30564 Federal Register / Vol. 87, No. 97 / Thursday, May 19, 2022 / Notices 

*A I have made minor, nonsubstantive, and 

grammatical changes to the RD and nonsubstantive 

conforming edits. Where I have added to the ALJ’s 

opinion to include additional information, I have 

noted the additions in brackets or in footnotes 

marked with an asterisk and a letter. Where I have 

made substantive changes, omitted language for 

brevity or relevance, or where I have modified the 

ALJ’s opinion, I have noted the edits in brackets 

and have included specific descriptions of the 

modifications in brackets or in footnotes marked 

with an asterisk and a letter. 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. 1 [Omitted for brevity. Specifically, Respondent 

was charged with violating:] 

a. Cal. Health & Safety Code § 11153(a), requiring 

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’’; 

b. Cal. Health & Safety Code § 11154(a), directing 

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 . . .’’; 

c. Cal. Bus.& Prof. Code § 2242, prohibiting the 

‘‘[p]rescribing, dispensing, or furnishing [of 

controlled substances] . . . without an appropriate 

prior examination and a medical indication,’’ the 

violation of which constitutes unprofessional 

conduct; 

d. Cal. Bus. & Prof. Code § 2234, defining 

unprofessional conduct to include: ‘‘[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 

e. Cal. Bus. & Prof. Code § 725, further defining 

unprofessional conduct to include ‘‘[r]epeated acts 

of clearly excessive prescribing, furnishing, 

dispensing, or administering of drugs. . . .’’ 

Additionally, [Respondent was alleged to have 

issued prescriptions outside of] California’s 

applicable standard of care as outlined in the 

‘‘Guide to the Laws Governing the Practice of 

Medicine by Physicians and Surgeons,’’ Medical 

Board of California, 7th ed. 2013 (the ‘‘Guide’’). 

[Omitted for brevity.] See ALJ Ex. 1. [The 

Government did not address (b) or (d) above in its 

Posthearing Brief, so I will not address those 

allegations herein.] 

*COmitted for brevity. 2The Respondent waived the opportunity to 

make an opening statement. Tr. 30. 

DEPARTMENT OF JUSTICE 

Drug Enforcement Administration 

[Docket No. 20–14] 

Fares Jeries Rabadi, M.D.; Decision 

and Order 

On March 2, 2020, a former Acting 

Administrator of the Drug Enforcement 

Administration (hereinafter, DEA or 

Government), issued an Order to Show 

Cause and Immediate Suspension of 

Registration (hereinafter collectively, 

OSC) to Fares Jeries Rabadi, M.D. 

(hereinafter, Respondent). 

Administrative Law Judge Exhibit 

(hereinafter, ALJ Ex.) 1 (OSC), at 1. The 

OSC immediately suspended 

Respondent’s DEA Certificate of 

Registration Number BR6081018 

(hereinafter, registration or COR) 

‘‘because [Respondent’s] continued 

registration constitutes an ‘imminent 

danger to the public health or safety.’ ’’ 

Id. (citing 21 U.S.C. 824(d)). The OSC 

also proposed revocation of 

Respondent’s registration, the denial of 

any pending applications for renewal or 

modification of such registration, and 

the denial of any pending applications 

for additional DEA registrations 

pursuant to 21 U.S.C. 824(a)(4) and 

823(f), because Respondent’s 

‘‘continued registration is inconsistent 

with the public interest.’’ Id. 

In response to the OSC, Respondent 

timely requested a hearing before an 

Administrative Law Judge. ALJ Ex. 2. 

The hearing in this matter was 

conducted on September 29–30, 2020, 

via video teleconference technology. On 

December 22, 2020, Administrative Law 

Judge Mark M. Dowd, (hereinafter, ALJ) 

issued his Recommended Rulings, 

Findings of Fact, Conclusions of Law 

and Decision (hereinafter, 

Recommended Decision or RD) to which 

both parties filed Exceptions. I have 

addressed both the Respondent’s and 

Government’s Exceptions in footnotes 

added to the corresponding parts of the 

RD. While I have made some 

modifications to the RD based on the 

Exceptions, none of those changes and 

none of Respondent’s arguments 

persuaded me to reach a different 

conclusion than the ALJ in this matter. 

I issue my final Order in this case 

following the Recommended 

Decision.*A

Recommended Rulings, Findings of 

Fact, Conclusions of Law, and Decision 

of the Administrative Law Judge *B

The issue to be decided by the 

Administrator is whether the record as 

a whole establishes by a preponderance 

of the evidence that the DEA Certificate 

of Registration, No. BR6081018, issued 

to Respondent should be revoked, and 

any pending applications for 

modification or renewal of the existing 

registration should be denied, and any 

pending applications for additional 

registrations should be denied, because 

his continued registration would be 

inconsistent with the public interest 

under 21 U.S.C. 823(f) and 824(a)(4). 

After 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. 

The Allegations 

The Government alleges the 

Respondent violated federal and 

California law,1 by issuing numerous 

prescriptions for Schedule II through IV 

controlled substances outside the usual 

course of professional practice and not 

for a legitimate medical purpose to 

seven individuals as recently as 

December 31, 2019. These prescriptions 

fell below minimal medical standards 

applicable to the practice of medicine in 

California. Therefore, these 

prescriptions violated federal and 

California state law. 

The Government alleges the 

Respondent regularly prescribed highly 

addictive and intoxicating combinations 

of controlled substances to his patients, 

and that he consistently failed to: (1) 

Perform adequate physical evaluations 

and obtain appropriate patient histories; 

(2) make appropriate diagnoses based on 

sufficient clinical evidence and 

document these diagnoses in his 

medical records; (3) document a 

legitimate medical purpose for the 

controlled substances that he 

prescribed; (4) monitor his patients’ 

medication compliance; and (5) respond 

to red flags of drug abuse and diversion. 

These failures constitute extreme 

departures from the standard of care in 

California, and that his actions were 

dangerous and reckless. Because of 

these failures, he regularly put his 

patients at significant risk for harm, 

including overdose or death. He also 

continued to prescribe controlled 

substances to these patients despite the 

fact that he knew they were suffering 

from opioid dependencies. [The OSC 

went on to provide specific examples of 

Respondent’s alleged failures related to 

seven individuals: S.B., M.B., B.C., J.C., 

D.D., J.M., and K.S. ALJX 1, at 14.] For 

each of the seven patients, he continued 

to prescribe opioids to them, even while 

noting that each patient suffered from 

an opioid dependency.*C

The Hearing 

Government’s Opening Statement 2

DEA initiated an investigation into Dr. 

Rabadi, a California registered 

physician, upon receipt of a report from 

the Department of Health and Human 

Services Office of Inspector General. Tr. 

23. The report characterized him as a 

‘‘high-risk prescriber’’ due to his 

prescribing of a large number of highly 

diverted and highly abused drugs. 

Initially, DEA reviewed Dr. Rabadi’s 

prescribing practices through the 

California PDMP. Tr. 23. Significant red 

flags were revealed, including 

dangerous combinations of controlled 

substances. Three drugs, hydrocodone 

acetaminophen, alprazolam and 


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3 Government allegations included a reference to 

statistics that 95% of the Respondent’s 

prescriptions were for the ‘‘Holy Trinity’’ suggesting 

that evidence, in itself, demonstrated illegitimate 

prescribing by the Respondent. The Government 

confirmed that those statistics did not form an 

independent allegation. Tr. 32–33. 

*D To be clear, the DI did not testify that 96% of 

the prescriptions that Respondent issued were 

issued in the ‘‘Holy Trinity’’ combination. Rather, 

DI testified that 96% of Respondent’s issued 

controlled substance prescriptions were for either 

hydrocodone (a narcotic), alprazolam (a 

benzodiazepine), or carisoprodol (a muscle 

relaxant). Tr. 42. 

carisoprodol constituted over 95% of 

the controlled substance prescriptions 

he issued between November 20, 2015, 

and November 21, 2018. Tr. 24. In 

combination, these three drugs make up 

a highly dangerous and diverted 

cocktail commonly known among drug 

seekers as the Holy Trinity. 

On November 6, 2018, an undercover 

agent (hereinafter, UC) posing as a 

prospective patient with back pain, 

sought treatment from Dr. Rabadi. Dr. 

Rabadi declined to treat UC, explaining 

that he was an internist and did not 

treat back pain. Tr. 24. 

In February of 2019, DEA executed 

federal search warrants on Dr. Rabadi’s 

clinic, home, and three safety deposit 

boxes. DEA seized a number of 

prescriptions and patient files. Tr. 24. 

DEA also seized an unusually large 

amount of cash from Dr. Rabadi’s home 

and clinic examination room suggestive 

of diversion and mis-prescribing. Tr. 25. 

Subpoenas to pharmacies produced 

prescriptions for a number of Dr. 

Rabadi’s patients, including the seven 

patients at issue in this case. Tr. 25. 

The Government’s expert, Dr. 

Timothy Munzing, will testify that his 

review of the patient files and 

prescriptions revealed, in his opinion, 

that Dr. Rabadi prescribed controlled 

substances to each of the seven patients 

outside the usual course of professional 

practice in California. Tr. 25. Dr. 

Munzing will testify that Dr. Rabadi 

never established a legitimate medical 

purpose for the controlled substances he 

prescribed, and was not acting in the 

usual course of professional practice. Tr. 

25. Dr. Munzing will testify that Dr. 

Rabadi consistently failed to meet 

fundamental elements of the California 

standard of care for prescribing 

controlled substances, including failure 

to obtain appropriate medical histories, 

failure to perform minimally 

appropriate physical exams, failure to 

make appropriate diagnoses based on 

sufficient medical evidence, failure to 

document appropriate treatment plans, 

failure to document a legitimate medical 

purpose for the controlled substances, 

failure to discuss the risks and benefits 

of the cocktails and controlled 

substances he prescribed, failure to 

conduct even a single urine drug screen, 

and failure to respond to red flags of 

abuse and diversion. Tr. 27. Dr. Rabadi 

prescribed controlled substances in 

dangerous and addictive combinations 

and outside the usual course of 

professional practice and without 

establishing a legitimate medical 

purpose. Dr. Rabadi diagnosed neck and 

back pain without sufficient medical 

evidence. Tr. 27. Dr. Rabadi frequently 

and plausibly diagnosed opioid 

dependency for patients on long term 

opioid use. Dr. Rabadi frequently issued 

Norco prescriptions to treat M.B., B.C., 

J.C., D.D., J.M., and K.S. for opioid 

dependency, which was a dangerous 

and illegal course that was outside the 

standard of care. Tr. 27–28. Dr. Rabadi 

prescribed Xanax in dangerously high 

dosages to Patients S.B., B.C., J.M., and 

K.S. of six to eight mgs per day, almost 

twice the recommended maximum 

dosage for anxiety disorder. Tr. 28. With 

early refills of Xanax, the Respondent 

exposed J.M. to more than 10 mgs per 

day for nearly two years. Tr. 29. He 

further exposed these patients to the 

risk of overdose and death by 

concurrently prescribing them opioids. 

Tr. 28. 

Thus, the Respondent was not 

providing medical care to these patients, 

he was exposing them to risk of harm by 

handing out dangerous and addictive 

drugs without medical justification. Dr. 

Rabadi’s controlled substance 

prescriptions to Patients S.B., M.B., 

B.C., J.C., D.D., J.M., and K.S. were not 

issued for a legitimate medical purpose, 

were not issued by a practitioner acting 

within the usual course of professional 

practice in California, and were issued 

in violation of the standard of care in 

California and in violation of the laws 

of the United States. Tr. 29. 

Accordingly, the Government then 

requested that the tribunal recommend 

revocation of Dr. Rabadi’s DEA 

certificate of registration.3

Government’s Case-in-Chief 

The Government presented its casein-chief through the testimony of two 

witnesses. First, the Government 

presented the testimony of a DEA 

Diversion Investigator (DI). Secondly, 

the Government presented the 

testimony of Dr. Timothy Munzing, 

M.D. 

Diversion Investigator 

DI has served as a Diversion 

Investigator at DEA’s Los Angeles Field 

Division for three years. Tr. 33–34. 

Previously, she served with United 

States Citizenship and Immigration 

Service for four years. Tr. 75. As a DI, 

she enforces compliance with the 

Controlled Substances Act (CSA), 

looking for signs of diversion within the 

registration system, including 

monitoring for regulatory compliance. 

Tr. 34–35. She has attended the basic 

diversion investigation training at the 

DEA Academy, which included training 

to spot signs of diversion, investigating 

diversion and enforcing compliance 

with the CSA, both in the criminal and 

administrative settings. Tr. 35. She has 

also received training regarding 

CURES—the California prescription 

drug monitoring program. 

Regarding the Respondent, in April 

2018, DEA received a report from the 

Department of Health and Human 

Service (HHS) that the Respondent was 

on a ‘‘high-risk model for 

overprescribing of controlled 

substances.’’ Tr. 37, 75. DEA ran two 

CURES reports, one in April of 2018, 

which revealed numerous red flags, 

including prescribing hydrocodone at 

the maximum strength and a large 

amount of polypharmaceutical cocktails 

or combinations of a benzodiazepine 

and an opioid. Additionally, the volume 

of opioid prescribing was high, at over 

9,000 prescriptions over the course of 

three years from November 2015 to 

November 2018. Tr. 38–39, 42, 56–57, 

82; GX 16–19. Fifty-percent of these 

were for hydrocodone. Tr. 42. 

According to DI, the combination of a 

benzodiazepine and an opioid are 

significant as they are highly sought 

after by the black market and are 

dangerous to the patient. Tr. 39. The 

Respondent also prescribed a large 

number of combinations of the highly 

sought after ‘‘Holy Trinity,’’ which 

includes a narcotic, a muscle relaxant 

and a benzodiazepine—96% of his 

prescriptions during that three-year 

period.*D Tr. 40, 42–43. These highly 

addictive and highly dangerous 

combinations were prescribed over a 

long period of time. Tr. 40–41. 

Due to these red flags, on September 

26, 2018, DEA sent an undercover agent 

(UC) to the Respondent’s clinic—posing 

as a prospective patient. Tr. 43. The first 

attempt was foiled as the clinic was 

closed. The second attempt occurred on 

October 30, 2018. Tr. 44, 75–76. The 

clinic was again closed. The third 

attempt occurred on November 6, 2018. 

UC complained of back pain and 

shoulder pain and sought help from Dr. 

Rabadi. Dr. Rabadi declined to help the 

UC—explaining that he was not taking 

new patients and that he was an 

internist and not a pain specialist. Tr. 

45, 75–76. Ultimately, DEA obtained 

five search warrants, four of which were 


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4The Respondent objected to the evidence of the 

cash seizure as irrelevant and immaterial. The 

objection was carried. Tr. 47–49. [I find that this 

evidence, while useful to understanding the course 

of DEA’s investigation, is immaterial to the ultimate 

issue in this case, which is whether or not 

Respondent issued controlled substance 

prescriptions that were outside the usual course of 

professional practice and beneath the standard of 

care. Accordingly, I have not considered this 

information in making my decision.] 

5 DI noted record-keeping deficiencies on the part 

of some of the pharmacies, Tr. 51–55, but clarified 

they were not a negative reflection on the 

Respondent. Tr. 79–80. 

6The Government authenticated Government 

Demonstrative Exhibits 1–8, which were summary 

charts for each of the seven subject patients 

containing the subject prescriptions and patient 

files consistent with the seized and stipulated to 

records. Tr. 57–73. 

executed on February 21, 2019. Tr. 46, 

76–77. The fifth was served on February 

22, 2019. Tr. 74. They were served on 

his clinic, on his home and on two 

safety deposit boxes at two separate 

banks. Tr. 46. DEA seized 1.2 million 

dollars in cash at his home.4 Dr. Rabadi 

was home when the search warrant was 

served. Tr. 77. He agreed to be 

interviewed regarding his prescribing 

practices. Tr. 77. At his clinic, DEA 

seized patient files and some 

prescriptions for S.B., B.C., M.B., J.C., 

D.D., J.M. and K.S. Tr. 49–50. 

Additional prescriptions and fill 

stickers were obtained from 

pharmacies.5 Tr. 50–55; GX 1–15. 

Thereafter, in January 2020, DEA issued 

an administrative subpoena to the 

Respondent for any and all updated 

medical records and prescriptions for 

the noted patients. Tr. 55–56.6 In all, 

DEA obtained twenty-seven files or 

updated files. Tr. 78. 

Dr. Timothy Munzing 

Dr. Munzing is a physician licensed 

in California and holds a DEA 

Certificate of Registration there. Tr. 86– 

87; GX 23. Dr. Munzing graduated from 

UCLA Medical School in 1982. Tr. 89. 

He completed his internship and 

residency in family medicine at the 

Kaiser Permanente Medical Center in 

Los Angeles in 1985. Tr. 89. He then 

went to Kaiser Permanente Orange 

County, where he has been employed 

for the last 35 years in the family 

medicine department. He is also 

available as a consultant. Tr. 90. 

In his family medicine practice, he 

takes care of his patients from ‘‘cradle 

to grave.’’ Tr. 90. Most of his present 

patients are adults. Tr. 90. Twenty-five 

percent of his work is spent treating his 

patients. Tr. 92. In his clinical practice, 

he has prescribed controlled substances, 

including opioids and benzodiazepines. 

Tr. 92. Thirty-two years ago Dr. 

Munzing founded a family medicine 

practice residency program, and 

continues to be the residency director 

for twenty-four residents. Tr. 90. He also 

sits on the National Accreditation Board 

for Family Medicine Residency. He is a 

member of the American Medical 

Association, the California Medical 

Association, and the American 

Academy of Family Physicians, to name 

a few. Tr. 91; GX 23. He also serves as 

a full clinical professor at the University 

of California Irvine, and at the Kaiser 

Permanente School of Medicine. Tr. 91. 

He has been called as an expert witness 

by the California Medical Board for the 

past ten years, and by federal law 

enforcement for the past six years. Tr. 

623. Dr. Munzing has been qualified 

approximately thirty-five times to offer 

his expert opinion for the California 

Medical Board, DEA, FBI, and the 

Department of Justice, including his 

opinion on the standard of care for 

prescribing controlled substances, and 

whether a prescription was issued for a 

legitimate medical purpose in the usual 

course of professional practice. Tr. 92– 

94, 623. He has testified as an expert in 

five or six prior DEA Administrative 

hearings. Most of his opinions have 

related to illegal prescribing of opioids. 

Tr. 95. Internal rules of Kaiser 

Permanente prevent him from testifying 

on behalf of physicians. Tr. 624. Dr. 

Munzing estimated he had received 

approximately $20,000 for his time on 

the instant case at $400 per hour. Tr. 

624. 

He is familiar with the California 

standard of care for prescribing 

controlled substances. Tr. 94. The 

California standard of care is informed 

by publications by the California 

Medical Board. Tr. 95–97; GX 20 at 59– 

61, GX 21. In particular, ‘‘The Laws 

Governing the Practice of Medicine by 

Physicians and Surgeons,’’ sets out 

minimum requirements for care, 

including history and physical 

examination, assessment of pain, 

physical and psychological functioning, 

substance abuse history, treatment plan, 

and maintaining accurate and complete 

records. Tr. 374–80. In forming his 

opinions in this case, Dr. Munzing 

reviewed the medical records and 

prescriptions for the subject patients. Tr. 

100–01. Dr. Munzing was qualified, 

without objection, as an expert in 

California medical practice, including 

the applicable standards of care in 

California for the prescribing of 

controlled substances within the usual 

course of the professional practice of 

medicine. Tr. 101–02. 

Dr. Munzing explained that the 

standard of care is generally ‘‘what a 

responsible, knowledgeable physician 

can do’’ under similar circumstances. 

Tr. 102–03. In prescribing controlled 

substances this would include 

performing a physical examination, 

taking a history, including both a 

medical history and a psychological and 

substance abuse history, attempting to 

obtain prior medical records, 

formulating a diagnosis, evaluating risk 

factors for the controlled medications 

including the risk of abuse, discussing 

the risks with the patient to obtain 

informed consent, developing a 

customized treatment plan with goals 

and objectives, documenting all of the 

above in the medical record, and 

providing ongoing monitoring of the 

patient and of his treatment, including 

urine drug screens (UDS) and alternate 

therapies. Tr. 103–112, 114–25, 128–35. 

Ongoing and comprehensive 

documentation is critical for accurate 

evaluation of a patient’s condition and 

treatment. Tr. 142–50. The goal is to 

maximize function, while minimizing 

risk. Tr. 139–40. Compliance with all 

relevant California statutes and 

regulations is also required by the 

standard of care. Tr. 104. It requires 

addressing, resolving and documenting 

red flags. Tr. 112. Dr. Munzing 

identified the FDA ‘‘black box’’ warning 

regarding combining opioids with 

benzodiazepines, titled New Safety 

Measures Announced for Opioid 

Analgesics, dated August 31, 2016. Tr. 

151; GX 22 at 1–3, 4, 25, 40. The FDA 

specifically noted diazepam, Klonopin, 

and Xanax should not be combined with 

opioids unless absolutely necessary, and 

for no longer than absolutely necessary. 

Tr. 153–55. 

Dr. Munzing testified that the higher 

the morphine milligram equivalent 

(MME) prescribed, the increased risk of 

addiction and overdose. Tr. 126–28. 

Prescribing controlled substances for 

psychological illness requires an even 

greater emphasis on history, and a morefocused physical exam [of the ‘‘heart, 

lung, vital signs . . . seeing if [there is] 

any evidence of some other medical 

diagnosis’’ in addition to the mental 

health disorder.] Tr. 136, 138–39, 141. 

The General Anxiety Disorder screening 

tool, GAD–7, is a useful tool in assessing 

a patient’s level of anxiety. Tr. 136–37. 

Dr. Munzing reviewed the patient 

files, prescriptions, and CURES data for 

Patients S.B., M.B., B.C., J.C., D.D., J.M., 

and K.S. [and concluded that the 

prescriptions at issue were ‘‘not 

consistent with the standard of care in 

the state of California.’’] Tr. 156–57. Dr. 

Munzing noted that the history for these 

seven patients was deficient. Tr. 157. 

There was no indication prior medical 

records were obtained. Tr. 157. The 

physical exams, if present, were missing 

key elements. There were no 

documented CURES checks. Tr. 158. 


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Diagnoses appeared and disappeared. 

Opioids were prescribed at high 

dosages. There was no indication of the 

necessary patient monitoring and there 

was no documentation of informed 

consent. Tr. 159–60, 207. Dr. Munzing 

summarized that none of the controlled 

prescriptions issued for the charged 

patients were issued for a legitimate 

medical purpose by a practitioner acting 

within the usual course of professional 

practice. Tr. 620–21. According to Dr. 

Munzing, all of the relevant 

prescriptions were issued outside the 

standard of care. Tr. 621. 

Patient S.B. 

As per the parties’ stipulations, 

between February 2, 2017, and January 

30, 2019, S.B. was prescribed 

hydrocodone, carisoprodol, Adderall 

and alprazolam. Tr. 162–63; GDX 1. Dr. 

Munzing characterized the patient file 

as meager. He characterized the 

controlled substance prescriptions as 

being outside the standard of care. Tr. 

163, 207, 241–44. For S.B.’s initial visit 

on August 3, 2016, she was diagnosed 

with Generalized Anxiety Disorder 

(GAD), Attention Deficit Disorder 

(ADD), and Fibromyalgia. Tr. 163–65; 

GX 1 at 62, 66. There were no 

supporting findings from a physical 

examination or history for the 

fibromyalgia diagnosis, which typically 

is reached after a certain number of 

tender points are determined. Tr. 166. 

Similarly, there were no supporting 

findings from a physical examination or 

history to support the GAD or ADD 

diagnoses. Tr. 166–71, 241–44. There 

was no physical functioning level 

documented nor mental functioning 

level documented. Tr. 171. Without 

sufficient evaluation and supporting 

documentation for the three diagnoses, 

Dr. Munzing deemed the diagnoses 

inappropriate. Tr. 241–44. Without an 

appropriate diagnosis, there was no 

legitimate medical purpose for the 

controlled substance prescriptions. Tr. 

172, 207, 241–44. Similarly, there was 

no documented treatment plan. Tr. 241– 

44. On February 2, 2017, S.B. presented 

to the clinic suffering from fibromyalgia 

and ADD. Tr. 173; GX 1 at 59. The 

Respondent diagnosed her with 

fibromyalgia-opioid dependent, refusing 

detox, and ADD. He prescribed 

hydrocodone, carisoprodol, and 

Adderall. Tr. 173–74. Again, there was 

no medical history justifying the 

diagnosis. The physical exam conducted 

on February 2, 2017, consisted of blood 

pressure, cardiovascular, heart and lung, 

all of which were normal. Again, the 

physical exam was insufficient to justify 

the fibromyalgia and ADD diagnoses. Tr. 

175. There was no documentation of the 

pain level, or functionality level, to 

justify continued controlled substance 

prescribing. Tr. 175–76. For the progress 

notes of June 28, 2017, the Respondent 

diagnosed her with fibromyalgia-opioid 

dependent, refusing detox, and ADD. He 

prescribed hydrocodone, carisoprodol, 

and Adderall. Tr. 177. Again, there was 

no medical history justifying the 

diagnoses. There was no documentation 

of the pain level, or functionality level, 

to justify continued controlled 

substance prescribing. Tr. 177–78; GX 1 

at 57. Again, blood pressure and heart 

and lung exams were performed. Tr. 

177. There was insufficient medical 

evidence to justify the three diagnoses. 

Tr. 177–78. For the progress note for 

December 21, 2018, S.B. presented with 

eczema and fibromyalgia. Tr. 179; GX 1 

at 49. The Respondent diagnosed her 

with fibromyalgia-opioid dependent, 

refusing detox. She was prescribed 

hydrocodone. No history was recorded. 

Again, blood pressure and heart and 

lung exams were performed. Tr. 180. 

There was no documentation of the pain 

level or functionality level, to justify 

continued controlled substance 

prescribing. Tr. 180. There was 

insufficient medical evidence to justify 

the fibromyalgia diagnosis. Tr. 181. In 

the progress notes for January 30, 2019, 

S.B. reported to the clinic with ADD and 

rhinitis. Tr. 181; GX 1 at 47. She was 

prescribed Adderall for the ADD. No 

medical history was taken. ADD patient 

progress was reported as ‘‘stable.’’ There 

was insufficient medical evidence to 

justify the ADD diagnosis. Tr. 183. Dr. 

Munzing deemed the ADD diagnoses 

inappropriate. Without an appropriate 

diagnosis, there is no legitimate medical 

purpose for the controlled substance 

prescription. Tr. 185–86. During the 

subject period of the Respondent’s 

treatment of S.B., he never obtained any 

prior medical records. Tr. 184. He never 

recorded a history, which would justify 

his diagnoses for Fibromyalgia, GAD, or 

ADD. Tr. 184–85. He never reported a 

sufficient physical or mental exam to 

justify the Fibromyalgia, GAD, or ADD 

diagnoses. Id. He never reported a 

sufficient evaluation to justify his 

diagnoses for Fibromyalgia, GAD, or 

ADD. Id. The relevant controlled 

substance prescriptions for S.B. were 

not issued within the California 

standard of care, nor were they issued 

within the usual course of professional 

practice. Tr. 186–87, 244. 

Dr. Munzing observed that the 

diagnoses would come and go in the 

records and were inconsistently 

reported, which is atypical for chronic 

diagnoses. Tr. 188–97. A chronic 

disease, with symptoms that appear to 

come and go would raise the question 

of whether the patient had the disease 

at all. Tr. 192. Even a lessening of 

symptoms should cause evaluation as to 

whether tapering of medication would 

be appropriate. Tr. 196. 

Dr. Munzing noted that the 

Respondent prescribed S.B. both 

hydrocodone and Soma to treat 

Fibromyalgia on numerous occasions. 

Tr. 197–98. On other occasions, he 

prescribed the hydrocodone only 

without documenting any explanation 

for changing the medication protocol, 

which was beneath the California 

standard of care for documentation. Tr. 

198–201; GX 20 at 61. [Dr. Munzing 

testified that Respondent did not 

establish a legitimate medical purpose 

for issuing to S.B. any of the controlled 

substances at issue. Tr. 201.] Dr. 

Munzing noted that S.B. was prescribed 

a dangerous, highly addictive 

combination of medications that was 

popular for abuse and diversion; namely 

hydrocodone and Soma, which are 

respiratory depressants, and Adderall. 

Tr. 202. 

Another dangerous combination, 

hydrocodone, Adderall and Xanax was 

prescribed March 1, 2017, April 2017, 

and June 2017. Tr. 203; GX 1. Dr. 

Munzing noted this combination is 

referred to by drug abusers as the ‘‘new 

Holy Trinity.’’ Tr. 204. It includes the 

depressants, hydrocodone and Soma, 

and is followed by the stimulant, 

Adderall, to counteract the effects of the 

depressants. Again, the combination of 

hydrocodone and Soma are the subject 

of the FDA ‘‘black box’’ warning. Tr. 

205. The high dosage of Xanax, 6 mg per 

day, heightens the risk of this already 

dangerous combination. With Xanax 

and Adderall prescribed at their highest 

commercially available dosage units, the 

danger and risk of addiction are further 

increased. Tr. 205. Additionally, two mg 

tablets of Xanax are popular for abuse 

and diversion. Tr. 217–18. On 

September 29, 2017, and monthly from 

July 2018, to July 2019, S.B. was 

prescribed hydrocodone and Adderall. 

Besides the serious risk of addiction 

posed by these two Schedule II 

medications, the hydrocodone was 

prescribed at a daily dosage of 60 mg 

MME, which significantly increases the 

risk of overdose and death. This risk 

was increased by its combination with 

Adderall. Tr. 206–07. Dr. Munzing 

could not foresee any medical condition 

in which this combination would be 

appropriate. Tr. 211–12. 

Dr. Munzing noted that the medical 

records failed to disclose any indication 

that the Respondent warned S.B. 

regarding the risks associated with these 

dangerous combinations of controlled 


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*E Dr. Munzing clarified that ‘‘knee pain and back 

pain are really symptoms, and chronic back pain is 

essentially, you have a symptom that’s there 

ongoing.’’ Tr. 250. He further testified that these 

symptoms are not diagnoses, though Respondent 

treated them as such, and that the distinction is 

important because the way knee and back pain are 

treated differs ‘‘depending on the more specific 

diagnoses or diagnosis causing the symptoms.’’ Tr. 

251. 

The Government’s attorney and Dr. Munzing 

agreed about the importance of this distinction and 

the Government’s attorney apologized in advance 

that he might refer to certain symptoms as 

diagnoses as ‘‘shorthand,’’ even though they both 

understood what he meant. Id. 

*F Dr. Munzing testified, ‘‘there was no back 

exam. There was no knee exam. Again, heart, lung, 

abdomen. There is a head, ear, eyes exam. . . . He, 

once again, did a testicular and a rectal exam. But 

there is no back and knee exam evident.’’ Tr. 256. 

substances. This failure precludes any 

informed consent by S.B. Tr. 207. The 

Declaration of Pain Medication Use 

document in the file, dated August 3, 

2016, which requires the patient to alert 

the Respondent if the patient takes 

additional medications [(other than 

those prescribed by Respondent)] 

because they could result in drug 

interactions, does not put the patient on 

notice of the dangerous combinations 

prescribed by the Respondent. Tr. 207– 

10; GX 1 at 67. Similarly, Dr. Munzing 

noted the repeated notation within the 

patient records of ‘‘SED,’’ which Dr. 

Munzing assumed meant, ‘‘side effects 

discussed,’’ was insufficient 

documentation within the standard of 

care to establish that Respondent 

discussed the various risks of these 

medication combinations. Tr. 210–11; 

GX 1 at 59. 

In March, April and June of 2017, the 

Respondent prescribed S.B. Xanax at 6 

mg per day, in excess of the FDA 

recommended daily limit of 4 mg per 

day. Tr. 212–15; GX 1 at 57, 58, 59. GX 

22 at 40, 59–61. In May of 2017, the 

Xanax was abruptly stopped. Tr. 216– 

17; GDX 1. And abruptly restarted in 

June of 2017, and again stopped. Tr. 

217. This is very dangerous as the 

abrupt stoppage of Xanax without 

titration, especially at this high dosage, 

can cause seizures, and restarting at this 

high dosage can trigger an overdose, 

especially in conjunction with the 

prescribed opioid. Tr. 212–18. 

Dr. Munzing testified that regarding 

the monitoring of S.B., there were no 

urine drug screens evident in the 

records, which the standard of care 

would have required at least quarterly. 

Tr. 218–21; GX 1 at 44. In the progress 

notes for February, March, April 2017, 

all the way to January 30, 2019, the 

Respondent noted ‘‘refusal to detox.’’ 

Tr. 220–21, 227–29; GX 1 at 58, 59. This 

is a huge red flag for opioid use disorder 

and for diversion. However, the chart 

reflects the Respondent did not take any 

necessary action, such as CURES 

monitoring, random pill count, UDS, 

counseling, or titration. Rather, he 

simply prescribed the same levels of 

medications she was on, PRN. Tr. 222– 

23. The Respondent’s course of action 

was outside the California standard of 

care. Tr. 223, 229. Respondent’s medical 

file for S.B. contained a June 2017 report 

from Dr. F., an orthopedic surgeon who 

saw S.B. for reported neck and back 

pain. According to Dr. F’s report, S.B. 

reported her past medical history as 

only ‘‘anxiety.’’ Tr. 229; GX 1 at 30, 32, 

36–42, 56. She did not report 

Fibromyalgia or ADD. Tr. 229–30. S.B. 

further reported to Dr. F. that she was 

not then taking any medication for pain, 

which is contrary to the Respondent’s 

medical records and prescription 

evidence. Tr. 231–32. Dr. F.’s report was 

part of S.B.’s disability application, 

claiming disability as of June 15, 2017. 

A report from Chiropractor B.H. is also 

included in the disability packet. Tr. 

235. Dr. B.H. reports the disability was 

caused by ‘‘accident or trauma,’’ which 

is inconsistent with what the patient 

reported to Dr. F. and to the 

Respondent. Tr. 236. There is no 

indication within the Respondent’s 

records for S.B. that he ever discussed, 

with S.B. or with Dr. F., the 

discrepancies revealed by Dr. F.’s 

report. Tr. 233–37. 

Contemporaneous to the preparation 

of the disability claim, Dr. Rabadi 

ordered a series of radiologic tests on 

S.B., none of which were related to the 

Respondent’s diagnosis of fibromyalgia. 

The progress notes from August 17, 

2017, say that S.B. presented with 

‘‘overactive thyroid, gait disturbance.’’ 

Tr. 237–40; GX 1 at 5, 7, 9, 11, 13, 16, 

17, 56. Dr. Rabadi ordered an MRI of the 

brain to rule out MS, a thyroid 

ultrasound to rule out hyperthyroidism, 

an MRI of the lumbar spine, and an MRI 

of the thoracic spine. The MRI of the 

cervical spine was ordered by Dr. F. Tr. 

241. 

[Dr. Munzing, summarizing his 

opinions based on his review of the 

entire file for S.B., testified that 

Respondent never took a proper medical 

or mental health history, never 

conducted a sufficient physical or 

mental health examination for S.B.’s 

relevant diagnoses, never made an 

appropriately supported diagnosis, 

never recorded S.B.’s pain and 

functionality level, never documented 

an appropriate treatment plan with 

goals or objectives, never appropriately 

documented discussion of the risks of 

the prescribed controlled substances 

with S.B., never appropriately 

monitored S.B. and failed to 

appropriately respond to red flags of 

diversion. Tr. 241–44. Accordingly, Dr. 

Munzing opined that each of the 

relevant prescriptions Respondent 

issued to S.B. were issued without a 

legitimate medical purpose, outside the 

usual course of professional practice 

and beneath the standard of care in 

California. Tr. 244.] 

Patient M.B. 

After a review of M.B.’s patient file, 

CURES report and related prescriptions, 

Dr. Munzing observed that between 

January 5, 2018, and November 20, 

2019, the Respondent prescribed 

hydrocodone and Adderall. Tr. 245. As 

with patient S.B., Dr. Munzing 

characterized the patient file as 

containing ‘‘very little’’ information. Tr. 

245–47. The Respondent never obtained 

prior medical records of M.B. Tr. 288. 

Dr. Munzing observed that none of the 

subject prescriptions were within the 

California standard of care. Tr. 248, 289. 

On April 19, 2006, M.B. presented for 

his first visit. Tr. 248–49; GX 3, p. 88, 

91. In his ‘‘Comprehensive History and 

Physical Examination,’’ the Respondent 

reported that M.B. presented with 

symptoms of ‘‘chronic back pain, left 

knee pain, dyslipidemia.’’ Tr. 249–50. 

However, there are no appropriate 

diagnoses relating to the back and knee 

pain and therefore no legitimate medical 

purpose for prescribing hydrocodone.*E

Tr. 250–51, 258. To address the reported 

pain, the Respondent prescribed 

hydrocodone. Tr. 252. The file fails to 

evidence sufficient history to justify the 

pain prescriptions under the standard of 

care. Tr. 252–54. The file fails to 

evidence any physical exam to justify 

the pain prescriptions under the 

standard of care.*F Tr. 254–55, 258, 287. 

The file fails to evidence any treatment 

plan or goals, or past drug abuse to 

justify the pain prescriptions under the 

standard of care. Tr. 254–55, 258, 287. 

Although M.B. declared on a 

‘‘Declaration of Pain Medication Use’’ 

form that he had no prior drug abuse in 

August 2009, which was three years 

after his first visit, such static 

declaration does not satisfy the 

physician’s ongoing responsibility 

under the standard of care to monitor 

this issue [to determine whether the 

patient is ‘‘currently using drugs.’’] Tr. 

259–61; GX 3 at 93. 

On July 9, 2013, M.B. presented with 

ADD and neck pain. Tr. 261–62; GX 3 

at 46. He was prescribed Adderall for 

the ADD. Tr. 262. Again, the records 

reveal there was no history taken to 

support the diagnosis or justify the 

prescriptions for Adderall. Tr. 262. 

There was no evident evaluation done 

by the Respondent. Tr. 287. There was 

no treatment plan. Tr. 263. Although 


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*GAs written, this language suggests that there is 

a specific California law prohibiting hydrocodone 

prescriptions for individuals who are opioid 

dependent and refusing detox. The Government did 

not introduce specific evidence of any such law. 

However, the Government, through Dr. Munzing’s 

testimony, has established that opioid dependency 

is not a legitimate medical purpose for prescribing 

hydrocodone and that such prescriptions are 

outside the usual course of professional practice. 

Furthermore, the Government has established that 

prescribing without a legitimate medical purpose 

and outside of the usual course of professional 

practice is a violation of Cal. Health & Safety Code 

§ 11153(a). Accordingly, I agree that the conduct is 

illegal and have moved the sentence for clarity. 

7On September 29, 2017, and monthly from July 

2018, to July, 2019, S.B. was prescribed 

hydrocodone and Adderall. Besides the serious risk 

of addiction posed by these two Schedule II 

medications, the hydrocodone was prescribed at a 

daily dosage of 60 mg MME, which significantly 

increases the risk of overdose and death. This risk 

was increased by its combination with Adderall. Tr. 

206–07. Dr. Munzing could not foresee a medical 

condition in which this combination would be 

appropriate. Tr. 211–12. 

there was a diagnosis related to the neck 

pain, there was no history or physical 

exam evident in the file. Tr. 263–64. 

The Respondent never established a 

legitimate medical purpose for 

hydrocodone. Tr. 264. On September 6, 

2013, M.B. presented with ADD. Tr. 

264–65; GX 3 at 46. He was prescribed 

Adderall for the ADD, but at double the 

dosage of the previous visit without any 

reported justification. Tr. 264–65. 

Dr. Munzing testified that on January 

5, 2018, M.B. presented to the clinic. Tr. 

265–66; GX 3 at 37. He was prescribed 

hydrocodone and Adderall. There was 

no medical history, assessment of M.B.’s 

response to treatment, evaluation of 

pain or functioning, substance abuse 

history, diagnoses, rationale for 

establishing a legitimate medical 

purpose for prescribing or to justify 

continuing the medication regimen. Tr. 

265–66. On March 6, 2018, M.B. 

presented to the clinic with ‘‘ADD and 

opioid dependency.’’ Tr. 266–67; GX 3 

at 36. Absent was any report of pain. He 

was diagnosed with ‘‘Opioid 

dependency, refusing detox.’’ Tr. 267. 

Hydrocodone as treatment for opioid 

dependency is not a legitimate medical 

purpose and is outside the usual course 

of professional practice. Tr. 268. He was 

prescribed hydrocodone, which not 

only is outside the standard of care, but 

is illegal in California.*G Tr. 267–68. Dr. 

Munzing observed that the Respondent 

prescribed hydrocodone repeatedly to 

address his diagnosis of opioid 

dependency until November 20, 2019. 

Tr. 268–69. On November 20, 2019, 

M.B. presented with ADD and back 

pain. Tr. 269; GX 3 at 27. He was 

prescribed Adderall, and his 

hydrocodone was increased. Tr. 270. No 

medical history was taken or updated. 

No response to treatment or patient 

functionality was included. Although 

vital signs were taken, no physical or 

mental exam was performed. Tr. 270– 

71. There was no appropriate diagnosis 

for the back pain. Tr. 272. There was no 

evaluation for ADD, such as mental 

functioning. Tr. 271, 274, 287–88. The 

Respondent never obtained a sufficient 

history to support the diagnosis for 

ADD. Tr. 273. There was no appropriate 

diagnosis for ADD. Tr. 272. 

[Dr. Munzing, in summary, testified 

that Respondent never took a proper 

medical or mental health history and 

never conducted a sufficient physical or 

mental health examination for M.B.’s 

relevant diagnoses; therefore, he never 

made an appropriately supported 

diagnosis. Tr. 273–74. Accordingly,] the 

Respondent never established a 

legitimate medical purpose to prescribe 

either hydrocodone or Adderall to M.B. 

throughout the reported treatment. Tr. 

274. Dr. Munzing opined that such 

prescriptions were not issued in the 

usual course of professional practice, 

were not for a legitimate medical 

purpose, and were outside the standard 

of care. Tr. 274–75. 

Dr. Munzing noted the inconsistency 

of the various diagnoses. Diagnoses 

would come and go within the records. 

Tr. 275–278; GX 3 at 35, 37, 43, 67. 

Although the recorded diagnoses were 

always treated with hydrocodone, the 

diagnoses varied greatly; [in 2009, it was 

prescribed for shoulder pain, in 2013, it 

was prescribed for neck pain, in 2014, 

it was prescribed for back pain, in 2018, 

it was prescribed for opioid 

dependency, and sometimes there was 

no diagnosis whatsoever given for the 

hydrocodone prescribed. Tr. 275–78.] 

Yet no explanation for the changing 

diagnoses is included in the file, as 

required by the standard of care. Tr. 

278–80. 

Dr. Munzing noted the serious 

dangers occasioned by the combination 

of Adderall and hydrocodone by 

reference to his testimony regarding 

S.B.’s similar prescriptions.7 Tr. 281. Dr. 

Munzing deemed this combination of 

medications for over ten years 

inappropriate and unsafe. Tr. 284. The 

only semblance of a warning to M.B. 

regarding these dangerous combinations 

appeared in a 2009 ‘‘Controlled 

Substance Therapy Agreement.’’ For the 

same reasons as Patient S.B., Dr. 

Munzing deemed the signed form 

wholly insufficient to satisfy the 

California standard of care in this 

regard. Tr. 281–82; GX 3 at 92. 

Similarly, the notation within the file, 

‘‘SED’’ was insufficient to satisfy the 

standard of care. Tr. 283. Dr. Munzing 

also testified that there was never a UDS 

ordered for M.B., which was necessary 

under the standard of care for any 

patient receiving opioids, but especially 

for a patient who has refused opioid 

detox. Tr. 284–85. A patient diagnosed 

with opioid dependency and refusing 

detox is also a red flag of abuse and 

diversion. Such red flag was not 

appropriately addressed by the 

Respondent repeatedly as to M.B. Tr. 

285–87; GX 3 at 36. 

[Dr. Munzing, summarizing his 

opinions based on his review of the 

entire file for M.B., testified that 

Respondent never took a proper medical 

or mental health history, never 

conducted a sufficient physical or 

mental health examination for M.B.’s 

relevant diagnoses, never made an 

appropriately supported diagnosis, 

never recorded M.B.’s pain and 

functionality level, never documented 

an appropriate treatment plan with 

goals or objectives, never appropriately 

documented discussion of the risks of 

the prescribed controlled substances 

with M.B., never appropriately 

monitored M.B. for medication 

compliance and failed to appropriately 

respond to red flags of diversion. Tr. 

287–89. Accordingly, Dr. Munzing 

opined that each of the relevant 

prescriptions Respondent issued to M.B. 

were issued without a legitimate 

medical purpose, outside the usual 

course of professional practice and 

beneath the standard of care in 

California. Tr. 289–90.] 

Patient B.C. 

Dr. Munzing reviewed the subject 

prescriptions, patient file and CURES 

report for Patient B.C., which he 

described as containing ‘‘very little.’’ Tr. 

290–92; GDX 3. He opined that the 

subject controlled substance 

prescriptions issued for hydrocodone, 

Xanax and Adderall, from January 25, 

2017, to December 19, 2019, were all 

issued outside the California standard of 

care. Tr. 290–92, 335–38. B.C. presented 

on March 27, 2014, with GAD and back 

pain. Tr. 293–94; GX 5 at 48, 55. B.C. 

was diagnosed with GAD and back pain, 

refusing detox. He was prescribed 

Xanax (6 mg per day) for the GAD, and 

hydrocodone for the back pain, refusing 

detox. Tr. 294. Dr. Munzing reiterated 

the risks involved in prescribing 6 mg 

of Xanax per day. Tr. 295. 

The records failed to disclose the 

minimum history necessary under the 

standard of care to appropriately 

diagnose ‘‘back pain’’ and GAD [or to 

prescribe controlled substances to treat 

those conditions.] Tr. 295–96. Other 

than limited vital signs, the records 

failed to disclose the minimum physical 

examination necessary under the 


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*H Dr. Munzing’s opinion regarding the credibility 

of any assigned diagnosis is not particularly 

relevant to my analysis. Here, the standard of care 

requires that a diagnosis be based on a patient’s 

history and physical examination. See infra, The 

Standard of Care for Prescribing. Accordingly, 

where, as here, Dr. Munzing has testified that the 

diagnosis was not adequately supported by the 

patient’s history and physical examination, then I 

find that, based on his expert testimony, the 

diagnosis is inadequate to serve as the basis for the 

prescribed prescriptions. This is true whether or not 

a practitioner acting in the usual course of 

professional practice could have properly reached 

the same diagnosis for that individual. 

standard of care to appropriately 

diagnose ‘‘back pain,’’ or to justify a 

hydrocodone prescription. Tr. 296–97. 

Dr. Munzing could not remember seeing 

any prior medical records in the 

Respondent’s subject files. Tr. 297. 

There were no entries in B.C.’s file 

indicating physical or mental 

functioning. Tr. 298, 335–38. There was 

no treatment plan indicated. The 

Declaration of Pain Medication Use, 

signed by B.C. at his first visit, as 

discussed previously, is insufficient to 

evaluate B.C. and to establish informed 

consent for the controlled substances 

prescribed. Tr. 299–300. There was 

insufficient medical evidence to support 

either diagnosis. Tr. 298, 335–38. 

Accordingly, there was no legitimate 

medical purpose for either controlled 

substance prescription. Tr. 299, 335–38. 

B.C. presented on May 20, 2014, with 

ADD and was prescribed Adderall. Tr. 

301–02; GX 5 at 47. The ADD diagnosis 

was deficient, as no history was 

developed, no mental functioning was 

assessed, the medical evidence was 

deficient, and a treatment plan was 

lacking. The Respondent failed to 

establish a legitimate medical purpose 

for prescribing Adderall. Tr. 302. 

Additionally, starting B.C. on 30 mg of 

Adderall twice daily is a very high 

dosage, and extremely inappropriate to 

an Adderall naive patient, which is not 

developed within the patient file. Tr. 

302–03. 

According to Dr. Munzing, B.C. 

presented on January 25, 2017, with 

ADD, opioid dependency and GAD. Tr. 

303; GX 5 at 33. He was diagnosed with 

ADD for which he was prescribed 

Adderall, and GAD for which he was 

prescribed Xanax (6 mg per day). Tr. 

304. Pain levels were not reported at 

this visit. The diagnoses were 

unsupported by sufficient medical 

history, medical evaluation, response to 

treatment, patient functionality, and 

medical evidence. Tr. 304–06. He failed 

to establish a legitimate medical 

purpose for both Adderall and Xanax. 

Tr. 306, 335–38. The Respondent further 

diagnosed, ‘‘Opioid dependency, 

refusing detox’’ for which the 

Respondent again prescribed 

hydrocodone. Tr. 306. Hydrocodone as 

treatment for opioid dependency is not 

a legitimate medical purpose and is 

outside the usual course of professional 

practice. Tr. 307. Prescribing 

hydrocodone for opioid dependence is 

not only outside the standard of care, 

but it is illegal in California. Tr. 307. A 

patient diagnosed with opioid 

dependency and refusing detox is also 

a red flag of abuse and diversion. Such 

red flag was not addressed by the 

Respondent repeatedly as to B.C. Tr. 

306–07; GX 5, at 33. 

On July 31, 2018, B.C. presented with 

ADD, back pain and GAD. Tr. 308; GX 

5 at 28. He was diagnosed with ADD for 

which he was prescribed Adderall (60 

mg per day), ‘‘back pain, opiate 

dependent, refusing detox’’ for which he 

was prescribed hydrocodone, and GAD 

for which he was prescribed Xanax (6 

mg per day). Tr. 308. There was no 

medical history supporting the 

prescriptions. There was no indication 

how the patient was responding to 

treatment and no indication that a 

physical exam was performed to 

support the diagnoses or justify the 

prescriptions. Tr. 308–09, 335–38. There 

was no reference to pain levels or 

physical functionality. Tr. 309–10. 

There was no reference to mental 

functioning with respect to the ADD and 

GAD diagnoses. Though three diagnoses 

were recorded, Dr. Munzing testified 

that none of them were appropriate. Tr. 

309–10. Neither did Respondent 

establish a legitimate medical purpose 

for the three controlled substance 

prescriptions. Tr. 311. 

B.C. presented on December 19, 2019, 

with ADD and back pain, which were 

also his diagnoses, and for which he 

was prescribed Adderall (60 mg per day) 

and hydrocodone. Tr. 311–12; GX 5 at 

20. The record is lacking documentation 

of a medical history, any updated 

medical history, the patient’s state of 

health, how he is responding to 

treatment, a physical exam, pain levels, 

mental or physical functioning, 

appropriate rationale for continued 

treatment, and information relating to 

drug abuse. Tr. 312–13, 335–38. As a 

result, the three diagnoses are without 

sufficient medical evidence. Tr. 313. Dr. 

Munzing testified that each of the 

controlled substance prescriptions were 

issued without a legitimate medical 

purpose, outside the usual course of 

professional practice, and beneath the 

standard of care. Tr. 313–16, 335–38. 

Dr. Munzing noted the inconsistency 

of diagnoses throughout B.C.’s records 

and the dual prescribing of 

hydrocodone, sometimes for opioid 

abuse, sometimes for skeletal pain, and 

sometimes for both, without explanation 

in the record. Tr. 316–19; GX 5 at 31, 

32, 33. [Dr. Munzing explained that it 

‘‘would be important to document [what 

is] going on here.’’ Tr. 318.] Dr. Munzing 

noted the GAD and ADD diagnoses 

appear and disappear within the record, 

as do their treatment medications 

without explanation. Tr. 319–24; GX 5 

at 27, 31, 32, 33. Dr. Munzing deemed 

it highly unlikely that ADD and GAD 

were appropriate diagnoses.*H Tr. 322, 

324. 

Dr. Munzing also testified that the 

Respondent prescribed B.C. a 

combination of hydrocodone, Adderall 

and Xanax. Tr. 327; GDX 3. Dr. Munzing 

could not conceive of a medical 

condition warranting this dosage, 

duration, and combination of 

medications, noting Adderall is counterindicated for GAD, and combining 

Xanax with an opioid represents a 

dangerous combination that is contrary 

to an FDA black box warning and CDC 

guidance. Tr. 327–29, 332–33; GDX 3. A 

further concern, as detailed earlier in 

his testimony, is reflected by the 

repeated combination of hydrocodone 

and Adderall by the Respondent. Tr. 

329–30; GDX 3. These dangerous 

combinations were prescribed without 

an established legitimate medical 

purpose, outside the usual course of 

professional practice, without sufficient 

warnings and informed consent, 

without sufficient patient monitoring, 

and without regard to obvious red flags. 

Tr. 330–35. 

[Dr. Munzing, summarizing his 

opinions based on his review of the 

entire file for B.C., testified that 

Respondent never took a proper medical 

or mental health history, never 

conducted a sufficient physical or 

mental health examination for B.C.’s 

relevant diagnoses, never made an 

appropriately supported diagnosis, 

never recorded B.C.’s pain and 

functionality level, never documented 

an appropriate treatment plan with 

goals or objectives, never appropriately 

documented discussion of the risks of 

the prescribed controlled substances 

with B.C., never appropriately 

monitored B.C. for medication 

compliance and failed to appropriately 

respond to red flags of diversion. Tr. 

335–37. Accordingly, Dr. Munzing 

opined that each of the relevant 

prescriptions Respondent issued to B.C. 

were issued without a legitimate 

medical purpose, Tr. 330, outside the 

usual course of professional practice 

and beneath the standard of care in 

California. Tr. 330, 338.] 


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*I Dr. Munzing testified that given the prescribed 

combination of medications and how ‘‘highly 

sought after [they are] in the drug abusing 

community,’’ it would have been ‘‘[v]itally 

important’’ to conduct appropriate ongoing 

monitoring, which was not done and was therefore 

outside the standard of care here. Tr. 421. 

Patient J.C. 

Dr. Munzing reviewed the subject 

prescriptions issued from January 16, 

2018, to December 30, 2019, patient 

records and CURES data relating to 

Patient J.C. Tr. 381–82; GDX 4. Dr. 

Munzing opined that none of the subject 

prescriptions issued to J.C. were issued 

within the California standard of care. 

Tr. 382. J.C. presented to the 

Respondent’s clinic on May 18, 2009, 

with a headache and GAD. Tr. 383–384; 

GX 7, at 216, 233. He was prescribed 

hydrocodone for migraine and Xanax for 

GAD and remained on this medication 

regimen for a long period. As to the 

migraine diagnosis, insufficient medical 

history was obtained, symptom 

evaluation was absent, no neurological 

exam was conducted, no evaluation of 

functioning level was made, no 

treatment plan was evident, and no 

evaluation of possible drug abuse was 

provided. Tr. 384–90. In short, there 

was insufficient medical evidence to 

support the diagnoses of migraines and 

GAD, nor was there a legitimate medical 

purpose to prescribe hydrocodone and 

Xanax. Tr. 386–88. 

[On August 17, 2009, J.C. signed a 

‘‘Declaration of Pain Medication Use’’ 

form indicating that he had no prior 

drug abuse, and Dr. Munzing testified 

that there is no record of J.C. ever being 

asked about illicit substance abuse 

again. Tr. 389–90. Dr. Munzing testified 

that the 2009 Declaration was an 

insufficient inquiry to cover 

Respondent’s prescribing during the 

relevant period. Id.] 

J.C. presented on July 21, 2016, with 

‘‘GAD, chronic back pain, consented for 

H&P.’’ Tr. 390; GX 7 at 189. He was 

diagnosed with GAD and back pain— 

refusing detox for which he was 

prescribed Xanax and hydrocodone, 

respectively. Tr. 390–91. There was no 

updated history taken for either 

diagnosis, no physical exam, no 

treatment plan, no response to 

treatment, no pain or functioning level 

evaluations, no discussion regarding 

drug abuse, and no rationale for 

continued treatment, as required by the 

standard of care. Tr. 390–94. There was 

deficient medical evidence to support 

either diagnosis. The Respondent did 

not establish a legitimate medical 

purpose to prescribe the controlled 

substances. Tr. 393–94. J.C. presented 

on January 16, 2018, with GAD and back 

pain for which he was diagnosed with 

GAD and back pain, opiate dependent, 

refused detox. Tr. 394–95; GX 7 at 180. 

He was prescribed Valium for the GAD 

(Klonopin was discontinued), and 

hydrocodone for back pain, although no 

explanation was given for substituting 

the Valium for the Klonopin. Tr. 395. 

There was no medical history included 

in the records, no response to treatment, 

no physical exam, no pain or 

functioning evaluation, no drug abuse 

history, rendering each diagnosis 

inappropriate. Tr. 395–97. Without a 

legitimate medical purpose, there was 

no appropriate rationale for continued 

treatment with controlled substances. 

Tr. 396–98. J.C. presented on February 

16, 2018, with ‘‘opioid dependency, 

GAD,’’ yet without the previously noted 

back pain. Tr. 398; GX 7, 9. There was 

no reference to pain. He was diagnosed 

with ‘‘Opioid dependency, refusing 

detox’’ for which he was prescribed 

hydrocodone, which again, is outside 

the usual course of professional practice 

and illegal in California. Tr. 398–400. 

The diagnosis for opioid dependency 

that was treated with hydrocodone 

appeared repeatedly in the records. Tr. 

399. J.C. presented on May 6, 2019, 

however no treatment notes for this visit 

are evident in the file. Tr. 401; GX 4, GX 

7 at 168. 

On April 9, 2019, J.C. presented with 

GERD and back pain for which he was 

prescribed hydrocodone. Tr. 402. 

However, there was no medical history 

included in the records, no response to 

treatment, no adequate physical exam, 

no pain or functioning evaluation, no 

mental health history, and no drug 

abuse history, which rendered the back 

pain diagnosis inappropriate. Tr. 402– 

04. Without a legitimate medical 

purpose, there was no appropriate 

rationale for continued treatment with 

controlled substances. Tr. 402–04. On 

December 30, 2019, J.C. presented with 

GERD and GAD. Tr. 404; GX 7, p. 171. 

He was prescribed Valium for the GAD. 

However, there was no appropriate 

medical history included in the records, 

no response to treatment, no 

documented evaluation for GAD or 

functioning evaluation, no mental 

health history, and no drug abuse 

history, rendering the GAD diagnosis 

inappropriate from January 16, 2018, to 

December 30, 2019. Tr. 404–08, 425–28. 

Without a legitimate medical purpose, 

there was no appropriate rationale for 

continued treatment with controlled 

substances. Tr. 408, 425–28. Such 

prescriptions, from January 16, 2018, to 

December 30, 2019, were issued outside 

the standard of care, without legitimate 

medical purpose and outside the usual 

course of professional practice. Tr. 408, 

425–28. 

Dr. Munzing noted the inconsistency 

of diagnoses throughout J.C.’s records, 

and the dual prescribing of 

hydrocodone for opioid abuse, 

migraines, and for skeletal (sometimes 

neck, sometimes back) pain, without 

documenting an explanation for the 

changes in the record. Tr. 410–14; GX 7 

at 188, 189, 205, 214, 215. [There was 

never any discussion regarding ‘‘where 

one condition was going and another 

was coming from’’ as Dr. Munzing 

agreed ‘‘would be important for a 

practitioner acting within the standard 

of care to understand’’ and to document. 

Tr. 414.] Dr. Munzing noted the skeletal 

pain diagnoses appears and disappears 

within the record. Tr. 414–15. Dr. 

Munzing suspected the skeletal pain 

complaints were not legitimate. Tr. 415; 

GX 7 at 188, 189, 205, 214, 215. Dr. 

Munzing noted the Respondent had 

prescribed a combination of 

hydrocodone and Valium monthly 

between January 2018 and January 2019 

without a legitimate medical purpose. 

Tr. 416–17; GX 4. Combining Valium 

with an opioid represents a dangerous 

combination and is contrary to an FDA 

black box warning and to CDC guidance, 

especially with the Valium at its highest 

available strength. Tr. 417. Dr. Munzing 

could not envision a condition for 

which this medication regimen would 

be appropriate treatment. Tr. 418. These 

dangerous combinations were 

prescribed without an established 

legitimate medical purpose, outside the 

usual course of professional practice, 

without sufficient warnings and 

informed consent, without sufficient 

patient monitoring,*I and without 

addressing obvious red flags. Tr. 418– 

23; GX 7 at 19, 25, 27, 180, 225. 

[Dr. Munzing, summarizing his 

opinions based on his review of the 

entire file for J.C., testified that 

Respondent never took a proper medical 

or mental health history, never 

conducted a sufficient physical or 

mental health examination for J.C.’s 

relevant diagnoses, never made an 

appropriately supported diagnosis, 

never recorded J.C.’s pain and 

functionality level, never documented 

an appropriate treatment plan with 

goals or objectives, never appropriately 

documented discussion of the risks of 

the prescribed controlled substances 

with J.C., never appropriately monitored 

J.C. for medication compliance and 

failed to appropriately respond to red 

flags of diversion. Tr. 424–27. 

Accordingly, Dr. Munzing opined that 

each of the relevant prescriptions 

Respondent issued to J.C. were issued 

without a legitimate medical purpose, 

outside the usual course of professional 


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*JOnly the prescriptions issued between January 

4, 2018, and February 12, 2019, were alleged in the 

OSC and are relevant to my decision. 

practice and beneath the standard of 

care in California. Tr. 428.] 

Patient D.D. 

Dr. Munzing reviewed the subject 

prescriptions issued from January 4, 

2018, to February 12, 2019, patient 

records and CURES data relating to 

Patient D.D. Tr. 428–29; GDX 5. Dr. 

Munzing opined that none of the subject 

prescriptions issued to D.D., which were 

for hydrocodone, Soma, and Xanax, 

were within the California standard of 

care. Tr. 430. Again, the records 

contained ‘‘very little information.’’ Tr. 

429. D.D. presented on July 9, 2008, 

with GAD and back pain. Tr. 430–31 GX 

9 at 74. For the GAD, he was prescribed 

Valium. For back pain, he was 

prescribed hydrocodone and Soma. Tr. 

431. The medical records reflect that 

D.D. refused an MRI and refused referral 

to orthopedist or a pain specialist. Tr. 

431. According to Dr. Munzing, each 

refusal is a red flag, and suggestive of 

drug-seeking behavior. Tr. 432. [‘‘Those 

are huge red flags. [For] someone who 

truly wants to be treated for back pain 

to be refusing kind of ways to try to 

improve that or to better diagnose it 

through an MRI or an evaluation from 

a subspecialist are just enormous red 

flags and certainly brings in the distinct 

possibility [he] is here seeking drugs 

rather than really trying to get his pain 

managed.’’ Tr. 432.] Instead of 

addressing the red flags, the Respondent 

prescribed opioids. Tr. 432. The 

Respondent’s response was the same 

throughout the subject treatment of 

D.D., a total of nine and a half years. Tr. 

433. 

According to Dr. Munzing, there was 

no appropriate medical history included 

in the records, no response to treatment, 

no physical exam, insufficient patient 

monitoring, no evaluation for GAD, no 

functioning evaluation, no mental 

health history, no drug abuse history, no 

discussion of risk factors and informed 

consent, and no patient monitoring, 

rendering the GAD and back pain 

diagnoses inappropriate from July 9, 

2008, to January 4, 2019. Tr. 433–38; GX 

9 at 37, 39, 41, 43, 44. Without a 

legitimate medical purpose, there was 

no appropriate rationale for continued 

treatment with controlled substances. 

Tr. 434–48. Such prescriptions, from 

July 9, 2008, to January 4, 2019,*J were 

issued outside the standard of care, 

without legitimate medical purpose and 

outside the usual course of professional 

practice. Tr. 434–48. 

[On January 11, 2019, D.D. was 

diagnosed with GERD and ‘‘back pain— 

opiate dependent refusing detox.’’ Tr. 

439. This is the last time Respondent 

prescribed D.D. both hydrocodone and 

Soma, but the medical records again 

reflected a lack of appropriate medical 

history, response to treatment, an 

appropriate physical examination, 

assessment of pain or physical 

functionality, an appropriate diagnosis, 

or an established legitimate medical 

purpose for the prescriptions. Tr. 439– 

40. On February 12, 2019, Respondent 

prescribed D.D. hydrocodone to treat 

opioid dependency—refusing detox 

without there being any mention of 

pain. Dr. Munzing testified that this was 

outside the standard of care for all of the 

reasons he had previously testified. Tr. 

441–42. Dr. Munzing testified that at no 

point during the treatment period did 

Respondent ever obtain a sufficient 

history to establish a diagnosis for back 

pain or support prescribing of 

hydrocodone and that the prescriptions 

for hydrocodone and Soma were not 

issued within the usual course of 

professional practice and were outside 

the standard of care. Tr. 443–44.’’] 

Dr. Munzing noted a period of over a 

year when no diagnosis for GAD 

appeared in D.D.’s records, from May 

10, 2017, to September 19, 2018, and the 

30 mg daily dose of Valium was 

stopped. Tr. 447–48. Then on 

September 19, 2018, the Respondent 

was placed on 6 mg of Xanax, which is 

a very high dosage especially for the 

beginning dosage. [Dr. Munzing testified 

that Respondent failed to obtain 

sufficient medical evidence upon which 

to base a GAD diagnosis. Tr. 446.] 

Compounding this dangerous dosage of 

Xanax, D.D. was prescribed 

hydrocodone in combination, which 

heightened the risk of overdose [without 

any warning from Respondent regarding 

the dangers of the controlled substances 

being prescribed.] Tr. 446, 448–50, 458. 

[Dr. Munzing testified that there was no 

established legitimate medical purpose 

for prescribing Xanax to D.D. Tr. 446.] 

Dr. Munzing noted the inconsistency 

of diagnoses throughout D.D.’s records 

and the dual prescribing of 

hydrocodone and Soma for 

fibromyalgia, opioid abuse, and skeletal 

pain (namely back pain or neck pain), 

without a documented explanation in 

the record. Tr. 450–56; GX 9 at 43, 51, 

64, 70; GDX 5. Dr. Munzing noted the 

skeletal pain diagnoses appear and 

disappear within the record. Tr. 450–56. 

Dr. Munzing suspected the skeletal pain 

complaints were not legitimate. Tr. 456; 

GX 9 at 43, 51, 64, 70. Prescribing Soma 

with hydrocodone presents considerable 

risks to the patient. Each are respiratory 

depressants, which presents a 

significant risk of overdose, [and each is 

highly abused.] Tr. 458. [Dr. Munzing 

also reiterated the risks of prescribing 

both hydrocodone and Xanax together. 

Tr. 458. Dr. Munzing testified that in 

2009, D.D. signed ‘‘the same controlled 

substance therapy agreement we’ve seen 

with the previous four patients,’’ and it 

was insufficient notice of the risks of 

using controlled substances for the 

reasons already discussed. Tr. 458–59. 

Dr. Munzing further testified that the 

record is lacking any documentation 

that Respondent adequately warned 

D.D. of the risks of the controlled 

substances he was taking, particularly in 

light of the various combinations and 

high dosages. Tr. 459–60.] 

D.D. presented on March 23, 2019, 

with opioid dependency, refusing detox, 

which is a red flag. He was again 

prescribed hydrocodone and Soma. Tr. 

463; GX 9 at 42, 43. [Dr. Munzing 

reiterated his testimony that 

hydrocodone is not an appropriate 

treatment for opioid dependency and 

added that neither is Soma. Tr. 454–55. 

Accordingly, Dr. Munzing testified, 

every relevant prescription for 

hydrocodone and/or Soma that was 

issued to treat opioid dependency was 

issued outside the standard of care. Tr. 

455.] The Respondent failed to address 

this red flag repeatedly, instead 

prescribing Soma and hydrocodone. Tr. 

465. 

[Dr. Munzing, summarizing his 

opinions based on his review of the 

entire file for D.D., testified that 

Respondent never took a proper medical 

or mental health history, never 

conducted a sufficient physical or 

mental health examination for D.D.’s 

relevant diagnoses, never made an 

appropriately supported diagnosis, 

never recorded D.D.’s pain and 

functionality level, never documented 

an appropriate treatment plan with 

goals or objectives, never appropriately 

documented discussion of the risks of 

the prescribed controlled substances 

with D.D., never appropriately 

monitored D.D. for medication 

compliance and failed to appropriately 

respond to red flags of diversion. Tr. 

465–68. Accordingly, Dr. Munzing 

opined that each of the relevant 

prescriptions Respondent issued to D.D. 

were issued without a legitimate 

medical purpose, outside the usual 

course of professional practice and 

beneath the standard of care in 

California. Tr. 468.] 

Patient J.M. 

Dr. Munzing reviewed the subject 

prescriptions and fill stickers issued 

from January 10, 2017, to December 31, 


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*KOmitted for relevance. 8These are prescription numbers. 

2019, patient records and CURES data 

relating to Patient J.M. Tr. 469–70; GDX 

6. [Again Dr. Munzing testified there 

was ‘‘very little information’’ in the 

patient’s medical records. Tr. 470.] Dr. 

Munzing opined that none of the subject 

prescriptions issued to J.C., namely for 

hydrocodone, Xanax and Soma, were 

issued within the California standard of 

care. Tr. 470–71. 

On May 13, 2007, J.M. presented with 

hypertension, back pain, GAD, 

dyslipidemia and insomnia. Tr. 470–72; 

GX 7 at 104, 111. He was diagnosed 

with hypertension, back pain, GAD, 

dyslipidemia and insomnia. He was 

prescribed hydrocodone for back pain 

and Xanax (6 mg per day) for GAD. Tr. 

472. Xanax and hydrocodone were 

recurring prescriptions. As discussed, 

the high dosage of Xanax was a concern 

to Dr. Munzing, as well as its 

combination with an opioid. Tr. 473. 

According to Dr. Munzing, there was 

no appropriate medical history included 

in the records, no response to treatment, 

no physical exam of the back or other 

areas of issue, insufficient patient 

monitoring, no evaluation for GAD, no 

treatment plan, no pain or functioning 

evaluation, no mental health history, no 

ongoing drug abuse history or 

monitoring, no discussion of risk factors 

and informed consent, and no patient 

monitoring, which rendered the GAD 

and back pain diagnoses inappropriate 

from May 13, 2007, to January 13, 2017. 

Tr. 473–76, 478, 481–83, 485–500. The 

MRI dated May 30, 2007, and its ‘‘mild’’ 

findings, did not independently satisfy 

the Respondent’s obligations or justify 

the subject prescriptions. Tr. 479–80, 

485–87; GX 11 at 14, 16, 17, 22, 26, 31, 

37, 41, 42, 115. [Dr. Munzing testified 

that for the five visits between January 

10, 2017, through March 27, 2017, there 

is so little documentation that Dr. 

Munzing cannot tell whether the 

records reflect ‘‘actual visits’’ or just 

‘‘documentation of a refill of the 

medication.’’ Tr. 482–85. This is 

because, according to Dr. Munzing, the 

records lack examination or history 

notations, documentation of the dose or 

strength prescribed, diagnoses, nothing 

to meet the standard of care for 

prescribing hydrocodone and Xanax for 

that period. Tr. 482–85. 

The first prescription for Soma during 

the relevant time period was on April 

13, 2017, and according to Dr. Munzing, 

the medical note said ‘‘Xanax number 

90, Soma number 50SED, and then a 

signature’’ with absolutely nothing else 

recorded and none of the elements of 

the standard of care met. Tr. 485–86. Dr. 

Munzing testified specifically about 

selected office visits. On April 25, 2018, 

Respondent’s records for J.M. contain 

information suggesting an office visit 

occurred, but they continue to have the 

same deficiencies. That day, J.M. was 

not diagnosed with pain, but with GAD 

and opioid dependence—refusing detox, 

which was treated with hydrocodone. 

Tr. 487. Dr. Munzing reiterated his 

concern that hydrocodone is not 

appropriate treatment for opioid 

dependence and was inappropriate each 

time it was prescribed for that purpose. 

Tr. 488. Dr. Munzing testified about the 

November 19, 2018 visit during which 

J.M. was prescribed Xanax for GAD and 

Soma for back pain; the February 20, 

2019 visit during which he was 

prescribed Xanax for GAD and 

hydrocodone for back pain; and the 

December 31, 2019 visit during which 

he was prescribed Xanax for GAD and 

was not diagnosed with back pain. Tr. 

489, 492–93, 495. Dr. Munzing again 

testified, amongst other things, that for 

each of these visits, there was an 

insufficient medical history or physical 

examination to make the diagnoses, 

there was no information regarding the 

response to treatment, pain level, or 

functionality, and there was no 

legitimate medical purpose established 

for the prescriptions at issue. Tr. 489– 

91, 493–97.] Without a legitimate 

medical purpose, there was no 

appropriate rationale for the controlled 

substance prescriptions, or to continue 

treatment with controlled substances. 

Tr. 473–76, 478, 485–500, 505; GDX 7. 

There were also red flags left 

unaddressed by the Respondent. J.M. 

refused to see a pain specialist, which 

gives rise to the suspicion that he is not 

concerned about getting better, but just 

getting medicated. Tr. 476–77.*K Dr. 

Munzing noted that there were gaps in 

prescribing hydrocodone and Soma 

without any required explanation for 

changes to the medication regimen. Tr. 

500–04; GX 11 at 36, 37, 40, 41, 42, 76. 

He observed that the hydrocodone was 

prescribed either for back pain or for 

opioid dependence. Tr. 504. However, 

as with the other patients, the required 

evaluation for the diagnoses coming and 

going and explanation for treatment is 

lacking. This further diminishes any 

medical legitimacy for prescribing 

hydrocodone. Tr. 504. 

Additionally, on multiple occasions 

the Respondent prescribed a very 

addictive and dangerous combination of 

medications including an opioid and a 

benzodiazepine. Tr. 558–60. Even more 

concerning, he added a muscle relaxant, 

to this already dangerous combination 

to form the ‘‘Holy Trinity,’’ which is a 

favorite drug combination for abuse. Tr. 

505–10. Dr. Munzing could not conceive 

of a medical condition in which the 

trinity combination would represent 

appropriate treatment. Tr. 512. This 

trinity of medications was prescribed to 

J.M. repeatedly. GDX 6. The file fails to 

reveal whether appropriate warnings 

were given to J.M. in connection with 

this dangerous combination. Tr. 511; GX 

11 at 113. The CURES report reveals 

that 40 Xanax prescriptions (totaling 

3600 dosage units and 7200 mgs) were 

issued to J.M. over a period of 22 

months between January 2017 and 

November 2018. This means that 

Respondent was issuing a Xanax 

prescription to Respondent every 16 

days on average for an average total of 

10.5 mgs per day. Tr. 512–17, 527–28; 

GX 7, 17, 18. Ten and a half mgs per day 

is considerably greater than the 

maximum 4 mg per day recommended 

for treatment of anxiety. The CURES 

report lists two different dates of birth 

for J.M., as well as two different 

spellings of his first name. Tr. 517–18, 

547–49; GX 18. A CURES search would 

be name and date of birth specific, so a 

search by one name and date of birth 

would not reveal prescriptions filed 

under the alternate name and date of 

birth. Tr. 526. The main sources of the 

CURES report information are two 

pharmacies, Reliable Rexall and 

Northridge Pharmacy. Tr. 518–19. 

Despite the fact that J.M. was using 

different names and dates of birth at 

different pharmacies, which was a 

considerable red flag suggesting abuse 

or diversion, the Respondent did not 

address these issues. Tr. 519–20, 525– 

26. Even if J.M. or the pharmacies were 

the source of the alternate dates of birth 

and alternate first names, with due 

diligence, the Respondent would have 

discovered that a search by a single 

name and date of birth would only 

include half of the Xanax prescriptions 

the Respondent issued to J.M. Tr. 521– 

26, 549–50. [Dr. Munzing testified that 

there is ‘‘nothing in the notes’’ 

addressing this red flag.’’ Tr. 550.] 

Additionally, two prescriptions, one 

written by the Respondent and one 

called in by the Respondent on the same 

day, contain two different dates of birth. 

Tr. 533–34. 

The CURES report also reveals J.M. 

was alternating the filling of the Xanax 

prescriptions between the two 

pharmacies—which could indicate that 

he was trying to hide the bi-monthly 

frequency of the prescriptions. Tr. 520; 

GX 17, 18. Dr. Munzing noted this was 

a suspicious prescribing practice by the 

Respondent. Tr. 530; GX 17, # 425 & 

575.8 He would issue two prescriptions 


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*LThis text replaces the ALJ’s summary 

paragraph for consistency. 

*M This sentence was modified for clarity. 

*N Dr. Munzing testified that Respondent did not 

obtain sufficient medical evidence to diagnose K.S. 

with ADD at any point between the November 2013 

visit and the January 2018 visit. Tr. 583. 

on the same day to J.M., one for 

hydrocodone and one for Xanax. He 

would issue a written prescription for 

hydrocodone, which J.M. would 

invariably fill at Northridge Pharmacy, 

but would call in the Xanax prescription 

to Reliable pharmacy. Tr. 531–33, 535– 

45, 550–58; GX 11 at 32, 33, 35, 36, 38, 

40, 41, GX 12 at 5, 6, 10, 11, 14, 22, 24, 

27, 33, 34; GX 13, at 20, 25, 27, 32, 34; 

GX 17, 18 #473, #474, #994, #1120, 

#1228, #1386, #1472, #1553, #2102, 

#2229, #2341, #2342. Dr. Munzing 

testified that this could have been an 

attempt to avoid the suspicion generated 

by the opioid/benzodiazepine 

combination if filled at a single 

pharmacy. Tr. 532–33, 557–60. There 

was an additional suspicious 

circumstance related to a Xanax 

prescription. The Respondent wrote in 

his medical notes that the medication 

should be taken once every eight hours, 

but the call-in information to the 

pharmacy was once every six hours. Tr. 

543–45, 554, 556–57. [Dr. Munzing 

testified ‘‘[there is] not consistency 

between what [Respondent is] telling 

the pharmacist and what [he is] 

documenting in the progress note.’’ Tr. 

545.] 

The red flag of refusing to detox was 

repeatedly evident within J.M.’s patient 

file. Tr. 562; GX 11 at 37. He was 

diagnosed with ‘‘Opioid dependency, 

refusing detox’’ for which he was 

prescribed hydrocodone, which again, is 

outside the usual course of professional 

practice and illegal in California. Tr. 

563–64. The diagnosis for opioid 

dependency being treated with 

hydrocodone appeared repeatedly in the 

records. The Respondent never 

addressed this red flag. Tr. 564. 

[Dr. Munzing, summarizing his 

opinions based on his review of the 

entire file for J.M., testified that 

Respondent never took a proper medical 

or mental health history, never 

conducted a sufficient physical or 

mental health examination for J.M.’s 

relevant diagnoses, never made an 

appropriately supported diagnosis, 

never recorded J.M.’s pain and 

functionality level, never documented 

an appropriate treatment plan with 

goals or objectives, never appropriately 

documented discussion of the risks of 

the prescribed controlled substances 

with J.M., never appropriately 

monitored J.M. for medication 

compliance and failed to appropriately 

respond to red flags of diversion. Tr. 

564–67. Accordingly, Dr. Munzing 

opined that each of the relevant 

prescriptions Respondent issued to J.M. 

were issued without a legitimate 

medical purpose, outside the usual 

course of professional practice and 

beneath the standard of care in 

California. Tr. 567–68.] *L

Patient K.S. 

Dr. Munzing reviewed the subject 

prescriptions and fill stickers issued 

from January 19, 2018, to January 31, 

2019, patient records and CURES data 

relating to Patient K.S. Tr. 469–70; GDX 

8. [Again Dr. Munzing testified there 

was ‘‘very little’’ information in the 

medical records. Tr. 569.] Dr. Munzing 

opined that none of the subject 

prescriptions issued to K.S., namely 

hydrocodone, Xanax and Adderall, were 

issued within the California standard of 

care. Tr. 568–70. K.S. presented on June 

21, 2007, with ‘‘back pain’’ for which he 

was prescribed hydrocodone and Soma. 

Tr. 570; GX 13 at 117. Although the 

Respondent noted he would get an MRI 

for the lumbar spine, no such MRI 

appears in the records. Tr. 571. There 

was no medical history included in this 

record regarding back pain, no treatment 

plan, no response to treatment, no 

physical exam of the back or 

musculoskeletal area, no pain or 

functioning evaluation, no ongoing drug 

abuse history, rendering the back pain 

diagnosis inappropriate. Tr. 570–74. 

Without a legitimate medical purpose, 

there was no appropriate rationale for 

continued treatment with controlled 

substances for back pain. Tr. 571–74. 

[On August 5, 2009, K.S. signed a 

‘‘Declaration of Pain Medication Use’’ 

form indicating that he had no prior 

drug abuse, and Dr. Munzing testified 

that there is no record of K.S. ever being 

asked about illicit substance abuse 

again. Tr. 575. Dr. Munzing testified that 

the 2009 Declaration was an insufficient 

inquiry to cover prescribing at any point 

in time when Respondent was treating 

K.S. Tr. 576.] 

On May 1, 2012, K.S. presented with 

GAD and neck pain. Tr. 576; GX 14 at 

80. He was diagnosed with GAD and 

neck pain, and prescribed Xanax for 

GAD and hydrocodone for the neck 

pain, refusing detox. Tr. 577. K.S. was 

prescribed a combination of 

hydrocodone and Xanax frequently 

throughout his treatment. This 

combination of an opioid and a 

benzodiazepine is dangerous, beneath 

the standard of care and represents a red 

flag unresolved by the Respondent 

throughout the records. Tr. 578–79. 

There was no medical history 

supporting the prescriptions. There was 

no indication of how the patient was 

responding to treatment. There was no 

treatment plan and no indication a 

physical exam was performed to 

support the diagnoses or justify the 

prescriptions. Tr. 579–81. There was no 

reference to pain levels or physical 

functionality. There was no reference to 

mental functioning with respect to the 

GAD diagnosis. There was no 

appropriate diagnosis for the GAD and 

neck pain. Respondent did not establish 

a legitimate medical purpose for the 

controlled substance prescriptions. Tr. 

580–81. 

According to Dr. Munzing, K.S. 

presented on November 18, 2013, and 

was prescribed Adderall (60 mg per day) 

with no documented evaluation for or 

diagnosis of any condition that Adderall 

may treat. Tr. 581–82; GX 14 at 70. 

There is also no medical history, 

physical exam, or treatment plan, and 

accordingly, the subject prescription is 

without a legitimate medical purpose.*M

Tr. 582. 

On January 19, 2018, K.S. presented 

with GAD, back pain and ADD.*N Tr. 

583, 599; GX 14 at 41. For GAD, the 

Respondent prescribed Xanax. For back 

pain—opioid dependent, refusing detox, 

the Respondent prescribed 

hydrocodone; and for ADD, Adderall. 

Tr. 584. The record is missing any 

medical history, any updated medical 

history, the patient’s state of health, 

how he is responding to treatment, a 

physical exam, pain levels, mental or 

physical functioning assessment, 

appropriate rationale for continued 

treatment, and information relating to 

drug abuse. Tr. 583–86. As a result, the 

treatment is without sufficient medical 

evidence. Tr. 584–86. Accordingly, the 

subject charged prescriptions are 

without a legitimate medical purpose. 

Tr. 586. 

On February 27, 2018, K.S. presented 

with ADD, opioid dependency and 

GAD. Tr. 586–87, 599–600; GX 14 at 39, 

40. He was diagnosed with ADD, opioid 

dependency-refusing detox, and GAD. 

Back pain was not reported, nor was any 

report of pain made. At the April 30, 

2018 visit, again, back pain was not 

reported, nor was any report of pain 

made. Tr. 601. Throughout the records, 

the Respondent failed to explain the 

appearance and disappearance of back 

pain. Tr. 601–02. Again, beneath the 

standard of care and against the law in 

California, K.S. was prescribed 

hydrocodone for opioid dependency, 

which Dr. Munzing testified was neither 

appropriate nor legal. Tr. 587–88. On 

November 28, 2018, K.S. presented with 

opioid dependency and GAD for which 


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he was diagnosed with opioid 

dependency-refusing detox and GAD, 

and for which he was prescribed 

hydrocodone and Xanax respectively. 

Tr. 588–589; GX 14 at 33; GDX 8. Again, 

beneath the standard of care and 

contrary to the law in California, K.S. 

was prescribed hydrocodone for opioid 

dependency. Tr. 588–89. And again, the 

medication regimen included the 

dangerous combination of an opioid and 

benzodiazepine. The record is missing 

any medical history, any updated 

medical history, the patient’s state of 

health, how he is responding to 

treatment, a physical exam, pain levels, 

mental or physical functioning, any 

evaluation for GAD, appropriate 

rationale for continued treatment, and 

information relating to drug abuse. As a 

result, the treatment is without 

sufficient medical evidence. Tr. 588–89. 

Accordingly, the subject charged 

prescriptions were issued without a 

legitimate medical purpose, outside the 

usual course of professional practice, 

and beneath the standard of care. Tr. 

590. 

On December 11, 2018, K.S. presented 

with ADD and eczema for which he was 

diagnosed with ADD and eczema. Tr. 

591; GX 14 at 33. For ADD, he was 

prescribed Adderall. [Dr. Munzing 

testified that the Adderall prescription 

lacked a legitimate medical purpose for 

the same reasons as the prior 

prescriptions he had just discussed. Tr. 

591–93.] On January 31, 2019, K.S. 

presented with and was diagnosed with 

back pain and stomatitis. Tr. 593–94; 

GX 14 at 31. For the back pain he was 

prescribed hydrocodone. [Again, Dr. 

Munzing testified that the hydrocodone 

prescription lacked a legitimate medical 

purpose for the same reasons as the 

prior prescriptions he had just 

discussed. Tr. 594–95.] 

A review of the entirety of K.S.’s 

subject medical records reveals that the 

Respondent never obtained any prior 

medical records. Tr. 596, 619. The 

record is missing an adequate prior 

medical history, any updated medical 

history, the patient’s state of health, 

how he is responding to treatment, a 

physical exam, pain levels, mental or 

physical functioning, any evaluation for 

GAD, appropriate rationale for 

continued treatment, and information 

relating to drug abuse. As a result, the 

treatment is without sufficient medical 

evidence. Tr. 598–99, 620. Accordingly, 

the subject charged prescriptions were 

issued without a legitimate medical 

purpose, outside the usual course of 

professional practice, and beneath the 

standard of care. Tr. 597–98, 619–20. 

[Dr. Munzing testified that, similar to 

the other patients, Respondent 

prescribed hydrocodone to K.S. for back 

pain, then neck pain, then for opioid 

dependency, and sometimes for a 

combination of these reasons, without 

any documentation regarding these 

changes or the coming and going of the 

pain issues as would be required by the 

standard of care. Tr. 598–602.] Dr. 

Munzing also noted the inconsistency of 

the GAD diagnoses throughout the 

records. Tr. 602–05; GX 14 at 31, 42, 47, 

48. With the GAD diagnoses appearing 

and disappearing within the records and 

without any explanation, Dr. Munzing 

observed there is no medical evidence it 

was a medically legitimate diagnosis. 

Tr. 605–09; GX 8. Similarly, ADD was 

inconsistently diagnosed with Adderall 

inconsistently prescribed. Tr. 605–06; 

GX 14 at 34, 35; GX 8. With the ADD 

diagnoses appearing and disappearing 

within the records and without any 

explanation, Dr. Munzing observed 

there is no medical evidence it was a 

medically legitimate diagnosis. Tr. 609. 

Dr. Munzing noted the Respondent 

prescribed a dangerous combination of 

medications, including hydrocodone, 

Adderall and Xanax, which was 

prescribed from January 2018, through 

August 2018. Tr. 609–10. Dr. Munzing 

noted it is referred to by drug abusers as 

the ‘‘new Holy Trinity.’’ Tr. 610. 

Additionally, the combination of an 

opioid and a benzodiazepine is present 

in August, October and November 2018. 

Tr. 610–11. The records fail to reveal 

that the appropriate warnings were 

conveyed to K.S., or that informed 

consent was obtained. Tr. 611–13; GX 8. 

Dr. Munzing could not conceive of a 

medical condition warranting the 

dangerous combinations of medications 

prescribed. Tr. 614. [Dr. Munzing also 

noted that Respondent failed to properly 

monitor medication compliance, and 

conducted no urine drug screens, as was 

required by the standard of care in 

California. Tr. 614.] 

Dr. Munzing noted the Respondent’s 

failure to resolve red flags, including 

K.S.’s diagnosis of opiate dependency 

with refusal to detox, the dangerous 

combinations of medications, and high 

dosages of controlled medications. Tr. 

615–18, 620; GX 14 at 39, 40, 41. The 

refusal to detox is a major red flag for 

opioid use disorder and for diversion. 

However, the Respondent did not take 

any necessary action, such as CURES 

monitoring, UDS, counseling, or 

titration. Rather, he simply prescribed 

the same levels of medications she was 

on, PRN. Tr. 615–17. The Respondent’s 

course of action was outside the 

California standard of care. 

[Dr. Munzing, summarizing his 

opinions based on his review of the 

entire file for K.S., testified that 

Respondent never took a proper medical 

or mental health history, never 

conducted a sufficient physical or 

mental health examination for K.S.’s 

relevant diagnoses, never made an 

appropriately supported diagnosis, 

never recorded K.S.’s pain and 

functionality level, never documented 

an appropriate treatment plan with 

goals or objectives, never appropriately 

documented discussion of the risks of 

the prescribed controlled substances 

with K.S., never appropriately 

monitored K.S. for medication 

compliance and failed to appropriately 

respond to red flags of diversion. Tr. 

617–20. Accordingly, Dr. Munzing 

opined that each of the relevant 

prescriptions Respondent issued to K.S. 

were issued without a legitimate 

medical purpose, outside the usual 

course of professional practice and 

beneath the standard of care in 

California. Tr. 620. 

In summarizing the entire body of 

evidence he reviewed in this matter, Dr. 

Munzing opined that each of the 

controlled substance prescriptions at 

issue in this matter were issued 

‘‘outside the standard of care’’ and that 

Respondent’s prescribing of high 

dosages of these controlled substances 

‘‘absolutely’’ constituted clear excessive 

prescribing. Tr. 621.] 

Respondent’s Case-in-Chief 

The Respondent presented his casein-chief through the testimony of one 

witness, the Respondent, Fares Rabadi, 

M.D. 

Fares Rabadi, M.D. 

Dr. Rabadi attended medical school in 

the former Soviet Union. Tr. 626. He 

underwent a three-year residency 

training in internal medicine at State 

University of New York School of 

Medicine and Biomedical Science in 

Buffalo, New York. Tr. 627. According 

to Respondent, he is currently licensed 

to practice medicine in New York 

(inactive), California, and Indiana. Tr. 

627. He has been licensed in California 

since September 25, 1998. His first two 

years practicing in California were spent 

working at another medical group. For 

the past twenty-years he has had his 

own practice. Tr. 628. He is a member 

of the American Medical Association 

(AMA), the American College of 

Physicians, a Master of the College of 

Physicians, the American Society of 

Internal Medicine, the Los Angeles 

Medical Association and Arab American 

Medical Association. Tr. 628. He is 

affiliated with the U.S.C. Keck School of 

Medicine, and is on the volunteer 

faculty with the UCLA’s David Geffen 

School of Medicine. He teaches family 


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9There was some confusion in the transcript as 

to the total number of patients in 2019. The 

Respondent estimated 400 total patients for 2019, 

but later agreed it was approximately 200 total 

patients in 2019. Tr. 804. [Respondent also testified 

at the hearing that ‘‘I have close to 550–600 

patients’’ suggesting that was his total number of 

patients at the time of the hearing in September 

2020. Tr. 792. He testified that he had 175–200 

patients who were specifically pain patients up 

until the time of the OSC which was dated March 

2020. I note that the exact number of patients that 

Respondent was treating at any given time has little 

relevance to my decision in this matter, other than 

as it relates to his ability to accurately recall the 

undocumented details of each medical visit to 

which he testified.] 

*OModified for clarity. 

*PAt this point in his testimony, Respondent 

stated, ‘‘[T]he Government seized more than 223 

charts . . . they returned more than 200. . . . And 

now, they are focusing and fixating on these seven 

charts. So, they’re just looking at the charts and 

some notes and immediately demonizing an astute 

clinician who’s been in the medical field for 41 

years without a blemish to my reputation and 

career. And now, I’m just portrayed as I’m just 

feeding the addicts; I’m just distributing his 

medications.’’ Tr. 648–49. I note that for the 

purposes of this Decision, I presume that all 

prescriptions issued by Respondent that are not at 

issue in this cases were legitimate. 

10 Dr. Rabadi contrasted these classifications with 

those he indicated were described by Dr. Munzing, 

mild, moderate and severe. Tr. 667–68. 

11As I understand Dr. Rabadi’s testimony, Dr. 

Rabadi noted that an unnamed study found that 

dosages 5–6 times higher than that recommended 

by the FDA were safe. This highly specific evidence 

was not noticed prehearing, was not reasonably 

anticipated by the Government, and will not be 

considered. 

medicine residents at the Northridge 

Hospital. Tr. 628–29. 

Dr. Rabadi was familiar with the 

federal regulations, the California 

Health and Safety Code, and the 

California Business and Professional 

Code cited in the Order to Show Cause. 

Tr. 630. Dr. Rabadi was familiar with 

the Government Exhibits 1–19 (records 

relating to the prescribing to the charged 

patients), and 20 (The [California] Guide 

to the Laws Governing the Practice of 

Medicine by Physicians and Surgeons). 

Tr. 630. He was specifically familiar 

with pages 59–60 relating to pain 

management. Tr. 630; GX 20. He was 

also familiar with the Guidelines for 

Prescribing Controlled Substances. Tr. 

630; GX 21. 

In his medical career Dr. Rabadi has 

treated thousands of patients, including 

hundreds of pain patients. At the time 

of the issuance of the Order to Show 

Cause, Dr. Rabadi had 300–400 patients 

of which 175–200 were pain 

management patients. Tr. 631, 792. In 

both 2017 and 2018, he estimated he 

treated 400 to 500 patients. Tr. 803. In 

2019, he estimated he saw 400 patients, 

and less than 200 in 2020.9 Tr. 804. 

Dr. Rabadi described his protocol 

upon a patient’s first visit to his clinic 

prior to the issuance of a prescription. 

Tr. 631. The patient initially fills out 

paperwork. His office verifies insurance 

coverage. The patient is weighed and 

then sent to an examination room. Dr. 

Rabadi enters the room, greets the 

patient and sits on a stool ‘‘so [his] eyes 

are with the same level as the patient’s 

eyes.’’ *O Tr. 632. Dr. Rabadi determines 

how the patient was referred to him. Dr. 

Rabadi then takes the patient’s history, 

which begins with the patient’s main 

complaint. Dr. Rabadi disagreed with 

Dr. Munzing’s estimate that a diagnosis 

is 85% based on the patient’s history. 

Dr. Rabadi believed it was upwards of 

95% based on history. Tr. 635–36. The 

Respondent conceded history is critical 

to understanding the patient’s condition 

and how to treat the patient. Tr. 804. He 

inquires about family history and their 

medical issues. Dr. Rabadi then inquires 

regarding social history, surgeries and 

present pain. He inquires into habits, 

such as smoking, and past and present 

use of illegal drugs. He then probes any 

allergies, including allergies to 

medications. If a patient has no 

allergies, he reports NKDA. Tr. 635. 

Following history, Dr. Rabadi testified 

he ‘‘starts going in depth about the main 

complaint,’’ with an eye toward 

isolating the ultimate medical source of 

the malady, and whether the symptoms 

are resolved with medication. Tr. 635– 

37. Regarding complaints of ‘‘back 

pain,’’ for example, Dr. Rabadi testified 

that he will review previous diagnoses, 

probe the source and triggers for the 

pain, explore any nerve restrictions, and 

discuss the success of different past 

treatment methods. Tr. 638–40. If pain 

medication management was the only 

treatment that alleviated the pain, Dr. 

Rabadi would explore the history of that 

treatment and its efficacy. [Respondent 

testified that ‘‘after [he] complete[s] the 

history in general, and organ-specific 

where the complaint is, then [he does 

the] physical examination.’’ Tr. 641.] 

Dr. Rabadi testified that the physical 

exam he performs for all patients starts 

with the head. He examines the skull. 

He explores headaches, noted in the 

records as, ‘‘HEENT.’’ Tr. 641. He then 

checks the eyes, the ears, and the 

mouth. Tr. 642. He moves down to the 

neck, checking for issues with the veins 

of the neck. He then checks the 

efficiency of the heart’s pumping and its 

rhythm. Next, he checks the lungs. 

Moving down to the abdominal cavity, 

he palpates the liver and spleen for 

abnormal size. Tr. 643. He then checks 

the remaining organs of the abdomen 

and the bowel for irregularities. Tr. 643. 

He then checks the extremities for 

circulation issues, often noting in the 

records, ‘‘No ECC’’ (edema, clubbing or 

cyanosis). He then checks for skin 

issues. Finally, he performs a 

neurological examination, including a 

mini mental-state exam and their 

orientation as to time and space. Tr. 

643–45. He checks their reflexes, their 

cranial nerves. Tr. 645. He decides if 

further radiologic testing is necessary. 

Tr. 651–52. For men aged 17–35, he 

offers a testicular exam to check for 

cancer. For men over 50, he offers a 

rectal exam to determine indications of 

prostate and colorectal cancer. The 

complete exam takes from 30–40 

minutes. Then, Dr. Rabadi formulates 

his diagnosis, [though he noted that 

‘‘the patient many times comes with a 

diagnosis already.’’] *P Tr. 647. He then 

establishes a treatment plan. Tr. 649. He 

discusses the treatment plan with the 

patient and obtains informed consent. 

Tr. 658. For patients experiencing pain, 

he explains the mechanism of pain, the 

modalities of pain and the type of pain; 

chronic pain, acute pain, malignant 

pain, post-traumatic pain, 

rheumatological pain, psychogenic pain, 

and neuropathic pain.10 Tr. 668. For 

patients receiving pain medication 

prescriptions, Dr. Rabadi explains the 

medications, their side effects, 

including addiction, overdose and 

death, and cautions patients not to 

operate machinery or use heavy 

equipment. Tr. 668–70. [When asked 

whether he had ever prescribed a 

controlled substance for a patient 

without having this discussion about 

the dangers, he responded, ‘‘Absolutely 

not. Absolutely not. Absolutely not.’’ Tr. 

669.] Dr. Rabadi assures his patients that 

if they take the medication as 

prescribed, they will not overdose. Tr. 

670.11 He typically sees his pain 

patients monthly. Tr. 672. 

For return visits, Dr. Rabadi is focused 

on the specific reason for their visit. Tr. 

673. This explains why Dr. Munzing’s 

noted diagnoses would appear and 

disappear from month to month. Tr. 

673. Dr. Rabadi does not make note each 

month of long-term chronic conditions. 

Tr. 673. If a patient has new symptoms, 

Dr. Rabadi will focus on these new 

symptoms and tailor his examination to 

these symptoms, although at least two 

organ systems are always examined. Tr. 

674. At least every three months blood 

pressure is checked. Tr. 675. Dr. Rabadi 

explained that much depends on the 

physician’s judgment. Guidelines are 

essentially recommendations. Following 

the guidelines does not make the 

Respondent a good doctor. The most 

important thing is to perform with 

knowledge, with care and in good faith, 

placing the interest of the patient as the 

Respondent’s top priority. Tr. 676. 


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*Q Respondent testified, ‘‘[i]f the patient tells me, 

‘Look, I’ve already been with pain specialists; I’ve 

already seen a couple of specialists; I already had 

three-four MRIs; I already had surgery; I’m on this 

medication for years, and it’s working for me,’ then 

it comes down to one of two options. Either I tell 

him I will fill his prescription or I kick him out of 

my office. And I don’t think it is ethical to do that 

latter approach.’’ Tr. 651. 

*R Respondent testified both generally and 

specifically to S.B. that he ‘‘take[s] personally a very 

lengthy history. [He] spend[s] close to 60 minutes 

in the first visit the patient comes.’’ Tr. 719, 721. 

*SRespondent testified that, ‘‘the record is 

probably missing these things, because maybe at the 

time of the documentation I did not feel that was 

crucial to be documented. As soon as the patient 

disclosed that to me, I memorize it. I remember it. 

You’ve seen how several years later I still remember 

it. . . . I did not feel I have to clutter my charts 

with, you know, this information.’’ Tr. 806–07. 

Respondent further testified that he does not have 

electronic medical records, he is ‘‘still writing . . . 

And when I see 15, 20 patients a day . . . There 

[are] only 24 hours a day. I don’t have the luxury 

to write ten pages on each patient. . . . [W]hat’s 

pertinent, what’s your diagnosis, what’s your main 

exam, and what’s your treatment is reflected there. 

The rest I remember. I don’t need to write it.’’ Tr. 

807–08. 

If patients’ symptoms subsided and 

they did not finish their medication, Dr. 

Rabadi would not prescribe more 

medication. He would wait until the 

medication was finished. This explains 

why prescriptions would sometimes 

stop and restart from month to month. 

Tr. 673. 

For patients on pain medication and 

desiring to continue on pain 

medication, he discusses the options of 

detox and referral to a pain specialist. 

Tr. 650. All of his patients on pain 

medications are required to sign a 

‘‘Controlled Substance Agreement.’’ Tr. 

658. Dr. Rabadi also verbally tells 

patients that they cannot obtain pain 

medication from different physicians, 

and they cannot go to different 

pharmacies for refills. Tr. 660. If a 

patient overdoses, or is arrested selling 

medications, he is banned from further 

treatment. Tr. 660. Dr. Rabadi has little 

sympathy for reports of lost or stolen 

medication. Tr. 661. 

In the United States, the patient ‘‘is in 

the driver’s seat.’’ The patient’s wishes 

are granted unless they are asking for 

something illegal or abnormal. 

Treatment cannot be forced on them. Tr. 

650. When a patient reports that he has 

received extensive radiologic testing 

and has exhausted medical treatment 

and surgeries for his injury and wishes 

to remain on pain medications, the only 

option is to prescribe those medications 

or to drop the patient, which Dr. Rabadi 

did not view as an ethical option.*Q Tr. 

651. No one deserves to be in pain. Tr. 

664–65, 670. If chronic pain patients 

were dropped from the practice, they 

may turn to buying illegal drugs off the 

street. Tr. 663. Dr. Rabadi was realistic 

as to most of his pain patients. Some 

had been on pain medications for 10, 15 

and 20 years and were chemically 

dependent on them. Tr. 662. The goal 

was not to make them pain free, which 

would be impossible. It was to minimize 

the pain, and maximize their 

functionality without making them a 

slave to the medications. Tr. 662, 664. 

For acute pain, Dr. Rabadi typically 

restricted pain medication to one week. 

Tr. 662. 

Dr. Rabadi noted that almost all of his 

patients work full time in the motion 

picture industry doing hard labor and 

suffer serious and sometimes recurring 

injuries. Tr. 647, 663. They have had 

long term injuries with surgeries, and 

have been on pain medication for a long 

period of time prior to coming to see 

him, and are still able to function. Tr. 

647–48, 663. 

Regarding the use of pain scales in 

diagnosing, Dr. Rabadi noted their 

limitations—it is purely subjective to 

each patient. Tr. 658–59. Regarding the 

high doses of medications he 

prescribed, Dr. Rabadi agreed with Dr. 

Munzing that starting patients on such 

high doses was dangerous. Tr. 640. 

However, if the patients were 

acclimated to such high doses, 

prescribing lower doses would be 

ineffectual and potentially dangerous. 

Tr. 656–58. If Dr. Rabadi was just 

starting treatment for ADD, for example, 

he would start the patient on .25 mg of 

Xanax per day. Tr. 657. 

Patient S.B. 

Patient S.B. remained a patient of Dr. 

Rabadi’s. Tr. 708–09. She was 

prescribed hydrocodone, Xanax and 

Adderall. Tr. 709. Dr. Rabadi believed 

his prescription practice concerning 

S.B. was within the California standard 

of care. Tr. 709. Dr. Rabadi began his 

treatment of S.B. on August 3, 2016. Tr. 

718. She presented as a 29 year-old 

female to establish care for the treatment 

of ongoing conditions of GAD, 

fibromyalgia, and ADD. Tr. 719. As per 

Dr. Rabadi’s policy, as detailed in his 

earlier testimony, he took a complete 

history.*R Tr. 719–20. He performed a 

complete physical examination [‘‘head 

to toe including every organ and 

system,’’] reviewed her existing 

diagnoses of GAD and ADD, and her 

medication history in general and 

specifically for those diagnoses. Tr. 720, 

722–24. He obtained her pain level with 

and without medication. Without 

medication her subjective pain level 

was eight. With medication, it was one 

to two, which permitted her to function 

and perform daily activities. Tr. 721. 

The Respondent conceded that the 

detailed findings of the complete 

physical exam are not reflected in his 

chart, but noted he was a clinician with 

41-years of experience, and not a 

medical student. Tr. 810. Tr. 810. [He 

testified that he inquired regarding any 

behavioral and psychological issued 

S.B. might have. Tr. 722.] Dr. Rabadi 

noted that patients with ADD are six 

times more likely to have other 

psychiatric conditions as people 

without ADD. Tr. 722. Ultimately, Dr. 

Rabadi concurred with the previous 

physician’s diagnoses of ADD, GAD, 

and fibromyalgia. Tr. 724, 728. To 

obtain informed consent to prescribe 

controlled substances to S.B., the 

Respondent executed the ‘‘pain 

management contract.’’ Tr. 728–29. The 

patient reads it and signs it. The 

Respondent then goes over the contract 

in detail with the patient. The 

Respondent then explains that the 

medications are meant to help the 

patient, not to cause side effects or 

addiction, although they tend to cause 

chemical dependence. Tr. 729. The 

Respondent then goes over all the 

alternative treatments, but in the end, it 

is the patient’s decision as to the 

treatment she will receive. Tr. 729. If the 

Respondent objected to every patient’s 

choice of treatment, there would no 

medical care. If a patient says she is on 

medication and it permits her to 

function, the Respondent will continue 

that treatment. Tr. 729–30. S.B. 

indicated she had been through several 

alternate treatments, including, 

occupational therapy, physical therapy, 

hydrotherapy, yoga and meditation. Tr. 

731, 805. 

The Respondent conceded the list of 

prior therapies was not in his progress 

notes. Tr. 805–06, 808. The Respondent 

explained its absence as maybe he ‘‘did 

not feel it was crucial to be 

documented,’’ as he memorizes what 

the patient tells him.*S Tr. 806. 

Respondent testified that including 

references to prior, concluded treatment 

was irrelevant as the prior treatment 

was concluded and the patient had 

moved on to the new treatment. Tr. 

807–08. The Respondent testified to 

S.B.’s prior treatment from memory. Tr. 

808. The Respondent explained that, as 

he still maintained handwritten records 

and saw up to 20 patients a day, with 

new patients taking an hour and 

returning patients taking up to 20 

minutes each, he did not have the 

luxury of documenting in detail. Tr. 

807, 849. So, the basic information is 

reflected in his written notes, while the 

rest he remembers; ‘‘I rely on my 

photographic memory.’’ Tr. 808–09. The 


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*TModified for clarity. 

12 In transcript pages 734–43, Patient J.M. is 

discussed. However, due to some confusion with 

patient initials, the Respondent described his 

treatment of J.M. as M.B. within the transcript. Tr. 

774. [All of the questions and responses for pages 

734–43 referred to this patient as ‘‘M.B.’’; however 

the factual information that was being discussed 

was actually applicable to ‘‘J.M.’’ The error was not 

discovered until Respondent was questioned about 

the patient whose initials were actually M.B. The 

parties entered ‘‘a stipulation that Dr. Rabadi’s 

[prior] testimony as to M.B., the second patient 

discussed, is actually applied or attributed to 

Patient J.M.’’ Tr. 774–75. This exchange did not fill 

me with confidence that Respondent’s testimony 

reflected his true recollection of the specific actions 

he took with regard to the specific patient being 

discussed. Rather, Respondent seemed to testify to 

the policies and procedures he followed in the 

regular course and assumed that those policies and 

procedures were followed with regard to all the 

named patients.] 

13 J.M.’s prestigious background will not be 

considered. It is an unnoticed matter that the 

government would have no way of checking or 

countering. [It is also completely irrelevant to my 

decision in this case.] 

14The Government objected to B.C.’s prior 

treatment history, which was not noticed in the 

RPHS. I ruled it was reasonably anticipated. The 

Respondent cited to specific treatment from a prior 

physician. The contested evidence is reflected in 

GX 5 at 14, so the Government was certainly not 

surprised by the evidence. 

Respondent conceded that ‘‘maybe’’ it 

was ‘‘inappropriate’’ of him not to more 

thoroughly detail this information in the 

charts. Tr. 809. But with handwritten 

charts he was only able to include the 

‘‘main ideas.’’ His notes are simply to 

remind him of the matters. Tr. 810–11. 

He keeps his notes as brief as possible 

to remind him in the future. Tr. 815. 

Respondent testified that S.B. further 

reported that she had been on the same 

dosage of medications for several years 

to good effect. Tr. 731–32. [Respondent 

testified that ‘‘medically it is very 

inappropriate when a patient is stable at 

[a] certain dose, to start cutting the dose 

because [the] patient will regress’’ and 

either] suffer withdrawal symptoms or 

have severe pain.*T Tr. 732. Prior to 

each prescription, the Respondent 

discussed side effects, and changes in 

status. Tr. 733. 

The Government sought to test the 

Respondent’s ‘‘photographic memory’’ 

by asking to confirm that, consistent 

with his direct testimony, he only 

treated S.B. with hydrocodone, Xanax 

and Adderall. Tr. 810–13. The 

Respondent confirmed his direct 

testimony. Tr. 812. The Government 

reminded the Respondent that he 

prescribed Soma as well, [but 

Respondent testified that he did not 

mention it on direct because it ‘‘was not 

[an] ongoing prescription. Maybe the 

patient got it once or twice over the 

course of the years.’’] Tr. 813. 

Although the Respondent testified he 

developed a treatment plan for each of 

his patients, the Government pointed 

out, and the Respondent agreed, that 

S.B.’s treatment plan and objectives 

were not documented in her chart. Tr. 

813–14. 

Although the Respondent testified he 

did not introduce any of his subject 

patients to controlled substances, the 

chart reflects he did prescribe Soma to 

S.B. for the first time. Tr. 816–17; GX 1 

at 61, 62. The Respondent remembered 

during cross-examination that, although 

not in the chart, S.B. told him she had 

been on Soma previously. Tr. 817–19. 

Patient J.M.12

J.M. has been a patient for thirteen 

years. Tr. 734. The Respondent has 

prescribed him Xanax, Soma and 

hydrocodone. The Respondent believed 

his treatment of J.M. was within the 

California standard of care. J.M. first 

presented on May 14, 2007, with 

chronic pain syndrome, which 

sometimes manifests as back pain, and 

neck pain, and GAD. Tr. 735; GX 11 at 

104. The Respondent took a history. J.M. 

had been involved in a motor vehicle 

accident injuring his back, neck and 

lumbar spine. Additionally, he suffered 

from GAD and hypertension. Tr. 736. 

The motor vehicle accident as the 

source of the injury was not 

documented. Tr. 853. J.M. had seen an 

orthopedic surgeon, although it was not 

documented in the chart. Tr. 853. 

Without medication, J.M. reported 

severe pain of 10 or 11 of 10. With 

medication, he reported pain levels of 

three of ten, which permitted him to 

function and to work full time; the pain 

levels were not documented in the 

chart. Tr. 736, 854–55. J.M. reported 

prior treatments and medication. He had 

received physical therapy, occupational 

therapy, hypnosis and acupuncture to 

no avail prior to turning to chronic pain 

management, although these previous 

therapies were not documented in the 

chart. Tr. 737, 854. His present 

medication protocol delivered the best 

results with the least side effects. Tr. 

737. The Respondent probed his 

psychological history, which included 

an all-consuming fear. 

The Respondent performed a 

comprehensive physical exam ‘‘head to 

toe.’’ Tr. 739. To obtain informed 

consent to prescribe J.M. controlled 

substances, the Respondent went over 

the pain management contract, which 

J.M. also read and signed. The 

Respondent cautioned J.M. about 

diversion and red flags of doctor 

shopping and pharmacy hopping, which 

would result in discharge. Tr. 739–40. 

The Respondent noted that J.M. is a very 

well-respected man. He’s very wellknown in the community. Tr. 740.13 The 

Respondent then discussed the 

beneficial aspects of the pain 

medication and potential negative 

effects if abused. Respondent testified 

that J.M. never gave any indication he 

represented a risk of diversion. Tr. 741. 

Prior to seeing the Respondent, J.M. was 

on a higher MME of opioids. He was 

able to reduce the dosages to the level 

he was on when he first saw the 

Respondent. He remains on that dosage. 

Again, he is able to function and work 

full-time on this dosage. Tr. 742. The 

Respondent noted that J.M. would 

sometimes try to avoid taking his 

medication, even if he suffered pain, as 

explanation for the breaks in 

prescribing. Tr. 743. 

The Respondent denied ever using a 

different first name for J.M., or using a 

different birth date for him [and 

attributed any mistake to the pharmacy.] 

Tr. 778–82. 

Patient B.C. 

Patient B.C. has been a patient of the 

Respondent since March 27, 2014. Tr. 

750–51. Patient B.C. has been prescribed 

hydrocodone, Xanax and Adderall. Tr. 

749. The Respondent obtained a 

complete history, a complete physical 

exam and then probed the complaint 

that brought him to the Respondent, 

which was right shoulder and chronic 

back pain. Tr. 751. Without medication, 

B.C. reported pain at seven or eight, and 

with medication at one or two. Tr. 752. 

As far as his medication history, B.C. 

had been on pain medication for years 

following a neurosurgical procedure to 

treat a herniated disc with 

radiculopathy.14 Tr. 752. To obtain 

informed consent, the Respondent 

discussed the pain management 

contract, which B.C. read and signed. 

Tr. 752–53. The Respondent then 

discussed side effects of the medication 

[including ‘‘addiction, overdose, and 

death.’’ Tr. 753.] B.C. is a married man 

with three children. He works full time. 

He gave the Respondent no indication 

he was a risk for diversion. Tr. 753. 

Regarding prior alternate treatment, 

B.C. reported that he has tried surgery, 

physical therapy and acupuncture, but 

that only pain medication therapy 

alleviates his pain to the extent he can 

function. Tr. 754. At each visit, the 

Respondent reviewed B.C.’s progress 

and believed B.C.’s condition warranted 

the medication he was prescribed. Tr. 

754, 757. Although the Respondent 

remembered discussing B.C.’s pain 

levels on March 27, 2014, and that it 

was one or two on medication, he 

conceded it was not documented in the 


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15The Respondent again explained the difficulty 

in obtaining prior medical records. Tr. 842. 

*U Respondent testified, ‘‘[w]hether he mentioned 

the surgery the very first visit, that I cannot tell you 

yes or no at this point because it’s not in my notes. 

So I’m just second guessing myself.’’ Tr. 841. 

*V There was no allegation that Respondent 

misspelled J.C.’s name, but the OSC did allege that 

Respondent ‘‘used a variant spelling of Patient 

J.M.’s first name.’’ OSC, at 13. Accordingly, 

Respondent’s testimony that he never intentionally 

misspelled J.C.’s first name is not relevant to this 

hearing other than it caused me to again question 

whether Respondent’s testimony reflected his true 

recollection of the specific actions he took with 

regard to the specific patient being discussed. See 

supra n.12. 

*W Respondent testified that, ‘‘whether it is 

specifically dirt bike as opposed to car accident, as 

opposed to falling off the second story, this has 

become, there is a good reason for the back pain. 

That’s the whole thing, why I did not mention 

specifically dirt bike injury.’’ Tr. 850. 

*X Specifically, when asked whether he 

considered alternative forms of treatment for M.B., 

Respondent testified: ‘‘I do. We do discuss that. 

However, patient’s already been through those. 

Again, the common denominator in my practice is 

unique thing . . . because these patients [have] 

been there, done that. They had surgeries, they had 

imaging, they had already physical therapy, 

activation, acupuncture, medication. I told you 

some of them had hypnosis, water pool or water 

therapy. Everything was done. But still . . . for the 

sake of clarity I have to discuss everything. The 

patient will tell me, Doctor, I’ve done that, I’ve been 

there, and this is what works for me right now.’’ Tr. 

785. On cross examination when asked specifically 

whether M.B. told Respondent that he had tried 

each of these forms of alternative treatment, 

Respondent replied ‘‘[n]ot necessarily all of this. I 

always ask questions, what alternative therapy did 

you discuss.’’ Tr. 825. When directed to identify 

specifically which forms of alternative treatment 

M.B. had tried, Respondent testified, ‘‘I don’t want 

to misspeak. I’m not sure if he had . . . 

acupuncture or not. But I know for a fact he had 

physical therapy.’’ Tr. 827. I find this testimony 

illustrative of two concerns I have with 

Respondents testimony. First, it appears that 

Respondent’s testimony does not always reflect an 

independent recollection of the undocumented 

events that occurred between him and the specific 

patients being discussed. Even where Respondent 

seems to be testifying about a specific patient, it 

morphs into testimony about his patients 

collectively rather than as individuals. This sort of 

collective focus that appears throughout 

Respondent’s testimony causes me to question 

Respondent’s credibility—specifically whether he 

remembers the events that occurred at each specific 

visit for each specific patient that he discussed in 

the absence of medical records documenting these 

events. Indeed, Respondent testified that ‘‘[o]ver 

[his] career, [he] worked [with] about 5,000 

patients.’’ Tr. 792. And at the time of the hearing 

he had ‘‘close to 550–600 patients’’ and prior to the 

order to show cause he ‘‘had between 175–200 

[pain] patients.’’ Id. Secondly, I am concerned that 

Respondent’s ‘‘photographic memory’’ may not be 

as reliable as he portrays it, particularly where, as 

Continued 

chart. Tr. 832–34; GX 5 at 48. Although 

the Respondent remembered B.C. 

reporting he had a herniated disc, this 

report was not documented in the chart. 

Tr. 836. Neither were B.C.’s reported 

prior surgery, physical therapy, 

acupuncture, or occupational therapy 

documented. Tr. 837. 

Patient J.C. 

Patient J.C. presented on May 18, 

2009, with chronic back pain, ulcerative 

colitis and GAD. Tr. 759–60, 761–62. He 

was prescribed hydrocodone, and 

Xanax, sometimes substituted with 

Valium. Tr. 759. The Government 

pointed out to the Respondent that there 

were visits during which several other 

controlled substances were prescribed. 

Tr. 842–46; GX 7 at 181, 214, 215. 

He had suffered multiple injuries, and 

had been immobile for some time. 

However, the Respondent did not 

document the injuries or the immobility 

in the chart, nor did the file contain any 

prior medical records.15 Tr. 839, 842; 

GX 7 at 216. He had undergone physical 

therapy, occupational therapy, and 

finally pain management, which 

permitted him to resume working fulltime. Tr. 760. These alternate treatments 

and therapies and prior surgeries were 

not documented within the chart. Tr. 

840. The Respondent could not 

remember if J.C. mentioned his prior 

surgeries at the first or second visit.*U

Tr. 840. The Respondent performed a 

full exam on J.C. Tr. 760–61. His GAD 

resulted from his ulcerative colitis. Tr. 

762. 

The Respondent obtained informed 

consent to prescribe controlled 

substances by explaining the pain 

contract; afterwards, J.C. read it and 

signed it. Tr. 763. The Respondent 

explained the dangers of overdose. Tr. 

764. The Respondent had no concerns 

about J.C. diverting his medication. Tr. 

764–65. On the basis of J.C.’s 

considerable injuries and condition, the 

Respondent felt J.C.’s medication 

protocol was fully justified. Tr. 765. The 

Respondent denied ever intentionally 

misspelling J.C.’s first name.*V Tr. 765– 

66. Although the Respondent 

remembered J.C. reporting that he had 

seen two previous doctors, including a 

pain physician, that report was not 

reflected in the chart. Tr. 841–42. 

Although the Respondent remembered 

performing a complete mental health 

evaluation on J.C., it is not documented 

in the chart. Tr. 842. 

Patient D.D. 

Patient D.D. first presented on July 9, 

2008, with GAD and severe back pain, 

although the source of the back injury 

was not documented. Tr. 767–68, 850; 

GX 9 at 74. Over the course of treatment, 

the Respondent prescribed 

hydrocodone, Xanax and Soma. Tr. 850. 

The Respondent added that he probably 

prescribed Valium, as well, explaining 

he was remembering from 13 years ago. 

Tr. 850. The Respondent remembered 

D.D. was prescribed Valium, 

hydrocodone and Soma the first visit. 

Tr. 851–52. The Respondent believes his 

treatment was within the standard of 

care in California. The Respondent took 

a complete medical history, family 

history, personal history and medication 

history. Tr. 768. The family history was 

not documented in the chart. Tr. 848. 

The Respondent explained that the 

family history was not documented 

because it was non-contributory to his 

assessment. Tr. 848. There were no 

heart conditions in his family, etc. Tr. 

849. The Respondent did document that 

D.D. was married, which he deemed 

contributory. Tr. 849. D.D. had a dirt 

bike accident, which shattered his 

shoulder and fractured several ribs, 

although the accident as the source of 

the injury was not documented.*W Tr. 

850. He underwent physical therapy 

and occupational therapy after 

treatment by an orthopedic surgeon, 

although neither was documented 

within the chart. Tr. 769, 771, 850–51. 

It was several years before he reached 

the medication regimen he was on when 

he first reported to the Respondent. The 

Respondent performed a full physical 

exam. He established informed consent 

with the pain contract and discussion of 

side effects and overdose, as with all his 

patients. Tr. 770. He verbally cautioned 

D.D. regarding diversion and other red 

flags. Again, D.D. gave no indication of 

diversion. Tr. 771. Respondent testified 

that alternative treatments were 

discussed. Tr. 771. 

Patient M.B. 

Patient M.B. presented on April 19, 

2006, with severe back pain, left knee 

pain and history of dyslipidemia. Tr. 

782. The Respondent obtained a full 

medical history, medication history, 

pain level, and performed a complete 

head to toe physical exam. Tr. 783. The 

Respondent discovered M.B. had 

chronic back pain related to an injury, 

a manageable knee injury, and 

dyslipidemia. Tr. 784. Although the 

Respondent maintains he obtained a 

complete medical history as to the back 

pain and chronic knee pain, he 

concedes it is not detailed in the chart. 

Tr. 820–23. [He testified, ‘‘[maybe . . . 

I should have documented more. I’m not 

going to say anything to that.’’ Tr. 821.] 

He was already on hydrocodone, 

previously prescribed, when M.B. first 

saw the Respondent. 

The Respondent obtained informed 

consent in the same manner as 

described for his earlier patients. Tr. 

784. He discussed alternative forms of 

treatment with M.B., however M.B. had 

exhausted those.*X M.B. had physical 


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here, there is no documentation in support of his 

memory. 

*YOn cross-examination Respondent testified 

‘‘the patient is in motion picture but he has also 

something that he does on the side that has to do 

[with] welding iron or something like that as well.’’ 

Tr. 832. 

*Z Specifically, when asked whether he had a 

conversation with this patient involving informed 

consent, Respondent testified: ‘‘Yes, I did. And, as 

usual, he read the entire contract, understood it. 

Indicated that [he] understood, both verbally and 

signed it. Then I . . . explain[ed] the potential side 

effects of these medications that include from my 

explaining with sedation and constipation, all the 

way to addiction, overdose, and possible death. 

And I indicate always to my patients on the last 

two, the overdose and the death, is on you, because 

you can cause it yourself, or you could use this 

medication indefinitely and never have any 

problem. . . .’’ Tr. 790; see also Tr. 670–71, 753, 

770. Once again, Respondent begins his testimony 

purporting to have a specific recollection of his 

2007 conversation with K.S., but then he turns to 

general language, which more supports a general 

assumption that he had the conversation. See, e.g., 

Respondent’s use of ‘‘as usual, he,’’ which is 

ambiguous because, while all of Respondent’s 

patients purportedly receive the contract, K.S. is 

only purported to have received it once. 

16Although the government objected to this 

opinion by the Respondent, I overruled its 

objection. A general disagreement by the 

Respondent of the government expert’s opinion is 

certainly reasonably anticipated. The Respondent 

did not cite to any unnoticed medical practice 

guide, medical theories or other basis for his 

contrary opinion. The government was readily able 

to confront the Respondent’s opinion. The 

Respondent’s opinions were not considered expert 

opinions. 

17See Tr. 950–52. Dr. Munzing testified credibly 

that the 2013 version was the 7th edition and the 

basic requirements have not changed over the years. 

therapy, and perhaps acupuncture, but 

the Respondent could not quite 

remember. Tr. 827. The Respondent 

conceded he did not document these 

therapies in the chart. Tr. 828. The 

Respondent monitored M.B. throughout 

his treatment. Tr. 785. The Respondent 

believed his prescribing was justified on 

the basis of M.B.’s medical conditions, 

level of chronic pain and present level 

of functioning, working in a welding 

factory lifting heavy things.*Y Tr. 786, 

832. The Respondent conceded that he 

did not document M.B.’s degree of pain, 

but minimized the value of the 

subjective pain scale. Tr. 823–24. The 

Respondent conceded there were no 

imaging reports in M.B.’s chart, but 

explained that these patients were from 

the movie business. They were treated 

by a Health Maintenance Organization 

(HMO) from which it is almost 

impossible to obtain records. Tr. 829. 

Patient K.S. 

Patient K.S. presented on June 21, 

2007, with chronic back pain. He was 

later diagnosed with ADD. He was 

prescribed hydrocodone, Soma and 

sometimes Adderall. Tr. 788–89, 861; 

GX 14 at 110. The Respondent added 

that he may have also prescribed Xanax, 

but it is difficult to be sure with 

hundreds of patients and treatment 

dating back fifteen years. Tr. 859. Even 

with a ‘‘good memory, sometimes you 

just miss something.’’ Tr. 859. 

Additionally, he noted that many times 

patients do not disclose all of their 

medications at the initial visit, if they 

have plenty and do not then need them 

to be refilled. So, he is not always aware 

of all of their medications at the initial 

visit. Tr. 860–62. 

The Respondent believed his 

prescribing was within the standard of 

care for California. Tr. 788. The 

Respondent obtained a full medical 

history, medication history, pain level, 

and performed a complete head-to-toe 

physical exam. Tr. 789. The Respondent 

discovered K.S. had chronic back pain 

related to a bike accident for which he 

had been treated by several doctors for 

several years, although the bike accident 

as the source of the injury and treatment 

by other doctors was not documented. 

Tr. 789, 856–57, 859. Additionally, 

there were no records from prior 

treatment in the patient’s records. Tr. 

857. Although the Respondent 

explained that he requested the prior 

medical records, none were provided. 

The Respondent explained that his 

request for records is simply faxed to 

the previous physician’s office. Tr. 857– 

58. Its absence from the file was 

probably because a staffer forgot to file 

it. Tr. 858. The Respondent did not 

contest the Government’s observation 

that no requests for previous medical 

records were in any of the seven patient 

files. Tr. 859. K.S. was already on 

hydrocodone when K.S. first saw the 

Respondent. The Respondent obtained 

informed consent [and disclosed the 

potential side effects including the risk 

of death] in the same manner as 

described for his earlier patients.*Z Tr. 

790. He discussed alternative forms of 

treatment with K.S. K.S. was obtaining 

physical therapy prior to seeing the 

Respondent and continued physical 

therapy after beginning treatment with 

the Respondent. Tr. 791. The 

Respondent monitored K.S. throughout 

his treatment. Tr. 791. K.S. presented no 

indications of diversion. The 

Respondent has treated K.S. for thirteen 

years during which time K.S. got 

married and had three children. Tr. 

790–91. 

The Respondent noted that, to the 

best of his knowledge, none of his 

thousands of patients have suffered any 

harm from his medication treatment. Tr. 

793. [Respondent testified that a 

combination of an opiate, muscle 

relaxant, and benzodiazepine, when 

‘‘used in the right dosages for the right 

indications, and used as prescribed by 

a knowledgeable M.D., . . . are safe to 

use in combination therapy.’’ Tr. 797.] 

The Respondent disagreed with Dr. 

Munzing’s assertion that he could 

perceive of no medical condition 

justifying the dangerous combinations 

of medications identified herein. Tr. 

794–800. The Respondent conceded the 

potential danger of individual pain 

medications, and the potential increase 

in risk in combination with other 

medications. However, according to 

him, if patients are responsible and take 

the medications as prescribed for the 

indications intended, these 

combinations are fairly safe. Tr. 800.16

The Respondent recognized his 

obligations to follow all federal and 

state rules concerning the practice of 

medicine, including the directives of the 

California Board of Medicine. Tr. 862. 

California’s Compliance with Controlled 

Substance Laws and Regulations 

includes a provision on records. Tr. 864; 

GX 20 at 61. According to Respondent, 

it mandates that, the physician and 

surgeon should keep accurate and 

complete records according to the items 

above between the medical history and 

physical examination, other evaluations 

and consultations, treatment plan 

objectives, informed consent, 

treatments, medications, rationale for 

changes in the treatment plan or 

medications, agreements with the 

patient, and periodic reviews of the 

treatment plan. Tr. 864–65. The 

provision further requires, ‘‘[a] medical 

history and physical examination must 

be accomplished . . . this includes an 

assessment of the pain, physical and 

psychological function.’’ Tr. 866; GX 20 

at 59. The Respondent assured the 

tribunal that the necessary assessments 

were made, but not fully documented. 

Tr. 866–67. The Respondent, [while 

again conceding that there was no 

documentation,] made the same 

assurances for the requirements as to 

‘‘Treatment Plan Objectives,’’ ‘‘Informed 

Consent,’’ and ‘‘Periodic Review,’’ 

noting these Guidelines were published 

in 2013.17 Tr. 867–72. [As justification 

for not documenting a treatment plan, 

Respondent testified that he was 

‘‘carrying the same treatment [plan] and 

no change and the patient is stable,’’ but 

that ‘‘[i]f [he] changed the treatment 

plan’’ it would be important to 

document. Tr. 874. Contrary to 

Respondent’s testimony, the treatment 

plan did change when on February 2, 

2017, the Respondent prescribed Soma 

to S.B. Tr. 875; GX 1 at 59. By March 

1, 2017, Soma had been discontinued, 

yet the chart reflected no rationale for 


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18Buprenorphine. 

19 [Omitted for brevity.] 

*AA For example, Dr. Munzing testified that 

Respondent could have checked CURES or urine 

drug tests to verify what the patients were saying 

or could have asked the patients to bring copies of 

their prior medical records in with them. Tr. 923– 

24. Dr. Munzing testified that it is outside the 

standard of care in California to simply take a 

patient at their word when they say that they are 

receiving certain controlled substances in certain 

doses. Tr. 928–29. 

that change in medication regimen. Tr. 

876–77. As the Respondent varied his 

prescribing between Soma and Xanax, 

he conceded he did document the 

reason for the variation in medication. 

Tr. 878–83. The Respondent conceded 

he did not document the rationale for 

the change in medication for J.M. or K.S. 

as well. Tr. 885. Similarly, the 

Respondent conceded he did not 

document pain level, function level and 

quality of life for any of the seven 

charged patients. Tr. 885–87; GX 20 at 

61. The Respondent reiterated that, to 

his knowledge, none of his patients 

exhibited red flags or violated the pain 

agreement. Tr. 888–89. 

[Respondent testified somewhat 

extensively and flippantly regarding his 

thoughts on California law’s 

documentation requirements. ‘‘I am not 

going to just say, okay, write in the chart 

I told the patient hello, they said hello, 

I said, okay, what did you have for 

breakfast? I am not going to document 

all that, there is no reason. It is just 

excessive wrecking [sic.] havoc on the 

documentation. . . . [E]verything was 

addressed, everything was talked about, 

and every exam, every consent, 

everything was done by the book. I am 

a perfectionist. I am a perfectionist.’’ Tr. 

871.] 

Rebuttal Testimony 

Diversion Investigator 

DI identified a CURES Audit Report 

for the Respondent’s Registration 

number. Tr. 893–94; GX 24. The audit 

report shows each time the Respondent 

accessed CURES to run a query on 

patients. Tr. 894. This particular audit 

included data from January 1, 2016, 

through January 13, 2020. DI also 

identified GX 25, which was a CURES 

Audit Report run on the DEA 

Registration of Dr. B.S., which included 

the patient M.B., a patient common to 

the Respondent. Tr. 904. Between 

October 10, 2018, and September 11, 

2020, Dr. B.S. prescribed Suboxone 18 to 

M.B. Tr. 909; GX 24, 25, 25B. On March 

15, 2019, the Respondent accessed 

CURES and would have observed M.B. 

was receiving Suboxone from Dr. B.S. 

Tr. 910; GX 24. DI identified GX 26, an 

additional CURES Audit Report for Dr. 

B.S.2, which spanned from January 

2017, to September 2020, and which 

shared a common patient with the 

Respondent, J.M. Tr. 911–13; GX 26, 

26B. Dr. B.S.2 similarly prescribed 

Suboxone to J.M. from January 2017 to 

August 2020. Tr. 913. The CURES Audit 

of the Respondent demonstrated he 

accessed the CURES database during the 

period J.M. was prescribed Suboxone by 

Dr. B.S.2, which would have been 

evident by this review. Tr. 914. 

Dr. Munzing 

Dr. Munzing repeatedly gave his 

opinion regarding the credibility of the 

Respondent’s testimony. I find that Dr. 

Munzing’s opinion as to the 

Respondent’s credibility is beyond Dr. 

Munzing’s qualified expertise. 

Accordingly, those opinions will not be 

considered herein.19

Dr. Munzing opined on the 

importance of documentation within 

medical records, including medical 

history and pain levels. Tr. 917, 936–38. 

He noted that documentation was not 

just for the then treating physician. It 

was important for other physicians, 

perhaps years later, who may treat the 

patient in an emergency room setting. 

[Dr. Munzing testified that ‘‘[t]rue, and 

accurate, and thorough documentation 

is vitally important for patient safety. 

It’s also part of the standard of care.’’ Tr. 

917.] He reiterated that the elements 

identified in the Board of Medicine’s 

Guidelines on documentation are part of 

the standard of care. Tr. 917–18; GX 20 

at 59, 60, 61. He noted the lapse in 

documentation regarding the history, 

pain levels, mental health exams, and 

treatment plans the Respondent testified 

he performed or obtained for each 

patient. Tr. 916, 921–22. [Specifically, 

Dr. Munzing testified that ‘‘practically 

none of the information that Respondent 

mentioned [during his testimony] was 

documented.’’ Tr. 916.] Dr. Munzing 

observed that the examination described 

by the Respondent for fibromyalgia was 

medically deficient and inconsistent 

with the standard of care, as it did not 

include a musculoskeletal exam. Tr. 

918–20. Dr. Munzing observed that the 

standard of care applies equally to 

electronic records as to written records. 

It does not matter whether the physician 

documents electronically or in writing, 

the standard remains the same. Tr. 922. 

Regarding the Respondent’s testimony 

that he would continue patients on 

medication prescribed by previous 

physicians if they reported they were 

doing well on the medication, Dr. 

Munzing opined that Respondent 

needed to conduct an ‘‘independent 

evaluation’’ and ‘‘verify what [the 

patient is] saying’’ *AA to comply with 

the standard of care. Tr. 923–27, 928– 

29. Dr. Munzing observed that the 

Respondent’s warnings regarding the 

potential for overdose were not 

consistent with the standard of care. Tr. 

927. Dr. Munzing believed the 

Respondent’s undocumented verbal 

caution that overdose was a potential 

risk if the patients took the medication 

other than as directed was misleading, 

because there were risks even if the 

medication were taken as prescribed, 

and it was beneath the standard of care. 

Tr. 927, 929–31. 

Regarding the Respondent’s 

explanation that he only documented 

the condition of which the patient was 

complaining, and did not document all 

the medications the patients were 

already on when coming to his clinic, 

Dr. Munzing opined such practice was 

inconsistent with the standard of care. 

Tr. 932. Dr. Munzing testified that the 

documentation was not just to remind 

the treating physician, but to alert any 

physician who may treat the patient. Tr. 

931–34. Dr. Munzing also criticized the 

Respondent’s handling of situations in 

which patients reported they still had 

medication remaining from the previous 

month. Rather than simply refraining 

from prescribing additional medication, 

Dr. Munzing indicated that that 

situation should trigger a discussion 

with the patient and evaluation whether 

the existing level of medication is 

appropriate, or whether titration is 

warranted. Tr. 933–36. Dr. Munzing 

deemed the Respondent’s prescribing 10 

mg a day of Xanax to J.M. to treat GAD 

and undocumented panic attacks as 

excessive and beneath the standard of 

care. Tr. 938–39. Dr. Munzing deemed 

the Respondent’s reluctance to reduce 

the opioid dosage lest the patient suffer 

pain or withdrawal symptoms 

misguided. Tr. 941. Titration of high 

opioid dosage of high risk patients or 

exploration of alternate treatment is 

consistent with the standard of care. Tr. 

941. Dr. Munzing was critical of the 

Respondent’s handling of J.M. and S.B. 

after discovering they were being 

prescribed Suboxone by other 

physicians. Tr. 941–48. Suboxone is 

typically prescribed for opioid use 

disorder or addiction. Tr. 943. It directly 

violates the Respondent’s pain contract 

for these patients, yet the Respondent 

took no action and continued to 

prescribe opioids. Tr. 947. 


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20 [The contents of the original footnote are 

omitted due to my omission of the Joint 

Stipulations. The parties agreed to Joint 

Stipulations numbered 1–38. See ALJX 3, Govt 

Prehearing, at 1–14 and ALJX 13, Resp Supp. 

Prehearing, at 1. The RD included many of the 

stipulated facts between the parties, but appears to 

have inadvertently left some out. See RD, at 54–67. 

I have omitted the joint stipulations from this 

decision in the interest of brevity, but I incorporate 

fully herein by reference Joint Stipulations 1–38. 

Where there is a reference to the Joint Stipulations 

herein, the numbering aligns with the numbering in 

the Government’s Prehearing Statement, GX3, at 1– 

14.] 

The Facts 20

Findings of Fact 

The factual findings below are based 

on a preponderance of the evidence, 

including the detailed, credible, and 

competent testimony of the 

aforementioned witnesses, the exhibits 

entered into evidence, and the record 

before me. 

During the hearing conducted, via 

video teleconference, from September 

28, 2020, to September 30, 2020, the 

Government established the following 

facts through evidence, testimony, or 

stipulation (‘‘Proposed Findings of 

Fact’’ or ‘‘PFF’’): 

I. Investigatory Background 

1. DI has been employed by DEA as 

a Diversion Investigator for three years. 

Tr. 33. 

2. DEA began investigating 

Respondent in April of 2018, after 

receiving a February 2018 report issued 

by the Department of Health and Human 

Services indicating that Respondent’s 

prescribing habits presented a high-risk 

for overprescribing. Tr. 37–38. 

3. DEA monitored California’s 

prescription drug monitoring program, 

known as CURES, and identified several 

red flags regarding Respondent’s 

prescribing. Tr. 35, 38. CURES reports 

obtained by DEA were admitted into 

evidence as GX 16, 17, 18, and 19. Tr. 

16–18; see also Joint Stipulation Nos. 

31–34. Among other things, DEA found 

that; (1) Respondent frequently 

prescribed opioids at their maximum 

strength, Tr. 38–39; (2) Respondent 

frequently prescribed patients a 

combination of an opioid and a 

benzodiazepine, Tr. 39; (3) Respondent 

issued prescriptions for a combination 

of an opioid, a benzodiazepine, and 

carisoprodol—a combination that is 

highly sought after on the illicit market, 

and is known as ‘‘the Holy Trinity,’’ Tr. 

40; (4) Respondent prescribed high 

doses of controlled substances to 

patients for long periods of time, Tr. 40– 

41; (5) between November 20, 2015, and 

November 21, 2018, Respondent issued 

approximately 9,000 prescriptions for 

controlled substances, Tr. 39; GX 16; GX 

17; GX 18; (6) Over half of those 9,000 

prescriptions were for hydrocodone, 

and approximately 96 percent of these 

prescriptions were for either 

hydrocodone, alprazolam, or 

carisoprodol—which together make up 

the ‘‘Holy Trinity’’ cocktail. Tr. 39, 42– 

43; GX 16; GX 17; GX 18. 

4. DEA obtained medical files from 

Respondent, pursuant to a federal 

search warrant executed at 

Respondent’s medical clinic in February 

of 2019, and pursuant to an 

administrative subpoena issued to 

Respondent in January of 2020. Tr. 46, 

49, 49, 55–56. These included medical 

files for Patients S.B., M.B., B.C., J.C., 

D.D., J.M., and K.S. (admitted as GXs 1, 

3, 5, 7, 9, 11, and 14; Tr. 16–18). 

5. DEA also obtained prescriptions for 

the above-mentioned patients (see PFF 

¶ 4) from its search of Respondent’s 

clinic, and from pharmacies at which 

these prescriptions were filled (admitted 

as GXs 2, 4, 6, 8, 10, 12, and 15; Tr. 

16:15–18:3). DEA also obtained fill 

stickers for certain prescriptions issued 

to Patient J.M. from one of the 

pharmacies at which Patient J.M. filled 

prescriptions Respondent issued to 

Patient J.M. (admitted as GX 13; Tr. 

16:15–18:3). 

II. The Government Expert’s 

Qualifications 

6. Dr. Munzing’s curriculum vitae was 

admitted into evidence as GX 23; Tr. 89. 

He is a licensed physician in the State 

of California, who has worked in the 

field of family medicine for nearly forty 

years. Tr. 89. 

7. Dr. Munzing received his medical 

degree from the University of California, 

Los Angeles, in 1982, and did his 

residency at Kaiser Permanente Medical 

Center in Los Angeles. Tr. 89. He then 

began working in the family medicine 

department of Kaiser Permanente 

Orange County, where he has been for 

the last thirty-five years, twice serving 

as president of the medical staff at the 

hospital. Tr. 89, 94. He has a DEA COR 

and an active clinical practice, 

prescribing, inter alia, opioids, 

benzodiazepines, and other controlled 

substances when indicated. Tr. 91–92. 

8. In addition to his clinical practice, 

Dr. Munzing teaches extensively to 

physicians, serving as the director of the 

Kaiser Permanente Orange County 

family medicine residency program. Tr. 

90. Further, he is a full clinical 

professor at University of California, 

Irvine. Tr. 91. He also sits on the 

National Accreditation Board for Family 

Medicine Residency, which accredits all 

of the residency programs in the United 

States of America. Tr. 90–91. 

9. Dr. Munzing has been called upon 

to provide opinions about the 

prescribing of other medical 

professionals, and he has been qualified 

as an expert witness in over 30 cases, 

including in DEA administrative 

hearings. Tr. 93–94. 

10. As a licensed California physician 

who has been practicing in California 

for nearly 40 years, Dr. Munzing is 

familiar with the standard of care for 

prescribing controlled substances in 

California. He also has reviewed 

publications by the Medical Board of 

California that inform his understanding 

of the standard of care, including the 

‘‘Guide to the Laws Governing the 

Practice of Medicine by Physicians and 

Surgeons (7th Edition)’’ (admitted as GX 

20, Tr. 16–18), and the ‘‘Guidelines for 

Prescribing Controlled Substances for 

Pain,’’ (admitted as GX 21, Tr. 16). In 

addition, he is familiar with the FDA’s 

black box warning regarding the risks of 

overdose and death posed by 

concurrently taking opioids and 

benzodiazepines, and the FDA labels for 

benzodiazepines including Klonopin, 

Valium, and Xanax (admitted as GX 22, 

Tr. 16–18). Further, Dr. Munzing 

reviewed several laws and regulations 

that informed his understanding of the 

standard of care. Tr. 99. 

11. Dr. Munzing was qualified as an 

expert in California medical practice, 

including, but not limited to, applicable 

standards of care in California for the 

prescribing of controlled substances 

within the usual course of the 

professional practice of medicine. Tr. 

102. 

III. The Standard of Care for 

Prescribing Controlled Substances in 

California 

12. Dr. Munzing testified that the 

standard of care in California first 

requires that, before prescribing 

controlled substances, a practitioner 

perform a sufficient evaluation of the 

patient, including, a medical history 

and appropriate physical examination. 

Tr. 103. 

a. In the context of treating a patient 

with controlled substances for pain, the 

standard of care in the state of California 

requires the following: 

i. Medical history: The practitioner 

must obtain detailed information about 

the pain, including where the pain is, 

how long a patient has had it, how 

severe the pain is, the impact of the pain 

on the patient’s functionality and 

activities of daily living, and any 

previous diagnoses and treatments the 

patient has received for the pain. The 

practitioner must also seek to obtain any 

relevant prior medical records and 

imaging. Tr. 114–115. 


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*BB The practitioner must determine the risk 

posed to a patient by controlled substances due to 

the patient’s overall health history—as well as the 

potential for substance abuse or addiction. Tr. 103, 

109. This text, which appeared in the RD originally, 

has been relocated for clarity. 

ii. Physical examination: The 

practitioner must look at the area of 

pain unclothed for any swelling, 

redness, or mass. Tr. 116–17. The 

practitioner must palpate the affected 

area and identify areas of particular 

tenderness or pain. Tr. 117–18. The 

practitioner also is required to test a 

patient’s range of motion, as well as the 

patient’s neurological conditions via 

targeted tests for the area affected by 

pain (e.g., tendon reflexes, and strength 

tests for the affected area). Tr. 118–19. 

b. In the context of treating a patient 

with controlled substances for mental 

health conditions, the standard of care 

in the state of California requires the 

following: 

i. Medical history: The practitioner 

must inquire into the patient’s 

condition, including symptoms the 

patient is experiencing, when the 

patient experiences symptoms, how 

those symptoms impact the patient’s 

functionality and activities of daily 

living, when the condition began, and if 

there is a family history of mental health 

issues. The practitioner must also seek 

to obtain any relevant prior medical 

records. Tr. 136–38. 

ii. Physical examination: The 

practitioner must conduct a limited and 

focused general examination, including 

heart, lungs, and vital signs, [to rule out 

other possible medical diagnosis.] Tr. 

138–39. 

13. As part of the medical history, the 

practitioner must inquire into the 

patient’s history of, and/or current use 

or abuse of, tobacco, drugs, or alcohol, 

as well as into any family history of use 

or abuse of tobacco, drugs, or alcohol. 

Tr. 120–21, 142. 

14. Based on the history and physical 

examination, the standard of care 

requires the practitioner to assign a 

diagnosis to the patient. Tr. 103. An 

appropriate history and physical 

examination are crucial to arriving at an 

appropriate diagnosis. Tr. 121–22, 141. 

Without an appropriate diagnosis, a 

practitioner cannot establish a 

legitimate medical purpose to prescribe. 

Tr. 124, 141. [The standard of care 

requires the diagnosis to be documented 

in the record. Tr. 122.] 

15. Next, the standard of care requires 

the practitioner to develop a customized 

and documented treatment plan for the 

patient with goals and objectives. Tr. 

109–110. The practitioner must relay 

that plan to the patient, inform the 

patient of the risks *BB and benefits of 

treatment with controlled substances, as 

well as potential alternative treatments, 

and obtain the patient’s informed 

consent for the treatment. Tr. 103–04, 

124–25. When prescribing high dosages 

of controlled substances, this discussion 

of risks must include risks of addiction, 

overdose, and death. Tr. 126–27. ‘‘All of 

[this] needs to be documented’’ in the 

medical record. Tr. 135. 

a. In the context of treating a patient 

with controlled substances for pain, the 

standard of care in the state of California 

requires that a treatment plan contain 

goals and objectives for pain 

management, such as maximizing 

benefit to function and minimizing 

pain, while also minimizing the risk to 

the patient from the controlled 

substances prescribed. Tr. 131. 

b. In the context of treating a patient 

with controlled substances for mental 

health conditions, the standard of care 

in the State of California still requires 

that the treatment plan contain goals 

and objectives for the patient. Tr. 143. 

c. With respect to risks of 

medications, Dr. Munzing explained 

that practitioner should only coprescribe opioids and benzodiazepines 

when ‘‘absolutely necessary,’’ and 

should do so for ‘‘[n]o longer than 

absolutely necessary and typically in as 

low doses as possible to . . . decrease 

the risk.’’ Tr. 154–55. 

16. As treatment progresses, the 

standard of care requires a physician to 

monitor the patient. Tr. 104, 132. A 

practitioner must periodically update 

the patient’s medical history, conduct 

further physical examinations, and 

obtain updated information regarding 

the etiology of a patient’s state of health. 

Tr. 106–08. The practitioner must 

periodically review the course of 

treatment, ascertain how the patient is 

responding thereto, determine if 

continued treatment is appropriate or if 

the treatment plan needs to be modified, 

and document the rationale for any 

modifications. Tr. 108–09, 206; GX 20 at 

61. The practitioner must also 

periodically re-inquire into the patient’s 

use or abuse of tobacco, drugs, or 

alcohol. Tr. 259–60. 

17. The practitioner must also 

periodically conduct updated physical 

examinations, both brief general 

examinations to ensure that the patient 

is healthy enough to continue receiving 

controlled substances, as well as 

focused examinations of the area for 

which pain is being treated to help in 

determining how the patient is 

responding to treatment. Tr. 111–12. 

18. When prescribing controlled 

substances, the standard of care in 

California also requires a practitioner to 

monitor medication compliance, 

including thorough reviews of CURES, 

Tr. 132, periodic urine drug screening, 

Tr. 133, and/or pill counts. Id. The 

practitioner must address any red flags 

of abuse or diversion. Tr. 112. 

19. In addition, the standard of care 

requires that a practitioner document all 

of these above steps in detail. See, e.g., 

Tr. 104, 109, 110, 112, 122, 135, 144. 

Such documentation is critically 

important as it: (1) enables the 

practitioner to recall important facts 

about the patient’s state of health and 

treatment, Tr. 145, 146; and (2) allows 

other practitioners who may also see the 

patient to see these facts. Tr. 145–146. 

20. Appropriate documentation is a 

well-known, fundamental requirement 

in the medical community. Tr. 146. 

[According to Dr. Munzing, ‘‘[t]he 

general mantra in medicine [is] . . . if 

[it is] not documented, it [did not] 

happen.’’ Tr. 148. Thus, it is not 

credible that a practitioner who 

consistently failed to document these 

basic elements for a patient actually 

performed them. Tr. 148–50. 

21. The practitioner must also comply 

with all relevant California laws. 

IV. Respondent’s Improper Prescribing 

of Controlled Substances 

A. Patient S.B. 

i. Patient S.B.’s Initial Visit 

22. Between February 2, 2017, and 

January 30, 2019, Respondent issued 

Patient S.B. the controlled substance 

prescriptions listed in Joint Stipulation 

No. 10. See ALJ Ex. 3 at 2–3. During this 

time, Respondent diagnosed Patient S.B. 

with fibromyalgia, GAD, and ADD. GX 

1 at 47–59. 

23. Respondent’s initial encounter 

with Patient S.B. took place on August 

3, 2016. GX 1 at 62, 66; Tr. 164–65. At 

that visit, Respondent diagnosed Patient 

S.B. with fibromyalgia, GAD, and ADD. 

GX 1 at 62; Tr. 165. Respondent 

prescribed Patient S.B. hydrocodone for 

fibromyalgia, Xanax for GAD, and 

Adderall for ADD. GX 1 at 62; Tr. 165. 

At this initial visit, Respondent failed 

to: 

a. Take an appropriate medical 

history, GX 1 at 62; Tr. 166–68; 

b. address Patient S.B.’s pain or 

functionality levels, GX 1 at 62; Tr. 171; 

c. conduct an appropriate physical 

examination, GX 1 at 62; Tr. 166, 168– 

71; 

d. establish appropriate diagnoses, 

and therefore to establish legitimate 

medical purposes for hydrocodone, 

Xanax, or Adderall, Tr. 171–72; or 

e. establish and document a treatment 

plan with goals and objectives, GX 1 at 

62; Tr. 172–73. 


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*CC I have made this change for S.B. and each of 

the subsequent patients for legal clarity pursuant to 

supra n. *HH. 

ii. Continued Controlled Substance 

Prescribing Violations 

24. Throughout the entire course of 

treatment, Respondent never obtained a 

proper medical history of Patient S.B., 

never recorded Patient S.B.’s pain or 

functionality levels, never obtained 

prior medical records for Patient S.B.— 

nor does Patient S.B.’s medical file 

reflect Respondent requested such 

records—failed to periodically update 

Patient S.B.’s medical history as 

treatment progressed, and never 

conducted a sufficient physical 

examination for fibromyalgia. See 

generally GX 1; Tr. 241–43. 

25. None of Respondent’s diagnoses of 

Patient S.B. for which he prescribed 

controlled substances were based on 

sufficient clinical evidence. Tr. 243. 

26. Over the course of his treatment 

of Patient S.B., Respondent’s diagnoses 

of Patient S.B. for ADD, GAD and 

fibromyalgia came and went without 

explanation or comment. See generally 

GX 1; Tr. 188, 193–95. Fibromyalgia and 

ADD are chronic diagnoses. Tr. 188, 

193. These erratic diagnoses were 

outside of the standard of care, 

[especially since these diagnoses,] 

including those made between February 

2, 2017, and January 30, 2019, [were not 

supported by an adequate medical 

history and physical examination].*CC

Tr. 191–92; 195–97. 

27. Respondent sometimes prescribed 

Patient S.B. both hydrocodone and 

Soma, and sometimes only 

hydrocodone, for fibromyalgia. See GX 

1 at 47–59; Tr. 197:3–17. Respondent 

never documented any rationale for 

changing Patient S.B.’s course of 

medication in violation of the California 

standard of care. See GX 1 at 47–59; PFF 

¶ 16; Tr. 199–200. 

28. Respondent never documented an 

appropriate treatment plan with goals 

and objectives for Patient S.B., never 

documented an appropriate rationale for 

continued treatment of Patient S.B. with 

controlled substances, and failed to 

properly discuss the risks and benefits 

of the controlled substances he 

prescribed to Patient S.B. See generally 

GX 1; Tr. 243. 

29. Respondent also prescribed 

Patient S.B. the following dangerous 

combinations of controlled substances 

that put Patient S.B. at serious risk of 

adverse medical consequences, 

including addiction, overdose, and 

death. Tr. 203–05: 

a. Hydrocodone, Adderall, and Soma 

on February 2, 2017, May 8, 2017, June 

2, 2017, August 1, 2017, August 30, 

2017, November 6, 2017, and January 

23, 2018. ALJ Ex. 3 at 2–3. 

b. Hydrocodone, Adderall, and Xanax 

on March 1, 2017, April 4, 2017, June 

28, 2017. ALJ Ex. 3 at 2–3. 

c. Hydrocodone and Adderall on 

September 29, 2017, July 2018, and in 

August 2018, September 2018, October 

2018, and November 2018. ALJ Ex. 3 at 

3. 

30. Respondent’s prescriptions to 

Patient S.B. for Xanax between February 

2, 2017, and January 30, 2019, were all 

for 6 mg of Xanax per day. GX 1 at 57– 

59; Tr. 212–13. The maximum 

recommended dosage for Xanax for 

treatment of GAD is 4 mg per day, 

according to the FDA label for Xanax. 

GX 22 at 59; Tr. 213. Prescribing such 

high dosages of Xanax placed Patient 

S.B. at risk of potentially lethal 

withdrawal, and presented risks of 

diversion. Tr. 217, 218–19. The fact that 

Respondent prescribed Xanax to Patient 

S.B. concurrently with opioids, see ALJ 

Ex. 3 at 2–3, dramatically increased her 

risk of overdose and death. Tr. 217–18. 

31. Respondent noted, on fifteen 

occasions between February 2, 2017, 

and December 21, 2018, that Patient S.B. 

was opioid dependent and refusing 

detoxification. GX 1 at 49–59. Refusal to 

detoxify is a significant red flag of abuse 

or diversion, indicating the prescriber 

feels the patient needs to detoxify, but 

the patient refuses. Tr. 221–22. 

Respondent never addressed this red 

flag, but simply continued to prescribe 

the patient opioids on an as-needed 

basis. GX 1 at 49–59; Tr. 222. 

Prescribing opioids to the patient on an 

as-needed basis when a patient is 

refusing detoxification is particularly 

inappropriate, because any prescribed 

opioids must be carefully controlled. Tr. 

223. 

32. Patient S.B. provided inconsistent 

information to other providers; she told 

an orthopedic surgeon during a June 28, 

2017 visit that she had only a past 

medical history of anxiety (with no 

mention of fibromyalgia or ADD), and 

she did not disclose taking any 

medications when she was receiving 

hydrocodone, Soma, Adderall, and 

Xanax from Respondent. See GX 1 at 30, 

57. Patient S.B. also informed the 

orthopedic surgeon that she had no 

history of trauma, see GX 1 at 30, but 

reported to the California Employment 

Development Department that she was 

disabled as a result of accident or 

trauma that had occurred on June 15, 

2017, see GX 1 at 40. These inconsistent 

reports were significant red flags of 

abuse or diversion. Tr. 230, 231–32. 

Respondent, however, never addressed 

these red flags. Tr. 233, 235–37. 

33. Respondent never conducted a 

urine drug screen on Patient S.B. in 

violation of the California standard of 

care. Tr. 219:13–16; PFF ¶ 18; see 

generally GX 1. 

34. None of the controlled substance 

prescriptions Respondent issued to 

Patient S.B. between February 2, 2017, 

and January 30, 2018, were issued for a 

legitimate medical purpose, or by a 

practitioner acting within the usual 

course of professional practice. Tr. 244. 

Indeed, according to Dr. Munzing, no 

patient should receive the drugs that 

Respondent prescribed to Patient S.B. in 

the dosages, durations, and 

combinations that Respondent 

prescribed. Tr. 211–12. 

B. Patient M.B. 

35. Between January 5, 2018, and 

November 20, 2019, Respondent issued 

to Patient M.B. the controlled substance 

prescriptions listed in Joint Stipulation 

No. 13. See ALJ Ex. 3 at 4–5. During this 

time, Respondent diagnosed Patient 

M.B. with back pain, ADD, and opioid 

dependency. GX 3 at 24–37. 

i. Patient M.B.’s Initial Visit and the 

First Diagnosis for ADD 

36. Respondent’s initial encounter 

with Patient M.B. took place on April 

19, 2006. GX 3 at 84, 91; Tr. 248–49. At 

that visit, Respondent diagnosed Patient 

M.B. with chronic back pain, chronic 

left knee pain, and dyslipidemia. GX 3 

at 84; Tr. 250–51. Respondent 

prescribed Patient M.B. hydrocodone for 

chronic back and left knee pain. GX 3 

at 84. At this initial visit, Respondent 

failed to: 

a. Take an appropriate medical 

history, GX 3 at 84; Tr. 252–54; 

b. address Patient M.B.’s pain or 

functionality levels, GX 3 at 84; Tr. 257; 

c. conduct an appropriate physical 

examination, GX 3 at 84; Tr. 254–56, 

257; 

d. establish appropriate diagnoses for 

back pain and knee pain and therefore 

to establish a legitimate medical 

purpose to prescribe hydrocodone, Tr. 

258; or 

e. establish and document a treatment 

plan with goals and objectives, GX 3 at 

84; Tr. 258. 

37. Respondent first diagnosed Patient 

M.B. with ADD on July 9, 2013, and 

prescribed 30 mg of Adderall per day. 

GX 3 at 46. No history was taken, nor 

evaluations performed, for ADD other 

than a note saying Patient M.B. 

presented as a ‘‘40 yom with ADD, 

neck[ ]pain.’’ GX 3 at 46; Tr. 262. 

Nothing supported Respondent’s 

diagnosis for ADD, and he did not 

establish a legitimate medical purpose 

to prescribe Adderall. Tr. 263. Nor did 


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he establish and document a treatment 

plan with goals and objectives for the 

Adderall. GX 3 at 46; Tr. 263. 

ii. Continued Controlled Substance 

Violations 

38. Throughout the entire course of 

treatment, Respondent never obtained a 

proper medical history of Patient M.B., 

recorded Patient M.B.’s pain or 

functionality levels, or obtained prior 

medical records for Patient M.B.—nor 

does Patient M.B.’s medical file reflect 

Respondent requested such records— 

failed to periodically update Patient 

M.B.’s medical history as treatment 

progressed, and never conducted a 

sufficient physical examination for pain. 

See generally GX 3; Tr. 287–88. 

39. None of Respondent’s diagnoses of 

Patient M.B. for which he prescribed 

controlled substances between January 

5, 2018, and November 20, 2019, were 

based on sufficient medical evidence. 

Tr. 288. 

40. Over the course of his treatment 

of Patient M.B., Respondent frequently 

changed without comment the 

diagnoses for which he prescribed 

Patient M.B. hydrocodone. See generally 

GX 3; Tr. 275–78. These erratic 

diagnoses were outside of the standard 

of care, [especially because these 

diagnoses], including those made 

between January 5, 2018, and November 

20, 2019, [were not supported by an 

adequate medical history and physical 

examination.] Tr. 278–80. 

41. Other than inquiring into smoking 

and alcohol use at Patient M.B.’s initial 

visit, see GX 3 at 84, Respondent did not 

inquire about current or past substance 

abuse until over three years later, on 

August 11, 2009, when he had Patient 

M.B. sign a form stating ‘‘I have no 

history of drug abuse, nor was I treated 

for drug or substance abuse in the past.’’ 

GX 3 at 94. Patient M.B. was never 

asked about substance abuse again— 

something the California standard of 

care required Respondent to do. PFF 

¶ 16; Tr. 261; see generally GX 3. 

42. Respondent never documented an 

appropriate treatment plan with goals 

and objectives for Patient M.B., never 

documented an appropriate rationale for 

continued treatment of Patient M.B. 

with controlled substances, and failed to 

properly discuss the risks and benefits 

of the controlled substances he 

prescribed to Patient M.B. See generally 

GX 3; Tr. 288–89. 

43. Respondent also prescribed 

Patient M.B. dangerous combinations of 

hydrocodone and Adderall 

approximately monthly from January 

2018, until July 2019, and once again on 

November 20, 2019. ALJ Ex. 3 at 4–5. 

These combinations put Patient M.B. at 

serious risk of adverse medical 

consequences, including addiction, 

overdose, and death. Tr. 105–06, 281. 

44. Respondent noted, on at least 11 

occasions between March 6, 2018, and 

February 4, 2019, that Patient M.B. was 

opioid dependent, and refusing 

detoxification. GX 3 at 30, 32–36. 

Respondent never addressed this red 

flag, but simply continued to prescribe 

the patient hydrocodone on an asneeded basis. GX 3 at 30, 32–36; see also 

Tr. 286–87. 

45. Indeed, Respondent frequently 

prescribed Patient M.B. hydrocodone as 

a treatment for the patient’s opioid 

dependency, including on March 6, 

2018, May 1, 2018, August 16, 2018, 

September 13, 2018, October 11, 2018, 

November 7, 2018, and January 2, 2019. 

GX 3 at 30, 32–36. 

46. Opioid dependency does not 

create a legitimate medical purpose to 

prescribe hydrocodone. To the contrary, 

treating a patient’s opioid dependency 

with hydrocodone is outside of the 

standard of care and outside the usual 

course of professional practice. Tr. 267– 

69. 

47. Respondent never conducted a 

urine drug screen on Patient M.B., in 

violation of the California standard of 

care. Tr. 284; PFF ¶ 18; see generally GX 

3. 

48. None of the controlled substance 

prescriptions Respondent issued to 

Patient M.B. between January 5, 2018, 

and November 20, 2019, were issued for 

a legitimate medical purpose or by a 

practitioner acting within the usual 

course of professional practice. Tr. 289– 

90. According to Dr. Munzing, there is 

nearly no situation in which a patient 

should receive the drugs that 

Respondent prescribed to Patient M.B. 

from January 5, 2018, to November 20, 

2019, in those dosages, durations, and 

combinations, and Patient M.B. did not 

present any such situation. Tr. 283–84. 

C. Patient B.C. 

49. Between January 25, 2017, and 

December 19, 2019, Respondent issued 

to Patient B.C. the controlled substance 

prescriptions listed in Joint Stipulation 

No. 16. See ALJ Ex. 3 at 5–7. During this 

time, Respondent diagnosed Patient B.C. 

with back pain, GAD, ADD, and opioid 

dependency. GX 5 at 17–33. 

i. Patient B.C.’s Initial Visit and the First 

Diagnosis for ADD 

50. Respondent’s initial encounter 

with Patient B.C. took place on March 

27, 2014. GX 5 at 48, 55; Tr. 293:1–16. 

At that visit, Respondent diagnosed 

Patient B.C. with GAD and back pain. 

GX 5 at 48; Tr. 294. Respondent 

prescribed Patient B.C. hydrocodone for 

back pain and 6 mg of Xanax for GAD. 

GX 5 at 48; Tr. 294. At this initial visit, 

Respondent failed to: 

a. Take an appropriate medical 

history, GX 5 at 84; Tr. 295:7–296:15; 

b. address Patient B.C.’s pain or 

functionality levels, GX 5 at 84; Tr. 297– 

98; 

c. conduct an appropriate physical 

examination, GX 5 at 84; Tr. 296:16– 

297; 

d. establish an appropriate diagnosis 

for back pain or GAD as necessary to 

establish a legitimate medical purpose 

to prescribe hydrocodone or Xanax, Tr. 

298–99; or 

e. establish and document a treatment 

plan with goals and objectives, GX 5 at 

85; Tr. 299. 

51. Respondent only inquired about 

Patient B.C.’s substance abuse on March 

27, 2014. See GX 5 at 48, 57; Tr. 296, 

299. Patient B.C. was never asked about 

substance abuse again—something the 

California standard of care required 

Respondent to do. PFF ¶ 16; Tr. 300; see 

generally GX 5. 

52. Respondent first diagnosed Patient 

B.C. with ADD on May 20, 2014, and 

prescribed 60 mg of Adderall per day. 

GX 5 at 47. He took no history, and 

performed no evaluations, for ADD, 

other than a note saying ‘‘Pt has ADD— 

give [A]dderall 30mg bid (SED).’’ Id. 

Respondent’s diagnosis for ADD was 

unsupported; he did not establish a 

legitimate medical purpose to prescribe 

Adderall, nor did he establish and 

document a treatment plan with goals 

and objectives. GX 5 at 47; Tr. 302. 

ii. Continued Controlled Substance 

Violations 

53. Throughout the entire course of 

treatment, Respondent never obtained a 

proper medical history of Patient B.C., 

never recorded Patient B.C.’s pain or 

functionality levels, failed to 

periodically update Patient B.C.’s 

medical history as treatment progressed, 

and never conducted a sufficient 

physical examination for pain. See 

generally GX 5; Tr. 335–36. 

54. None of Respondent’s diagnoses of 

Patient B.C. for which he prescribed 

controlled substances between January 

25, 2017, and December 19, 2019, were 

based on sufficient medical evidence. 

Tr. 336. 

55. Over the course of his treatment 

of Patient B.C., Respondent’s diagnoses 

for pain, GAD, and ADD frequently 

came and went without comment or 

explanation. See generally GX 5; Tr. 

316–19; 319–21; 322–25. Like chronic 

pain and GAD, ADD is a chronic 

condition. Tr. 167:13–16. These erratic 

diagnoses were outside of the standard 

of care, [especially since these 


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diagnoses,] including those made 

between January 25, 2017, and 

December 19, 2019, [were not supported 

by an adequate medical history and 

physical examination.] Tr. 318–19; 321– 

22; 325–26. 

56. Respondent never documented an 

appropriate treatment plan with goals 

and objectives for Patient B.C., never 

documented an appropriate rationale for 

continued treatment of Patient B.C. with 

controlled substances, and failed to 

properly discuss the risks and benefits 

of the controlled substances he 

prescribed to Patient B.C. See generally 

GX 5; Tr. 337. 

57. Respondent also prescribed 

Patient B.C. the following dangerous 

combinations of controlled substances, 

which put Patient B.C. at serious risk of 

adverse medical consequences, 

including addiction, overdose and 

death. Tr. 326–30: 

a. Hydrocodone, Adderall, and Xanax 

on January 25, 2017, April 18, 2017, 

June 19, 2017, and July 31, 2018. ALJ 

Ex. 3 at 5–6. 

b. Hydrocodone and Xanax on May 

19, 2017, and approximately monthly 

from February 16, 2018, until July 3, 

2018. ALJ Ex. 3 at 5–06. 

c. Hydrocodone and Adderall on 

September 25, 2018, December 19, 2018, 

February 13, 2019, April 9, 2019, June 

5, 2019, July 30, 2019, October 25, 2019, 

and December 19, 2019. ALJ Ex. 3 at 5– 

7. 

58. Respondent’s prescriptions to 

Patient B.C. for Xanax between January 

25, 2017, and July 31, 2018, were all for 

6 mg of Xanax per day. GX 5 at 28–33. 

Such high dosages of Xanax placed 

Patient B.C. at risk of potentially lethal 

withdrawal, and presented risks of 

diversion. Tr. 294–95. The fact that 

Respondent prescribed Xanax to Patient 

B.C. concurrently with opioids, see ALJ 

Ex. 3 at 5–6, dramatically increased his 

risk of overdose and death. Tr. 295. 

59. Respondent noted, on 19 

occasions between January 25, 2017, 

and February 13, 2019, that Patient B.C. 

was opioid dependent, and refusing 

detoxification. GX 5 at 23, 25–33. 

Respondent never addressed this red 

flag, but simply continued to prescribe 

the patient hydrocodone on an asneeded basis. GX 5 at 23, 25–33; see also 

Tr. 333–34. 

60. Indeed, Respondent frequently 

improperly and illegally prescribed 

Patient B.C. hydrocodone as a treatment 

for the patient’s opioid dependency, 

including on January 25, 2017, June 19, 

2017, July 17, 2017, March 26, 2018, 

May 11, 2018, July 3, 2018, August 28, 

2018, October 22, 2018, December 19, 

2018, and February 13, 2019. GX 5 at 23, 

25–33; Tr. 306–07. 

61. Respondent never conducted a 

urine drug screen on Patient B.C., in 

violation of the California standard of 

care. Tr. 333; PFF ¶ 18; see generally GX 

5. 

62. None of the controlled substance 

prescriptions Respondent issued to 

Patient B.C. between January 25, 2017, 

and December 19, 2019, were issued for 

a legitimate medical purpose or by a 

practitioner acting within the usual 

course of professional practice. Tr. 289– 

90. According to Dr. Munzing, there is 

nearly no situation in which a patient 

should receive the drugs that 

Respondent prescribed to Patient B.C. 

from January 25, 2017, to December 19, 

2019, in those dosages, durations, and 

combinations, and Patient B.C. did not 

present any such situation. Tr. 337–38. 

D. Patient J.C. 

63. Between January 16, 2018, and 

December 30, 2019, Respondent issued 

to Patient J.C. the controlled substance 

prescriptions listed in Joint Stipulation 

No. 19. See ALJ Ex. 3 at 7–8. During this 

time, Respondent diagnosed Patient J.C. 

with back pain, GAD, and opioid 

dependency. GX 7 at 168–180. 

i. Patient J.C.’s Initial Visit and the First 

Diagnosis for Back Pain 

64. Respondent’s initial encounter 

with Patient J.C. took place on May 18, 

2009. GX 7 at 216, 233; Tr. 383:1–384:5. 

At that visit, Respondent diagnosed 

Patient J.C. with migraine headaches 

and GAD. GX 7 at 216; Tr. 384. 

Respondent prescribed Patient J.C. 

hydrocodone for migraines and Xanax 

for GAD. GX 7 at 216; Tr. 384. At this 

initial visit, Respondent failed to: 

a. Take an appropriate medical 

history, GX 7 at 216; Tr. 385–86; 

b. address Patient J.C.’s pain or 

functionality levels, GX 7 at 216; Tr. 

387; 

c. conduct an appropriate physical 

examination, GX 7 at 216; Tr. 386:16– 

387:3; 

d. establish appropriate diagnoses for 

migraines or GAD and so establish a 

legitimate medical purpose to prescribe 

hydrocodone or Xanax, Tr. 387–88; or 

e. establish and document a treatment 

plan with goals and objectives, GX 7 at 

216; Tr. 388. 

65. Respondent first diagnosed Patient 

J.C. with back pain on July 21, 2016, and 

prescribed hydrocodone. GX 7 at 189. 

There was no history taken, or 

evaluations performed, for back pain, 

other than a note saying Patient J.C. 

presented as a ‘‘39 yom with GAD, 

chronic back pain.’’ Id. Respondent’s 

diagnosis for back pain was 

unsupported; he did not establish a 

legitimate medical purpose to prescribe 

hydrocodone, nor did he establish and 

document a treatment plan with goals 

and objectives. Tr. 391, 392–93, 393–94. 

ii. Continued Controlled Substance 

Violations 

66. Throughout the entire course of 

treatment, Respondent never obtained a 

proper medical history of Patient J.C., 

never recorded Patient J.C.’s pain or 

functionality levels, never obtained 

prior medical records for Patient J.C.— 

nor does Patient J.C.’s medical file 

reflect Respondent requested such 

records—failed to periodically update 

Patient J.C.’s medical history as 

treatment progressed, and never 

conducted a sufficient physical 

examination for pain. See generally GX 

7; Tr. 424–26. 

67. None of Respondent’s diagnoses of 

Patient J.C. for which he prescribed 

controlled substances between January 

16, 2018, and December 30, 2019, were 

based on sufficient medical evidence. 

Tr. 426. 

68. Over the course of his treatment 

of Patient J.C., Respondent frequently 

changed without comment the 

diagnoses for which he prescribed 

Patient J.C. opioids, as well as the 

opioids prescribed. See generally GX 7; 

Tr. 409–14. These erratic diagnoses 

were outside of the standard of care, 

[especially since those diagnoses,] 

including those made between January 

16, 2018, and December 30, 2019, [were 

not supported by an adequate medical 

history and physical examination.] Tr. 

414–15. 

69. Other than inquiring into smoking 

and alcohol use at Patient J.C.’s initial 

visit, see GX 7 at 216, Respondent did 

not inquire about current or past 

substance abuse until August 17, 2009, 

when he had Patient J.C. sign a form 

stating, ‘‘I have no history of drug abuse, 

nor was I treated for drug or substance 

abuse in the past.’’ GX 7 at 227. Patient 

J.C. was never asked about substance 

abuse again—something the California 

standard of care required Respondent to 

do. PFF ¶ 16; Tr. 359–60; see generally 

GX 7. 

70. Respondent never documented an 

appropriate treatment plan with goals 

and objectives for Patient J.C., never 

documented an appropriate rationale for 

continued treatment of Patient J.C. with 

controlled substances, and failed to 

properly discuss the risks and benefits 

of the controlled substances he 

prescribed to Patient J.C. See generally 

GX 7; Tr. 426–27. 

71. Respondent also prescribed 

Patient J.C. dangerous combinations of 

hydrocodone and Valium approximately 

monthly from January 16, 2018, until 

January 18, 2019, and once again on 


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May 6, 2019. ALJ Ex. 3 at 7–8. These 

combinations put Patient J.C. at serious 

risk of adverse medical consequences, 

including addiction, overdose, and 

death. Tr. 417–18. 

72. Respondent noted, on 14 

occasions between January 16, 2018, 

and February 19, 2019, that Patient J.C. 

was opioid dependent, and refusing 

detoxification. GX 7 at 173, 175–180. 

Respondent never addressed this red 

flag, but simply continued to prescribe 

the patient hydrocodone on an asneeded basis. GX 7 at 173, 175–80; see 

also Tr. 423–24. 

73. Indeed, Respondent frequently 

improperly and illegally prescribed 

Patient J.C. hydrocodone as a treatment 

for the patient’s opioid dependency, 

including on February 16, 2018, April 

16, 2018, June 15, 2018, August 15, 

2018, October 17, 2018, and December 

13, 2018. GX 7 at 175–80; Tr. 398–400. 

74. Respondent never conducted a 

urine drug screen on Patient J.C., in 

violation of the California standard of 

care. Tr. 421; PFF ¶ 18; see generally GX 

7. 

75. None of the controlled substance 

prescriptions Respondent issued to 

Patient J.C. between January 16, 2018, 

and December 30, 2019, were issued for 

a legitimate medical purpose or by a 

practitioner acting within the usual 

course of professional practice. Tr. 427– 

28. According to Dr. Munzing, there is 

nearly no situation in which a patient 

should receive the drugs that 

Respondent prescribed to Patient J.C. 

from January 16, 2018, to December 30, 

2019, in those dosages, durations, and 

combinations, and Patient J.C. did not 

present any such situation. Tr. 418–19. 

E. Patient D.D. 

76. Between January 4, 2018, and 

February 12, 2019, Respondent issued to 

Patient D.D. the controlled substance 

prescriptions listed in Joint Stipulation 

No. 22. See ALJ Ex. 3 at 9. During this 

time, Respondent diagnosed Patient 

D.D. with back pain, GAD, and opioid 

dependency. GX 9 at 37–43. 

i. Patient D.D.’s Initial Visit 

77. Respondent’s initial encounter 

with Patient D.D. took place on July 9, 

2008. GX 9 at 74, 80; Tr. 430–31. At that 

visit, Respondent diagnosed Patient 

D.D. with GAD and back pain. GX 9 at 

74; Tr. 431. Respondent prescribed 

Patient D.D. hydrocodone and Soma for 

back pain, and Valium for GAD. GX 9 

at 74; Tr. 431. At this initial visit, 

Respondent failed to: 

a. Take an appropriate medical 

history, GX 9 at 74; Tr. 433–34; 

b. address Patient D.D.’s pain or 

functionality levels, GX 9 at 74; Tr. 435– 

36; 

c. conduct an appropriate physical 

examination, GX 9 at 74; Tr. 434–35; 

d. establish appropriate diagnoses for 

back pain or GAD and so to establish a 

legitimate medical purpose to prescribe 

hydrocodone, Soma, or a 

benzodiazepine, Tr. 436:3–21; or 

e. establish and document a treatment 

plan with goals and objectives, GX 9 at 

74; Tr. 436:22–25. 

ii. Continued Controlled Substance 

Violations 

78. Throughout the entire course of 

treatment, Respondent never obtained a 

proper medical history of Patient D.D., 

never recorded Patient D.D.’s pain or 

functionality levels, never obtained 

prior medical records for Patient D.D.— 

nor does Patient D.D.’s medical file 

reflect Respondent requested such 

records—failed to periodically update 

Patient D.D.’s medical history as 

treatment progressed, and never 

conducted a sufficient physical 

examination for pain. See generally GX 

9; Tr. 465–66. 

79. None of Respondent’s diagnoses of 

Patient D.D. for which he prescribed 

controlled substances between January 

4, 2018, and February 12, 2019, were 

based on sufficient medical evidence. 

Tr. 467. 

80. Over the course of his treatment 

of Patient D.D., Respondent frequently 

changed without comment the 

diagnoses for which he prescribed 

Patient D.D. opioids. See generally GX 

9; Tr. 450–56. These erratic diagnoses 

were outside of the standard of care, 

[especially since these diagnoses,] 

including those made between January 

4, 2018, [were not supported by an 

adequate medical history and physical 

examination.] Tr. 453–56. 

81. Other than inquiring into smoking 

and alcohol use at Patient D.D.’s initial 

visit, see GX 9 at 74, Respondent did not 

inquire about current or past substance 

abuse until over one year later, on 

August 28, 2009, when he had Patient 

D.D. sign a form stating ‘‘I have no 

history of drug abuse, nor was I treated 

for drug or substance abuse in the past.’’ 

GX 9 at 77. Respondent never asked 

Patient D.D. about substance abuse 

again—something the California 

standard of care required Respondent to 

do. PFF ¶ 16; see generally GX 9. 

82. Respondent never documented an 

appropriate treatment plan with goals 

and objectives for Patient D.D., never 

documented an appropriate rationale for 

continued treatment of Patient D.D. with 

controlled substances, and failed to 

properly discuss the risks and benefits 

of the controlled substances he 

prescribed to Patient D.D. See generally 

GX 9; Tr. 467. 

83. Respondent also prescribed 

Patient D.D. the following dangerous 

combinations of controlled substances, 

which put Patient D.D. at serious risk of 

adverse medical consequences, 

including addiction, overdose, and 

death, Tr. 457–58: 

a. Hydrocodone and Soma 

approximately monthly from January 4, 

2018, through August 10, 2018, and 

October 16, 2018, through January 11, 

2019. ALJ Ex. 3 at 9. 

b. Hydrocodone and Xanax on 

September 19, 2018. ALJ Ex. 3 at 9. 

84. Respondent noted, on 10 

occasions between January 16, 2018, 

and February 12, 2019, that Patient D.D. 

was opioid dependent and refusing 

detoxification. GX 9 at 37, 39–43. 

Respondent never addressed this red 

flag, but simply continued to prescribe 

the patient hydrocodone on an asneeded basis. GX 9 at 37, 39–43.; see 

also Tr. 463–65. 

85. Indeed, Respondent frequently 

illegally and improperly prescribed 

Patient D.D. hydrocodone as a treatment 

for the patient’s opioid dependency, 

including on March 23, 2018, July 6, 

2018, August 10, 2018, October 16, 

2018, December 13, 2018, and February 

12, 2019. GX 9 at 37, 39–43; Tr. 454. 

Moreover, on all of those occasions 

except February 12, 2019, Respondent 

also prescribed Patient D.D. Soma for 

his opioid dependency. Soma is not 

indicated as a treatment for opioid 

dependency, and prescribing it to treat 

opioid dependency is outside the usual 

course of professional practice. GX 9 at 

39–43; Tr. 454–55. 

86. Although Patient D.D. presented a 

risk of abuse or diversion, Respondent 

never conducted a urine drug screen on 

Patient D.D., in violation of the 

California standard of care. Tr. 461–62; 

PFF ¶ 18; see generally GX 9. 

87. None of the controlled substance 

prescriptions Respondent issued to 

Patient D.D. between January 4, 2018, 

and February 12, 2019, were issued for 

a legitimate medical purpose or by a 

practitioner acting within the usual 

course of professional practice. Tr. 

468:4–16. According to Dr. Munzing, 

there is nearly no situation in which any 

patient should receive the drugs that 

Respondent prescribed to Patient D.D. 

between January 4, 2018, and February 

12, 2019, in those dosages, durations, 

and combinations, and Patient D.D. did 

not present any such situation. Tr. 460– 

61. 


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*DDWhether or not Respondent was knowingly 

assisting J.M. in diversion was not material to my 

decision in this matter as the overwhelming 

evidence already established that Respondent 

issued the relevant prescriptions outside the usual 

course of professional practice and beneath the 

standard of care in California. 

F. Patient J.M. 

88. Between January 10, 2017, and 

December 31, 2019, Respondent issued 

to Patient J.M. the controlled substance 

prescriptions listed in Joint Stipulation 

No. 25. See ALJ Ex. 3 at 10–12. During 

this time, Respondent diagnosed Patient 

J.M. with back pain, GAD, and opioid 

dependency. GX 11 at 18–42. 

i. Patient J.M.’s Initial Visit 

89. Respondent’s initial encounter 

with Patient J.M. took place on May 14, 

2007. GX 11 at 104, 111; Tr. 471. At that 

visit, Respondent diagnosed Patient J.M. 

with, inter alia, back pain and GAD. GX 

11 at 104; Tr. 472. Respondent 

prescribed Patient J.M. hydrocodone for 

back pain and 6 mg of Xanax per day 

for GAD. GX 11 at 104; 472. At this 

initial visit, Respondent failed to: 

a. Take an appropriate medical 

history, GX 11 at 104; Tr. 473–74 

b. address Patient J.M.’s pain or 

functionality levels, GX 11 at 104; Tr. 

474–75; 

c. conduct an appropriate physical 

examination, GX 11 at 104; Tr. 474; 

d. establish an appropriate diagnosis 

for back pain and so establish a 

legitimate medical purpose to prescribe 

hydrocodone or Soma, Tr. 475; or 

e. establish and document a treatment 

plan with goals and objectives, GX 11 at 

104; Tr. 475–76. 

ii. Controlled Substance Violations 

90. Throughout the entire course of 

treatment, Respondent never obtained a 

proper medical history of Patient J.M., 

never recorded Patient J.M.’s pain or 

functionality levels, never obtained 

prior medical records for Patient J.M.— 

nor does Patient J.M.’s medical file 

reflect Respondent requested such 

records—failed to periodically update 

Patient J.M.’s medical history as 

treatment progressed, and never 

conducted a sufficient physical 

examination for pain. See generally GX 

11; Tr. 564–66. 

91. None of Respondent’s diagnoses of 

Patient J.M. for which he prescribed 

controlled substances between January 

10, 2017, and December 31, 2019, were 

based on sufficient medical evidence. 

Tr. 566. 

92. Over the course of his treatment 

of Patient J.M., Respondent frequently 

changed without comment the 

diagnoses for which he prescribed 

Patient J.M. hydrocodone. See generally 

GX 11; Tr. 502–03, 504. These erratic 

diagnoses were outside of the standard 

of care, [especially since these 

diagnoses,] including those made 

between January 10, 2017, [were not 

supported by an adequate medical 

history and physical examination.] Tr. 

503–04. 

93. Other than inquiring into smoking 

and alcohol use at Patient J.M.’s initial 

visit, see GX 11 at 104; Tr. 475, 

Respondent did not inquire about 

substance abuse until over two years 

later, on September 21, 2009, when he 

had Patient J.M. sign a form stating ‘‘I 

have no history of drug abuse, nor was 

I treated for drug or substance abuse in 

the past.’’ GX 11 at 115. Respondent 

never asked Patient J.M. about substance 

abuse again as required by the California 

standard of care. PFF ¶ 16; Tr. 481–82; 

see generally GX 11. 

94. Respondent never documented an 

appropriate treatment plan with goals 

and objectives for Patient J.M., never 

documented an appropriate rationale for 

continued treatment of Patient J.M. with 

controlled substances, and failed to 

properly discuss the risks and benefits 

of the controlled substances he 

prescribed to Patient J.M. See generally 

GX 11; Tr. 566–67. 

95. Respondent also prescribed 

Patient J.M. the following dangerous 

combinations of controlled substances, 

which put Patient J.M. at serious risk of 

adverse medical consequences, 

including addiction, overdose, and 

death, Tr. 505–10: 

a. Hydrocodone, Xanax, and Soma (a 

combination referred to by illicit users 

as ‘‘the Holy Trinity,’’ Tr. 506) in May 

of 2018, and November of 2018. ALJ Ex. 

3 at 11. 

b. Hydrocodone and Xanax on 26 

occasions between January 25, 2017, 

and February 20, 2019. ALJ Ex. 3 at 10– 

11. 

96. These combinations of drugs are 

highly sought after for abuse and 

diversion. Tr. 505–06, 510. Indeed, there 

is almost never any medical justification 

for prescribing a combination of 

hydrocodone, Xanax, and Soma. Tr. 

507–08. Specifically, this combination 

was prescribed on January 25, 2017, 

June 19, 2017, August 14, 2017, 

September 14, 2017, October 17, 2017, 

November 6, 2017, November 20, 2017, 

January 25, 2018, February 7, 2018, 

February 23, 2018, March of 2018, April 

9, 2018, April 25, 2018, May 23, 2018, 

June 11, 2018, June 27, 2018, July 11, 

2018, July 25, 2018, August 29, 2018, 

September 17, 2018, October 17, 2018, 

December 5, 2018, December 21, 2018, 

January of 2019, February 6, 2019, and 

February 20, 2019. 

97. Respondent’s prescriptions to 

Patient J.M. for Xanax between January 

10, 2017, and February 20, 2019, were 

repeatedly for at least 6 mg of Xanax per 

day. GX 11 at 26–42; ALJ Ex. 3 at 10– 

11. Prescribing such high dosages of 

Xanax placed Patient J.M. at risk of 

potentially lethal withdrawal, and 

presented risks of diversion. Tr. 217, 

218–19. The fact that Respondent often 

prescribed Xanax to Patient J.M. 

concurrently with opioids, see ALJ Ex. 

3 at 10–11, dramatically increased his 

risk of overdose and death. Tr. 217–18. 

98. Indeed, between January 10, 2017, 

and November 2, 2018, Respondent 

repeatedly issued Patient J.M. 

substantially early prescriptions for 

Xanax—issuing Patient J.M. 40 

prescriptions for 90 units of Xanax 2 

mg, or a prescription approximately 

every 17 days. ALJ Ex. 3 at 10–11. This 

provided Patient J.M. with over 10.5 mg 

of Xanax per day, or more than double 

the maximum recommended daily dose 

of 4 mg. Id.; Tr. 513–15. 

99. Further, between January 10, 

2017, and November 2, 2018, Patient 

J.M. alternated filling his Xanax 

prescriptions at one of two different 

pharmacies. Tr. 520–21; GX 17; GX 18. 

This was a significant red flag or abuse 

and diversion, indicating that Patient 

J.M. was seeking to avoid the 

pharmacies detecting how much Xanax 

he was being prescribed, but 

Respondent did nothing to address this. 

Tr. 521–22. 

100. Instead, Respondent actually 

assisted Patient J.M. in obtaining 

controlled substances Patient J.M. might 

not otherwise have been able to have 

filled.*DD Respondent frequently issued 

Patient J.M. a written prescription for 

hydrocodone which Patient J.M. would 

fill at one pharmacy, and that same day, 

Respondent would call in a prescription 

for Xanax to another pharmacy. Tr. 528– 

547, 550–58. Respondent did this on at 

least the following dates: 

a. January 25, 2017, see GX 11 at 42; 

GX 12 at 1–2; GX 17 at rows 425, 575; 

b. June 19, 2017, see GX 11 at 41; GX 

12 at 5–6; GX 17 at rows 1,746, 1,825; 

28 

c. November 6, 2017, see GX 11 at 40; 

GX 12 at 10–11; GX 17 at rows 2,764, 

2,788; 

d. February 7, 2018, see GX 11 at 38; 

GX 12 at 14; GX 13 at 20; GX 18 at rows 

473, 474; 

e. May 11, 2018, see GX 11 at 36; GX 

12 at 22; GX 13 at 25; GX 18 at rows 994, 

1,120; 

f. June 11, 2018, see GX 11 at 36; GX 

12 at 24; GX 13 at 27; GX 18 at rows 

1,228, 1,386; 

g. July 11, 2018, see GX 11 at 35; GX 

12 at 26–27; GX 18 at rows 1,472, 1,553; 


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h. September 17, 2018, see GX 11 at 

33; GX 12 at 33; GX 13 at 32; GX 18 at 

rows 2,102, 2,229; and 

i. October 17, 2018, see GX 11 at 32; 

GX 12 at 34; GX 13 at 34; GX 18 at rows 

2,341, 2,342. 

101. This was a ‘‘bright red flag’’ 

indicating that Patient J.M. was seeking 

to avoid having a pharmacy potentially 

refuse to fill concurrent prescriptions 

for opioids and benzodiazepines. Tr. 

558–59. 

102. Between November 20, 2017, and 

February 20, 2019, Respondent noted 17 

times in Patient J.M.’s medical file that 

Patient J.M. was opioid dependent, and 

refusing detoxification. GX 11 at 26–39. 

Respondent never addressed this red 

flag, but simply continued to prescribe 

the patient hydrocodone on an asneeded basis. GX 11 at 26–39; see also 

Tr. 561–64. 

103. Indeed, Respondent frequently 

improperly and illegally prescribed 

Patient J.M. hydrocodone as a treatment 

for the patient’s opioid dependency, 

including on at least April 25, 2018, 

May 23, 2018, June 27, 2018, August 29, 

2018, October 17, 2018, and December 

21, 2018. GX 11 at 30, 32, 34–37; Tr. 

486–88. 

104. Further, Respondent’s 

prescribing of hydrocodone was 

sporadic. See, e.g., GX 11 at 3942; Tr. 

500:5–501:13. However, Respondent 

never documented any rationale for 

changing Patient J.M.’s course of 

medication with respect to 

hydrocodone. See GX 1 at 18–42; Tr. 

501. 

105. Although Patient J.M. presented 

significant risks of abuse or diversion, 

Respondent never conducted a urine 

drug screen on Patient J.M., in violation 

of the California standard of care. Tr. 

560–61:12; PFF ¶ 18; see generally GX 

11. 

106. None of the controlled substance 

prescriptions Respondent issued to 

Patient J.M. between January 10, 2017, 

and December 31, 2019, were issued for 

a legitimate medical purpose or by a 

practitioner acting within the usual 

course of professional practice. Tr. 567– 

68. Dr. Munzing testified that there is no 

situation in which any patient should 

receive the drugs that Respondent 

prescribed to Patient J.M. between 

January 10, 2017, and December 31, 

2019, in those dosages, durations, and 

combinations. Tr. 507–08. 

G. Patient K.S. 

107. Between January 19, 2018, and 

January 31, 2019, Respondent issued to 

Patient K.S. the controlled substance 

prescriptions listed in Joint Stipulation 

No. 29. See ALJ Ex. 3 at 12–13. During 

this time period, Respondent diagnosed 

Patient K.S. with back pain, GAD, ADD, 

and opioid dependency. GX 14 at 31– 

41. 

i. Patient K.S.’s Initial Visit and the First 

Prescriptions for Xanax and Adderall 

108. Respondent’s initial encounter 

with Patient K.S. took place on June 21, 

2007. GX 14 at 110, 117; Tr. 570:8– 

571:3. At that visit, Respondent 

diagnosed Patient K.S. with back pain. 

GX 14 at 110; Tr. 571. Respondent 

prescribed Patient K.S. hydrocodone 

and Soma for back pain. GX 14 at 110; 

Tr. 571. At this initial visit, Respondent 

failed to: 

a. Take an appropriate medical 

history, GX 14 at 110; Tr. 572:4–23; 

b. address Patient K.S.’s pain or 

functionality levels, GX 14 at 110; Tr. 

573:1823; 

c. conduct an appropriate physical 

examination, GX 14 at 110; Tr. 572–73 

d. establish an appropriate diagnosis 

for back pain and so establish a 

legitimate medical purpose to prescribe 

hydrocodone or Soma, Tr. 574; or 

e. establish and document a treatment 

plan with goals and objectives, GX 14 at 

110; Tr. 574:16–21. 

109. Respondent first diagnosed 

Patient K.S. with GAD on May 1, 2012, 

and prescribed 6 mg of Xanax per day. 

GX 14 at 80; Tr. 577. There was no 

history taken, or evaluations performed 

for GAD, other than an insufficient note 

saying Patient K.S. presented as a ‘‘28 

yom with GAD, neck pain.’’ GX 14 at 80. 

Respondent’s diagnosis for GAD was 

completely unsupported as he did not 

establish a legitimate medical purpose 

to prescribe Xanax, nor did he establish 

and document a treatment plan with 

goals and objectives. Id.; Tr. 579–81. 

110. Respondent first prescribed 

Patient K.S. Adderall on November 18, 

2013. GX 14 at 70. There was no history 

taken, evaluations performed, or even 

any diagnosis made; there was only a 

note saying ‘‘Adderall 30 mg #60, [one] 

bid (SED).’’ Id.; Tr. 581. Respondent did 

not establish a legitimate medical 

purpose to prescribe Adderall, nor did 

he establish and document a treatment 

plan with goals and objectives. Tr. 

582:16–23. Respondent later diagnosed 

Patient K.S. with ADD, see e.g., GX 14 

at 41, but he had never obtained 

sufficient medical evidence for such a 

diagnosis. Tr. 583–84. 

ii. Continued Controlled Substance 

Violations 

111. Throughout the entire course of 

treatment, Respondent never obtained a 

proper medical history of Patient K.S., 

never recorded Patient K.S.’s pain or 

functionality levels, never obtained 

prior medical records for Patient K.S.— 

nor does Patient K.S.’s medical file 

reflect Respondent requested such 

records—failed to periodically update 

Patient K.S.’s medical history as 

treatment progressed, and never 

conducted a sufficient physical 

examination for pain. See generally GX 

14; Tr. 617–19. 

112. None of Respondent’s diagnoses 

of Patient K.S. for which he prescribed 

controlled substances between January 

19, 2018, and January 31, 2019, were 

based on sufficient medical evidence. 

Tr. 619:6–13. 

113. Over the course of his treatment 

of Patient K.S., Respondent’s diagnoses 

for pain, GAD, and ADD frequently 

came and went without comment or 

explanation. See generally GX 14; Tr. 

598–601; 602–05; 605–08. These erratic 

diagnoses were outside of the standard 

of care, [especially since these 

diagnoses,] including those made 

between January 19, 2018, and January 

31, 2019, [were not supported by an 

adequate medical history and physical 

examination.] Tr. 601–02; 604–05; 608– 

09. 

114. Other than inquiring into 

smoking and alcohol use at Patient 

K.S.’s initial visit, see GX 14 at 110; Tr. 

573–74, Respondent did not inquire 

about current or past substance abuse 

until over two years later, on August 5, 

2009, when he had Patient K.S. sign a 

form stating, ‘‘I have no history of drug 

abuse, nor was I treated for drug or 

substance abuse in the past.’’ GX 14 at 

119. Respondent never asked Patient 

K.S. about substance abuse again as 

required by the California standard of 

care. PFF ¶ 16; Tr. 574–75; see generally 

GX 14. 

115. Respondent never documented 

an appropriate treatment plan with 

goals and objectives for Patient K.S., 

never documented an appropriate 

rationale for continued treatment of 

Patient K.S. with controlled substances, 

and failed to properly discuss the risks 

and benefits of the controlled 

substances he prescribed to Patient K.S. 

See generally GX 14; Tr. 619–20. 

116. Respondent also prescribed 

Patient K.S. the following dangerous 

combinations of controlled substances, 

that put Patient K.S. at serious risk of 

adverse medical consequences, 

including addiction, overdose, and 

death, Tr. 609–11: 

a. Hydrocodone, Adderall, and Xanax 

approximately monthly from January 

19, 2018, through August of 2018, and 

again in November of 2018. ALJ Ex. 3 

at 12–13. 

b. Hydrocodone and Xanax on August 

29, 2018, October 2, 2018, October 31, 

2018, and November 28, 2018. ALJ Ex. 

3 at 13. 


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* EEText modified for legal clarity. 

*FFRemaining text omitted for brevity and clarity. 

*GGHowever, see supra n. 1. 

117. Respondent’s prescriptions to 

Patient K.S. for Xanax between January 

19, 2018, and January 31, 2019, were all 

for 6 mg of Xanax per day. GX 14 at 33– 

41; ALJ Ex. 3 at 12–13. Prescribing such 

high dosages of Xanax placed Patient 

K.S. at risk of potentially lethal 

withdrawal, and presented risks of 

diversion. Tr. 577–78. The fact that 

Respondent prescribed Xanax to Patient 

K.S. concurrently with opioids, see ALJ 

Ex. 3 at 12–13, dramatically increased 

his risk of overdose and death. Tr. 579. 

118. Respondent noted on 13 

occasions between January 19, 2018, 

and January 31, 2019, that Patient K.S. 

was opioid dependent, and refusing 

detoxification. GX 14 at 31–41. 

Respondent never addressed this red 

flag, but simply continued to prescribe 

the patient hydrocodone on an asneeded basis. GX 14 at 31–41; see also 

Tr. 615–17. 

119. Indeed, Respondent frequently 

improperly and illegally prescribed 

Patient K.S. hydrocodone as a treatment 

for the patient’s opioid dependency, 

including on February 27, 2018, April 

30, 2018, July 3, 2018, August 3, 2018, 

October 2, 2018, November 28, 2018, 

and January 2, 2019. GX 14 at 31, 33, 

35–37, 39–40; Tr. 586–88. 

120. Although Patient K.S. presented 

significant risks of abuse or diversion, 

Respondent never conducted a urine 

drug screen on Patient K.S. in violation 

of the California standard of care. Tr. 

614; PFF ¶ 18; see generally GX 14. 

121. None of the controlled substance 

prescriptions Respondent issued to 

Patient K.S. between January 19, 2018, 

and January 31, 2019, were issued for a 

legitimate medical purpose or by a 

practitioner acting within the usual 

course of professional practice. Tr. 620. 

According to Dr. Munzing, there is no 

situation in which a patient should 

receive the drugs that Respondent 

prescribed to Patient K.S. between 

January 19, 2018, and January 31, 2019, 

in those dosages, durations, and 

combinations. Tr. 613. 

122. Respondent’s prescribing of 

controlled substances to Patients S.B., 

M.B., B.C., J.C., D.D., J.M., K.S. 

constituted clearly excessive 

prescribing. Tr. 621. 

Analysis 

Findings as to Allegations 

The Government alleges that the 

Respondent’s COR should be revoked 

and any applications should be denied, 

because the Respondent violated federal 

and California law, by issuing numerous 

prescriptions for Schedule II through IV 

controlled substances outside the usual 

course of professional practice and not 

for a legitimate medical purpose to 

seven individuals as recently as 

December 31, 2019. [I find that each of 

the relevant prescriptions were issued 

outside of the usual course of 

professional practice and beneath the 

standard of care in California in 

violation of both federal and state 

law.] *EE In the adjudication of a 

revocation or suspension of a COR, DEA 

bears the burden of proving that the 

requirements for such revocation or 

suspension are satisfied. 21 CFR 

1301.44(e). Where the Government has 

sustained its burden and established 

that a respondent has committed acts 

that render his registration inconsistent 

with the public interest, to rebut the 

Government’s prima facie case, a 

respondent must both accept 

responsibility for his actions and 

demonstrate that he will not engage in 

future misconduct. Patrick W. Stodola, 

M.D., 74 FR 20727, 20734 (2009). 

Acceptance of responsibility and 

remedial measures are assessed in the 

context of the ‘‘egregiousness of the 

violations and the [DEA’s] interest in 

deterring similar misconduct by [the] 

Respondent in the future as well as on 

the part of others.’’ David A. Ruben, 

M.D., 78 FR 38363, 38364 (2013). Where 

the Government has sustained its 

burden and established that a 

respondent has committed acts 

inconsistent with the public interest, 

that respondent must present sufficient 

mitigating evidence to assure the 

Administrator that he can be entrusted 

with the responsibility commensurate 

with such a registration. Medicine 

Shoppe-Jonesborough, 73 FR 364, 387 

(2008). 

The Agency’s conclusion that ‘‘past 

performance is the best predictor of 

future performance’’ has been sustained 

on review, Alra Labs., Inc. v. DEA, 54 

F.3d 450, 452 (7th Cir. 1995), as has the 

Agency’s consistent policy of strongly 

weighing whether a registrant who has 

committed acts inconsistent with the 

public interest has accepted 

responsibility and demonstrated that he 

or she will not engage in future 

misconduct. Hoxie v. DEA, 419 F.3d 

477, 482–83 (6th Cir. 2005); see also 

Ronald Lynch, M.D., 75 FR 78745, 

78754 (2010) (holding that the 

Respondent’s attempts to minimize 

misconduct undermined acceptance of 

responsibility); George C. Aycock, M.D., 

74 FR 17529, 17543 (2009) (finding that 

much of the respondent’s testimony 

undermined his initial acceptance that 

he was ‘‘probably at fault’’ for some 

misconduct); Jayam Krishna-Iyer, M.D., 

74 FR 459, 463 (2009) (noting, on 

remand, that despite the respondent’s 

having undertaken measures to reform 

her practice, revocation had been 

appropriate because the respondent had 

refused to acknowledge her 

responsibility under the law); Medicine 

Shoppe-Jonesborough, 73 FR at 387 

(noting that the respondent did not 

acknowledge recordkeeping problems, 

let alone more serious violations of 

federal law, and concluding that 

revocation was warranted).*FF

California Law 

The applicable California Codes 

are: *GG

1. Cal. Health & Safety Code 

§ 11153(a), requiring 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’’; 

2. Cal. Health & Safety Code 

§ 11154(a), directing 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 . . .’’; 

3. Cal. Bus. & Prof. Code § 2242, 

prohibiting the ‘‘[p]rescribing, 

dispensing, or furnishing [of controlled 

substances] . . . without an appropriate 

prior examination and a medical 

indication,’’ the violation of which 

constitutes unprofessional conduct; 

4. Cal. Bus. & Prof. Code § 2234, 

defining unprofessional conduct to 

include: ‘‘[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 

5. Cal. Bus. & Prof. Code § 725, further 

defining unprofessional conduct to 

include ‘‘[r]epeated acts of clearly 

excessive prescribing, furnishing, 

dispensing, or administering of 

drugs. . . .’’ 

ALJ Ex. 1. 

Allegations Common to Multiple 

Patients 

There were allegations common to 

many or all of the subject patients. They 

will be discussed here generally. They 

may be discussed in detail in the 

context of the particular patients as 

well, and as needed. 


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21For example, the Respondent conceded he did 

not document the rationale for the change in 

medication for J.M. and K.S. Tr. 885. On February 

2, 2017, the Respondent prescribed Soma to S.B. Tr. 

875; GX 1 at 59. By March 1, 2017, Soma had been 

discontinued, yet the chart reflected no rationale for 

that change in medication regimen. Tr. 876–77. As 

the Respondent varied his prescribing between 

Soma and Xanax, he conceded he did not document 

the reason for the variation in medication. Tr. 878– 

83. Similarly, the Respondent conceded he did not 

document pain level, function level and quality of 

life in the seven charged patients. Tr. 885–87; GX 

20 at 61. Although the Respondent testified he 

developed a treatment plan for each of his patients, 

the Government pointed out S.B.’s treatment plan 

and objectives were not documented in her chart. 

Tr. 813–14. 

22The list of prior therapies was not in his 

progress notes. Tr. 805–06, 808. The Respondent 

explained its absence by stating that maybe he did 

not feel it was crucial to document them, because 

he memorizes what the patient tells him. Tr. 806. 

Respondent thought the documentation did not 

need to include references to prior, concluded 

treatment, because the patient had moved on to the 

new treatment. Tr. 807–08. The Respondent 

testified to S.B.’s prior treatment from memory. Tr. 

808. [Some footnote text was omitted for brevity, 

and other portions were moved to the body of the 

discussion or to other footnotes where the 

information was more pertinent.] 

23The Respondent could not remember if J.C. 

mentioned his prior surgeries at the first or second 

visit (in 2009). Tr. 840. The Respondent added that 

he probably prescribed Valium to J.C., as well, 

explaining he was remembering from 13 years ago. 

Tr. 850. The Respondent added that he may have 

also prescribed Xanax to K.S., but it is difficult to 

be sure with hundreds of patients and treatment 

dating back 15 years. Tr. 859. M.B. had physical 

therapy, and perhaps acupuncture, but the 

Respondent could not quite remember. Tr. 827. 

Even with a good memory, Respondent admitted 

that sometimes the he may just miss something. Tr. 

859. 

24The Government sought to test the 

Respondent’s memory by asking to confirm that, 

consistent with his direct testimony, he only treated 

S.B. with hydrocodone, Xanax and Adderall. Tr. 

810–13. The Respondent confirmed his direct 

testimony. Tr. 812. The Government reminded the 

Respondent that he prescribed Soma as well. Tr. 

813. Although the Respondent testified he did not 

introduce any of his subject patients to controlled 

substances, the chart reflects he did prescribe Soma 

to S.B. for the first time. Tr. 816–17; GX 1 at 61, 

62. The Respondent remembered during crossexamination that, although not in the chart, S.B. 

told him she had been on Soma previously. Tr. 

817–19. *HH Sentence modified for clarity. 

Failure To Maintain Accurate and 

Complete Patient Charts 

There was a recurring theme 

throughout the Respondent’s patient 

files that he failed to maintain accurate 

and complete patient charts. This failing 

itself is contrary to the ‘‘Guide to the 

Laws Governing the Practice of 

Medicine by Physicians and Surgeons,’’ 

Medical Board of California, 7th ed. 

2013, which requires the practitioner to 

‘‘keep accurate and complete records, 

including but not limited to, records of 

the patient’s medical history, physical 

examinations of the patient, the 

treatment plan objectives and the 

treatments given, and the rationale for 

any changes in treatment.’’ Id. at 59. Not 

surprisingly, the failure to maintain 

accurate and complete patient records 

itself is outside the usual course of 

professional practice and represents a 

violation of the California standard of 

care. 

Dr. Munzing also explained that this 

failure in documentation rendered any 

resulting treatment or diagnosis 

unjustified and inappropriate. Tr. 241– 

44. Without an appropriate diagnosis 

that is justified by the documentation, 

there is no legitimate medical purpose 

for the controlled substance 

prescriptions. Tr. 172, 207, 241–44. 

The Respondent conceded repeatedly 

that matters allegedly discussed with 

the patients, information gathered from 

them, evaluation of treatment plans and 

changes in treatment, and 

determinations regarding treatment, 

were not recorded in the patient chart.21

He gave various reasons for not 

documenting the missing information, 

including his 41-years of clinical 

experience, his busy practice, and his 

practice of maintaining paper records, 

which prevents the degree of detail 

permitted by electronic record-keeping, 

and results in him keeping his notes as 

brief as possible and only recording the 

‘‘main ideas.’’ Tr. 809. The Respondent 

conceded that ‘‘maybe’’ it was 

‘‘inappropriate’’ of him not to more 

thoroughly detail this information in the 

charts. Tr. 809. But with handwritten 

charts, he claimed that he was only able 

to include the ‘‘main ideas.’’ His notes 

are simply to remind him of the matters 

in the future, so he keeps his notes as 

brief as possible. Tr. 810–11, 815. 

Finally, he defended his limited 

documentation by claiming that more 

was unnecessary due to his 

photographic memory.22 Although the 

Respondent sometimes displayed a 

seemingly extraordinary memory,23 it 

was not always infallible. [See infra 

Credibility Analysis of the Respondent. 

Consistent with Dr. Munzing’s opinions, 

the Respondent misperceives the 

purpose of these medical records. Not 

only do medical records remind the 

treating practitioner of the basis and 

ongoing treatment strategy; they also 

provide an accurate history of 

symptoms, ongoing treatment and 

medication protocol for other 

practitioners who may treat the patient 

in the future. Tr. 917.] 

Moreover, as the Respondent 

indicated he was essentially testifying 

from memory regarding appointments 

and treatment from sometimes up to 

fourteen years ago, the Government was 

permitted to test the Respondent’s 

memory. The Respondent’s memory 

may not be as good as he believes.24

[See infra Credibility Analysis of the 

Respondent.] Of course, even the 

extraordinary memory of the 

Respondent will not help another 

practitioner who may treat one of the 

Respondent’s patients and expect to rely 

on the Respondent’s chart. 

Respondent’s belief that all of the 

necessary patient information was 

accurately kept in his mind is no 

justification for Respondent’s failure to 

maintain accurate and complete patient 

files. I find the Respondent violated the 

California professional standards and 

standard of care by failing to maintain 

complete and accurate medical charts as 

to each of the subject patients.*HH

In his Post-hearing Brief (PHB), the 

Respondent argues that Dr. Munzing’s 

assertions that the deficient medical 

charts demonstrate treatment outside 

the standard of care is faulty, as Dr. 

Munzing failed to speak with the subject 

patients to determine if the 

prescriptions were justified. Only then, 

he argues, could Dr. Munzing 

convincingly opine regarding whether 

the actual treatment was consistent with 

the standard of care. The Respondent 

misses the point. Although certainly the 

extent of Dr. Munzing’s review of 

relevant material is normally critical to 

the conclusions he draws, the focus of 

Dr. Munzing’s opinions relate to 

whether the Respondent complied with 

his obligations under the standard of 

care prior to prescribing the subject 

medications, and documentation was 

part of his obligation. It is neither here 

nor there that Dr. Munzing could have 

resolved his own concerns regarding the 

subject prescriptions by speaking to the 

patients years later. Nor is it dispositive 

that Dr. Munzing might have 

determined, through his own 

investigation, that the prescriptions 

were justified at the time they were 

issued [but for the documentation 

failures.] The Respondent failed to 

satisfy his obligations, which include 

obligations to accurately document, at 

the time the prescriptions were issued. 

Accordingly, I do not view the fact that 

Dr. Munzing did not speak with the 

subject patients as diminishing the 

probity of his relevant opinions as to the 

Respondent’s acts or omissions, at all. 

The instant evaluation relates to 

whether the Respondent provided 

appropriate controlled substance 

prescriptions on the basis of the 

information developed by the 

Respondent prior to issuing the 

prescriptions. 

Although the Respondent argues in 

his PHB that he testified credibly that he 

fully complied with his obligations 


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25For example, S.B. reported to Dr. F. that she 

was not then taking any medication for pain, which 

is contrary to the Respondent’s medical records and 

prescription evidence. Tr. 231–32. Also, CURES 

records disclosed his patients were being prescribed 

Suboxone by another physician. 

26See Holloway Distrib., 72 FR 42118, 42124 

(2007) (a policy of ‘‘see no evil, hear no evil’’ is 

fundamentally inconsistent with the obligations of 

a DEA registrant). Agency precedent has long 

recognized that ‘‘[l]egally, there is absolutely no 

difference between the sale of an illicit drug on the 

street and the illicit dispensing of a licit drug by 

means of a physician’s prescription.’’ EZRX, L.L.C., 

69 FR 63178, 63181 (1988); Floyd A. Santner, M.D., 

55 FR 37581 (1988); Michael J. Aruta, M.D., 76 FR 

19420, 19434 (2011). 

*IIThe RD included an extensive write up of the 

OSC’s allegations pertaining to each of the seven 

individuals at issue prior to discussing each 

individual. The allegations are set forth clearly in 

the OSC, see ALJX 1, and are summarized above; 

therefore, for brevity, I have omitted each of the 

seven sections outlining the allegations pertaining 

to each of the seven individuals. 

*JJText omitted for brevity and clarity. 

under the standard of care, the 

Respondent was not fully credible as 

detailed in my credibility analysis of the 

Respondent. In the Government’s 

Supplemental Pre-hearing Statement 

(GSPHS), the Government argues that 

the failure to document procedures or 

findings within the chart justifies a 

finding that the procedures, evaluation 

or findings did not occur. On the basis 

of the instant record, I concur. I further 

adopt Dr. Munzing’s conclusions that 

without sufficient documentation of 

procedures or evaluation required by 

the standard of care, resulting diagnoses 

are deemed inappropriate, there is no 

legitimate medical purpose established 

for treatment and any resulting 

controlled substance prescriptions were 

outside the usual course of professional 

practice. [I have discussed this further 

infra at Factors Two and Four.] 

Patients Were Left on Their Original 

Medication Protocols Despite Being 

Prescribed High MME and Dangerous 

Combinations 

Patients were permitted to remain on 

the medications and dosages they were 

previously prescribed if the Respondent 

found them to be doing well, that their 

pain level was low enough that they 

could work full time, and they could 

complete their ADLs. [Respondent 

testified, ‘‘[i]f the patient tells me, 

‘‘Look, I’ve already been with pain 

specialists; I’ve already seen a couple of 

specialists; I already had three-four 

MRIs; I already had surgery; I’m on this 

medication for years, and it’s working 

for me,’’ then it comes down to one of 

two options. Either I tell him I will fill 

his prescription or I kick him out of my 

office. And I don’t think it is ethical to 

do that latter approach.’’ Tr. 651.] This 

was the case even with patients at 

dangerous levels of medication and in 

dangerous combinations that are known 

to be popular for abuse and diversion. 

[Interestingly, despite Dr. Munzing’s 

consistent testimony supported by CDC 

guidance and a FDA black box warning, 

Respondent testified that the prescribed 

combination of an opiate, muscle 

relaxant, and benzodiazepine, when 

‘‘used in the right dosages for the right 

indications, and used as prescribed by 

a knowledgeable M.D., . . . are safe to 

use in combination therapy.’’ Tr. 797.] 

The Respondent maintained this 

laissez faire attitude despite being 

confronted with significant red flags 

suggesting that his patients could have 

been abusing and/or diverting.25 Even 

patients the Respondent acknowledged 

as opioid dependent and refusing detox 

were continued on these dangerous 

medications and combinations without 

even UDS monitoring.26 In fact, the 

Respondent treated opioid dependence 

with opioids, which is clearly outside 

the California standard of care. In fact, 

Dr. Munzing testified that it is illegal in 

California. Tr. 267–68, 306, 398–400. 

The Respondent failed to make any 

attempt at titration, even for patients 

who attempted to titrate on their own 

and who skipped pain medication when 

they could tolerate it. As Dr. Munzing 

observed, the standard of care would 

require an attempt at titration. 

I find the Respondent’s failures to 

sufficiently monitor, and to attempt 

titration from dangerous levels of 

medication and in dangerous 

combinations were outside the 

California standard of care. 

Discussion as to Patient S.B.*II

As per the parties’ stipulations, 

between February 2, 2017, and January 

30, 2019, S.B. was prescribed 

hydrocodone, carisoprodol, Adderall 

and alprazolam. Tr. 162–63; GDX 1. 

Patient S.B. remains a patient of Dr. 

Rabadi. Tr. 708–09.*JJ Dr. Rabadi 

believed his prescription practice 

concerning S.B. was within the 

California standard of care. Tr. 709. Dr. 

Rabadi began his treatment of S.B. on 

August 3, 2016. Tr. 718. She presented 

as a 29 year-old female with ongoing 

conditions of GAD, fibromyalgia and 

ADD. Tr. 719. Dr. Rabadi noted that 

patients with ADD are six times more 

likely to have other psychiatric 

conditions as people without ADD. 

Ultimately, Dr. Rabadi concurred with 

the previous physician’s diagnoses of 

ADD, GAD, and fibromyalgia. Tr. 724, 

728. 

Respondent testified that, as per his 

policy, he took a complete history. Tr. 

719–20. He testified that he performed 

a complete physical exam, reviewed her 

existing diagnoses of GAD and ADD, 

and her medication history in general, 

and specifically for those diagnoses. Tr. 

720, 722–24. He testified, [from 

memory,] that he obtained her pain 

level with and without medication. 

Without medication her subjective pain 

level was eight. With medication, it was 

one to two, which permitted her to 

function and perform daily activities. 

Tr. 721. [In summary, Respondent 

testified that he did everything required 

by the California standard of care, 

except ‘‘maybe’’ it was ‘‘inappropriate’’ 

of him to not more thoroughly 

document the details in the charts. Tr. 

809.] 

Dr. Munzing disagreed with 

Respondent and characterized the 

controlled substance prescriptions as 

being issued outside the standard of 

care. Tr. 163, 207, 241–44. For S.B.’s 

initial visit on August 3, 2016, she was 

diagnosed with GAD, ADD, and 

fibromyalgia. Tr. 163–65; GX1 at 62, 66. 

However, there was no supporting 

findings or history for the fibromyalgia 

diagnosis, which typically is reached 

after a certain number of tender points 

are determined. Tr. 166. Similarly, there 

was no supporting findings or history to 

support the GAD or ADD diagnoses. Tr. 

166–71, 241–44. There is no physical 

functioning level documented nor 

mental functioning level. Tr. 171. 

Without sufficient evaluation and 

supporting documentation for the three 

diagnoses, Dr. Munzing deemed the 

diagnoses inappropriate. Tr. 241–44. 

Without an appropriate diagnosis, there 

is no legitimate medical purpose for the 

controlled substance prescriptions. Tr. 

172, 207, 241–44. The Respondent 

conceded that the detailed findings of 

the complete physical exam are not 

reflected in his chart, but noted he was 

a clinician with 41-years of experience, 

and not a medical student. Tr. 810. 

In accordance with Dr. Munzing’s 

credible and unrebutted expert 

testimony, the Respondent misperceives 

the purpose of these medical records. 

The documentation is necessary without 

regard to the skill level of the treating 

practitioner. It reminds the treating 

practitioner of the basis and ongoing 

treatment strategy. It also provides an 

accurate history of symptoms, ongoing 

treatment and medication protocol for 

other practitioners who may treat the 

patient in the future. 

Dr. Munzing highlights that there is 

no documented treatment plan for this 

patient. Tr. 241–44. On February 2, 

2017, S.B. presented to the clinic 

suffering from fibromyalgia and ADD. 

Tr. 173; GX 1 at 59. The Respondent 

diagnosed her with fibromyalgia-opioid 


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dependent, refusing detox, and ADD. He 

prescribed hydrocodone, carisoprodol, 

and Adderall. Tr. 173–74. Again, there 

was no medical history justifying the 

diagnoses. The physical exam 

conducted on February 2, 2017, 

consisted of blood pressure, 

cardiovascular, heart and lung, which 

were normal, which is insufficient to 

justify the fibromyalgia and ADD 

diagnosis. Tr. 175. There was no 

documentation of the pain level, or 

functionality level, to justify continued 

controlled substance prescribing. Tr. 

175–76. For the progress note dated 

June 28, 2017, the Respondent 

diagnosed her with fibromyalgia-opioid 

dependent, refusing detox, and ADD. He 

prescribed hydrocodone, carisoprodol, 

and Adderall. Tr. 177. Again, there was 

no medical history justifying the 

diagnoses. There was no documentation 

of the pain level, or functionality level, 

to justify continued controlled 

substance prescribing. Tr. 177–78; GX 1 

at 57. Again, only blood pressure, heart, 

and lung exams were performed. Tr. 

177. There was insufficient medical 

evidence to justify the three diagnoses. 

Tr. 177–78. For the progress note dated 

December 21, 2018, S.B. presented with 

eczema and fibromyalgia. Tr. 179; GX 1 

at 49. The Respondent diagnosed her 

with Fibromyalgia-opioid dependent, 

refusing detox. She was prescribed 

hydrocodone. No history was recorded. 

Again, only blood pressure, heart, and 

lung exams were performed. Tr. 180. 

There was no documentation of the pain 

level, or functionality level, to justify 

continued controlled substance 

prescribing. Tr. 180. There was 

insufficient medical evidence to justify 

the fibromyalgia diagnosis. Tr. 181. In 

the progress notes for January 30, 2019, 

S.B. reported to the clinic with ADD and 

rhinitis. Tr. 181; GX1 at 47. She was 

prescribed Adderall for the ADD. No 

medical history was taken. ADD patient 

progress was reported as ‘‘stable.’’ There 

was insufficient medical evidence to 

justify the ADD diagnosis. Tr. 183. Dr. 

Munzing deemed the ADD diagnoses 

inappropriate. Without an appropriate 

diagnosis, there is no legitimate medical 

purpose for the controlled substance 

prescription. Tr. 185–86. 

During the subject period of the 

Respondent’s treatment of S.B., he never 

obtained any prior medical records. Tr. 

184. He never recorded a history, which 

would justify his diagnoses for 

fibromyalgia, GAD or ADD. He never 

reported a sufficient physical or mental 

exam to justify the fibromyalgia, GAD or 

ADD diagnoses. He never reported a 

sufficient evaluation to justify his 

diagnoses for fibromyalgia, GAD or 

ADD. Tr. 184–85. The controlled 

substance prescriptions for S.B. were 

not issued within the California 

standard of care, nor were they issued 

within the usual course of professional 

practice. Tr. 187, 244. 

Dr. Munzing observed that the 

diagnoses would come and go in the 

records and were inconsistently 

reported, which is atypical for chronic 

diagnoses. Tr. 188–97. A chronic 

disease with symptoms which appear to 

come and go would question whether 

the patient had the disease at all. Tr. 

192. Even a lessening of symptoms 

should cause evaluation of whether 

tapering of medication was appropriate. 

Tr. 196. 

Dr. Munzing noted that the 

Respondent prescribed S.B. both 

hydrocodone and Soma to treat 

fibromyalgia on numerous occasions. 

Tr. 197–98. On other occasions he 

prescribed hydrocodone alone without 

any explanation for changing the 

medication protocol, which was beneath 

the California standard of care for 

documentation. Tr. 198–201; GX 20 at 

61. Dr. Munzing noted that S.B. was on 

a dangerous, highly addictive, 

combination of medications that was 

popular for abuse, namely hydrocodone 

and Soma, which are respiratory 

depressants, combined with Adderall. 

Tr. 202. Another dangerous 

combination, hydrocodone, Adderall 

and Xanax, was prescribed on March 1, 

2017, in April 2017, and June 2017. Tr. 

203; GDX 1. Dr. Munzing noted it is 

referred to by drug abusers as the ‘‘new 

Holy Trinity.’’ Tr. 204. It includes the 

depressants, hydrocodone and Soma, 

and is followed by the stimulant, 

Adderall, to counteract the effects of the 

depressants. Again, the combination of 

hydrocodone and Soma are the subject 

of the FDA ‘‘black box’’ warning. Tr. 

205. The high dosage of Xanax, 6 mg per 

day, heightens the risk of this already 

dangerous combination. With Xanax 

and Adderall prescribed at their highest 

commercially available dosage units, the 

danger and risk of addiction are further 

increased. Tr. 205. Additionally, two mg 

tablets of Xanax are popular for abuse 

and diversion. Tr. 217–18. On 

September 29, 2017, and monthly from 

July 2018, to July, 2019, S.B. was 

prescribed hydrocodone and Adderall. 

Besides the serious risk of addiction 

posed by these two Schedule II 

medications, the hydrocodone was 

prescribed at a high daily dosage of 60 

mg MME, which significantly increases 

the risk of overdose and death. This risk 

was increased by its combination with 

Adderall. Tr. 206–07. Dr. Munzing 

could not foresee a medical condition 

for which this combination would be 

appropriate. Tr. 211–12. 

The Respondent defended his keeping 

S.B. on this medication protocol, noting 

that if the Respondent objected to every 

patient’s choice of treatment, there 

would be no medical care. If a patient 

says they are on medication and it 

permits them to function, the 

Respondent will continue that 

treatment. Tr. 729–30. Respondent, 

[based on his memory alone,] testified 

that S.B. indicated she had been through 

several alternate treatments, including, 

occupational therapy, physical therapy, 

hydrotherapy, yoga and meditation. Tr. 

731, 805. 

Respondent, [testifying from 

memory,] said S.B. further reported that 

she had been on the same dosage of 

medications for several years to good 

effect. Tr. 731–32. To reduce her from 

those dosages would have to be done 

gradually, lest the patient have 

withdrawal symptoms or suffer severe 

pain. Tr. 732. Prior to each prescription, 

the Respondent testified that he 

discussed side effects, and changes in 

status. Tr. 733. However, the record 

discloses that the patient was not 

always taking the medications as 

prescribed. There were a number of 

notations that the patient refused detox. 

The Respondent misperceives his role 

as an independent practitioner. In 

accordance with Dr. Munzing’s 

testimony, Respondent has a 

responsibility to independently 

determine the course of treatment, even 

in patients he inherits from other 

prescribers. Completely deferring to his 

patients’ wishes in determining 

appropriate treatment is contrary to his 

role within the California standard of 

care. He concedes titration would have 

to be done gradually. However, he kept 

this patient on high levels of dangerous 

medication, in dangerous combinations, 

for two years, without attempting 

titration. This [prescribing] is below the 

California standard of care. The 

Respondent’s failure to obtain prior 

medical records and failure to document 

the patient’s history, and to even order 

a single UDS, is consistent with this 

relinquishment of his responsibility to 

independently evaluate and to monitor 

the patient’s condition and to develop 

an appropriate treatment plan. 

The Respondent explained his 

process to obtain informed consent to 

prescribe controlled substances to S.B. 

The Respondent executed the ‘‘pain 

management contract,’’ which is 

documented in the record. Tr. 728–29. 

The patient reads it and signs it. The 

Respondent testified that he then goes 

over the contract in detail with the 

patient. The Respondent testified that 


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he then explains that the medications 

are meant to help the patient, not to 

cause side effects or addiction, although 

they tend to cause chemical 

dependence. Tr. 729. The Respondent 

testified that he then goes over all the 

alternative treatments, but in the end, it 

is the patient’s decision as to the 

treatment he will receive. Tr. 729. 

Dr. Munzing noted that the medical 

records failed to disclose any indication 

that the Respondent warned S.B. 

regarding the risks associated with these 

dangerous combinations of medications. 

This failure precludes any informed 

consent by S.B. Tr. 207. The Declaration 

of Pain Medication Use document in the 

file, dated August 3, 2016, which 

requires the patient to alert the 

Respondent if the patient takes 

additional medications that could result 

in drug interactions, does not put the 

patient on notice of the dangerous 

combinations prescribed by the 

Respondent. Tr. 207–10; GX 1 at 67. 

Similarly, Dr. Munzing noted the 

repeated notation within the patient 

records of ‘‘SED,’’ which Dr. Munzing 

assumed meant, ‘‘side effects 

discussed,’’ was insufficient 

documentation within the standard of 

care to document discussion of the 

various risks of these medication 

combinations. Tr. 210–11; GX 1 at 59. 

I agree with Dr. Munzing’s assessment 

that, on the basis of the above lapses, 

the Respondent failed to obtain 

informed consent under the California 

standard. The Respondent’s failure to 

document the details of his informed 

consent process itself renders his 

process below the California standard of 

care. 

In March, April, and June of 2017, the 

Respondent prescribed S.B. Xanax at 6 

mg per day, in excess of the FDA 

recommended daily limit of 4 mg per 

day. Tr. 212–15; GX 1 at 57, 58, 59; GX 

22 at 40, 59–61. In May of 2017, the 

Xanax was abruptly stopped, Tr. 216– 

17; GDX 1, and abruptly restarted in 

June of 2017, and again stopped, Tr. 

217. According to Dr. Munzing, this was 

very dangerous as the abrupt stoppage 

of Xanax, especially at this high dosage, 

can cause seizures, and restarting at this 

high dosage can trigger an overdose, 

especially in conjunction with the 

prescribed opioid. Tr. 212–18. 

Regarding the monitoring of S.B., 

there were no urine drug screens 

evident in the records, which Dr. 

Munzing testified the standard of care 

would have required at least quarterly. 

Tr. 218–21; GX 1 at 44. In the progress 

notes for February, March, April 2017, 

all the way to January 30, 2019, the 

Respondent noted ‘‘refusal to detox.’’ 

Tr. 220–21, 227–29; GX 1 at 58, 59. 

According to Dr. Munzing, this is a huge 

red flag for opioid use disorder and for 

diversion. However, the chart suggests 

the Respondent did not take any 

necessary action, such as CURES 

monitoring, UDS, counseling, or 

titration. Rather, he simply prescribed 

the same levels of medications she was 

on, PRN. Tr. 222–23. The Respondent’s 

course of action was outside the 

California standard of care. Tr. 223, 229. 

In a June 2017 report from Dr. F., an 

orthopedic surgeon who saw S.B. for 

reported neck and back pain, S.B. 

reported her past medical history as 

only ‘‘anxiety.’’ Tr. 229; GX 1, p. 30, 32, 

36–42, 56. She did not report 

fibromyalgia, ADD or GAD. Tr. 229–30. 

S.B. further reported to Dr. F. that she 

was not then taking any medication for 

pain, which is contrary to the 

Respondent’s medical records and 

prescription evidence. Tr. 231–32. Dr. 

F.’s report was part of S.B.’s disability 

application, claiming disability as of 

June 15, 2017. A report from 

Chiropractor, Dr. B.H. is included in the 

disability packet. Tr. 235. Dr. B.H. 

reports the disability was caused by 

‘‘accident or trauma,’’ which is 

inconsistent with what the patient 

reported to Dr. F. and to the 

Respondent. Tr. 236. There is no 

indication in the Respondent’s records 

for S.B. that he ever discussed, with S.B. 

or with Dr. F., the discrepancies 

revealed by Dr. F.’s report. Tr. 233–37. 

Contemporaneous to the preparation 

of the disability claim, Dr. Rabadi 

ordered a series of radiologic tests for 

S.B., none of which were related to the 

Respondent’s diagnosis of fibromyalgia. 

The progress notes from August 17, 

2017, state that S.B. presented with 

‘‘overactive thyroid, gait disturbance.’’ 

Tr. 237–40; GX 1 at 5, 7, 9, 11, 13, 16, 

17, 56. Respondent ordered an MRI of 

the brain to rule out MS, a thyroid 

ultrasound to rule out hyperthyroidism, 

an MRI of the lumbar spine, and an MRI 

of the thoracic spine. The MRI of the 

cervical spine was ordered by Dr. F. Tr. 

241. In the context of S.B.’s disability 

claim, the Respondent ordered a series 

of tests in support of the disability 

claim, but neglected to order any tests 

related to the fibromyalgia, for which 

the Respondent was treating S.B. 

According to Dr. Munzing, this further 

calls the Respondent’s [prescribing for 

fibromyalgia] into question. 

I find, as alleged, that the 

Respondent’s controlled substance 

prescriptions to Patient S.B. from at 

least February 2, 2017, through January 

30, 2019, were not issued ‘‘for a 

legitimate medical purpose by an 

individual practitioner acting in the 

usual course of his professional 

practice’’; [they were issued outside the 

usual course of professional practice 

and beneath the standard of care in 

violation of 21 CFR 1306.04(a).] 

Discussion as to Patient M.B. 

The Respondent testified that Patient 

M.B. presented on April 19, 2006, with 

severe back pain, left knee pain, and 

history of dyslipidemia. Tr. 782. The 

Respondent testified that he obtained a 

full medical history, medication history, 

pain level, and performed a complete 

head to toe physical exam. Tr. 783. The 

Respondent claimed that M.B. had 

chronic back pain related to an injury, 

a knee injury, which was manageable, 

and dyslipidemia. Tr. 784. Although the 

Respondent maintains he obtained a 

complete medical history as to the back 

pain, and chronic knee pain, he 

concedes it is not detailed in the chart. 

Tr. 820–23. M.B. was already on 

hydrocodone, previously prescribed, 

when he first saw the Respondent. The 

Respondent testified that he obtained 

informed consent in the same manner as 

described for his earlier patients. Tr. 

784. [Testifying from memory alone,] 

Respondent said he discussed 

alternative forms of treatment with 

M.B., however M.B. had exhausted 

those. Respondent testified that M.B. 

had physical therapy, and perhaps 

acupuncture, but the Respondent could 

not quite remember. Tr. 827. The 

Respondent conceded he did not 

document these therapies in the chart. 

Tr. 828. 

Dr. Munzing observed that between 

January 5, 2018, and November 20, 

2019, the Respondent prescribed 

hydrocodone and Adderall. Tr. 245. As 

with patient S.B., Dr. Munzing 

characterized the patient file as meager. 

Tr. 245–47. The Respondent never 

obtained prior medical records of M.B. 

Tr. 288. Dr. Munzing observed that none 

of the subject prescriptions were within 

the California standard of care. Tr. 248, 

289. On April 19, 2006, M.B. presented 

for his first visit. Tr. 248–49; GX 3 at 88, 

91. In his ‘‘Comprehensive History and 

Physical Examination,’’ the Respondent 

reported that M.B. presented with 

symptoms of ‘‘chronic back pain, left 

knee pain, dyslipidemia.’’ Tr. 249–50. 

However, there are no diagnoses relating 

to the back and knee pain. Tr. 250–51, 

258. To address the reported pain, the 

Respondent prescribed hydrocodone. 

Tr. 252. The file fails to evidence 

sufficient history to justify the pain 

prescriptions under the standard of care. 

Tr. 252–54. The file fails to evidence 

any physical exam to justify the pain 

prescriptions under the standard of care. 

Tr. 254–55, 258, 287. The file fails to 

evidence any treatment plan or goals, 


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27On September 29, 2017, and monthly from July 

2018, to July, 2019, S.B. was prescribed 

hydrocodone and Adderall. Besides the serious risk 

of addiction posed by these two Schedule II 

medications, the hydrocodone was prescribed at a 

daily dosage of 60 mg MME, which significantly 

increases the risk of overdose and death. This risk 

was increased by its combination with Adderall. Tr. 

206–07. Dr. Munzing could not foresee a medical 

condition in which this combination would be 

appropriate. Tr. 211–12. 28Buprenorphine. 

past drug abuse to justify the pain 

prescriptions under the standard of care. 

Tr. 254–55, 258, 287. Although M.B. 

declared on a ‘‘Declaration of Pain 

medication Use’’ form that he had no 

prior drug abuse in August 2009, which 

was three years after his first visit, such 

static declaration does not satisfy the 

physician’s ongoing responsibility 

under the standard of care to monitor 

this issue. Tr. 259–61; GX 3 at 93. 

On July 9, 2013, M.B. presented with 

ADD and neck pain. Tr. 261–62; GX 3 

at 46. He was prescribed Adderall for 

the ADD. Tr. 262. Again, the records 

reveal there was no history taken to 

support the diagnosis or prescriptions 

for Adderall. Tr. 262. There was no 

evident evaluation done by the 

Respondent. Tr. 287. There was no 

treatment plan. Tr. 263. Although there 

was a written diagnosis related to the 

neck pain, there was no history or 

physical exam evident in the file to 

support it. Tr. 263–64. The Respondent 

never established a legitimate medical 

purpose for hydrocodone. Tr. 264. On 

September 6, 2013, M.B. presented with 

ADD. Tr. 264–65; GX 3 at 46. He was 

prescribed Adderall for the ADD, but at 

double the dosage of the previous visit, 

yet without any reported justification. 

Tr. 264–65. On January 5, 2018, M.B. 

presented to the clinic. Tr. 265–66; GX 

3 at 37. He was prescribed hydrocodone 

and Adderall. There was no medical 

history, no discussion of M.B.’s 

response to treatment, evaluation of 

pain or functioning, substance abuse 

history, diagnoses, or rationale for 

establishing a legitimate medical 

purpose to justify continuing the 

medication regimen. Tr. 265–66. On 

March 6, 2018, M.B. presented to the 

clinic with ‘‘ADD and opioid 

dependency.’’ Tr. 266–67; GX 3 at 36. 

Absent was any report of pain. He was 

diagnosed with ‘‘Opioid dependency, 

refusing detox.’’ Tr. 267. Hydrocodone 

as treatment for opioid dependency is 

not a legitimate medical purpose and is 

outside the usual course of professional 

practice. Tr. 267–68. Dr. Munzing 

observed that the Respondent 

prescribed hydrocodone repeatedly to 

address his diagnosis of opioid 

dependency until November 20, 2019. 

Tr. 268–69. On November 20, 2019, 

M.B. presented with ADD and back 

pain. Tr. 269; GX 3 at 27. He was 

prescribed Adderall and his 

hydrocodone was increased. Tr. 270. No 

medical history was taken or updated. 

No response to treatment or patient 

functionality was included. Although 

vital signs were taken, no physical exam 

was performed. Tr. 270–71. There was 

no appropriate diagnosis for the back 

pain. Tr. 272. There was no evaluation 

for ADD, such as mental functioning. Tr. 

271, 274, 287–88. The Respondent never 

obtained a sufficient history to support 

the diagnosis for ADD. Tr. 273. There 

was no appropriate diagnosis for ADD. 

Tr. 272. The Respondent never 

established a legitimate medical 

purpose to prescribe either hydrocodone 

or Adderall to M.B. throughout the 

reported treatment. Tr. 274. Such 

prescriptions were not in the usual 

course of professional practice, were not 

for a legitimate medical purpose, and 

were outside the standard of care. Tr. 

274–75. 

Dr. Munzing noted the inconsistency 

of the various diagnoses. Diagnoses 

would come and go within the records. 

Tr. 275–278; GX 3 at 35, 37, 43, 67. 

Although the reported pain was always 

treated with hydrocodone, the source of 

the pain varied greatly without any 

explanation in the file, as required by 

the standard of care. Tr. 278–80. 

Dr. Munzing noted the serious 

dangers occasioned by the combination 

of Adderall and hydrocodone, by 

reference to his testimony regarding 

S.B.’s similar prescriptions.27 Tr. 281. 

Dr. Munzing deemed this combination 

of medications for over ten years 

inappropriate and unsafe. Tr. 284. The 

only semblance of a warning to M.B. 

regarding these dangerous combinations 

appeared in a 2009 ‘‘Controlled 

Substance Therapy Agreement.’’ For the 

same reasons voiced as to Patient S.B., 

Dr. Munzing deemed the signed form 

wholly insufficient to satisfy the 

California standard of care in this 

regard. Tr. 281–82; GX 3 at 92. 

Similarly, the notation within the file, 

‘‘SED’’ was insufficient to satisfy the 

standard of care. Tr. 283. There was 

never a UDS ordered for M.B., which is 

necessary under the standard of care for 

any patient receiving opioids, but 

especially for a patient who has refused 

opioid detox. Tr. 284–85. A patient 

diagnosed with opioid dependency and 

refusing detox is also a red flag of abuse 

and diversion. Such red flag was not 

addressed by the Respondent repeatedly 

as to M.B. Tr. 285–87; GX 3 at 36. 

The Respondent defended his 

treatment of M.B. by noting that he 

monitored M.B. throughout his 

treatment. Tr. 785. The Respondent 

believed his prescribing was justified on 

the basis of M.B.’s medical conditions, 

level of chronic pain and present level 

of functioning, working in a welding 

factory, and in the movie business. Tr. 

786, 832. The Respondent conceded that 

he did not document M.B.’s degree of 

pain and he minimized the value of the 

subjective pain scale. Tr. 823–24. The 

Respondent conceded there were no 

imaging reports in M.B.’s chart, but 

explained that these patients were from 

the movie business. They were treated 

by an HMO, from which it is almost 

impossible to obtain records. Tr. 829. 

[While it may be] true that the 

Respondent [did some] monitoring of 

M.B. during treatment, not all this 

monitoring found its way into M.B.’s 

chart. Alarming evidence revealed the 

Respondent was or should have been 

aware that M.B. was receiving Suboxone 

from Dr. B.S. during the period the 

Respondent was prescribing high levels 

of dangerous medications and in 

dangerous combinations. DI identified 

GX 25, which is a CURES Audit Report 

run on the DEA Registration of Dr. B.S., 

which included the patient M.B., a 

patient common to the Respondent. Tr. 

904. Between October 10, 2018, and 

September 11, 2020, Dr. B.S. prescribed 

Suboxone 28 to M.B. Tr. 909; GX 24, 25, 

25B. On March 15, 2019, the 

Respondent accessed CURES and would 

have observed M.B. was receiving 

Suboxone from Dr. B.S. Tr. 910; GX 24. 

Despite having evidence of the 

Suboxone prescriptions, the Respondent 

continued prescribing these dangerous 

medications, and like his other patients, 

without any UDS. 

I find, as alleged, that the 

Respondent’s controlled substance 

prescriptions to Patient M.B. from at 

least January 5, 2018, through November 

2019, were not issued ‘‘for a legitimate 

medical purpose by an individual 

practitioner acting in the usual course of 

his professional practice’’; [they were 

issued outside the usual course of 

professional practice and beneath the 

standard of care in violation of 21 CFR 

1306.04(a).] 

Discussion as to Patient B.C. 

The Respondent explained his 

treatment of Patient B.C. He has been a 

patient of the Respondent since March 

27, 2014. Tr. 750–51. Patient B.C. has 

been prescribed hydrocodone, Xanax 

and Adderall. Tr. 749. The Respondent 

testified that he obtained a complete 

history, a complete physical exam and 

then probed the complaint which 

brought him to the Respondent, which 

was right shoulder and chronic back 


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29 [Repeated text omitted for brevity.] 

pain. Tr. 751. [Based on his memory 

alone, Respondent testified that] 

without medication, B.C. reported pain 

at seven or eight; and with medication, 

the pain was one or two. Tr. 752. As far 

as his medication history, [Respondent 

testified based on his memory that] B.C. 

had been on pain medication for years 

following a neurosurgical procedure to 

treat a herniated disc with 

radiculopathy.29 Tr. 752. 

To obtain informed consent, the 

Respondent testified that he verbally 

discussed the pain management 

contract, which B.C. read and signed. 

Tr. 752–53. The Respondent then 

discussed side effects of the medication. 

B.C. is a married man with three 

children. He works full time. He gave 

the Respondent no indication he was a 

risk of diversion. Tr. 753. Regarding 

prior alternate treatment, [Respondent 

testified from memory that] B.C. 

reported that he had tried surgery, 

physical therapy and acupuncture, but 

that only pain medication therapy 

alleviates his pain to the extent he can 

function. Tr. 754. At each visit, the 

Respondent reviewed B.C.’s progress 

and believed B.C.’s condition warranted 

the medication he was prescribed. Tr. 

754, 757. Although the Respondent 

testified that he remembered discussing 

B.C.’s pain levels on March 27, 2014, 

which was a one or two on medication, 

he conceded it was not documented in 

the chart. Tr. 832–34; GX 5 at 48. 

Although the Respondent testified that 

he remembered B.C. reporting he had a 

herniated disc, this report was not 

documented in the chart. Tr. 836. 

Neither were B.C.’s reported prior 

therapies documented. Tr. 837. 

Dr. Munzing reviewed the subject 

prescriptions, patient file and CURES 

report for Patient B.C, which he 

described as lean. Tr. 290–92; GDX 3. 

He opined that the subject controlled 

substance prescriptions issued for 

hydrocodone, Xanax and Adderall, from 

January 25, 2017, to December 19, 2019, 

were all issued outside the California 

standard of care. Tr. 290–92, 335–38. 

B.C. presented on March 27, 2014, with 

GAD and back pain. Tr. 293–94; GX 5 

at 48, 55. B.C. was diagnosed with GAD 

and back pain, refusing detox. He was 

prescribed Xanax (6 mg per day) for the 

GAD, and hydrocodone for the back 

pain, refusing detox. Tr. 294. Dr. 

Munzing reiterated the risks involved in 

prescribing 6 mg of Xanax per day. Tr. 

295. 

The records failed to include the 

minimum history necessary under the 

standard of care to appropriately 

diagnose back pain and GAD [or to 

prescribe controlled substances to treat 

those conditions.]. Tr. 295–96. Other 

than limited vital signs, the records 

failed to disclose the minimum physical 

examination necessary under the 

standard of care to appropriately 

diagnose back pain, or to justify a 

hydrocodone prescription. Tr. 296–97. 

Dr. Munzing could not remember seeing 

any prior medical records in the 

Respondent’s subject files. Tr. 297. 

There were no entries in B.C.’s file 

indicating physical or mental 

functioning. Tr. 298, 335–38. There is 

no treatment plan indicated. The 

Declaration of Pain Medication Use, 

signed by B.C. at his first visit, as 

discussed supra, is insufficient to 

evaluate B.C., and to establish informed 

consent for the controlled substances 

prescribed. Tr. 299–300. There was 

insufficient medical evidence to support 

either diagnosis. Tr. 298, 335–38. So, 

there was no legitimate medical purpose 

for either controlled substance 

prescription. Tr. 299, 335–38. 

B.C. presented on May 20, 2014, with 

ADD and was prescribed Adderall. Tr. 

301–02; GX 5 at 47. The ADD diagnosis 

was deficient, as no history was 

developed, no mental functioning was 

assessed, the medical evidence was 

deficient, and a treatment plan was 

lacking. The Respondent failed to 

establish a legitimate medical purpose 

for the Adderall. Tr. 302. Additionally, 

starting B.C. on 30 mg of Adderall twice 

daily is a very high dosage, and 

extremely inappropriate for an Adderall 

naive patient, which is not justified 

within the patient file. Tr. 302–03. B.C. 

presented on January 25, 2017, with 

ADD, opioid dependency and GAD. Tr. 

303; GX 5 at 33. He was diagnosed with 

ADD for which he was prescribed 

Adderall, and GAD for which he was 

prescribed Xanax (6 mg per day). Tr. 

304. Pain levels were not recorded at 

this visit. The diagnoses were 

unsupported by sufficient, medical 

history, medical evaluation, response to 

treatment, patient functionality, and 

medical evidence. Tr. 304–06. He failed 

to establish a legitimate medical 

purpose for both Adderall and Xanax. 

Tr. 306, 335–38. The Respondent further 

diagnosed, ‘‘Opioid dependency, 

refusing detox’’ for which the 

Respondent again prescribed 

hydrocodone. Tr. 306. Prescribing 

hydrocodone for opioid dependence is 

not only outside the standard of care, 

but it is illegal in California according 

to Dr. Munzing. Tr. 307. Hydrocodone is 

not a legitimate medical treatment for 

opioid dependency and thus the 

prescription was outside the usual 

course of professional practice. Tr. 307. 

A patient diagnosed with opioid 

dependency and refusing detox is also 

a red flag of abuse and diversion. Such 

red flag was repeatedly left unaddressed 

by the Respondent as to B.C. Tr. 306– 

07; GX 5 at 33. 

On July 31, 2018, B.C. presented with 

ADD, back pain and GAD. Tr. 308; GX 

5 at 28. He was diagnosed with ADD for 

which he was prescribed Adderall (60 

mg per day), ‘‘back pain, opiate 

dependent, refusing detox’’ for which he 

was prescribed hydrocodone, and GAD 

for which he was prescribed Xanax (6 

mg per day). Tr. 308. There was no 

medical history supporting the 

prescriptions. There was no indication 

how the patient was responding to 

treatment and no indication a physical 

exam was performed to support the 

diagnoses or justify the prescriptions. 

Tr. 308–09, 335–38. There was no 

reference to pain levels or physical 

functionality. Tr. 309–10. There was no 

reference to mental functioning with 

respect to the ADD and GAD diagnoses. 

There was no appropriate or 

documented support for the three 

diagnoses. Tr. 309–10. 

Neither did he establish a legitimate 

medical purpose for the three controlled 

substance prescriptions. Tr. 311. B.C. 

presented on December 19, 2019, with 

ADD and back pain, which were also his 

diagnoses, and for which he was 

prescribed Adderall (60 mg per day) and 

hydrocodone. Tr. 311–12; GX 5 at 20. 

The record is absent medical history, 

any updated medical history, the 

patient’s state of health, how he is 

responding to treatment, a physical 

exam, pain levels, mental or physical 

functioning, appropriate rationale for 

continued treatment, and information 

relating to drug abuse. Tr. 312–13, 335– 

38. As a result, the three diagnoses are 

without sufficient medical evidence. Tr. 

313. Accordingly, the subject charged 

prescriptions are without a legitimate 

medical purpose, are outside the usual 

course of professional practice, and are 

beneath the standard of care. Tr. 313– 

16, 335–38. 

Dr. Munzing noted the inconsistency 

of diagnoses throughout B.C.’s records 

and the dual prescribing of 

hydrocodone for opioid abuse and for 

skeletal pain, without explanation in the 

record. Tr. 316–19; GX 5, p. 31, 32, 33. 

Dr. Munzing noted the GAD and ADD 

diagnoses appear and disappear within 

the record, as did their treatment 

medications. Tr. 319–24; GX 5 at 27, 31, 

32, 33. Dr. Munzing deemed it highly 

unlikely that ADD and GAD were 

appropriate diagnoses. Tr. 322, 324. The 

Respondent prescribed B.C. a 

combination of hydrocodone, Adderall 

and Xanax. Tr. 327; GDX 3. Dr. Munzing 


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30The Respondent again explained the difficulty 

in obtaining prior medical records. Tr. 842. *KK See supra, n.*V. 

could not conceive of a medical 

condition warranting this dosage, 

duration, and combination of 

medications, noting that Adderall is 

counter-indicated for GAD and that 

combining Xanax with an opioid 

represents a dangerous combination 

addressed in a FDA black box warning 

and CDC guidance. Tr. 327–29, 332–33; 

GDX 3. A further concern, as detailed 

earlier in his testimony, is reflected by 

the repeated combination of 

hydrocodone and Adderall prescribed 

by the Respondent. Tr. 329–30; GDX 3. 

These dangerous combinations were 

prescribed without an established 

legitimate medical purpose, outside the 

usual course of professional practice, 

without sufficient warnings and 

informed consent, without sufficient 

patient monitoring, and without regard 

to obvious red flags. Tr. 330–35. 

I find, as alleged, that the 

Respondent’s controlled substance 

prescriptions to Patient B.C. from at 

least January 25, 2017, through 

December 19, 2019, were not issued ‘‘for 

a legitimate medical purpose by an 

individual practitioner acting in the 

usual course of his professional 

practice’’; [they were issued outside the 

usual course of professional practice 

and beneath the standard of care in 

violation of 21 CFR 1306.04(a).] 

Discussion as to Patient J.C. 

The Respondent discussed his 

treatment of Patient J.C. He presented on 

May 18, 2009, with chronic back pain, 

ulcerative colitis, and GAD. Tr. 759–60, 

761–62. [Respondent testified from 

memory that J.C.] was prescribed 

hydrocodone and Xanax, which was 

sometimes substituted with Valium. Tr. 

759. The Government prompted the 

Respondent to visits in which several 

other controlled substances were also 

prescribed. Tr. 842–46; GX 7 at 181, 

214, 215. 

The Respondent explained that J.C. 

had suffered multiple injuries and had 

been immobile for some time. However, 

the Respondent did not document the 

injuries nor the immobility in the chart, 

nor did the file contain any prior 

medical records.30 Tr. 839, 842; GX 7 at 

216. [Respondent, testifying from 

memory,] stated that J.C. had undergone 

physical therapy, occupational therapy, 

and finally pain management, which 

permitted him to resume working fulltime. These alternate treatments, 

therapies, and prior surgeries were not 

documented within the chart. Tr. 840. 

The Respondent could not remember if 

J.C. mentioned his prior surgeries at the 

first or second visit. Tr. 840. The 

Respondent testified that he performed 

a full exam on J.C. Tr. 760–61. His GAD 

resulted from his ulcerative colitis. Tr. 

762. The Respondent testified that he 

obtained informed consent to prescribe 

controlled substances by explaining the 

pain contract, and afterwards, J.C. read 

it and signed it. Tr. 763. The 

Respondent testified that he verbally 

explained the dangers of overdose to J.C. 

Tr. 764. The Respondent had no 

concerns over J.C. diverting his 

medication. Tr. 764–65. On the basis of 

J.C.’s considerable injuries and 

condition, the Respondent felt J.C.’s 

medication protocol was fully justified. 

Tr. 765. Although the Respondent 

remembered J.C. reporting that he had 

seen two previous doctors, including a 

pain physician, that report was not 

reflected in the chart. Tr. 841–42. 

Although the Respondent remembered 

performing a complete mental health 

evaluation on J.C., it is not documented 

in the chart. Tr. 842. The Respondent 

denied ever intentionally misspelling 

J.C.’s first name.*KK Tr. 765–66. 

Dr. Munzing reviewed the subject 

prescriptions issued from January 16, 

2018, to December 30, 2019, patient 

records and CURES data relating to 

Patient J.C. Tr. 381–82; GDX 4. Dr. 

Munzing opined that none of the subject 

prescriptions issued to J.C. were within 

the California standard of care. Tr. 381– 

82; GDX 4. J.C. presented to the 

Respondent’s clinic on May 18, 2009, 

with a headache and GAD. Tr. 383–384; 

GX 7, at 216, 233. He was prescribed 

hydrocodone for migraines and Xanax 

for GAD, and he remained on this 

medication regimen for a long period. 

As to the migraines, insufficient medical 

history was obtained, symptom 

evaluation was absent, no neurological 

exam was conducted, no evaluation of 

functioning level, no treatment plan 

evident, and no evaluation of possible 

drug abuse. Tr. 384–90. In short, there 

was insufficient medical evidence to 

support the diagnosis of migraines and 

GAD, nor was there a legitimate medical 

purpose to prescribe hydrocodone and 

Xanax. TR. 386–88. 

[On August 17, 2009, J.C. signed a 

‘‘Declaration of Pain Medication Use’’ 

form indicating that he had no prior 

drug abuse, and Dr. Munzing testified 

that there is no record of J.C. ever being 

asked about illicit substance abuse 

again. Tr. 389–90. Dr. Munzing testified 

that the 2009 Declaration was an 

insufficient inquiry to cover prescribing 

occurring in 2018. Id.] 

J.C. presented on July 21, 2016, with 

‘‘GAD, chronic back pain, consented for 

H&P.’’ Tr. 390; GX 7, p. 189. He was 

diagnosed with GAD, ‘‘back pain— 

refusing detox’’ for which he was 

prescribed Xanax and hydrocodone, 

respectively. Tr. 390–91. There was no 

updated history taken for either 

diagnosis, no physical exam, no 

treatment plan, no response to 

treatment, no pain or functioning level 

evaluations, no discussion regarding 

drug abuse, and no rationale for 

continued treatment, as was required by 

the standard of care. Tr. 390–94. 

According there was insufficient 

medical evidence to support either 

diagnosis. The Respondent did not 

establish a legitimate medical purpose 

to prescribe the controlled substances. 

Tr. 393–94. J.C. presented on January 

16, 2018, with GAD and back pain for 

which he was diagnosed with GAD and 

back pain, opiate dependent, refused 

detox. Tr. 394–95; GX 7 at 180. He was 

prescribed Valium for the GAD to 

replace Klonopin, and hydrocodone for 

back pain, although no explanation was 

giving for substituting the Valium for 

the Klonopin. Tr. 395. There was no 

medical history included in the records, 

no response to treatment, no physical 

exam, no pain or functioning 

evaluation, no drug abuse history, 

rendering each diagnosis inappropriate. 

Tr. 395–97. Without a legitimate 

medical purpose, there was no 

appropriate rationale for continued 

treatment with controlled substances. 

Tr. 396–98. J.C. presented on February 

16, 2018, with ‘‘opioid dependency, 

GAD,’’ yet without the previously noted 

back pain. Tr. 198; GX 7, 9. There is no 

reference to pain. He was diagnosed 

with ‘‘Opioid dependency, refusing 

detox’’ for which he was prescribed 

hydrocodone, which again, is outside 

the standard of care and usual course of 

professional practice, and illegal in 

California. Tr. 398–400. The diagnosis 

for opioid dependency being treated 

with hydrocodone appeared repeatedly 

in the records. Tr. 399. J.C. presented on 

May 6, 2019, however no treatment 

notes for this visit are evident in the file. 

Tr. 401; GDX 4, GX 7 at 168. 

On April 9, 2019, J.C. presented with 

GERD, and back pain for which he was 

prescribed hydrocodone. Tr. 402. 

However, there was no medical history 

included in the records, no response to 

treatment, no physical exam, no pain or 

functioning evaluation, no mental 

health history, no drug abuse history, 

rendering the back pain diagnosis 

inappropriate. Tr. 402–04. Without a 

legitimate medical purpose, there was 

no appropriate rationale for continued 

treatment with controlled substances. 

Tr. 402–04. On December 30, 2019, J.C. 


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presented with GERD and GAD. Tr. 404; 

GX 7 at 171. He was prescribed Valium 

for the GAD. However, there was no 

appropriate medical history included in 

the records, no response to treatment, 

no evaluation for GAD, or functioning 

evaluation, no mental health history, no 

drug abuse history, rendering the GAD 

diagnosis inappropriate from January 

16, 2018, to December 30, 2019. Tr. 

404–08, 425–28. Without legitimate 

medical purpose, there was no 

appropriate rationale for continued 

treatment with controlled substances. 

Tr. 408, 425–28. Such prescriptions, 

from January 16, 2018, to December 30, 

2019, were outside the standard of care, 

without legitimate medical purpose, and 

outside the usual course of professional 

practice. Tr. 408, 425–28. 

Dr. Munzing noted the inconsistency 

of diagnoses throughout J.C.’s records, 

and the dual prescribing of 

hydrocodone for opioid abuse, 

migraines and for skeletal pain, without 

explanation in the record. Tr. 410–14; 

GX 7 at 188, 189, 205, 214, 215. Dr. 

Munzing noted the skeletal pain 

diagnosis appears and disappears 

within the record. Tr. 414–15. Dr. 

Munzing suspected the skeletal pain 

complaints were not legitimate. Tr. 415; 

GX 7 at 188, 189, 205, 214, 215. Dr. 

Munzing noted the Respondent had 

prescribed the combination of 

hydrocodone and Valium monthly 

between January 2018, and January 

2019, without a legitimate medical 

purpose. Tr. 416–17; GX 4. Combining 

Valium with an opioid represents a 

dangerous combination and is contrary 

to a FDA black box warning and to CDC 

guidance, especially with the Valium at 

its highest available strength. Tr. 417. 

Dr. Munzing could not envision a 

condition in which this medication 

regimen would be appropriate. Tr. 418. 

These dangerous combinations were 

prescribed without an established 

legitimate medical purpose, outside the 

usual course of professional practice, 

without sufficient warnings and 

informed consent, without sufficient 

patient monitoring, and without regard 

to obvious red flags. Tr. 418–23; GX 7 

at 19, 25, 27, 180, 225. 

I find, as alleged, that the 

Respondent’s controlled substance 

prescriptions to Patient J.C. from at least 

January 16, 2018, through December 

2019, were not issued ‘‘for a legitimate 

medical purpose by an individual 

practitioner acting in the usual course of 

his professional practice’’; [they were 

issued outside the usual course of 

professional practice and beneath the 

standard of care in violation of 21 CFR 

1306.04(a).] 

Discussion as to Patient D.D. 

The Respondent explained his 

treatment of Patient D.D. He first 

presented on July 9, 2008, with GAD 

and severe back pain, although the 

source of the back injury was not 

documented. Tr. 767–68, 850; GX 9 at 

74. Over the course of treatment, the 

Respondent prescribed hydrocodone, 

Xanax, and Soma. Tr. 850. The 

Respondent added that he probably 

prescribed Valium, as well, explaining 

he was remembering from 13 years ago. 

Tr. 850. The Respondent remembered 

D.D. was prescribed Valium, 

hydrocodone, and Soma at the first visit. 

Tr. 851–52. The Respondent believes his 

treatment was within the standard of 

care in California. The Respondent 

testified that he took a complete medical 

history, family history, personal history 

and medication history. Tr. 768. The 

family history was not documented in 

the chart. Tr. 848. The Respondent 

explained that the family history was 

not documented because it was noncontributory to his assessment. Tr. 848. 

[Based on Respondent’s memory, he 

testified that] there were no heart 

conditions in his family, etc. Tr. 849. 

The Respondent did document that D.D. 

was married, which he deemed 

contributory. Tr. 849. Respondent 

testified that D.D. had a dirt bike 

accident, which shattered his shoulder 

and fractured several ribs, although the 

accident as the source of the injury was 

not documented. Tr. 850. [Based on his 

memory, Respondent testified that] D.D. 

underwent prior physical therapy and 

occupational therapy after treatment by 

an orthopedic surgeon, although it was 

not documented within the chart. Tr. 

769, 771, 850–51. [Again from memory, 

Respondent testified that] it was several 

years before D.D. reached the 

medication regimen he was on when he 

first reported to the Respondent. The 

Respondent testified that he performed 

a full physical exam. He testified that he 

established informed consent with the 

pain contract and discussion of side 

effects and overdose, as with all his 

patients. Tr. 770. He verbally cautioned 

D.D. regarding diversion and other red 

flags. Again, Respondent testified that 

D.D. gave no indication of diversion. Tr. 

771. 

Dr. Munzing reviewed the subject 

prescriptions issued from January 4, 

2018, to February 12, 2019, patient 

records and CURES data relating to 

Patient D.D. Tr. 428–29; GDX 5. Dr. 

Munzing opined that none of the subject 

prescriptions issued to D.D., which were 

for hydrocodone, Soma, and Xanax, 

were within the California standard of 

care. Tr. 430. Again, the records were 

very lean. D.D. presented on July 9, 

2008, with GAD and back pain. Tr. 430– 

31 GX 9 at 74. For the GAD, he was 

prescribed Valium, and for back pain, 

hydrocodone and Soma. Tr. 431. The 

medical records reflect that D.D. refused 

an MRI and referral to an orthopedist or 

pain specialist. Tr. 431. Each refusal 

was a red flag and was suggestive of 

drug-seeking behavior. Tr. 432. Instead 

of addressing the red flags, the 

Respondent prescribed opioids. Tr. 432. 

The Respondent’s response was the 

same throughout the subject treatment 

of D.D., a total of nine and a half years. 

Tr. 433. 

There was no appropriate medical 

history included in the records, no 

response to treatment, no physical 

exam, insufficient patient monitoring, 

no evaluation for GAD, or functioning 

evaluation, no mental health history, no 

drug abuse history, no discussion of risk 

factors and informed consent, and no 

patient monitoring, which rendered the 

GAD and back pain diagnoses 

inappropriate from July 9, 2008, to 

January 4, 2019. Tr. 433–38; GX 9 at 37, 

39, 41, 43, 44. Without a legitimate 

medical purpose, there was no 

appropriate rationale for continued 

treatment with controlled substances. 

Tr. 434–48. Such prescriptions, from 

July 9, 2008, to January 4, 2019, were 

beneath the standard of care, without a 

legitimate medical purpose, and outside 

the usual course of professional 

practice. Tr. 434–48. [On January 11, 

2019, D.D. was diagnosed with GERD 

and back pain—opiate dependent 

refusing detox. Tr. 439. This is the last 

time Respondent prescribed D.D. both 

hydrocodone and Soma, but the medical 

records again reflected a lack of 

appropriate medical history, response to 

treatment, an appropriate physical 

examination, assessment of pain or 

physical functionality, an appropriate 

diagnosis, or an established legitimate 

medical purpose for the prescriptions. 

Tr. 439–40. On February 12, 2019, 

Respondent prescribed D.D. 

hydrocodone to treat opioid 

dependency—refusing detox without 

there being any mention of pain, and Dr. 

Munzing testified that this was 

problematic for all of the reasons he had 

previously testified to. Tr. 441–42. Dr. 

Munzing testified that at no point 

during the treatment period did 

Respondent ever obtain a sufficient 

history to establish a diagnosis for back 

pain or support prescribing of 

hydrocodone, and that the prescriptions 

for hydrocodone and Soma were not 

issued within the usual course of 

professional practice and were beneath 

the standard of care. Tr. 443–44.] 


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31 [This footnote and the preceding text are 

omitted for brevity and relevance.] 

Dr. Munzing noted a period of over a 

year, from May 10, 2017, to September 

19, 2018, when no diagnosis for GAD 

appeared in D.D.’s records and the 30 

mg daily dose of Valium was stopped. 

Tr. 447–48. Then on September 19, 

2018, the Respondent prescribed 6 mg 

of Xanax, a very high dosage, especially 

for the beginning dosage. [Dr. Munzing 

testified that Respondent failed to 

obtain sufficient medical evidence upon 

which to base a GAD diagnosis. Tr. 446.] 

Compounding this dangerous dosage, 

D.D. was prescribed hydrocodone in 

combination, which heightened the risk 

of overdose [without any documented 

warning from Respondent regarding the 

dangers of the controlled substances 

being prescribed.] Tr. 446, 448–50, 458. 

[Dr. Munzing testified that there was no 

established legitimate medical purpose 

for prescribing Xanax to D.D. Tr. 446.] 

Dr. Munzing noted the inconsistency 

of diagnoses throughout D.D.’s records, 

and the dual prescribing of 

hydrocodone and Soma for 

Fibromyalgia, opioid abuse, migraines, 

and for skeletal pain, without 

explanation in the record. Tr. 450–56; 

GX 9, p. 43, 51, 64, 70, GDX 5. Dr. 

Munzing noted the skeletal pain 

diagnosis appears and disappears 

within the record. Tr. 450–56. Dr. 

Munzing suspected the skeletal pain 

complaints were not legitimate. Tr. 456; 

GX 9 at 43, 51, 64, 70. Prescribing Soma 

with hydrocodone presents considerable 

risks to the patient. Each are respiratory 

depressants, which present a significant 

risk of overdose [and addiction.] Tr. 

458. [Dr. Munzing also reiterated the 

risks of prescribing both hydrocodone 

and Xanax together. Tr. 458. Dr. 

Munzing testified that in 2009, D.D. 

signed ‘‘the same controlled substance 

therapy agreement we’ve seen with the 

previous four patients,’’ and it was 

insufficient notice of the risks of using 

controlled substances for the reasons 

already discussed. Tr. 458–59. Dr. 

Munzing further testified that the record 

is lacking any documentation that 

Respondent adequately warned D.D. of 

the risks of the controlled substances he 

was taking, particularly in light of the 

various combinations and high dosages. 

Tr. 459–60.] 

D.D. presented on March 23, 2019, 

with opioid dependency, refusing detox. 

He was again prescribed hydrocodone 

and Soma. Tr. 463; GX 9 at 42, 43. The 

Respondent failed to address this red 

flag repeatedly, and instead 

inappropriately prescribed Soma and 

hydrocodone. Tr. 465. 

I find, as alleged, that the 

Respondent’s controlled substance 

prescriptions to Patient D.D. from at 

least January 4, 2018, through February 

12, 2019, were not issued ‘‘for a 

legitimate medical purpose by an 

individual practitioner acting in the 

usual course of his professional 

practice’’; [they were issued outside the 

usual course of professional practice 

and beneath the standard of care in 

violation of 21 CFR 1306.04(a).] 

Discussion as to Patient J.M. 

The Respondent explained his 

treatment of J.M. He has been a patient 

for 13 years. Tr. 734. The Respondent 

has prescribed him Xanax, Soma, and 

hydrocodone. The Respondent believed 

his treatment of J.M. was within the 

California standard of care. J.M. first 

presented on May 14, 2007, with 

chronic pain syndrome, which 

sometimes manifests as back pain, and 

neck pain, and GAD. Tr. 735; GX 11 at 

104. The Respondent testified that he 

took a history. [Testifying based on his 

memory, Respondent said] J.M. had 

been involved in a motor vehicle 

accident injuring his back, neck and 

lumbar spine. The motor vehicle 

accident as the source of the injury was 

not documented. Additionally, he 

suffered from GAD and hypertension. 

Tr. 736. Tr. 853. Respondent testified 

that J.M. had seen an orthopedic 

surgeon, although it was not 

documented in the chart. Tr. 853. 

[Testifying based on memory, 

Respondent said that without 

medication, J.M. reported severe pain of 

10 or 11 out of 10. With medication, he 

reported three of ten, permitting him to 

function and to work full time, although 

the pain levels were not documented in 

the chart. Tr. 736, 854–55. J.M. reported 

prior treatments and medication. Based 

on his memory, Respondent testified] 

J.M. had received physical therapy, 

occupational therapy, hypnosis, and 

acupuncture to no avail prior to turning 

to chronic pain management, although 

these previous therapies were not 

documented in the chart. Tr. 737, 854. 

His present medication protocol 

delivered the best results with the least 

side effects he had. Tr. 737. The 

Respondent testified that he probed 

J.M.’s psychological history, which 

included an all-consuming fear. 

The Respondent testified that he 

performed a comprehensive physical 

exam. Tr. 739. To obtain informed 

consent to prescribe J.M. controlled 

substances, the Respondent said he 

went over the pain management 

contract, which J.M. also read and 

signed. The Respondent testified that he 

verbally cautioned J.M. about diversion 

and the red flags of doctor shopping and 

pharmacy hopping, which would result 

in discharge. Tr. 739–40.31 The 

Respondent then testified that he 

discussed the beneficial aspects of the 

pain medication and potential negative 

effects if abused. According to 

Respondent, J.M. never gave any 

indication he represented a risk of 

diversion. Tr. 741. Prior to seeing the 

Respondent, Respondent testified that 

J.M. was on a higher MME of opioids. 

He was able to reduce the dosages to the 

level he was on when he first saw the 

Respondent. He remains on that dosage. 

Again, he is able to function and work 

full-time on this dosage. Tr. 742. The 

Respondent noted that J.M. would 

sometimes try to avoid taking his 

medication, even if he suffered pain, as 

explanation for the breaks in 

prescribing. Tr. 743. 

Dr. Munzing reviewed the subject 

prescriptions and fill stickers issued 

from January 10, 2017, to December 31, 

2019, patient records and CURES data 

relating to Patient J.M. Tr. 469–70; GDX 

6. [Again Dr. Munzing testified there 

was ‘‘very little information’’ in the 

medical records. Tr. 470.] Dr. Munzing 

opined that none of the subject 

prescriptions issued to J.M. were within 

the California standard of care. Tr. 470– 

71. 

On May 13, 2007, J.M. presented with 

hypertension, back pain, GAD, 

dyslipidemia and insomnia. Tr. 470–72; 

GX 7 at 104, 111. He was diagnosed 

with hypertension, back pain, GAD, 

dyslipidemia and insomnia. He was 

prescribed hydrocodone for back pain 

and Xanax (6 mg per day) for GAD. Tr. 

472. Xanax and hydrocodone were 

recurring prescriptions. As discussed 

earlier, the high dosage of Xanax was a 

concern, as well as its combination with 

an opioid. Tr. 473. 

There was no appropriate medical 

history included in the records, no 

response to treatment, no physical 

exam, insufficient patient monitoring, 

no evaluation for GAD, no treatment 

plan, no pain or functioning evaluation, 

no mental health history, no ongoing 

drug abuse history or monitoring, no 

discussion of risk factors and informed 

consent, and no patient monitoring, 

rendering the GAD and back pain 

diagnoses inappropriate from May 13, 

2007, to January 13, 2017. Tr. 473–76, 

478, 481–83, 485–500. Per Dr. Munzing, 

the MRI of May 30, 2007, and its mild 

findings, did not independently satisfy 

the Respondent’s related obligations or 

justify the subject prescriptions. Tr. 

479–80, 485–87; GX 11 at 14, 16, 17, 22, 

26, 31, 37, 41, 42, 115. [Dr. Munzing 

testified that for the five visits between 


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32These are prescription numbers. 

January 10, 2017, through March 27, 

2017, there is so little documentation 

that Dr. Munzing cannot tell whether 

the records reflect ‘‘actual visits’’ or just 

‘‘documentation of a refill of the 

medication,’’ because there are no 

examination or history notations, no 

documentation of the dose or strength 

prescribed, no diagnoses, nothing to 

meet the standard of care for prescribing 

hydrocodone and Xanax for that period. 

Tr. 482–85. The first prescription for 

Soma during the relevant time period 

was on April 13, 2017, and according to 

Dr. Munzing, the medical note said 

‘‘Xanax number 90, Soma number 

50SED, and then a signature’’ with 

absolutely nothing else recorded and 

none of the elements of the standard of 

care met. Tr. 485–86. Dr. Munzing 

testified specifically about selected 

office visits. On April 25, 2018, 

Respondent’s records for J.M. contain 

information suggesting an office visit 

occurred, but they continue to have the 

same deficiencies. That day, J.M. was 

not diagnosed with pain, but with GAD 

and opioid dependence—refusing detox 

which was treated with hydrocodone. 

Tr. 487. Dr. Munzing reiterated his 

concerns that hydrocodone was not 

appropriate treatment for opioid 

dependence and was inappropriate each 

time it was prescribed for that purpose. 

Tr. 488. Dr. Munzing testified about the 

November 19, 2018 visit where J.M. was 

prescribed Xanax for GAD and Soma for 

back pain; the February 20, 2019 visit 

where he was prescribed Xanax for GAD 

and hydrocodone for back pain; and the 

December 31, 2019 visit where he was 

prescribed Xanax for GAD and was not 

diagnosed with back pain. Tr. 489, 492– 

93, 495. Dr. Munzing again testified, 

amongst other things, that for each of 

these visits there was an insufficient 

medical history or physical examination 

to make the diagnoses, there is no 

information regarding the response to 

treatment, pain level, or functionality, 

and there was no legitimate medical 

purpose established for the 

prescriptions at issue. Tr. 489–91, 493– 

97.] Without a legitimate medical 

purpose, there was no appropriate 

rationale for the controlled substance 

prescriptions, or to continue treatment 

with controlled substances. Tr. 473–76, 

478, 485–500, 505; GDX 7. 

There were also red flags left 

unaddressed by the Respondent. J.M. 

refused to see a pain specialist, which 

gives rise to the suspicion that he is not 

concerned about getting better, but just 

getting medicated. Tr. 476–77. [Omitted 

for relevance.] Dr. Munzing noted that 

there were gaps in the hydrocodone and 

Soma prescriptions without any 

required explanation for changes to the 

medication regimen. Tr. 500–04; GX 11 

at 36, 37, 40, 41, 42, 76. He observed 

that the hydrocodone was prescribed 

either for back pain or for opioid 

dependence. Tr. 504. However, the 

required evaluation for the diagnoses 

coming and going and explanation for 

treatment is lacking. This further 

diminishes any medical legitimacy for 

the hydrocodone. Tr. 504. 

Additionally, the Respondent 

prescribed a very addictive and 

dangerous combination of medications, 

an opioid and a benzodiazepine. Tr. 

558–60. Even more concerning, he 

added a muscle relaxant to this already 

dangerous combination to form the 

‘‘Holy Trinity,’’ a favorite drug 

combination for abuse by the drugabusing community. Tr. 505–10. Dr. 

Munzing could not conceive of a 

medical condition in which the trinity 

combination would represent 

appropriate treatment. Tr. 512. This 

trinity of medications was prescribed to 

J.M. repeatedly. GDX 6. The file fails to 

reveal that appropriate warnings were 

given to J.M. in connection with these 

dangerous combinations. Tr. 511; GX 11 

at 113. The CURES report reveals 40 

Xanax prescriptions (3600 dosage units 

and 7200 mgs) were issued to J.M. 

between January 2017, and November 

2018, a period of 22 months, which 

averages 10.5 mgs per day. Tr. 512–17; 

GX 7, 17, 18. This averaged a 

prescription every 16 days. Tr. 527–28. 

Ten and a half mgs per day is 

considerably greater than the maximum 

4 mg per day recommended for 

treatment of anxiety. 

DI identified GX 26, an additional 

CURES Audit Report, one for Dr. B.S.2, 

which spanned from January 2017, to 

September 2020, and which shared a 

common patient with the Respondent, 

J.M. Tr. 911–13; GX 26, 26B. Dr. B.S.2 

prescribed Suboxone to J.M. from 

January 2017, to August 2020. Tr. 913. 

The CURES Audit of the Respondent 

demonstrated that Respondent accessed 

the CURES database during the period 

J.M. was prescribed Suboxone by Dr. 

B.S.2, which would have been evident 

by this review. Tr. 914. The Respondent 

testified he cautioned J.M. regarding 

diversion and other red flags and J.M. 

gave no indication of diversion. Tr. 771. 

But the CURES report belies the 

Respondent’s assurances. The 

Respondent was or should have been 

aware J.M. was obtaining Suboxone 

from Dr. B.S.2, yet the Respondent did 

not mention that critical fact in J.M.’s 

chart. [Dr. Munzing testified that he had 

‘‘great concerns with continuing to 

prescribe hydrocodone despite the fact 

that he’s on Suboxone and had been 

identified . . . as [having] opiate use 

disorder.’’ Tr. 948.] Yet, the Respondent 

continued prescribing controlled 

substances to J.M. This action likely 

exceeds the bounds of benign neglect 

and crosses into the realm of intentional 

diversion. [Either way, I find that 

Respondent’s prescribing was outside 

the usual course of professional practice 

and beneath the standard of care.] 

The Respondent denied ever using a 

different first name for J.M. or using a 

different birth date for him [and 

attributed any mistake to the pharmacy.] 

Tr. 778–82. However, the CURES report 

lists two different dates of birth for J.M., 

as well as two different spellings of his 

first name. Tr. 517–18, 547–49; GX 18. 

A CURES search would be name and 

date of birth specific. So that a search 

by one name and date of birth would 

not reveal prescriptions filed under the 

alternate name and date of birth. Tr. 

526. The main sources of the CURES 

report information are two pharmacies, 

Reliable Rexall and Northridge 

Pharmacy. Tr. 518–19. Despite the fact 

that J.M. was using different names and 

dates of birth at different pharmacies, a 

considerable red flag suggesting abuse 

or diversion, the Respondent did not 

address these issues. Tr. 519–20, 525– 

26. Even if J.M. or the pharmacies were 

the source of the alternate dates of birth 

and alternate first names, with due 

diligence, the Respondent would have 

discovered that a search by a single 

name and date of birth would only 

include half of the Xanax prescriptions 

the Respondent issued to J.M. Tr. 521– 

26, 549–50. Additionally, a review of 

two prescriptions, one written by the 

Respondent and one called in by the 

Respondent on the same day contain 

two different dates of birth. Tr. 533–34. 

Of further suspicion, the CURES 

report reveals J.M. is alternating the 

filling of the Xanax prescriptions 

between the two pharmacies, apparently 

trying to hide the bi-monthly frequency 

of the prescriptions. Tr. 520; GX 17, 18. 

Dr. Munzing noted this was a suspicious 

prescribing practice by the Respondent. 

Tr. 530; GX 17, #s 425 & 575.32 He 

would issue two prescriptions on the 

same day to J.M., one for hydrocodone 

and one for Xanax. He would issue a 

written prescription for hydrocodone, 

which J.M. would invariably fill at 

Northridge Pharmacy, but call in to 

Reliable Pharmacy the prescription for 

Xanax. Tr. 531–33, 535–45, 550–58; GX 

11 at 32, 33, 35, 36, 38, 40, 41, GX 12 

at 5, 6, 10, 11, 14, 22, 24, 27, 33, 34; GX 

13, at 20, 25, 27, 32, 34; GX 17, 18 #s 

473, 474, 994, 1120, 1228, 1386, 1472, 

1553, 2102, 2229, 2341, 2342. In 


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*LLWhile I do not disagree with the ALJ’s 

analysis here, it is unnecessary and immaterial to 

my decision. There is plenty of evidence supporting 

revocation on the grounds that Respondent’s 

prescribing was outside the usual course of 

professional practice and beneath the standard of 

care in California, and Respondent has failed to take 

any responsibility for his actions. Thus, while I 

have left the ALJ’s discussions and findings that 

Respondent assisted J.M. in a diversion scheme 

intact throughout this decision, I have ultimately 

not based my decision on those findings. See also 

supra n. *DD. 

accordance with Dr. Munzing’s 

testimony, this appears to be an attempt 

by J.M. to avoid the suspicion generated 

by the opioid/benzodiazepine 

combination if filled at a single 

pharmacy. Tr. 532–33, 557–60. There 

was an additional suspicious 

circumstance related to a Xanax 

prescription. The Respondent wrote in 

his medical notes that the medication 

should be taken once every eight hours, 

while the call-in information to the 

pharmacy was once every six hours. Tr. 

543–45, 554, 556–57. 

In light of the fact that Respondent 

knew or should have known about the 

Suboxone prescriptions by Dr. B.S.2 and 

this prescribing strategy, which was 

unaddressed or unexplained by the 

Respondent in his testimony, and on the 

basis of this record, drawing all rational 

inferences warranted by the evidence, it 

is more believable than not that the 

Respondent was involved in J.M.’s 

sophisticated attempt to avoid detection 

by the pharmacies.*LL

The red flag of refusing to detox was 

repeatedly evident within J.M.’s patient 

file. Tr. 562; GX 11 at 37. He was 

diagnosed with ‘‘Opioid dependency, 

refusing detox’’ for which he was 

prescribed hydrocodone, which again, is 

beneath the standard of care, outside the 

usual course of professional practice, 

and illegal in California. Tr. 563–64. 

The diagnosis for opioid dependency 

being treated with hydrocodone 

appeared repeatedly in the records. The 

Respondent never addressed this red 

flag. Tr. 564. 

A review of the entirety of J.M.’s file 

and related records revealed there was 

no appropriate medical history included 

in the records, no response to treatment, 

no physical exam, insufficient patient 

monitoring, no evaluation for GAD, or 

pain level/functioning evaluation, no 

mental health history, no drug abuse 

history, no discussion of risk factors and 

informed consent, no patient 

monitoring, no resolution of the 

multiple red flags noted, rendering the 

GAD and back pain diagnoses 

inappropriate from January 10, 2017, to 

December 31, 2019, and beneath the 

California standard of care. Each was 

without a legitimate medical purpose 

and outside the usual course of 

professional practice. Tr. 565–68. 

I find, as alleged, that the 

Respondent’s controlled substance 

prescriptions to Patient J.M. from at 

least January 10, 2017, through 

December 31, 2019, were not issued ‘‘for 

a legitimate medical purpose by an 

individual practitioner acting in the 

usual course of his professional 

practice’’; [they were issued outside the 

usual course of professional practice 

and beneath the standard of care in 

violation of 21 CFR 1306.04(a).] 

Discussion as to Patient K.S. 

The Respondent explained Patient 

K.S.’s treatment. K.S. presented on June 

21, 2007, with chronic back pain. He 

was later diagnosed with ADD. He was 

prescribed hydrocodone, Soma, and 

sometimes Adderall. Tr. 788–89, 861; 

GX 14 at 110. The Respondent added 

that he may have also prescribed Xanax, 

but it is difficult to be sure with 

hundreds of patients and treatment 

dating back 15 years. Tr. 859. He 

testified that even with a ‘‘good 

memory, sometimes [the Respondent] 

just miss[es] something.’’ Tr. 859. 

Additionally, he noted that patients do 

not always disclose all of their 

medications at the initial visit if they 

have plenty and do not then need them 

to be refilled. So, he is not always aware 

of all of their medications at the initial 

visit. Tr. 860–62. 

The Respondent believed his 

prescribing was within the standard of 

care for California. The Respondent 

testified that he obtained a full medical 

history, medication history, pain level, 

and performed a complete head to toe 

physical exam. Tr. 789. [Based on 

memory alone,] the Respondent testified 

that he discovered K.S. had chronic 

back pain related to a bike accident for 

which he had been treated by several 

doctors for several years, although the 

bike accident as the source of the injury 

and treatment by other doctors was not 

documented. Tr. 856–57, 859. 

Additionally, there were no records 

from prior treatment in the patient’s 

records. Tr. 857. Although the 

Respondent explained that he requested 

the prior medical records, none were 

provided. The Respondent explained 

that his request for records is simply 

faxed to the previous physician’s office. 

Tr. 857–58. Respondent speculated that 

the absence of a documented request for 

records in K.S.’s file was probably due 

to a staffer forgetting to file it. Tr. 858. 

The Respondent did not contest the 

Government’s observation that no 

requests for previous medical records 

were in any of the seven patient files. 

Tr. 859. According to Respondent, K.S. 

was already on hydrocodone when K.S. 

first saw the Respondent. The 

Respondent testified that he obtained 

informed consent in the same manner as 

described for his earlier patients. Tr. 

790. He discussed alternative forms of 

treatment with K.S., and [based on his 

memory] K.S. was obtaining physical 

therapy prior to seeing the Respondent. 

K.S. continued physical therapy after 

beginning treatment with the 

Respondent. Tr. 791. The Respondent 

testified that he monitored K.S. 

throughout his treatment. Tr. 791. 

Respondent believed that K.S. presented 

no indications of diversion. The 

Respondent has treated K.S. for thirteen 

years, during which time K.S. got 

married and had three children. Tr. 

790–91. 

Dr. Munzing reviewed the subject 

prescriptions and fill stickers issued 

from January 19, 2018, to January 31, 

2019, patient records, and CURES data 

relating to Patient K.S. Tr. 469–70; GDX 

8. [Again Dr. Munzing testified there 

was ‘‘very little’’ information in the 

medical records. Tr. 569.] Dr. Munzing 

opined that none of the relevant 

prescriptions issued to K.S. were within 

the California standard of care. Tr. 568– 

70. K.S. presented on June 21, 2007, 

with ‘‘back pain’’ for which he was 

prescribed hydrocodone and Soma. Tr. 

570; GX 13 at 117. Although the 

Respondent noted he would get an MRI 

for the lumbar spine, no such MRI 

appears in the records. Tr. 271. There 

was also no medical history included in 

this record regarding back pain, no 

treatment plan, no response to 

treatment, no physical exam, no pain or 

functioning evaluation, no ongoing drug 

abuse history, rendering the back pain 

diagnosis inappropriate. Tr. 570. 

Without a legitimate medical purpose, 

there was no appropriate rationale for 

continued treatment with controlled 

substances for back pain. Tr. 571–76. 

[On August 5, 2009, K.S. signed a 

‘‘Declaration of Pain Medication Use’’ 

form indicating that he had no prior 

drug abuse, and Dr. Munzing testified 

that there is no record of K.S. ever being 

asked about illicit substance abuse 

again. Tr. 575. Dr. Munzing testified that 

the 2009 Declaration was an insufficient 

inquiry to cover prescribing occurring at 

any point in time when Respondent was 

treating K.S. Tr. 576.] 

On May 1, 2012, K.S. presented with 

GAD and neck pain. Tr. 576; GX 14 at 

80. He was diagnosed with GAD and 

neck pain, and prescribed Xanax for 

GAD and hydrocodone for the neck 

pain, refusing detox. Tr. 577. K.S. was 

prescribed the combination of 

hydrocodone and Xanax frequently 

throughout his treatment. This 


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*MM This sentence was modified for clarity. 

combination of an opioid and a 

benzodiazepine is dangerous, beneath 

the standard of care and represents a red 

flag that went unresolved by the 

Respondent throughout the records. Tr. 

578–79. There was no medical history 

supporting the prescriptions. There was 

no indication of how the patient was 

responding to treatment. There was no 

treatment plan, and no indication that a 

physical exam was performed to 

support the diagnoses or justify the 

prescriptions. Tr. 579–81. There was no 

reference to pain levels or physical 

functionality. There was no reference to 

mental functioning with respect to the 

GAD diagnosis. There was no 

appropriate diagnosis for the GAD and 

neck pain. Neither did he establish a 

legitimate medical purpose for the 

controlled substance prescriptions. Tr. 

580–81. 

K.S. presented on November 18, 2013, 

and was prescribed Adderall (60 mg per 

day) with no documented evaluation for 

or diagnosis of any condition which 

Adderall may treat. Tr. 581–82; GX 14 

at 70. There is also no medical history, 

physical exam, or treatment plan, and 

accordingly, the subject prescription is 

without a legitimate medical 

purpose.*MM Tr. 582. 

On January 19, 2018, K.S. presented 

with GAD, back pain, and ADD. Tr. 583, 

599; GX 14 at 41. For GAD, the 

Respondent prescribed Xanax. For back 

pain—opioid dependent, refusing detox, 

the Respondent prescribed 

hydrocodone, and for ADD, Adderall 

was prescribed. Tr. 584. The record is 

missing a medical history, any updated 

medical history, an explanation of why 

back pain has returned, the patient’s 

state of health, how he’s responding to 

treatment, a physical exam, pain levels, 

mental or physical functioning, 

appropriate rationale for continued 

treatment, and information relating to 

drug abuse. As a result, the treatment is 

without sufficient medical evidence. Tr. 

584–86. Accordingly, the subject 

charged prescriptions are without a 

legitimate medical purpose, are outside 

the usual course of professional 

practice, and are beneath the standard of 

care. Tr. 586. 

On February 27, 2018, K.S. presented 

with ADD, opioid dependency, and 

GAD. Tr. 586–87, 599–600; GX 14 at 39, 

40. He was diagnosed with ADD, opioid 

dependency-refusing detox, and GAD. 

Back pain was not reported, nor was any 

report of pain made. At the April 30, 

2018 visit, again, back pain was not 

reported, nor was any report of pain 

made. Tr. 601. Throughout the records, 

the Respondent failed to explain the 

appearance and disappearance of back 

pain. Tr. 601–02. Again, beneath the 

standard of care and contrary to the law 

in California, K.S. was prescribed 

hydrocodone for opioid dependency. Tr. 

587–88. On November 28, 2018, K.S. 

presented with opioid dependencyrefusing detox and GAD, and for which 

he was prescribed hydrocodone and 

Xanax respectively. Tr. 588–589; GX 14 

at 33; GDX 8. Again, beneath the 

standard of care and contrary to the law 

in California, K.S. was prescribed 

hydrocodone for opioid dependency. Tr. 

588–89. And again the medication 

regimen included the dangerous 

combination of an opioid and 

benzodiazepine. The record is missing 

any medical history, any updated 

medical history, the patient’s state of 

health, how he was responding to 

treatment, a physical exam, pain levels, 

mental or physical functioning, any 

evaluation for GAD, appropriate 

rationale for continued treatment, and 

information relating to drug abuse. As a 

result, the treatment is without 

sufficient medical evidence. Tr. 588–89. 

Accordingly, the subject charged 

prescriptions are without a legitimate 

medical purpose, are outside the usual 

course of professional practice, and are 

beneath the standard of care. Tr. 590. 

On December 11, 2018, K.S. presented 

with ADD and eczema for which he was 

diagnosed with ADD and eczema. Tr. 

591; GX 14 at 33. For ADD he was 

prescribed Adderall. [Dr. Munzing 

testified that the Adderall prescription 

lacked a legitimate medical purpose for 

the same reasons as the prior 

prescriptions he had just discussed. Tr. 

591–93.] On January 31, 2019, K.S. 

presented with back pain and stomatitis. 

Tr. 593–94; GX 14 at 31. For the back 

pain he was prescribed hydrocodone. 

[Again, Dr. Munzing testified that the 

hydrocodone prescription lacked a 

legitimate medical purpose for the same 

reasons as the prior prescriptions he had 

just discussed. Tr. 594–95.] 

A review of the entirety of K.S.’s 

subject medical records reveals that the 

Respondent never obtained any prior 

medical records. Tr. 596, 619. The 

record is missing an adequate medical 

history, any updated medical history, 

the patient’s state of health, how he was 

responding to treatment, a physical 

exam, pain levels, mental or physical 

functioning, any evaluation for GAD, 

appropriate rationale for continued 

treatment, and information relating to 

drug abuse. As a result, the treatment is 

without sufficient medical evidence. Tr. 

598–99, 620. Accordingly, the subject 

charged prescriptions are without a 

legitimate medical purpose, are outside 

the usual course of professional 

practice, and are beneath the standard of 

care. Tr. 598, 619–20. 

[Dr. Munzing testified that, similar to 

the other patients, Respondent 

prescribed hydrocodone to K.S. for back 

pain, then neck pain, then for opioid 

dependency, and sometimes for a 

combination of these reasons, without 

any documentation regarding these 

changes or the coming and going of the 

pain issues as would be required by the 

standard of care. Tr. 598–602.] Dr. 

Munzing also noted the inconsistency of 

the GAD diagnoses throughout the 

records. Tr. 602–05; GX 14 at 31, 42, 47, 

48. With the GAD diagnoses appearing 

and disappearing within the records 

without any explanation, Dr. Munzing 

observed there is no medical evidence it 

was a medically legitimate diagnosis. 

Tr. 605–09; GX 8. Similarly, ADD was 

inconsistently diagnosed and Adderall 

was inconsistently prescribed. Tr. 605– 

06; GX 14 at 34, 35; GX 8. With the ADD 

diagnoses appearing and disappearing 

within the records without any 

explanation, Dr. Munzing observed 

there is no medical evidence it was a 

medically legitimate diagnosis. Tr. 609. 

Dr. Munzing noted the Respondent 

prescribed a dangerous combination of 

medications, including hydrocodone, 

Adderall and Xanax, which was 

prescribed from January 2018, through 

August 2018. Tr. 609–10. Dr. Munzing 

noted it is referred to by drug abusers as 

the ‘‘new Holy Trinity.’’ Tr. 610. 

Additionally, the combination of an 

opioid and a benzodiazepine is present 

in August, October, and November 

2018. Tr. 610–11. The records do not 

establish that the appropriate warnings 

were conveyed to K.S., or that informed 

consent was obtained. Tr. 611–13; GX 8. 

Dr. Munzing could not conceive of a 

medical condition warranting the 

dangerous combinations of medications 

prescribed. Tr. 614. [Dr. Munzing also 

noted that Respondent failed to properly 

monitor medication compliance, and 

conducted no urine drug screens, as was 

required by the standard of care in 

California. Tr. 614.] 

Dr. Munzing noted the Respondent’s 

failure to resolve red flags, including, 

K.S.’s refusal to detox, the dangerous 

combinations of medications, and high 

dosages of controlled medications. Tr. 

615–18, 620; GX 14 at 39, 40, 41. The 

refusal to detox is a major red flag for 

opioid use disorder and for diversion. 

However, the Respondent did not take 

any necessary action, such as CURES 

monitoring, UDS, counseling, or 

titration. Rather, he simply prescribed 

the same levels of medications she was 

on, PRN. Tr. 615–17. The Respondent’s 

prescribing was beneath the California 

standard of care. 


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33 [Omitted repetitious text for brevity.] 

34See Tr. 950–52. [Though this Decision 

discusses Respondent’s early treatment of the seven 

individuals, which often predates 2013, Respondent 

is not being held responsible for any acts or 

omissions prior to the relevant time period which 

begins in January 2017. Any discussion of events 

prior to January 2017, are only relevant to 

establishing that the subject prescriptions issued 

during the relevant time period were issued outside 

the usual course of professional practice and 

beneath the standard of care.] Dr. Munzing testified 

credibly that the 2013 version was the 7th edition 

and the basic requirement have not changed over 

the years. 

*NN On direct and cross, Respondent agreed that 

it would ‘‘be a problem’’ and a ‘‘red flag of abuse 

or diversion’’ for a patient to be receiving two 

opioids at once. Tr. 888–89. He also testified that 

he tells his patients ‘‘that they cannot run to 

different doctors for medications,’’ and he testified 

that all of his patients abided by the terms of the 

agreement ‘‘to the best of [his] knowledge, yes, 

because if not, then [they would] have to be 

discharged from the practice.’’ Tr. 659, 888. 

Similarly, the Controlled Substances Therapy 

Agreement states that ‘‘[a]ll controlled substances 

must come from [Respondent,]’’ and that the 

patient’s ‘‘failure to adhere to these policies may 

result in cessation of therapy with controlled 

substances.’’ GX 11 at 114. The CURES reports that 

were introduced on rebuttal revealed that at least 

two patients were receiving controlled substances 

from other physicians, notably opioids when they 

were already getting opioids from Respondent, and 

there is no indication that this agreement violation 

was addressed by Respondent, let alone that the 

patients were discharged from the practice. 

35 ‘‘While proof of intentional or knowing 

diversion is highly consequential in these 

proceedings, the Agency’s authority to act is not 

limited to those instances in which a practitioner 

is shown to have engaged in such acts. . . . 

Accordingly, under the public interest standard, 

DEA has authority to consider those prescribing 

practices of a physician, which, while not rising to 

the level of intentional or knowing misconduct, 

nonetheless create a substantial risk of diversion.’’ 

Dewey C. Mackay, M.D., 75 FR 49956, 49974–75 

n.35 (2010) (citing Paul J. Caragine, Jr., 63 FR at 

51601 (‘‘Just because misconduct is unintentional, 

innocent or devoid of improper motivation, does 

not preclude revocation or denial [of a registration]. 

Careless or negligent handling of controlled 

substances creates the opportunity for diversion 

and could justify revocation or denial.’’)). 

*OO See supra n. *DD and n. *LL. While I have 

left the ALJ’s discussions and findings that 

Respondent assisted J.M. in a diversion scheme 

intact throughout this decision, I have ultimately 

not based my decision on those findings. 

Additionally, as noted above, during 

this time period the Respondent 

repeatedly prescribed hydrocodone to 

Patient K.S. as ‘‘treatment’’ for Patient 

K.S.’s opioid dependency, in violation 

of 21 CFR 1306.04(c). 

I find, as alleged, that the 

Respondent’s controlled substance 

prescriptions to Patient K.S. from at 

least January 19, 2018, through January 

31, 2019, were not issued ‘‘for a 

legitimate medical purpose by an 

individual practitioner acting in the 

usual course of his professional 

practice’’; [they were issued outside the 

usual course of professional practice 

and beneath the standard of care in 

violation of 21 CFR 1306.04(a).] 

The Respondent’s General Denial 

The Respondent testified that, to the 

best of his knowledge, none of his 

thousands of patients have suffered any 

harm from his medication treatment. Tr. 

793. The Respondent also disagreed 

with Dr. Munzing’s assertion that there 

was likely no medical condition 

justifying the dangerous combinations 

of medications identified herein. Tr. 

794–800. [Respondent testified that 

combinations of opiates, muscle 

relaxants, and benzodiazepines, when 

‘‘used in the right dosages for the right 

indications, and used as prescribed by 

a knowledgeable M.D., . . . are safe to 

use in combination therapy.’’ Tr. 797.] 

The Respondent conceded the potential 

danger of individual pain medications, 

and the potential increase in risk when 

combined with other medications. 

However, he stated that, if patients are 

responsible and take the medications as 

prescribed for the indications intended, 

these combinations are fairly safe. Tr. 

800.33

The Respondent recognized his 

obligation to follow all federal and state 

rules concerning the practice of 

medicine, including the directives of the 

California Board of Medicine. Tr. 862. 

California’s Compliance with Controlled 

Substance Laws and Regulations 

includes a provision on records. Tr. 864; 

GX 20 at 61. It mandates that, ‘‘[t]he 

physician and surgeon should keep 

accurate and complete records 

according to the items above, 

[including] the medical history and 

physical examination, other evaluations 

and consultations, treatment plan 

objectives, informed consent, 

treatments, medications, rationale for 

changes in the treatment plan or 

medications, agreements with the 

patient, and periodic reviews of the 

treatment plan.’’ Tr. 864–65. The 

provision further requires, ‘‘[a] medical 

history and physical examination must 

be accomplished . . . this includes an 

assessment of the pain, physical and 

psychological function.’’ Tr. 866; GX 20 

at 59. The Respondent assured the 

tribunal that the necessary assessments 

were made, but admitted they were not 

fully documented. Tr. 866–67. The 

Respondent made the same assurances 

for the requirement as to ‘‘Treatment 

Plan Objectives,’’ ‘‘Informed Consent,’’ 

‘‘Periodic Review,’’ noting that these 

Guidelines were published in 2013.34

Tr. 867–72. 

The Respondent reiterated that, to his 

knowledge, none of his patients 

exhibited red flags, or violated the pain 

agreement. Tr. 888–89. 

Credibility Analysis of the Respondent 

In his testimony, the Respondent 

[initially] came off as very sincere and 

credible. Accepting his testimony as 

true and accurate (although his 

perception of the standard of care was, 

in several instances, unfounded, and his 

treatment was, in many cases, outside 

the standard of care), his explanations 

seemed to present that of a caring, 

dedicated practitioner, who may be 

guilty of benign neglect in his 

[prescribing] and failure to maintain 

complete and accurate records. 

However, the discovery during 

rebuttal that Respondent had accessed 

the CURES report for S.B. and J.M. and 

made no changes to his prescribing 

practices thereafter, dramatically 

changed that perception.*NN The 

Respondent was [or should have been] 

fully aware that those patients were 

being prescribed Suboxone, an opioid 

commonly prescribed for abuse, by 

other physicians in violation of 

Respondent’s own controlled substance 

agreements with those patients. Yet the 

Respondent failed to note that 

significant fact in the charts, and even 

more alarmingly, continued the patients 

on opioids and other controlled 

substances. Not only was this 

information missing from the patient 

charts, the Respondent failed to address 

the results of his CURES monitoring in 

his testimony. The Respondent has lost 

a great deal of credibility. 

I was [originally] willing to give the 

Respondent the benefit of the doubt 

regarding the alias used by J.M. in filling 

opioid/benzodiazepine prescriptions, 

the unexplained simultaneous 

dispensing of the opioid and 

benzodiazepine prescriptions to two 

separate pharmacies by the Respondent, 

and the inconsistent instructions for 

usage of the benzodiazepine. But, [in 

light of the credibility issues], it appears 

more believable than not that the 

Respondent was a knowing participant 

in what appears to be a sophisticated 

attempt to divert medication by 

J.M.35 *OO

The Respondent’s testimony that he 

performed all of the procedures, 

undocumented in the charts, and [but 

for documentation failures] fully 

complied with the California standard 

of care suffers from the same loss of 

credibility. 

[In his Exceptions, Respondent 

‘‘disagree[d] with the weight that the 

ALJ assigned to the Government’s 

rebuttal evidence regarding the CURES 

audit report, and [argued] that such 

rebuttal evidence is insufficient to 

overcome [Respondent’s] testimony.’’ 


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*PPAlthough not included in the section 

dedicated to analyzing Respondent’s credibility, the 

ALJ noted several instances of Respondent’s 

memory failures and found that Respondent’s 

memory was ‘‘not always infallible.’’ RD, at 99; see 

also supra n. 23 and n. 24. 

*QQ But see supra n. 9 which documents 

confusion in the record regarding how many 

patients Respondent was actually seeing at any 

given point. There I noted that while the exact 

number of patients that Respondent was treating at 

any given time has little relevance to my decision 

in this matter, it is one another small thing that 

contributes to me questioning Respondent’s ability 

to accurately recall the undocumented details of 

each medical visit to which he testified. 

Resp Exceptions, at 3–4 (internal 

citations omitted). This is because, 

Respondent argued, the substance of 

Respondent’s testimony was that ‘‘he 

overlooked some details during his 

treatment of [the seven] patients,’’ and 

that the rebuttal evidence affirms that 

testimony, ‘‘to wit: due to the same 

benign negligence he overlooked S.B.’s 

and J.M.’s prescription by other 

physicians when accessing the CURES 

database.’’ Id. at 4. In summary, all of 

Respondent’s Exceptions challenge that 

ALJ’s credibility finding because it is 

‘‘solely based on [the Government’s] 

questionable rebuttal evidence.’’ Id. at 5. 

I find, in agreement with the ALJ, that 

Respondent’s testimony lacked 

credibility where it was inconsistent 

with, or provided additional 

information not included in, the patient 

files and documentary evidence in the 

record. However, I base my finding on 

Respondent’s questionable credibility as 

demonstrated throughout the entirety of 

the hearing, not just on the 

Government’s rebuttal evidence. The 

ALJ is best situated to observe the 

testimony of the Respondent, and I note 

that he appeared to be describing 

Respondent’s demeanor when he stated 

that Respondent ‘‘came off as very 

sincere and credible.’’ I credit the ALJ’s 

description of Respondent’s demeanor, 

but in spite of his described sincerity, 

both the ALJ *PP and I found many 

instances of objective issues with the 

credibility of Respondent’s direct 

testimony. Specifically, when 

Respondent was asked questions about 

a specific patient, he often answered 

with testimony about his general 

practices or regarding his patients 

collectively. Secondly, Respondent’s 

memory was shown to be less than fully 

reliable, which calls into question those 

actions that he testified he remembered 

taking, but that he did not document in 

the patient files. 

First, throughout Respondent’s 

testimony about his prescribing, it was 

difficult to tell whether he was actually 

testifying specifically as to each 

individual. It often seemed that he was 

testifying generally as to the policies 

and procedures he purportedly followed 

in the regular course of his practice, and 

was just assuming that those policies 

and procedure were followed with 

regard to the named patients. Even 

where Respondent seemed to be 

testifying about a specific patient, his 

testimony quickly would morph into 

testimony about his patients 

collectively. See supra n. *X for an 

illustration of how difficult it was to pin 

down whether Respondent was 

testifying about a specific individual or 

his patients collectively. This sort of 

collective focus that appears throughout 

Respondent’s testimony causes me to 

question Respondent’s credibility— 

specifically whether he remembered the 

events that occurred at each specific 

visit for each specific patient that he 

discussed in the absence of medical 

records documenting these events. 

Indeed, Respondent testified that 

‘‘[o]ver [his] career, [he] worked [with] 

about 5,000 patients,’’ that he had 

‘‘close to 550–600 patients’’ at the time 

of the hearing, and that prior to the 

order to show cause he ‘‘had between 

175–200 [pain] patients.’’ *QQ Tr. 792. 

With that many patients, Respondent 

surely would have been required to 

keep track of a lot of specific 

undocumented information. This 

concern about collective testimony and 

Respondent’s specific memory was 

highlighted when during Respondent’s 

entire testimony about J.M., Respondent 

and his counsel both called J.M. by the 

initials M.B. (a different individual at 

issue in the case). See supra n. 12; Tr. 

734–43. The error was not discovered 

until sometime later when Respondent 

was questioned about J.M. again and 

responded that he had already 

discussed J.M. (though referring to him 

as M.B. the whole time). Tr. 772–76. 

This exchange did not fill me with 

confidence that Respondent’s testimony 

reflected his true recollection of the 

specific actions he took with regard to 

the specific patient being discussed. 

Secondly, Respondent’s credibility is 

diminished where he testified based on 

his memory. Respondent repeatedly 

testified that we should trust him and 

his photographic memory. For example, 

he testified, ‘‘I rely on my photographic 

memory.’’ Tr. 808–09. ‘‘As soon as the 

patient disclosed [the prior treatments] 

to me, I memorize it. I remember it. 

You’ve seen how several years later I 

still remember it. . . . I did not feel I 

have to clutter my charts with, you 

know, this information.’’ Tr. 806–07. He 

also testified, ‘‘[W]hat’s pertinent, 

what’s your diagnosis, what’s your main 

exam, and what’s your treatment is 

reflected [in the notes]. The rest I 

remember. I don’t need to write it.’’ Tr. 

807–08. But Respondent testified with 

equal frequency that we should not rely 

on his memory. For example, he 

testified, that even with a ‘‘good 

memory, sometimes you just miss 

something.’’ Tr. 859. He testified that he 

could not always provide a specific 

response because the information was 

not in his notes. ‘‘Whether [J.C.] 

mentioned the surgery the very first 

visit, that I cannot tell you yes or no at 

this point because it’s not in my notes. 

So I’m just second guessing myself.’’ Tr. 

841; supra n. *U. And when directed to 

identify specifically which forms of 

alternative treatment M.B. had tried, 

Respondent testified, ‘‘I don’t want to 

misspeak. I’m not sure if he had . . . 

acupuncture or not. But I know for a fact 

he had physical therapy.’’ Tr. 827; supra 

n. *X. He also testified that the passage 

of time had impacted his memory. 

When asked what he prescribed to D.D., 

Respondent initially answered and then 

added, ‘‘[a]nd probably Valium. So I 

mean, I cannot testify exactly to you, 

depending on the visit, but yes, 

probably over the course, and again, this 

was in what, 2007 and now we are [in] 

2020, 13 years.’’ Tr. 851; see also, Tr. 

853 (‘‘I mean, again, this was 13, 14 

years ago.’’). 

There were also examples when 

Respondent’s memory appears to have 

failed him and he seems to have 

provided a speculative response. For 

example, when asked where he had 

documented prior treatments tried by 

S.B., he testified ‘‘the record is probably 

missing these things, because maybe at 

the time of the documentation I did not 

feel that was crucial to be documented.’’ 

Tr. 806; see also Tr. 870–71 (‘‘Maybe I 

did not feel it was necessary because 

this is my patent, I am caring for the 

patient, I am doing the best job.’’). 

Ultimately, Respondent’s memory was 

demonstrated to be less than fully 

credible. 

It is for these reasons that I find that 

Respondent’s testimony lacked 

credibility where it was inconsistent 

with, or provided additional 

information not included in, the patient 

files and documentary evidence in the 

record. I have credited Respondent’s 

testimony where it was supported by 

and consistent with the documentary 

record. In light of Respondent’s failure 

to document almost any of the relevant 

and necessary information required by 

the standard of care, most of 

Respondent’s testimony cannot be 

credited. 

Ultimately, because of Respondent’s 

extreme failure to document, 

Respondent’s credibility has almost no 


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*RR Respondent’s credibility also does not impact 

my findings based on Dr. Munzing’s unrebutted 

expert testimony that Respondent’s acts were 

beneath the standard of care. For example, 

Respondent does not contest that there was 

information missing from the patient files; he 

argues that the standard of care did not require him 

to document further. Similarly, Respondent does 

not contest that he prescribed the ‘‘Holy Trinity’’ 

and other combinations of dangerous drugs; he 

simply argues that the combinations were permitted 

by the standard of care. He does not contest the lack 

of urine drug screens; he argues his monitoring was 

proper under the standard of care. Here, Dr. 

Munzing is the unrebutted expert regarding the 

standard of care in California. Accordingly, 

Respondent’s credibility issues aside, where 

Respondent and Dr. Munzing reached a different 

conclusion regarding whether uncontested acts 

were performed within the standard of care, I credit 

Dr. Munzing’s opinion. 

36 [This text replaces the ALJ’s original text and 

omits his original footnote for clarity.] 

37 [There is nothing in the record to suggest that 

a state licensing board made any recommendation 

regarding Respondent’s prescribing practices 

(Factor One). Where the record contains no 

evidence of a recommendation by a state licensing 

board that absence does not weigh for or against 

revocation. See Roni Dreszer, M.D., 76 FR 19434, 

19444 (2011) (‘‘The 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 the Respondent’s 

DEA certification is consistent with the public 

interest.’’) As to Factor Three, there is no evidence 

in the record that Respondent has a ‘‘conviction 

record under Federal or State laws relating to the 

manufacture, distribution, or dispensing of 

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

However, as 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 

held 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 does not allege Factor Five as relevant. 

*SSThe ALJ evaluated Factors 2 and 4 in separate 

sections and I have combined and expanded on his 

analysis herein. This change also addresses the 

Government’s Exceptions. 

bearing on my final decision in this 

case. Even if I fully credited 

Respondent’s testimony regarding his 

treatment of the individuals at issue and 

found that Respondent otherwise acted 

within the standard of care, his repeated 

and severe documentation failures and 

failure to accept responsibility would 

have still led me to revoke his 

registration. DEA has previously made 

clear that ‘‘a physician may not expect 

to vindicate himself through oral 

representations at the hearing about his 

compliance with the standard of care 

that were not documented in 

appropriately maintained patient 

records.’’*RR Lesly Pompy, M.D., 84 FR 

57749, 57760 (2019).] 

Dr. Munzing’s Credibility 

Conversely, Dr. Munzing was fully 

credible. His opinion regarding the 

California standard of care was 

consistent with the relevant California 

regulations, the practitioner Guides 

issued by the California Medical Board 

and guidance issued by federal agencies, 

such as the CDC, FDA and DEA. His 

specific opinions that the Respondent’s 

subject treatment fell below the 

minimum California standard of care 

were factually well-founded, and were 

based on clear edicts of the standard. As 

the Government notes in its PHB, the 

Respondent did not credibly contest Dr. 

Munzing’s opinions regarding the 

specific parameters of the standard of 

care. [As Dr. Munzing’s expert opinion 

was unrebutted regarding the 

application of the standard of care to the 

facts in this case, I defer to Dr. Munzing 

on all issues related to the standard of 

care.] 

Accordingly, I adopt each of Dr. 

Munzing’s opinions regarding the 

Respondent’s prescribing falling below 

the California standard of care. 

Government’s Burden of Proof and 

Establishment of a Prima Facie Case 

Based upon my review of each of the 

allegations brought by the Government, 

it is necessary to determine if it has met 

its prima facie burden of proving the 

requirements for a sanction pursuant to 

21 U.S.C. 824(a)(4). At the outset, I find 

that the Government has demonstrated 

and met its burden of proof in support 

of its allegations relating to the 

prescribing of controlled substances to 

patients S.B., M.B., B.C., J.C., D.D., J.M., 

and K.S. 

Public Interest Determination: The 

Standard 

[Under Section 304 of the CSA, ‘‘[a] 

registration . . . to . . . dispense a 

controlled substance . . . may be 

suspended or revoked by the Attorney 

General upon a finding that the 

registrant . . . has committed such acts 

as would render his registration under 

section 823 of this title inconsistent 

with the public interest as determined 

by such section.’’ 21 U.S.C. 824(a)(4).] 36

Evaluation of the following factors have 

been mandated by Congress in 

determining whether maintaining such 

registration would be inconsistent with 

the ‘‘the public interest’’: 

(1) The recommendation of the 

appropriate State licensing board or 

professional disciplinary authority. 

(2) The [registrant’s] experience in 

dispensing, or conducting research with 

respect to controlled substances. 

(3) The [registrant’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). ‘‘These factors are 

. . . considered in the disjunctive.’’ 

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

15230 (2003). 

Any one or a combination of factors 

may be relied upon, and when 

exercising authority as an impartial 

adjudicator. Id. (citation omitted); David 

H. Gillis, M.D., 58 FR 37507, 37508 

(1993); see also Morall v. DEA, 412 F.3d 

at 173–74; Henry J. Schwarz, Jr., M.D., 

54 FR 16422, 16424 (1989). Moreover, 

the Agency is ‘‘not required to make 

findings as to all of the factors,’’ Hoxie 

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

2005); see also Morall, 412 F.3d at 173. 

[Omitted for brevity.] 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). 

The Government’s case invoking the 

public interest factors of 21 U.S.C. 823(f) 

seeks revocation of the Respondent’s 

COR based primarily on conduct most 

aptly considered under Public Interest 

Factors Two, and Four.37

[Factors Two and Four: The 

Respondent’s Experience in Dispensing 

Controlled Substances and Compliance 

With Applicable Laws Related to 

Controlled Substances *SS

According to the Controlled 

Substances Act’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). 


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Respondent has demonstrated 

substantial experience as a licensed 

California doctor since 1998 who has 

been operating his own practice for over 

20 years. Tr. 627–27. Regarding his 

experience, Respondent testified that he 

is ‘‘an astute clinician who’s been in the 

medical field for 41 years without a 

blemish to [his] reputation and career’’, 

and points out that ‘‘the Government 

seized more than 223 charts, . . . [but] 

they returned more than 200’’ and only 

seven patients are at issue in the case. 

Tr. 648–49. The Agency assumes that 

Respondent has prescribed legally 

except where the Government has 

established that the prescriptions at 

issue violated the law. Here, 

Respondent’s treatment of the patients 

as alleged in the OSC demonstrates that 

his prescribing practices fell short of the 

applicable standard of care. 

I found above that the Government’s 

expert credibly testified as supported by 

California law and California’s Guide to 

the Laws and Guidelines for Prescribing, 

that the standard of care in California 

for prescribing controlled substances 

requires a physician to, amongst other 

things, obtain a detailed medical 

history, perform and document a 

physical examination, assign a 

diagnosis, develop and document a 

customized treatment plan, monitor the 

patient including monitoring for 

medication compliance, and have 

complete and accurate records 

documenting all of the above steps in 

detail. See supra The Standard of Care 

for Prescribing Controlled Substances in 

California. I also found above, in 

accordance with Dr. Munzing’s 

testimony, that Respondent issued each 

of the relevant controlled substance 

prescriptions at issue to the seven 

patients at issue without taking a proper 

medical or mental health history, 

conducting a sufficient physical and/or 

mental examination, making a 

supportable diagnosis, recording pain 

and functionality levels, documenting 

an appropriate treatment plan, 

documenting discussion of the risks of 

the prescribed controlled substances, 

monitoring for medication compliance, 

and/or resolving red flags of diversion. 

See supra Respondent’s Improper 

Prescribing of Controlled Substances. I 

further found that each of the relevant 

prescriptions Respondent issued to the 

seven individuals were issued without a 

legitimate medical purpose, and outside 

the usual course of professional practice 

and beneath the standard of care in 

California. Accordingly, I find that 

Respondent violated 21 CFR 1306.04(a). 

Indeed, Respondent repeatedly issued 

prescriptions without complying with 

the applicable standard of care and state 

law, thus demonstrating that his 

conduct was not an isolated occurrence, 

but occurred with multiple patients. See 

Kaniz Khan Jaffery, 85 FR 45667, 45685 

(2020). For each of the seven 

individuals, Respondent failed to 

perform and document a physical and/ 

or mental examination that was 

sufficient to inform a diagnosis for 

which the controlled substances at issue 

could be prescribed. Additionally, I 

have found that for each of the seven 

individuals, Respondent prescribed 

dangerous combinations of controlled 

substances without properly discussing 

their risks. 

Agency decisions highlight the 

concept that ‘‘[c]onscientious 

documentation is repeatedly 

emphasized as not just a ministerial act, 

but a key treatment tool and vital 

indicator to evaluate whether the 

physician’s prescribing practices are 

‘within the usual course of professional 

practice.’ ’’ Cynthia M. Cadet, M.D., 76 

FR 19450, 19464 (2011). DEA’s ability to 

assess whether controlled substances 

registrations are consistent with the 

public interest is predicated upon the 

ability to consider the evidence and 

rationale of the practitioner at the time 

that he prescribed a controlled 

substance—adequate documentation is 

critical to that assessment. See KanizKhan Jaffery, 85 FR at 45686. Dr. 

Munzing testified that ‘‘[t]rue, and 

accurate, and thorough documentation 

is vitally important for patient safety. 

It’s also part of the standard of care.’’ Tr. 

917. But, as Dr. Munzing testified, 

‘‘practically none of the information that 

Respondent mentioned [during his 

testimony] was documented.’’ Tr. 916. 

The extreme failures in Respondent’s 

documentation extended to each of the 

seven individuals. 

DEA decisions have found that ‘‘just 

because misconduct is unintentional, 

innocent, or devoid of improper motive, 

[it] does not preclude revocation or 

denial. Careless or negligent handling of 

controlled substances creates the 

opportunity for diversion and [can] 

justify the revocation of an existing 

registration . . .’’ Bobby D. Reynolds, 

N.P., Tina L. Killebrew, N.P., & David R. 

Stout, N.P., 80 FR 28643, 28662 (2015) 

(quoting Paul J. Caragine, Jr. 63 FR 

51592, 51601 (1998). ‘‘Diversion occurs 

whenever controlled substances leave 

‘the closed system of distribution 

established by the CSA . . . .’ ’’ Id. 

(citing Roy S. Schwartz, 79 FR 34360, 

34363 (2014)). In this case, I have found 

that Respondent issued controlled 

substance prescriptions without 

complying with his obligations under 

the CSA and California law. See George 

Mathew, M.D., 75 FR 66138, 66148 

(2010)). 

With regard to California law, just as 

I found a violation of 21 CFR 1306.04(a), 

I find that Respondent repeatedly issued 

controlled substance prescriptions what 

were not ‘‘for a legitimate medical 

purpose by an individual practitioner 

acting in the usual course of his or her 

professional practice,’’ in violation of 

Cal. Health & Safety Code § 11153(a). 

California law also prohibits 

‘‘[p]rescribing, dispensing, or 

furnishing’’ controlled substances 

‘‘without an appropriate prior 

examination.’’ Cal. Bus. & Prof. Code 

§ 2242(a). Crediting Dr. Munzing’s 

testimony, I have found above that the 

Respondent failed to conduct an 

appropriate prior physical and/or 

mental examination with regard to his 

prescribing to each of the seven 

individuals at issue, which I find 

violates Cal. Bus. & Prof. Code § 2242(a). 

Finally, California law prohibits 

‘‘[r]epeated acts of clearly excessive 

prescribing, furnishing, dispensing, or 

administering of drugs.’’ Cal. Bus. & 

Prof. Code § 725(a). At the hearing Dr. 

Munzing unequivocally testified that 

Respondent’s prescribing of high 

dosages of controlled substances to the 

seven individuals at issue, often in 

dangerous combinations, without a 

legitimate medical purpose constituted 

‘‘clear excessive prescribing.’’ Tr. 621. 

Accordingly, I find that Respondent’s 

prescribing also violated Cal. Bus. & 

Prof. Code § 725(a). Crediting Dr. 

Munzing’s testimony, I found above that 

Respondent acted outside the bounds of 

these laws with regard to his prescribing 

to each of the seven patients.] The 

Respondent has violated the charged 

federal and California regulations 

related to controlled substances. He has 

violated the California standard of care, 

as alleged. Thus [Factors Two and Four] 

weigh heavily in favor of revocation. 

[Summary of Factors Two and Four 

and Imminent Danger 

As found above, the Government’s 

case establishes by substantial evidence 

that Respondent issued controlled 

substance prescriptions outside the 

usual course of the professional 

practice. I, therefore, conclude that 

Respondent engaged in misconduct 

which supports the revocation of his 

registration. See Wesley Pope, 82 FR 

14944, 14985 (2017). 

For purposes of the imminent danger 

inquiry, my findings also lead to the 

conclusion that Respondent has 

‘‘fail[ed] . . . to maintain effective 

controls against diversion or otherwise 

comply with the obligations of a 

registrant’’ under the CSA. 21 U.S.C. 


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*TT I am replacing portions of the Sanction 

section in the RD with preferred language regarding 

prior Agency decisions; however, the substance is 

primarily the same. 

824(d)(2). The substantial evidence that 

Respondent issued controlled substance 

prescriptions outside the usual course of 

the professional practice establishes ‘‘a 

substantial likelihood of an immediate 

threat that death, serious bodily harm, 

or abuse of a controlled substance . . . 

[would] occur in the absence of the 

immediate suspension’’ of Respondent’s 

registration. Id. The risk of death was 

established in this case. There was 

ample evidence introduced to establish 

that combined use of opioid medicines 

with benzodiazepines or other drugs 

that depress the central nervous system 

has resulted in serious side effects 

including slowed or difficult breathing, 

comas, and deaths. GX 22, at 1. 

Respondent testified that none of his 

patients had suffered any harm, such as 

overdose, as a result of his prescribing 

practices. Tr. 792. However, I credit Dr. 

Munzing’s repeated testimony that not 

only did Respondent prescribe 

‘‘incredibly high doses’’ of individual 

dangerous drugs, but that many of the 

prescriptions at issue were issued in 

dangerous combinations including the 

‘‘holy trinity’’ the ‘‘new holy trinity’’ 

and other dangerous combinations as 

have been discussed. As Dr. Munzing 

testified, ‘‘inherently [the controlled 

substances] each . . . have their own 

inherent dangers, but putting them 

together, it even escalated that much 

more dangerously, both for addictive 

issues for overdose and overdose death 

issues.’’ Tr. 506; see also id. at 933–34. 

Even if I credit Respondent’s testimony 

that none of his patients overdosed, I 

cannot rule out addiction issues. Two of 

the individuals at issue were prescribed 

Suboxone by other providers, which Dr. 

Munzing testified was typically 

prescribed for opioid use disorder or 

addiction, Tr. 943; and Respondent 

himself diagnosed almost all of the 

individuals at issue with opioid 

dependency. Accordingly, I cannot fully 

credit Respondent’s testimony that none 

of them were harmed. Even the 

individuals’ exposure to the increased 

risks caused by the dangerous 

combinations of the controlled 

substances Respondent prescribed could 

be harmful. 

Thus, as I have found above, at the 

time the Government issued the OSC/ 

ISO, the Government had clear evidence 

of violations of law based on the many 

controlled-substance prescriptions 

Respondent issued without complying 

with the California standard of care. See 

supra Respondent’s Improper 

Prescribing of Controlled Substances.] 

[Sanctions *TT

Where, as here, the Government has 

met its prima facie burden of showing 

that Respondent’s continued registration 

is inconsistent with the public interest, 

the burden shifts to the Respondent to 

show why he can be entrusted with a 

registration. Garrett Howard Smith, 

M.D., 83 FR 18882, 18910 (2018) 

(collecting cases). Respondent has made 

no effort to establish that he can be 

entrusted with a registration. 

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 v. Oregon, 546 U.S. 243, 259 

(2006). A clear purpose of this authority 

is to ‘‘bar[ ] doctors from using their 

prescription-writing powers as a means 

to engage in illicit drug dealing and 

trafficking.’’ Id. at 270. 

In efficiently executing the revocation 

and suspension authority delegated to 

me under the CSA for the 

aforementioned purposes, I review the 

evidence and arguments Respondent 

submitted to determine whether or not 

he 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. 

DEA, 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 Jackson, 72 FR at 

23853; John H. Kennedy, 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 factdependent 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). 

Here, the Respondent did not accept 

responsibility for any of his misconduct 

and instead excused his deficiencies 

and provided unsupportable 

explanations for why he should not 

have to comply with California’s laws. 

For example, Respondent testified, 

‘‘[n]ow, is it deficient on my part not to 

have written all that [in the medical 

record]? I’m not going to say deficiency, 

but maybe it was, you know, 

inappropriate. Maybe I should have 

written that. But it is too much. . . . I 

don’t have the luxury of writing every 

single thing that transpires.’’ Tr. 808–09. 

In no way is this an unequivocal 

acceptance of responsibility. He excused 

his lack of documentation by claiming 

documentation was unnecessary 

because of his ‘‘photographic memory,’’ 

which was clearly not infallible, 

because he was a clinician with 41-years 

of experience not a medical student, and 

because ‘‘maybe’’ he did not feel it was 

crucial information to document. 

Moreover, based on Respondent’s 

testimony, I am not confident that he 

has any desire to improve his conduct 

in the future. He testified, ‘‘I am not 

going to just say, okay, write in the chart 

I told the patient hello, they said hello, 

I said, okay, what did you have for 

breakfast? I am not going to document 

all that, there is no reason. It is just 

excessive [wreaking] havoc on the 

documentation . . . . [E]verything was 

addressed, everything was talked about, 

and every exam, every consent, 

everything was done by the book. I am 

a perfectionist. I am a perfectionist.’’ Tr. 

871.] 

The following testimony by 

Respondent further supports my finding 

that Respondent failed to accept 

responsibility for his actions: ‘‘[S]o, [the 

Government is] just looking at the charts 

and some notes and immediately 

demonizing an astute clinician who’s 

been in the medical field for 41 years 

without a blemish to my reputation and 

career. And now, I’m just portrayed as 

I’m just feeding the addicts; I’m just 

distributing his medications.’’ Tr. 648– 

49.] 

Additionally, as I have found, the 

Respondent’s testimony was less than 

credible [for a wide variety of 


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30608 Federal Register / Vol. 87, No. 97 / Thursday, May 19, 2022 / Notices 

*UU Respondent, in his Exceptions, argues that the 

ALJ’s finding that the Respondent did not 

unequivocally accept responsibility was flawed 

because it was based entirely on the ALJ’s 

credibility analysis, which as discussed above, was 

the subject to another exception. Resp Exceptions, 

at 5; Supra Credibility Analysis of the Respondent. 

My finding that Respondent failed to unequivocally 

accept responsibility is based primarily on 

Respondent’s own testimony. He testified at times 

that ‘‘maybe’’ his documentation could be better, 

but never without excuses and equivocation. He 

refused to take any responsibility for his prescribing 

of high dosages of controlled substances or 

dangerous combinations of controlled substances. I 

find Respondent’s second exception to be without 

merit. 

38The degree of candor displayed by a registrant 

during a hearing is ‘‘an important factor to be 

considered in determining . . . whether [the 

registrant] has accepted responsibility’’ and in 

formulating an appropriate sanction. Hills 

Pharmacy, LLC, 81 FR 49816, 49845 (2016) (citing 

Michael S. Moore, 76 FR 45867, 45868 (2011)). 

39A registrant’s acceptance of responsibility must 

be unequivocal, or relief for sanction is not 

available, and where there is equivocation any 

evidence of remedial measures is irrelevant. Daniel 

A. Glick, D.D.S., 80 FR 74800, 74801, 74810 (2015). 

*VV Remaining analysis of egregiousness omitted 

for relevance. 

reasons,*UU including] as evidenced by 

the Government’s rebuttal evidence. The 

Respondent cannot credibly claim that 

he forgot the alarming discoveries he 

made as to Patients S.B. and J.M. when 

he monitored their CURES reports. The 

Respondent’s failure to discuss this 

critical information in describing the 

justification for their treatment during 

testimony constitutes a significant lack 

of candor.38

I therefore find that the Respondent 

has not unequivocally accepted 

responsibility.39

Egregiousness and Deterrence 

[The Agency also looks to the 

egregiousness and extent of the 

misconduct, which are significant 

factors in determining the appropriate 

sanction. Garrett Howard Smith, M.D., 

83 FR at 18910 (collecting cases).] I find 

that the proven misconduct is egregious 

and that deterrence considerations 

weigh in favor of revocation. In addition 

to the myriad of prescribing events 

falling below the California standard of 

care, the proven misconduct involved 

being directly aware of two patients’ 

apparent abuse or diversion of 

controlled substances, and being an 

apparent party to one of those patient’s 

abuse or diversion. Respondent treated 

opioid abuse with hydrocodone which 

is not a legitimate medical purpose for 

prescribing hydrocodone and is outside 

the usual course of professional 

practice, therefore it was an illegal 

action under state regulations. Beyond 

that, his actions unnecessarily exposed 

his patients to dangerous levels of 

medication and to dangerous 

combinations of those medications.*VV

[In sanction determinations, the 

Agency has historically considered its 

interest in deterring similar acts, both 

with respect to the respondent in a 

particular case and the community of 

registrants. See Joseph Gaudio, M.D., 74 

FR 10083, 10095 (2009); Singh, 81 FR at 

8248. I find that considerations of both 

specific and general deterrence weigh in 

favor of revocation in this case.] 

Allowing the Respondent to retain his 

COR despite the proven misconduct 

would send the wrong message to the 

regulated community. Imposing a 

sanction less than revocation would 

create the impression that registrants 

can maintain DEA registration despite 

ongoing treatment below the California 

standard of care, knowledge and 

acquiescence of the abuse or diversion 

demonstrated herein, the repeated 

prescribing of dangerous combinations 

of medications, and the wholesale 

failure to maintain complete and 

accurate medical charts. Revoking the 

Respondent’s COR communicates to 

registrants that DEA takes all failings 

under the CSA seriously and that severe 

violations will result in severe 

sanctions. 

[There is simply no evidence that 

Respondent’s behavior is not likely to 

recur in the future such that I can 

entrust him with a CSA registration; in 

other words, the factors weigh in favor 

of revocation as a sanction.] 

Recommendation 

Considering the entire record before 

me, the conduct of the hearing, and 

observation of the testimony of the 

witnesses presented, I find that the 

Government has met its burden of proof 

and has established a prima facie case 

for revocation. In evaluating Factors 

Two and Four of 21 U.S.C. 823(f), I find 

that the Respondent’s COR is 

inconsistent with the public interest. 

Furthermore, I find that the Respondent 

has failed to overcome the 

Government’s prima facie case by 

unequivocally accepting responsibility. 

Therefore, I recommend that the 

Respondent’s DEA COR No. BR6081018 

should be revoked, and that any 

pending applications for modification or 

renewal of the existing registration, and 

any applications for additional 

registrations, be denied. 

Mark M. Dowd, 

U.S. Administrative Law Judge. 

Order 

Pursuant to 28 CFR 0.100(b) and the 

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

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

revoke DEA Certificate of Registration 

No. BR6081018 issued to Fares Jeries 

Rabadi, M.D. Pursuant to 28 CFR 

0.100(b) and the authority vested in me 

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

I further hereby deny any other pending 

applications for renewal or modification 

of this registration, as well as any other 

pending application of Fares Jeries 

Rabadi, M.D., for registration in 

California. This Order is effective June 

21, 2022. 

Anne Milgram 

Administrator. 

[FR Doc. 2022–10592 Filed 5–18–22; 8:45 am] 

BILLING CODE 4410–09–P 


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