of things and 

making efforts to try to mitigate the risk 

. . . making attempts to try to bring 

down the medications whenever 

possible and reduce the potential 

interactions between opiates and other 

medications.’’ Id. at 115–16. 

Dr. Munzing testified about the 

medical care Respondent provided, and 

controlled substance prescriptions 

Respondent issued to, A.A., R.B., S.D., 

L.D., S.H., and J.M. Id. at 125–301). He 

testified about why the applicable 

standard of care requires physicians to 

reduce the daily morphine milligram 

equivalents (hereinafter, MME) they 

prescribe.22 Id. at 113. He framed his 

testimony by stating that physicians 

‘‘take care of patients for all kinds of 

issues that are inherently dangerous, 

and constantly look[ ] at how can we 

minimize and reduce the risk to the 

patient.’’ 23 Id. at 112. He stated that 

‘‘really . . . there is no safe, inherent 

safe dosage in opiate.’’ Id. at 119. Dr. 

Munzing cited studies showing that 

opiates, ‘‘even at the level of 50 . . . 

[MME/day, increase] the risk for 

overdose and death.’’ Id. at 113. He 

continued his testimony by stating that 

‘‘[o]nce you get to 100 [MME/day], it 

goes up even farther. It’s approximately 

8.9 times more risky for overdose than 

someone who is on a very low dosage.’’ 

Id.; see also id. at 120 (Dr. Munzing’s 

testimony that ‘‘[s]tudies have shown 

that when you go over 120, the risk of 

developing opiate abuse or opiate use 

disorder goes up . . .[,] [t]he numbers 

are as high as 20 to 30 percent over that 

amount’’). Dr. Munzing testified that the 

applicable standard of care ‘‘requires 

that we try to mitigate the risk any way 

possible.’’ Id. He testified that there are 

patients for whom opiates cannot be 

reduced and that there are patients who 

are ‘‘optimized’’ at a low dosage that is 

‘‘not a very dangerous level, and so it 

may be that you continue.’’ Id. ‘‘But,’’ 

Dr. Munzing testified, ‘‘when someone’s 

on the higher end, probably, you know, 

somewhere over 100, 120, 150 . . . 

[MME/day], if there are ways we can 

bring them down, you’re greatly 

benefitting them because they are in the 

higher risk kind of category.’’ 24 Id. at 

114; see also id. at 807–10 (Dr. Helm’s 

testimony that he thinks it is ‘‘obvious’’ 

that higher doses of controlled 

substances carry higher risk and that, if 

a physician is going to prescribe high 

doses, the physician has ‘‘got to 

document why these doses are 

appropriate’’). 

Similarly, Dr. Munzing also testified 

about how, consistent with the 

applicable standard of care and the 

usual course of professional practice, a 

physician increases the dosage of a 

controlled substance. Id. at 91–92. 

According to Dr. Munzing, a physician 

would increase the dosage of a 

controlled substance due to ‘‘continued 

symptoms and . . . potentially 

worsening symptoms.’’ Id. at 92. Before 

increasing the dosage of a controlled 

substance, the applicable standard of 

care calls for an updated history to 

determine, for example, whether there 

was a sudden injury or accident, and an 

evaluation of the severity of the 

associated symptoms, for example, 

determining whether there are 

neurological and other symptoms. Id. 

Following the applicable standard of 


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25 ‘‘PDMP’’ means a Prescription Drug Monitoring 

Program, such as CURES. 

26 I note that there are instances when Dr. 

Munzing’s testimony sets out the applicable 

standard of care even though he does not explicitly 

state that he is doing so. See, e.g., Tr. 119–20. 

27Regarding the section in the MBC Guidelines 

for Prescribing Controlled Substances for Pain 

(2014) (hereinafter, MBC Guidelines for Prescribing) 

addressing ‘‘Ongoing Patient Assessment’’ and Dr. 

Munzing’s testimony about it, they also are 

consistent with the MBC Guide to the Laws. See, 

e.g., MBC Guide to the Laws, at 58 (material 

addressing periodic reviews). 

The Government also asked Dr. Munzing to 

testify about the section called ‘‘Compliance 

Monitoring’’ in the MBC Guidelines for Prescribing. 

Tr. 100–01. Dr. Munzing testified that ‘‘compliance 

monitoring’’ is ‘‘trying to do the best that we can 

as prescribers to ensure that the patient is 

complying with what we’re prescribing.’’ Id. at 100. 

When asked for examples of what physicians can 

do to ensure compliance, Dr. Munzing’s testimony 

addressed ‘‘monitoring and checking’’ CURES 

which, he stated, is ‘‘[n]ow . . . mandatory in the 

State of California . . . whether it be in primary 

care, specialty care, pain medication—pain 

management, we have to check all patients on 

chronic controlled substance medications on at 

least an every four-month basis.’’ Id. at 101. ‘‘And,’’ 

he testified, ‘‘if you start a new medication, you’ve 

got to check it again.’’ Id. In response to the ALJ’s 

questioning, Dr. Munzing testified that checking 

CURES became mandatory on October 2, 2018. Id. 

Some of the controlled substance prescribing about 

which the parties stipulated occurred after October 

2, 2018. See, e.g., Stipulations 37 (A.A.), 40 (R.B.), 

43 (S.D.), 49 (S.H.), and 52 (J.M.). 

28 Dr. Munzing’s testimony is consistent with the 

section called ‘‘Important Information for Patients’’ 

in the Food & Drug Administration’s (hereinafter, 

FDA) publication entitled ‘‘New Safety Measures 

Announced for Opioid Analgesics, Prescription 

Opioid Cough Products, and Benzodiazepines’’ 

August 31, 2016, GX 9, at 1–2. That section states, 

in part, that ‘‘FDA is warning patients and their 

caregivers about the serious risks of taking opioids 

along with benzodiazepines or other central 

nervous system (CNS) depressant medicines, 

including alcohol. Serious risks include unusual 

dizziness or lightheadedness, extreme sleepiness, 

slowed or difficult breathing, coma, and death. 

These risks result because both opioids and 

benzodiazepines impact the CNS, which controls 

most of the functions of the brain and body. . . . 

If you are taking both opioids and benzodiazepines 

together, consult your health care provider to see 

if continued combined use is needed.’’ Id. 

29 Dr. Munzing testified that the frequency of 

conducting urine drug testing ‘‘depends on a lot of 

issues.’’ Tr. 109. Dr. Munzing stated that ‘‘a lot 

depends on the dosage that they’re on. Are they on 

a low dosage, a medium dosage, a high dosage? And 

are they on multiple controlled substances? Is it just 

one opiate, or is it an opiate and other medications? 

And so a lot goes into the determination, but at least 

once a year, and on high dosage, probably once a 

month.’’ Id. at 110. 

care, the physician would do a thorough 

exam of the pained area, which may or 

may not call for imaging and laboratory 

testing. Id. According to Dr. Munzing, 

under the applicable standard of care, 

the physician is ‘‘to determine that what 

. . . [the physician is] doing needs to be 

increased[, to] weigh that with the 

increased risk or potential risk . . . [to] 

the patient, . . . typically looking at 

kind of a multidisciplinary, multimodal 

way of managing[, and to determine] are 

there safer alternatives that we can bring 

in, whether it be physical therapy or 

others, that might be of benefit that may 

be safer.’’ Id. Dr. Munzing also stated 

that ‘‘certainly, when you go over 90 

[MME], one needs to make it clear to the 

patient that . . . the risk . . . is higher 

and so, again, the informed consent.’’ Id. 

at 119. 

Regarding monitoring, given the 

increased risk that increased MME may 

lead to opiate abuse or opioid use 

disorder, Dr. Munzing testified about 

the physician’s continuing need to look 

for whether there is ‘‘any evidence that 

there’s any opioid abuse going on, 

addiction going on.’’ Id. at 120. ‘‘[S]o,’’ 

he stated, ‘‘it’s more intense monitoring 

once you’re over’’ 120 MME. Id. 

Referencing ‘‘a number of organizations 

and agencies . . . [that] are 

recommending more frequent urine 

drug tests,’’ Dr. Munzing’s testimony 

stated that ‘‘monitoring . . . [patients] 

more closely . . . , seeing them more 

frequently, urine drug tests more 

frequently, checking CURES or the 

PDMPs more frequently to ensure that 

they’re actually complying with what 

you’re doing.’’ 25 Id. at 119–20. Dr. 

Munzing stated that there are patients 

who ‘‘desperately need’’ high dosages of 

opioids, ‘‘but one would want to ensure 

that they’re in full compliance with 

what you’re prescribing and that you’re 

benefitting [them]—and, again, once 

you’re over . . . [120 MME] constantly 

trying to see when can we start to step 

down if at all possible.’’ 26 Id. at 120. 

Dr. Munzing also testified about the 

need for physicians to be looking out for 

red flags of abuse or diversion.27 Id. at 

95–96; see also id. at 581–82 (Dr. 

Munzing responding to the ALJ’s 

question about what, if anything, a 

doctor should do if a patient requests a 

particular medication). Stating that 

‘‘there’s probably a list of at least 20 or 

more’’ red flags, Dr. Munzing 

specifically identified refilling 

medications early; escalating dosages of 

opiates; seeing multiple physicians to 

get controlled substances; using 

multiple pharmacies; driving long 

distances to see the physician or 

provider; and having opiates in 

combination with benzodiazepines, 

with benzodiazepines and muscle 

relaxants, and with stimulants.28 Id. at 

95. 

The Government asked Dr. Munzing 

to address urine drug testing. Id. at 102. 

Dr. Munzing explained that controlled 

substances are ‘‘scheduled because 

they’re dangerous drugs in many ways.’’ 

Id. at 100. According to his testimony, 

‘‘[i]t’s vitally important when you’re 

prescribing controlled substances . . . 

to do the best that we can as prescribers 

to ensure that the patient is complying 

with what we’re prescribing’’ to 

determine, for example, ‘‘if there’s any 

conflicts between medications’’ and to 

try to ‘‘mitigate the risk of the 

treatments’’ and to ‘‘optimize 

treatment.’’ Id. at 100, 102. Dr. Munzing 

testified that drug testing indicates 

‘‘whether or not . . . medications that 

you’re prescribing [are] showing up as 

they should . . . [and whether] other 

things [are] showing up that shouldn’t 

be there.’’ 29 Id. at 102. 

Dr. Munzing described aberrant drug 

test results. Id. at 103–09. He testified 

that a positive test for a substance that 

the physician did not prescribe is an 

aberrant result, that ‘‘it’s your 

responsibility to try to find out why that 

is there,’’ that the result of the inquiry 

‘‘should be very well documented in the 

record,’’ and that, ‘‘if it’s not legitimate, 

then what are your actions based on the 

non-legitimate result?’’ Id. at 103–04; 

see also id. at 584–85 (Dr. Munzing’s 

testimony responding to the ALJ’s 

question about whether the applicable 

standard of care requires a doctor to 

document an aberrant UDS result); id. at 

775 (Dr. Helm’s testimony ‘‘agree[ing] 

that there should be, and this holds 

throughout whenever there’s a UDS 

which is not consistent for whatever 

reason, including this one, that yes, 

there should be a discussion of your 

findings on the UDS’’). Dr. Munzing also 

testified that a negative test for a drug 

that the physician prescribed, when the 

testing took place less than 30 days after 

a 30-day prescription was filled, is 

aberrant. Id. at 104. He testified that it’s 

‘‘incumbent’’ on the physician ‘‘to try to 

investigate’’ the negative result. Id.; see 

also id. at 111 (Dr. Munzing’s testimony 

equating his use of the word 

‘‘incumbent’’ with the ‘‘standard of care 

in the usual course of professional 

practice’’). For example, he testified, it 

could be negative due to the ‘‘sensitivity 

of the test, if they’re on a fairly low 

dosage.’’ Id. at 105; see also id. at 110– 

11 (citing GX 7, at 19). In such a 

situation, Dr. Munzing stated that he has 

‘‘called the toxicology lab, talked to the 

person, and they said, oh, well, the 

number was this[, . . .] [i]t’s just under 

that and so they’re really taking it, but 

it comes across negative.’’ Id. at 105; see 

also id. at 110–11. Dr. Munzing again 

testified that the physician’s inquiry 

would be ‘‘well documented in the 

record so someone looking at it . . . 

[knows] that they are taking it, but it just 

doesn’t test positive because we’re 

looking at a negative positive, not at a 


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numerical number.’’ Id. at 105; see also 

id. at 111–12. 

Dr. Munzing testified that a negative 

UDS result for a prescription drug, filled 

more than thirty days before the UDS, 

is aberrant. Id. at 106. He stated that the 

way such an aberrant result is handled 

depends on the circumstances. Id. When 

the drug that tested negative is a very 

high dose of a prescription drug, the 

individual for whom the drug was 

prescribed is ‘‘probably going through 

withdrawal’’ if the individual is ‘‘really 

. . . out’’ of the drug. Id. at 106–07. 

Consequently, ‘‘you need to inquire of 

them, are you having withdrawal 

symptoms?’’ and employ one of the 

standardized objective withdrawal 

scales to assess the presence of 

withdrawal. Id. at 107. Dr. Munzing also 

testified that ‘‘if people desperately 

need these medications, they usually 

will do everything possible not to run 

out.’’ Id. With that starting point, Dr. 

Munzing testified that he would ‘‘use 

that as an opportunity . . . to start 

bringing you down, not necessarily to 

zero, but start cranking it down a little 

bit over time and using that as an 

opportunity.’’ Id. Dr. Munzing 

immediately added, ‘‘[b]ut that again 

would be well documented in the 

records.’’ Id. 

Dr. Munzing also testified that, for 

non-cancer pain patients, it is not safe 

to use marijuana while also taking 

prescribed opioids due to the ‘‘inherent 

risks of THC’’ and ‘‘it’s . . . [his] 

responsibility as a treating physician to 

try to keep you as safe as possible in 

. . . managing . . . patients . . . [a]nd 

if there’s something else coming into 

that that . . . [he] can’t determine what 

dosage of THC, . . . it just puts the 

patient at much higher risk.’’ Id. at 108– 

09; see also id. at 701–02 (Dr. Helm’s 

testimony about THC). He also testified 

that he has ‘‘seen a few people where 

they encourage the use of THC as they 

are tapering down significantly, and so 

you can see that this is part of their 

management plan.’’ Id. at 109. In this 

instance, ‘‘[a]gain, that would be very 

well documented in the medical records 

exactly what the plan is, how we’re 

going to reduce that.’’ Id. 

When the aberrant result is due to 

non-compliance with the treatment, the 

applicable standard of care informs the 

physician’s response based on the cause 

of the aberrancy, Dr. Munzing testified. 

Id. at 106. For example, Dr. Munzing 

testified, the physician may treat for 

addiction, do more frequent compliance 

monitoring, or change treatment. Id. 

‘‘So,’’ Dr. Munzing testified, ‘‘it all 

depends on what you determined was 

the cause of the aberrancy . . . [b]ut 

whatever you choose to do, it needs to 

be well documented so it’s obvious for 

anyone else looking at it.’’ Id. 

E. Respondent’s Case 

Respondent testified and called one 

witness, Dr. Standiford Helm, II, his 

expert. Id. at 628. According to 

Respondent’s case, he, as a fellowshiptrained pain specialist, received 

extensive training in both medication 

and procedural pain treatments, has an 

unblemished medical record, has never 

been sued for medical malpractice, and 

has never had any disciplinary action 

brought against his license, presumably 

meaning his medical license. 

Respondent’s Post-Hearing Brief dated 

January 24, 2020 (hereinafter, Resp 

Posthearing), at 2, 21–22. His position is 

that, due to the ‘‘totally inaccurate and 

baseless opinion’’ of the Government 

expert, eight ‘‘DEA agents raid[ed] his 

office and then had his DEA certificate 

suspended.’’ Id. at 2. According to 

Respondent, ‘‘[t]here was never any 

malpractice lawsuit; no patient 

overdose; no patient harm; no adverse 

Medical Board action; nor any criminal 

activity or even suspicion of 

malfeasance.’’ Id. Respondent’s position 

is that ‘‘this process has been ruinous to 

. . . [his] career and dangerous to his 

patients’’ and the ‘‘destruction of a 

fellowship-trained professional all 

occurred because a family doctor offered 

inaccurate opinions without bothering 

to read the complete medical records 

and who lacked basic knowledge on 

many topics related to opiates.’’ Id. 

Respondent testified that 

‘‘[u]nfortunately, everything has become 

so difficult these days. And again, . . . 

[he has] been doing this for 30 years, 

and . . . [his] training is very, very 

different.’’ Tr. 920. 

Respondent testified about each of his 

medical files at issue in the OSC and, in 

the process, gave his perspective on 

many matters relevant to this 

adjudication. Regarding UDSes, 

Respondent testified about his use of 

UDSes in his practice, stating that ‘‘we 

do our very best to check’’ UDSes and 

‘‘have done it for years and years and 

years,’’ and that they are ‘‘just one 

component of patient compliance.’’ Id. 

at 1099–100; see also id. (Respondent’s 

testimony that CURES is another way to 

check compliance although he ‘‘clearly 

understand[s]’’ that CURES only shows 

prescriptions that are filled, not 

prescribed drugs that are being 

ingested); id. at 1120–22 (Respondent’s 

testimony confirming that S.D. received 

carisoprodol prescription from him and 

from another physician within two 

weeks of each other, and admitting that 

he has no recollection of addressing that 

with S.D.). 

According to Respondent’s testimony, 

‘‘under the best circumstances’’ it 

‘‘would be preferable’’ to have UDS 

results before seeing the patient ‘‘but 

[that] didn’t always happen.’’ Id. at 

1098. He testified that he did not recall 

whether he conducted a UDS and did 

not document it, or whether he did not 

conduct a UDS. Id. at 933 (Respondent’s 

testimony that it does not appear that he 

ordered a UDS for A.A. in 2011); id. at 

935–41 (Respondent’s testimony that he 

was ordering UDSes in 2011 but that he 

did not recall whether he had A.A. take 

a UDS on her first two visits with him 

and did not document having done so, 

or whether he did not have A.A. take a 

UDS on those first two visits). 

Respondent testified that he did not 

consider a UDS to be aberrant if it is 

negative for a substance he prescribed, 

admitting that his ‘‘attorney then, you 

know, corrected me on that statement.’’ 

Id.; see also, e.g., id. at 1077–78, 1085; 

but see id. at 1144–51 (Respondent’s 

testimony that UDSes are ‘‘appropriate’’ 

when a drug he prescribed is missing 

because, even though it was not 

documented, he ‘‘discussed with the 

patient every single time’’ and because 

Respondent had a ‘‘clear 

understanding’’ with at least one of his 

patients that the patient ‘‘only took 

medication that was needed’’ and that 

he ‘‘could afford’’ financially). Instead, 

Respondent testified, he used UDS to 

look for the presence of substances that 

he had not prescribed. Id. at 1098; id. at 

910–15 (Respondent’s testimony that he 

‘‘wanted to make sure that there was no 

illicit substances being used’’). 

Regarding an A.A. visit when her UDS 

was aberrant because it was negative for 

the Percocet he had prescribed, 

Respondent testified that ‘‘she only had 

three Percocet a day . . . [a]nd if she 

had excessive knee pain, for the last two 

weeks, she obviously finished her 

Percocet early.’’ Id. at 938. When asked 

if taking medication early was a 

deviation from his prescribing 

instructions, Respondent testified that it 

‘‘[m]ight be a deviation from 

instructions, but she had an acute 

exacerbation of pain that she was trying 

to treat.’’ Id. at 938–39; see also id. at 

950 (Respondent’s testimony about 

another aberrant A.A. UDS). Regarding 

A.A.’s methadone-negative UDS in 

February of 2013, Respondent testified 

that ‘‘in this particular case, she took 

more [m]ethadone. And she saved the 

Oxy for the end. So she’s playing 

around—again assuming no operator 

error. Assuming no manufacturer’s 

error. Assuming they didn’t read the 

fake lines. I mean I have to assume all 

these things.’’ Id. at 957. Respondent 

testified that he had no problem with 


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30 I note, however, that Dr. Helm, Respondent’s 

expert, testified that the difference between when 

a physician first writes a prescription for an opioid 

patient versus when a pain specialist assumes care 

of the patient is that the ‘‘option we have of looking 

at non-opioid alternatives has been taken away from 

us.’’ Tr. 631–32. 

31See also Tr. 558–60 (Dr. Munzing’s testimony) 

and id. at 684 (Dr. Helm’s testimony). 

I note that Respondent’s medical records for R.B. 

on this point are not accurate and, therefore, that 

they do not comply with the applicable standard of 

care. MBC Guide to the Laws, at 61 (accurate and 

complete medical records). For four visits, from July 

24, 2017 through October 16, 2017, Respondent 

inaccurately stated under ‘‘Current Medications’’ 

the number of oxycodone 30 mg tablets he last 

prescribed for R.B. GX 14B, at 32–38; see also GX 

18B, at 70–78 (inaccuracies in medical records 

concerning Respondent’s prescribing of Fentanyl 

patches to L.D.). I further note that I did not 

consider these matters in my Decision/Order 

because they were not noticed or litigated by 

consent. 

32See also Tr. 554–58 (Dr. Munzing’s testimony 

that, although the x-ray of L.D.’s knee was ‘‘normal’’ 

(GX 18A, at 39), an x-ray may not show all injuries, 

and that a Fentanyl patch is a controlled substance 

for chronic pain, not for treating an acute injury, 

such as a knee injured due to a slip, for a brief 

period of time); id. at 570–71 (re-cross); id. at 573, 

614 (re-direct). 

I credit Dr. Munzing’s testimony that Fentanyl 

patches are normally written for every three days, 

not every other day as Respondent prescribed them 

for L.D. Tr. 489. 

A.A.’s ‘‘playing around’’ with the 

controlled substances he had prescribed 

for her, testifying that ‘‘she had an 

allowance of four [m]ethadone a day. 

And she took them earlier because she 

was having these issues with pain, and 

she was saving the Oxycodone for later. 

But she was using her allowance.’’ Id. at 

958. He compared A.A.’s ‘‘us[ing] her 

allowance’’ of controlled substances 

with a child who receives a $5.00 

allowance, uses it all on Monday, and 

does not have ‘‘any money the rest of 

the week,’’ testifying that A.A. is a 

‘‘grown-up . . . [who] can make . . . 

those [controlled substance dosing] 

decisions.’’ Id. at 946. 

When asked if such a deviation from 

his prescribed controlled substance 

dosing was grounds for terminating the 

doctor-patient relationship, Respondent 

interrupted the question, responding 

‘‘[u]nder no . . . circumstances.’’ Id. at 

939. He testified that A.A. ‘‘had three 

Percocet a day . . . [,] 30 milligrams. I 

know in today’s world three Percocet is 

devastating. I get it. But three Percocet 

is not devast[at]ing to an opioid-tolerant 

patient who’s had three back surgeries, 

has significant pain, and has been on 

pain medication for a long time.’’ Id. 

According to Respondent’s testimony, 

A.A.’s negative UDSes ‘‘tell[ ] me that 

she’s not taking any medications that 

she wasn’t prescribed. And that’s what’s 

important.’’ Id. at 953; see also id. at 

944–45 (Respondent’s testimony that ‘‘if 

she was taking more Percocet, that’s 

fine. . . . It’s a sign not of abuse, and 

not of diversion. It’s a sign that she’s not 

having adequate pain relief’’); id. at 964 

(Respondent’s testimony describing 

A.A. as someone who ‘‘is following the 

rules’’ and, therefore, her increasing the 

Percocet dosage he prescribed for her 

‘‘was no issue’’). 

When asked why he did not 

document his thoughts about A.A.’s 

aberrant UDS, Respondent testified that 

‘‘[b]ecause I’m sure this visit went on 

forever and ever. And I’m injecting her 

knee, and I’m doing everything. And it 

was just, it was not of significance to 

me. . . . I’m just saying, it was not of 

concern to me.’’ Id. at 940. Also during 

his testimony, Respondent dismissed 

his inaccurately documented medical 

records by stating that he was ‘‘so busy 

talking to the patient’’ and ‘‘again, from 

this chart, that’s not a big problem, 

because it’s historically her left knee,’’ 

not her right knee as he had 

inaccurately documented. Id. at 962–63. 

In his testimony, Respondent admitted 

that he is ‘‘the keeper of . . . [his 

medical] records’’ and stated that he 

was ‘‘not restoring backwards.’’ Id. at 

972. According to Respondent’s 

testimony, ‘‘a lot of the [medical] 

records have been read wrong and 

interpreted wrong because I’m doing a 

million things at once, and people are 

trying to read the exact word.’’ Id. 

Additionally, Respondent’s case 

highlighted that his medical records 

show he explored surgical options, 

physical therapy, and the like, reduced 

the controlled substances he prescribed, 

complied with documentation 

requirements, and reduced pain.30 See, 

e.g., id. at 377 (surgery option explored); 

id. at 738 (surgery option explored); id. 

at 437 (injection); id. at 451–52 

(injection); id. at 453 (physical therapy); 

id. at 742–43 (intrathecal pump); id. at 

461–62 (increase non-opioid therapy); 

id. at 446 (decrease controlled 

substances prescribed); id. at 478–80 in 

conjunction with GX 14B, at 31–42 

(Respondent’s medical records for R.B. 

showing that Respondent increased 

oxycodone 30 mg prescription to 150 

tablets on June 26, 2017, due to new 

‘‘hand pain’’ (finger fracture) injury, 

reissued the increased number of 

oxycodone 30 mg tablets on July 24, 

2017, reduced the number of oxycodone 

30 mg tablets prescribed to 140 tablets 

on August 23, 2017, and returned the 

number of oxycodone 30 mg prescribed 

to the prescription’s May 24, 2017 

amount of 120 tablets on October 16, 

2017); 31 Tr. 692 (Dr. Helm’s testimony 

that Respondent, for S.D., substituted 

Zanaflex for Soma and tried to wean 

S.D. off Norco); id. at 434–35, 663 

(spinal cord stimulator trial); id. at 488– 

89 in conjunction with GX 18B, at 141 

(Respondent’s medical records for L.D. 

stating ‘‘[w]ould like to attempt to 

decrease narcotics’’ and showing that 

Respondent decreased the Fentanyl 

patch he prescribed for her from 100 

micrograms every other day to 75 

micrograms every other day); see also 

Tr. 490 (discontinuation of Fentanyl 

patch); but see id. at 504–05 in 

conjunction with GX 18B, at 76–81 

(showing that Respondent resumed 

prescribing Fentanyl patches (every 

three days) after L.D. slipped and 

sprained her left knee, and then 

increased the prescription to every other 

day); 32 Tr. 414–15 (documentation of 

A.A.’s daughter stealing controlled 

substances Respondent prescribed for 

A.A.); id. at 476 (medical records 

showing that the controlled substances 

Respondent prescribed ‘‘appeared to be 

reducing’’ R.B.’s pain); id. at 485 (Dr. 

Munzing’s testimony that Respondent 

managed R.B.’s pain); id. at 515 (Dr. 

Munzing’s testimony that, based on 

Respondent’s notes, L.D.’s pain 

appeared to decrease); id. at 519–20 (Dr. 

Munzing’s testimony that S.H.’s 

function improved over time); id. at 526 

(Dr. Munzing’s testimony that ‘‘pain 

medication is helping . . . [S.H.] be 

more productive’’). 

Based on substantial record evidence, 

however, Respondent was not 

successful at rebutting the OSC’s 

allegations that he prescribed controlled 

substances beneath the applicable 

standard of care and outside the usual 

course of professional practice, 

including that Respondent failed to 

conduct the requisite physical 

examinations, failed to obtain the 

requisite history, failed to develop an 

appropriate treatment plan, failed to 

conduct appropriate monitoring of those 

for whom Respondent prescribed 

controlled substances, and failed to 

comply with recordkeeping 

requirements. Supra section II.; infra 

section III.F. 


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33 Dr. Helm testified that, as an author of the 

ASIPP Guidelines, he agrees with their content, 

specifically addressing the ASIPP Guidelines’ 

statements about pain contracts and obtaining 

informed consent. Tr. 758. Yet, Dr. Helm testified 

that Respondent’s pain contract, while not in 

compliance with the ASIPP Guidelines, ‘‘can be 

accepted as an informed consent agreement 

although it . . . could be more fully documented 

and, you know, if you wanted to, the language 

could be changed from any form of . . . opioids or 

narcotics to any controlled substances, you know, 

there is that variation.’’ Id. at 758–59; see also id. 

at 748–50 (Dr. Helm’s testimony about 

Respondent’s pain contract and its non-compliance 

with the MBC Guidelines for Prescribing 

concerning obtaining a patient’s informed consent 

about the ‘‘risk’’ of using controlled substances). Dr. 

Helm’s testimony also stated that ‘‘not complying 

with this [sic] specific guidelines and deviating 

from standard of care are two different—two 

different entities, two different thesis [sic].’’ Id. at 

759. 

34Respondent’s Exhibit (hereinafter, RX) 5 is Dr. 

Helm’s curriculum vitae. 

Further, there is substantial record 

evidence that Respondent did not 

identify as problematic requests for 

specific controlled substances by name 

and self-dosing contrary to his 

prescribed dosing orders. See, e.g., Tr. 

966 (Respondent’s testimony that A.A. 

‘‘all of a sudden’’ said she would like to 

try Oxycodone instead of Methadone 

and that is ‘‘perfectly fine’’ with him); 

id. at 1030–32 (Respondent’s testimony 

about L.D.’s non-appointment 

appearance at Respondent’s office ‘‘with 

a crippling illness’’ for which she asked 

Respondent, and received, a Fentanyl 

patch (12.5 microgram) prescription, her 

ensuing complaint that the dosage he 

issued for her was too low, L.D.’s 

subsequent ‘‘classic’’ self-dosing ‘‘up to 

75 micrograms,’’ and his description of 

L.D. as ‘‘an actress, to be honest’’); see 

also id. at 1124–28 in conjunction with 

GX 18B, at 79–81 (Respondent’s 

testimony that L.D. ‘‘historically treated 

her pain with either 75 microgram or 

100 microgram [Fentanyl] patches,’’ that 

he re-started L.D. on 12.5 microgram per 

hour Fentanyl patches ‘‘because she had 

not been on it for quite some time,’’ that 

L.D. ‘‘found the dosage strength of 75 

micrograms per hour helpful in this— 

what turned out to be a very devastating 

injury and cascade of events, this all 

made absolute perfect sense,’’ and that 

he was thus justified to prescribe 75 

micrograms per hour Fentanyl patches 

on a visit when L.D.’s UDS was positive 

only for benzodiazepine); Tr. 1101–04 

(Respondent’s testimony that it is not 

unusual for his patients, ‘‘within . . . 

[the] allotted allowance of the month’’ 

to choose to ‘‘vary,’’ despite his 

prescribing instructions, the amount of 

controlled substances ingested each day 

‘‘based on . . . activity level and based 

on what . . . needed to [be] 

accomplish[ed] that day’’ and that he 

would tell them ‘‘there would be a 

maximum amount that . . . [he] would 

be comfortable with’’ their ingesting 

each day); id. at 1039–42, 1108 

(Respondent’s testimony that he 

complied with R.B.’s request for a 

specific controlled substance 

prescription—stating that he ‘‘felt for 

this man’’ given his experiences with 

his 86 year-old father whom he ‘‘can’t 

really take anywhere because he has this 

cough that embarrasses the entire family 

in a restaurant and everything else like 

that,’’ minimizing the controlled 

substance prescribing as ‘‘22 doses of 

cough syrup a month,’’ and pointing out 

that he stopped prescribing controlled 

substances on behalf of other doctors 

because he ‘‘didn’t want to be further 

involved in it’’). 

I decline to adopt Respondent’s 

excuses and arguments to overlook his 

failures to follow the applicable 

standard of care and to act within the 

usual course of professional practice. 

See, e.g., id. at 452 (the prolonged use 

of anti-inflammatories can cause serious 

organ damage); id. at 456 (a loose screw 

was subsequently discovered in S.D.’s 

spine justifying Respondent’s 

‘‘dramatically increased’’ controlled 

substance prescribing); id. at 481–83 in 

conjunction with GX 14B, at 11 (a 

pulmonologist may have subsequently 

prescribed Promethazine); Tr. 419–20 

(there is no record evidence that 

Respondent’s controlled substance 

prescribing led to respiratory 

depression, overdose, or side effects); 

see also id. at 535 (Dr. Munzing’s 

testimony that ‘‘just because someone 

doesn’t have a terrible outcome doesn’t 

mean that what you did was correct and 

right’’); id. at 1153–54 (Respondent’s 

testimony stating his belief that another 

pain doctor picking up his medical 

records ‘‘would gain a much greater 

knowledge from . . . [his] records than 

they would many other physician’s 

records,’’ instead of answering the ALJ’s 

direct questions of whether ‘‘they would 

be able to pick up from where you left 

off based on the content of your 

records’’ and whether ‘‘they [would] 

understand what you had’’). 

Having read and analyzed all of the 

record evidence, I find that Respondent 

is the witness with the most at stake in 

this adjudication. I find that, while 

Respondent’s testimony does include 

reliable statements, it also includes 

statement that lack credibility, are 

implausible, and/or are not persuasive. 

I find that Respondent’s testimony must 

be considered with much caution, and 

where his testimony conflicts with 

credible record evidence and the 

applicable standard of care, I do not 

credit it. Supra section II and section 

III.D.; infra. 

According to Respondent’s case, the 

Government’s expert witness is trained 

in family medicine, not in pain 

medicine, and did not do, let alone 

complete, a fellowship in pain 

management. Resp Posthearing, at 23. 

The testimony of the Government’s 

expert witness, Respondent charges, 

‘‘was rife with error,’’ including its 

reference to the CDC Guidelines during 

his evaluation of the controlled 

substance prescribing of Respondent, a 

pain management specialist. Id. 

According to Respondent’s case, his 

expert witness, Dr. Standiford Helm, II, 

is a ‘‘pre-eminent expert in the area of 

pain management,’’ ‘‘holds diplomate 

status with a number of organizations 

specializing in the treatment of pain,’’ 

and has affiliations with various pain 

organizations and ‘‘top journals in the 

area of pain management.’’ Id. at 25–26. 

Dr. Helm, according to Respondent, ‘‘is 

one of the authors of pain guidelines for 

. . . [the American Society of 

Interventional Pain Physicians 

(hereinafter, ASIPP)], and those 

guidelines were used as evidence in this 

hearing’’ and ‘‘has served as an expert 

reviewer for the Medical Board of 

California for pain specialists, because 

he is a pain specialist.’’ 33 Id. at 26. 

Respondent offered, and the ALJ 

accepted, Dr. Helm ‘‘as an expert in 

support of . . . [Respondent] and the 

care rendered by . . . [Respondent] to 

the patients in the areas of pain 

management and for these specific 

treatments for the patients at issue.’’ Tr. 

628. 

According to Dr. Helm’s testimony, he 

was trained in internal medicine and 

anesthesiology, became involved in pain 

management ‘‘[p]robably about ’82,’’ 

and ‘‘evolved’’ with the field as the field 

evolved.34 Id. at 620–21. He was ‘‘able to 

be grandfathered’’ when ‘‘the first 

boarding became available in 1993’’ and 

‘‘then just continued from there to the 

point where since then . . . [he has] 

been very active nationally and 

internationally, lectured and written 

and continued to do those things.’’ Id. 

at 621. Dr. Helm testified that he 

received research support from the 

manufacturer of opioids in this case, 

Purdue Pharma, one of whose founders 

was a ‘‘marketing genius’’ who 

‘‘probably helped develop the [opioid] 

problem.’’ Id. at 626–27. 

Dr. Helm testified that a doctor is 

required to do several things when 

issuing a new controlled substance 

prescription: ‘‘review whatever records 

are available,’’ including ‘‘whatever past 

medical records you have and have 


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35 Dr. Helm also stated that a pain management 

doctor is to ‘‘review a CURES Report.’’ Tr. 864–65. 36 Dr. Helm was also asked ‘‘[w]hat, if anything, 

[is] a doctor acting with [sic] the usual course of 

professional practice required to do . . . to 

document an increase in strength or quantity of a 

previously prescribed prescription?’’ Tr. 873–74. 

Since the question is not specifically about 

controlled substance prescriptions, Dr. Helm’s 

response is not relevant to my adjudication of this 

matter. 

37 I credit none of Dr. Helm’s responses to 

questions calling for a legal analysis as it is not in 

his expertise to provide a legal opinion. See, e.g., 

Tr. 864–892. To his credit, Dr. Helm testified that 

he ‘‘attempted’’ to read Gonzales v. Oregon, found 

it ‘‘very hard to read,’’ called it ‘‘interesting’’ that 

‘‘DEA deferred to the state’’ about the ‘‘usual course 

of professional practice within California,’’ and 

‘‘defer[red] to the Court’’ on such matters. Id. at 870, 

884, 873. Dr. Helm’s ‘‘deferral’’ testimony and other 

testimony about the meaning and scope of the 

‘‘usual course of professional practice’’ and the 

applicable standard of care support my decision to 

give limited weight to Dr. Helm’s testimony. See, 

e.g., id. at 867–68, 870–73. 

38Respondent subsequently testified that the only 

refill L.D. said she needed during her first visit with 

Respondent was amphetamine salts. Tr. 1019. 

Respondent testified that ‘‘[m]aybe this [medical 

record] note is not as long as it should be. But 

obviously this was a very complex patient . . . 

[a]nd so . . . a lot of time was taken in the history 

and establishing a relationship.’’ Id. 1020; see also 

id. at 1020–21 (Respondent’s testimony, when 

asked if it was an oversight for him not to document 

that chronic fatigue syndrome was the diagnosis on 

which his amphetamine salts prescription for L.D. 

was based, that he ‘‘was so busy writing down, you 

know, symptoms, and so busy doing other things, 

that . . . [he] just really didn’t get to the problem 

list at the time’’). Respondent testified that he ‘‘was 

comfortable with’’ issuing L.D. a prescription for 

amphetamine salts because he ‘‘had a list of all of 

her physicians’’ and ‘‘[t]here’s the CURES Report in 

the chart that confirms all of that information.’’ Id. 

at 1020. Respondent’s testimony does not include 

details about the source of the list of L.D.’s 

physicians, does not explain how the CURES 

Report confirms ‘‘all of that information,’’ and does 

not include information showing that the first visit 

amphetamine salt prescription complies with the 

applicable standard of care. 

39 Dr. Helm did not further identify the ‘‘CDC 

guidelines’’ he was referencing. 

access to;’’ ‘‘meet with the patient;’’ 

‘‘obtain a thorough history;’’ ‘‘perform 

an exam, really focused on, attempting 

to find out what the cause of the pain 

is, if you can;’’ ‘‘integrate that data, 

come up with a treatment plan;’’ ‘‘get[ ] 

a urine drug screen;’’ ‘‘risk 

stratification;’’ and ‘‘obtain[ ] informed 

consent and pain agreement.’’ 35 Id. at 

864–65. I find that Dr. Helm’s response 

lists half of the elements of the 

applicable standard of care.36 Supra 

section II. 

Dr. Helm’s testimonial elaboration on, 

and application of, these elements and 

on other matters pertaining to the 

applicable standard of care, however, 

fall far short and I do not credit them.37

For example, Dr. Helm’s testimony was 

inconsistent. While initially testifying 

that a UDS is one of the things a doctor 

is required to do when issuing a new 

controlled substance prescription, he 

subsequently testified that ‘‘as long as 

the physician is seeing the patient and 

carrying out an exam and coming to a 

determination absent either one of those 

data points—either the CURES or the 

UDS, it is still within the course of 

professional practice.’’ Tr. 870–71. 

Further, Dr. Helm testified that a doctor 

is required to have a ‘‘legitimate 

encounter’’ with the individual before 

he writes a controlled substance 

prescription and, during that ‘‘legitimate 

encounter,’’ is to get a ‘‘current history,’’ 

‘‘perform[ ] [an] appropriate exam,’’ and 

‘‘com[e] to a determination.’’ Id. at 871. 

According to Dr. Helm, then, if one of 

the elements he initially testified to 

being required before the issuance of a 

new controlled substance prescription is 

not performed, ‘‘even if those errors are 

made, you’re still within the 

professional practice.’’ Id. 

By way of further example, Dr. Helm 

was asked whether Respondent’s patient 

contracts satisfy informed consent. Id. at 

876. Dr. Helm testified that those 

contracts ‘‘referred to side effects’’ but 

‘‘they didn’t specifically discuss some of 

the specific risks, tolerance, death.’’ Id. 

Dr. Helm testimony concluded, though, 

that, although they are not ‘‘optimal,’’ 

the contracts are ‘‘close enough to at 

least be acceptable.’’ Id. 

Regarding his testimony that a doctor 

must ‘‘perform an exam, really focused 

on, attempting to find out what the 

cause of the pain is, if you can’’ and 

‘‘integrate that data, come up with a 

treatment plan,’’ Dr. Helm testified that 

Respondent’s initial prescribing of 

amphetamine salts for L.D. preceded 

Respondent’s noting the chronic fatigue 

syndrome diagnosis in the medical 

records for L.D.’s third visit. Id. at 879– 

82; accord id. at 1122–24 (Respondent’s 

testimony). Nevertheless, Dr. Helm 

excused Respondent’s failure, testifying 

that Respondent was ‘‘maintaining a 

medication’’ that a different medical 

professional had previously prescribed. 

Id. at 880; but see id. at 1135–36 

(Respondent’s failure to answer fully the 

ALJ’s question about the purported ‘‘list 

of . . . [L.D.’s] meds’’ and physicians at 

GX 18A, 82–83) and infra n.38. Dr . 

Helm testified that he viewed 

Respondent’s failure as ‘‘an error in 

documentation,’’ but not an ‘‘error in 

documentation [that] takes it outside the 

usual course of professional practice.’’ 38

Tr. 880. 

Regarding UDSes, Dr. Helm testified 

that the controlled substance 

prescriptions Respondent issued on the 

visit at which L.D.’s UDS was positive 

for cocaine were issued within the usual 

course of professional practice, even 

though Respondent did not ‘‘resolv[e]’’ 

the cocaine aberrancy. Id. at 882. Dr. 

Helm’s testimony was that Respondent’s 

actions were a ‘‘documentation 

problem, rather than taking [sic] outside 

the practice of medicine.’’ Id. at 885; but 

see id. at 1136–37 (Respondent’s 

testimony that the cocaine-positive UDS 

of L.D. ‘‘must have been a click of the 

box error’’ because ‘‘one thing my boys 

did if there was ever an elicit [sic] drug, 

they immediately brought the dipstick 

to me and we evaluated it together’’); id. 

at 1025–26 (Respondent’s testimony that 

L.D. ‘‘did not use cocaine,’’ that he 

phoned L.D. after reviewing the medical 

records the week before the hearing and 

received L.D.’s ‘‘confirmation’’ that she 

did not use cocaine, that he trusts his 

patients because they are ‘‘honest’’ with 

him, and that he has to ‘‘assume’’ the 

cocaine-positive result was the error of 

one of his employees who ‘‘clicked the 

wrong box’’). Instead of explaining his 

‘‘documentation problem’’ assessment, 

however, Dr. Helm warned against 

stopping opioid prescriptions ‘‘abruptly 

unless you had documentation that 

the[y] weren’t taking the opioids just 

because of the withdrawal issue.’’ Id. at 

883. Dr. Helm’s testimony did not 

elaborate on what ‘‘documentation that 

the[y] weren’t taking the opioids’’ he 

believes is needed, how a physician 

would obtain that documentation, and 

the bases for his conclusion that 

Respondent’s failure to address the 

cocaine UDS aberrancy was a 

‘‘documentation problem.’’ Id. at 882– 

83, 885. He did testify, however, that he 

is ‘‘not aware of anywhere where it is 

codified that one needs to—and forget 

UDS—any inappropriate result or after, 

whether again, malignancy, tests, 

whatever it’s going to be—anything that 

would require—high blood pressure—it 

would require a response despite the 

absence of codification.’’ Id. at 884–85. 

Dr. Helm testified that there is no 

upper limit for the MME dosages a 

physician can prescribe, stated that 

guidelines exist but do not determine 

the standard of care, and defined the 

standard of care as ‘‘what a reasonably 

trained physician in the community 

would do in similar circumstances at a 

similar time.’’ Id. at 625–26; see also id. 

at 630; id. at 807–11. According to his 

testimony, guidelines do not apply 

equally to all specialties in the area of 

opioid prescribing, stating that the CDC 

guidelines, explicitly, and MBC 

guidelines, implicitly, apply to primary 

care physicians.39 Id. at 630. Dr. Helm’s 

testimony was that the MBC guidelines 

implicitly apply to primary care 

physicians ‘‘because they refer 

repeatedly to consultations not only to 

pain management but to other 


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40See also Tr. 530 (Dr. Munzing’s testimony, 

stating that ‘‘the guidelines aren’t the standard of 

care and if one is in substantial compliance with 

the guidelines, and with any other laws that dictate 

the prescribing, one would be compliant with the 

standard of care. But could one be within the 

standard of care and not do one little thing within 

the guidelines? In my mind, yes it could be, but a 

substantial compliance with the guidelines, which 

is what . . . we all do when we’re practicing is we 

are in substantial compliance with whatever the 

guidelines are for taking care of the patients for 

whichever problems’’). 

specialties, too.’’ Id. Dr. Helm was 

asked, but did not answer, whether the 

MBC Guidelines for Prescribing are 

relevant to pain care specialists.40 Id. at 

762. He testified that ‘‘pain physicians 

can take it wherever we want to, but 

you’ve got to justify why you’re so 

doing.’’ Id. at 763. Respondent asked Dr. 

Helm if he ‘‘would say that a pain care 

specialist has an even higher standard of 

care that they should follow rather than 

just the primary care physician,’’ and 

Dr. Helm stated in agreement, 

‘‘Basically.’’ Id. 

Dr. Helm testified about the medical 

care Respondent provided, and 

controlled substance prescriptions 

Respondent issued to, A.A., R.B., S.D., 

L.D., S.H., and J.M. Tr. 632–897; infra 

section III.F. I find that Dr. Helm’s 

testimony focused largely on describing, 

explaining, and even justifying or 

excusing Respondent’s medical records 

and actions those medical records state 

that Respondent took, as opposed to 

addressing Respondent’s compliance or 

non-compliance with the applicable 

standard of care and the usual course of 

professional practice and whether the 

OSC’s allegations are founded and 

whether I should entrust Respondent 

with a controlled substance registration. 

For example, when Respondent’s 

counsel specifically asked Dr. Helm 

whether Respondent’s treatment plan 

for A.A. was appropriate, Dr. Helm 

responded that ‘‘he gave early refills,’’ 

‘‘[p]ost-dated triplicate for the 

Methadone, and then it was just 

continued following up for the 

psychological evaluation and plan to 

proceed to the epidural’’ before being 

cut off by Respondent’s counsel’s next 

question. Tr. 646–47; see also id. at 680– 

81 (Dr. Helm’s not responding to a 

question about Respondent’s 

compliance with the standard of care, 

Respondent’s counsel’s rephrasing the 

question to ask about whether 

Respondent’s controlled substance 

prescribing was ‘‘acceptable,’’ and Dr. 

Helm’s response to the re-phrased 

question); id. at 731–32 (Dr. Helm’s 

testimony, when asked, ‘‘[i]n view of the 

totality of the care and the notes and the 

history and the information provided, 

how would you describe . . . 

[Respondent’s] treatment, of this 

patient,’’ that ‘‘[y]ou know, I think he’s 

allowing this gentleman to function, to 

support a multi-generational essentially 

family, although the girlfriend’s not 

married. But he’s supporting the kids, 

her and his grandmother, and he surely 

is, you know, providing a benefit to 

them, and there’s no threat here or risk 

to public safety’’); id. at 683 (Dr. Helm, 

answering Respondent’s counsel’s 

question about if there is any reason to 

doubt R.B. was in increased pain and 

would benefit from more medication, by 

stating that it is ‘‘[r]easonable to have 

increased pain after a car accident’’); id. 

at 715 (Dr. Helm’s testimony that 

Respondent’s medical records ‘‘clearly 

showed’’ that L.D.’s criminal 

involvement was ‘‘business,’’ but no 

direct response to Respondent’s 

counsel’s question of whether 

Respondent ‘‘adequately document[ed]’’ 

L.D.’s criminal status); id. at 687 (Dr. 

Helm’s summary testimony, without 

explanation, after Respondent’s counsel 

asked if the controlled substance 

prescriptions that Respondent issued to 

R.B. were ‘‘medically justified,’’ that 

‘‘[t]here was a legitimate medical 

purpose and they were done in the 

course of professional practice’’); id. at 

741 (Dr. Helm’s conclusory testimony 

that continuing controlled substance 

prescriptions ‘‘to allow . . . [J.M.] to 

perform [activities of daily living] and 

have quality of life despite his physical 

limitations’’ is ‘‘an appropriate goal for 

the opioid therapy’’). 

Another example, regarding the 

requisite physical examination, is Dr. 

Helm’s testimony about Respondent’s 

medical records for A.A. He testified 

about the ‘‘type of exams done by pain 

specialists in the treatment of chronic 

pain,’’ stating that Respondent 

conducted an ‘‘appropriate lumbar 

exam’’ of A.A. that was a ‘‘focused 

musculoskeletal exam.’’ Id. at 635–36; 

see also id. at 644. Dr. Helm approvingly 

testified about Respondent’s focus on 

A.A.’s back, gait, response to palpation 

of ‘‘various areas of the back,’’ range of 

motion, lower extremity exam, muscle 

strength, reflexes, and sensation, 

concluding ‘‘that’s really the gist of it.’’ 

Id. at 636; see also id. at 740 (Dr. Helm’s 

agreement with Respondent’s counsel 

that Respondent’s examination of J.M. 

on all visits was ‘‘appropriate’’ without 

testimony about the applicable standard 

of care and the usual course of 

professional practice). Dr. Helm 

mentioned the heart and lungs ‘‘because 

the surgery centers want[ ]’’ that 

information ‘‘but it’s not, you know, that 

doesn’t influence the diagnosis.’’ Id. Dr. 

Helm did not address the applicable 

standard of care and the usual course of 

professional practice regarding a pain 

management physician’s conduct of a 

heart or lung examination, let alone 

testify about the connection between the 

condition of a patience’s heart or lung 

and a pain management physician’s 

assessment of the appropriateness of 

prescribing a controlled substance. 

A further example is Dr. Helm’s 

testimony about the reasonableness and 

consistency with the standard of care of 

Respondent’s controlled substance 

prescribing. Regarding A.A., for 

example, Dr. Helm testified that, 

‘‘[s]ure,’’ the controlled substances 

Respondent prescribed during A.A.’s 

first two visits were ‘‘reasonable and 

consistent with the standard of care as 

a pain physician,’’ elaborating only that 

‘‘as long as she was getting pain relief 

and increased function with the 

medications with no side effects and 

there are no signs of aberrancy.’’ Id. at 

639. 

Also regarding A.A., as another 

example, Dr. Helm testified that it was 

appropriate for Respondent to increase 

the methadone he prescribed for her on 

January 11, 2013, stating that ‘‘the pain 

meds are worse’’ and Respondent is 

‘‘carrying out a further evaluation to 

solve—to see if there’s anything that 

could be identified and in the interim 

increasing the medications.’’ Id. at 658. 

Dr. Helm testified that one methadonenegative UDS ‘‘really it isn’t a basis for 

. . . [a] run to action on because of one 

negative in the face of multiple 

positives.’’ Id. at 892. He did not explain 

his testimony that increased methadone 

prescribing was ‘‘appropriate’’ in the 

context of Respondent’s continuation of 

it through June 5, 2013, despite one 

UDS that was negative for methadone, 

and of Respondent’s discontinuation of 

it, on June 28, 2013, based on a note that 

‘‘Pt would like to try Oxycontin’’ and 

prescribing ‘‘Oxycontin 10 mg[ ] #120 1 

QID’’ and ‘‘Percocet 10/325 #120 1 QID 

prn.’’ GX 12B, at 114; Tr. 658–60 (Dr. 

Helm’s testimony about June 5, 2013, 

including A.A.’s subsequent 

hospitalization ‘‘for concern of 

suicide’’); see also id. 740–41 (Dr. 

Helm’s testimony, without elaboration, 

that it was ‘‘appropriate and reasonable’’ 

for Respondent to prescribe ‘‘anxietyprovoking . . . large quantities of 

narcotics’’ to J.M.). Dr. Helm also did 

not explain his repeated testimony that 

Respondent’s methadone prescribing for 

A.A. was appropriate in the face of his 

testimony that methadone is 

‘‘disproportionately a cause of death 

because the half[-]life in the body is 

longer than the period of pain relief’’ 

and his agreement that there is no 

evidence in A.A.’s medical records that 


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41 Dr. Helm did not agree with Respondent’s 

counsel that Respondent ‘‘was ahead of the curve 

in terms of what he was doing to monitor patients.’’ 

Tr. 652. Instead, Dr. Helm’s responded: ‘‘I would 

say that he and I are some of the few doctors in the 

state who still remember that back in the day you 

had to fax in requests for the CURES back before 

then Attorney General Brown went electronic with 

it in 2009.’’ Id. 

42See also Tr. 746–47 (Dr. Helm’s testimony 

about J.M.’s July 13, 2018 visit with Respondent 

and CURES reports, stating that they ‘‘are all 

consistent and compliant suggest[ing] that the UDS 

results, while they should be more clearly 

documented, . . . do not . . . provide any evidence 

of risk to the public, so he’s really doing well’’); see 

also id. at 768–69. 43 Dr. Helm testified that it is expensive to send 

UDS results for confirmation. Tr. 642. 44 Dr. Helm agreed, however, that family and 

friends ‘‘may not necessarily be a good source of 

checking for compliance’’ as ‘‘they, too, might be 

abusing or diverting,’’ and that family and friends 

attending a visit with Respondent is ‘‘not really a 

substitute’’ for not doing UDSes. Tr. 766–67. 

45Again, Dr. Helm did not further identify the 

‘‘CDC guidelines’’ he was referencing. I note, 

though, that Respondent’s position in this matter is 

that the ‘‘CDC Guidelines’’ do not apply to 

Respondent. 

46The content of RX 8 alludes to the 

communication but does not include it. 

Respondent had A.A. undergo an 

electrocardiogram, as the ASIPP 

guidelines that Dr. Helm co-authored 

recommend, to prevent such ‘‘big 

problem[s]’’ as cardiac arrythmia and 

heart pump failure. Id. at 842–45; see 

also id. at 842 (Dr Helm’s testimony that 

‘‘[m]ethadone’s great advantage is that 

it’s cheap’’). 

Regarding Respondent’s monitoring of 

those for whom he prescribed controlled 

substances and his use of UDSes, Dr. 

Helm agreed with Respondent’s counsel 

that there were ‘‘several’’ aberrant 

UDSes in Respondent’s medical files. Id. 

at 650. He testified that an aberrant UDS 

is the ‘‘absence of what’s prescribed or 

the presence of what is not prescribed.’’ 

Id. at 846. Regarding how to handle 

aberrant UDSes, Dr. Helm testified that, 

‘‘as a pain physician,’’ he would ‘‘want 

to discuss with the patient . . . two 

things.’’ Id. at 648. First, he testified, a 

pain physician would want to ‘‘find out 

what’s going on,’’ document awareness 

of the aberrancy, and provide 

counseling about how to ingest the 

controlled substance. Id. Second, Dr. 

Helm testified that a pain physician 

would want to send the urine sample 

out for confirmatory testing.’’ Id. at 648– 

49. Dr. Helm clearly testified an aberrant 

UDS is ‘‘obviously something that 

should be—I, you know, I have in other 

scenarios and continue here to say that 

these results need to be documented, 

these findings need to be documented 

. . . [and] [t]hey’re not.’’ 41 Id. at 651; see 

also id. at 833 (Dr. Helm’s testimony 

that ‘‘every aberrancy on the UDS 

should be documented’’); id. at 831 (Dr. 

Helm’s testimony that his position is ‘‘if 

it’s not documented it didn’t happen’’). 

After specifically criticizing 

Respondent’s handling of aberrant 

UDSes, however, Dr. Helm minimized 

Respondent’s failures, testifying that the 

instances of aberrant UDSes in 

Respondent’s medical records are 

‘‘unlikely to represent any abuse or 

diversion or present any risk to the 

public’’ due to the ‘‘analysis of the 

patient, and these patients, there seems 

to be all the confirmatory evidence from 

the social environment and the 

CURES.’’ Id. at 649–51; see also id. at 

896 (Dr. Helm’s testimony that ‘‘we’re 

looking at documentation errors rather 

than a causative concern for public 

safety’’). When asked about 

Respondent’s failure to conduct UDSes 

for a year, Dr. Helm testified that 

Respondent’s previous ‘‘custom and 

practice was to do them, so not doing 

them is not related to a failure, 

indifference to urine drug screens.’’ Id. 

at 765. Dr. Helm declined to conclude 

that Respondent’s re-prescribing of 

methadone after repeated non-negative 

methadone UDSes was more than a 

‘‘consistent lack of documentation on 

that issue, and throughout all the 

charts.’’ Id. at 851. Instead, Dr. Helm 

testified that an aberrant UDS is ‘‘not 

one that in isolation should be the 

determinate as to what you do’’ and that 

he ‘‘look[s] at the totality of the data,’’ 

including ‘‘the patient’s response to the 

medications, ability to function, 

reported decreased pain, reported 

increased function’’ and would 

‘‘continue it.’’ 42 Id. at 846–51; see also 

id. at 897. 

At the end of his direct testimony, Dr. 

Helm stated his views of Respondent as 

a pain physician. Id. at 746–47. He 

testified that Respondent prescribed 

high doses of controlled substances, 

justifying that prescribing by stating 

‘‘but . . . his patients on high doses are 

having functional improvement.’’ Id. at 

746. Dr. Helm testified that Respondent 

monitored his patients, adding the 

excuse that the UDSes Respondent 

conducted were ‘‘hampered by the 

inability to get confirmatory tests.’’ 43 Id. 

He testified that Respondent ‘‘strongly 

documented’’ psycho-social status, 

which was ‘‘confirmed by the presence 

of family members.’’ 44 Id. Dr. Helm 

added that Respondent’s medical record 

‘‘documentation is far better than that 

which . . . [he has] seen in many, many 

records that . . . [he has] reviewed.’’ Id. 

at 747. 

Dr. Helm disagreed with Dr. 

Munzing’s ‘‘criticisms overall’’ of 

Respondent. Id. He testified that 

Respondent’s pain medicine 

adjustments ‘‘were not arbitrary’’ and 

that ‘‘the notes document rationales for 

the adjustments.’’ Id. Dr. Helm testified 

that Respondent’s ‘‘high doses are 

high,’’ that ‘‘we know [high doses] do 

have increased risks,’’ but that 

Respondent ‘‘is providing the 

monitoring, which the author of the 

CDC guidelines requests be done.’’ 45 Id. 

He concluded his direct testimony by 

referencing Respondent’s UDSes and 

stating that he does not ‘‘see’’ that 

Respondent ‘‘represents a risk.’’ Id. 

Although Dr. Helm’s testimony 

specifically addressed Respondent’s 

high dose prescribing, ‘‘pain medicine 

adjustments,’’ UDS practices, 

monitoring, use of CURES, and medical 

record documentation, it did not 

address them squarely in the context of 

the applicable standard of care and the 

usual course of professional practice. As 

already discussed, Dr. Helm’s testimony 

contained limited and unconvincing 

evaluations of Respondent’s controlled 

substance prescribing against the 

applicable standard of care and the 

usual course of professional practice. 

Accordingly, I give Dr. Helm’s 

testimony limited weight in this 

Decision/Order. 

Based on my analysis of the 

applicable standard of care and the 

existence of substantial record evidence, 

I credit the standard of care-related 

testimony of Dr. Munzing when there is 

a conflict between his testimony and the 

standard of care-related testimony of Dr. 

Helm or of Respondent. Supra sections 

II, III.D., and III.E. 

Respondent also submitted 

documentary evidence, including about 

seventy-five pages of letters from 

supporters who describe themselves as 

physicians, patients, or family members 

of patients whom Respondent has 

treated. RX 8, at 1–76. It appears, from 

my having read the legible portions of 

the letters, that Respondent reached out 

regarding his ‘‘alleged misuse of 

prescribing drugs.’’ 46 RX 8, at 74. 

Although the content of RX 8 indicates 

the strong and positive feelings and 

opinions of many individuals about 

Respondent, I can only afford that 

content limited weight in this 

adjudication because of my limited 

ability to assess the credibility of the 

letters given their written form. See 

Michael S. Moore, M.D., 76 FR 45867, 

45873 (2011) (evaluating the weight to 

be attached to letters provided by the 

respondent’s hospital administrators 

and peers in light of the fact that the 

authors were not subjected to the rigors 

of cross examination). Further, the 

content of RX 8 provides limited 

evidence about whether Respondent 


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47The OSC’s allegations include that Respondent 

prescribed controlled substances at daily MME 

levels above 90 mg per day although the CDC 

‘‘recommends avoiding or carefully justifying’’ 

doing so. See, e.g., OSC, at 4–7, 9–10. The 

Government’s questioning of Dr. Munzing included 

asking him whether Respondent’s medical records 

documented reasons or justifications for prescribing 

the specific MME value associated with specific 

controlled substance prescriptions. See, e.g., Tr. 

128–31, 167, 185. This questioning by the 

Government, though, followed Dr. Munzing’s 

testimony that, for example, there is no maximum 

MME above which a physician may prescribe and 

‘‘[t]here are occasions when one needs to go beyond 

the 90.’’ Id. at 118. Dr. Munzing’s testimony, when 

he offered to explain his response with an analogy, 

was cut off by a ‘‘nonresponsive’’ objection by 

Respondent. Id. at 119–22 (colloquy including ALJ’s 

ruling sustaining the objection and his subsequent 

recap and explanation of his ruling). Given the 

entirety of the record transmitted to me, including 

the many examples of Respondent’s controlled 

substance prescribing beneath the applicable 

standard of care and outside the usual course of 

professional practice, there is no need for me to 

consider the OSC’s MME-levels-above-90-mg/day 

allegations, I am not doing so, and those allegations 

play no role in this Decision/Order. Cf. id. at 188 

in conjunction with Jt. Stip. 79 (Dr. Munzing’s 

testimony that Respondent’s prescribing 90 mg/day 

of oxycodone for S.D. on February 4, 2019, March 

1, 2019, and April 2, 2019, was beneath the 

applicable standard of care and outside the usual 

course of professional practice ‘‘because we just 

don’t have any information’’). 

48The medical records for the June 5, 2013 visit 

state that A.A. experienced left knee pain for three 

weeks and that Respondent gave A.A. an intraarticular steroid knee injection under ‘‘strict aseptic 

technique’’ during that visit. GX 12B, at 115–17. 

prescribed controlled substance in 

conformity with the applicable standard 

of care, an issue central to my legal 

responsibilities in this adjudication. 

Heart-felt statements of individuals who 

have suffered, or who continue to suffer, 

tremendously from pain, if not specific 

or presented in a context that allows me 

to apply the controlling legal standards, 

are of limited value in an adjudication 

such as this one. Accordingly, I find that 

the substantial record evidence of 

Respondent’s multiple controlled 

substance-related violations outweighs 

the evidence in RX 8. 

F. Allegation That Respondent Issued 

Controlled Substance Prescriptions 

Beneath the Applicable Standard of 

Care and Outside the Usual Course of 

Professional Practice 

Having read and analyzed all of the 

record evidence, I find substantial 

record evidence that Respondent issued 

many controlled substance prescriptions 

beneath the applicable standard of care 

and outside the usual course of 

professional practice. Accordingly, I 

find that the Government has presented 

a prima facie case, as outlined below.47

Regarding the Xanax 2 mg controlled 

substance prescription that Respondent 

issued to A.A. on October 8, 2013, I 

credit Dr. Munzing’s testimony. Tr. 132– 

36; supra sections II, III.D., and III.E; see 

GX 12B, at 104–06. I find substantial 

record evidence that Respondent’s first 

prescribing of Xanax to A.A. was at its 

‘‘highest dosage’’ for anxiety, was at 

A.A.’s request (‘‘Cannot afford to see 

PCP; only sees him for Prilosec and 

Xanax. Would like me to prescribe her 

these meds.’’), was not associated with 

a ‘‘real detailed history regarding 

anxiety as should be included if one is 

going to take over the management of 

prescribing a benzodiazepine such as 

Xanax for anxiety,’’ was not issued after 

documented consideration of a ‘‘safer, 

noncontrolled medication[ ] that can be 

used for anxiety,’’ was issued ‘‘in 

conjunction with an opiate’’ and, 

therefore, posed a ‘‘significantly 

increased risk’’ to A.A. and was a 

‘‘significant red flag for abuse or 

diversion.’’ Tr. 133–36; GX 12B, at 104– 

06; see also Tr. 431–33; id. at 228–29 

(L.D.). 

Respondent testified about his 

decision to do A.A. that ‘‘favor,’’ to 

‘‘accommodate’’ her. Tr. 1106–08. He 

testified that even though prescribing 

benzodiazepines was ‘‘something . . . 

[he’d] really never done in . . . [his] 

practice,’’ he had a ‘‘relationship’’ with 

A.A., seeing A.A. ‘‘monthly for at least 

two years.’’ Id. at 1106. Respondent 

testified that he ‘‘did not see where . . . 

[Xanax] was interfering with her 

function.’’ Id. at 1106–07. ‘‘In fact,’’ he 

testified, Xanax ‘‘improved her anxiety 

and it improved her level of functioning 

and the like.’’ Id. at 1107. Accordingly, 

when A.A. said that she ‘‘could save 

some money as her funds were limited,’’ 

Respondent decided to ‘‘accommodate’’ 

her. Id. Respondent admitted that he 

continued to prescribe Xanax for A.A. 

‘‘in the face of UDSes that did not detect 

levels of . . . [Xanax] in her body.’’ Id. 

When asked whether it ‘‘was ever a 

concern to him’’ that A.A.’s UDSes ‘‘did 

not detect levels’’ of Xanax in her body, 

Respondent testified that A.A. ‘‘never 

obtained that medication from anyone 

else,’’ and ‘‘if the time came at the visit 

where it had already been out of her 

system, which implied that she took a 

little bit more earlier in the month[,] she 

had her monthly allowance and she did 

with it what she pleased.’’ Id.; see also 

supra section III.E. 

Accordingly, I find substantial record 

evidence that Respondent’s first 

issuance of Xanax 2 mg to A.A. was 

beneath the applicable standard of care 

and outside the usual course of 

professional practice. 

Regarding the parties’ stipulations 

that, on June 5, 2013, Respondent 

increased the monthly amount of 

Percocet 10/325 he prescribed for A.A. 

from 90 to 120 tablets, and that the next 

month, on July 23, 2013, Respondent 

again increased the monthly amount of 

Percocet 10/325 he prescribed for A.A. 

from 120 to 180 tablets, I credit Dr. 

Munzing’s testimony responding to 

whether the prescriptions ‘‘met the 

standard of care in California and were 

issued in the usual course of 

professional practice.’’ 48 Supra sections 

II, III.D., and III.E. Dr. Munzing testified 

that Respondent’s Percocet 

prescriptions for A.A. did not meet the 

standard of care in California and were 

not issued in the usual course of 

professional practice. Jt. Stips. 59 and 

60; Tr. 137–41 (Dr. Munzing’s testimony 

that A.A. is ‘‘already on an extremely 

high dosage of opioids and no real 

justification [in the medical records] to 

increase that,’’ ‘‘it appeared to have 

been increased . . . without medical 

justification and essentially increased it 

and then just kept on going rather than 

looking for an opportunity to over time 

gradually reduce it by some other 

management of the need other than just 

. . . prescribing opioids,’’ and ‘‘they’re 

not medically justified, not used in 

professional practice, but it’s not just 

because of that one visit. It’s because 

other visits that I reviewed, my opinion 

was the same, is that, both where it 

went up but also ongoing, there wasn’t 

an ongoing plan and the patient was 

being put at risk over long periods of 

time . . . . I could easily conclude that 

they were not medically justified.’’); but 

cf. Tr. 661–63 (Dr. Helm’s testimony 

that Respondent’s increasing the 

Percocet prescription was ‘‘medically 

justified based upon . . . [A.A.’s] 

complaints and examination and 

history’’ and the side effects she 

experienced from Gabapentin). I credit 

Dr. Munzing’s testimony over Dr. 

Helm’s testimony when the two conflict. 

Supra sections II, III.D., and III.E. 

Accordingly, I find substantial record 

evidence that Respondent’s prescription 

of 120 tablets of Percocet 10/325 for 

A.A. on June 5, 2013, an increase from 

90 tablets, and his prescriptions of 180 

tablets of Percocet 10/325 for A.A. the 

next month on July 23, 2013, through 

March 25, 2019, were issued beneath 

the applicable standard of care and 

outside the usual course of professional 

practice. GX 11, at 1–31. 

The parties also stipulated that, on 

January 11, 2013, Respondent increased 

the monthly amount of methadone 10 

mg he prescribed for A.A. from 90 to 

120 tablets, and that on June 2, 2014, 

Respondent again increased the 

monthly amount of methadone 10 mg he 

prescribed for A.A. from 120 tablets to 

180 tablets. Jt. Stips. 61 and 62. 

According to Respondent’s testimony, 

‘‘one source of pain in the back could 


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49The ALJ stated, after hearing this portion of 

Respondent’s testimony, that ‘‘I don’t understand 

your answer.’’ Tr. 1142. 

50The Government alleged that Respondent’s 

Xanax prescriptions were not legitimate because he 

continued them in the face of A.A.’s aberrant urine 

drug screens. Tr. 144–53. The Government’s case 

did not note, analyze, or address the ‘‘prn’’ notation 

on the Xanax prescriptions. Accordingly, I find that 

the Government did not present a prima facie case 

on this allegation. See, e.g., GX 11, 1–31. 

The record evidence, though, that Respondent 

conducted urine drug screens, yet did not analyze 

and note, let alone act on, the results is puzzling 

at best. At worst, it raises serious questions about 

Respondent’s knowledge about, and 

implementation of, controlled substance-related 

best practices. Supra section III.E. The Government 

did not pursue these matters and, accordingly, they 

play no role in my Decision/Order. 

be adhesions in the epidural space’’ 

from ‘‘inserting these percutaneous 

leads into the epidural space’’ that ‘‘do 

break up adhesions and stuff like that’’ 

and ‘‘there is a tiny bit of a therapeutic 

kind of thing there when you break up 

some adhesions.’’ Tr. 1141. He testified 

that A.A. ‘‘varied her dose from three to 

six tablets [of methadone] a day’’ 

meaning that she ‘‘had increased her 

activity level because she was doing 

things at—that she didn’t necessarily 

do’’ because ‘‘she was able to figure out, 

‘If I took more medication on a 

particular day, I was able to accomplish 

greater tasks.’ ’’ Id. at 1142. 

Respondent’s testimony about this 

matter included an example: ‘‘I can go 

to Costco if I take an extra [methadone] 

tablet.’’ 49 Id.; see also id. at 141–44; id. 

at 665–74 (Dr. Helm’s testimony stating 

Respondent ‘‘documented increased 

pain reports and that would provide the 

basis for an increase’’ and concluding 

that ‘‘someone could argue should you 

increase or not, but that’s a medical 

judgment’’). Respondent’s testimony 

about these matters did not address 

safety concerns or risks to A.A. of her 

self-dosing methadone. Supra section 

III.E. (Dr. Helm’s testimony that 

methadone is disproportionately a cause 

of death because its half-life in the body 

is longer than the period of pain relief). 

I credit Dr. Munzing’s testimony 

regarding the medical records 

Respondent created about these 

methadone increases. Supra sections II, 

III.D., and III.E. Dr. Munzing addressed 

the first part of the paragraph called 

‘‘Pain HPI’’ for the January 11, 2013 

visit, which states A.A. ‘‘appeared to be 

improved after the stimulator was 

tried.’’ GX 12B, at 80. He testified that 

‘‘one would not certainly want to 

increase . . . [methadone] when there’s 

improvement.’’ Tr. 142; see also id. at 

551–52; id. at 566–67. Regarding the last 

part of the same ‘‘Pain HPI’’ paragraph 

which states ‘‘[h]igher dose of MTD 

necessary lately due to the intensity of 

her complaints,’’ Dr. Munzing testified 

that A.A. was already at high risk due 

to very high dosages and the 

combination of medicines. Id. at 143; 

GX 12B, at 80; see also Tr. 551 (Dr. 

Munzing’s testimony that increasing 

methadone from four a day to six a day 

is a ‘‘large jump’’); id. at 666 (Dr. Helm’s 

testimony that ‘‘some consider’’ 

Respondent’s doses high). Dr. Munzing 

testified that ‘‘there are other 

alternatives, safer alternatives than just 

continuing to increase the dosage of 

medicine and putting a patient at much 

higher risk than they already are.’’ Tr. 

143; see also id. at 673 (Dr. Helm’s 

testimony that, although A.A. reported 

benefits at the higher dose, ‘‘it’s 

something you don’t want to encourage 

going forward’’ because ‘‘patient safety 

is the number one concern’’); id. at 773 

(Dr. Helm’s testimony that ‘‘there’s no 

question you don’t want patients taking 

meds ad lib, and I would share that, you 

know, while I get somebody who tells 

me that they have to do something it 

really raises an eyebrow because I don’t 

want them to be just doing whatever it 

is they feel to do because—what they 

feel like they should do because that 

does create great risk’’); id. at 773, 778 

(Dr. Helm’s testimony that Respondent 

did not document a conversation with 

A.A. about her not having taken the 

methadone as prescribed, that Dr. Helm 

agrees ‘‘that is a documentation issue,’’ 

and, consequently, that ‘‘[w]e don’t 

know what’s going on’’) in conjunction 

with id. at 782 (Dr. Helm’s testimony, 

positing without a factual basis, that 

Respondent’s failure to document is not 

a public health issue, but that Dr. 

Helm’s ‘‘practice would be . . . if she’[s] 

taking less to provide less’’) and id. at 

674 (Dr. Helm’s testimony that ‘‘what’s 

remarkable about these patients is that 

by and large they did present improved 

benefit, which is unusual for the highdose opioid patients,’’ citing the Opioid 

Pain Consortium FDA-mandated study 

about opioid-induced hyperalgesia); id. 

at 885–889. I credit Dr. Munzing’s 

testimony over Dr. Helm’s testimony 

when the two conflict, and I afford 

Respondent’s testimony limited 

credibility as the respondent in this 

adjudication. Supra sections II, III.D., 

and III.E. 

Accordingly, I find substantial record 

evidence that Respondent issued the 

methadone prescriptions for A.A. in GX 

11 beneath the applicable standard of 

care and outside the usual course of 

professional practice.50 Tr. 144; GX 11, 

at 1–31. 

The parties stipulated that 

Respondent’s first medical recorddocumented visit with R.B. took place 

on January 8, 2016. Jt. Stip. 63. During 

that initial visit, the parties stipulated, 

R.B. told Respondent that he ‘‘was 

constantly in pain and had previously 

taken oxycodone and was then currently 

taking six tablets of Norco 

(hydrocodone-acetaminophen) 10/325 

mg[ ] a day.’’ Jt. Stip. 64. R.B.’s urine 

drug screen from that first visit, 

according to the parties’ stipulation, was 

positive for THC. Jt. Stip. 65. The urine 

drug screen results did not corroborate 

R.B.’s statement to Respondent that he 

‘‘was then currently taking six tablets of 

Norco . . . a day.’’ Jt. Stip. 64. The 

parties further stipulated that 

Respondent issued R.B. a controlled 

substance prescription for 90 tablets of 

oxycodone 30 mg at this initial visit. Jt. 

Stip. 66. 

Based on my review of the record 

evidence regarding R.B.’s first visit with 

Respondent, I find substantial record 

evidence that Respondent issued a 

controlled substance prescription to 

R.B., for 90 tablets of oxycodone 30 mg, 

without documenting his knowledge of 

R.B.’s medical history based on input 

directly from R.B.’s previous physician 

or physician assistant, without 

documenting that he addressed R.B.’s 

in-house, positive THC urine drug 

screen, and without documenting that 

he assessed R.B. for the risk of opioid 

abuse. Tr. 155–56 (Dr. Munzing’s 

testimony, including that he ‘‘do[es]n’t 

see any further history and specifics in 

detail regarding other drug use,’’ that 

‘‘there’s no kind of detailed evaluation 

of both current and also past drug use 

and is there any history,’’ that he 

‘‘do[es]n’t see any kind of opioid risk 

tool or other screening for—there’s 

SOAPP . . . and also the ORG, Opioid 

Risk Tool, that gives you an idea about 

risk for abuse,’’ and that he ‘‘do[es]n’t 

see any specifics in past medical records 

that would verify a lot of this . . . [s]o 

you’re going essentially from zero . . . 

immediately to 135, so . . . [he has] 

great concerns about that visit’’); MBC 

Guide to the Laws, at 59–61; see also GX 

14B, at 72–74; compare Tr. 675–78 (Dr. 

Helm’s testimony that it was ‘‘medically 

appropriate’’ to ‘‘initiate care’’ and 

‘‘appropriate treatment’’ for Respondent 

to prescribe oxycodone because it was 

of benefit in the past and the R.B. 

reported he was not benefitting from 

Norco) with id. at 784–85 (Dr. Helm’s 

testimony agreeing that a physician 

‘‘can’t just rely on what another 

physician did in . . . [his] own 

decisions to prescribe a particular 

controlled substance’’). I credit Dr. 

Munzing’s testimony. 

Accordingly, I find substantial record 

evidence that Respondent issued the 

first 90 tablet oxycodone 30 mg 


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prescription for R.B. beneath the 

applicable standard of care and outside 

the usual course of professional 

practice. MBC Guide to the Laws, at 59– 

61. 

Regarding the record evidence 

concerning R.B.’s second visit with 

Respondent, I find substantial record 

evidence that R.B. reported feeling 

‘‘much improved’’ with ‘‘[s]ome of . . . 

[his] pain . . . even down to a 1–2/10.’’ 

GX 14B, at 70; see also Tr. 156, 159–60. 

I credit Dr. Munzing’s testimony that 

‘‘you have to take in the whole context 

. . . [a]nd . . . [Respondent] should not 

have issued that prescription. You have 

. . . aberrant urine drug tests that aren’t 

being explained . . . [and R.B.] starts 

out [saying he] is much improved. Well, 

if you’re much improved, then maybe 

we’ve overshot and we can . . . give 

you much less.’’ Tr. 159–60. I find no 

record evidence that Respondent 

documented use of his professional 

judgment to evaluate R.B.’s changed 

pain report and to consider adjusting 

the 90 tablet oxycodone 30 mg therapy 

he initiated on R.B.’s prior visit. GX 

14B, at 70–71. 

Accordingly, I find substantial record 

evidence that Respondent issued the 

second 90 tablet oxycodone 30 mg 

prescription for R.B. beneath the 

applicable standard of care and outside 

the usual course of professional 

practice. MBC Guide to the Laws, at 59– 

61. 

Also concerning R.B.’s second visit 

with Respondent, there is substantial 

record evidence that the in-house UDS 

was again positive for THC and was also 

positive for oxycodone, opioid, and 

benzodiazepine. GX 14B, at 71; see also 

Tr. 157–58. However, there is no record 

evidence that Respondent ever issued 

R.B. a prescription for THC or for a 

benzodiazepine. See, e.g., Tr. 1114–15. 

I credit Dr. Munzing’s testimony, and I 

find substantial record evidence that 

this second-visit, in-house UDS was 

aberrant and that Respondent’s medical 

record for this visit with R.B. does not 

document that he addressed this 

aberrancy in any way. Id. at 157–58; 

supra sections II, III.D., and III.E. 

Accordingly, I find further substantial 

record evidence that Respondent issued 

the second 90 tablet oxycodone 30 mg 

prescription for R.B. beneath the 

applicable standard of care and outside 

the usual course of professional 

practice. GX 14B, at 71; MBC Guide to 

the Laws, at 60–61. 

Further, the parties stipulated that 

Respondent increased the oxycodone 30 

mg prescription for R.B. from 90 tablets 

to 120 tablets on April 6, 2016. Jt. Stip. 

74; GX 14B, at 69. During the same visit, 

however, the substantial record 

evidence shows that Respondent 

documented in R.B.’s medical record 

that R.B. reported ‘‘[f]eeling much 

improved,’’ that ‘‘all complaints of pain 

are less,’’ and that R.B. exercised daily, 

predominantly by walking four to six 

miles. GX 14B, at 68; see also Jt. Stip. 

75. I find no evidence in Respondent’s 

medical record for the April 6, 2016 

visit with R.B. that Respondent 

documented the professional judgment 

and analysis that led him to increase the 

oxycodone 30 mg prescription he issued 

for R.B. from 90 to 120 tablets. Tr. 170– 

71; see also GX 14B, at 68–69; Tr. 678– 

79 (Dr. Helm’s testimony that the 

rationale for Respondent’s prescribing 

‘‘would have to be . . . decrease pain 

and increase function’’). 

Accordingly, I find substantial record 

evidence that Respondent issued the 

April 6, 2016 120 tablet oxycodone 30 

mg prescription for R.B. beneath the 

applicable standard of care and outside 

the usual course of professional 

practice. GX 14B, at 68–69; MBC Guide 

to the Laws, at 59–61. 

I find substantial record evidence that 

Respondent prescribed R.B. the 

controlled cough medicine 

promethazine with codeine. See, e.g., 

GX 14B, at 13–24. According to Dr. 

Munzing’s testimony, which I credit, 

promethazine with codeine is a highly 

abused controlled substance. Tr. 172; 

supra sections II, III.D., and III.E. I find 

substantial record evidence that 

Respondent’s medical record for R.B.’s 

February 7, 2018 visit states that R.B.’s 

primary care physician ‘‘will no longer 

prescribe . . . [R.B.] the cough syrup’’ 

and that Respondent issued R.B. a 

prescription for that controlled 

substance, including a refill, on that 

day. GX 14B, at 24; see also Tr. 1108. 

Dr. Munzing’s analysis of Respondent’s 

medical records for R.B., which I credit, 

includes that Respondent did not 

document conducting a lung 

examination or evaluation of R.B. prior 

to issuing this controlled substance 

prescription. Tr. 173; supra sections II, 

III.D., and III.E.; see also Tr. 480–81 and 

id. at 1109 (Respondent’s testimony that 

he ‘‘never delved into’’ why R.B. had 

the cough and the ‘‘bottom line is, he 

had a cough’’). Dr. Munzing’s testimony 

about Respondent’s medical records 

states, and I credit his testimony, that 

the ‘‘primary physician has cut . . . 

[R.B.] off[, w]e don’t know why[, i]t’s 

not explored[,] and it’s not documented 

why the primary physician cut him off.’’ 

Id. at 174; supra sections II, III.D., and 

III.E. I also find that Dr. Munzing 

credibly testified that Respondent is a 

pain management doctor, not a 

pulmonologist, and credibly questioned 

whether Respondent is the ‘‘right 

person’’ to diagnose a pulmonary matter 

and to evaluate whether this controlled 

substance is the appropriate way to treat 

this pulmonary matter. Tr. 174; see also 

id. at 481. Specifically, Dr. Munzing 

testified, and I credit his testimony, that 

‘‘prescribing promethazine with codeine 

on a chronic, ongoing basis is not the 

treatment for anything and is high risk 

for abuse.’’ Id. at 176; supra sections II, 

III.D., and III.E.; but cf. Tr. 684–85 (Dr. 

Helm’s testimony answering ‘‘[s]ure’’ 

when asked whether it was ‘‘within the 

standard of care’’ for Respondent to 

‘‘agree to take over prescribing’’ the 

promethazine with codeine because 

‘‘the primary care physician bluntly had 

been low-hanging fruit for the Medical 

Board in terms of their prescribing, so 

. . . many of them just don’t want to 

prescribe controlled substances, and it 

is very consistent with the 

environment’’) and id. at 1108 

(Respondent’s similar testimony). 

Accordingly, I find substantial record 

evidence that Respondent issued the 

February 7, 2018 promethazine with 

codeine prescription for R.B. beneath 

the applicable standard of care and 

outside the usual course of professional 

practice. MBC Guide to the Laws, at 59– 

61. 

In sum, based on all of the record 

evidence, I find substantial record 

evidence that Respondent issued 

controlled substance prescriptions for 

R.B. below the applicable standard of 

care and outside the usual course of 

professional practice. MBC Guide to the 

Laws, at 59–61; see also, e.g., Tr. 164; 

id. at 166; id. at 175–77. 

There is substantial record evidence 

that Respondent’s controlled substance 

prescribing for S.D. was below the 

applicable standard of care and outside 

the usual course of professional 

practice. For example, there is 

substantial record evidence that 

Respondent concurrently issued on 

twelve occasions between January 2018 

and January 2019, and S.D. filled, 

controlled substance prescriptions for 

methadone 10 mg, Roxicodone 15 mg, 

and carisoprodol 350 mg. GX 15, at 1– 

24. There is also substantial record 

evidence that the number of tablets 

Respondent prescribed for S.D. during 

this period increased from 180 to 270 

tablets of methadone and from 60 to 120 

tablets of carisoprodol. Id. According to 

Dr. Munzing’s testimony, which I credit, 

Respondent issued these prescriptions 

beneath the applicable standard of care 

and outside the usual course of 

professional practice. Tr. 206–207 (Dr. 

Munzing’s testimony that ‘‘based on not 

just the prescription but . . . what 

we’ve reviewed, the medical records, is 

that that’s not medically justified, not 


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51See also Tr. 190 (Dr. Munzing’s testimony that 

S.D. ‘‘has chronic significant medical problem[s]’’ 

and ‘‘[n]o one’s arguing that’’). 

52According to a document in GX 18A entitled 

‘‘[L.D.’s] Doctors & Medication List,’’ a 

pulmonologist prescribed L.D. amphetamine. GX 

18A, at 82. The document is not dated and does not 

indicate its origin. Although Respondent testified 

about the document, his testimony did not address 

the document’s origin. Supra section III.E. 

53 I note, in contrast, that Respondent’s medical 

records for A.A. state that A.A.’s ‘‘[d]aughter has 

been stealing her medications regularly, police 

report filed. Patient will now file a restraining order 

against her daughter,’’ and that Dr. Munzing’s 

testimony agrees with Respondent’s counsel that 

‘‘[t]hat’s all a very reasonable explanation to deal 

with stolen medication.’’ GX 12B, at 154; Tr. 415. 

For A.A.’s next visit, Respondent wrote in the 

medical record that ‘‘[d]aughter no longer living 

with her and therefore no further issues with meds 

being stolen,’’ and that Dr. Munzing’s testimony 

agrees with Respondent’s counsel that that ‘‘was 

good follow[-]up with respect to the daughter 

having stolen medications.’’ GX 12B, at 151; Tr. 

416; see also id. at 639–40 (Dr. Helm’s testimony). 

usual professional practice); supra 

sections II, III.D., and III.E. 

Accordingly, I find substantial record 

evidence that Respondent issued these 

controlled substance prescriptions for 

S.D. below the applicable standard of 

care and outside the usual course of 

professional practice. MBC Guide to the 

Laws, at 59–61. 

The parties stipulated that 

Respondent prescribed 90 mg of 

oxycodone/day for S.D. on February 4, 

2019, March 1, 2019, and April 2, 2019. 

Jt. Stip. 79. According to Dr. Munzing’s 

testimony, which I credit, Respondent’s 

issuance of these three stipulated 

prescriptions did not comply with the 

applicable standard of care and was 

outside the usual course of professional 

practice because Respondent did not 

document their issuance in S.D.’s 

medical records. Tr. 188 (Dr. Munzing’s 

testimony that these prescriptions were 

issued beneath the applicable standard 

of care and outside the usual course of 

professional practice); supra sections II, 

III.D., and III.E. 

Accordingly, I find substantial record 

evidence that Respondent issued these 

controlled substance prescriptions for 

S.D. below the applicable standard of 

care and outside the usual course of 

professional practice. MBC Guide to the 

Laws, at 59–61. 

The parties stipulated that, on 

February 24, 2016, Respondent 

increased the methadone prescription 

for S.D. from 120 tablets to 180 tablets. 

Jt. Stip. 80; GX 16D, at 76–77. According 

to Dr. Munzing’s testimony, which I 

credit, the medical record Respondent 

created for S.D.’s February 24, 2016 

visit, documents a ‘‘very minimal exam’’ 

on which the increased dosage 

‘‘couldn’t be based.’’ GX 16D, at 76–77; 

Tr. 188–89 (Dr. Munzing’s testimony, 

including that, ‘‘without an exam, 

without a lot of details . . . I don’t see 

anything that would justify that 

increase’’); supra sections II, III.D., and 

III.E. 

Similarly, the parties stipulated that, 

on April 20, 2018, Respondent 

increased the methadone prescription 

for S.D. from 180 tablets to 270 tablets. 

Jt. Stip. 81; GX 16D, at 23–25 (‘‘current 

meds are inadequate in controlling her 

pain even if she takes them exactly on 

schedule’’ and ‘‘[d]ue to inadequate 

pain relief, increase MTD 10 mg to #270 

3 tabs TID prn. Continue other meds; 

appropriate refills given’’). According to 

Dr. Munzing’s testimony, which I credit, 

Respondent’s April 20, 2018 

prescription for S.D., increasing the 

methadone prescribed from 180 tablets 

to 270 tablets, was issued beneath the 

applicable standard of care and outside 

the usual course of professional 

practice. Tr. 190–91; supra sections II, 

III.D., and III.E. Dr. Munzing testified, 

regarding these methadone tablet 

increases, that they put S.D. ‘‘at 

incredibly high risk,’’ particularly 

because of S.D,’s age, and that there is 

no medical record documentation that 

S.D. was made aware of and consented 

to that ‘‘incredibly high risk.’’ Tr. 191– 

92. 

Accordingly, I find substantial record 

evidence that Respondent issued his 

February 24, 2015 and April 20, 2018 

methadone prescriptions for S.D. below 

the applicable standard of care and 

outside the usual course of professional 

practice.51 MBC Guide to the Laws, at 

59–61. 

The parties stipulated that the first 

visit of Respondent with L.D. was on 

June 20, 2011. Jt. Stip. 82; see also GX 

18B, at 145–46. The parties also 

stipulated, about this first visit, that 

Respondent documented that L.D. was 

‘‘taking amphetamine.’’ Jt. Stip. 83; see 

also GX 18B, at 145. According to his 

medical records for L.D.’s first visit on 

June 20, 2011, Respondent documented 

‘‘[r]efill of Amphetamine salts given.’’ 

GX 18B, at 146. Dr. Munzing testified, 

and I credit his testimony, that 

Respondent’s medical record for L.D.’s 

first visit is ‘‘completely unclear ’’ about 

why L.D. was taking amphetamine. Tr. 

208; see also id. at 491–92 (Dr. 

Munzing’s testimony that Respondent’s 

medical records document that L.D. 

complained of pain, do not document 

that L.D. complained of fatigue, do not 

document an exhaustive review of 

symptoms, and do not document an 

evaluation or diagnosis of chronic 

fatigue syndrome); id. at 568–69; id. at 

709–10 (Dr. Helm’s testimony that the 

medical records for L.D.’s first visit with 

Respondent show no diagnosis for 

which Respondent prescribed 

amphetamine salt); id. at 797–99 (Dr. 

Helm’s testimony that a diagnosis 

(chronic fatigue syndrome) that might 

call for treatment with amphetamine 

salt first appears in the medical records 

for L.D.’s third visit). Dr. Munzing 

further testified that Respondent’s 

medical records for L.D.’s June 20, 2011 

visit include ‘‘no diagnosis of ADHD, 

attention deficit hyperactivity disorder, 

or similar’’ diagnosis. Id. at 208. Dr. 

Munzing also testified that, ‘‘typically, 

for most conditions, including the one 

that it’s typically prescribed for, ADHD, 

when someone is on high doses of 

opioids, there are alternatives which 

generally are not controlled and are 

much safer, not addicting. And so one 

would typically not use . . . an 

amphetamine salt.’’ Id. at 212–13. Dr. 

Munzing additionally testified that 

amphetamine salt ‘‘would not typically 

be a medication prescribed by a pain 

medication pain management 

doctor.’’ 52 Id. at 209; see also id. at 491 

(amphetamine salt is not a regularly 

labeled treatment for chronic fatigue 

syndrome); id. at 573–75. I credit Dr. 

Munzing’s testimony. Supra sections II, 

III.D., and III.E. In addition, I note that 

there is agreement between Dr. Munzing 

and Dr. Helm on some of these matters. 

Supra. 

Accordingly, I find, based on 

substantial record evidence, that 

Respondent’s issuance to L.D. of a 

prescription for amphetamine salt on 

L.D.’s first visit with him was beneath 

the applicable standard of care and 

outside the usual course of professional 

practice. MBC Guide to the Laws, at 59. 

Although Respondent’s medical 

records for L.D. reference the criminal 

incarceration, up-coming trial, 

conviction, and sentencing of L.D.’s 

former spouse and L.D.’s up-coming 

sentencing hearing, I find no credible 

record evidence that they address 

whether the underlying criminal bases 

for these events were related to drugs.53

GX 18B, at 82, 88. Dr. Munzing testified 

that such criminal-related litigation is a 

‘‘huge red flag’’ that Respondent ‘‘left 

wide open’’ and ‘‘all one needs to do is 

document and resolve the red flag.’’ Tr. 

232, 496–99; see also id. at 504. He 

testified that a ‘‘medical record doesn’t 

need the specifics, but it certainly does 

need to know does it have anything to 

do with the issues that we’re dealing 

with here, and it was silent to that 

effect.’’ Id. at 231; cf. id. at 715 (Dr. 

Helm’s testimony that Respondent’s 

medical records ‘‘clearly showed’’ that 

L.D.’s criminal involvement was 

‘‘business,’’ but no direct response to 

Respondent’s counsel’s question of 


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54According to the testimony of Dr. Munzing, 

‘‘DP’’ means Duragesic Patch, or fentanyl patch. 

See, e.g., Tr. 208. 

55According to the record evidence, Respondent 

failed to document and address, explicitly, negative 

UDS results for controlled substances that he 

prescribed ‘‘prn.’’ See, e.g., GX 20B, at 67–69 (S.H./ 

methadone). While the analysis of UDS results for 

controlled substances issued ‘‘prn’’ differs from the 

analysis of UDS results for controlled substances 

not issued ‘‘prn,’’ an analysis would still ensue 

including, if appropriate, an assessment of whether 

to issue another prescription for the ‘‘prn’’ 

controlled substance if the controlled substance was 

not being ingested with the frequency the 

prescription allowed. The record evidence does not 

document that Respondent conducted any such 

analysis; however, I do not consider these matters 

in this Decision/Order. 

56 I note that Respondent’s medical records state 

that, on June 18, 2012, he issued L.D. refills of 

Dilaudid, Klonopin, and amphetamine salt and that 

L.D. would see him again in two months. GX 18B, 

at 118. Respondent’s medical records for L.D. on 

that date also document that L.D.’s UDS was 

positive for cocaine. Id.; see also Tr. 594 (Dr. 

Munzing’s testimony that a cocaine-positive UDS is 

‘‘[s]uper aberrant’’). I see nothing in the medical 

records documenting Respondent’s review, 

consideration, evaluation, assessment, or 

addressing of L.D.’s cocaine-positive UDS. I find 

that these medical records are substantial record 

evidence of Respondent’s failure to comply with the 

applicable standard of care and the usual course of 

professional practice. See, e.g., MBC Guide to the 

Laws, at 60–61; see also Tr. 584–85, 610–12 (Dr. 

Munzing’s testimony); but see id. at 713–14 (Dr. 

Helm’s testimony that the cocaine-positive UDS 

was ‘‘probably a false positive’’ because ‘‘[t]his is 

not a patient who—one would think would be 

getting cocaine,’’ that he ‘‘would have preferred to 

see a note in the chart just acknowledging that the 

finding is there,’’ and that he ‘‘think[s] there should 

have been more steps to confirm’’ that the cocainepositive UDS was a ‘‘false positive’’). 

whether Respondent ‘‘adequately 

document[ed]’’ L.D.’s criminal status). 

‘‘[I]t’s something that would be fairly 

simple to close that red flag, but was not 

addressed, was not done,’’ Dr. Munzing 

further testified. Id. at 232. I credit Dr. 

Munzing’s testimony that these criminal 

litigation-related medical records of 

Respondent are beneath the applicable 

standard of care and outside the usual 

course of professional practice. Supra 

sections II, III.D., and III.E. 

Accordingly, I find substantial record 

evidence that Respondent’s medical 

records pertaining to these criminal 

litigation-related matters are beneath the 

applicable standard of care and outside 

the usual course of professional 

practice. MBC Guide to the Laws, at 61. 

As already discussed, the record 

evidence addresses the UDSes that 

Respondent conducted. Supra sections 

III.D. and III.E; see also, e.g., GX 12, 14, 

16, 18, 20, 22. Regarding Respondent’s 

January 9, 2017 visit with L.D., for 

example, I find substantial record 

evidence that Respondent conducted a 

UDS and that Respondent’s medical 

records show the UDS results to have 

been positive for benzodiazepine and 

opioid. GX 18B, at 35. I further find 

substantial record evidence that 

Respondent’s medical records for that 

visit with L.D. also show that L.D.’s 

‘‘[m]eds include . . . [a]mphetamine 

salt 30 mg qd,’’ that L.D.’s ‘‘Current 

Medications’’ section includes 

‘‘Amphetamine Salt Combo 30 mg 

Tab—Dispense: 30: 1 TABLET ORAL Q 

Day; Started: 06/20/2011,’’ and that the 

‘‘Working Treatment Plan’’ section 

states ‘‘2 months scripts given for Amp 

Salt, DP, and Dilaudid 8 mg[ ]’’ 54 Id. at 

34–36. According to Dr. Munzing’s 

testimony, which I credit, L.D.’s January 

9, 2017 UDS result is ‘‘[a]bsolutely’’ 

aberrant—because it did not show a 

positive result for amphetamine salt— 

and Respondent did not address the 

aberrancy in the medical record. Tr. 

234–35; supra sections II, III.D., and 

III.E.; see also Tr. 234–35 (Dr. Munzing’s 

testimony that Respondent’s compliance 

monitoring, including 2017 aberrant 

UDSes, ‘‘certainly falls far short of the 

standard of care’’), id. at 502–03 and GX 

18B, at 101 (Respondent’s May 14, 2013 

medical records for L.D. noting 

‘‘[i]ntolerable’’ pain, spasm, 

‘‘exacerbating RUE pain,’’ and tension 

headache, yet recording UDS results as 

negative for prescribed controlled 

substances and being ‘‘silent’’ about, 

and recording no explanation for, the 

aberrancy, particularly when viewed in 

conjunction with the noted 

‘‘[i]ntolerable’’ pain), and Tr. 236–37 

(S.H.).55

Accordingly, I find substantial record 

evidence that Respondent acted beneath 

the applicable standard of care and 

outside the usual course of professional 

practice by failing to address an aberrant 

UDS and, despite the aberrancy, issued 

for L.D. a prescription for a two-month 

supply of amphetamine salt.56 See, e.g., 

MBC Guide to the Laws, at 60. 

According to the parties’ stipulation, 

J.M.’s first documented visit with 

Respondent was on May 17, 2011. Jt. 

Stip. 97. At that time, the parties further 

stipulated, J.M. ‘‘reported to Respondent 

that he had difficulty getting OxyContin 

authorized and wanted to try oxycodone 

instead.’’ Jt. Stip. 98. The parties also 

stipulated that Respondent checked 

CURES for J.M. on May 17, 2011. Jt. 

Stip. 103.a. I find, based on substantial 

record evidence, that Respondent issued 

a controlled substance prescription for 

J.M. on May 17, 2011. GX 22B, at 133 

(Roxicodone 30 mg 180 tablets 1 q4–6 

prn to a max of 6/day). 

I find, based on substantial record 

evidence including Respondent’s 

medical records for J.M., that the 

medical office that treated J.M. before 

Respondent’s treatment transmitted a 

seven-page fax to Respondent on June 

14, 2011. GX 22A, at 71–77. I find 

substantial record evidence that the fax 

cover sheet states ‘‘[p]lease see attached 

medical records for . . . [J.M.] per your 

request.’’ Id. at 71. I find substantial 

record evidence that the transmittal 

includes a letter from the medical 

practice to J.M. dated June 1, 2011. Id. 

at 72. I find substantial record evidence 

that the letter states that ‘‘[i]t has been 

brought to . . . [the] attention’’ of the 

medical office that J.M. ‘‘violated our 

Controlled Substance Policy by 

receiving medications from multiple 

physicians per the DOJ report from 05/ 

31/2011.’’ Id. I find substantial record 

evidence that, after stating that the 

practice has ‘‘nothing further to offer’’ 

J.M. due to the ensuing ‘‘eliminat[ion] of 

trust,’’ the letter states that J.M. ‘‘will 

receive a 30-day supply of . . . 

Oxycontin, and Roxicodone today,’’ 

which will be J.M.’s ‘‘final prescriptions 

filled by . . . [that] office.’’ Id. 

The parties stipulated that 

Respondent’s medical records for J.M.’s 

June 17, 2011 visit document that J.M.’s 

mother ‘‘came to the office’’ with J.M. Jt. 

Stip. 99; see also Jt. Stip. 100 and GX 

22B, at 128 (‘‘Here with mother to plead 

mercy. Needs a doctor close to home. 

Wants a second chance.’’). I find 

substantial record evidence that, in the 

‘‘Working Treatment Plan’’ section of 

Respondent’s medical records for J.M. 

for the June 17, 2011 visit, Respondent 

wrote ‘‘One final chance; script for #180 

Roxi given.’’ GX 22B, at 129; see also Jt. 

Stip. 101–02. 

Respondent testified about these 

initial visits with J.M. Among other 

things, Respondent admitted in his 

testimony that J.M. was on a high dose 

of oxycodone. Tr. 1097. Regarding J.M.’s 

visit with Respondent on May 17, 2011, 

Respondent testified that he ‘‘was trying 

to put the pieces of the puzzle together’’ 

and that he was with J.M. ‘‘for excess of 

an hour, observing the way . . . [J.M.] 

walked into the room, observing the 

way he left the room, [and] observing 

the way that he remained seated for an 

excess of an hour.’’ Id. at 1138. 

Respondent testified that he ‘‘felt that 

that was adequate exam for these 

particular diagnoses’’ and that he 

‘‘would not expect anything acute on 

exam’’ related to J.M.’s ‘‘long history of 

compression fractures.’’ Id. 

Regarding J.M.’s June 17, 2011 visit, 

Respondent testified, defending his 

issuance of a controlled substance 

prescription for J.M. without having 

conducted a physical exam, that 

‘‘nothing had changed in these few 

weeks and there were no acute 

findings’’ and that he ‘‘again, . . . 

would expect absolutely nothing acute 


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57While not explicitly addressed in the record 

evidence, Dr. Helm’s testimony appears plausible 

that J.M. returned to his prior physician’s medical 

practice after seeing Respondent on May 17, 2011, 

the prior physician’s medical practice discovered 

from CURES that J.M. filled Respondent-issued 

controlled substance prescriptions, and the prior 

physician’s medical practice dismissed J.M. for 

violating the policy of receiving medications from 

only one physician. Tr. 734–35. Dr. Helm’s 

suppositions on these matters are irrelevant to, and 

therefore do not impact, my Decision/Order. 

on the exam’’ because he was ‘‘only 

treating chronic pain.’’ Id. at 1139. 

Respondent also testified about J.M.’s 

July 15, 2011 visit with him. According 

to Respondent, he conducted a 

comprehensive physical examination of 

J.M. at that visit ‘‘[b]ecause now the dust 

had settled,’’ ‘‘everything’s organized,’’ 

‘‘we’re all in agreement,’’ ‘‘[w]e 

understand everything that’s going on,’’ 

‘‘[t]here was time, and it was time to 

carry on with this . . . situation,’’ and 

‘‘[w]e had time to develop a baseline 

exam and everything like that.’’ Id. at 

1139–40. Respondent also testified that, 

during the July 15, 2011 visit, J.M. 

reported experiencing ‘‘an exacerbation 

of pain,’’ ‘‘changes in his range of 

motion,’’ and ‘‘changes in his body 

movement,’’ and ‘‘so then we carry on 

with the full exam.’’ Id. at 1140. 

Dr. Helm also testified about 

Respondent’s initial visits with J.M.57

According to Dr. Helm, it is 

‘‘acceptable’’ to ‘‘defer’’ a physical 

examination for a patient who is already 

on medications issued by another 

provider. Id. at 733. He testified that the 

physician is ‘‘deferring the bulk of the 

exam’’ due to being ‘‘so busy . . . 

collecting the history and determining 

on the basis of histories or [sic] 

legitimate medical purpose for the 

medications’’ and ‘‘document[s] why’’ 

the exam is being deferred. Id. at 733– 

34. Dr. Helm testified that he 

‘‘understands’’ what Respondent’s 

documentation of ‘‘one final chance’’ 

means, ‘‘that . . . [Respondent] is 

willing to go forward with . . . [J.M.] on 

a, you know, if you will, a tight leash 

where he’s really got to continue with 

the meds or continue with compliance 

and he can’t be doing what he just did.’’ 

Id. at 806. 

Dr. Munzing also testified about 

Respondent’s initial visits with J.M. 

Regarding J.M.’s May 17, 2011 visit with 

Respondent, Dr. Munzing testified that 

Respondent prescribed controlled 

substances for J.M. even though ‘‘[w]e 

just don’t know . . . [if J.M. was] 

actually taking all that medication’’ 

based on J.M.’s own documented 

statement to Respondent that ‘‘he had 

difficulty getting OxyContin authorized 

and wanted to try oxycodone instead.’’ 

Id. at 548; Jt. Stip. 98; see also Tr. 548 

(Dr. Munzing’s testimony that ‘‘[t]here’s 

no documentation in here regarding 

urine drug test [sic], regarding prior 

records at this point, regarding any of 

that, and so that medication was 

prescribed strictly based on whether a 

patient told you without any other 

investigation, without a detailed review 

of the patient from what we can see, 

from what’s documented, and without 

doing any examination of the patient’’), 

id. at 547 (Dr. Munzing’s testimony that 

‘‘[t]here’s nothing—it does not appear 

based on what’s documented that 

actually the Respondent even actually 

touched the patient, had him do any 

specific maneuvers . . . none of [what 

is done during a back exam] existed. 

None of that was documented.’’), id. at 

563–64 (same). 

Regarding J.M.’s June 17, 2011 visit 

with Respondent, Dr. Munzing testified 

that ‘‘it’s a significant red flag that here 

[sic] pleading for mercy, one more 

chance . . . [and] no other significant 

information is documented. That’s a 

great concern.’’ Tr. 267. Dr. Munzing 

also addressed Respondent’s issuance of 

Roxicodone 30 mg (180 tablets) and 

oxycodone 30 mg (180 tablets) to J.M. 

during their initial visits. Dr. Munzing 

testified that ‘‘here we’re three visits 

into it at least, and we have no exam at 

all but you’re prescribing extremely 

high dosages of medication,’’ that ‘‘here 

we are just over two weeks later [from 

when J.M. received controlled substance 

prescriptions from his prior physician] 

and you’re giving some more . . . [even 

though h]e should still have . . . at least 

another couple of weeks left, and so 

there’s no indication to get more,’’ and 

that ‘‘there’s a cascade of things that 

ought to be here,’’ specifically listing 

information about mental health issues 

and about drug and alcohol current or 

past history, or use. Id. at 267–68. 

I credit Dr. Munzing’s testimony. 

Supra sections II, III.D., and III.E. 

Accordingly, I find substantial record 

evidence that Respondent acted beneath 

the applicable standard of care and 

outside the usual course of professional 

practice by, for example, issuing J.M. 

controlled substance prescriptions at 

J.M.’s first two documented visits. E.g., 

MBC Guide to the Laws, at 59. 

As already discussed, based on these 

founded violations alone, I find that the 

Government presented a prima facie 

case. Accordingly, I see no need, and I 

decline, to discuss and assess the other 

OSC allegations and the other elements 

of the Government’s case. 

IV. Discussion 

A. The Controlled Substances Act 

Under Section 304 of the CSA, ‘‘[a] 

registration . . . to . . . distribute[ ] or 

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 by such section.’’ 21 U.S.C. 

824(a)(4). In the case of a ‘‘practitioner,’’ 

which is defined in 21 U.S.C. 802(21) to 

include a ‘‘physician,’’ Congress 

directed the Attorney General to 

consider the following factors in making 

the public interest determination: 

(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 . . . 

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). These factors are 

considered in the disjunctive. Robert A. 

Leslie, M.D., 68 FR 15227, 15230 (2003). 

According to Agency decisions, 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 a 

registration. Id.; see also Jones Total 

Health Care Pharmacy, LLC v. Drug 

Enf’t Admin., 881 F.3d 823, 830 (11th 

Cir. 2018) (citing Akhtar-Zaidi v. Drug 

Enf’t Admin., 841 F.3d 707, 711 (6th Cir. 

2016); MacKay v. Drug Enf’t Admin., 

664 F.3d 808, 816 (10th Cir. 2011); 

Volkman v. U. S. Drug Enf’t Admin., 

567 F.3d 215, 222 (6th Cir. 2009); Hoxie 

v. Drug Enf’t Admin., 419 F.3d 477, 482 

(6th Cir. 2005). Moreover, while I am 

required to consider each of the factors, 

I ‘‘need not make explicit findings as to 

each one.’’ MacKay, 664 F.3d at 816 

(quoting Volkman, 567 F.3d at 222); see 

also Hoxie, 419 F.3d at 482. ‘‘In short, 

. . . the Agency is not required to 

mechanically count up the factors and 

determine how many favor the 

Government and how many favor the 

registrant. Rather, it is an inquiry which 

focuses on protecting the public 

interest; what matters is the seriousness 

of the registrant’s misconduct.’’ Jayam 

Krishna-Iyer, M.D., 74 FR 459, 462 

(2009). Accordingly, as the Tenth 

Circuit has recognized, findings under a 

single factor can support the revocation 


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58As to Factor One, the Government does not 

dispute, and there is no record evidence disputing, 

Respondent’s claims that he has an unblemished 

medical record and has never had any disciplinary 

action brought against his license, presumably 

meaning his medical license. Resp Posthearing, at 

2, 21–22; 21 U.S.C. 823(f)(1). State authority to 

practice medicine is ‘‘a necessary, but not a 

sufficient condition for registration . . . .’’ Robert 

A. Leslie, M.D., 68 FR at 15230. Therefore, ‘‘[t]he 

fact that the record contains no evidence of a 

recommendation by a state licensing board does not 

weigh for or against a determination as to whether 

continuation of Respondent’s DEA certification is 

consistent with the public interest.’’ Roni Dreszer, 

M.D., 76 FR 19434, 19444 (2011). 

As to Factor Three, there is no evidence in the 

record that Respondent has a ‘‘conviction record 

under Federal or State laws relating to the 

manufacture, distribution, or dispensing of 

controlled substances.’’ 21 U.S.C. 823(f)(3). 

However, as prior Agency decisions have noted, 

there are a number of reasons why a person who 

has engaged in criminal misconduct may never 

have been convicted of an offense under this factor, 

let alone prosecuted for one. Dewey C. MacKay, 

M.D., 75 FR 49956, 49973 (2010), pet. for rev. 

denied, MacKay v. Drug Enf’t Admin., 664 F.3d 808 

(10th Cir. 2011). Those Agency decisions have 

therefore concluded that ‘‘the absence of such a 

conviction is of considerably less consequence in 

the public interest inquiry’’ and is therefore not 

dispositive. Id. 

The Government’s case includes no allegation 

under Factor Five. 

of a registration. MacKay, 664 F.3d at 

821. 

According to DEA regulations, ‘‘[a]t 

any hearing for the revocation . . . of a 

registration, the . . . [Government] shall 

have the burden of proving that the 

requirements for such revocation . . . 

pursuant to . . . 21 U.S.C. [§ ] 824(a) 

. . . are satisfied.’’ 21 CFR 1301.44(e). 

In this matter, while I have considered 

all of the factors, the Government’s 

evidence in support of its prima facie 

case is confined to Factors Two and 

Four.58 Govt Posthearing, at 31. As 

already discussed, I find that a segment 

of the Government’s case includes 

sufficient evidence with respect to 

Factors Two and Four to satisfy its 

prima facie burden of showing that 

Respondent’s continued registration 

would be ‘‘inconsistent with the public 

interest’’ without my needing to 

consider its entire case, some of which 

is insufficiently developed. 21 U.S.C. 

823(f). I further find that Respondent 

failed to produce sufficient evidence to 

rebut the Government’s prima facie 

case. 

B. Factors Two and/or Four—The 

Respondent’s Experience in Dispensing 

Controlled Substances and Compliance 

With Applicable Laws Related to 

Controlled Substances 

Allegation That Respondent’s 

Registrations Are Inconsistent With the 

Public Interest 

According to the CSA’s implementing 

regulations, a lawful prescription for 

controlled substances is one that is 

‘‘issued for a legitimate medical purpose 

by an individual practitioner acting in 

the usual course of his professional 

practice.’’ 21 CFR 1306.04(a). The 

Supreme Court has stated, in the context 

of the CSA’s requirement that schedule 

II controlled substances may be 

dispensed only by written prescription, 

that ‘‘the prescription requirement . . . 

ensures patients use controlled 

substances under the supervision of a 

doctor so as to prevent addiction and 

recreational abuse . . . [and] also bars 

doctors from peddling to patients who 

crave the drugs for those prohibited 

uses.’’ Gonzales v. Oregon, 546 U.S. 

243, 274 (2006). 

Respondent engaged a skillful team 

and defended himself against all of the 

OSC’s allegations. I read and analyzed 

every aspect of Respondent’s defense 

including his record evidence. As 

already discussed, Respondent’s 

evidence and argument are not 

persuasive on the founded violations. 

Supra section III.F. 

Respondent’s case admits that some of 

Respondent’s medical recordkeeping is 

substandard. See, e.g. supra section 

III.F; Tr. 773, 778 (Dr. Helm’s testimony 

about the lack of Respondent’s 

documentation and, in the absence of 

his documentation, ‘‘[w]e don’t know 

what’s going on’’). Respondent’s case 

and hearing testimony about the 

existence, content, and accuracy of his 

medical records, however, largely 

excuse his documentation failures. See, 

e.g., supra section III.E.; Tr. 940 

(Respondent’s testimony that A.A.’s 

aberrant UDS ‘‘was not of significance to 

me’’ and ‘‘was not of concern to me’’ 

because ‘‘she is my patient,’’ ‘‘I’m her 

doctor,’’ and ‘‘I have a relationship with 

her . . . an understanding with her . . . 

[a]nd this was not a cause for alarm’’); 

id. at 962–63 (Respondent’s testimony 

that his ‘‘record is wrong because I’m so 

busy talking to the patient . . . [b]ut 

again, from this chart, that’s not a big 

problem, because it’s historically her 

left knee’’); id. at 972 (Respondent’s 

testimony that ‘‘a lot of [his medical] 

records have been read wrong and 

interpreted wrong [at the hearing] 

because I’m doing a million things at 

once, and people are trying to read the 

exact word’’). Respondent’s case does 

not include citation to the applicable 

standard of care’s allowance for such 

excuses, and I found none. See supra 

section II. 

By way of further example, 

Respondent’s case admits that some of 

Respondent’s controlled substance 

prescription monitoring is substandard. 

See, e.g., supra section III.E; Tr. 1098 

(Respondent’s testimony that he did not 

consider a UDS to be aberrant if it is 

negative for a substance he prescribed, 

admitting that his ‘‘attorney then, you 

know, corrected me on that statement’’). 

Respondent testified that he used UDSes 

to look for the presence of substances 

that he had not prescribed. Tr. 1098. 

Yet, despite this testimony, by his own 

admission he did not follow up on 

L.D.’s cocaine-positive UDS 

documented in the medical records 

until during preparations for this 

hearing. Supra section III.E. 

As already discussed, there is 

substantial record evidence that 

Respondent issued controlled substance 

prescriptions before conducting the 

requisite physical examination and 

before documenting a diagnosis. Supra 

section III.F. There is substantial record 

evidence that he prescribed controlled 

substances as favors or 

accommodations. Id. There is 

substantial record evidence that 

Respondent increased the dosages of 

controlled substances he was 

prescribing, even controlled substances 

that are highly abused and diverted and 

that are a disproportionate cause of 

death, without the requisite 

documentation. Id. There is even 

substantial record evidence that 

Respondent increased the dosage of a 

controlled substance on the recipient’s 

demand, against his previous medical 

analysis and medical judgment, and 

increased the dosage of other controlled 

substances based on ‘‘ad lib’’ selfdosing. Id. There is substantial record 

evidence that Respondent issued 

controlled substance prescriptions 

without accurate and complete 

documentation and based on the 

representations of others, as opposed to 

basing it on his independent medical 

analysis and judgment. Id. There is 

substantial record evidence that 

Respondent failed correctly to identify 

aberrant UDSes, to document them, and 

to resolve them before further 

prescribing the controlled substance at 

issue in the aberrancy. Id. There is 

substantial record evidence that 

Respondent failed to identify and 

resolve other red flags of abuse and 

diversion before further prescribing the 

controlled substance. Id. 

As already discussed, I find that these 

unrebutted actions and inactions by 

Respondent in his controlled-substance 

related prescribing are violations of the 

applicable standard of care and are 

outside the usual course of professional 

practice and, therefore, are CSA 

violations. 21 CFR 1306.04(a). 

Accordingly, I find that it is appropriate 

to sanction Respondent for these 

violations. 


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Summary of Factors Two and Four and 

Imminent Danger 

As already discussed, Respondent’s 

case does not successfully rebut the 

Government’s prima facie case, 

established by substantial record 

evidence, that Respondent issued 

controlled substance prescriptions 

beneath the applicable standard of care 

and outside the usual course of 

professional practice. Accordingly, I 

find that Respondent engaged in 

egregious misconduct which supports 

the revocation of his registrations. See 

Wesley Pope, 82 FR 14944, 14985 

(2017). 

For purposes of the imminent danger 

inquiry, my findings also lead to the 

conclusion that Respondent ‘‘fail[ed] 

. . . to maintain effective controls 

against diversion or otherwise comply 

with the obligations of a registrant’’ 

under the CSA. 21 U.S.C. 824(d)(2). The 

substantial record evidence that 

Respondent issued controlled substance 

prescriptions beneath the applicable 

standard of care and outside the usual 

course of professional practice 

establishes that there was ‘‘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 

registrations. Id.; see, e.g., Tr. 1030–32 

(Respondent’s testimony about his 

prescribing Duragesic patch when ‘‘you 

haven’t been on it for a while, and you 

might not even need that much’’ and 

then increasing the dosage based on 

self-dosing reports); id. at 842 (the 

testimony of Dr. Helm that methadone 

is a disproportionate cause of death). 

Thus, I find that, at the time the OSC 

was issued, there was clear evidence of 

imminent danger. 

V. Sanction 

Where, as here, the Government has 

met its prima facie burden of showing 

that Respondent’s continued registration 

is inconsistent with the public interest 

due to his numerous violations 

pertaining to controlled substance 

prescribing, the burden shifts to the 

Respondent to show why he can be 

entrusted with a new registration. 

Garrett Howard Smith, M.D., 83 FR 

18,882, 18,910 (2018) (collecting cases). 

Moreover, as past performance is the 

best predictor of future performance, 

DEA Administrators have required that 

a registrant who has committed acts 

inconsistent with the public interest 

must accept responsibility for those acts 

and demonstrate that he will not engage 

in future misconduct. Id. A registrant’s 

acceptance of responsibility must be 

unequivocal. Id. In addition, a 

registrant’s candor during the 

investigation and hearing has been an 

important factor in determining 

acceptance of responsibility and the 

appropriate sanction. Id. (collecting 

cases). In addition, DEA Administrators 

have found that the egregiousness and 

extent of the misconduct are significant 

factors in determining the appropriate 

sanction. Id. DEA Administrators have 

also considered the need to deter similar 

acts by the respondent and by the 

community of registrants. Id. 

Regarding these matters, I find that 

Respondent did not take responsibility, 

let alone unequivocal responsibility, for 

the founded violations. Tr. 1116 

(Respondent’s ‘‘I don’t’’ response during 

his testimony when asked ‘‘Do you 

accept responsibility for the 

prescriptions at issue not being issued 

in the usual course of professional 

practice? ’’). Concerning his medical 

recordkeeping, while Respondent 

‘‘acknowledged’’ that it ‘‘could be 

improved,’’ this acknowledgement is 

not an acceptance of responsibility, let 

alone an unequivocal acceptance of 

responsibility. Id. at 1133. Further, 

Respondent’s testimony after 

‘‘acknowledging’’ that his medical 

recordkeeping could be improved was 

that ‘‘in retrospect, thinking last night, 

I could have actually—even with what 

I have, I could have improved my 

recordkeeping because it’s part of my 

electronic medical record under 

treatment plan where you click 

boxes. . . . [T]here is a section where 

you can click that the urine drug screens 

were checked.’’ Id. at 1133–34. The ALJ 

followed up with the Respondent on 

this portion of his testimony, stating 

that ‘‘these medical records that you 

have . . . the capability of checking a 

box that shows that you checked the 

CURES report or checking a box to show 

that you had conducted a UDS . . . 

really is not the problem with this 

case.’’ Id. at 1134. ‘‘The problem with 

this case,’’ the ALJ continued, ‘‘is that— 

it doesn’t show that you did anything 

with it.’’ Id. When Respondent reacted 

to the ALJ by stating ‘‘[t]hat I discussed 

it,’’ the ALJ stated ‘‘Yes. So that’s not 

checking a box.’’ Id. at 1135. I agree 

with the ALJ. Accordingly, even if it 

were appropriate to consider 

Respondent’s electronic medical record 

testimony to be Respondent’s proposed 

remedial measures, I would find 

Respondent’s proposal to be 

insufficient. 

I also note that Respondent testified 

further about his substandard 

recordkeeping and the ways he will 

improve. Id. at 1086. Respondent 

testified that he ‘‘need[s] to learn to type 

and speak at the same time’’ instead of 

‘‘spending so much time discussing 

with the patient’s issues.’’ Id. He also 

testified that he ‘‘guess[es]’’ he could 

hire a scribe, ‘‘somebody who is sitting 

there typing while you talk,’’ but that 

he’s ‘‘not interested in having someone 

interfere with . . . [his] relationship 

with . . . [his] patient.’’ Id. Respondent 

further testified that ‘‘the world has 

changed’’ and that he ‘‘now need[s] to 

think of . . . [his medical records] as 

not about . . . [him but as a] document 

[that] is going to be scrutinized by 

everyone.’’ Id. at 1087. I reject the 

suggestion that the applicable standard 

of care forces a physician to choose 

between compliance with that standard 

of care and providing patients medical 

care that complies with the applicable 

standard of care within the usual course 

of professional practice. I find that 

Respondent’s suggestion of this false 

choice reflects an insufficient 

appreciation and understanding of 

medical recordkeeping standards of care 

and the responsibilities of a registrant. 

In sum, I find that the record supports 

the imposition of a sanction because 

Respondent did not unequivocally 

accept responsibility and because 

Respondent has not convinced me that 

he can be entrusted with a registration. 

The interests of specific and general 

deterrence weigh in favor of revocation. 

Respondent explicitly refused to accept 

responsibility for his substandard 

controlled substance prescribing. Id. at 

1116. Respondent has not convinced me 

that he understands that his controlled 

substance prescribing fell short of the 

applicable standard of care and that this 

substandard controlled substance 

prescribing has serious negative 

ramifications for the health, safety, and 

medical care of individuals who come 

to him for medical care. As such, it is 

not reasonable for me to believe that 

Respondent’s future controlled 

substance prescribing and 

recordkeeping will comply with legal 

requirements. Further, given the nature 

and number of Respondent’s violations, 

a sanction less than revocation would 

send a message to the existing and 

prospective registrant community that 

compliance with the law is not a 

condition precedent to maintaining a 

registration. 

Accordingly, I shall order the 

sanctions the Government requested, as 

contained in the Order below. 

Order 

Pursuant to 28 CFR 0.100(b) and the 

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

823(f) and 824(a), I hereby revoke DEA 

Certificates of Registration BR0869719 

and BA7661564 along with DATAVerDate Sep<11>2014 17:39 Apr 08, 2022 Jkt 256001 PO 00000 Frm 00126 Fmt 4703 Sfmt 4703 E:\FR\FM\11APN1.SGM 11APN1

lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 87, No. 69 / Monday, April 11, 2022 / Notices 21209 

Waiver No. XR0869719 issued to Craig 

S. Rosenblum, M.D. I further hereby 

deny any pending application(s) of 

Craig S. Rosenblum, M.D., to renew or 

modify these registrations, as well as 

any other pending application(s) of 

Craig S. Rosenblum, M.D., or Aurora 

Surgery Center LP for registration in 

California. This Order is effective May 

9, 2022. 

Anne Milgram, 

Administrator. 

[FR Doc. 2022–07727 Filed 4–8–22; 8:45 am] 

BILLING CODE 4410–09–P 

DEPARTMENT OF JUSTICE 

Drug Enforcement Administration 

Christopher King, C.N.P.; Decision and 

Order 

On December 18, 2019, a former 

Assistant Administrator, Diversion 

Control Division, Drug Enforcement 

Administration (hereinafter, DEA or 

Government), issued an Order to Show 

Cause (hereinafter, OSC) to Christopher 

C. King, N.P. (hereinafter, Applicant) of 

Manchester, Maine. Request for Final 

Agency Action (hereinafter, RFAA), 

Exhibit (hereinafter, RFAAX) 2 (OSC), at 

1. The OSC proposed to deny 

Applicant’s DEA Certificate of 

Registration application, Number 

W19022896M, as well as to deny any 

pending applications for renewal or 

modification of such registration and 

any applications for any other 

registrations pursuant to 21 U.S.C. 

824(a)(4) and 823(f), because 

‘‘[Applicant’s] registration is 

inconsistent with the public interest.’’ 

Id. 

The OSC alleged that Applicant had 

‘‘exhibited negative experience in 

handling controlled substances . . . and 

[had] failed to comply with applicable 

federal and state laws relating to 

controlled substances.’’ Id. at 2. 

Specifically, the OSC alleged that, while 

employed at Mercy Hospital from April 

10, 2013, to June 13, 2013, Applicant 

diverted controlled substances on at 

least two different occasions in violation 

of federal and state law. Id. at 4–6. The 

OSC also alleged that, while employed 

at St. Mary’s Regional Medical Center 

(hereinafter, St. Mary’s Hospital) from 

August 25, 2014, until November 1, 

2016, Applicant diverted controlled 

substances on at least five different 

occasions in violation of federal and 

state law. Id. at 2–3. 

The OSC notified Respondent of the 

right to request a hearing on the 

allegations or to submit a written 

statement, while waiving the right to a 

hearing, the procedures for electing each 

option, and the consequences for failing 

to elect either option. Id. at 3 (citing 21 

CFR 1301.43). The OSC also notified 

Respondent of the opportunity to 

submit a corrective action plan. Id. at 6– 

7 (citing 21 U.S.C. 824(c)(2)(C)). 

Adequacy of Service 

In a Declaration dated August 23, 

2021, a Diversion Investigator 

(hereinafter, the DI) assigned to the 

Manchester District Office stated that on 

December 18, 2019, she sent a copy of 

the OSC to ‘‘both [Applicant’s] 

registered and mailing address via First 

Class Mail’’ and ‘‘sent the [OSC] via 

certified mail on the following day.’’ 

DI’s Declaration, at 2. The DI stated that 

on December 19, 2019, she ‘‘contacted 

[Applicant] by phone at the mobile 

number listed on his application.’’ Id. 

According to the DI, she ‘‘explained 

what an [OSC] was, and requested that 

[Applicant] contact [her] when he 

received a copy of the [OSC].’’ Id. The 

DI stated that on December 26, 2019, she 

received an email from Applicant that 

read, ‘‘ ‘I have received the hard copy of 

the [OSC] in the mail. I do not want to 

pursue this matter and do not feel it is 

necessary to meet and discuss.’ ’’ Id.; see 

also RFAAX 3 (email from Applicant). 

The Government forwarded its RFAA, 

along with the evidentiary record, to 

this office on August 26, 2021. In its 

RFAA, the Government represents that 

Applicant did not request a hearing. 

RFAA, at 1. The Government requests 

that ‘‘the Administrator issue a final 

order denying the DEA Certificate of 

Registration application for [Applicant]’’ 

because ‘‘Applicant’s [r]egistration is 

not in the public interest.’’ Id. 

Based on the DI’s Declaration, the 

Government’s written representations, 

and my review of the record, I find that 

the Government accomplished service 

of the OSC on Applicant on or before 

December 26, 2019. I also find that more 

than thirty days have now passed since 

the Government accomplished service 

of the OSC. Further, based on the DI’s 

Declaration, the Government’s written 

representations, and my review of the 

record, I find that neither Applicant, nor 

anyone purporting to represent 

Applicant, requested a hearing, 

submitted a written statement while 

waiving Applicant’s right to a hearing, 

or submitted a corrective action plan. 

Accordingly, I find that Applicant has 

waived the right to a hearing and the 

right to submit a written statement and 

corrective action plan. 21 CFR 

1301.43(d) and 21 U.S.C. 824(c)(2)(C). I, 

therefore, issue this Decision and Order 

based on the record submitted by the 

Government, which constitutes the 

entire record before me. 21 CFR 

1301.43(e). 

I. Findings of Fact 

A. Application for DEA Registration 

On March 12, 2019, Applicant 

applied for a DEA Certificate of 

Registration as a practitioner in 

Schedules II through V with a proposed 

registered address of 29 Bowdoin St, 

Manchester, ME 04351. RFAAX 1, at 1. 

Applicant’s application was assigned 

Control No. W19022896M. Id. 

B. Government’s Case 

The Government’s RFAA includes the 

DI’s Declaration and 10 attached 

Exhibits, including a copy of 

Applicant’s application for DEA 

registration, various documents 

pertaining to the drug diversion 

allegations against Applicant at both St. 

Mary’s Hospital and Mercy Hospital, 

and a copy of a Consent Agreement 

between Applicant and the Maine Board 

of Nursing in which Applicant’s license 

to practice nursing was suspended. See 

RFAAX 1–10. 

The DI’s Declaration described the 

investigation into Applicant, including 

the collection of the Government’s 

Exhibits. DI’s Declaration, at 1–3. On 

June 13, 2013, Mercy Hospital issued a 

letter to Applicant following an 

investigation regarding Applicant’s 

‘‘suspicious behavior’’ during his shift 

on June 4, 2013. RFAAX 9. According 

to the letter, on June 4, 2013, ‘‘medical 

waste (wet bloody paper towel, open 

syringe wrapper, syringe cap, open band 

aid wrapper, and an open alcohol wipe 

wrapper) was found in the bathroom in 

the staff break room.’’ Id. Applicant’s 

nurse manager ‘‘had noted that 

[Applicant] had recently come into the 

area and had been in the bathroom.’’ Id. 

According to the letter, video footage of 

the Emergency Department area prior to 

the medical waste being found was 

reviewed, and Applicant was observed 

pulling Dilaudid from the Pyxis 

machine and then entering the patient 

area for several minutes. Id. The video 

footage showed Applicant going to a 

supply cart and putting supplies in his 

pants pocket, then exiting the 

Emergency Department and entering the 

staff break room around the same time 

that Applicant’s nurse manager had 

seen Applicant enter the bathroom. Id. 

The video footage showed Applicant 

returning to the Emergency Department 

several minutes later and going 

immediately to a sharps disposal 

container, where he pulled something 

from his pants pocket to dispose of in 

that container. Id. Finally, the video 

footage showed Applicant requesting an 


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