Opinion ID: 186461
Heading Depth: 3
Heading Rank: 3

Heading: DEA's Investigation of Dr. Morall

Text: 15 On December 1, 1998, Investigator Lisa Barnhill and Task Force Officer John Gray went to Dr. Morall's residence. Investigator Barnhill testified that Dr. Morall initially denied having any controlled substances at her home and only acknowledged their existence when specifically asked about the recent shipment. When Dr. Morall retrieved the controlled substances, they were in a box on the floor of a closet. The box, which also contained open bottles, loose pills, and trash, did not comport with DEA requirements that drugs be stored in a locked and substantially constructed cabinet. 16 Dr. Morall did not recall initially denying the existence of controlled substances in her home and noted that there was no reason for her to deny it as she had called DEA to change her registration address in order to have them there. 17 Also during the December 1 inspection, the investigators requested that Dr. Morall provide them with records of her handling of controlled substances. According to Investigator Barnhill, Dr. Morall told her that she was in the process of moving her practice from the Steele Street location and that her records were still at that location, but agreed to provide them the next day. On December 3, Dr. Morall left a voice mail message for Investigator Barnhill saying the records were in the mail. On December 4, she left a second message saying she wanted to speak with an attorney before sending them. Dr. Morall testified to changing her mind on the way to the post office, because she was not sure whether providing the records could violate any privacy obligations she owed her patients. 18 On December 21, 1998, Dr. Morall sent some copies of records to Investigator Barnhill. They appeared to have been reconstructed rather than contemporaneous; they were incomplete and inaccurate and they did not conform to Investigator Barnhill's specifications in a number of ways. Dr. Morall testified that the documents she sent to Investigator Barnhill on December 21 were an attempt to reconstruct records from memory and some contemporaneous notes. She asserted that she knew the records were incomplete and that the documents were not contemporaneous with her dispensing of the drugs, and that she had not intended to represent otherwise. 19 According to Investigator Barnhill, the investigators requested the originals of the reconstructed documents but received no response from Dr. Morall. On January 5, 1999, having obtained an administrative subpoena to inspect Dr. Morall's home, Investigator Barnhill and others executed the warrant. They found Dr. Morall's records intermingled with personal papers, financial data, and other such documents, as well as a notepad on which Dr. Morall had apparently tried to reconcile the quantities of drugs given to patients. 20 Investigators also found a vial of phentermine belonging to a patient named Carl Ousley that identified Dr. Morall as the prescribing physician. According to Investigator Barnhill, when Dr. Morall was asked the identity of Mr. Ousley, she answered that he was her uncle, while Dr. Morall's husband said that Ousley was a friend. Dr. Morall testified that she had referred to Ousley as Uncle Carl, because that is what her family called him as he had been like a family member for 20 years joining the family on trips and family reunions. Tr. at 374. 21 Investigators also found an empty manufacturer's 100-count bottle of phentermine, as well as other empty prescription vials in different locations in Dr. Morall's home. Dr. Morall told the investigators that she had dispensed the medications to her patients, but she was unable to provide the documentation to support this assertion. Investigators also found the empty bottles of Meridia and three open bottles of phentermine that Dr. Morall showed them during the December 1 visit; they were in a file cabinet in the closet, which had a lock, but the key was in the key hole. Investigators counted 542 tablets of phetermine 15 mg on January 5, compared to an earlier count of 735 tablets on December 1. 22 According to Investigator Barnhill, Dr. Morall informed her that she had not dispensed from her home since the investigators' December 1 visit. Dr. Morall, however, testified that she had actually told Investigator Barnhill that she had not dispensed from the Steele Street address since that time. Indeed, the records that Dr. Morall supplied to Investigator Barnhill on December 21 had indicated that she provided phentermine to patients after December 1. It is undisputed that, as of the January 5 inspection, Dr. Morall had not informed Investigator Barnhill that she had been evicted from the Steele Street location. Dr. Morall testified that she was embarrassed by the situation and didn't want to say that if [she] didn't have to, because she thought she would be able to work something out to get back in. Tr. at 363. 23 In the course of the January 5 inspection, investigators asked Dr. Morall if she had ever taken phentermine herself. She testified that when she began working at the Holland clinic, Dr. Holland had written her a prescription and suggested that she try it. She never used the prescription and did not try the medication until she gained weight related to her illness. At that point, she received a prescription from a physician who was a friend and tried the medication, but [i]t didn't work.... [She] had too many complicated problems going on at the time . . . . Tr. at 343. She asserted that she never tried it for any reason other than to address [her] symptom of weight gain, id., and she did not take phentermine from the bottles and vials found in her home. 24 In the course of their investigation of Dr. Morall, the investigators also learned of a theft at the Holland clinic, in July 1997, which had not been properly reported to DEA. Investigator Barnhill initially asserted that the drugs in the Holland clinic had been ordered under Dr. Morall's DEA registration number and that Dr. Morall was therefore responsible for reporting the theft. Investigator Barnhill conceded on cross-examination, however, that she had no evidence that Dr. Morall ordered the medications that were stolen and that she had no evidence that Dr. Morall ordered controlled substances prior to November 25, 1997, which was after the Holland clinic had closed. Investigator Barnhill admitted that she just assume[d] that Dr. Morall had ordered the drugs, because she had been registered at that location, though she did not know whether Dr. Holland was also registered there. Tr. at 191. Moreover, it is undisputed that Dr. Morall reported the theft to the police. 25 Dr. Morall maintained that she did not order medications for the Holland clinic and that Dr. Holland's assistant in Phoenix ordered medications for both his Denver and Phoenix clinics. She also testified that when she learned of the theft, she called Dr. Holland and the medical board and that someone at the board gave her a toll-free number to call DEA, which she did. 26 Investigator Barnhill also suggested that Dr. Morall was responsible for failing to document a return of controlled substances. She asserted that the investigators learned of an instance in which Dr. Morall did not document a return, in May 1998, of drugs that had been recalled. Dr. Morall maintained that Dr. Holland had ordered the particular drugs, which were no longer available as of November 1997, and that she had not heard that they had been returned under her registration number until the day of the hearing. She noted that when she moved from Suite 200 to Suite 202 in the Steele Street building, the remaining medications in the Holland clinic were locked in a room inside Suite 200, which she could not access. 27 As to Suite 202, Investigator Barnhill testified that Dr. Morall agreed to allow investigators to inspect that location, but that, despite numerous calls and conversations, they were not able to arrange a specific date. Dr. Morall acknowledged that investigators called her to arrange a visit to the Steele Street location, and explained that she discussed the calls with her attorney at the time, who instructed her that all contacts should be through him. Investigator Barnhill admitted that Dr. Morall's attorney had contacted her to inform her that he was representing Dr. Morall, but stated that she did not try to contact him because [h]e made no statements that he did not want [investigators] to talk to [Dr. Morall] directly. Tr. at 217. 28 Investigator Barnhill admitted that she was told, in writing, by Dr. Morall, to contact her attorney prior to contacting any of her patients, but Investigator Barnhill conceded that she did not do so when she attempted to call a few patients in the course of her investigation. 29 Investigators ultimately obtained a search warrant for Suite 202 of the Steele Street building and executed that warrant on May 6, 1999. Investigator Barnhill testified that the premises were in disarray. There were records that were not current and did not meet DEA requirements. The investigators also found a wheeled plastic cart with no locking device that contained controlled substances. 30 Dr. Morall explained that she had kept controlled substances in a locked filing cabinet in Suite 202 and, each day, placed medications that she intended to provide to patients that day on the plastic cart. She further asserted that the day she was evicted from the Steele Street office, she was in the process of moving her possessions out of the office when the building manager saw her and locked her out. Consequently, she had no opportunity to secure the medications that she had previously placed on the cart. 31 One item seized from Suite 202 was a price list of certain controlled substances for weight loss. Based solely on this price list, Investigator Barnhill testified that it looked to [her] like [Dr. Morall] was just pretty much pushing drugs. Tr. at 111. On cross-examination, however, Investigator Barnhill admitted that the name of the clinic at the top of the price list was actually Dr. Holland's clinic, not Total Health Care Systems, the name that Dr. Morall gave her own practice in Suite 202. She also admitted that she did not know of any patient who was ever given the price list, at least by Dr. Morall. 32 DEA performed a number of accountability audits of Dr. Morall, which reflected various shortages and/or overages of the drugs. One particular audit covering the time period from November 25, 1997 to January 5, 1999 and incorporating the records seized at the Steele Street location revealed shortages of thousands of dosage units of controlled substances. Dr. Morall maintained that she had dispensed the drugs to her patients, but she lacked the documentation to support this assertion. 33 Investigator Barnhill admitted on cross-examination, however, that, if Dr. Morall was correct in her testimony that she was treating seventeen patients during that time and prescribing a regiment of about two pills per day, the number of unaccounted-for medications could easily be accounted for by such legitimate dispensing. Investigator Barnhill also admitted that she did not attempt to check if Dr. Morall's patients had received the medications. She and her partner tried to contact just very few of the patients and only actually spoke to one patient, who did not deny that he and his wife were both patients of Dr. Morall or that they had received medication from her. Tr. at 181-82. 34 Following completion of the investigation of Dr. Morall, Investigator Barnhill provided a copy of her report to the Colorado Board of Medical Examiners (Medical Board). It is undisputed that the Medical Board elected to take no action against Dr. Morall. 35 At the hearing before the ALJ, Dr. Morall fully acknowledged that her record keeping was abysmal after the closure of the Holland clinic. Tr. at 330-31. In light of the stressful events transpiring in her life at the time—her father's death, her son's illness, her own health problems, including depression, and the deaths of several close friends—Dr. Morall described her personal state during the relevant time period: I would spend hours sitting in my office, and I wasn't doing anything, I was just sitting, and I took notes always with the intention of transferring information to the charts, but I never did. I had boxes from my office in between the living room and the dining room that I needed to sort through. I couldn't do it. I really was not able to do much of anything, and it wasn't like me. Tr. at 347-48. 36 Stephen Teich, M.D. testified at the hearing that he is a psychiatrist who has known Dr. Morall since the late 1980s and that he considered himself her friend as well as her colleague. He amplified the consuming events in Dr. Morall's life during the time period in question. Dr. Teich also asserted that he considered Dr. Morall an excellent psychiatrist who handled medications at least as well as most everybody I've seen, if not better. Tr. at 260. Dr. Teich thought it would be a great limitation on her ability to work and a loss to the patient population she deals with if she were not able to prescribe.... Id. When asked about Dr. Morall's risk to abuse or divert controlled substances, he underscored that he could not imagine such a possibility. Indeed, there is absolutely no evidence in the record of substance abuse by Dr. Morall or her family. Investigator Barnhill explicitly admitted on cross-examination that she had received no reports of diversion or abuse pertaining to Dr. Morall, there was no evidence that Dr. Morall ever abused phentermine, and there was no indication that any patient of Dr. Morall ever received phentermine for other than a legitimate medical purpose. 37 According to Dr. Morall, as of the date of her hearing, she had been working as a staff psychiatrist for the Jefferson Center, a mental health center providing care for low-income and indigent clients, for two and a half years. She also submitted into evidence an affidavit by Holly Greenfield, M.D., a psychiatrist and, between 1995 and 2001, Medical Director of the Jefferson Center. Dr. Greenfield stated that she had hired Dr. Morall at the Jefferson Center and served as her immediate supervisor. According to Dr. Greenfield, Dr. Morall was an exceptionally competent and compassionate psychiatrist and a tremendous asset to the [Jefferson] Center. Aff. of Holly Greenfield, M.D. at 2-3, reprinted in App. tab H. Dr. Greenfield also stated that she never had any reason to suspect that Dr. Morall in any way abused or diverted any controlled substance, and she found no problems with her documentation of [their] use. Id. at 3. According to Dr. Greenfield, Dr. Morall was too good of a psychiatrist and too much of an asset to Jefferson Center and its patients to lose her registration. Id. at 4. 38 Dr. Morall stated unequivocally that she would take a course in record keeping for controlled substances in order to maintain her DEA registration; indeed, she [thought] it would be appropriate. Tr. at 453.