Source: https://www.deadiversion.usdoj.gov/fed_regs/actions/2011/fr0930_4.htm
Timestamp: 2019-04-21 04:26:20+00:00

Document:
On February 4, 2011, Administrative Law Judge Timothy D. Wing issued the attached recommended decision. Neither party filed exceptions to the decision.
Having reviewed the entire record, I have decided to adopt the ALJ's ruling, findings of fact, conclusions of law (except as explained below), and recommended order. Accordingly, Respondent's application for a registration will be granted subject to a condition.
In his discussion of factor three--Respondent's "conviction record under Federal or State laws relating to the manufacture, distribution, or dispensing of controlled substances," 21 U.S.C. 823(f)--the ALJ found that she had pled guilty to a felony count of obtaining a narcotic drug by means of a forged prescription in violation of Cal. Health & Safety Code Sec. 11368. ALJ at 15-16.\1\ However, pursuant to Cal. Penal Code Sec. 1000.1, Respondent was allowed to participate in the deferred entry of judgment program, GX 10, and upon her successful completion of treatment, her guilty plea was set aside and the charge was dismissed. GX 11.
Noting that California law provides that "[a] defendant's plea of guilty pursuant to this chapter shall not constitute a conviction for any purpose unless a judgment of guilty is entered pursuant to" Cal Penal Code Sec. 1000.3, and that Agency precedent holds that a deferred adjudication is nonetheless a conviction for purposes of the CSA, the ALJ explained that "the fact that a finding of guilt was specifically not entered as to Respondent and the charges dismissed, leaves open the question as to whether Respondent's plea constitutes a conviction under 21 U.S.C. 823(f)." ALJ at 17. The ALJ deemed it unnecessary to reach the issue, however, reasoning that the offense committed by Respondent "does not 'relate to the manufacture, distribution, or dispensing of controlled substances,' the standard embraced in" 21 U.S.C. 823(f)(3). Id. (citing Super-Rite Drugs, 56 FR 46014 (1995)).
Contrary to the ALJ's understanding, the Agency has long since resolved both issues. In Edson W. Redard, 65 FR 30616 (2000), a practitioner, who was charged with three felony counts of obtaining and attempting to obtain hydrocodone by fraud under California law, pled nolo contendere to a single count and was allowed to participate in the State's deferred entry of judgment program (the same statutory scheme at issue here), which he successfully completed. Id. at 30617-18. Thereupon, the state court granted deferred entry of judgment and the charges were dismissed. Id. at 30618.
Thereafter, the Agency proposed the revocation of the practitioner's registration on the ground that he had been convicted of a felony offense relating to controlled substances under state or Federal law. Id. (citing 21 U.S.C. 824(a)(2)). In opposition, the practitioner argued that he had not been "convicted of a felony offense [because] no judgment was entered against him and the criminal proceedings were dismissed." Id.
The Agency rejected the practitioner's argument, explaining that "there is still a 'conviction' within the meaning of the Controlled Substances Act even if the proceedings are later dismissed. * * * [A]ny other interpretation would mean that the conviction could only be considered between its date and the date of its subsequent dismissal." Id. (int. quotations omitted). The Agency thus held that the practitioner had "been convicted of a felony relating to controlled substances" and that this was ground to revoke his registration under 21 U.S.C. 824(a)(2). Id.
In Harlan J. Borcherding, 60 FR 28796 (1995), a practitioner who had been indicted under Texas law on three counts of prescribing a controlled substance "without a valid medical purpose," was allowed to plead guilty to a single misdemeanor count and was placed on probation; following the practitioner's completion of his probation, the proceeding was dismissed without an adjudication of guilt. Id. at 28797. While the practitioner argued "that he had not been 'convicted' of any offense within the meaning of 21 U.S.C. 823(f)(3)," the Agency rejected the argument, holding that "[t]he law is well settled that a DEA registrant may be found to have been 'convicted' within the meaning of the Controlled Substances Act, despite a deferred adjudication of guilt." Id. (citations omitted).
More recently, in Pamela Monterosso, 73 FR 11146, 11148 (2008), a case in which an applicant pled guilty to a state law controlled substance offense but was granted probation before judgment and the charge was dismissed, I explained that "DEA has long taken the view that even when a court withholds adjudication and ultimately dismisses the charge after the completion of probation, the proceeding is still a conviction within the meaning of the Controlled Substances Act." See also Thomas G. Easter II, 69 FR 5579, 5580-81 (2004) ("DEA has consistently held that a deferred adjudication of guilt following a guilty plea, is a conviction within the meaning of the Controlled Substances Act."); Clinton D. Nutt, 55 FR 30992 (1990); Eric A. Baum, 53 FR 47272 (1988); Stanley Granet Rosen, 50 FR 46844 (1985).
Moreover, the Superior Court form evidencing Respondent's guilty plea includes the "Court's Finding And Order." GX 9, at 3. This section of the form concludes by stating: "The Court accepts the defendant's plea and admissions, and the defendant is convicted thereby." Id. For purposes of the CSA, including whether this action must be disclosed on an application for registration and whether it provides ground to deny an application or revoke a registration, see 21 U.S.C. 824(a)(1) & (2), Respondent's plea and the Superior Court's finding constitutes a conviction notwithstanding that her plea was eventually set aside and the charge dismissed.
\2\ It is acknowledged that there are a number of older cases which held that convictions for the offense of simple possession of a controlled substance could be considered under factor three. However, in Alvin Darby, 75 FR 26993, 27000 (2009), I explained that a conviction for simple possession does not fall within factor three. However, as I also noted in Darby, such a conviction can be considered under factor five. Id.
Most significantly, in several cases, the Agency has held that the offense of obtaining controlled substances by using fraudulent prescriptions constitutes an offense related to the manufacture, distribution, or dispensing of controlled substances within the meaning of factor three. See Redard, 65 FR at 30619 (practitioner obtained controlled substances by issuing fraudulent prescriptions); Ronald D. Springel, 62 FR 67092, 67094 (1997) (holding that conviction for federal offense "of obtaining a controlled substance by fraud" was actionable under factor three); Rick's Pharmacy, Inc., 62 FR 42595, 42597 (1997) (same); Ronald Phillips, 61 FR 15304, 15305-06 (1996) (same). Forging a prescription to obtain a controlled substance clearly relates to the "distribution or dispensing of controlled substances," 21 U.S.C. 823(f)(3), whether the practitioner wrote the prescriptions on her own pad, or, as here, stole prescriptions from another practitioner's pad.
However, aside from the ALJ's analysis of factor three, I agree with the ALJ's findings as to the remaining factors. Moreover, I agree with the ALJ that Respondent has "credibly" accepted responsibility for her misconduct and that she has put forward compelling and unrebutted evidence of her rehabilitation, thus demonstrating that "she will not engage in future misconduct." ALJ at 22. Because there is no evidence that Respondent harmed others or diverted the drugs she illegally obtained, and this episode is, in essence, a first offense, I conclude that consideration of the Agency's interest in deterrence is not warranted. Accordingly I will adopt the ALJ's recommended order and grant Respondent's application for registration subject to the following condition.
(1) Any violation of either condition 13 or 14 of the California Board of Registered Nursing's Order shall be deemed an act inconsistent with the public interest and subject her registration to proceedings under 21 U.S.C. 824(a).
Pursuant to the authority vested in me by 21 U.S.C. 823(f) and 28 CFR 0.100(b), I order that the application of Kimberly Maloney, N.P., for a DEA Certificate of Registration as a mid-level practitioner be, and it hereby is, granted. This Order is effective immediately.
Paul E. Soeffing, Esq., for the Government.
Kimberly Maloney, N.P., Pro Se, for the Respondent.
Timothy D. Wing, Administrative Law Judge. This proceeding is an adjudication pursuant to the Administrative Procedure Act (APA), 5 U.S.C. 551 et seq., to determine whether the Drug Enforcement Administration (DEA) should deny a nurse practitioner's application for a Certificate of Registration (COR) as a mid-level \1\ practitioner. Without this registration the nurse practitioner, Kimberly Maloney, N.P. (Respondent), of Chula Vista, California, will be unable to lawfully handle controlled substances in the course of her practice.
\1\ See 21 CFR 1300.01(b)(28) (2010).
On September 10, 2010, the DEA Deputy Assistant Administrator, Office of Diversion Control, issued an Order to Show Cause \2\ (OSC) to Respondent, giving Respondent an opportunity to show cause why the DEA should not deny her application for a DEA COR, assigned Control No. W09131151M, pursuant to 21 U.S.C. 824(a)(4), and deny any other pending applications for a DEA COR, alleging that Respondent's registration would be inconsistent with the public interest, as that term is defined in 21 U.S.C. 823(f).
\3\ Respondent's post-hearing brief, filed on January 25, 2011, indicates that the California Board of Registered Nursing (BRN) adopted the proposed decision of the California Administrative Law Judge (ALJ) on December 28, 2010, and notes that the BRN took the extraordinary step of reducing Respondent's period of probation to one year and cost recovery to zero. The Government filed with its post-hearing brief a December 28, 2010 Order of the BRN entitled "Decision After Non-Adoption," of which I take official notice. (See Gov't Br. at Gov't Ex. 17.) Under the APA, an agency "may take official notice of facts at any stage in a proceeding--even in the final decision." U.S. Dept. of Justice, Attorney General's Manual on the Administrative Procedure Act 80 (1947) (Wm. W. Gaunt & Sons, Inc., Reprint 1979). In accordance with the APA and DEA's regulations, Respondent is "entitled on timely request, to an opportunity to show to the contrary." 5 U.S.C. 556(e); 21 CFR 1316.59(e) (2010); see, e.g., R & M Sales Co., 75 FR 78,734, 78,736 n.7 (DEA 2010). Respondent can dispute the facts of which I take official notice by filing a properly supported motion for reconsideration within twenty days of service of this Recommended Decision, which shall begin on the date it is mailed. See, e.g., Joseph Gaudio, M.D., 74 FR 10,083, 10,088 (DEA 2009) (granting respondent opportunity to dispute officially noticed facts within fifteen days of service).
Respondent, appearing pro se, timely requested a hearing on the allegations in the OSC. Following prehearing procedures, a hearing was held in San Diego, California, on December 14, 2010, with the Government represented by counsel and Respondent appearing pro se. Both parties called witnesses to testify and introduced documentary evidence. After the hearing, both parties filed proposed findings of fact, conclusions of law and argument. All of the evidence and post- hearing submissions have been considered, and to the extent the parties' proposed findings of fact have been adopted, they are substantively incorporated into those set forth below.
Whether the record establishes by substantial evidence that Respondent's application for a DEA COR, Control Number W09131151M, as a mid-level practitioner, should be denied pursuant to 21 U.S.C. 823(f) and 824(a)(4), because Respondent's registration would be inconsistent with the public interest as that term is used in 21 U.S.C. 823(f).
[o]n or about December 18, 2006, an RxNET agent interviewed Respondent at the San Diego Bureau of Narcotics Enforcement office. Respondent initially denied forging any prescriptions, but eventually admitted that she had stolen Dr. [JR]'s prescription pad from his La Jolla office. Respondent stated that she forged prescriptions for Oxycontin and Actiq to administer to herself for migraine headaches. Respondent further admitted that she would dissolve the Actiq in a saline solution and inject herself with it.
The Government's documentary evidence included a handwritten confession by Respondent dated December 18, 2006, describing several life stresses and admitting to taking "the prescription pads because I was scared that my migraines were out of control, that I would need more medicine.
* * *" (Gov't Ex. 4.) The Government also submitted as evidence three photographs (Gov't Ex. 5), which Respondent testified were taken on the day she met with DI Bartolomeo and another person (Tr. 60). Respondent speculated that investigators photographed her arm because "they wanted to prove that I was a drug addict." (Tr. 61.) Respondent was candid: "I'm not here to dispute the fact that I got addicted to drugs. I mean, I accept what happened, and I'm here to tell you what happened after that. So I don't dispute that they took pictures of me on that day." (Tr. 61.) No other testimony or evidence was offered with regard to the photographs.
\4\ Government Exhibit 6 duplicates Respondent Exhibit 7 at 3.
\5\ Government Exhibit 7 duplicates Respondent Exhibit 7 at 4.
Respondent successfully participated in the Nursing Diversion Program for 22 months when she was asked to leave the program because of a technical violation of the Diversion Program's rules. While in the Diversion Program, respondent was working as a Nurse Practitioner in the bone marrow transplant unit at the University of California, San Diego (UCSD) Medical Center. When patients were admitted to the unit, respondent, using a preprogrammed computer check sheet, admitted the patients by checking the appropriate admission box that appeared on the computer screen. By checking the box, the computer program automatically issued a standard set of admission orders. In some instances, the set orders included an order for the patient to receive Oxycodone. Consequently, when the fact respondent had been "prescribing" Oxycodone came to the attention of the Diversion Program, respondent was asked to leave even though she had been in full compliance with the strict Diversion Program requirements, including: Calling every morning between 6 and 7 a.m.; taking random drug tests several times per month with no "dirty" tests; turning in monthly paperwork on time; attending AA and NA meetings five to seven days per week; attending weekly nurse-to-nurse meetings; completing 16 CEU's on substance abuse; calling monthly to check in with her case manager; and always getting permission before leaving San Diego.
\7\ Although I find Mr. Mayer's testimony credible, I do note a disparity between the November 29, 2006 sobriety date he and others identified (see Tr. 80; see also Resp't Ex. 8 at 1), and DI Bartolomeo's testimony suggesting that Respondent forged a prescription as late as December 6, 2006 (Tr. 27; see Gov't Ex. 2 at 28).
\13\ See Henry J. Schwarz, Jr., M.D., 54 FR 16,424 (DEA 1989).
\14\ That subsection provides that a DEA COR may be revoked upon a finding that the registrant: (1) Has materially falsified an application; (2) has been convicted of a felony under the CSA or any other federal or state law relating to any controlled substance; (3) has had a state license or registration suspended, revoked or denied and is no longer authorized by state law to handle controlled substances; (4) has committed such acts as would render his registration under 21 U.S.C. 823 inconsistent with the public interest; or (5) has been excluded from participation in incorporating the public interest factors from Sec. 823(f). See 21 U.S.C. 824(a)(4).
\15\ Kuen H. Chen, M.D., 58 FR 65,401, 65, 402 (DEA 1993) (citing Serling Drug co. & Detroit Prescription Wholesaler, Inc., 40 FR 11,918, 11,919 (DEA 1975)); accord Scott J. Loman, D.D.S., 50 FR 18,941 (DEA 1985); Roger Lee Palmer, D.M.D., 49 FR 950 (DEA 1984).
\16\ See Chen, 58 FR at 65,402.
\17\ Registered Nurse Licdense No. 513926; Nurse Practitioner Certificate No. 12026; Nurse Practitioner Furnisher Certificate No. 12026; Public Health Nurse Certificate No. 55127.
\18\ See supra note 3.
The most recent action by the California BRN reflects a determination that notwithstanding findings of unprofessional conduct, Respondent can be entrusted with an active license subject to probationary terms and conditions. While not dispositive,\19\ I find the careful deliberations and action by the state licensing authorities weigh in favor of a finding that Respondent's registration would be consistent with the public interest under 21 U.S.C. 823(f).
\19\ Mortimer B. Levin, D.O., 55 FR 8209, 8210 (DEA 1990) (finding DEA maintains separate oversight responsibility and statutory obligation to make independent determination whether to grant registration).
As noted above, one of the factors in determining whether Respondent's registration would be inconsistent with the public interest is "[t]he applicant's conviction record under Federal or state laws relating to the manufacture, distribution, or dispensing of controlled substances." 21 U.S.C. 823(f)(3).\20\ The OSC alleges that Respondent pled "guilty to a felony count of obtaining a narcotic drug (OxyContin) by means of a forged prescription, in violation of California Health & Safety Code Sec. 11368." (ALJ Ex. 1 at 2.) Pursuant to applicable state law,\21\ the entry of judgment was deferred and upon successful completion of a treatment program, the charges were dismissed. (Gov't Ex. 11.) The California statute provides in pertinent part that a "defendant's plea of guilty pursuant to this chapter shall not constitute a conviction for any purpose," unless judgment of guilt is entered.\22\ But even the clearest statement of state law is not controlling on the question of what constitutes a "conviction" pursuant to the federal CSA. The question therefore remains whether Respondent's plea of guilty, which was ultimately dismissed, constitutes a "conviction" on the facts of this case.
\20\ I note that 21 U.S.C. 824(a)(2) (factor considering whether registrant "has been convicted of a felony under the Controlled Substances Act or any other federal or state law relating to any controlled substance") was not cited in either the OSC or otherwise noticed prior to hearing, and therefore is not applicable to this Recommended Decision. See CBS Wholesale Distribs., 74 FR 36,746, 36,749 (DEA 2009).
\21\ Cal. Penal Code 1000.1.
Federal case law has established that "[a] conviction alone is sufficient to allow the Attorney General (through the DEA Administrator) to revoke or suspend a DEA registration." Pearce v. DEA, 867 F.2d 253, 255 (6th Cir. 1988) (citing Fitzhugh v. DEA, 813 F.2d 1248, 1253 (DC Cir. 1987)). Agency precedent takes an expansive view of what constitutes a "conviction." "The law is well settled that a DEA registrant may be found to have been 'convicted' within the meaning of the Controlled Substances Act, despite a deferred adjudication of guilt." Harlan J. Borcherding, D.O., 60 FR 28796-01, 28798 (DEA 1995) (citing Mukand Lal Arora, M.D., 60 FR 4447, 4448 (DEA 1995) (fine, two years of probation and deferred adjudication deemed sufficient), Clinton D. Nutt, D.O., 55 FR 30,992, 30,992 (DEA 1990) (nolo contendere plea and deferred adjudication of guilt deemed sufficient) and Eric A. Baum, M.D., 53 FR 47,272, 47,272 (DEA 1988) ("best interest" plea, probation, drug counseling and withholding of adjudication deemed sufficient)).
10 M.J. 138, 139 (U.S. Ct. Mil. App. 1981) (cited, but not quoted, in Eric A. Baum, M.D., 53 FR 47,272 (DEA 1988)). Accordingly, a registrant whose criminal adjudication has been deferred is nevertheless considered to have been "convicted" under DEA precedent.
In this case, the fact that a finding of guilt was specifically not entered as to Respondent and the charges dismissed, leaves open the question as to whether the foregoing Agency precedent is controlling on the issue of whether Respondent's plea constitutes a conviction under 21 U.S.C. 823(f).\23\ It is unnecessary to reach that issue, however, because the underlying offense to which Respondent pled guilty does not "relate[ ] to the manufacture, distribution, or dispensing of controlled substances," the standard embraced in Sec. 823(f). See Super-Rite Drugs, 56 FR 46,014, 46,015 (DEA 1991) ("Although [applicant] entered a guilty plea to a drug-related felony, his actions did not relate to the manufacture, distribution, or dispensing of controlled substances.").
\23\ Agency precedent as embodied in Baum and other cases, carried to its logical conclusion, could arguably deem a plea that was later withdrawn, and a defendant found not guilty after trial, to be a conviction, on the claim preclusion grounds discussed in United States v. Cook, 10 M.J. 138, 139 (U.S. Ct. Mil. App. 1981), a case cited favorably in Baum. Cf. Baum, 53 FR at 47,274.
Accordingly, I find that Respondent has not been convicted of any laws relating to the manufacture, distribution or dispensing of controlled substances. I therefore find that Factor Three under Section 823(f), while not dispositive, does weigh in favor of a finding that Respondent's registration would be consistent with the public interest.
The central issue in this case centers on Respondent's addiction to prescription pain medications, which began in or about 2006 while under medical care for chronic migraine headaches. (See Tr. 45-46.) Respondent's use of prescription pain medications eventually culminated in a course of conduct between June 2006 to December 2006, where she forged approximately nine prescriptions for Schedule II controlled substances for herself using a stolen prescription pad (see, e.g., Tr. 24-26, 46), and wrongfully used and possessed Schedule II controlled substances (e.g., Gov't Ex. 13 at 6). Other than the time period from June to December 2006, with a single exception noted below, there is no evidence that Respondent has failed to comply with all applicable laws and regulations relating to controlled substances during her professional career.
To comport with due process requirements, the DEA must "provide a Respondent with notice of those acts which the Agency intends to rely on in seeking the revocation of [her] registration so as to provide a full and fair opportunity to challenge the factual and legal basis for the Agency's action." CBS Wholesale Distribs., 74 FR 36,746, 36,749 (DEA 2009) (citing NLRB v. I.W.G., Inc., 144 F.3d 685, 688-89 (10th Cir. 1998) and Pergament United Sales, Inc., v. NLRB, 920 F.2d 130, 134 (2d Cir. 1990)). An issue cannot be the basis for a sanction when the Government has failed to "disclose 'in its prehearing statements or indicate at any time prior to the hearing' that an issue will be litigated." Id. at 36,750 (citing Darrell Risner, D.M.D., 61 FR 728, 730 (DEA 1996)). The DEA has also previously found, however, that a respondent may waive objection to the admission of evidence not noticed by the Government prior to the hearing when the respondent does not timely object and when the respondent also raises the issue. Gregory D. Owens, D.D.S., 74 FR 36,751, 36,755 (DEA 2009).
[w]hen patients were admitted to the unit, respondent, using a preprogrammed computer check sheet, admitted the patients by checking the appropriate admission box that appeared on the computer screen. By checking the box, the computer program automatically issued a standard set of admission orders. In some instances, the set orders included an order for the patient to receive [o]xycodone.
(Resp't Ex. 1 at 4.) The circumstances of this single incident and Respondent's early termination from the Nursing Diversion Program after approximately twenty-two fully successful months does not weigh against Respondent's application for DEA registration. I also note that as with all other aspects of Respondent's testimony, Respondent was fully credible and candid in her explanation of this incident.
The Government maintains that Factors Four and Five are relevant to the public interest inquiry, relying in part on the undisputed evidence of Respondent's history of self-abuse of controlled substances, and citing Gary E. Stanford, M.D., 58 FR 14,430 (DEA 1993) and William L. Pigg, M.D., 55 FR 3120 (DEA 1990), cases finding a registrant's abuse of controlled substances and alcohol relevant to the public interest inquiry.
and if his rehabilitation efforts have continued successfully, investigation of that application should be expedited, and favorable consideration should be given to the application." Id. In Pigg, a case in which the respondent waived hearing and the Agency issued a final decision on grounds of lack of state authority, as well as drug abuse, the facts relating to substance abuse included abuse of cocaine and alcohol over at least a two-year period, along with a subsequent abuse of alcohol and controlled substances following entry to an Impaired Physicians Program. Pigg, 55 FR at 3120.
Other cases reflect long-held "precedent that a practitioner's self-abuse of controlled substances constitutes 'conduct which may threaten public health and safety.'" Steven B. Brown, M.D., 75 FR 65,660, 65,662 (DEA2010) (citing Tony T. Bui, M.D., 75 FR 49,979, 49,990 (DEA 2010); Kenneth Wayne Green, Jr., M.D., 59 FR 51,453 (DEA 1994); David E. Trawick, D.D.S, 53 FR 5326 (DEA 1988). In Brown, the evidence of self-abuse spanned approximately a two year period during which the registrant prescribed 160-180 tablets of oxycodone 30 mg monthly to a patient in exchange for return of half of the controlled substances. Brown, 75 FR at 65,661. Additional evidence included a finding that the registrant was a drug abuser and a threat to public health and safety, when he offered the patient "a hit of liquid oxycodone." Id. at 65,662.
\24\ Compare Tr. 46, with Tr. 27, and Gov't Ex. 2 at 9, 14, 16, 18, 20, 22, 24, 26, & 28 (forged prescriptions ranging between August 9, 2006, and December 6, 2006).
\25\ This evidence is somewhat consistent with testimony of DI Bartolomeo with regard to Respondent's confession on December 18, 2006, although DI Bartolomeo did not reference Respondent's initial denial. (See, e.g., Tr. 29.) For instance, the record was unclear whether Respondent made two separate admissions on December 18, 2006. Notwithstanding the ambiguity and intial denial, I find that Respondent's admission of misconduct and cooperation with law enforcement authorities was timely and is to her credit.
To summarize, Respondent's admitted misconduct and substance abuse between June and December 2006, if viewed standing alone, does weigh against a finding that Respondent's unconditional registration would be consistent with the public interest under Factors Four and Five.
After balancing the foregoing public interest factors, I find the Government has established by substantial evidence a prima facie case in support of denial of Respondent's application for registration, based on Respondent's unlawful possession, use and fraudulent acquisition of controlled substances between June and December 2006. Once DEA has made its prima facie case for revocation, the burden then shifts to the respondent to show that, given the totality of the facts and circumstances in the record, denial of the application would not be appropriate. See Morall v. DEA, 412 F.3d 165, 174 (DC Cir. 2005); Humphreys v. DEA, 96 F.3d 658, 661 (3d Cir. 1996); Shatz v. United States Dep't of Justice, 873 F.2d 1089, 1091 (8th Cir. 1989); Thomas E. Johnston, 45 FR 72, 311 (DEA 1980).
Additionally, where a registrant has committed acts inconsistent with the public interest, the registrant must accept responsibility for his or her actions and demonstrate that he or she will not engage in future misconduct. Patrick W. Stodola, M.D., 74 FR 20,727 (DEA 2009). Also, "[c]onsideration of the deterrent effect of a potential sanction is supported by the CSA's purpose of protecting the public interest." Joseph Gaudio, M.D., 74 FR 10,083, 10,094 (DEA 2009).
confronted with allegations of misconduct (Gov't Ex. 13 at 6), behavior which weighs in Respondent's favor. See Karen A. Kruger, M.D., 69 FR 7016, 7017-18 (DEA 2004) (timely cooperation with investigators when questioned on past misconduct held a significant consideration in granting subsequent application for registration).
\27\ Gov't Br. at 6.
Respondent's abstinence from drug abuse since 2006, and her efforts at rehabilitation have been consistent, substantial, and successful. The uncontroverted evidence of rehabilitation shows that Respondent: successfully completed a seven-week outpatient alcohol and drug treatment program (Gov't Ex. 6); successfully completed a one-year dependency aftercare program (Gov't Ex. 7); successfully participated in a Nursing Diversion Program for twenty-two months (Resp't Ex. 1 at 4); regularly attended AA and NA meetings (Resp't Ex. 7 at 5-6; Resp't Ex. 8 at 2); regularly attended nurse-to-nurse meetings (Resp't Ex. 1 at 4); and has had sustained sobriety since December 2006, as evidenced by repeated negative random drug tests (see Resp't Ex. 1 at 4), inter alia. Credible and unrebutted testimony even reveals that Respondent went as far as avoiding medically indicated pain medication in 2010, just to avoid any potential for relapse. (Tr. 79.) In addition to the foregoing, the record is replete with credible evidence from family, friends, colleagues, students, treating sources and mentors, all consistently attesting to Respondent's sustained recovery and abstinence from prescription drug abuse. In light of the significant evidence of rehabilitation and ongoing monitoring by the California BRN, I find Respondent has sustained her burden in accepting responsibility and demonstrated that she has taken the necessary steps to avoid a repeat of her mistakes. Granting Respondent's application for a COR, subject to conditions, is fully consistent with the public interest.
Accordingly, I recommend that Respondent's application for DEA COR be granted, subject to the following conditions: (1) Respondent shall comply with all of the terms and conditions specified in the December 28, 2010 Order of the California BRN (see Gov't Br. at Gov't Ex. 17); and (2) for one (1) year following the issuance of a final order in this proceeding, Respondent shall upon request, submit to the nearest Field Division Office of DEA, copies of the results of any random or directed drug screening tests involving Respondent.

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