Federal Register / Vol. 87, No. 69 / Monday, April 11, 2022 / Notices 21175 

1Under the Administrative Procedure Act, an 

agency ‘‘may take official notice of facts at any stage 

in a proceeding—even in the final decision.’’ 

United States Department of Justice, Attorney 

General’s Manual on the Administrative Procedure 

Act 80 (1947) (Wm. W. Gaunt & Sons, Inc., Reprint 

1979). Pursuant to 5 U.S.C. 556(e), ‘‘[w]hen an 

agency decision rests on official notice of a material 

fact not appearing in the evidence in the record, a 

party is entitled, on timely request, to an 

opportunity to show the contrary.’’ Accordingly, 

Registrant may dispute my finding by filing a 

properly supported motion for reconsideration of 

finding of fact within fifteen calendar days of the 

date of this Order. Any such motion and response 

shall be filed and served by email to the other party 

and to Office of the Administrator, Drug 

Enforcement Administration at 

dea.addo.attorneys@dea.usdoj.gov. 

Findings of Fact 

Registrant’s DEA Registration 

Registrant is the holder of DEA 

Certificate of Registration No. 

AB2619510 at the registered address of 

11525 Brookshire Avenue, Suite 101, 

Downey, California 90241. RFAAX B, at 

1. Pursuant to this registration, 

Registrant is authorized to dispense 

controlled substances in schedules II 

through V as a practitioner. Id. 

Registrant’s registration expires on July 

31, 2022. Id. 

The Status of Registrant’s State License 

On October 4, 2019, the Medical 

Board of California (hereinafter, the 

Board) issued an Accusation against 

Registrant alleging repeated negligent 

acts and failure to maintain adequate 

and accurate records throughout his 

treatment and care of six specific 

patients. RFAAX B–1, at 9–15. Further, 

according to the Accusation, ‘‘on or 

about September 27, 2019, in a prior 

disciplinary action . . . [Registrant’s] 

license was revoked with revocation 

stayed for five (5) years of probation for 

self-prescribing of controlled substances 

and conviction of crimes substantially 

related to qualifications, functions, or 

duties of a physician and surgeon.’’ Id. 

at 16. On March 9, 2020, Registrant 

entered into a Stipulated Surrender of 

License and Disciplinary Order 

(hereinafter, Stipulated Surrender) in 

which he admitted the truth of the 

allegations in the Accusation and 

surrendered his California medical 

license for the Board’s formal 

acceptance without further process. Id. 

at 4–7. The Stipulated Surrender 

ordered Registrant’s medical license 

surrendered and was signed by 

Registrant and his attorney. Id. at 5–6. 

On March 30, 2020, the Board adopted 

the Stipulated Surrender, effective April 

29, 2020. Id. at 1. 

According to California’s online 

records, of which I take official notice, 

Registrant’s medical license is still 

surrendered.1 Medical Board of 

California License Verification, https://

www.mbc.ca.gov/License-Verification 

(last visited date of signature of this 

Order). Accordingly, I find that 

Registrant is not licensed to engage in 

the practice of medicine in California, 

the state in which he is registered with 

the DEA. 

Discussion 

Pursuant to 21 U.S.C. 824(a)(3), the 

Attorney General is authorized to 

suspend or revoke a registration issued 

under section 823 of the Controlled 

Substances Act (hereinafter, CSA) 

‘‘upon a finding that the registrant . . . 

has had his State license or registration 

suspended . . . [or] revoked . . . by 

competent State authority and is no 

longer authorized by State law to engage 

in the . . . dispensing of controlled 

substances.’’ With respect to a 

practitioner, the DEA has also long held 

that the possession of authority to 

dispense controlled substances under 

the laws of the state in which a 

practitioner engages in professional 

practice is a fundamental condition for 

obtaining and maintaining a 

practitioner’s registration. See, e.g., 

James L. Hooper, M.D., 76 FR 71371 

(2011), pet. for rev. denied, 481 F. App’x 

826 (4th Cir. 2012); Frederick Marsh 

Blanton, M.D., 43 FR 27616, 27617 

(1978). 

This rule derives from the text of two 

provisions of the CSA. First, Congress 

defined the term ‘‘practitioner’’ to mean 

‘‘a physician . . . or other person 

licensed, registered, or otherwise 

permitted, by . . . the jurisdiction in 

which he practices . . . , to distribute, 

dispense, . . . [or] administer . . . a 

controlled substance in the course of 

professional practice.’’ 21 U.S.C. 

802(21). Second, in setting the 

requirements for obtaining a 

practitioner’s registration, Congress 

directed that ‘‘[t]he Attorney General 

shall register practitioners . . . 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). Because Congress has 

clearly mandated that a practitioner 

possess state authority in order to be 

deemed a practitioner under the CSA, 

the DEA has held repeatedly that 

revocation of a practitioner’s registration 

is the appropriate sanction whenever he 

is no longer authorized to dispense 

controlled substances under the laws of 

the state in which he practices. See, e.g., 

James L. Hooper, 76 FR at 71371–72; 

Sheran Arden Yeates, M.D., 71 FR 

39130, 39131 (2006); Dominick A. Ricci, 

M.D., 58 FR 51104, 51105 (1993); Bobby 

Watts, M.D., 53 FR 11919, 11920 (1988); 

Frederick Marsh Blanton, 43 FR at 

27617. 

According to California statute, 

‘‘dispense’’ means ‘‘to deliver a 

controlled substance to an ultimate user 

or research subject by or pursuant to the 

lawful order of a practitioner, including 

the prescribing, furnishing, packaging, 

labeling, or compounding necessary to 

prepare the substance for that delivery.’’ 

Cal. Health & Safety Code § 11010 

(West, current with urgency legislation 

through Ch. 6 of 2022 Reg.Sess.). 

Further, a ‘‘practitioner’’ means a person 

‘‘licensed, registered, or otherwise 

permitted, to distribute, dispense, 

conduct research with respect to, or 

administer, a controlled substance in 

the course of professional practice or 

research in this state.’’ Id. at § 11026(c). 

Here, the undisputed evidence in the 

record is that Registrant currently lacks 

authority to practice medicine in 

California. As discussed above, a 

physician must be a licensed 

practitioner to dispense a controlled 

substance in California. Thus, because 

Registrant lacks authority to practice 

medicine in California and, therefore, is 

not authorized to handle controlled 

substances in California, Registrant is 

not eligible to maintain a DEA 

registration. Accordingly, I will 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. AB2619510 issued to 

Douglas A. Blose, 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 Douglas A. Blose, M.D. to 

renew or modify this registration, as 

well as any other pending application of 

Douglas A. Blose, M.D. for additional 

registration in California. This Order is 

effective May 11, 2022. 

Anne Milgram, 

Administrator. 

[FR Doc. 2022–07686 Filed 4–8–22; 8:45 am] 

BILLING CODE 4410–09–P 

DEPARTMENT OF JUSTICE 

Drug Enforcement Administration 

David H. Betat, M.D.; Decision and 

Order 

On August 21, 2019, a former 

Assistant Administrator of the Diversion 

Control Division of the Drug 

Enforcement Administration 

(hereinafter, Government) issued an 


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1Currently named California Department of 

Consumer Affairs, Division of Investigation, and 

Health Quality Investigation Unit (‘‘HQIU’’). 

RFAAX 9, at ¶ 3. 

Order to Show Cause (hereinafter, OSC) 

seeking to revoke the DEA Certificate of 

Registration, number BB0500365, of 

David H. Betat, M.D. (hereinafter, 

Registrant). Government Request for 

Final Agency Action (hereinafter, 

RFAA) Exhibit (hereinafter, RFAAX) 1 

(OSC). The OSC sought to revoke 

Registrant’s registration pursuant to 21 

U.S.C. 824(a)(4) on the ground that it is 

inconsistent with the public interest, as 

that term is defined in 21 U.S.C. 823(f), 

and to deny any pending applications 

for renewal or modification of such 

registration pursuant to 21 U.S.C. 823(f). 

Id. at 1. 

Specifically, the OSC alleged that 

Registrant, from at least 2012 through at 

least 2017, prescribed controlled 

substances to various patients that were 

not issued for a legitimate medical 

purpose, that were beneath the standard 

of care for the practice of medicine in 

the State of California, and that were not 

issued in the usual course of 

professional practice. Id. at 2–4. The 

OSC further alleged that Registrant’s 

controlled substance prescribing 

practices violated both federal and state 

law. Id. at 4. 

In response to the OSC, Registrant 

submitted a timely request for a hearing. 

RFAAX 3 (Request for Hearing for the 

OSC). The case was subsequently 

assigned to Administrative Law Judge 

(hereinafter, ALJ) Mark M. Dowd, who 

ordered that the Government file its 

prehearing statement by October 16, 

2019, and that Registrant file his 

prehearing statement by November 1, 

2019. RFAAX 4 (Order for Prehearing 

Statements). Registrant failed to file a 

prehearing statement by November 1, 

2019. ALJ Dowd subsequently issued an 

order to show cause on November 8, 

2019, providing Registrant until 

November 20, 2019, to file both a 

prehearing statement and a statement 

demonstrating good cause for failure to 

meet the original deadline. See RFAAX 

5 (ALJ Dowd Order to Show Cause). 

Registrant did not respond to the ALJ’s 

order to show cause. Consequently, ALJ 

Dowd issued an order finding that 

Registrant had waived his right to a 

hearing and terminating the 

proceedings. RFAAX 6 (Order 

Terminating Proceedings). 

On August 17, 2020, the Government 

forwarded its RFAA, along with the 

evidentiary record in this matter, to my 

office. The Government seeks a final 

order of revocation because Registrant 

has ‘‘committed acts that render his 

continued registration inconsistent with 

the public interest under 21 U.S.C. 

824(a) and 823(f).’’ RFAA, at 3. 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. Registrant’s DEA Registration 

Registrant is registered with DEA as a 

practitioner authorized to handle 

controlled substances in schedules II 

through V under DEA Certificate of 

Registration number BB0500365 at the 

registered address of 925 Bevins Court, 

Lakeport, California 95453. RFAAX 7 

(Certificate of Registration). Registrant’s 

registration expires by its terms on July 

31, 2022. Id. 

b. Investigation of Registrant 

On May 10, 2018, a DEA Diversion 

Investigator (hereinafter, the DI) served 

an administrative subpoena on 

Registrant for patient files reflecting 

Registrant’s treatment of various 

patients. RFAAX 8 (Declaration of 

Diversion Investigator), App. A. 

Registrant provided copies of various 

patient files in response to DEA’s 

subpoena, including patient files for 

Patients K.K., G.K., T.L., J.P., and Y.P. 

RFAAX 8, at 2 and Apps. B–F (Copies 

of patient files). 

In furtherance of the DEA 

investigation of Registrant, the DI 

obtained information from the 

California Controlled Substance 

Utilization Review Evaluation System 

(CURES) database regarding Registrant’s 

prescriptions to Patients K.K., G.K., T.L., 

J.P., and Y.P. for the period of 2012 

through 2017. Id. at ¶ 13 and App. G 

(Copy of CURES database report). The 

DI also issued administrative subpoenas 

to various pharmacies to obtain copies 

of Registrant’s prescriptions to Patients 

K.K., G.K., T.L., J.P., and Y.P. Id. at ¶ 16. 

The pharmacies responded with copies 

of prescriptions for the requested 

patients. Id. at Apps. I–M (Copies of 

prescriptions from CVS Pharmacy), O– 

P (Copies of prescriptions from Kmart 

Pharmacy), R–T, V–X (Copies of 

prescriptions from North Lake Medical 

Pharmacies), Z–AA (Copies of 

prescriptions from Safeway Pharmacy), 

AC (Copies of prescriptions from 

Omnicare, Inc.), AE (Copies of 

prescriptions from Pharmacy Care 

Concepts), AG–AH (Copies of 

prescriptions from Lucerne Pharmacy), 

AJ (Copies of prescriptions from 

Moran’s Pharmacy), AL (Copies of 

prescriptions from Walmart Pharmacy). 

In addition to producing copies of 

Registrant’s prescriptions to Patients 

K.K., G.K, T.L, J.P, and Y.P., two 

pharmacies informed the DI that there 

were certain prescriptions they failed to 

produce because they were unable to 

locate them or the records had been lost. 

Id. at ¶¶ 48–49, App. AM–AN. 

c. The Government Expert’s Review of 

Registrant’s Prescriptions 

The DEA hired Dr. Timothy A. 

Munzing to review Registrant’s patient 

files for the patients under review and 

the CURES report showing Registrant’s 

prescriptions to those patients for the 

period from 2012–2017. Id. at ¶ 15. Dr. 

Munzing is a physician licensed and 

practicing in the State of California, who 

has more than three decades of clinical 

work and has served as a Medical 

Expert Reviewer for the Medical Board 

of California.1 RFAAX 9, at ¶¶ 1–3 

(Declaration of Dr. Munzing); see also 

id. at App. A (Dr. Munzing CV). 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’s expert report 

‘‘review[ed] the management of the five 

patients [K.K., G.K., T.L., J.P, and Y.P.] 

and opine[d] on the controlled 

substance prescriptions, specifically 

whether they were medically legitimate 

and in the usual course of professional 

practice.’’ RFAAX 9, App. B, at 4 

(Munzing Report) (emphasis omitted). 

Dr. Munzing concluded, and I agree, 

that with regard to patients K.K., G.K., 

T.L., J.P., and Y.P., Registrant repeatedly 

issued controlled substance 

prescriptions without a legitimate 

medical purpose, outside the usual 

course of professional practice in the 

State of California, and ‘‘in violation of 

the minimum standard of care that 

governs California physicians with 

respect to the use of controlled 

substances in pain management.’’ Id. at 

¶ 15. 

i. Standard of Care in California 

Dr. Munzing attested that several 

statutes inform the standard of care in 

California for the use of controlled 

substances in pain management. 

RFAAX 9, at ¶ 10. Among them, 

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.’’ California 

Business and Professional Code 2241.5 

permits California physicians to treat 

patients under their care for pain, 

including intractable pain, by 

prescribing controlled substances, but 

requires them to ‘‘exercise reasonable 


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2 Dr. Munzing explained that a patient’s daily 

dosage of opioids is evaluated using morphine 

milligram equivalency (‘‘MME’’), also known as the 

daily morphine equivalent dosage (‘‘MED’’), under 

which each different opioid is assigned a value to 

represent its potency relative to morphine sulfate. 

RFAAX 9, at n. 1. 

3Although the Government’s evidence did not 

include the Centers for Disease Control and 

Prevention (CDC), Guideline for Prescribing Opioids 

for Chronic Pain, 2016, it is publically available at: 

https://www.cdc.gov/drugoverdose/prescribing/ 

guideline.html. 

4 Dr. Munzing referenced the 2007 and 2014 

Medical Board of California Guidelines for 

Prescribing Controlled Substances for Pain in his 

expert report. RFAAX 9, App. B, at 66. Although 

the Government’s evidence did not include the 

Guidelines, the 2014 update is publically available 

at: http://www.mbc.ca.gov/Licensees/Prescribing/ 

Pain_Guidelines.pdf. 

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.’’ Finally, California 

Business and Professional Code 2242 

provides that ‘‘[p]rescribing, dispensing, 

or furnishing’’ controlled substances to 

a patient ‘‘without an appropriate prior 

examination and a medical indication’’ 

is ‘‘unprofessional conduct’’ by the 

prescribing physician. RFAAX 9, at 

¶ 10. Dr. Munzing further noted that 

California’s applicable standard for the 

use of controlled substances in pain 

management is also informed by the 

‘‘Guide to the Laws Governing the 

Practice of Medicine by Physicians and 

Surgeons,’’ Medical Board of California, 

7th ed. 2013 (hereinafter, the Guide). Id. 

at ¶ 11. 

Dr. Munzing opined that, as informed 

by the above statutes and the Guide, the 

California standard of care for the use of 

controlled substances in pain 

management requires, among other 

things, that a physician prescribing 

controlled substances: 

‘‘(1) perform a sufficient physical 

examination and take a medical history; 

(2) make an assessment of the 

patient’s pain, their physical and 

psychological function, and their 

history of prior pain treatment; 

(3) make an assessment of any 

underlying or coexisting diseases or 

conditions and order and perform 

diagnostic testing if necessary; 

(4) discuss with the patient the risks 

and benefits of the use of controlled 

substances or any other treatment 

modules; 

(5) review periodically the course of 

pain treatment and gather any new 

information, if any, about the etiology of 

a patient’s state of health; and 

(6) give special attention to patients 

who, by their own words and actions, 

pose a risk for medication misuse and/ 

or diversion.’’ 

Id. at ¶ 12. Dr. Munzing also opined that 

the California standard of care imposes 

additional requirements for certain 

specific controlled substance 

prescriptions that Registrant prescribed 

to the subject patients. First, a physician 

must closely monitor patients 

prescribed opioid doses equivalent to or 

greater than 100 mg of morphine per 

day due to the substantially increased 

risks of overdose and death.2 Id. at ¶ 13; 

see also id. at App. B, at 62 and 66 

(referencing Centers for Disease Control 

guideline 3 that encourages keeping 

opioid dosing less than 50 mg per day 

MED if possible). In particular, Dr. 

Munzing attested that a California 

physician must specifically counsel the 

patient on the risks posed by such 

prescriptions and document that 

counseling; conduct urine drug screens 

of the patient and review the patient’s 

profile in the CURES database at least 

every 3–4 months; refer the patient for 

co-management by a specialist in pain 

management where appropriate; and 

attempt to lower the medication dosage 

prescribed as much as possible. Id. at 

¶ 13. 

Second, a physician prescribing both 

opioids and benzodiazepines to a 

patient must exercise extra caution 

because both groups of drugs are 

respiratory depressants and 

simultaneous prescriptions can increase 

the patient’s risk of overdose and death. 

Id.; see also id. at App. B, at 63 

(referencing Food and Drug 

Administration 2016 ‘‘Black Box 

Warning’’ on the serious risks associated 

with the combined use of certain opioid 

medications and benzodiazepines and 

the Centers for Disease Control 2016 

Guideline for Prescribing Opioids for 

Chronic Pain). Dr. Munzing attested that 

a physician who simultaneously 

prescribes both an opioid and a 

benzodiazepine should document the 

medical necessity for prescribing both, 

discuss the risks of prescribing with the 

patient, and document that 

conversation. Id. 

Third, a physician prescribing opioids 

for pain management must avoid issuing 

overlapping prescriptions with the same 

therapeutic effect, commonly referred to 

as therapeutic duplication. Id. at ¶ 13. 

Fourth, a physician prescribing 

methadone to a patient for an extended 

term must exercise special care because 

methadone increases the risk of cardiac 

arrhythmia in certain patients. Id.; see 

also id. at App. B, at 64–66 (citing Food 

and Drug Administration November 

2006 ‘‘Black Box Warning’’ regarding 

methadone hydrochloride). In 

particular, Dr. Munzing attested that a 

physician should conduct a baseline 

EKG test and conduct follow-up EKGs at 

least annually. Id. 

Finally, Dr. Munzing opined that the 

California standard of care for the use of 

controlled substances in pain 

management requires physicians to be 

vigilant for the ‘‘red flags’’ of drug abuse 

or diversion of controlled substances. 

Id. at ¶ 14. A physician who encounters 

a red flag of abuse or diversion must 

address it, including through 

documented discussions with the 

patient, closer monitoring, adjusting the 

prescribed medication, or discontinuing 

treatment. Id. Dr. Munzing attested that 

the following are examples of wellknown red flags of abuse and diversion 

of controlled substances: Extended gaps 

between patient visits or prescription 

refills; early requests for refills of 

controlled substances; filling 

prescriptions at multiple pharmacies, 

which could indicate the patient is 

attempting to avoid oversight by the 

pharmacist; and prescribing a ‘‘Trinity 

cocktail’’ of a narcotic painkiller, a 

benzodiazepine, and a muscle relaxer, 

which is combination widely known to 

be abused and/or diverted and which is 

dangerous because each component 

causes respiratory depression. Id. 

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— 

in particular that it is consistent with 

the explicit text of California law, the 

Guide, and the Medical Board of 

California’s 2014 Guidelines for 

Prescribing Controlled Substances for 

Pain.4 As such, I apply the standard of 

care of the state of California as 

described by Dr. Munzing and 

California law. 

ii. The Subject Patients 

Patient K.K. 

Registrant issued at least 244 

controlled substance prescriptions to 

Patient K.K. between January 2012 and 

November 2016, including prescriptions 

for methadone, morphine sulfate, 

oxycodone, oxycodone-acetaminophen, 

hydromorphone, and zolpidem tartrate. 

RFAAX 9, at ¶ 17; see also RFAAX 8, 

App. G (CURES data); RFAAX 8, Apps. 

I, O, R, V, Z, AG, and AJ (copies of 

prescriptions from the filling 

pharmacies). Registrant’s prescriptions 

to K.K. also included various strengths 

and quantities across different 

prescriptions for the same controlled 

substances. For example, at different 

times, Registrant prescribed morphine 

sulfate to K.K. in 30mg, 60mg, and 

100mg strengths. See RFAAX 8, App. G. 


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5 Dr. Munzing’s declaration also states that 

Registrant’s prescriptions to K.K., G.K., T.L., and 

J.P. fell below the standard of care in part because 

he prescribed high levels of opioids without 

monitoring the patients through urine drug screens. 

RFAAX 9, at ¶¶ 17, 19, 21, and 23. All of the 

patients’ files, however, contain results for at least 

one urine drug screen during the relevant five year 

time period. See, e.g., RFAAX 8, at App. B at 122, 

App. C at 93, App. D at 113, and App. E at 384. 

Dr. Munzing’s declaration and report focused on the 

absence of urine drug screens, and did not provide 

an opinion regarding the frequency with which a 

physician prescribing the levels of opioids that 

Registrant was prescribing should conduct drug 

testing to meet the applicable standard of care. 

Accordingly, I cannot find substantial evidence that 

Registrant’s urine drug screening fell below the 

standard of care in California based on the record 

evidence, and therefore, I am not sustaining the 

Government’s allegations related to urine drug 

testing for any of these patients. 

After reviewing the prescriptions and 

Registrant’s patient file for Patient K.K., 

Dr. Munzing noted several deficiencies 

and departures from the standard of care 

and usual course of professional 

practice with respect to Registrant’s 

controlled substance prescriptions for 

K.K. RFAAX 9, at ¶ 17. First, Registrant 

repeatedly issued ‘‘dangerous levels of 

opioids’’ to Patient K.K., including daily 

morphine equivalent doses ranging from 

over 1,600 mg per day to as high as 

3,780 mg per day, without monitoring 

the patient through checks of the 

CURES database or co-management by a 

specialist in pain management.5 Id. 

Registrant also issued prescriptions to 

K.K. for opioids with duplicated 

therapeutic effects, including 

overlapping prescriptions for oxycodone 

and oxycodone-acetaminophen and 

overlapping prescriptions for 

hydromorphone and oxycodone. Id. 

Furthermore, in Dr. Munzing’s expert 

opinion, Registrant failed to conduct 

and document an evaluation of Patient 

K.K., including an adequate physical 

examination and medical history, 

sufficient to justify the controlled 

substance prescriptions that he issued to 

K.K. Id. 

Finally, Patient K.K. presented red 

flags of drug abuse and diversion that 

Registrant failed to address or 

document. Id. The red flags included 

early refill requests for controlled 

substances, the use of multiple 

pharmacies to fill controlled substance 

prescriptions, and an extended gap in 

care during 2013, without an adequate 

explanation. Id. 

Based on the above deficiencies, 

particularly the lack of an appropriate 

physical exam and medical history prior 

to Registrant’s issuance of controlled 

substance prescriptions, Dr. Munzing 

found, and I agree, that the controlled 

substance prescriptions that Registrant 

issued to Patient K.K represent ‘‘an 

extreme departure’’ from the standard of 

care in California and were issued 

outside the usual course of professional 

practice. Id. at ¶ 18. 

Patient G.K. 

Registrant issued at least 269 

controlled substance prescriptions to 

Patient G.K. between January 2012 and 

July 2017, including prescriptions for 

hydrocodone-acetaminophen, 

hydromorphone, methadone, 

oxycodone, oxycodone-acetaminophen, 

temazepam, and tramadol. RFAAX 9, at 

¶ 19; see also RFAAX 8, App. G (CURES 

data); RFAAX 8, Apps. J and P (copies 

of prescriptions from the filling 

pharmacies). 

After reviewing the prescriptions and 

Registrant’s patient file for Patient G.K., 

Dr. Munzing noted several deficiencies 

and departures from the standard of care 

and usual course of professional 

practice with respect to Registrant’s 

controlled substance prescriptions for 

G.K. RFAAX 9, at ¶ 19. Registrant 

repeatedly issued ‘‘dangerous levels of 

opioids’’ to Patient G.K., including daily 

morphine equivalent doses ranging from 

600 mg per day to as high as 1,820 mg 

per day, without monitoring the patient 

through checks of the CURES database, 

co-management by a specialist in pain 

management, or discussing and 

documenting the discussion of the risks 

posed by the high levels of opioids 

prescribed. Id. There is also no record 

that Registrant ever conducted EKG 

testing to detect abnormalities caused by 

long-term methadone use despite 

prescribing methadone to Patient G.K. 

from 2012 through at least 2017. Id. 

Registrant additionally issued 

prescriptions to G.K. for opioids with 

duplicated therapeutic effects, including 

overlapping prescriptions for 

hydromorphone and oxycodone, and 

concurrently prescribed G.K. with 

opioids and benzodiazepines without 

documenting the medical necessity for 

prescribing those controlled substances 

together or document any discussion 

with G.K. regarding the risks of doing 

so. Id. Furthermore, in Dr. Munzing’s 

expert opinion, Registrant failed to 

conduct and document an evaluation of 

Patient G.K., including an adequate 

physical examination and medical 

history, sufficient to justify the 

controlled substance prescriptions that 

he issued to G.K. Id. 

Finally, Patient G.K. presented red 

flags of drug abuse and diversion that 

Registrant failed to address or 

document. Id. The red flags included 

early refill requests for controlled 

substances and the use of multiple 

pharmacies to fill controlled substance 

prescriptions. Id. 

Based on the above deficiencies, 

particularly the lack of an appropriate 

physical exam and medical history prior 

to Registrant’s issuance of controlled 

substance prescriptions, Dr. Munzing 

found, and I agree, that the controlled 

substance prescriptions that Registrant 

issued to Patient G.K represent ‘‘an 

extreme departure’’ from the standard of 

care in California and were issued 

outside the usual course of professional 

practice. Id. at ¶ 20. 

Patient T.L. 

Registrant issued at least 120 

controlled substance prescriptions to 

Patient T.L. between January 2012 and 

July 2017, including prescriptions for 

hydromorphone, methadone, and 

oxycodone. RFAAX 9 at ¶ 21; see also 

RFAAX 8, App. G (CURES data); 

RFAAX 8, Apps. K, W (copies of 

prescriptions from the filling 

pharmacies). 

After reviewing the prescriptions and 

Registrant’s patient file for Patient T.L, 

Dr. Munzing noted several deficiencies 

and departures from the standard of care 

and usual course of professional 

practice with respect to Registrant’s 

controlled substance prescriptions for 

T.L. RFAAX 9, at ¶ 21. First, Registrant 

repeatedly issued ‘‘dangerous levels of 

opioids’’ to Patient T.L., including daily 

morphine equivalent doses ranging from 

over 1,100 mg per day to as high as 

2,380 mg per day. Id. Registrant also 

issued prescriptions to T.L. for opioids 

with duplicated therapeutic effects, 

including overlapping prescriptions for 

hydromorphone and oxycodone. Id. 

Furthermore, in Dr. Munzing’s expert 

opinion, Registrant failed to conduct 

and document an evaluation of Patient 

T.L., including an adequate physical 

examination and medical history, 

sufficient to justify the controlled 

substance prescriptions that he issued to 

T.L. Id. 

Based on the above deficiencies, 

particularly the lack of an appropriate 

physical exam and medical history prior 

to Registrant’s issuance of controlled 

substance prescriptions, Dr. Munzing 

found, and I agree, that the controlled 

substance prescriptions that Registrant 

issued to Patient T.L represent a 

departure from the standard of care in 

California and were issued outside the 

usual course of professional practice. Id. 

at ¶ 22. 

Patient J.P. 

Registrant issued at least 409 

controlled substance prescriptions to 

Patient J.P. between January 2012 and 

July 2017, including prescriptions for 

clonazepam, diazepam, fentanyl, 

hydrocodone-acetaminophen, 


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hydromorphone, methadone, morphine 

sulfate, oxycodone, temazepam, and 

tapentadol. RFAAX 9, at ¶ 23; see also 

RFAAX 8, App. G (CURES data); 

RFAAX 8, Apps. L, T, AA, AC, AE, and 

AH (copies of prescriptions from the 

filling pharmacies). Registrant’s 

prescriptions to J.P. also included 

various strengths and quantities across 

different prescriptions for the same 

controlled substances. For example, at 

different times, Registrant prescribed 

clonazepam to J.P. in .5 mg, 1 mg, and 

2 mg strengths. See RFAAX 8, App. G. 

After reviewing the prescriptions and 

Registrant’s patient file for Patient J.P., 

Dr. Munzing noted several deficiencies 

and departures from the standard of care 

and usual course of professional 

practice with respect to Registrant’s 

controlled substance prescriptions for 

J.P. RFAAX 9, at ¶ 23. Registrant 

repeatedly issued ‘‘dangerous levels of 

opioids’’ to Patient J.P., including daily 

morphine equivalent doses ranging from 

150 mg per day to as high as 2,460 mg 

per day, without monitoring the patient 

through checks of the CURES database 

or co-management by a specialist in 

pain management. Id. The prescribed 

opioids included prescriptions for 

methadone ‘‘beginning in 2012 and 

continuing through at least 2016 even 

though EKG testing in October 2014 

revealed that patient J.P. had developed 

a prolonged QT interval,’’ meaning that, 

in Dr. Munzing’s opinion, ‘‘continued 

use of methadone put J.P. at increased 

risk of death.’’ Id. Registrant also 

concurrently prescribed J.P. opioids and 

benzodiazepines without documenting 

the medical necessity for prescribing 

those controlled substances together or 

documenting any discussion with J.P. 

regarding the risks of doing so. Id. 

Furthermore, in Dr. Munzing’s expert 

opinion, Registrant failed to conduct 

and document an evaluation of Patient 

J.P., including an adequate physical 

examination and medical history, 

sufficient to justify the controlled 

substance prescriptions that he issued to 

J.P. Id. 

Finally, Patient J.P. presented red 

flags of drug abuse and diversion that 

Registrant failed to address or 

document. Id. The red flags included 

early refill requests for controlled 

substances and the use of multiple 

pharmacies to fill controlled substance 

prescriptions. Id. 

Based on the above deficiencies, 

particularly the lack of an appropriate 

physical exam and medical history prior 

to Registrant’s issuance of controlled 

substance prescriptions, Dr. Munzing 

found, and I agree, that the controlled 

substance prescriptions that Registrant 

issued to Patient J.P represent ‘‘an 

extreme departure’’ from the standard of 

care in California and were issued 

outside the usual course of professional 

practice. Id. at ¶ 24. 

Patient Y.P. 

Registrant issued at least 122 

controlled substance prescriptions to 

Patient Y.P. between January 2012 and 

July 2017, including prescriptions for 

carisoprodol, diazepam, hydrocodoneacetaminophen, and oxycodoneacetaminophen. RFAAX 9, at ¶ 25; see 

also RFAAX 8, App. G (CURES data); 

RFAAX 8, Apps. M, X, and AL (copies 

of prescriptions from the filling 

pharmacies). 

After reviewing the prescriptions and 

Registrant’s patient file for Patient Y.P., 

Dr. Munzing noted several deficiencies 

and departures from the standard of care 

and usual course of professional 

practice with respect to Registrant’s 

controlled substance prescriptions for 

Y.P. RFAAX 9, at ¶ 25. Registrant 

concurrently prescribed Y.P. opioids 

and benzodiazepines without 

documenting the medical necessity for 

prescribing those controlled substances 

together or documenting any discussion 

with Y.P. regarding the risks of doing so. 

Id. Registrant also repeatedly prescribed 

the ‘‘Trinity cocktail’’ to Patient Y.P., 

which as noted above, Dr. Munzing 

opined to be a dangerous combination 

of controlled substances widely known 

to be abused and/or diverted. 

Furthermore, in Dr. Munzing’s expert 

opinion, Registrant failed to conduct 

and document an evaluation of Patient 

Y.P., including an adequate physical 

examination and medical history, 

sufficient to justify the controlled 

substance prescriptions that he issued to 

Y.P. Id. 

Finally, Patient Y.P. presented red 

flags of drug abuse and diversion that 

Registrant failed to address or 

document. Id. The red flags included 

early refill requests for controlled 

substances, the use of multiple 

pharmacies to fill controlled substance 

prescriptions, and multiple extended 

gaps in care including from October 

2012 to December 2013, from December 

2013 to March 2014, from June 2014 to 

October 2014, and from December 2015 

to March 2016. Id. 

Based on the above deficiencies, 

particularly the lack of an appropriate 

physical exam and medical history prior 

to Registrant’s issuance of controlled 

substance prescriptions and the 

prescriptions for the ‘‘Trinity cocktail,’’ 

Dr. Munzing found, and I agree, that the 

controlled substance prescriptions that 

Registrant issued to Patient Y.P 

represent ‘‘an extreme departure’’ from 

the standard of care in California and 

were issued outside the usual course of 

professional practice. Id. at ¶ 26. 

II. Discussion 

Under Section 304 of the Controlled 

Substances Act (hereinafter, CSA), ‘‘[a] 

registration . . . to . . . dispense a 

controlled substance . . . may be 

suspended or revoked by the Attorney 

General upon a finding that the 

registrant . . . has committed such acts 

as would render his registration under 

section 823 of this title inconsistent 

with the public interest as determined 

by such section.’’ 21 U.S.C. 824(a)(4). In 

the case of a ‘‘practitioner,’’ 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 


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6As to Factor One, there is no record evidence 

of disciplinary action against Registrant’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 Registrant’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 Registrant 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). 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. Dewey C. 

MacKay, M.D., 75 FR at 49973. 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. 

Circuit has recognized, findings under a 

single factor can support the revocation 

of a registration. MacKay, 664 F.3d at 

821. 

DEA regulations state, ‘‘[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.6 I find that the evidence satisfies 

the Government’s prima facie burden of 

showing that Registrant’s continued 

registration would be ‘‘inconsistent with 

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

I further find that Registrant has not 

produced any evidence to rebut the 

Government’s prima facie case. 

Registrant filed a request for a hearing 

upon receipt of the OSC but did not 

make any subsequent filings and failed 

to respond to an order issued by the 

ALJ. The ALJ, therefore, properly 

determined that Registrant had waived 

his right to a hearing and terminated the 

proceedings. 

a. Factors Two and/or Four—The 

Registrant’s Experience in Dispensing 

Controlled Substances and Compliance 

With Applicable Laws Related to 

Controlled Substances 

Evidence is considered under Public 

Interest Factors Two and Four when it 

reflects a registrant’s compliance (or 

non-compliance) with laws related to 

controlled substances and experience 

dispensing controlled substances. 

Established violations of the Controlled 

Substances Act, DEA regulations, or 

other laws regulating controlled 

substances at the state or local level are 

cognizable when considering if a 

registration is consistent with the public 

interest. 

i. Allegations of Violations of Federal 

Law 

The Government has alleged that from 

at least January 2012 through at least 

December 2017, Registrant unlawfully 

issued prescriptions for controlled 

substances in violation of the CSA. OSC, 

at 4. Specifically, the Government 

alleges that Registrant repeatedly 

violated 21 CFR 1306.04 by issuing 

prescriptions for controlled substances 

to Patients K.K., G.K., T.L., J.P., and Y.P. 

beneath the standard of care in 

California, the state in which Registrant 

holds DEA registration, outside the 

usual course of professional practice, 

and without a legitimate medical 

purpose. Id. 

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 the California 

Guide to the Laws Governing the 

Practice of Medicine by Physicians and 

Surgeons, 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 and document the 

discussions, and give special attention 

to patients who pose a risk for 

medication misuse and diversion. Based 

on the credible and unrebutted opinion 

of the Government’s expert, I also found 

above that Registrant issued at least 

1,164 controlled substance 

prescriptions, often for extremely high 

doses of opioids and in dangerous 

combinations of opioids and 

benzodiazepines, without performing or 

documenting physical examinations or 

conducting medical histories adequate 

to justify the prescribed medications, 

and often without counseling the 

patients on the risks posed by their 

medications; proper ongoing 

monitoring; or resolving or documenting 

resolution of red flags of abuse and/or 

diversion as required by the standard of 

care. See supra I.c.ii. 

My findings demonstrate that 

Registrant 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). For 

example, I found, based on Dr. 

Munzing’s credible and unrebutted 

expert opinion, that Registrant did not 

perform adequate physical exams or 

take appropriate medical histories 

before issuing controlled substances to 

the five subject patients. 

I also found that Registrant repeatedly 

ignored signs of abuse and/or diversion. 

Dr. Munzing credibly opined that a 

California physician who prescribes 

controlled substances for pain 

management within the standard of care 

and in the usual course of professional 

practice must be vigilant for red flags of 

abuse or diversion of controlled 

substances and must address any such 

red flags he encounters, including 

through ‘‘documented discussions with 

the patient, closer monitoring, adjusting 

the medication or quantity of 

medication prescribed, or discontinuing 

treatment.’’ RFAAX 9, at ¶ 14. As 

discussed supra, I found four of the 

subject patients presented red flags of 

abuse and diversion of controlled 

substances, including early requests for 

refills of controlled substances. 

Registrant, however, did not document 

discussions with the patients regarding 

the majority of the red flags, and there 

is no evidence in the patient files that 

Registrant otherwise addressed the red 

flags of abuse and diversion presented 

by Patients K.K., G.K., J.P., and Y.P. 

Registrant’s failure to document and 

address the red flags was a violation of 

the standard of care in accordance with 

the credible and unrebutted opinion of 

the Government’s expert. 

For these reasons, in addition to the 

reasons I detailed supra I.c.ii, I find that 

the Government has presented 

substantial evidence that between 2012 

and 2017 Registrant issued controlled 

substance prescriptions to the five 

subject patients that were issued outside 

the usual course of professional practice 

and beneath the applicable standard of 

care in California. Accordingly, I am 


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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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