21156 Federal Register / Vol. 87, No. 69 / Monday, April 11, 2022 / Notices 

1After an applicant has received an OSC 

regarding his or her application for DEA 

registration, the application may not be withdrawn 

without the permission of the Administrator. 21 

CFR 1309.36(a). Here, Applicant had already 

received the OSC before attempting to withdraw his 

application, and he has not demonstrated good 

cause why his application should be withdrawn, 

nor do I find that withdrawal would be in the 

public interest due to the nature and extent of the 

allegations in front of me and the Applicant’s stated 

intention that he will reapply for a registration. 

Adjudicating this matter to finality will create an 

official record the Agency can use in any future 

interactions with Applicant. As additionally noted 

in Olsen, ‘‘a final adjudication is a public record of 

the Agency’s expectations for current and 

prospective members of that community,’’ and 

adjudications inform stakeholders, such as 

legislators and the public, about the Agency’s work 

and allow them to provide feedback to the Agency, 

thereby helping shape how the Agency carries out 

its responsibilities under the CSA. Id. Adjudicating 

this matter to finality will create a public record to 

educate current and prospective registrants about 

the Agency’s expectations regarding the 

responsibilities of registrants under the CSA and 

allow stakeholders to provide feedback regarding 

the Agency’s enforcement priorities and practices. 

I have not permitted Applicant’s application to be 

withdrawn. Accordingly, Applicant’s withdrawal is 

not effective. 

controlled substance license, stating that 

‘‘[a] registration under Section 303 to 

manufacture, distribute, or dispense a 

controlled substance . . . may be 

denied, refused renewal, suspended, or 

revoked by the Department of Financial 

and Professional Regulation.’’ Id. at 570/ 

304(a). 

Here, the undisputed evidence in the 

record is that Registrant currently lacks 

authority to handle controlled 

substances in Illinois as his Illinois 

medical license is suspended and his 

Illinois controlled substance license is 

inoperative. As already discussed, a 

practitioner must hold a valid 

controlled substance license to dispense 

a controlled substance in Illinois. Thus, 

because Registrant lacks authority to 

handle controlled substances in Illinois, 

Registrant is not eligible to maintain a 

DEA registration. Accordingly, I order 

that Registrant’s DEA registration be 

revoked. 

Order 

Pursuant to 28 CFR 0.100(b) and the 

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

824(a), I hereby revoke DEA Certificate 

of Registration No. BH9069205 issued to 

Kirk A. Hopkins, M.D. 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 

Kirk A. Hopkins, M.D. to renew or 

modify this registration, as well as any 

other pending application of Kirk A. 

Hopkins, M.D. for additional 

registration in Illinois. This Order is 

effective May 11, 2022. 

Anne Milgram, 

Administrator. 

[FR Doc. 2022–07696 Filed 4–8–22; 8:45 am] 

BILLING CODE 4410–09–P 

DEPARTMENT OF JUSTICE 

Drug Enforcement Administration 

Kareem Hubbard, M.D.; Decision and 

Order 

On June 4, 2020, the former Assistant 

Administrator, Diversion Control 

Division, Drug Enforcement 

Administration (hereinafter, DEA or 

Government), issued an Order to Show 

Cause (hereinafter, OSC) to Kareem 

Hubbard, M.D. (hereinafter, Applicant) 

of San Leandro, California. Request for 

Final Agency Action (hereinafter, 

RFAA) Exhibit (hereinafter RFAAX) 2 

(OSC), at 1 and 12. The OSC proposed 

to deny Applicant’s application for a 

DEA Certificate of Registration, as well 

as to deny any applications for any 

other registrations, pursuant to 21 

U.S.C. 824(a)(1) and (4) because 

Applicant ‘‘materially falsified [his] 

application’’ and because ‘‘[Applicant’s] 

registration is inconsistent with the 

public interest, as that term is defined 

in 21 U.S.C. 823(f).’’ Id. at 1. 

The OSC alleged that Applicant’s 

application contained a materially false 

statement in which Applicant failed to 

disclose his previous surrender for 

cause of his DEA registration. Id. at 3. 

According to the OSC, Applicant had 

surrendered for cause his previous DEA 

registration ‘‘less than two months 

before submitting [his] application.’’ Id. 

Further, the OSC alleged that Applicant 

‘‘violated federal and California law by 

issuing prescriptions for controlled 

substances to four patients outside the 

usual course of professional practice 

and not for a legitimate medical 

purpose.’’ Id. at 4. 

The OSC notified Applicant 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 11 (citing 21 

CFR 1301.43). The OSC also notified 

Applicant of the opportunity to submit 

a corrective action plan. Id. at 11–12 

(citing 21 U.S.C. 824(c)(2)(C)). 

By letter dated July 23, 2020, 

Applicant requested a hearing through 

counsel. RFAAX 3 (Request for 

Hearing), at 1. In his Request for 

Hearing, Applicant requested that his 

application for DEA registration be 

granted, because ‘‘he applied for it in 

good faith and did not believe his 

surrender of [his] previous certificate 

was ‘for cause.’ ’’ Id. Additionally, 

Applicant’s Request for Hearing 

included an attachment addressing the 

Government’s allegations in detail. Id. at 

3–5. On July 23, 2020, Applicant also 

submitted a Corrective Action Plan in 

which he offered a ‘‘historical 

perspective, in addition to [his] interim 

practice activities and corrective action 

plan.’’ RFAAX 4, at 5. On August 14, 

2020, Applicant submitted a 

Withdrawal of Hearing Request in 

which he ‘‘with[drew] his request for a 

hearing in [the] matter’’ and 

‘‘with[drew] his pending application for 

a new DEA Certificate of Registration’’ 1

without ‘‘waiv[ing] his future right to 

reapply for [the] same.’’ RFAAX 5, at 1; 

RFAAX 6 (Order Terminating 

Proceedings). On August 17, 2020, the 

Chief Administrative Law Judge John J. 

Mulrooney, II (hereinafter, the Chief 

ALJ) terminated the proceedings. 

RFAAX 6. 

On September 23, 2020, the 

Government forwarded its RFAA, along 

with the evidentiary record for this 

matter, to my office. The Government 

seeks a final order of denial of 

Applicant’s application for DEA 

registration because Applicant 

‘‘materially falsified his application 

under 21 U.S.C. 824(a)(1), and 

committed acts which render his 

continued registration inconsistent with 

the public interest’’ under 21 U.S.C. 

824(a)(4) and 823(f). RFAA, at 1. I issue 

this Decision and Order after 

considering the entire record before me, 

21 CFR 1301.43(e); and I make the 

following findings of fact. 

I. Findings of Fact 

A. Application for DEA Registration 

On or about April 8, 2019, Applicant 

applied for a DEA Certificate of 

Registration as a practitioner in 

Schedules II through V with a proposed 

registered address of 15035 E 14th St., 

San Leandro, CA 94578. RFAAX 1 

(Certification of Non Registration), at 1. 

Applicant’s application was assigned 

Control No. W19032408C and is in a 

‘‘new pending’’ status. Id. On 

Applicant’s application, when 

presented with the question, ‘‘Has the 

applicant ever surrendered (for cause) or 

had a federal controlled substance 

registration revoked, suspended, 

restricted or denied, or is any such 

action pending?’’ Applicant answered, 

‘‘No.’’ Id. Applicant previously held 

DEA Certificate of Registration Control 

No. FH4372859, which expired on 

October 31, 2016, and DEA Certificate of 

Registration Control No. FH4334037, 

which expired on October 31, 2019. Id. 

at 2. Both of Applicant’s previous DEA 


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registrations are currently in a ‘‘retired’’ 

status. Id. 

B. Investigation of Applicant 

1. Declaration of Group Supervisor 

According to a DEA Group Supervisor 

(hereinafter, the GS 1) in the San Jose 

Resident Office of the San Francisco 

Field Division assigned to investigate 

Applicant, ‘‘DEA began investigating 

[Applicant] in 2018 after receiving 

information that he had prescribed large 

quantities of controlled substances.’’ 

RFAAX 8 (GS’s Declaration), at 1. GS 

stated that in early 2019, ‘‘DEA 

reviewed [Applicant’s] report from 

CURES, California’s Prescription Data 

Monitoring Program’’ and ‘‘identified 

several red flags of abuse or diversion in 

[Applicant’s] controlled substance 

prescribing, such as patients traveling 

long distances and receiving drug 

cocktails, among other red flags.’’ Id. On 

February 21, 2019, DEA served an 

administrative subpoena on Applicant’s 

practice for Applicant’s patient files. Id. 

at 2; see also id. at Appendix 

(hereinafter, App.) A (administrative 

subpoena). On the same day, DEA also 

‘‘interviewed [Applicant] regarding his 

care of some of the patients whose files 

were the subject of the administrative 

subpoena’’ and ‘‘informed [Applicant] 

about several red flags of abuse or 

diversion (such as long distances 

traveled by patients, high dosages, and 

opioid cocktails) that DEA identified in 

his controlled substance prescribing.’’ 

Id. at 2. Accordingly, DEA asked 

Applicant to voluntarily surrender his 

DEA Certificate of Registration Control 

No. FH4334037, and he did. Id.; see also 

id. at App B (Applicant’s signed 

surrender for cause). 

2. Declaration of Diversion Investigator 

T.B. 

A DEA Diversion Investigator 

(hereinafter, the DI) assigned to 

investigate Applicant’s application 

found that Applicant voluntarily 

surrendered for cause his previous DEA 

Certificate of Registration Control No. 

FH4334037 on February 21, 2019. 

RFAAX 7 (DI’s Declaration), at 2. The DI 

also found that Applicant ‘‘did not 

previously possess a DATA (Drug 

Addiction Treatment Act)[ ] Waiver 

number, which authorizes registrants to 

prescribe controlled substances for 

maintenance or detoxification 

treatment.’’ Id. 

Additionally, the DI obtained 

Applicant’s 2017–2019 report from the 

CURES database to review Applicant’s 

controlled substance prescribing from 

2017–2019. Id. at 3; see also id. at App. 

B (CURES Report for Applicant dated 

from May 1, 2017 to June 30, 2019). In 

response to administrative subpoenas 

served to various pharmacies, the DI 

obtained copies of the controlled 

substance prescriptions issued by 

Applicant to Patients L.C., P.B., S.N., 

and J.H. Id. at 3; see also id. at Apps. 

C–F (copies of patient prescription 

records). Further, the DI determined the 

respective distances between 

Applicant’s previous registered address 

and the home addresses for Patients 

L.C., P.B., and S.N. by entering the 

addresses online into Bing Maps. Id. at 

3; see also id. at App. G (printouts from 

Bing Maps). The DI found that the 

distance between Patient L.C.’s home 

address and Applicant’s previous 

registered location was at least 30 miles; 

the distance between Patient P.B.’s 

home address and Applicant’s previous 

registered location was nearly 80 miles; 

and the distance between Patient S.N.’s 

home and Applicant’s previous 

registered location was at least 35 miles. 

Id. at 4; see also id. at App. G (printouts 

from Bing Maps). Finally, in response to 

administrative subpoenas served to 

Applicant’s practice, the DI obtained 

copies of the patient files for Patients 

L.C., P.B., S.N., and J.H. Id.; see also id. 

at Apps. H(i)–K (copies of patient files). 

C. The Government Expert’s Review of 

Applicant’s Prescriptions 

The DEA hired Dr. Timothy Munzing, 

M.D. to opine on Applicant’s controlled 

substance prescribing based on the 

CURES report and the patient files 

described above. Id. at 4. Dr. Munzing 

is a physician licensed in California 

who has been the Family Medicine 

Residency Program Director at Kaiser 

Permanente Orange County for three 

decades. RFAAX 9 (Dr. Munzing’s 

Declaration), at 1; see also id. at App. A 

(Dr. Munzing’s CV). Dr. Munzing has 

also held an appointment as a full 

Clinical Professor at the University of 

California, Irvine School of Medicine 

since 2005 and has served on the Board 

of Directors of the Orange Academy of 

Family Physicians for over twenty years 

as well as on the Board of Directors for 

the California Academy of Family 

Physicians for five years. Id. Dr. 

Munzing currently serves on several 

other national and state boards and 

committees overseeing quality of care 

and residency and medical student 

training and in his three decades of 

practice has formally taught and/or 

lectured to thousands of physicians and 

students the core principles and 

guidelines of appropriate opioid and 

controlled substance medication 

prescribing. Id. at 1–2; see also id. at 

App. A. I find that Dr. Munzing is an 

expert in the standard of care for 

prescribing controlled substances in 

California, and I give his report full 

credit. 

Dr. Munzing was retained as an expert 

to determine whether or not Applicant’s 

prescribing was ‘‘consistent with the 

usual course of professional practice, as 

required under 21 CFR 1306.04(a), and 

with California law.’’ Id. at 2. 

Accordingly, Dr. Munzing’s Declaration 

‘‘explain[ed] [his] expert opinion on the 

standard of care in California for 

medical practice, particularly with 

respect to the prescribing of controlled 

substances, and [his] conclusions as to 

[Applicant’s] prescribing outside of that 

standard of care with regard to specific 

prescriptions that [Applicant] issued to 

[the] four different patients’’ described 

above. Id. 

1. The Standard of Care in California 

Dr. Munzing attested that various 

state laws and regulations, as well as 

two guidelines published by the 

Medical Board of California, informed 

his opinion as to California’s standard of 

care for the practice of medicine, 

particularly with respect to the 

prescribing of controlled substances for 

pain. Id. at 3–7. Dr. Munzing noted that 

California Health and Safety Code 

§ 11153(a) requires 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.’ ’’ Id. at 

3. Further, California Health and Safety 

Code § 11154(a) states that ‘‘ ‘no person 

shall knowingly prescribe, administer, 

dispense, or furnish a controlled 

substance to or for any person . . . not 

under his or her treatment for a 

pathology or condition.’ ’’ Id. Dr. 

Munzing also cited California Business 

and Professions Code §§§ 2242(a), 2234, 

and 725(a), noting that unprofessional 

conduct subject to sanction includes 

‘‘ ‘[p]rescribing, dispensing, or 

furnishing [controlled substances] 

without an appropriate prior 

examination and a medical indication’ 

. . . ‘[g]ross negligence’; ‘[r]epeated 

negligent acts’; ‘[i]ncompetence’; or 

‘[t]he commission of any act involving 

dishonesty or corruption that is 

substantially related to the 

qualifications, functions, or duties of a 

physician and surgeon’ . . . and 

‘[r]epeated acts of clearly excessive 

prescribing, furnishing, dispensing, or 

administering of drugs . . .’ ’’ Id. at 3– 

4. Finally, the two Medical Board of 

California guidelines referenced by Dr. 

Munzing included the Guide to the 

Laws Governing the Practice of 


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2Available at: http://web.archive.org/web/ 

20210921192242/http://www.mbc.ca.gov/ 

Download/Documents/laws-guide.pdf. 3Available at: https://www.mbc.ca.gov/ 

Download/Publications/pain-guidelines.pdf. 4The CDC guidelines referenced by Dr. Munzing 

included the CDC publication, ‘‘Calculating Total 

Daily Dose of Opioids for Safer Dosage’’ and the 

CDC’s ‘‘Guideline for Prescribing Opioids for 

Chronic Pain’’ published in 2016. Id. at 5; see 

https://www.cdc.gov/drugoverdose/pdf/calculating_

total_daily_dose-a.pdf and https://www.cdc.gov/ 

drugoverdose/prescribing/guideline.html. 

5 Dr. Munzing referenced the FDA publication, 

‘‘New Safety Measures Announced for Opioid 

Analgesics, Prescription Opioid Cough Products, 

and Benzodiazepines’’ published in 2016. RFAAX 

9, at 5–6; see https://www.fda.gov/Drugs/ 

DrugSafety/InformationbyDrugClass/ 

ucm518110.htm. 

Medicine by Physicians and Surgeons 2

and the Guidelines for Prescribing 

Controlled Substances for Pain.3 Id. at 3. 

Dr. Munzing opined that, as informed 

by the above statutes and guidelines, the 

California standard of care requires that 

before prescribing controlled 

substances, at minimum, a practitioner 

must: 

(1) ‘‘obtain a medical history and perform 

an appropriate physical examination’’; 

(2) ‘‘assess the patients’ pain, physical and 

psychological functions, substance abuse 

history, and history of prior pain treatment 

(such as reviewing past medical records, 

laboratory studies, and imaging studies to 

establish a diagnosis and medical 

necessity)’’; 

(3) ‘‘assess any underlying or coexisting 

diseases or conditions and order and perform 

diagnostic testing if necessary’’; 

(4) ‘‘discuss the risks and benefits of using 

controlled substances and any other 

treatment modalities (such as non-opioid 

therapeutic options)’’; 

(5) ‘‘periodically review the course of pain 

treatment or gather any new information, if 

any, about the etiology of a patient’s state of 

health’’; 

(6) ‘‘give special attention to patients who, 

by their own words and actions, pose a risk 

for medication misuse and/or diversion’’; 

(7) ‘‘maintain accurate and complete 

records’’; and 

(8) ‘‘document the presence of a recognized 

medical indication for the use of a controlled 

substance.’’ 

Id. at 4. Additionally, Dr. Munzing 

opined that, as informed by guidelines 

from the Centers for Disease Control and 

Prevention (hereinafter, CDC) 4 and from 

the Food and Drug Administration 

(hereinafter, FDA),5 the California 

standard of care imposes additional 

requirements and considerations for 

prescribing opioids as well as for 

prescribing benzodiazepines in 

combination with opioids. RFAAX 9, at 

5–6. These additional requirements and 

considerations include that: 

(1) ‘‘[o]pioids prescribed at Morphine 

Milligram Equivalent (‘MME’) dosages above 

90 mg per day significantly increase a 

patient’s risk of overdose and death’’; 

(2) practitioners must ‘‘carefully adjust, as 

well as closely monitor, patients who are 

prescribed MME dosages above 90 MME a 

day—a dangerously high dosage of opioids’’; 

(3) ‘‘required monitoring when high-dosage 

opioids are prescribed include[s]: Periodic 

and close evaluations or examinations to 

determine the appropriateness of high-dosage 

opioids or [the consideration of] non-opioid 

alternatives; frequent and periodic review of 

a patient’s report from [CURES]; and periodic 

urine drug screens’’; 

(4) MME dosages above 90 mg per day 

should be avoided or carefully justified; 

(5) ‘‘[t]he FDA requires ‘Black Box’ 

warnings about combining benzodiazepines 

with opioids’’ because ‘‘taking 

benzodiazepines with opioids can cause 

profound sedation, respiratory depression, 

coma, and death’’; 

(6) ‘‘the combination of opioids and 

benzodiazepines should be avoided except in 

limited circumstances given the heightened 

risk of overdose and death when opioids and 

benzodiazepines are taken in combination’’; 

(7) ‘‘[t]he combination of oxycodone, a 

benzodiazepine, and the muscle relaxant 

carisoprodol, is a dangerous drug cocktail 

known as the ‘Holy Trinity’ ’’; 

(8) ‘‘[t]he ‘Holy Trinity’ cocktail, as well as 

the combination of an opioid and a 

benzodiazepine, are both red flags of abuse 

or diversion’’; and 

(9) ‘‘[t]he ‘Holy Trinity’ cocktail, in 

particular, is a combination of drugs that is 

popular among the drug-abusing 

community.’’ 

Id. Finally, Dr. Munzing opined that the 

California standard of care requires 

‘‘practitioners prescribing controlled 

substances to monitor and address red 

flags of abuse or diversion, such as long 

distances traveled, inconsistent urine 

drug screen results, early refills, and 

drug cocktails’’ and to ‘‘document how 

they addressed or resolved red flags of 

abuse or diversion.’’ Id. at 6. 

Specifically, Dr. Munzing noted that, 

per the California standard of care: 

(1) ‘‘[p]atients willing to travel long 

distances to see a physician to obtain 

controlled substances is a red flag of abuse 

or diversion’’ and physicians must address or 

resolve this red flag; 

(2) ‘‘[p]eriodic urine drug screening is part 

of a physician’s duty to perform ongoing 

monitoring of patients prescribed controlled 

substances’’ and physicians prescribing 

controlled substances must ‘‘address or 

resolve inconsistent urine drug screen 

results, which are red flags of abuse or 

diversion’’; 

(3) ‘‘[i]nconsistent urine drug screen results 

that must be addressed or resolved are: (1) 

Positive results for non-prescribed controlled 

substances; and (2) negative results for 

prescribed controlled substances’’; 

(4) ‘‘[e]ven should a physician address or 

resolve an inconsistent urine drug screen 

result,’’ the physician must ‘‘proceed to 

closely monitor the patient, which may 

include additional and more frequent urine 

drug screens’’; and 

(5) ‘‘[p]atients with a history or pattern of 

obtaining or requesting early refills is a red 

flag of abuse or diversion’’ and physicians 

must address or resolve this red flag. 

Id. at 6–7. 

Having read and analyzed all of the 

record evidence and law, I find that Dr. 

Munzing’s declaration concerning a 

California physician’s standard of care 

when prescribing controlled substances 

is supported by substantial evidence 

and is consistent with the explicit text 

of California law as well as state and 

federal guidelines. As such, I apply the 

standard of care of the state of California 

as described by Dr. Munzing. 

2. The Subject Patients 

i. Patient L.C. 

From May 1, 2017, to February 21, 

2019, and on an approximately monthly 

basis, Applicant prescribed Patient L.C. 

various opioids including oxycodone, 

hydrocodone-acetaminophen, Nucynta, 

Belbuca (buprenorphine), and 

hydromorphone, which Dr. Munzing 

calculated to amount to at least 420 mg 

MME per day. RFAAX 9, at 8; see also 

RFAAX 7, App. B (Applicant’s CURES 

Report), App. C (prescription records for 

Patient L.C.), and Apps. H(i)–(ii) 

(patient file for Patient L.C.). Based 

upon his review of Patient L.C.’s file, Dr. 

Munzing concluded that Applicant 

‘‘prescribed such high-dosage opioids 

without consistently performing 

detailed examinations or evaluations, 

dependably considering non-opioid 

alternatives, or reliably weaning Patient 

L.C. off such high dosages.’’ RFAAX 9, 

at 8. In particular, ‘‘[Applicant’s] 

frequent concurrent prescribing for 

Patient L.C. of oxycodone and 

hydrocodone-acetaminophen (both 

short-acting opioids) was 

therapeutically duplicative and 

therefore medically unnecessary.’’ Id. 

Dr. Munzing also stated that, ‘‘[t]here 

was no medical justification for 

[Applicant’s] Belbuca (buprenorphine) 

prescriptions for Patient L.C.’’ and noted 

that ‘‘[Applicant] could not have 

prescribed Belbuca (a Schedule III 

opioid) for maintenance or 

detoxification treatment (for which 

Belbuca is usually prescribed) because 

[Applicant] did not possess a DATAwaiver at the time he issued these 

prescriptions.’’ Id. Moreover, according 

to Dr. Munzing, ‘‘given all the other 

high-dosage opioids Patient L.C. was 

prescribed, there was no legitimate 

medical purpose for additionally 

prescribing buprenorphine for pain 

management.’’ Id. 

Additionally, Dr. Munzing concluded, 

based upon his review of Patient L.C.’s 

file, that ‘‘[Applicant] frequently 

prescribed to Patient L.C. either (1) a 

combination of opioids and the 


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6 Dr. Munzing noted that ‘‘[e]ven though 

[Applicant] documented on several occasions about 

providing early refills due to Patient L.C. claiming 

to have lost her tablets from vomiting, there was no 

legitimate medical purpose for consistently 

continuing to provide early refills for this reason 

without first treating Patient L.C.’s issues with 

vomiting.’’ Id. at 11. 

benzodiazepine, clonazepam . . . or (2) 

the ‘Holy Trinity’ cocktail, which 

consists of an opioid; a benzodiazepine, 

such as clonazepam; and carisoprodol 

. . . without performing adequate 

evaluation or monitoring to medically 

justify these combinations.’’ Id. at 8–9. 

Specifically, Dr. Munzing noted that by 

February 6, 2018, Patient L.C. reported 

experiencing ‘‘side effects attributable to 

[Applicant’s] controlled substance 

prescriptions and which [Applicant] did 

not adequately examine or evaluate.’’ Id. 

at 9. Further, ‘‘[Applicant] improperly 

continued to prescribe these dangerous 

drug cocktails after February 6, 2018[,] 

without further examining or evaluating 

Patient L.C.’s reported side effects.’’ Id. 

Finally, Dr. Munzing concluded, 

based upon his review of Patient L.C.’s 

file, that Applicant failed to address 

several red flags of abuse or diversion. 

Id. First, Dr. Munzing noted that there 

was no documentation that Applicant 

adequately addressed or resolved 

Patient L.C.’s inconsistent urine drug 

screen results, which included positive 

results for controlled substances that 

Applicant had not prescribed to Patient 

L.C. and that Patient L.C. had not filled 

the prescriptions anywhere in California 

according to CURES reports, some of 

which were dangerous in combination 

with the high-dosage opioids that 

Applicant had prescribed to Patient L.C. 

Id. at 9–10. Patient L.C.’s urine drug 

screen results also included negative 

results for controlled substances for 

which Applicant had issued 

prescriptions to Patient L.C. and which 

Patient L.C. had filled. Id. at 10. Second, 

Dr. Munzing noted that there was no 

documentation that Applicant 

adequately addressed or resolved 

evidence of Patient L.C.’s early refills of 

controlled substances on at least 34 

occasions between 2017 and 2019.6 Id. 

at 10–11. Finally, Dr. Munzing noted 

that there was no documentation that 

Applicant addressed or resolved 

evidence that Patient L.C. traveled a 

long distance (at least 60 miles 

roundtrip from Martinez, CA to 

Applicant’s office in San Leandro, CA) 

to obtain controlled substances from 

Applicant on a nearly monthly basis. 

Id.; see also RFAAX 7, App. G (printouts 

from Bing Maps), at 3. 

ii. Patient P.B. 

On an approximately monthly basis, 

Applicant prescribed Patient P.B. 

various opioids including OxyContin, 

oxycodone, Nucynta, and levorphanol 

tartrate, which Dr. Munzing calculated 

to amount to at least 840 mg MME per 

day. RFAAX 9, at 11; see also RFAAX 

7, App. B (Applicant’s CURES Report), 

App. D (prescription records for Patient 

P.B.), and App. I (patient file for Patient 

P.B.). Based upon his review of Patient 

P.B.’s file, Dr. Munzing concluded that 

Applicant ‘‘prescribed such high-dosage 

opioids without consistently performing 

detailed examinations or evaluations, 

dependably considering non-opioid 

alternatives, or reliably weaning Patient 

P.B. off such high dosages.’’ RFAAX 9, 

at 11–12. In particular, Dr. Munzing 

stated that, ‘‘[Applicant’s] concurrent 

prescribing for Patient P.B. of 

oxycodone and Nucynta (both shortacting opioids) on at least one occasion 

was therapeutically duplicative and 

therefore medically unnecessary.’’ Id. at 

12. Additionally, Dr. Munzing 

concluded, based upon his review of 

Patient P.B.’s file, that ‘‘[Applicant] 

frequently prescribed to Patient P.B. 

either (1) a combination of opioids and 

the benzodiazepine, clonazepam . . . or 

(2) the ‘‘Holy Trinity’’ cocktail, which 

consists of an opioid; a benzodiazepine, 

such as clonazepam; and carisoprodol 

. . . without performing adequate 

evaluation or monitoring to medically 

justify these combinations.’’ Id. 

Finally, Dr. Munzing concluded, 

based upon his review of Patient P.B.’s 

file, that Applicant failed to address 

several red flags of abuse or diversion. 

Id. Specifically, Dr. Munzing noted that 

there was no documentation that 

Applicant adequately addressed or 

resolved Patient P.B.’s inconsistent 

urine drug screen results, which 

included positive results for controlled 

substances that Applicant had not 

prescribed to Patient P.B. and for which 

Patient P.B. had not filled the 

prescriptions anywhere in California 

according to CURES reports. Id. at 12– 

13. Patient P.B.’s inconsistent urine 

drug screen results also included a 

negative result for a controlled 

substance for which Applicant had 

issued prescriptions to Patient P.B. and 

which Patient P.B. had filled. Id. at 13. 

Dr. Munzing also noted that there was 

no documentation that Applicant 

addressed or resolved evidence that 

Patient P.B. traveled a long distance (at 

least 160 miles roundtrip from Newman, 

CA to Applicant’s office in San Leandro, 

CA) to obtain controlled substances 

from Applicant on a nearly monthly 

basis. Id. at 14; see also RFAAX 7, App. 

G (printouts from Bing Maps), at 4. 

iii. Patient S.N. 

On an approximately monthly basis, 

Applicant prescribed Patient S.N. 

various opioids including OxyContin, 

oxycodone, and Xtampza, which Dr. 

Munzing calculated to amount to at 

least 405 mg and 885 mg MME per day. 

RFAAX 9, at 14; see also RFAAX 7, 

App. B (Applicant’s CURES Report), 

App. E (prescription records for Patient 

S.N.), and App. J (patient file for Patient 

S.N.). Based upon his review of Patient 

S.N.’s file, Dr. Munzing concluded that 

Applicant ‘‘prescribed such high-dosage 

opioids without consistently performing 

detailed examinations or evaluations, 

dependably considering non-opioid 

alternatives, or reliably weaning Patient 

S.N. off such high dosages.’’ RFAAX 9, 

at 14. 

Additionally, Dr. Munzing concluded, 

based upon his review of Patient S.N.’s 

file, that Applicant failed to address 

several red flags of abuse or diversion. 

Id. First, Dr. Munzing noted that there 

was no documentation that Applicant 

adequately addressed or resolved 

Patient S.N.’s inconsistent urine drug 

screen results, which included a 

positive result for controlled substances 

that Applicant had not prescribed to 

Patient S.N. and for which Patient S.N. 

had not filled the prescriptions 

anywhere in California according to 

CURES reports. Id. Dr. Munzing also 

noted that ‘‘[Applicant] failed to 

document any test results for Patient 

S.N.’s three subsequent urine drug 

screens performed in 2018.’’ Id. at 14– 

15. Second, Dr. Munzing noted that 

there was no documentation that 

Applicant adequately addressed or 

resolved evidence of Patient S.N.’s early 

refills of controlled substances on at 

least three occasions between 2017 and 

2019. Id. at 15. Finally, Dr. Munzing 

noted that there was no documentation 

that Applicant addressed or resolved 

evidence that Patient S.N. traveled a 

long distance (at least 70 miles 

roundtrip from Pittsburg, CA to 

Applicant’s office in San Leandro, CA) 

to obtain controlled substances from 

Applicant on a nearly monthly basis. 

Id.; see also RFAAX 7, App. G (printouts 

from Bing Maps), at 1–2. 

iv. Patient J.H. 

On an approximately monthly basis, 

Applicant prescribed Patient J.H. 

various opioids including oxycodone, 

oxycodone-acetaminophen, OxyContin, 

and fentanyl, which Dr. Munzing 

calculated to amount to at least 1,350 

mg MME per day. RFAAX 9, at 15; see 

also RFAAX 7, App. B (Applicant’s 


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7Applicant specifically did not opt to submit a 

written statement in lieu of a hearing under 21 CFR 

1316.49. In this case, I have considered these 

unsworn submissions minimally to represent 

Applicant’s position because they address the 

underlying allegations. Even if I afforded these 

unsupported and unsworn statements the weight of 

a written statement, they would be insufficient to 

rebut the Government’s case for denial of 

Applicant’s application for the reasons stated 

herein. 

CURES Report), App. F (prescription 

records for Patient J.H.), and App. K 

(patient file for Patient J.H.). Based upon 

his review of Patient J.H.’s file, Dr. 

Munzing concluded that Applicant 

‘‘prescribed such high-dosage opioids 

without consistently performing 

detailed examinations or evaluations, 

dependably considering non-opioid 

alternatives, or reliably weaning Patient 

J.H. off such high dosages.’’ RFAAX 9, 

at 15. In particular, ‘‘[Applicant’s] 

frequent concurrent prescribing for 

Patient J.H. of oxycodone and 

oxycodone-acetaminophen (both shortacting opioids) was therapeutically 

duplicative and therefore medically 

unnecessary.’’ Id. 

Dr. Munzing also concluded, based 

upon his review of Patient J.H.’s file, 

that ‘‘[Applicant] frequently prescribed 

Patient J.H. the ‘Holy Trinity’ cocktail, 

which consists of an opioid; a 

benzodiazepine, such as alprazolam 

. . . and carisoprodol . . . without 

performing adequate evaluation or 

monitoring to medically justify this 

combination.’’ Id. at 15–16. Specifically, 

Dr. Munzing noted that by January 29, 

2018, Patient J.H. reported having 

experienced ‘‘side effects attributable to 

[Applicant’s] controlled substance 

prescriptions and which [Applicant] did 

not adequately examine or evaluate.’’ Id. 

at 16. Further, ‘‘[Applicant] improperly 

continued to prescribe the ‘Holy Trinity’ 

after January 29, 2018[,] without further 

examining or evaluating Patient J.H.’s 

reported side effects.’’ Id. Dr. Munzing 

also concluded, based upon his review 

of Patient J.H.’s file, that, ‘‘[Applicant] 

frequently prescribed stimulants, either 

amphetamine salts . . . or modafinil 

. . . without any legitimate medical 

purpose.’’ Id. Dr. Munzing noted that he 

did not find any apparent medical 

diagnosis or evaluation in Patient J.H.’s 

file for Attention-Deficit Hyperactivity 

Disorder (ADHD), ‘‘for which 

amphetamine salts are normally used to 

treat.’’ Id. Additionally, Dr. Munzing 

noted that ‘‘while amphetamine salts 

and modafinil can be used to treat 

drowsiness or extreme sleepiness, the 

use of such stimulants for Patient J.H. 

was not medically appropriate as the 

patient’s drowsiness or sleepiness were 

likely side effects of his prescribed highdosage opioids.’’ Id. 

Finally, Dr. Munzing concluded, 

based upon his review of Patient J.H.’s 

file, that Applicant failed to address or 

resolve several red flags of abuse or 

diversion. Id. Specifically, Dr. Munzing 

noted that there was no documentation 

that Applicant adequately addressed or 

resolved Patient J.H.’s inconsistent urine 

drug screen results, which included 

positive results for controlled 

substances that Applicant had not 

prescribed to Patient J.H. and for which 

Patient J.H. had not filled the 

prescriptions anywhere in California 

according to CURES reports, some of 

which were dangerous in combination 

with the high-dosage opioids that 

Applicant had prescribed to Patient J.H. 

Id. at 16–17. Applicant’s inconsistent 

urine drug screen results also included 

positive results for alcohol, which Dr. 

Munzing noted can ‘‘amplify the risk of 

overdose and death associated with the 

‘Holy Trinity’ cocktail [Applicant] 

prescribed Patient J.H.’’ Id. at 17. 

Moreover, Applicant’s inconsistent 

urine drug screen results included 

negative results for controlled 

substances for which Applicant had 

issued prescriptions to Patient J.H. and 

which Patient J.H. had filled. Id. at 17– 

18. 

Based on his expert medical opinion, 

Dr. Munzing concluded, and I agree, 

that ‘‘the controlled substance[ ] 

prescriptions issued by [Applicant] for 

Patients L.C., P.B., S.N., and J.H. 

between May 1, 2017, and February 21, 

2019[,] were issued without a legitimate 

medical purpose and were issued 

beneath the standard of care for the 

practice of medicine in the State of 

California, and therefore outside of the 

usual course of professional practice.’’ 

Id. at 7. 

II. Discussion 

A. Government’s Position 

In its RFAA, the Government sought 

denial of Applicant’s application for 

DEA registration because Applicant 

‘‘materially falsified his application 

under 21 U.S.C. 824(a)(1), and 

committed acts which render [granting 

his] registration inconsistent with the 

public interest.’’ RFAA, at 1 (citing 21 

U.S.C. 824(a)(1), (a)(4) and 823(f). 

Specifically, the Government argued 

that Applicant had materially falsified 

his application when he falsely 

provided a ‘‘No’’ response to the 

liability question asking him whether he 

had ever surrendered for cause a federal 

controlled substance registration and 

when he knew or should have known 

that his ‘‘No’’ response was false. Id. at 

19. The Government also argued that 

Applicant had repeatedly violated state 

and federal law by issuing prescriptions 

for controlled substances to four 

patients outside of the standard of care 

in the State of California and outside of 

the usual course of professional 

practice. Id. at 21. The Government 

concluded its RFAA by requesting that 

Applicant’s application for DEA 

registration be denied and that any 

applications by Applicant for any other 

registrations be denied. Id. at 25. 

B. Applicant’s Position 

Within his Request for Hearing and 

his Corrective Action Plan, both 

submitted in response to the OSC, 

Applicant offered explanation as to his 

misconduct, however, Applicant did not 

offer supporting evidence nor any 

ability for me to assess the credibility of 

his unsworn statements.7 See RFAAX 3 

(Request for Hearing) and RFAAX 4 

(Corrective Action Plan). In his Request 

for Hearing, Applicant addressed the 

allegations of material falsification and 

stated that when, on February 21, 2019, 

DEA investigators visited Applicant’s 

registered location to serve an 

administrative subpoena for patient files 

from his practice, the investigators 

‘‘explained that the DEA was concerned 

about certain red flags associated with 

[his] controlled substance prescribing, 

including but not limited to, long 

distances traveled by patients, high 

dosages, and drug cocktails.’’ RFAAX 3, 

at 3. Applicant stated that he ‘‘believed 

that if [he] surrendered [his] DEA 

certificate that [he] would be 

demonstrating good faith that [he] had 

done nothing wrong.’’ Id. Applicant also 

stated that he ‘‘was unaware and did not 

understand that [he] was being asked to 

surrender [his] DEA certificate ‘for 

cause.’ ’’ Id. 

In both his Request for Hearing and 

his Corrective Action Plan, Applicant 

offered a ‘‘historical perspective’’ 

regarding the improper prescribing 

allegations. RFAAX 3, at 3–5; RFAAX 4, 

at 5. According to Applicant, in 2018, 

he ‘‘acquired a medical practice from 

anesthesiologist/pain medicine 

specialist [M. J.], a frequent prescriber of 

schedule II and III medications.’’ 

RFAAX 4, at 5. Applicant stated that 

prior to considering the purchase of M. 

J.’s practice, and before working with 

him, Applicant ‘‘discussed with him his 

patient population’’ and ‘‘ [a] contract 

was drawn up ensuring that all [M. J.] 

was doing was within state and deferral 

[sic] laws.’’ RFAAX 3, at 3. Applicant 

stated that he and M. J. agreed that M. 

J. would continue to work with 

Applicant for the first year and then 

turn the practice over to Applicant. Id. 

The contract was signed by both 


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Applicant and M. J. and witnessed by a 

third party. Id. According to Applicant, 

CDC guidelines were also discussed, 

and M.J. ‘‘informed [Applicant] that 

[they] were recommendations, not 

mandates.’’ Id. M.J. said that patients 

had been established with him for 20– 

30 years. Id. Further, M.J. discussed the 

‘‘tolerance displayed by long term 

chronic pain patients,’’ their 

‘‘functionality’’ (that patients could ‘‘go 

to work, address activities of daily life, 

[and] enjoy the benefits of being 

sociable’’) and ‘‘an overall high level of 

productivity of patients.’’ Id. M.J. 

further stated that ‘‘if there had been 

any problems, he would not [have been] 

allowed to operate for all this time, 

incident free.’’ Id. 

According to Applicant, upon his 

evaluation of the patients, he realized 

that ‘‘many patients were not getting the 

proper workups, diagnostic studies[,] 

and referrals needed to improve their 

pain.’’ Id. Further, ‘‘[m]any of them 

were exhibiting chronic pain due to lack 

of early appropriate treatment’’ and 

‘‘patients had been pushed toward 

interventional procedures that either 

were not indicated or ended up hurting 

them.’’ Id. Applicant stated that ‘‘[t]his 

was all done under the guise of 

performing a ‘trial’ ’’ and that 

‘‘[m]edications had been escalated due 

to failed ‘trials’ and recommended due 

to inability to control pain with 

interventions.’’ Id. Applicant stated that 

‘‘[a]s medications were elevated and 

encouraged by [M.J.], patients had 

become dependent on their current 

regimens, and had been educated that 

their pain was so severe that high 

medication dosages were indicated.’’ Id. 

According to Applicant, in April 

2019, he was the victim of a cyber crime 

when ransomware was placed onto his 

servers and corrupted all of his 

electronic medical records. Id. at 4. 

Applicant stated that ‘‘[although] no 

HIPPA violation occurred and the charts 

were retrieved on an external hard 

drive, upon attempting to upload the 

data, the external hard drive became 

corrupted leading to loss of all charting 

information.’’ Id. As a result of the data 

loss, Applicant was only able to provide 

management details for the four patients 

referenced in the OSC by memory and 

not by specific references to their 

patient records. Id. Applicant stated that 

‘‘[a]ll four patients cited in the [OSC] 

were patients managed or at one time 

managed by [M.J.].’’ Id. Further, ‘‘[n]one 

of them were naı ̈ve to opioids and were 

elevated to the regimens in question by 

[M.J.].’’ Id. Applicant concluded that 

‘‘[a]ll of these patients, from the moment 

[he] inherited them, were already and 

for years [had been] above the current 

state, federal[,] and CDC guidelines.’’ Id. 

Regarding Patient L.C., Applicant 

stated that her medications had been 

escalated prior to her becoming 

Applicant’s patient. Id. According to 

Applicant, Patient L.C. had indicated 

that ‘‘she had tried many procedures for 

her condition including [ ] a trial of a 

Spinal Cord Stimulator (SCS).’’ Id. 

However, Patient L.C. said that during 

the SCS trial she had been hurt and she 

‘‘frequently had her mother [with her] at 

appointments to advocate that she 

would never have [an] SCS [again] due 

to the adverse experience during the 

trial.’’ Id. Applicant stated that he and 

other physicians believed that Patient 

L.C. was getting too much medication 

and Applicant ‘‘used [other] opinions to 

further bolster [his own],’’ but Patient 

L.C. disagreed and ‘‘cit[ed] [M.J.].’’ Id. 

Applicant then started Patient L.C. on a 

‘‘slow wean’’ of her medications. Id. 

According to Applicant, Patient L.C. 

was also undergoing a trial of Belbuca 

for her pain, and as he was weaning 

down her medications, Belbuca was 

used ‘‘to continue to cover her chronic 

pain.’’ Id. Applicant stated that Belbuca 

‘‘is indicated for the management of 

pain severe enough to require daily, 

around-the-clock, long-term opioid 

treatment and for which alternative 

treatment options are inadequate.’’ Id. 

For Patient L.C., Belbuca was ‘‘not being 

used for maintenance or detoxification 

treatment.’’ Id. 

Regarding Patient P.B., Applicant 

stated that her medications had been 

escalated prior to her becoming 

Applicant’s patient. Id. According to 

Applicant, there had been no diagnostic 

studies on file for Patient P.B. and 

weaning down of her medications 

occurred once diagnostic studies were 

performed. Id. 

Regarding Patient S.N., Applicant 

stated that his medications had also 

been escalated prior to him becoming 

Applicant’s patient. Id. at 5. According 

to Applicant, Patient S.N. ‘‘cited 

tailbone pain that made sitting for long 

periods difficult’’ and ‘‘had a job where 

he often traveled by plane and was not 

able to stop and take breaks from 

sitting.’’ Id. ‘‘Refills made early usually 

represented a documented trip he had 

on behalf of his profession.’’ Id. 

According to Applicant, Patient S.N. 

‘‘had never been worked up for his 

pain’’ and ‘‘[m]ultiple diagnostic studies 

were conducted in attempts to find a 

solution.’’ Id. Applicant stated that he 

started Patient S.N. on a weaning down 

of his medication and ‘‘[a]fter S.N. 

transferred care to obtain medication 

from another provider, he continued to 

work with [Applicant] in an attempt to 

solve his pain.’’ Id. Applicant also 

stated that Patient S.N. ‘‘attempted a 

nerve block to further investigate a 

solution to his pain, though no opioids 

were being prescribed by [Applicant] at 

the time.’’ Id. 

Finally, regarding Patient J.H., 

Applicant stated that his medications 

too had been escalated prior to him 

becoming Applicant’s patient. Id. 

According to Applicant, Patient J.H. had 

sustained an occupational injury and 

was being managed under a workers’ 

compensation insurer. Id. Patient J.H. 

previously had a failed surgical 

procedure and was a candidate for a 

revision procedure. Id. Applicant stated 

that he had agreed with the revision 

procedure as an option, but that the 

procedure was denied by the insurer. Id. 

According to Applicant, ‘‘[o]ther nonopioid options were recommended to 

help decrease [Patient J.H.’s use of] 

opioids and [to] manage his pain.’’ Id. 

Applicant concluded his Request for 

Hearing by asserting that his patients 

‘‘had been taught that issues that could 

have normally been mitigated by 

appropriate treatment were instead only 

able to be addressed with high levels of 

medication’’ and that ‘‘[t]he belief had 

been ingrained that medications were 

the only option.’’ Id. Applicant asserted 

that his patients in turn became 

dependent on their medications and 

that ‘‘[a]s a competent, caring doctor, 

[he] could not abandon them.’’ Id. 

Applicant stated that he ‘‘was working 

diligently to reduce their medication 

use, but found a number of patients who 

had been on long term opiate use’’ and 

thus ‘‘[had] to very slowly wean them.’’ 

Id. 

In his Corrective Action Plan, 

Applicant stated, ‘‘Given my training in 

physical medicine and rehabilitation, 

my focus was to taper his patients from 

high dose opioids and offer them an 

array of alternative treatment options.’’ 

RFAAX 4, at 5. According to Applicant, 

‘‘[o]n February 23, 2019, in the midst of 

this process, DEA officers presented to 

the clinic and requested that [he] 

surrender [his] DEA license’’ to which 

Applicant ‘‘voluntarily complied.’’ Id. 

Applicant further stated that ‘‘[a]t that 

time, patients who were on scheduled 

medications were provided the option 

of tapering off their medications or 

provided a list of alternative physicians 

for transfer of care, including an 

addiction medicine specialist.’’ Id. 

Applicant asserted that ‘‘[f]or those 

patients who decided to taper/ 

discontinue their medications, [he] 

continued to provide them care in the 

framework of holistic treatment options 

such as physical and behavioral 

therapies, procedures, durable medical 


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8As to Factor One, there is no record evidence 

of disciplinary action against Applicant’s state 

medical license. 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 [or granting of a] 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 Applicant has been convicted of an 

offense under either federal or state law ‘‘relating 

to the manufacture, distribution, or dispensing of 

controlled substances.’’ 21 U.S.C. 823(f)(3). 

However, as Agency cases 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). Agency cases have therefore 

found that ‘‘the absence of such a conviction is of 

considerably less consequence in the public interest 

inquiry’’ and is therefore not dispositive. Id. 

As to Factor Five, the Government’s evidence fits 

squarely within the parameters of Factors Two and 

Four and does not raise ‘‘other conduct which may 

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

823(f)(5). Accordingly, Factor Five does not weigh 

for or against Applicant. 

equipment, self-directed exercise, and 

other non-medical pain management 

strategies.’’ Id. 

Applicant stated that he ‘‘proceeded 

to close the practice, and after full 

disclosure, [he has] been evaluating and 

treating patients at RehabOne Medical 

Group, Inc.’’ Id. Applicant chose to 

work at RehabOne ‘‘because of their 

positive reputation in the community 

[and] their focus on functional 

restoration.’’ Id. Applicant also chose 

RehabOne for ‘‘their attentiveness to 

documentation, record keeping, and 

compliance [as well as] medical 

provider supervision[,] oversight, and 

collaboration.’’ Finally, Applicant chose 

RehabOne for their ‘‘adherence with 

evidence-based guideline 

recommendations for prescribing 

controlled substances.’’ Id. Applicant 

stated that ‘‘[a]lthough [he has] not 

personally prescribed any scheduled 

medications, RehabOne has a strong risk 

management policy that utilizes opioid 

and addiction risk screening tools, longterm controlled substance agreements, 

routine CURES analysis, initial and 

random urine toxicology, and ‘5 As’ 

monitoring.’’ Id. Further, ‘‘[w]hen 

opioid or non-opioid medications are 

considered appropriate as part of a 

treatment plan, all efforts are made to 

utilize the lowest dose and frequency 

possible to achieve optimal outcomes.’’ 

Id. According to Applicant, ‘‘[a]t 

RehabOne, medications are very 

carefully considered as part of an 

overall, comprehensive treatment 

strategy with the primary goal of 

functional restoration and quality of 

living.’’ Id. 

Applicant concluded his Corrective 

Action Plan by stating that ‘‘[m]oving 

forward, [he plans] to strictly adhere to 

these practices and principles as [he 

strives] to help [his] patients lead full 

and meaningful lives.’’ Id. Applicant 

stated that he ‘‘will continue to review 

and implement the most current 

evidence-based guidelines for the 

treatment of chronic pain’’ and 

requested that ‘‘[DEA] reinstate [his] 

DEA license so that [he] can utilize 

appropriate medications as one tool in 

the toolbox to achieve these outcomes.’’ 

Id. 

C. Analysis 

1. 21 U.S.C. 823(f): The Five Public 

Interest Factors 

Pursuant to section 303(f) of the 

Controlled Substances Act (hereinafter, 

CSA), ‘‘[t]he Attorney General shall 

register practitioners . . . to dispense 

. . . controlled substances . . . if the 

applicant is authorized to dispense . . . 

controlled substances under the laws of 

the State in which he practices.’’ 21 

U.S.C. 823(f). Section 303(f) further 

provides that an application for a 

practitioner’s registration may be denied 

upon a determination that ‘‘the issuance 

of such registration . . . would be 

inconsistent with the public interest.’’ 

Id. In making the public interest 

determination, the CSA requires 

consideration of the following factors: 

(1) The recommendation of the appropriate 

State licensing board or professional 

disciplinary authority. 

(2) The applicant’s experience in 

dispensing, or conducting research with 

respect to controlled substances. 

(3) The applicant’s conviction record under 

Federal or State laws relating to the 

manufacture, distribution, or dispensing of 

controlled substances. 

(4) Compliance with applicable State, 

Federal, or local laws relating to controlled 

substances. 

(5) Such other conduct which may threaten 

the public health and safety. 

21 U.S.C. 823(f). 

The DEA considers these public 

interest factors in the disjunctive. Robert 

A. Leslie, M.D., 68 FR 15227, 15230 

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

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

2005). Any one factor, or combination of 

factors, may be decisive. David H. Gillis, 

M.D., 58 FR 37507, 37508 (1993). Thus, 

there is no need to enter findings on 

each of the factors. Hoxie v. Drug Enf’t 

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

2005). Furthermore, there is no 

requirement to consider a factor in any 

given level of detail. Trawick v. Drug 

Enf’t Admin., 861 F.2d 72, 76–77 (4th 

Cir. 1988). The balancing of the public 

interest factors ‘‘is not a contest in 

which score is kept; 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 . . . .’’ Jayam Krishna-Iyer, 

M.D., 74 FR 459, 462 (2009). When 

deciding whether registration is in the 

public interest, the DEA must consider 

the totality of the circumstances. See 

generally Joseph Gaudio, M.D., 74 FR 

10083, 10094–95 (2009) (basing sanction 

on all evidence on record). 

The Government does not dispute that 

Applicant holds a valid state medical 

license and is authorized to dispense 

controlled substances in the State of 

California where he practices. See 

RFAAX 2 (OSC), at 2. While I have 

considered all of the public interest 

factors 8 in 21 U.S.C. 823(f), the 

Government’s evidence in support of its 

prima facie case for denial of 

Applicant’s application is confined to 

Factors Two and Four. See RFAA, at 

19–25. Moreover, the Government has 

the burden of proof in this proceeding. 

21 CFR 1301.44. I find that the 

Government’s evidence satisfies its 

prima facie burden of showing that 

Applicant’s registration would be 

‘‘inconsistent with the public interest.’’ 

21 U.S.C. 824(f). I further find that 

Applicant failed to provide sufficient 

evidence to rebut the Government’s 

prima facie case. 

i. Factors Two and Four 

Evidence is considered under Public 

Interest Factors Two and Four when it 

reflects compliance (or non-compliance) 

with laws related to controlled 

substances and experience dispensing 

controlled substances. Established 

violations of the CSA, DEA regulations, 

or other laws regulating controlled 

substances at the state or local level are 

cognizable when considering whether 

granting a registration is consistent with 

the public interest. 

Here, the Government has alleged that 

from at least May 1, 2017, through at 

least February 21, 2019, Applicant 

unlawfully issued prescriptions for 

controlled substances in violation of the 

CSA. RFAAX 2 (OSC), at 2 and 4–10. 

Specifically, the Government alleges 

that Applicant repeatedly violated 21 

CFR 1306.4(a) by issuing prescriptions 

for controlled substances to Patients 

L.C., P.B., S.N., and J.H. beneath the 

standard of care and outside the usual 

course of professional practice in 

California—the state in which Applicant 

is applying for DEA registration. Id. 


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9The Government also alleged that Applicant 

violated California Health and Safety Code 

§ 11154(a), which states that ‘‘no person shall 

knowingly prescribe, administer, dispense, or 

furnish a controlled substance to or for any person 

. . . not under his or her treatment for a pathology 

or condition.’’ Dr. Munzing’s expert report did not 

address whether Applicant knowingly prescribed 

controlled substances to or for any person not under 

his treatment for a pathology or condition. 

Accordingly, I find that the Government has not 

met its burden to prove by substantial evidence that 

Applicant violated California Health and Safety 

Code § 11154(a). 

10The Government also alleged that Applicant 

violated California Business and Professions Code 

§§ 2234 and 725(a), which state that unprofessional 

conduct includes ‘‘[g]ross negligence’’; ‘‘[r]epeated 

negligent acts’’; ‘‘[i]ncompetence’’; or ‘‘[t]he 

commission of any act involving dishonesty or 

corruption that is substantially related to the 

qualifications, functions, or duties of a physician 

and surgeon’’ as well as ‘‘[r]epeated acts of clearly 

excessive prescribing, furnishing, dispensing, or 

administering of drugs.’’ Dr. Munzing’s expert 

report did not address whether Applicant engaged 

in these particular forms of unprofessional conduct. 

Accordingly, I find that the Government has not 

met its burden to prove by substantial evidence that 

Applicant violated California Business and 

Professions Code §§ 2234 and 725(a). 

According to the CSA’s implementing 

regulations, 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 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). 

I found above that the Government’s 

expert credibly declared, as supported 

by California law and federal and state 

guidelines, that the standard of care in 

California requires physicians to, among 

other things, perform a sufficient 

physical exam and take a medical 

history, counsel patients on the risks 

and benefits of the use of particular 

controlled substances, periodically 

review the course of treatment and 

adjust as needed, give special attention 

to patients who pose a risk for 

medication misuse and diversion, and 

monitor and address any red flags of 

abuse or diversion. Further, the 

standard of care in California requires 

additional care and consideration for 

the prescribing of opioids, as well as for 

the prescribing of benzodiazepines in 

combination with opioids. 

Based on the credible and unrebutted 

opinion of the Government’s expert, I 

found above that Applicant issued a 

high number of controlled substance 

prescriptions to at least four different 

patients, often for extremely high doses 

of opioids and in dangerous 

combinations of opioids and 

benzodiazepines, without performing 

detailed examinations or evaluations, 

dependably considering non-opioid 

alternatives, reliably weaning patients 

off such high dosages, or resolving or 

documenting resolution of red flags of 

abuse and/or diversion as required by 

the standard of care. See supra I.C.2.i– 

iv. My findings demonstrate that 

Applicant repeatedly violated the 

applicable standard of care when 

prescribing controlled substances and 

that his conduct was not an isolated 

occurrence, but occurred with multiple 

patients. See Kaniz Khan Jaffery, 85 FR 

45667, 45685 (2020); Wesley Pope, M.D., 

82 FR 42961, 42986 (2017). As such, I 

find that the Government has presented 

substantial evidence that from May 1, 

2017, to February 21, 2019, Applicant 

issued controlled substance 

prescriptions to the four subject patients 

beneath the applicable standard of care 

in California and outside the usual 

course of professional practice. 

Accordingly, I am sustaining the 

Government’s allegation that Applicant 

violated 21 CFR 1306.04(a). 

The Government has also alleged that 

Applicant’s prescribing practices in 

regard to the subject patients violated 

California State law. RFAAX 2, at 2–3 

and 4–10. 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).9

Further, California Business and 

Professions Code § 2242(a) states, 

‘‘Prescribing, dispensing, or furnishing 

[controlled substances] without an 

appropriate prior examination and a 

medical indication[ ] constitutes 

unprofessional conduct.’’ 10

Accordingly, I find that, similarly to 21 

CFR 1306.04(a), the record contains 

substantial evidence that Applicant 

violated these provisions with respect to 

the controlled substance prescriptions 

for Patients L.C., P.B., S.N., and J.H. 

In sum, I find that the record contains 

substantial evidence that Applicant 

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 professional 

practice, and in violation of federal and 

state law. I, therefore, find that Factors 

Two and Four weigh in favor of denial 

of Applicant’s application and thus find 

Applicant’s registration to be 

inconsistent with the public interest in 

balancing the factors of 21 U.S.C. 823(f). 

2. 21 U.S.C. 824(a)(1): Material 

Falsification 

In addition to the public interest 

allegations, as previously mentioned, 

the OSC in this matter also alleges that 

Applicant’s application for registration 

should be denied, because Applicant’s 

application contains a materially false 

response to a liability question. RFAAX 

2, at 1 and 3–4; see supra I.A–B.1. The 

CSA, however, places the provision 

addressing the ramification of a material 

falsification with the bases for 

revocation or suspension of a 

registration. 21 U.S.C. 824(a). Prior 

Agency decisions have addressed 

whether it is appropriate to consider a 

material falsification and other 

provisions of 21 U.S.C. 824(a) when 

determining whether or not to grant a 

practitioner registration application. For 

over forty-five years, Agency decisions 

have concluded that it is. See, e.g., Lisa 

M. Jones, N.P., 86 FR 52196 (2021), 

Robert Wayne Locklear, 86 FR 33738 

(2021) (collecting Agency decisions). 

These decisions offer multiple bases and 

analyses for that conclusion. 86 FR at 

33744–45. 

Having read and analyzed all of the 

record evidence, I find from clear, 

unequivocal, convincing, and 

unrebutted record evidence that 

Applicant surrendered (for cause) his 

previous DEA registration on February 

21, 2019. See supra I.A–B.1. Having 

read and analyzed all of the record 

evidence, I find from clear, unequivocal, 

convincing, and unrebutted record 

evidence that when presented with the 

liability question, ‘‘Has the applicant 

ever surrendered (for cause) or had a 

federal controlled substance registration 

revoked, suspended, restricted or 

denied, or is any such action 

pending?’’—Applicant answered, ‘‘No.’’ 

Id. Applicant’s false answer to this 

liability question in his application 

implicates two of the public interest 

factors that the CSA requires me to 

consider (see supra II.C.1): Applicant’s 

experience in dispensing controlled 

substances and Applicant’s compliance 

with applicable federal laws relating to 

controlled substances. 21 U.S.C. 

823(f)(2) and (4); Frank Joseph Stirlacci, 

M.D., 85 FR 45229, 45234 (2020). As 

such, Applicant’s false response to this 

liability question in his application was 

‘‘predictably capable of affecting, i.e., 

had a natural tendency to affect’’ my 

official decision on Applicant’s 

application. Frank Joseph Stirlacci, 


lotter on DSK11XQN23PROD with NOTICES1
21164 Federal Register / Vol. 87, No. 69 / Monday, April 11, 2022 / Notices 

11 It is noted that in spite of Applicant’s claims 

that he did not know that he was surrendering his 

previous registration ‘‘for cause,’’ RFAAX 3, at 3, 

the DEA Form 104 that Applicant signed was 

clearly entitled, ‘‘Surrender for Cause of DEA 

Certificate of Registration,’’ RFAAX 8, App. B 

(emphasis added). 

M.D., 85 FR at 45238. Accordingly, I 

find from clear, unequivocal, 

convincing, and unrebutted record 

evidence that Applicant’s application 

for DEA registration contains a material 

falsification, which is an independent 

basis for the denial of Applicant’s 

application. 

III. Sanction 

The Government has established 

grounds to deny a registration; therefore, 

I will review any evidence and 

argument that Applicant submitted to 

determine whether or not Applicant has 

presented ‘‘sufficient mitigating 

evidence to assure the Administrator 

that [he] can be trusted with the 

responsibility carried by such a 

registration.’’ Samuel S. Jackson, D.D.S., 

72 FR 23848, 23853 (2007) (quoting Leo 

R. Miller, M.D., 53 FR 21931, 21932 

(1988)). ‘‘ ‘Moreover, 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 459, 463 (2009) (quoting Medicine 

Shoppe, 73 FR 364, 387 (2008)); see also 

Samuel S. Jackson, D.D.S., 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 respondent; 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). 

A. Acceptance of Responsibility 

As previously discussed, although 

Applicant initially requested a hearing 

and submitted a Corrective Action Plan 

on July 23, 2020, Applicant later 

withdrew his hearing request on August 

14, 2020, and the proceedings were 

terminated. See RFAAX 3 (Request for 

Hearing); RFAAX 4 (Corrective Action 

Plan); RFAAX 5 (Withdrawal of Hearing 

Request); RFAAX 6 (Order Terminating 

Proceedings). As such, there is no 

credible, sworn evidence on the record 

regarding acceptance of responsibility 

for me to consider. Further, even if I 

could consider the explanations that 

Applicant offered in his initial Request 

for Hearing and Corrective Action Plan, 

they do not demonstrate sufficient 

acceptance of responsibility or evidence 

of remedial measures that would aid me 

in entrusting Applicant with 

registration. See RFAAX 3 and RFAAX 

4. 

As to the allegations of material 

falsification, Applicant claimed that, at 

the time he surrendered his DEA 

certificate for cause, he misunderstood 

that he was doing so and believed 

instead that he was ‘‘demonstrating 

good faith that [he] had done nothing 

wrong.’’ 11 RFAAX 3, at 3. Whether or 

not Applicant’s claims are truthful, they 

do not demonstrate acceptance of 

responsibility for his (intentional or not) 

materially false response to a liability 

question. Rather, Applicant’s claims 

demonstrate an attempt to either shift 

the blame to DEA investigators for 

failing to properly explain the situation 

to him or to simply use his ignorance as 

an excuse, neither of which inspire 

confidence that Applicant fully 

appreciates an applicant’s obligation to 

provide truthful and accurate responses 

on an application for DEA registration. 

As to the allegations of improper 

prescribing, Applicant claimed that he 

had inherited the subject patients from 

his purchase of another physician’s 

practice and that the physician he had 

purchased the practice from had assured 

him that all was proper regarding the 

practice and his patients. RFAAX 3, at 

3; RFAAX 4, at 5. However, Applicant 

claimed that he only later realized that 

all was not proper regarding the practice 

and the patients that he had inherited 

and that he had done the best that he 

could to wean the four subject patients 

off of their high dosages of controlled 

substances. RFAAX 3, at 3–5; RFAAX 4, 

at 5. Again, Applicant’s statements do 

not demonstrate acceptance of 

responsibility for his improper 

prescribing, but instead demonstrate an 

attempt to shift the blame to the 

physician whom he had inherited the 

subject patients from or, at the very 

least, a failure to acknowledge that, 

regardless of his intentions, his 

prescribing was beneath the applicable 

standard of care and outside the usual 

course of professional practice. 

As for remedial measures, I do not 

consider them when an Applicant has 

not unequivocally accepted 

responsibility, however, even if I were 

to consider Applicant’s remedial 

measures here, I do not find them to be 

sufficient. Applicant discussed how 

since surrendering his DEA registration, 

he has closed his practice and has begun 

treating patients at another practice, one 

which he lauds for its adherence to best 

practices for prescribing controlled 

substances. RFAAX 4, at 5. Applicant 

also stated his own commitment to 

adhering to these best practices moving 

forward, however, Applicant did not 

specify in what ways he would ensure 

this adherence. Id. As such, Applicant 

has not sufficiently demonstrated that 

he is ready to be entrusted with the 

responsibility of registration. 

B. Specific and General Deterrence 

In addition to acceptance of 

responsibility, the Agency considers 

both specific and general deterrence 

when determining an appropriate 

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

74,800, 74,810 (2015). Specific 

deterrence is the DEA’s interest in 

ensuring that a registrant complies with 

the laws and regulations governing 

controlled substances in the future. Id. 

General deterrence concerns the DEA’s 

responsibility to deter conduct similar 

to the proven allegations against the 

registrant for the protection of the 

public at large. Id. In this case, I believe 

that denial of Applicant’s application 

for DEA registration would deter 

Applicant and the general registrant 

community from the improper 

prescribing of controlled substances as 

well as from ignoring their obligation to 

provide accurate and truthful responses 

on an application for DEA registration. 

C. Egregiousness 

The Agency also looks to the 

egregiousness and the extent of the 

misconduct as significant factors in 

determining the appropriate sanction. 

Garrett Howard Smith, M.D., 83 FR at 

18,910 (collecting cases). Here, the 

record contains substantial evidence 

that Applicant issued a high number of 

prescriptions for controlled substances, 

including high dosages of opioids and 

dangerous combinations of opioids and 

benzodiazepines, to at least four 

different patients beneath the applicable 

standard of care and outside the usual 

course of professional practice. Further, 

Applicant gave a materially false 

response to a liability question on his 

application for DEA registration that 

directly concerned his improper 

prescribing practices and his negative 

history with DEA registration. 

As discussed above, to be granted a 

registration when grounds for denial 


lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 87, No. 69 / Monday, April 11, 2022 / Notices 21165 

*A I have made minor modifications to the RD. I 

have substituted initials or titles for the names of 

witnesses and patients to protect their privacy and 

I have made minor, nonsubstantive, grammatical 

changes and nonsubstantive, conforming edits. 

Where I have made substantive changes, omitted 

language for brevity or relevance, or where I have 

added to or modified the ALJ’s opinion, I have 

noted the edits with an asterisk, and I have 

included specific descriptions of the modifications 

in brackets following the asterisk or in footnotes 

marked with a letter and an asterisk. Within those 

brackets and footnotes, the use of the personal 

pronoun ‘‘I’’ refers to myself—the Administrator. 

*B I have omitted the RD’s discussion of the 

procedural history to avoid repetition with my 

introduction. 

exist, an Applicant must convince the 

Administrator that his acceptance of 

responsibility is sufficiently credible to 

ensure that his misconduct will not 

reoccur and that he can be entrusted 

with registration. I find that Applicant 

has not met this burden. In sum, 

Applicant has not offered any credible 

evidence on the record to rebut the 

Government’s case for denial of his 

application and Applicant has not 

demonstrated that he can be entrusted 

with the responsibility of registration. 

Accordingly, I will order the denial of 

Applicant’s application below. 

Order 

Pursuant to 28 CFR 0.100(b) and the 

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

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

deny the pending application for a 

Certificate of Registration, Control 

Number W19032408C, submitted by 

Kareem Hubbard, M.D., as well as any 

other pending application of Kareem 

Hubbard, M.D. for additional 

registration in California. This Order is 

effective May 11, 2022. 

Anne Milgram, 

Administrator. 

[FR Doc. 2022–07702 Filed 4–8–22; 8:45 am] 

BILLING CODE 4410–09–P 

DEPARTMENT OF JUSTICE 

Drug Enforcement Administration 

[Docket No. 20–17] 

Noah David, P.A.; Decision and Order 

On March 9, 2020, a former Assistant 

Administrator, Diversion Control 

Division, of the Drug Enforcement 

Administration (hereinafter, DEA or 

Government), issued an Order to Show 

Cause (hereinafter, OSC) to Noah David, 

P.A. (hereinafter, Respondent) of 

Richmond, Virginia. Administrative 

Law Judge Exhibit (hereinafter, ALJX) 1 

(OSC), at 1. The OSC proposed the 

revocation of Respondent’s DEA 

Certificate of Registration No. 

MD3130717 (hereinafter, COR or 

registration) and the denial of ‘‘any 

pending application for renewal or 

modification of such registration and 

any applications for any other DEA 

registrations, pursuant to 21 U.S.C. 

824(a)(4), because [Respondent’s] 

registration is inconsistent with the 

public interest, as that term is defined 

in 21 U.S.C. 823(f).’’ Id. 

On April 7, 2020, the Respondent 

timely requested a hearing, which 

commenced (and ended) on September 

22, 2020, at the DEA Hearing Facility in 

Arlington, Virginia with the parties, 

counsel, and witnesses participating via 

video teleconference (VTC). On 

December 8, 2020, Chief Administrative 

Law Judge John J. Mulrooney, II 

(hereinafter, the Chief ALJ) issued his 

Recommended Rulings, Findings of 

Fact, Conclusions of Law and Decision 

of the Administrative Law Judge 

(hereinafter, Recommended Decision or 

RD). By letter dated January 5, 2021, the 

ALJ certified and transmitted the record 

to me for final Agency action. In that 

letter, the ALJ advised that neither party 

filed exceptions. Having reviewed the 

entire record, I adopt the ALJ’s rulings, 

findings of fact, as modified, 

conclusions of law and recommended 

sanction with minor modifications, 

where noted herein.*A

Recommended Rulings, Findings of 

Fact, Conclusions of Law, and Decision 

of the Administrative Law Judge 

John J. Mulrooney, II 

Chief Administrative Law Judge 

December 8, 2020 

*BAfter carefully considering the 

testimony elicited at the hearing, the 

admitted exhibits, the arguments of 

counsel, and the record as a whole, I 

have set forth my recommended 

findings of fact and conclusions of law 

below. 

I. Findings of Fact 

A. Allegations 

The Government alleges that the 

Respondent’s COR should be revoked 

because he has committed acts which 

render his continued registration against 

the public interest. ALJX 1, at 1. 

Specifically, the Government contends 

that on numerous occasions between 

April 2014 and November 2018, the 

Respondent unlawfully prescribed 

controlled substances to his wife 

without establishing a bona fide 

practitioner-patient relationship and 

without properly documenting 

treatment. Id. at 3–4. The Government 

additionally alleges that the Respondent 

conspired with colleagues to unlawfully 

receive controlled substances. Id. at 4. 

B. Stipulations 

The parties entered into a robust set 

of factual stipulations which were 

accepted by the tribunal. Accordingly, 

the following factual matters are 

deemed conclusively established in this 

case: 

1. The Respondent is registered with 

the DEA as a practitioner to handle 

controlled substances in Schedules II–V 

under DEA COR No. MD3130717 at 

5211 West Broad Street, Suite 101, 

Richmond, Virginia 23230–3000. 

2. DEA COR No. MD3130717 was 

issued on May 15, 2019 and expires by 

its own terms on June 30, 2022. 

3. The Respondent is presently 

licensed as a physician assistant in 

Virginia under License No. 0110004505, 

which expires April 30, 2021. 

4. Respondent Exhibit 1 is a true and 

correct copy of the Respondent’s COR. 

5. The Respondent prescribed the 

following controlled substances on the 

following dates to his wife, B.D.: 

(1) 11/28/2018: Oxycodone-Acetaminophen 

5–325, 36 tablets 

(2) 11/20/2018: Oxycodone-Acetaminophen 

5–325, 36 tablets 

(3) 11/08/2018: Oxycodone-Acetaminophen 

5–325, 36 tablets 

(4) [10/30/2018: Oxycodone-Acetaminophen 

5–325, 36 tablets] 

(5) 10/01/2018: Oxycodone-Acetaminophen 

10–325, 18 tablets 

(6) 9/21/2018: Oxycodone-Acetaminophen 

10–325, 18 tablets 

(7) 9/13/2018: Oxycodone-Acetaminophen 

10–325, 18 tablets 

(8) 9/06/2018: Oxycodone-Acetaminophen 5– 

325, 60 tablets 

(9) 8/22/2018: Oxycodone-Acetaminophen 5– 

325, 60 tablets 

(10) 8/17/2018: Oxycodone-Acetaminophen 

5–325, 60 tablets 

(11) 7/23/2018: Oxycodone-Acetaminophen 

5–325, 42 tablets 

(12) 7/10/2018: Oxycodone-Acetaminophen 

5–325, 84 tablets 

(13) 7/03/2018: Oxycodone-Acetaminophen 

10–325, 18 tablets 

(14) 5/30/2018: Acetaminophen-Codeine #3, 

60 tablets 

(15) 5/30/2018: Acetaminophen-Codeine #3, 

60 tablets (refill) 

(16) 5/30/2018: Acetaminophen-Codeine #3, 

60 tablets (refill) 

(17) 5/21/2018: Oxycodone-Acetaminophen 

5–325, 12 tablets 

(18) 5/08/2018: Diazepam 5mg, 30 tablets 

(19) 4/24/2018: Oxycodone-Acetaminophen 

10–325, 28 tablets 

(20) 3/16/2018: Oxycodone-Acetaminophen 

10–325, 28 tablets 

(21) 2/15/2018: Oxycodone-Acetaminophen 

10–325, 28 tablets 

(22) 2/09/2018: Oxycodone-Acetaminophen 

10–325, 12 tablets 

(23) 1/23/2018: Oxycodone-Acetaminophen 

10–325, 28 tablets 

(24) 1/19/2018: Oxycodone-Acetaminophen 

10–325, 12 tablets 

(25) 1/05/2018: Oxycodone-Acetaminophen 


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