Federal Register / Vol. 79, No. 222 / Tuesday, November 18, 2014 / Notices 68701 

Desk Officer, Washington, DC 20530 or 

sent to OIRA_submissions@

omb.eop.gov. 

SUPPLEMENTARY INFORMATION: Written 

comments and suggestions from the 

public and affected agencies concerning 

the proposed collection of information 

are encouraged. Your comments should 

address one or more of the following 

four points: 

—Evaluate whether the proposed 

collection of information is necessary 

for the proper performance of the 

functions of the agency, including 

whether the information will have 

practical utility; 

—Evaluate the accuracy of the agency’s 

estimate of the burden of the 

proposed collection of information, 

including the validity of the 

methodology and assumptions used; 

—Enhance the quality, utility, and 

clarity of the information to be 

collected; and 

—Minimize the burden of the collection 

of information on those who are to 

respond, including through the use of 

appropriate automated, electronic, 

mechanical, or other technological 

collection techniques or other forms 

of information technology, e.g., 

permitting electronic submission of 

responses. 

Overview of This Information 

Collection 

(1) Type of Information Collection: 

Extension of a currently approved 

collection. 

(2) Title of the Form/Collection: Fee 

Waiver Request. 

(3) Agency form number: EOIR–26A 

(OMB #1125–0003). 

(4) Affected public who will be asked 

or required to respond, as well as a brief 

abstract: Primary: An individual 

submitting an appeal or motion to the 

Board of Immigration Appeals. Other: 

Attorneys or representatives 

representing an alien in immigration 

proceedings before EOIR. Abstract: The 

information on the fee waiver request 

form is used by the Board of 

Immigration Appeals to determine 

whether the requisite fee for a motion or 

appeal will be waived due to an 

individual’s financial situation. 

(5) An estimate of the total number of 

respondents and the amount of time 

estimated for an average respondent to 

respond: It is estimated that 8,614 

respondents will complete each form 

within approximately 1 hour. 

(6) An estimate of the total public 

burden (in hours) associated with the 

collection: There are an estimated 8,614 

total annual burden hours associated 

with this collection. 

If additional information is required 

contact: Jerri Murray, Department 

Clearance Officer, United States 

Department of Justice, Justice 

Management Division, Policy and 

Planning Staff, Two Constitution 

Square, 145 N Street NE., Room 

3E.405B, Washington, DC 20530. 

Dated: November 13, 2014. 

Jerri Murray, 

Department Clearance Officer for PRA, U.S. 

Department of Justice. 

[FR Doc. 2014–27250 Filed 11–17–14; 8:45 am] 

BILLING CODE 4410–30–P 

DEPARTMENT OF JUSTICE 

Drug Enforcement Administration 

Richard D. Vitalis, D.O.; Decision and 

Order 

On August 12, 2013, the Deputy 

Assistant Administrator, Office of 

Diversion Control, Drug Enforcement 

Administration, issued an Order to 

Show Cause to Richard D. Vitalis, D.O. 

(Applicant), of Debary, Florida. GX 1. 

The Show Cause Order proposed the 

denial of Applicant’s application for a 

DEA Certificate of Registration on the 

ground that his continued ‘‘registration 

would be inconsistent with the public 

interest.’’ Id. at 2 (citing 21 U.S.C. 

823(f)). 

The Show Cause Order made 

numerous allegations against Applicant. 

First, it stated that on October 1, 2008, 

the Florida Department of Health (DOH) 

entered an emergency suspension of 

Applicant’s medical license on the basis 

of his history of alcohol dependency 

and his failure to comply with DOH 

orders requiring the monitoring of his 

medical practice. Id. The Order then 

specifically alleged that after 

reinstatement of his Florida medical 

license on March 26, 2009, Applicant 

materially falsified three applications 

for a DEA registration when he falsely 

answered ‘‘no’’ on each application to 

the liability question which asks: ‘‘Has 

the applicant ever surrendered (for 

cause) or had a state professional license 

or controlled substances registration 

revoked, suspended, denied, restricted 

or place on probation?’’ Id. at 2–3 (citing 

21 U.S.C. 843(a)(4)(A)). The Order 

alleged that Applicant submitted these 

applications on October 5, 2009; May 

22, 2012; and January 7, 2013. Id. 

The Show Cause Order also alleged 

that on October 6, 2009, Applicant 

became registered as a practitioner to 

handle schedule II controlled 

substances under DEA registration 

number FV1682269, at the registered 

address of 230 Caddie Court, Debary, 

Florida. The Order then alleged that 

between July 2010 and June 3, 2011, 

Applicant ‘‘issued and/or authorized 

prescriptions for controlled substances 

in Schedules 2N, 3, 3N, 4 and 5, for 

which [he] did not have the authority to 

handle, in violation of 21 U.S.C. 

822(b).’’ Id. at 3. The Show Cause Order 

also alleged that on June 3, 2011, 

Applicant’s registration was modified to 

add all schedules. Id. 

Next, the Show Cause Order alleged 

that between July 7, 2011 and March 22, 

2012, three law enforcement officers 

made six undercover visits to Applicant 

at All Family Medical (hereinafter, 

AFM), a state-registered pain 

management clinic. Id. The Order then 

alleged that at the conclusion of each 

visit, Applicant prescribed Schedule II 

and IV controlled substances, including 

oxycodone and Xanax, to the 

undercover officers, for other than a 

legitimate medical purpose and outside 

the usual course of professional practice 

in violation of applicable federal, state 

and local law. Id. at 3–4 (citing 21 CFR 

1306.04(a)). 

The Show Cause Order further alleged 

that a medical expert reviewed the 

undercover visits and determined that 

Applicant prescribed unnecessary and 

excessive doses of controlled substances 

to the undercover officers, in deviation 

from the standard of care in pain 

medicine. Id. at 4–5. The Order alleged 

that the Expert further found that 

Applicant failed to comply with 

Florida’s standards for the use of 

controlled substances for the treatment 

of pain, and that the prescriptions were 

issued for other than a legitimate 

medical purpose and outside the usual 

scope of professional practice. Id. at 5 

(citing Fla. Stat. § 456.44; Fla. Admin. 

Code r.64B15–14.005; 21 CFR 

1306.04(a)). 

Finally, the Show Cause Order alleged 

that on January 1, 2012, D.V., a 34-year 

old male died as a result of an 

accidental overdose of controlled 

substances. Id. The Order then alleged 

that on December 27, 2011, Applicant 

issued prescriptions to D.V. for 180 

tablets of oxycodone 30mg, 120 tablets 

of oxycodone 15mg, 40 tablets Percocet 

10/325 mg, 60 tablets of alprazolam 

2mg, and 90 tablets of Motrin 800mg, 

and that the prescriptions ‘‘were for 

other than a legitimate medical purpose 

and outside the usual scope of 

professional practice.’’ Id. (citing 21 

CFR 1306.04(a)). 

The Show Cause Order, which also 

notified Applicant of his right to request 

a hearing on the allegations or to submit 

a written statement in lieu of a hearing, 

the procedure for electing either option, 

and the consequence of failing to elect 


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1This location is also known by an alternate 

address, 995 Rock Island Rd, North Lauderdale, FL 

33068 as referenced by the UCs in their 

declarations. See GXs 11, 24, 30. 

2This form states that: ‘‘Pursuant to Florida Code 

Section 458.32654(2)(c) a physician who prescribes 

more than a 72 hour dose of a controlled substance 

must document in the patient’s record the reason 

for prescribing that quantity. If it is found by the 

applicable regulatory agencies that this clinic 

qualifies as a pain clinic under such Florida Statute, 

I hereby document the following medical 

justification for prescribing the amounts prescribed 

to this patient.’’ GX 5, at 19. 

3An identical form is found in the medical file 

for each visit made by the undercovers, each 

indicating that ‘‘an adequate physical exam had 

been performed utilizing the standards of practice 

required by the Florida Board of Medicine.’’ Each 

form contains brief, illegible handwritten notes. 

either option, was served on Applicant 

by certified mail addressed to him at his 

proposed registered address. As 

evidenced by the signed return-receipt 

card, service was accomplished on 

August 27, 2013. 

Since that date, more than thirty days 

have now passed and neither Applicant, 

nor anyone purporting to represent him, 

has requested a hearing or submitted a 

written statement in lieu of a hearing. 

Accordingly, I find that Applicant has 

waived his right to a hearing or to 

submit a written statement on the 

allegations of the Show Cause Order. 21 

CFR 1301.43(c) & (d). I therefore issue 

this Decision and Order based on the 

investigative record submitted by the 

Government and make the following 

findings of fact. 

Findings 

Applicant’s Licensure and Registration 

Status 

Applicant is an osteopathic physician 

licensed by the Florida DOH. On 

October 1, 2008, the DOH ordered the 

emergency suspension of his medical 

license, on the ground that Applicant 

had been diagnosed with alcohol 

dependency and that absent monitoring 

by the Professional Resource Network, 

his continued practice of osteopathic 

medicine constituted an immediate and 

serious danger to the health, safety and 

welfare of the public. GX 10, at 9–10. 

However, on March 26, 2009, the DOH 

reinstated his Florida medical license. 

Government Request for Final Agency 

Action (Gov. Request), at 2. 

During this period, Applicant held a 

DEA practitioner’s registration, pursuant 

to which he was authorized to dispense 

controlled substances in schedules II 

though V. GX 4. However, on May 31, 

2009, Applicant allowed his registration 

to expire and the number was 

subsequently retired by the Agency. Id. 

at 2. 

On October 5, 2009, Applicant 

applied for a new DEA practitioner’s 

registration at an address in Debary, 

Florida. On the application, Applicant 

sought authority to dispense schedule II 

narcotics and no other controlled 

substances. GX 4, at 7. Applicant was 

also required to answer four questions, 

including Question Three which asked: 

‘‘Has the applicant ever surrendered (for 

cause) or had a state professional license 

or controlled substances registration 

revoked, suspended, denied, restricted, 

or placed on probation, or is any such 

action pending?’’ GX 4, at 11. Applicant 

answered ‘‘no.’’ Id. The following day, 

DEA issued Applicant a new 

registration which was limited to 

schedule II. Id. at 7. Applicant did not 

submit a request to add the additional 

drug schedules until June 6, 2011. GX 

8, at 3. 

On December 2, 2010, Applicant 

requested a change in his registered 

address to ‘‘The Center for Wellness and 

Weight Loss D/B/A All Family 

Medical,’’ a pain management clinic 

located in North Lauderdale, Florida. 

GX 4, at 7; GX 8, at 2 (DI Declaration). 

Applicant’s request was approved. GX 

4, at 7; GX 8, at 2. 

On May 22, 2012, Applicant 

submitted a renewal application for his 

registration. Id. at 3. Once again, he 

provided a ‘‘no’’ answer to Question 

Three. GX 4, at 8; see also GX 8, at 3. 

The next day, DEA Agents and Task 

Force Officers (who had previously 

conducted undercover operations), 

along with members of the Broward 

County Sheriff’s Office, executed a 

federal search warrant at AFM. GX 8, at 

3. 

On July 27, 2012, an Order to Show 

Cause and Immediate Suspension Order 

was personally served on Applicant. Id. 

While Applicant filed a timely hearing 

request, prior to the hearing date, 

Applicant’s counsel advised the 

Government that he would submit a 

voluntary surrender in lieu of a hearing. 

Id. at 4. On December 20, 2012, the 

Miami Field Office received a letter 

which voluntarily surrendered 

Applicant’s registration and his 

registration was subsequently retired 

from the DEA registration system. Id.; 

see also GX 4, at 7. 

On January 4, 2013, Applicant again 

applied for a registration as a 

practitioner in Schedules II–V, at the 

address of 230 Caddie Court, Debary, 

Florida, 32713. GX 4, at 1. Question 

Two asked: ‘‘Has the applicant ever 

surrendered (for cause) or had a federal 

controlled substance registration 

revoked, suspended, restricted or 

denied, or is any such action pending?’’ 

Id. at 4. Applicant answered ‘‘Yes.’’ Id. 

However, in response to Question 

Three, Applicant again answered ‘‘No.’’ 

Id. 

The DEA Investigation 

Between July 7, 2011 and March 22, 

2012, three law enforcement officers, 

acting in an undercover capacity, made 

a total of six visits to AFM.1 GX 11, GX 

24, GX 30. The Officers were able to see 

Applicant five times and were 

successful at obtaining controlled 

substance prescriptions at each of these 

visits. 

DEA Task Force Officer M.C., using 

an undercover name with the same 

initials, visited AFM on July 7, 2011; 

August 11, 2011; and September 8, 

2011. Declaration of M.C., at 2. 

On each visit, he was equipped with 

a device which recorded his interactions 

with Applicant. The evidence includes 

the audio recordings, as well as a 

transcribed record of the portion of the 

visit during which M.C. met with 

Applicant. GX 12, 13, 15, 16, 18, 19. 

During his first visit, M.C. filled out 

a pain management questionnaire and 

rated his average pain at a 5 on a scale 

from 1 to 10, with 10 being ‘‘pain as bad 

as you can imagine.’’ GX 5, at 43. He 

underwent a urine screening, which 

showed that he had no controlled 

substances in him. GX 11, at 2. At some 

point unspecified in the record, his 

weight, blood pressure and pulse were 

recorded on an ‘‘Intake Form’’; this form 

also stated that his CC (chief complaint) 

was ‘‘chronic LBP’’ and ‘‘shoulder 

pain.’’ GX 5, at 38. Handwritten notes 

under the Examination and Symptoms 

Findings are largely undecipherable. Id. 

The patient record also includes a 

form, which is appropriately mistitled 

as: ‘‘Medical Justifiction (sic) Form for 

Prescribing More Than a 72 Hour Dose 

of Controlled Substance for the 

Treatment of Non-Malignant Pain’’ 2; 

this form was signed by Applicant and 

dated July 7, 2011. On the form, 

Applicant checked the box next to the 

section which reads: 

I have performed an adequate physical 

examination of this patient this same day 

utilizing the standard of practice required by 

the Florida Board of Medicine for physicians 

practicing in a pain management clinic, and 

I find that his/her medical condition justifies 

the use of this medication to treat such 

condition.3

GX 5, at 19. Directly below this 

statement is a place for comments, 

which appear to be in Applicant’s 

handwriting, but which are illegible. Id. 

M.C.’s file also includes a form, 

entitled ‘‘Pain Management Treatment 

Plan Medical Record’’ (Treatment Plan), 

which appears to track the various 


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4The form contains sections with such headings 

as ‘‘Patient Evaluation/Assessment,’’ ‘‘Medical 

Diagnosis,’’ ‘‘Objectives of Treatment Used to 

Determine Treatment Success,’’ ‘‘Recommended 

Non-Medication Treatment Modalities,’’ ‘‘Risks and 

Benefits,’’ ‘‘Periodic Review,’’ ‘‘Patient Drug Testing 

Completed’’ and ‘‘Compliance With Controlled 

Substance Laws.’’ 

5Applicant also checked ‘‘no,’’ indicating that he 

did not recommend that M.C. consult with a 

specialist or undergo additional evaluations or tests. 

Yet he made another indecipherable note in the 

section for listing additional evaluations and tests. 

6The patient record includes an undated, 

unsigned handwritten note stating: ‘‘pt said you 

were going to write some Xanax but forgot.’’ GX 5, 

at 1. 

components of the guidelines 4 adopted 

by the Florida Board of Osteopathic 

Medicine as part of its regulations 

entitled ‘‘Standards for the Use of 

Controlled Substances for Treatment of 

Pain.’’ See Fla. Admin. R.64B15–14.005. 

Several of the form’s sections list 

various line items with either a place to 

check ‘‘yes’’ or ‘‘no’’ or to check 

applicable boxes; in addition, several 

sections have a place for the physician 

to write notes. See GX 5, at 15–18. 

With respect to the first section of this 

form, which pertains to the patient 

evaluation, the form indicates that a 

pain survey was completed. Id. at 15. 

While this portion of the form contains 

places to indicate whether therapeutic 

goals were discussed, whether a 

functional assessment was performed, 

whether social and drug use histories 

were taken, whether a medication use 

assessment was done and whether prior 

records were reviewed, Applicant 

checked neither the yes nor the no line 

and the corresponding notes section 

contains two indecipherable words. Id. 

So too, the medical diagnosis section 

appears to simply state ‘‘as above.’’ Id. 

As for the treatment objectives, check 

marks are placed next to entries for 

‘‘improvement of pain without complete 

resolution,’’ ‘‘ability to return to some 

sort of employment,’’ and ‘‘return to 

certain level of physical activity,’’ but 

no further notes were made. Id. at 16. As 

for non-medication treatments, which 

lists ten different modalities, the word 

‘‘cold’’ is circled but none of the boxes 

are checked. Id. Applicant checked 

‘‘yes’’ to indicate that he had discussed 

the risks and benefits of controlled 

substances with M.C. Id. at 17. He also 

indicated that drug testing had been 

completed, but left blank the results. Id 

at 18. Yet other evidence in M.C.’s 

record shows that his urine drug screen 

was negative.5 Id. at 40. 

The audio recording of the initial 

office visit reveals Applicant greeted 

M.C. and stated, ‘‘I understand you’ve 

been having some low back pain,’’ to 

which M.C. replied: ‘‘yeah low back 

pain and, like, my shoulder’s bugging 

me too.’’ GX 12; GX 13, at 1. M.C. told 

Applicant he did not have an MRI of his 

shoulder because it was an additional 

charge to the MRI for his back. GX 13, 

at 1. 

M.C. told Applicant that he controlled 

his pain by taking oxycodone, and that 

‘‘it’s really the only thing that’s helped. 

I’ve done . . . Advil and Tylenol, but it 

doesn’t really help me.’’ Id. Applicant 

stated ‘‘so it’s partially controlled with 

those, but you get much better pain 

relief when you take Roxicodone.’’ Id. 

He then asked if M.C. had ‘‘taken 

anything else, like hydrocodone,’’ to 

which M.C. replied: ‘‘No. Just the blue 

thirties (30’s).’’ Id. 

Applicant then asked M.C. what was 

wrong with his shoulder. M.C. replied: 

‘‘it’s just more sore. Cause right after I 

play it will be sore for a couple days and 

. . . it kinda goes away.’’ Id. Next, 

Applicant asked M.C. whether he had 

undergone surgeries; whether he used 

tobacco, alcohol and either illegal or 

illicit drugs; and if there was a family 

history of various diseases. Id. 

Applicant then listened to M.C.’s 

breathing with a stethoscope. 

After asking about M.C.’s work, 

Applicant stated he had ordered 

Roxicodone and Ibuprofen to help 

control his pain. Id. at 3. He then asked 

M.C., ‘‘what, other than pain 

medication, seems to help with your 

pain; heat, cold or relaxation?’’ Id. M.C. 

replied ‘‘a little cold.’’ Id. Applicant 

then repeated that he was going to 

prescribe Motrin and Roxicodone and 

told M.C. he wanted to see him back in 

about one month. Id. The visit ended, 

with M.C. receiving a prescription for 90 

Motrin 800mg and 150 Roxicodone 

30mg. GX 14; see also GX 11, at 3. 

On August 11, 2011, M.C. returned to 

AFM. Upon meeting, Applicant asked 

M.C. ‘‘[h]ow are you doing?’’ to which 

M.C. replied ‘‘[g]ood.’’ GX 16, at 1. 

Applicant then asked M.C. if he was 

‘‘getting pain relief with [his] current 

medications’’ and if he was ‘‘tolerating 

[his] medications well’’; M.C. replied 

‘‘yes’’ to both questions. Id.; see also GX 

15. After a silence which lasted 

approximately 3 minutes, GX 15, 

Applicant stated, ‘‘Alright Michael . . . 

I re-ordered your Motrin and 

Roxicodone for you . . . and see you 

back in about one (1) month.’’ GX 16, at 

1. 

Following another brief silence, M.C. 

asked: ‘‘Do you want me to stand up?’’ 

Applicant replied, ‘‘[y]ou’re fine. Take 

some deep breaths.’’ Id. Applicant then 

told M.C., ‘‘[s]ee you in about one (1) 

month,’’ and the visit ended. Id. at 2. 

The total length of the visit was 

approximately 5 minutes, GX 15, and 

Applicant issued M.C. prescriptions for 

150 Roxicodone 30mg and 90 Motrin 

800mg. GX 17. A note for the visit lists 

M.C.’s weight, blood pressure, and pulse 

(although it is unclear if these were ever 

taken), and also includes Applicant’s 

notes, which are largely indecipherable, 

but state that ‘‘pt states good pain relief 

with current meds’’ and ‘‘tolerates meds 

well.’’ GX 5, at 35. Id. 

On September 8, 2011, M.C. made a 

third visit to AFM. GX 19; GX 5, at 32. 

M.C. filled out a Daily Pain Summary 

Form, on which he stated that he had 

pain on that day, that it was on average 

a three out of ten, and that he had 

‘‘experienced unrelieved breakthrough 

pain’’ on three occasions on that date. 

GX 5, at 8. 

During this appointment, Applicant 

asked M.C. if he was ‘‘getting good relief 

with [his] current medications?’’ GX 18; 

GX 19, at 1. M.C. answered ‘‘[y]es,’’ but 

added: ‘‘I’m having a little trouble 

sleeping some nights . . . I didn’t know 

if I can get any Xanax . . . Just a couple 

Xanax . . . I’ve taken it before and it 

helped.’’ GX 19, at 1. Applicant replied, 

‘‘[s]o you’re having some insomnia’’; 

M.C. stated, ‘‘[y]eah, not too bad, but 

sometimes.’’ Id. 

After placing his stethoscope on 

M.C.’s back and listening to him 

breathe, Applicant told M.C. that he had 

‘‘renewed’’ both his Roxicodone and 

Motrin and added that he wanted to see 

M.C. ‘‘back in about one (1) month.’’ Id. 

The visit then concluded. Id. at 2. While 

the visit lasted approximately nine 

minutes, the recordings establish that 

M.C. and Applicant exchanged very 

little dialog other than that which is 

quoted above. In fact, after Applicant 

said to M.C., ‘‘breathe normal’’ and 

‘‘sounds good’’ (apparently while 

listening with his stethoscope), 

approximately four and one-half 

minutes passed without further dialogue 

until Applicant told M.C. that he had 

‘‘renewed [his] Roxicodone.’’ Id., see 

also GX 18 (audio recording.) Applicant 

again issued M.C. prescriptions for 150 

Roxicodone 30mg and 90 Motrin 800mg. 

GX 20. 

On October 11, 2011, M.C. made a 

fourth visit to AFM. GX 5, at 3. After 

Applicant greeted M.C. and made an 

unintelligible comment, M.C. stated: 

‘‘[y]eah, I asked you for them last time 

. . . I don’t know if you forgot, but, you 

said you would, but I didn’t get the 

script for them,’’ apparently referring to 

the Xanax he had sought at his previous 

visit.6 GX 22, at 1. 

The following exchange then ensued: 


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68704 Federal Register / Vol. 79, No. 222 / Tuesday, November 18, 2014 / Notices 

7There is, however, no evidence that Applicant 

ever made this Statement to M.C. during his 

September 8, 2011 visit. See GX 19, at 1–2; see also 

GX 18. 

8The record also contains an exhibit which 

purports to be a transcript of the meeting between 

TB and Applicant. The record, however, contains 

no statement establishing that the transcript is 

reliable and accurate. 

Applicant: ‘‘I think I said I wanted you to 

try and go without them.’’ 7

M.C.: ‘‘Oh, OK.’’ 

Applicant: ‘‘I will go ahead and prescribe 

them for you this time.’’ 

M.C.: ‘‘OK.’’ 

Applicant: ‘‘Did you do ok when you 

didn’t have them?’’ 

M.C.: ‘‘Um, I had taken them before and I 

did better with them when I was taking 

them. . . . And also, I work in a warehouse, 

and I know the holidays are coming up. So, 

it’s a lot of heavy lifting. I didn’t know if I 

could get a couple more of the Oxy’s . . . 

You gave me one hundred and fifty (150) last 

time . . . I didn’t know if you could bump 

it up to, like, one hundred eighty (180) 

maybe, if that’s possible.’’ 

Applicant: ‘‘I’ll see what I can do.’’ 

Id. 

Next, Applicant asked M.C. if he was 

‘‘doing well,’’ with M.C. answering 

‘‘yes.’’ Id. at 2. M.C. then asked if 

Applicant wanted him ‘‘to stand up.’’ 

Id. Applicant said ‘‘you’re fine,’’ asked 

M.C. to ‘‘take some deep breaths,’’ and 

said ‘‘sounds good.’’ Id. Approximately 

four minutes of silence followed (see GX 

21), after which Applicant told M.C. 

that he had ‘‘renewed [his] scripts,’’ as 

well as given him ‘‘Xanax for the sleep’’ 

and needed to see him ‘‘back in about 

a month.’’ GX 22, at 2. The total length 

of the visit was approximately eight 

minutes and Applicant issued M.C. 

prescriptions for 160 Roxicodone 15mg, 

150 Roxicodone 30mg, 60 Xanax 2mg, 

and Motrin. GX 5, at 28. 

On July 7, 2011, a second Special 

Agent (B.O.), made an undercover visit 

to AFM. GX 24, at 2; GX 26, at 1 

(transcript). B.O. provided paperwork 

and an MRI to the clerk as a walk-in 

patient, and returned to AFM later in 

the day for his appointment. GX 26, at 

1–3. He provided a urine sample, which 

tested negative for controlled 

substances. GX 24, at 2. He also 

completed a Pain Survey on which he 

reported that in the last 24 hours, his 

pain (on a zero to ten scale) was a five 

(5) at its worst, a two (2) at its least, and 

averaged a three (3). GX 6, at 35. 

The form also asked the patient to rate 

the extent to which the pain interfered 

with various things, such as general 

activities, work, and sleep, with zero 

being no interference and ten being 

complete interference. B.O. circled three 

(3) for both his general activity and 

work, and five (5) for sleep. Id. at 36. He 

also wrote that he had taken nonprescription Motrin which had no effect 

on his pain. Id. at 37. Another form 

included in the patient file, signed by 

B.O. on July 7, 2011, included an oath 

that he ‘‘had not been prescribed 

narcotic pain medication within the last 

30 days, or from another physician, 

since my last visit to this clinic.’’ Id. at 

15. 

Thereafter, B.O. was seen by 

Applicant, but the recording device 

malfunctioned and depicts only about 

two minutes of their interaction, during 

which Applicant was sitting at his desk 

and asked B.O. what type of work he 

did and how many hours a week he 

worked before ending. GX 26, at 5–6; 

GX 25. However, the Special Agent 

submitted a sworn declaration stating 

that he told Applicant he was 

experiencing back problems due to 

work, and that he had taken oxycodone 

from a friend which relieved the pain. 

GX 24, at 2. The Special Agent further 

stated that following this, Applicant 

‘‘placed a stethoscope on my back and 

printed prescriptions for 180 tablets of 

oxycodone 30mg and 90 tablets of 

Motrin 800mg.’’ Id.; see also GX 27. 

B.O.’s patient file includes an intake 

form which purports to document his 

chief complaint, his symptoms, and 

exam findings. GX 6, at 27. Again, most 

of the handwritten notes for the exam 

findings are illegible. The Pain 

Management Treatment Plan form notes 

a diagnosis of ‘‘chronic lbp’’; it also 

includes the words ‘‘work out, 

stretching, chiropractic’’ in the notes 

section under objectives of treatment. 

Id. at 6–7. In addition, the ‘‘yes’’ box is 

checked indicating that a pain survey 

was done, that the risks and benefits 

were discussed, that a follow-up 

appointment was scheduled and that a 

drug test was done; the ‘‘no’’ box is 

checked indicating that specialist 

consultations or additional tests were 

not being scheduled. Id. at 6–9. 

However, the rest of the form is blank. 

Id. 

On August 4, 2011, B.O. returned to 

AFM. GX 29; see also GX 24, at 2. 

During the visit he was required to 

submit a urine sample, which registered 

negative for controlled substances. GX 

29, at 2. He was then informed by the 

office clerk that he was dismissed from 

the practice. Id. at 3; see also GX 6, at 

1–2. 

On March 22, 2012, a local sheriff’s 

deputy, using an alias with the initials 

T.B., went to AFM. GX 30, at 1. T.B. was 

initially told by the office staff that his 

MRI was too old because it was over two 

years old; he then obtained a new MRI 

for his neck and returned to AFM that 

same day. Id.; see also GX 31 

(audiovisual recording). 

T.B. completed two forms regarding 

his pain, a Daily Pain Summary and a 

Pain Management Questionnaire. On the 

former, he placed an x on his upper 

back to indicate the area where he had 

pain. GX 7, at 2. On the latter, he noted 

that in the last twenty-four hours, his 

pain was a four (4) at its worst, a three 

(3) at its least, and on average a three 

(3). GX 7, at 20. He also wrote that the 

onset of his pain was in 2005, and that 

‘‘oxycodone—helps.’’ Id. at 22. 

While the audio-video recording of 

T.B.’s visit depicts his interactions with 

the office staff regarding his MRI and his 

urine sample (which was negative for 

controlled substances), the recording in 

the evidentiary record ends before T.B. 

actually met with Applicant.8 See 

generally GX 31. However, the 

undercover officer submitted a 

declaration summarizing his visit with 

Applicant. Therein, the Officer stated 

that Applicant said to him, ‘‘ ‘I 

understand you are having some 

chronic low back pain,’ despite the MRI 

I provided of my neck.’’ GX 30, at 2. The 

Officer further stated that Applicant 

then asked if he ‘‘had any success with 

pain relief in the past’’; the Officer ‘‘told 

[Applicant] that [he had] taken 

oxycodone, and that worked.’’ Id. 

According to the Officer, Applicant 

‘‘then placed a stethoscope on [his] 

chest and back,’’ after which Applicant 

wrote him prescriptions for 120 

Roxicodone 15mg, 180 Roxicodone 

30mg, as well as Motrin. Id., see also GX 

33. 

T.B.’s patient file includes both an 

intake form and a pain management 

treatment plan. While the first form 

includes entries for T.B.’s chief 

complaint and ‘‘examination and 

symptom findings,’’ here again, most of 

the entries are illegible. GX 7, at 15. As 

for the second form, it contains a ‘‘yes’’ 

checkmark next to the entries indicating 

that a pain survey was taken, that nonmedication treatment of heat/cold was 

recommended, that risks and benefits 

were discussed, that a patient drug test 

was completed, and a ‘‘no’’ checkmark 

indicating that neither specialist 

consultations nor additional evaluations 

or tests were recommended; there are 

also two two-word long handwritten 

notes under the medical diagnosis and 

dates of appointment which are 

illegible. Id. at 3–6. However, nearly 

every other line and entry is blank. Id. 

The record also includes the medical 

file of D.V., a thirty-four year old male, 

who was under Applicant’s care for 

approximately thirteen months. On 

January 1, 2012, D.V., who had received 

several controlled substance 

prescriptions from Applicant only days 


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9The record does not include copies of DV’s 

actual prescriptions, but does contain Discharge 

Summaries which correspond to office visit records 

and list medications prescribed by Applicant. 

10The file contain a second discharge summary 

for the same date which was printed at 3:08:57 

p.m., and which documents that Applicant issued 

DV prescriptions for 180 Roxicodone 30mg, 120 

Percocet 10/325mg, 60 Xanax 2mg, and Motrin. It 

is unclear, however, whether these were additional 

prescriptions beyond those listed in the first 

discharge summary. GX 37, at 54. 

11An undated, unsigned handwritten note in the 

file states ‘‘trade in 50 30’s and get 100 15s.’’ Id. 

at 53. 

before, died of ‘‘acute combined drug 

toxicity.’’ See generally GX 37 (Patient 

File), GX 38 (Medical Examiner’s Cause 

of Death Report), GX 39 (Autopsy). 

D.V.’s patient file included medical 

records from his initial visit in June 

2010 to AFM (then called the ‘‘Center 

for Wellness and Weight Loss’’) through 

his final visit on December 27, 2012. GX 

37. D.V. was initially seen by a different 

physician who recorded ‘‘low back pain 

and left lower extremity radiculopathy’’ 

as D.V.’s chief complaint. GX 37, at 113. 

His patient file included two MRI 

reports from March 2006, and a 

prescription record from Holiday CVS 

dated January 2010 through June 14, 

2010. Id. at 115–121. 

D.V. first saw Applicant on November 

9, 2010. Id. at 102. According to the 

records for this date, Applicant issued 

D.V. prescriptions for 210 Roxicodone 

30mg, 90 Roxicodone 15mg, and 30 

Xanax 2mg.9 Id. at 103. While most of 

the notes on the intake form for the visit 

are illegible, the notes state that D.V.’s 

‘‘CC’’ (chief complaint) was ‘‘chronic 

LBP’’ (chronic lower back pain). Under 

‘‘Examination and Symptom Findings,’’ 

the notes list D.V.’s weight as ‘‘265 lbs’’ 

and blood pressure as ‘‘162/90.’’ The 

findings further state: ‘‘he also notes 

good pain relief with current meds . . . 

overall feels well.’’ Id. at 102. 

On December 8, 2010, D.V. again saw 

Applicant as a follow-up for ‘‘chronic 

LBP.’’ Id. at 99. The Intake Form notes 

which are legible read: ‘‘overall feels 

well . . . tolerating pain meds’’ and 

‘‘Back full ROM [symbol] 

tenderness. . . .’’ Id. Applicant wrote 

that the treatment plan was to ‘‘continue 

meds,’’ which were listed as 210 

Roxicodone 30mg, 80 Roxicodone 15mg 

and 80 Xanax 2mg. GX 37, at 100. 

However, the file does not contain 

copies of the prescriptions or a 

discharge summary for this visit. Id. 

On December 28, 2010, D.V. again 

saw Applicant, who documented a 

diagnosis of chronic LBP and anxiety. 

GX 37, at 98. The physician’s 

handwritten notes state: ‘‘Overall feels 

well . . . good pain relief with current 

meds . . . does report running out of 

15mg Roxicodone.’’ Id. The notes also 

list D.V.’s weight at ‘‘278 lbs’’ and blood 

pressure as ‘‘180/116.’’ Id. The 

Discharge Summary lists the 

prescriptions issued that date as 210 

Roxicodone 30mg, 120 Roxicodone 

15mg, 90 Xanax 2mg, and Motrin. Id. at 

97. 

D.V. returned to AFM on a monthly 

basis for his ‘‘chronic LBP’’ throughout 

2011. Id. at 49–96. Throughout this 

period, Applicant repeatedly issued 

D.V. prescriptions on a monthly basis 

providing 210 Roxicodone 30mg, 90 or 

120 Roxicodone 15mg, and 60 or 90 

Xanax 2mg. Also, on multiple dates, 

Applicant provided additional 

prescriptions or early refills. 

For example, on August 30, 2011, 

Applicant issued D.V. prescriptions for 

210 Roxicodone 30mg, 120 Roxicodone 

15mg, and 60 Xanax 2mg. Id. at 69. Yet 

on September 6, Applicant wrote D.V. a 

script for an additional 180 Roxicodone 

30mg, followed by a script on 

September 13 for 180 Percocet 10/325, 

a schedule II drug combining oxycodone 

and acetaminophen. Id. at 67–68. Yet 

only three days later, Applicant issued 

D.V. a further script for 180 Roxicodone 

30mg. Id. at 66. 

Indeed, during the 63-day period 

between D.V.’s August 30, 2011 visit 

and his next appointment on November 

1, 2011, the record shows that Applicant 

issued D.V. prescriptions totaling 738 

tablets of Roxicodone 30mg, 390 tablets 

of Roxicodone 15mg, 300 Percocet 10/

325 mg, and 180 Xanax 2mg. Id. at 62– 

69. Per Applicant’s dosing instruction of 

one Roxicodone 30mg tablet every 4–6 

hours, even if D.V. took one tablet every 

4 hours, he still would have used only 

378 tablets in that 63 day period, 

leaving 360 tablets unaccounted for. As 

for the Xanax, based on the dosing 

instruction of one tablet every twelve 

hours, D.V. would have had 60 tablets 

remaining. Yet, at D.V.’s November 1st 

visit, Applicant provided him with 

prescriptions for 180 Roxicodone 30mg, 

120 Roxicodone 15mg, 60 Percocet 10/ 

325, and 60 Xanax. Id. at 59. 

Regarding Applicant’s prescribing to 

D.V. during this period, the 

Government’s Expert found that ‘‘[t]here 

is no documentation in the history as to 

why the additional prescriptions had 

been provided to the patient between 

that visit of 11/01/2011 and the 

previous visit of 8/30/2011.’’ GX 35, at 

12. There is, however, a Sheriff’s Office 

Event Report which establishes that on 

September 30th, D.V. was a passenger in 

a car which was followed by the 

Sheriff’s Office as it left Applicant’s 

clinic and was stopped after its driver 

ran a stop sign. GX 37, at 9. During the 

traffic stop, the Officers learned that 

D.V. was on probation; D.V. consented 

to a search of his person, during which 

the Officers found a clear orange pill 

bottle which contained twenty-seven 

tablets of oxycodone 30mg; the vial’s 

label was partially torn off and the 

remaining information ‘‘was 

unreadable.’’ Id. The Officers also seized 

D.V.’s prescriptions for oxycodone 

15mg, alprazolam 2mg, and Motrin. Id. 

D.V. ‘‘was released and given a case 

number for the pills and prescriptions.’’ 

Id. 

There is also a one-page document in 

the file, which is titled: ‘‘[D.V.] 

Medication Report.’’ Id. at 6. The 

document lists the dates of the various 

oxycodone prescriptions Applicant 

wrote between August 2 and October 6 

and contains various notations as to 

why several of the prescriptions were 

issued. Id. For example, the document 

states that D.V. could not fill the August 

30 prescription for 210 oxycodone 30mg 

and that he turned in the prescription, 

thus suggesting the reason why 

Applicant issued him a prescription for 

180 oxycodone 30mg on September 6. 

Id. Yet the document also includes a 

notation that the reason Applicant 

issued D.V. a prescription for 120 

oxycodone 15mg on September 29 was 

because the police had taken D.V.’s 

prescription (dated September 27) for 

138 oxycodone 30mg. Id. The reliable 

evidence shows, however, that the 

police did not take this prescription but 

rather the September 29 prescription for 

120 oxycodone 15mg. Id. Moreover, the 

handwriting is markedly more legible 

than that on the various intake forms, 

thus suggesting that Applicant did not 

create the document. 

On November 29, D.V. again saw 

Applicant, who noted on the Intake 

Form: ‘‘pt reports good pain relief with 

current meds . . . tolerates meds well 

overall feels well . . . Back full ROM.’’ 

Id. at 57. According to a Discharge 

Summary, which was printed at 12:16 

p.m., Applicant prescribed 180 

Roxicodone 30mg, 120 Roxicodone 

15mg, 60 Xanax 2mg, and Motrin.10 GX 

37, at 56. 

On December 9, 2011, Applicant 

issued D.V. a prescription for 100 tablets 

of Roxicodone 15mg. Id. at 55. There 

are, however, no notes in D.V.’s file 

bearing this date.11

On December 27, D.V. made his next 

and last visit. On the Intake Form, 

Applicant wrote: ‘‘pt states good pain 

relief with current meds . . . tolerates 

meds well . . . overall feels well.’’ Id. 

at 51. An unsigned, undated, 

handwritten note in the file states ‘‘Due 

for urine.’’ Id. at 50. Applicant issued 

D.V. prescriptions for 180 Roxicodone 

30mg, 120 Roxicodone 15mg, 40 


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Percocet 10/325mg, 60 Xanax 2mg, and 

Motrin. Id. at 49. 

As found above, on January 1, 2012, 

D.V. ‘‘died as a result of acute combined 

drug toxicity.’’ GX 39, at 1. The medical 

examiner’s toxicology report found that 

D.V.’s blood was positive for 

alprazolam, cocaine, diazepam, 

methadone, and oxycodone. Id. at 5. 

The Medical Examiner’s Cause of Death 

Report states that D.V.’s family reported 

that he was ‘‘currently taking Xanax and 

Oxycodone . . . and had been addicted 

to pain medications for a number of 

years for treatment of back pain and a 

shoulder injury, but all incidents were 

remote and full recovery was reached.’’ 

GX 38, at 1. On the date of his death, 

D.V. ‘‘was drinking alcohol throughout 

the day while continuing to take his 

daily Xanax and Oxycodone regimen 

[that] he was prescribed.’’ Id. at 2. 

The Expert’s Report 

The medical files of the three 

undercover officers and patient D.V. 

were reviewed by the Government’s 

Expert, Mark Rubenstein, M.D. Dr. 

Rubenstein, who is licensed in Florida, 

Maryland, and Virginia, is a diplomate 

of the American Board of Physical 

Medicine and Rehabilitation with a 

subspecialty certificate in Pain 

Medicine; a Fellow of the American 

Academy of Physical Medicine and 

Rehabilitation; a diplomate of the 

American Academy of Pain 

Management; and has held positions 

with several pain and rehabilitation 

clinics. GX 34. He has also held various 

appointments, including that of clinical 

professor at several medical schools, 

and has made numerous presentations 

on the treatment of injuries and chronic 

pain. Id. 

Using the Florida Standards for the 

Use of Controlled Substances for [the] 

Treatment of Pain, see Fla. Admin. Code 

r. 64B15–14.005, Dr. Rubenstein 

reviewed the patient files of the 

undercover officers and D.V. and 

evaluated Applicant’s controlled 

substance prescribing practices. He then 

provided a report with his conclusions. 

See GX 35, at 1. 

Regarding T.B., Dr. Rubenstein found 

that the patient file ‘‘showed no 

objective abnormality for the chief 

complaint of low back pain.’’ Id. He 

noted that ‘‘the only objective 

abnormality contained within the file 

was a cervical MRI scan, but the 

patient’s complaints as per the 

physician were chronic low back pain.’’ 

Id. Yet there was ‘‘no documentation of 

any musculoskeletal or neurologic 

examination germane to the neck or 

back region.’’ Id. at 4. 

Dr. Rubenstein further found that 

Applicant failed to do a ‘‘a complete 

history and physical examination’’ and 

‘‘therefore, there was no justification for 

the use of high doses of opioids, 

specifically high quantities of 

Roxicodone 15 and 30mg, with no other 

treatment alternatives afforded to the 

patient other than Motrin 800 mg.’’ Id. 

Dr. Rubenstein also observed that: 

[T.B.]’s initial drug screen was negative, 

indicating he was either opioid naı ̈ve or 

clearly not using any opioid medications 

demonstrating any tolerance at the initial 

visit, therefore it would be considered 

inappropriate to initiate a dose of 

Roxicodone 30 mg every four to six hours for 

a patient who is not using same . . . this 

dose would be aggressive, excessive and 

place the patient at risk for drug toxicity or 

overdose including respiratory depression. 

Id. 

Dr. Rubenstein thus concluded that 

Applicant’s treatment ‘‘represents a 

deviation from the standard of care in 

pain medicine.’’ Id. He also observed 

that the physician’s handwriting and 

medical records were not legible, which 

would ‘‘be a deviation from the Florida 

statutes for the standards of adequacy of 

medical records, as well as a deviation 

from the standards for the use of 

controlled substances for the treatment 

of pain.’’ Id. 

With regard to M.C., Dr. Rubenstein 

found that the only objective pathology 

was an MRI of the lumbar spine 

showing only some disc bulging. Id. at 

6. Yet, ‘‘[t]here was no documented 

detailed neurologic or musculoskeletal 

exam, and the only follow-up visits 

were [sic] a neurologic exam is even 

referenced indicated that the neurologic 

exam was ‘‘intact.’’ ’’ Id. According Dr. 

Rubenstein, ‘‘[t]he medical records are 

lacking legibility, and clearly a detailed 

history and physical was not performed 

or documented by the physician.’’ Id. 

Dr. Rubenstein observed Applicant 

‘‘offered the patient only medications 

with no other treatment alternatives for 

a complaint of chronic low back pain.’’ 

Id. at 6. He further observed that while 

M.C.’s ‘‘initial urine drug screen was 

completely negative’’ and ‘‘there was no 

documented history of using 

medications from other providers and 

no records of same,’’ Applicant 

prescribed M.C. ‘‘Roxicodone 30mg to 

take every four to six hours.’’ Id. 

Dr. Rubenstein explained that ‘‘[t]his 

would be an inappropriate dose for an 

opioid naı ̈ve patient’’ and ‘‘would be 

considered excessive for a young male 

who had no significant pathology 

documented from an objective 

perspective.’’ Id. He then noted that 

‘‘[t]here were no follow-up [sic] urine 

screens to ensure compliance with the 

medication regimen.’’ Id. 

Dr. Rubenstein further observed that 

there were no treatment alternatives 

afforded to the patient for his back pain, 

such as physical therapy, injection 

therapy, activity modification and nonopioid alternatives other than Motrin. 

Id. He also noted that on October 11, 

2011, Applicant added Roxicodone 

15mg to M.C.’s medications, and that 

M.C. ‘‘may have been taking up to six 

Roxicodone 30mg tablets and six 15mg 

tablets for a total of 270mg of oxycodone 

daily if the full dose was utilized.’’ Id. 

Yet there was no documentation ‘‘as to 

why the Roxicodone 15mg was being 

added, and especially why an additional 

160 of these tablets were 

recommended.’’ Id. at 5. 

As for the Xanax 2mg prescription 

which Applicant provided on M.C.’s 

last visit, Dr. Rubenstein observed that 

this would be excessive for an initial 

starting dose. Id. at 6. He further noted 

that ‘‘[t]here was no mental health 

consultation or other documented 

abnormal mental status exam to have 

even warranted such a dose.’’ Id. 

Next, Dr. Rubenstein noted that 

Applicant violated the standards for the 

adequacy of medical records by not 

keeping legible medical records. Id. 

Finally, he concluded that Applicant 

violated the Florida standards for the 

use of controlled substances in treating 

pain, because he did not perform a 

detailed history and physical, use 

appropriate consultations for treatment 

objectives, keep accurate and complete 

medical records, or individualize 

treatment. Id. As such, this represented 

a deviation from the standard of care in 

pain medicine. Id. 

As for B.O., Dr. Rubinstein found that 

he presented with low level back pain 

and an MRI showing only some disc 

bulging and facet hypertrophy. Id. at 8. 

Yet Applicant did not perform a 

‘‘detailed physical examination’’ to 

include a musculoskeletal or neurologic 

exam. Id. 

Dr. Rubinstein also found that 

Applicant did not take a detailed history 

of B.O.’s pain. Id. While Dr. Rubenstein 

acknowledged that the file included a 

completed pain questionnaire, ‘‘it was 

not even specific to low back pain.’’ Id. 

Moreover, while the MRI listed a 

referring physician of Robert Green, 

there were no records in the chart from 

prior physicians and there was ‘‘no 

information in the chart’’ that Applicant 

‘‘attempt[ed] to discern what had been 

done by [Dr. Green] or any other 

providers in the past.’’ Id. According to 

Dr. Rubenstein, ‘‘[t]here was not nearly 

enough documentation on physical 

exam to support any diagnosis other 


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than ‘chronic low back pain,’ which is 

a generic diagnosis and not specific for 

a neurologic or musculoskeletal 

abnormality.’’ Id. There was also no 

documentation that Applicant had 

considered alternative treatments ‘‘such 

as physical therapy, referral to a spine 

specialist, non-opioid alternatives such 

as medications or other agents, injection 

therapy, [or] exercise specifically for 

lumbar stabilization.’’ Id. 

Dr. Rubenstein further noted that 

B.O.’s initial urine drug screen was 

negative and thus ‘‘there was clearly no 

basis to initiate a dose of Roxicodone 

30mg every four to six hours.’’ Id. Dr. 

Rubenstein then observed that ‘‘[t]his 

dose would be considered excessive, 

aggressive, and placed the patient at risk 

for drug overdose or drug toxicity.’’ Id. 

Based on his conclusion that Applicant 

had failed to perform an adequate 

history and physical examination, Dr. 

Rubenstein concluded that Applicant 

breached the standard of care for pain 

medicine and violated Florida rule 

64B8–9.013 when he prescribed 

Roxicodone 30mg at B.O.’s first visit. Id. 

at 9. 

Dr. Rubenstein also noted that 

Applicant’s physical exam notes were 

illegible and lacked ‘‘sufficient detail to 

document why the course of treatment 

was undertaken.’’ Id. Thus, he 

concluded that Applicant violated 

Florida’s regulation governing the 

‘‘Standards of Adequacy of Medical 

Records.’’ Id. 

Dr. Rubenstein reviewed D.V.’s 

patient file and the medical examiner’s 

report. He described D.V.’s file as 

‘‘[d]isconcerting.’’ Id. at 15. He found 

that the only imaging study was a 2006 

MRI and there was ‘‘no attempt to 

obtain previous medical records for his 

pain management.’’ Id. at 16. He then 

noted that 

The young male with a history of chronic 

low back pain and no focal neurologic 

abnormality [was] given high doses of 

Roxicodone, oxycodone, and alprazolam. 

There was never any documented mental 

status examination, referral for treatment of 

anxiety, specialist referral for evaluation of 

back pain, etc. There were no consults with 

other specialists, no consideration of treating 

drug dependence or addiction, and no 

treatment alternatives [were] afforded to the 

patient. There was no documentation as to 

any history of shoulder pain or evaluation of 

same despite the . . . medical examiner’s 

report indicating presence of same that 

initiated [D.V.’s] drug dependence and drug 

addiction. There was no attempt to recognize 

[D.V.’s] drug addiction . . . and no serial 

drug monitoring to ensure the prescriptions 

were being utilized appropriately. No 

attempts were made . . . to reliably reduce 

the risk of drug diversion, such as urine drug 

screens to ensure compliance. . . . Had drug 

screens been performed . . . then a proper 

treatment protocol may have been afforded to 

the individual. 

Id. at 15–16. 

Dr. Rubinstein further observed that 

while Applicant documented on the 

‘‘Pain Management Treatment Plan’’ 

form that drug testing had been 

completed at several of D.V.’s visits, 

there were no drug test results in the 

file. Id. at 13–14. Dr. Rubinstein thus 

explained that Applicant’s documenting 

that monitoring had been performed 

when there were no test results in D.V.’s 

file ‘‘represents improprieties in the 

medical records themselves.’’ Id. at 16. 

Dr. Rubinstein also observed that 

D.V.’s weight rendered him obese and 

yet Applicant never addressed this issue 

or his intermittent hypertension with 

him. Id. Moreover, D.V. ‘‘was clearly 

either drug dependent, drug addicted, or 

drug diverting and no attempts were 

made to address those issues’’ with him. 

Id. 

Dr. Rubenstein thus concluded that 

Applicant did not meet ‘‘the standard of 

care for pain medicine in prescribing 

such high doses of medications with the 

frequency performed to this 

individual.’’ Id. He further found that 

Applicant deviated ‘‘from the Standards 

for the Use of Controlled Substances for 

the Treatment of Pain by failing to 

perform periodic reviews, ensure 

compliance, obtain consultations for the 

evaluation of ongoing back pain, and by 

fail[ing] to provide any treatment 

alternatives to opioid medications and 

high-dose benzodiazepines.’’ Id. 

Dr. Rubinstein thus found that 

Applicant deviated from the standard of 

care in pain medicine with respect to 

each of the undercover officers and D.V. 

He further concluded that the 

prescriptions Applicant issued ‘‘for 

these individuals were issued for other 

than a legitimate medical purpose and 

would be considered outside the usual 

course of professional practice.’’ GX 35, 

at 1. 

Other Evidence 

In preparation for the previous Order 

to Show Cause proceeding, Investigators 

reviewed prescription data from the 

Florida Prescription Monitoring 

Program (PDMP), as well as pharmacy 

records from various states, including 

Florida. GX 8, at 3–4 (Declaration of 

Diversion Investigator). They also 

obtained from several pharmacies some 

of the prescriptions which Applicant 

had authorized between July 2010 and 

June 3, 2011. Id. at 3. As found above, 

when Applicant applied for a new 

registration in October 2009, he sought 

authority to dispense only schedule II 

narcotics. Accordingly, the Agency 

issued him a registration which 

authorized him to dispense schedule II 

narcotics but no other controlled 

substances. Thus, Applicant did not 

have authority to dispense non-narcotic 

schedule II controlled substances or any 

controlled substances in schedules III, 

IV, and V. 

According to the declaration of an 

Agency Investigator, various records 

show that during this period, Applicant 

issued approximately 1,116 

prescriptions, which authorized the 

dispensing of approximately 85,432 

dosage units of controlled substances in 

drug schedules 2N (non-narcotic), 3, 4, 

and 5. Id. at 3–4. 

Included in the evidentiary record are 

fifteen prescriptions for Xanax, a 

schedule IV controlled substance, five 

prescriptions for Adderall, a schedule 

2N controlled substance, and two 

prescriptions for Valium, a schedule IV 

controlled substance, which Applicant 

issued between November 30, 2010 and 

May 24, 2011. GX 9. 

The record also includes a computergenerated sixteen (16) page document, 

which lists various prescriptions for 

drugs such as alprazolam, diazepam, 

phentermine, zolpidem, and 

amphetamine salts issued by Applicant 

between July 2, 2010 and June 3, 2011, 

along with the names of the patients 

(and their city of residence) and the 

dispensing pharmacy (and city where 

located). See GX 40. While in the 

record’s Table of Contents, the 

Government refers to this document as 

‘‘Chart and PDMP Report for 

Respondent’s Prescribing Outside 

Registration (19 pages),’’ GX Table of 

Contents, the document bears no label 

identifying it as such. Moreover, while 

an Investigator stated that she had had 

reviewed Florida PDMP records, her 

affidavit does not identify this 

document as being part of the PDMP 

records she reviewed. See generally GX 

8. 

Discussion 

Section 303(f) of the Controlled 

Substances Act provides that an 

application for a practitioner’s 

registration may be denied upon a 

determination ‘‘that the issuance of such 

registration would be inconsistent with 

the public interest.’’ 21 U.S.C. 823(f). In 

making the public interest 

determination, the CSA requires the 

consideration of the following factors: 

(1) The recommendation of the appropriate 

State licensing board or professional 

disciplinary authority. 

(2) The applicant’s experience in 

dispensing . . . controlled substances. 

(3) The applicant’s conviction record under 

Federal or State laws relating to the 


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12While Kungys involved a denaturalization 

proceeding, in other civil proceedings, courts have 

required that a party establish that a falsification is 

material by ‘‘clear, unequivocal, and convincing 

evidence’’ and not simply by a ‘‘preponderance of 

the evidence.’’ Driscoll v. Cebalo, 731 F.2d 878, 884 

(Fed. Cir. 1984). In any event, the Government has 

produced no evidence as to why the statement is 

material. 

13Citing Bickman, the Government argues that 

‘‘[a] falsification is material if the state medical 

board ‘concluded that Respondent’s conduct posed 

such a risk to patients as to warrant the suspension 

or revocation of his medical license (and authority 

to prescribe controlled substances under [s]tate 

law).’’ Gov. Req. for Final Agency Action, at 14. The 

quoted language, however, does not support the 

Government’s contention as it served only to 

distinguish Bickman’s circumstance of having been 

placed on probation by his state board from that 

which would have existed had his state license 

been suspended or revoked at the time he submitted 

his application. As explained above, because 

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. 

Id. 

‘‘These factors are . . . considered in 

the disjunctive.’’ Robert A. Leslie, M.D., 

68 FR 15227, 15230 (2003). I ‘‘may rely 

on any one or a combination of factors, 

and may give each factor the weight [I] 

deem[] appropriate in determining 

whether . . . an application for 

registration [should be] denied.’’ Id. 

Moreover, it is well established that I 

am ‘‘not required to make findings as to 

all of the factors.’’ Hoxie v. DEA, 419 

F.3d 477, 482 (6th Cir. 2005); see also 

Kevin Dennis, M.D., 78 FR 52787, 52974 

(2013); MacKay v. DEA, 664 F.3d 808, 

816 (10th Cir. 2011). 

Furthermore, under Section 304(a)(1), 

a registration may be revoked or 

suspended ‘‘upon a finding that the 

registrant . . . has materially falsified 

any application filed pursuant to or 

required by this subchapter.’’ 21 U.S.C. 

824(a)(1). DEA has long held that the 

various grounds for revocation or 

suspension of an existing registration 

that Congress enumerated in section 

304(a), 21 U.S.C. 824(a), are also 

properly considered in deciding 

whether to grant or deny an application 

under section 303. See Anthony D. 

Funches, 64 FR 14267, 14268 (1999); 

Alan R. Schankman, 63 FR 45260 

(1998); Kuen H. Chen, 58 FR 65401, 

65402 (1993). Thus, the allegation that 

Respondent materially falsified his 

application is properly considered in 

this proceeding. See Samuel S. Jackson, 

72 FR 23848, 23852 (2007). The 

Government bears the burden of proof 

in showing that the issuance of a 

registration is inconsistent with the 

public interest. 21 CFR 1301.44(d). 

The Material Falsification Allegation 

As found above, on October 1, 2008, 

the Florida Department of Health 

entered an emergency suspension of 

Applicant’s Florida medical license, on 

the basis of his history of alcohol 

dependency and his failure to comply 

with the DOH’s orders which required 

the monitoring of his medical practice. 

GX 10, at 10. In March 2009, the DOH 

re-instated his medical license. 

Applicant, however, allowed his DEA 

registration to expire on May 31, 2009. 

On October 5, 2009, Applicant 

applied for a new DEA registration and 

provided a ‘‘no’’ answer to the third 

liability question, which asked whether 

he had previously had a state 

professional license revoked or 

suspended. GX 4, at 10. Applicant’s 

answer was clearly false, and knowingly 

so, as the DOH had suspended his 

medical license on October 1, 2008 and 

Applicant’s license was not reinstated 

until March 26, 2009. Moreover, 

Applicant also provided a ‘‘no’’ answer 

to question three on the applications he 

filed on May 22, 2012 and January 4, 

2013. Thus, Applicant has submitted 

three applications in which he provided 

a false answer to question three. 

Congress did not, however, grant the 

Agency authority to revoke an existing 

registration or deny an application 

based on any falsification, but rather, 

only those which are material. See 21 

U.S.C. 824(a)(1). As the Supreme Court 

has explained, ‘‘[t]he most common 

formulation’’ of the concept of 

materiality ‘‘is that a concealment or 

misrepresentation is material if it ‘has a 

natural tendency to influence, or was 

capable of influencing, the decision of’ 

the decisionmaking body to which it 

was addressed.’’ Kungys v. United 

States, 485 U.S. 759, 770 (1988) (quoting 

Weinstock v. United States, 231 F.2d 

699, 701 (D.C. Cir. 1956)) (other citation 

omitted); see also United States v. Wells, 

519 U.S. 482, 489 (1997) (quoting 

Kungys, 485 U.S. at 770). The Supreme 

Court has further explained that ‘‘[i]t 

has never been the test of materiality 

that the misrepresentation or 

concealment would more likely than not 

have produced an erroneous decision, 

or even that it would more likely than 

not have triggered an investigation.’’ 

Kungys, 485 U.S. at 771 (emphasis 

added). Rather, the test is ‘‘whether the 

misrepresentation or concealment was 

predictably capable of affecting, i.e., had 

a natural tendency to affect, the official 

decision.’’ Id. ‘‘ ‘[T]he ultimate finding 

of materiality turns on an interpretation 

of substantive law,’ ’’ id. at 772 (int. 

quotations and other citation omitted), 

and must be met ‘‘by evidence that is 

clear, unequivocal, and 

convincing.’’ 12 Id. 

As the above makes clear, the relevant 

decision for assessing whether a false 

statement is material is the Agency’s 

decision as to whether an applicant is 

entitled to be registered (or in the case 

of a current registrant, remain 

registered). Thus, because possessing 

authority to dispense controlled 

substances under the laws of the State 

in which a physician practices medicine 

is a requirement for holding a DEA 

registration, see 21 U.S.C. 802(21) & 

823(f), a false answer to question three 

is material where an applicant no longer 

holds authority to practice medicine 

(regardless of the reason for the State’s 

action) or authority to dispense 

controlled substances, as well as where 

the State has placed restrictions on a 

practitioner’s authority to prescribe 

controlled substances. So too, because 

in determining whether an application 

should be granted, Congress directed the 

Agency to consider the five public 

interest factors, even where an applicant 

currently holds unrestricted state 

authority to dispense controlled 

substances, the failure to disclose state 

action against his medical license may 

be material if the action was based on 

conduct (or on the status arising from 

such conduct, i.e., a conviction for a 

controlled substance offense or 

mandatory exclusion from federal 

health care programs) which is 

actionable under either the public 

interest factors or the grounds for 

denial, suspension, and revocation set 

forth in section 824. See Scott C. 

Bickman, 76 FR 17694, 17701 (2011) 

(holding that failure to disclose state 

probation was not material where 

probation was based on an act of 

medical malpractice and did not involve 

controlled substances). 

Here, citing Bickman, the Government 

contends that Applicant’s falsification is 

material because the Florida DOH 

concluded that as a result of his 

dependency on alcohol, ‘‘his ‘continued 

practice as an osteopathic physician 

constitute[d] an immediate serious 

danger to the health, safety, and welfare 

of the public’ ’’ and that ‘‘ ‘[n]othing 

short of suspending [his] license will 

adequately protect the public.’ ’’ Req. for 

Final Agency Action, at 14. Had 

Applicant’s state license been 

suspended at the time he filed any of his 

DEA applications, his answer to 

question three would have been 

materially false because he would have 

lacked authority to dispense controlled 

substances and would not have been 

entitled to be registered.13 But it wasn’t. 


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Federal Register / Vol. 79, No. 222 / Tuesday, November 18, 2014 / Notices 68709 

possessing state authority is a requirement for 

obtaining a DEA registration, failing to disclose a 

continuing state suspension (or a revocation order 

which remains in effect) is always material. See 21 

U.S.C. 802(21) & 823(f)). By contrast, whether the 

failure to disclose a suspension which has since 

terminated is material depends upon the basis of 

the State’s action. 

14As for factor one—the recommendation of the 

state licensing board—it is undisputed that 

Applicant holds a current license as an osteopathic 

physician in the State of Florida and possesses state 

authority to dispense controlled substances. While 

Respondent therefore meets an essential 

prerequisite for obtaining a registration under the 

CSA, 21 U.S.C. 823(f), DEA has held repeatedly that 

a practitioner’s possession of State authority is not 

dispositive of the public interest determination. 

DEA maintains a separate oversight responsibility 

with respect to the handling of controlled 

substances and has a statutory obligation to make 

its independent determination as to whether the 

granting of such privileges would be in the public 

interest. Mortimer Levin, 57 FR 8680, 8681 (1992). 

Thus, neither a State’s failure to take action against 

a registrant’s medical license, nor a State’s 

restoration of a practitioner’s prescribing authority, 

is dispositive in determining whether or not an 

application should be granted. See Jayam KrishnaIyer, 74 FR 459, 461 (2009); Paul Weir Battershell, 

76 FR 44359, 44366 (2011) (citing Edmund Chein, 

72 FR 6580, 6590 (2007), pet. for rev. denied Chein 

v. DEA, 533 F.3d 828 (D.C. Cir. 2008)). 

As for factor three, there is no evidence that 

Respondent has been convicted of an offense 

‘‘relating to the manufacture, distribution or 

dispensing of controlled substances.’’ 21 U.S.C. 

823(f)(3). However, there are a number of reasons 

why even a person who has engaged in misconduct 

may never have been convicted of an offense under 

this factor, let alone prosecuted for one. Dewey C. 

MacKay, 75 FR 49956, 49973 (2010), pet. for rev. 

denied MacKay v. DEA, 664 F.3d 808 (10th Cir. 

2011). The Agency has 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. 

Moreover, the Government makes no 

argument that had Applicant truthfully 

disclosed the State’s suspension, it 

would have uncovered information that 

he had committed actionable 

misconduct under the public interest 

standard or the other grounds provided 

in 21 U.S.C. 824(a). Indeed, the State’s 

suspension order made no allegation 

that Applicant engaged in misconduct 

actionable under the public interest 

standard (whether resulting in a 

criminal conviction or not) or that he 

was convicted of an offense subjecting 

him to mandatory exclusion from 

federal health care programs. See id. 

Rather, the DOH’s Order was based on 

its conclusion that Applicant is an 

alcoholic. Notably, the DOH made no 

allegation that Applicant was also a 

drug abuser and the Government cites 

no decision in which this Agency has 

denied the application of a physician, 

who was then duly authorized by the 

State in which he/she practiced to 

dispense controlled substances, on the 

sole ground that the physician was an 

alcoholic. Accordingly, I reject the 

allegation. Hoi Y Kam, 78 FR 62694, at 

62696 (2013); see also Scott C. Bickman, 

76 FR 17694, 17701 (2011). 

The Public Interest Allegations 

The Government alleges that granting 

Applicant’s registration would be 

inconsistent with the public interest 

based on his conduct which is relevant 

in assessing his experience as a 

dispenser of controlled substances 

(Factor Two) and his compliance with 

applicable laws related to controlled 

substances (Factor Four).14 More 

specifically, the Government contends 

that Applicant violated the CSA in two 

respects. First, he issued prescriptions 

to three undercover officers and D.V. 

which lacked a legitimate medical 

purpose in violation of the CSA’s 

prescription regulation. Second, he 

issued controlled substances 

prescriptions for drugs he was not 

authorized to prescribe under his 

registration. I agree. 

Factors Two and Four 

To effectuate the dual goals of 

conquering drug abuse and controlling 

both the legitimate and illegitimate 

traffic in controlled substances, 

‘‘Congress devised a closed regulatory 

system making it unlawful to 

manufacture, distribute, dispense, or 

possess any controlled substance except 

in a manner authorized by the CSA.’’ 

Gonzales v. Raich, 545 U.S. 1, 13 (2005). 

Consistent with the maintenance of the 

closed regulatory system, a controlled 

substance may only be dispensed upon 

a lawful prescription issued by a 

practitioner. Carlos Gonzalez, M.D., 76 

FR 63118, 63141 (2011). 

Fundamental to the CSA’s scheme is 

the Agency’s longstanding regulation, 

which provides that ‘‘[a] prescription for 

a controlled substance [is not] effective 

[unless it 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). This regulation further 

provides that ‘‘an order purporting to be 

a prescription issued not in the usual 

course of professional treatment . . . is 

not a prescription within the meaning 

and intent of [21 U.S.C. 829] and . . . 

the person issuing it, shall be subject to 

the penalties provided for violations of 

the provisions of law relating to 

controlled substances.’’ Id. 

As the Supreme Court has explained, 

‘‘the prescription requirement . . . 

ensures patients use controlled 

substances under the supervision of a 

doctor so as to prevent addiction and 

recreational abuse. As a corollary, [it] 

also bars doctors from peddling to 

patients who crave the drugs for those 

prohibited uses.’’ Gonzales v. Oregon, 

546 U.S. 243, 274 (2006) (citing United 

States v. Moore, 423 U.S. 122, 135, 143 

(1975)); United States v. Alerre, 430 

F.3d 681, 691 (4th Cir. 2005), cert. 

denied, 574 U.S. 1113 (2006) (stating 

that the prescription requirement 

likewise stands as a proscription against 

doctors acting not ‘‘as a healer[,] but as 

a seller of wares’’). 

Under the CSA, it is fundamental that 

a practitioner must establish and 

maintain a legitimate doctor-patient 

relationship in order to act ‘‘in the usual 

course of . . . professional practice’’ 

and to issue a prescription for a 

‘‘legitimate medical purpose.’’ Ralph J. 

Chambers, 79 FR 4962 at 4970 (2014) 

(citing Paul H. Volkman, 73 FR 30629, 

30642 (2008), pet. for rev. denied 

Volkman v. DEA, 567 F.3d 215, 223–24 

(6th Cir. 2009)); see also Moore, 423 U.S. 

at 142–43 (noting that evidence 

established that the physician exceeded 

the bounds of professional practice, 

when ‘‘he gave inadequate physical 

examinations or none at all,’’ ‘‘ignored 

the results of the tests he did make,’’ 

and ‘‘took no precautions against . . . 

misuse and diversion’’). The CSA, 

however, generally looks to state law to 

determine whether a doctor and patient 

have established a legitimate doctorpatient relationship. Volkman, 73 FR 

30642. 

Pursuant to Florida Stat. 

§ 456.44(3)(a), a ‘‘complete medical 

history and a physical examination 

must be conducted before beginning any 

treatment and must be documented in 

the medical record.’’ Moreover, ‘‘the 

medical record must, at a minimum, 

document the nature and intensity of 

the pain, current and past treatments for 

pain, underlying or coexisting diseases 

or conditions, the effect of the pain on 

physical and psychological function, 

and a review of previous medical 

records, previous diagnostic studies, 

and history of alcohol and substance 

abuse.’’ Id. This section also requires a 

physician to develop a written plan for 

assessing ‘‘each patient’s risk for of 

aberrant drug-related behavior, and 

monitor that risk on an ongoing basis in 

accordance with the plan.’’ Id.; see also 

Fla. Admin. Code r. 64B15–14.005(3)(a). 

The Government also cites to the 

Florida Standards for the Use of 

Controlled Substances for Treatment of 

Pain. One of the Standards states that 

‘‘osteopathic physicians should be 

diligent in preventing the diversion of 

drugs for illegitimate purposes,’’ and 

that ‘‘all such prescribing must be based 

on clear documentation of unrelieved 

pain and in compliance with applicable 

state or federal law.’’ Fla. Admin. Code 

r. 64B15–14.005(1)(d) & (e). 


tkelley on DSK3SPTVN1PROD with NOTICES
68710 Federal Register / Vol. 79, No. 222 / Tuesday, November 18, 2014 / Notices 

As found above, upon reviewing the 

patient files of the undercover officers 

as well as D.V., the Government’s Expert 

found that Applicant issued controlled 

substances for other than a legitimate 

medical purpose and outside the usual 

course of professional practice. As 

support for his conclusion, the Expert 

observed that Applicant failed to 

perform detailed histories and adequate 

physical examinations, failed to develop 

any treatment plan other than to 

prescribe controlled substances, 

prescribed large and excessive doses of 

controlled substances, failed to properly 

monitor patients, and failed to keep 

legible and complete medical records. I 

agree with the Expert’s analysis and 

conclude that Applicant knowingly 

diverted controlled substances 

including oxycodone (schedule II) and 

alprazolam (schedule IV) to the 

undercover officers and D.V. and thus 

violated federal law. 21 U.S.C. 841(a)(1); 

21 CFR 1306.04(a). I further find that 

Applicant’s misconduct was egregious. 

This finding provides reason alone to 

deny Applicant’s application. 

However, the record also supports the 

conclusion that Applicant exceeded the 

authority of his registration by 

prescribing controlled substances in 

schedules which were outside the scope 

of his registration. Pursuant to 21 U.S.C. 

822(b), ‘‘[p]ersons registered by the 

Attorney General . . . to . . . dispense 

controlled substances . . . are 

authorized to possess . . . or dispense 

such substances . . . to the extent 

authorized by their registration.’’ 

(emphasis added). 

As found above, on October 5, 2009, 

Applicant applied for a new registration 

as a practitioner. Notwithstanding that 

the application form clearly instructed 

him to check all drug schedules for 

which he sought authority, Applicant 

checked the box for only schedule II 

narcotics. Accordingly, the Agency 

granted him a registration which was 

limited to schedule II narcotics. 

Applicant did not seek authority to 

dispense controlled substances in the 

additional schedules until June 6, 2011. 

Thus, between October 6, 2009 (the 

date the application was granted) and 

June 6, 2011, Applicant could not 

lawfully prescribe any controlled 

substances outside of those narcotics in 

schedule II. The record, however, 

contains fifteen prescriptions for Xanax 

(alprazolam) and two prescriptions for 

Valium (diazepam), both of which are 

schedule IV controlled substances, as 

well as five prescriptions for Adderall 

(amphetamine), a schedule II nonnarcotic, which Applicant issued 

without authority to do so. Even though 

Applicant eventually obtained a 

registration for the remaining drug 

schedules, Applicant was responsible 

for ensuring that he had obtained the 

necessary authority for each schedule of 

controlled substances he intended to 

dispense. I thus conclude that Applicant 

violated federal law by dispensing 

controlled substances for which he 

lacked authorization. 21 U.S.C. 822(b) & 

841(a)(1). 

Accordingly, I find that the 

Government’s evidence with respect to 

factor two and four establishes a prima 

facie case that granting Applicant’s 

application ‘‘would be inconsistent with 

the public interest.’’ Id. § 823(f). Because 

Applicant failed to respond to the Show 

Cause Order, whether by requesting a 

hearing or submitting a written 

statement, and thus has failed to offer 

any evidence to the contrary, I will 

order that his application be denied. 

Order 

Pursuant to the authority vested in me 

by 21 U.S.C. 823(f), as well as 28 CFR 

0.100(b) and 0.104, I order that the 

application of Richard D. Vitalis, D.O., 

for a DEA Certificate of Registration as 

a practitioner, be, and it hereby is, 

denied. This Order is effective 

immediately. 

Dated: November 10, 2014. 

Thomas M. Harrigan, 

Deputy Administrator. 

[FR Doc. 2014–27206 Filed 11–17–14; 8:45 am] 

BILLING CODE 4410–09–P 

DEPARTMENT OF JUSTICE 

Parole Commission 

Sunshine Act Meeting 

TIME AND DATE: 10:30 a.m., Friday, 

November 21, 2014. 

PLACE: U.S. Parole Commission, 90 K 

Street NE., 3rd Floor, Washington, DC 

STATUS: Closed. 

MATTERS TO BE CONSIDERED: 

Determination on seven original 

jurisdiction cases. 

CONTACT PERSON FOR MORE INFORMATION: 

Jacqueline Graham, Staff Assistant to 

the Chairman, U.S. Parole Commission, 

90 K Street NE., 3rd Floor, Washington, 

DC 20530, (202) 346–7001. 

Dated: November 14, 2014. 

Isaac Fulwood, 

Chairman, U.S. Parole Commission. 

[FR Doc. 2014–27444 Filed 11–14–14; 4:15 pm] 

BILLING CODE 4410–31–P 

DEPARTMENT OF LABOR 

Office of the Secretary 

Agency Information Collection 

Activities; Submission for OMB 

Review; Comment Request; Certificate 

of Medical Necessity 

ACTION: Notice. 

SUMMARY: The Department of Labor 

(DOL) is submitting the Office of 

Workers’ Compensation Programs 

(OWCP) sponsored information 

collection request (ICR) revision titled, 

‘‘Certificate of Medical Necessity,’’ to 

the Office of Management and Budget 

(OMB) for review and approval for use 

in accordance with the Paperwork 

Reduction Act (PRA) of 1995 (44 U.S.C. 

3501 et seq.). Public comments on the 

ICR are invited. 

DATES: The OMB will consider all 

written comments that agency receives 

on or before December 18, 2014. 

ADDRESSES: A copy of this ICR with 

applicable supporting documentation; 

including a description of the likely 

respondents, proposed frequency of 

response, and estimated total burden 

may be obtained free of charge from the 

RegInfo.gov Web site at http://

www.reginfo.gov/public/do/

PRAViewICR?ref_nbr=201410-1240-001 

(this link will only become active on the 

day following publication of this notice) 

or by contacting Michel Smyth by 

telephone at 202–693–4129, TTY 202– 

693–8064, (these are not toll-free 

numbers) or sending an email to DOL_

PRA_PUBLIC@dol.gov. 

Submit comments about this request 

by mail or courier to the Office of 

Information and Regulatory Affairs, 

Attn: OMB Desk Officer for DOL– 

OWCP, Office of Management and 

Budget, Room 10235, 725 17th Street 

NW., Washington, DC 20503; by Fax: 

202–395–5806 (this is not a toll-free 

number); or by email: OIRA_

submission@omb.eop.gov. Commenters 

are encouraged, but not required, to 

send a courtesy copy of any comments 

by mail or courier to the U.S. 

Department of Labor—OASAM, Office 

of the Chief Information Officer, Attn: 

Departmental Information Compliance 

Management Program, Room N1301, 

200 Constitution Avenue NW., 

Washington, DC 20210; or by email: 

DOL_PRA_PUBLIC@dol.gov. 

FOR FURTHER INFORMATION CONTACT: 

Contact Michel Smyth by telephone at 

202–693–4129, TTY 202–693–8064, 

(these are not toll-free numbers) or 

sending an email to DOL_PRA_

PUBLIC@dol.gov. 

Authority: 44 U.S.C. 3507(a)(1)(D). 


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