Opinion ID: 186461
Heading Depth: 2
Heading Rank: 2

Heading: DEA's Decision To Revoke Dr. Morall's Registration

Text: 71 The Deputy Administrator's decision to order the harshest of possible sanctions—revocation—turned primarily on her determination that the record revealed evidence of other conduct which may threaten the public health and safety. 21 U.S.C. § 823(f)(5). She determined that if Dr. Morall's only failures involved record-keeping, the Deputy Administrator might find it appropriate to impose a lesser sanction than revocation of [Dr. Morall's] DEA registration. 69 Fed.Reg. at 59,960. The extenuating circumstances to which the Deputy Administrator alluded included Dr. Morall's physical health problems involving her pituitary gland (which led her to believe that she might have to undergo brain surgery), her son's seizure and ultimate diagnosis of a disease related to sickle cell anemia, the deaths of several of her friends (including one by suicide), and her own serious depression during the relevant time period. See id. 72 The Deputy Administrator's overarching finding under factor five was that Dr. Morall is a liar. While Dr. Morall had testified that she never meant to mislead the investigators and denied making false statements, id., the Deputy Administrator found that Dr. Morall has no credibility, because it is absolutely clear that she lied to the investigators on numerous occasions, id. The Deputy Administrator found that these lies obliterate Dr. Morall's credibility, reflect a failure to cooperate with investigators, and justify terminating the physician's capacity to prescribe and dispense controlled substances. Id. 73 There is no doubt that Dr. Morall was not as forthcoming as she might have been. This is very different, however, from characterizing Dr. Morall as a willful liar, a conclusion that simply does not emanate from the record before us. That said, it is not our job to evaluate Dr. Morall's credibility. Rather, our job is to determine whether the conclusions drawn by the Deputy Administrator follow from a fair and reasonable review of the relevant evidence. 74 Our lodestar is the question whether the record as a whole provides substantial evidence to support the agency action. We conclude that it does not, because the decision of the Deputy Administrator gives no indication whatsoever that the decision maker considered any of Dr. Morall's testimony bearing directly on each of the purported lies. To be clear, DEA's decision does not withstand review because the agency decisionmaker entirely ignored relevant evidence. See El Rio Santa Cruz Neighborhood Health Ctr., 396 F.3d at 1278 (finding agency action arbitrary and capricious in failing to address relevant evidence before it); Robinson, 28 F.3d at 216 (agency may not ignore testimony bearing on critical fact in case); Lakeland Bus Lines, 347 F.3d at 962 (court cannot find substantial evidence solely on the basis of evidence that supports the result, without considering contradictory evidence). The Deputy Administrator concluded that 75 [Dr. Morall] lied about possessing controlled substances at her house. She lied about having a safe in her house in which to store controlled substances. She lied about treating patients from her home. She lied about the true identity of a friend for whom she had written prescriptions for controlled substances. She misled the investigators about the existence of patient records. She continually maintained that she had controlled substance records at her office, when in truth she did not. She later admitted that she had tried to create the records from memory.... 76 ... [She] also made false statements regarding the transfer of drugs. 77 69 Fed.Reg. at 59,960. 78 As indicated above, Dr. Morall presented extensive testimony pertaining to each of these disputed facts, though one would not know it from the Deputy Administrator's analysis. We will consider here just a few examples of the testimony that the Deputy Administrator ignored. It is particularly troubling that the Deputy Administrator does not appear to have considered testimony by Dr. Morall that the ALJ credited. The ALJ expressly credited Dr. Morall's testimony that she told Ms. Garcia that she was taking care of patients from her home, but did not say that she saw them there. See ALJ Decision at 18. The Deputy Administrator gave no indication that she considered Dr. Morall's testimony, nor any reason for rejecting the ALJ's decision to credit Dr. Morall's account, when she made the conclusory finding that Dr. Morall lied about treating patients from her home. 79 The ALJ also credited Dr. Morall's account that she did not order the drugs that were returned using her DEA registration number and did not know they were returned under her number. ALJ Decision at 18. Dr. Morall had testified at length that at the time that the recalled drugs could have been ordered— i.e., when they were still on the market—she was an employee of Dr. Holland's, and that her understanding was that Dr. Holland's assistant ordered drugs for the clinic. See Tr. at 296, 334. She maintained that she had not heard anything about the returned drugs at issue until the day of the hearing. Id. The Deputy Administrator ignored both Dr. Morall's testimony and the ALJ's decision to credit it in finding that Dr. Morall made false statements regarding the transfer of drugs. 80 The Deputy Administrator also ignored the ALJ's conclusion that Dr. Morall appeared to regret her past conduct and ... is unlikely to repeat it, a finding that clearly implicates credibility. See ALJ Decision at 20. 81 Although DEA is the ultimate fact finder, the agency's decision is vulnerable when it does not take the ALJ's findings into consideration. The reviewing court must take the ALJ's findings into account as part of the record[;] ... the significance to be ascribed to them `depends largely on the importance of credibility in the particular case.' Reckitt & Colman, Ltd. v. Adm'r, DEA, 788 F.2d 22, 26-27 (D.C.Cir. 1986) (quoting Universal Camera Corp., 340 U.S. at 496-97, 71 S.Ct. 456). Obviously, credibility is central to the Deputy Administrator's analysis here. DEA provides no reason for ignoring the ALJ's decision to credit critical portions of Dr. Morall's testimony or the ALJ's conclusion that Dr. Morall regretted her actions and was unlikely to repeat them. Indeed, it does not so much as acknowledge evidence that the ALJ found determinative. The Deputy Administrator's failure to consider findings of the ALJ, which get at the heart of Dr. Morall's credibility, fortifies our conclusion that DEA's decision does not survive substantial evidence review. See E. Tenn. Natural Gas Co. v. FERC, 953 F.2d 675, 681 (D.C.Cir.1992) (per curiam) (Because the ALJ relied on substantial evidence in the record, coupled with a well-reasoned and highly sensible analysis, in reaching [its] conclusion ..., we can find no basis upon which to accept the [agency's] unsupported and ill-reasoned conclusion to the contrary.). 82 The DEA's decision is disturbing for another reason. Although the Deputy Administrator [did] not necessarily find that [the unaccounted-for] controlled substances were diverted, she [n]evertheless concluded that the lack of proper documentation to account for the shortage of large quantities of drugs; [Dr. Morall's] admission to the use of phentermine; her demonstrated lack of candor; empty drug vials around her home of which she was unable to account for their origins or disposition, all suggest possible drug use on [Dr. Morall's] part, or by someone close to her. 69 Fed.Reg. at 59,960. In other words, while the Deputy Administrator acknowledged that the record does not support a finding of diversion, she insinuated that Dr. Morall or someone close to her was abusing drugs. 83 In light of the record evidence presented in this case, the DEA's suggestion of possible drug use by Dr. Morall is both irresponsible and appalling. The suggestion is dangerously arbitrary and entirely unsupported. And it unnecessarily damns Dr. Morall, who was viewed by her colleagues to be an exceptionally competent and compassionate psychiatrist, Aff. of Holly Greenfield, M.D. at 2-3, and someone with very high ethical standards. Tr. at 251 (testimony of Dr. Teich). 84 The record contains absolutely no evidence that Dr. Morall, her family, or anybody else abused drugs. Indeed, the ALJ found that § 823(f)(5) weighed in Dr. Morall's favor, because [t]he record does not establish that [Dr. Morall] has engaged in any other conduct that may threaten the public health or safety, ALJ Decision at 19, and concluded that the record does not establish that [Dr. Morall] diverted any controlled substances, id. at 20. Dr. Morall testified that she did not abuse or divert controlled substances, and testimony by Dr. Teich and Dr. Greenfield corroborated her position. See Tr. at 292, 422-23 (testimony of Dr. Morall); Tr. at 252-53 (testimony of Dr. Teich); Aff. of Holly Greenfield, M.D. at 3. Even Investigator Barnhill—the Government's sole witness—conceded that she was aware of no reports of diversion or abuse and no evidence that Dr. Morall ever abused drugs or prescribed them for an illegitimate purpose. Tr. at 79, 159, 198-99, 223. The Deputy Administrator failed to consider any of this evidence before making the unsupported and profoundly stigmatizing insinuation that Dr. Morall abused drugs or diverted them to someone close to her. 85 No one doubts that Dr. Morall kept poor records and that her work and living environs were a mess during an unusually stressful time in her life. It is not at all clear, however, that the unaccounted-for dosage units constitute anything other than a manifestation of the poor record keeping, i.e., the failure to document when patients were provided with what dosages. Indeed, the record contains evidence—evidence entirely omitted in the Deputy Administrator's decision—that the missing dosages could have been accounted for if Dr. Morall's patients had been contacted, and Investigator Barnhill admitted that the investigators spoke with only one patient, who did not deny that he was a patient of Dr. Morall's who received medication from her. See Tr. at 181-82, 207-08. Dr. Morall's admitted use of phentermine, meanwhile, related to a prescribed amount of the medication that she tried as a possible treatment for weight gain related to a serious medical condition. See Tr. at 343. 86 In short, the profoundly stigmatizing suggestion that Dr. Morall or a member of her family abused drugs simply is not sustainable on the record before us. See Humphreys, 96 F.3d at 665-66 (The Deputy Administrator's inferences of a threat of public harm are overly broad and only weakly, if at all, supported by the present record. Indeed, the Deputy Administrator admitted that no such diversion in fact occurred. The conclusion that substantial risk for diversion existed ..., under these circumstances, is so unlikely as to be unsustainable.). What is particularly troubling here is that DEA's suggestion of possible drug abuse by Dr. Morall is offered for no apparent reason other than to disparage Dr. Morall. The conclusion of DEA's decision makes it clear that the agency's action against Dr. Morall rests solely on her record-keeping failures and her alleged lying to investigators, and the decision to impose the harshest of possible sanctions rests on the alleged lies alone. The decision does not purport to rest on diversion of controlled substances or drug abuse. Therefore, the Deputy Administrator's passing comment on possible drug abuse is gratuitous and condemnable. 87 In light of the foregoing, we hold that DEA's decision to revoke Dr. Morall's registration cannot withstand substantial evidence review. The agency's decision fails to consider relevant contradictory evidence, including evidence that led the ALJ to contrary findings of fact and credibility. And it inappropriately insinuates that Dr. Morall or someone in her family may have abused drugs when there is not a shred of evidence to support this suggestion. In sum, DEA's decision is arbitrary and capricious and therefore cannot stand.