Algirdas J. Krisciunas, M.D.; Revocation of Registration, 4940-4944 [2011-1693]

Agencies

• Drug Enforcement Administration
• Department of Justice

[Federal Register Volume 76, Number 18 (Thursday, January 27, 2011)]
[Notices]
[Pages 4940-4944]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-1693]


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DEPARTMENT OF JUSTICE

Drug Enforcement Administration


Algirdas J. Krisciunas, M.D.; Revocation of Registration

    On January 19, 2010, I, the Deputy Administrator of the Drug 
Enforcement Administration, issued an Order to Show Cause and Immediate 
Suspension of Registration (Order) to Algirdas J. Krisciunas, M.D. 
(``Registrant''), of Lauderdale Lakes, Florida. The Order proposed the 
revocation of Registrant's DEA Certificate of Registration, BK4015334, 
and the denial of any applications for renewal or modification of his 
registration, on the ground that his ``continued registration is 
inconsistent with the public interest, as that term is defined in 21 
U.S.C. Sec.  823(f).'' Order, at 1. Based on the allegations presented, 
I also concluded that Registrant's continued registration during the 
pendency of this proceeding ``constitutes an imminent danger to the 
public health and safety'' and immediately suspended his registration. 
Id. at 2.
    The Order alleged that Registrant was the ``owner of Social Medical 
Center (SMC), a pain clinic located at [his] registered location'' and 
that he ``issue[d] many purported prescriptions for controlled 
substances'' from there. Id. at 1. The Order further alleged that 
Registrant ``prescribed and dispensed controlled substances, including 
oxycodone \1\ and alprazolam,\2\ to two undercover law enforcement 
officers on five different occasions from July 13 through September 10, 
2009, in violation of 21 U.S.C. Sec. Sec.  841(a)(1) and 846.'' Id. at 
2. The Order also alleged that Registrant and his staff ``falsified 
medical records for the two undercover officers'' and that Registrant 
``advised the undercover officers how to falsify medical records to 
make it appear that they had legitimate medical conditions warranting 
the use of controlled substances.'' Id. The Order next alleged that 
Registrant and his staff ``sold the medical records of others to an 
undercover officer so that the records could be altered to appear that 
they were the medical records of the undercover officer.'' Id.
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    \1\ Oxycodone is a schedule II controlled substance. 21 CFR 
1308.12(b)(1)(xiii).
    \2\ Alprazolam is a schedule IV controlled substance. 21 CFR 
1308.14(c)(1).
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    The Order further alleged that ``[b]ased on [his] consultations 
with, and examinations of, the two undercover officers,'' Registrant 
``knew, or should have known, that neither of the undercover officers 
had a legitimate medical condition warranting the prescribing of 
controlled substances'' because the ``undercover officers provided 
inconsistent statements regarding the nature of their alleged injuries 
and gave negative answers when queried about any pain they were 
experiencing.'' Id. The Order thus alleged that Registrant ``issu[ed] 
[controlled substance] prescriptions outside the usual course of 
professional practice or for other than a legitimate medical purpose,'' 
in violation of Federal law. Id. (citing 21 U.S.C. 823(f)(4); 21 CFR 
1306.04).
    Finally, the Order alleged that on July 1, 2009, Registrant's 
``office staff sold 53 oxycodone 30 mg pills to an undercover officer 
for $500, in violation of 21 U.S.C. Sec.  [] 841(a)(1),'' and that 
``[t]his transaction occurred at [his] office during regular business 
hours while [he was] on the premises.'' Id. The Order thus alleged that 
Registrant ``failed to exercise proper oversight of [his] office staff 
or take proper measures to ensure the safeguarding of controlled 
substances stored at [his] office.'' Id.
    Based on the above, I made the ``preliminary finding that 
[Registrant's] continued registration is inconsistent with the public 
health and safety.'' Id. (citing 21 U.S.C. 823(f), 824(a)(4)). Having 
concluded that Registrant's ``continued registration while these 
proceedings are pending constitutes an imminent danger to the public 
health and safety because [he has] repeatedly displayed a willingness 
to prescribe widely abused controlled substances for other than a 
legitimate medical purpose,'' I further ordered the immediate 
suspension of his registration. Id. (citing 21 U.S.C. 824(d); 21 CFR 
1301.36(e); 28 CFR 0.100). Id.
    On January 20, 2010, the Order, which also notified Registrant of 
his rights to either request a hearing or submit a written statement in 
lieu of a hearing, the procedures for doing either, and the 
consequences for failing to do either, was personally served on 
Registrant by a DEA Diversion Investigator. Since the date of service 
of

[[Page 4941]]

the Order, more than thirty days have passed and neither Registrant, 
nor anyone purporting to represent him, has requested a hearing on the 
allegations or submitted a written statement. 21 CFR 1301.43(a)-(c). I 
therefore find that Registrant has both waived his right to a hearing 
and to submit a written statement, and I issue this Decision and Final 
Order based on relevant evidence contained in the Investigative Record 
submitted by the Government.\3\ 21 CFR 1301.43(d)-(e). I make the 
following findings.
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    \3\ In its Request for Final Agency Action, the Government 
argues that revocation is warranted under the additional ground that 
Registrant ``has been convicted of a felony under subchapter 1 of 
chapter 13, Title 21, United States Code.'' Request for Final Agency 
Action, at 4. Thereafter, the Government submitted a First 
Supplement to Request for Final Agency Action which argued that 
revocation was also warranted because on August 20, 2010, the State 
of Florida issued an Order of Emergency Suspension, which 
immediately suspended Registrant's medical license and that he no 
longer has authority under State law to dispense controlled 
substances. First Supplement to Request for Final Agency Action, at 
1 (citing 21 U.S.C. 824(a)(3)). Attached to the filing was a copy of 
the State order.
     Finally, the Government submitted a Second Supplement to 
Request for Final Agency Action, which noted that on October 13, 
2010, the U.S. District Court for the Southern District of Florida 
entered a judgment, which adjudicated Registrant guilty of six 
felony counts under the Controlled Substances Act. Attached to the 
filing was a copy of the Judgment.
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Findings

    Registrant holds DEA Certificate of Registration, BK4015334, which 
authorizes him to dispense as a practitioner controlled substances in 
schedules II through V. Cert. of Reg. Hist. (March 18, 2010). 
Registrant is registered at the address of 3401 West Oakland Park 
Blvd., Lauderdale Lakes, Florida 33311; this address was the location 
of a pain clinic which was owned by his wife, Maria Bulich, and which 
did business under the name of ``Social Medical Center'' (SMC). Id.; 
Aff. of Task Force Officer (TFO) 1, at 1, 3.
    On July 1, 2009, a Broward County Sheriff's Office detective 
assigned to a DEA Task Force attempted an undercover buy at SMC. Using 
the name Bill Rix,\4\ the detective posed as a personal trainer who had 
recently moved to the area and who ``needed a supplier of pain medicine 
due to discomfort from an old auto accident.'' \5\ Aff. of TFO1, at 1.
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    \4\ Throughout this decision, each TFO's assumed name is used 
interchangeably with the titles of TFO 1 and TFO 2.
    \5\ The officer wore a wire during the visit to record it; the 
recording was later transcribed.
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    Immediately on entering SMC, Rix met both Registrant and his 
receptionist, M.L.A. Id. M.L.A told Rix that, to obtain controlled 
substances from Registrant, he would need an MRI report (to show ``the 
nature and location of chronic pain-causing injuries'') and a pharmacy 
drug profile (to ``show the drugs the patient has been receiving''). 
Registrant stated that this was because state regulations required that 
a chronic pain patient first undergo a thirty-day regimen with non-
controlled pain medications and that controlled substances could only 
be prescribed upon a determination that the non-controlled medications 
were not effective. Id. at 2; Tr. 3-4 (July 1, 2009). When Rix told 
Registrant and M.L.A. that his most recent MRI was from 2002, both 
Registrant and M.L.A. told Rix that he needed a newer MRI and referred 
him to a mobile MRI, which could probably perform the exam the same day 
and would charge $250. Tr. 6 (July 1, 2009). Registrant further 
explained that he needed to have documentation on file to adequately 
justify his prescribing of controlled substances in the event that DEA 
investigators inspected the clinic. Id. at 9.
    After Registrant exited the room, Rix asked M.L.A. and another 
female, M.R., whether he could just change the date on his old MRI. Id. 
at 11. In response, M.L.A. offered to sell Rix an MRI, on which he 
could change the name and date, as well as a pharmacy record. Id. at 
11-12. M.R. then asked Rix whether he currently had controlled 
substances or needed some, and offered to sell him oxycodone 30 mg 
pills for $10 per pill; Rix and M.R. agreed that he would buy 50 pills. 
Id. at 13-16. M.R. then counted out 53 oxycodone 30 mg pills, put them 
in a prescription bottle, and sold them to Rix for $500. Aff. of TFO 1, 
at 2. Rix confirmed with M.L.A. and M.R. that he would take the MRI and 
change the date, but then asked whether someone would be calling the 
radiologist to verify the study. Tr. 17 (July 1, 2009). M.L.A. assured 
him that there would be no problem with the verification, as she was 
the individual who verified MRIs. Id. She also stated that she would 
take care of the pharmacy report and that Rix just needed to alter the 
name and date on the MRI and bring it back. Id. at 21.
    Rix then stated, ``I'm glad you guys came back up here[.] I was 
like you got to be kidding me with what he was telling me, I'm like to 
go through all that [b.s.], are you kidding.'' Id. M.L.A. replied: ``I 
know I wish you would have talked to me first, but he was there.'' Id. 
Later, M.L.A. stated that ``[Registrant] knows, he knows. He'll write 
you whatever you want, but he has to cover his ass too.'' Id. at 22. 
She then added that Registrant would give Rix up to 240 oxycodone 
pills. Id.
    On July 13, 2009, Rix returned to SMC with the altered MRI and an 
altered pharmacy profile. Aff. of TFO 1, at 3. Rix handed the records 
to M.L.A. and then met with Registrant in the presence of his wife, 
Maria Bulich. Id. Registrant examined the records and inquired as to 
the type of accident that had caused Rix's pain. Id. Rix responded that 
he had been in a car accident. Id. With regard to the pharmacy profile, 
Registrant told Rix that he would have to reduce the amount of Xanax he 
was taking because it could cause memory loss. Id. Registrant then 
stated that he could not provide that much oxycodone in 80 mg doses; 
Rix replied that oxycodone 30 mg would suffice. Id.
    After that, M.L.A. gave Rix a form to complete, which included a 
diagram for specifying the location of his pain and blanks for noting 
his pain levels. Id. Rix did not complete either of these sections. Id. 
In the examining room, Registrant noticed the incomplete form and asked 
Rix to complete it. Id. Although Rix's MRI indicated that he had back 
pain, on the diagram Rix noted that he had neck pain. Id. Registrant 
noticed the discrepancy and changed the marking on the diagram, 
explaining that the medical record needed to match the MRI to satisfy 
any inspectors who might examine the records. Id.
    Registrant and Rix then discussed the number of oxycodone 30 mg 
pills Registrant would need to prescribe to provide the equivalent of 
the dosages noted in Rix's pharmacy profile. Id.; Tr. 31 (July 13, 
2009). While Rix's profile indicated that he had been taking two 80 mg 
pills a day (totaling 160 mg per day), Registrant offered to prescribe 
six tablets of oxycodone 30 mg per day (totaling 180 mg per day). Tr. 
31 (July 13, 2009). The conversation then turned to Xanax, with Rix 
stating that he was not ``especially interested'' in the drug. Aff. of 
TFO 1, at 3-4; Tr. 32-33 (July 13, 2009).
    Rix then asked Registrant what he should write on the forms so that 
his medical record would look legitimate to the inspectors. Aff. of TFO 
1, at 4. According to Rix, Registrant instructed him to write false 
information, such as that Rix could not lift more than twenty pounds 
even though he had told Registrant that he was a personal trainer who 
frequently lifted weights. Id.; Tr. 36 (July 13, 2009). As to a 
question regarding whether he exercised, Registrant told Rix that ``you 
don't want to compromise yourself'' and to ``just put down swimming and 
walking'' because ``any kind of catch word * * * they get hang [sic] up 
on.'' Tr. 37 (July 13, 2009).
    Registrant and Rix then went through the questions on the form 
together, and

[[Page 4942]]

Registrant conducted a brief physical examination of Rix. Id. at 35-45, 
48-49. Rix deliberately followed Registrant's instructions without 
complaining of any problems and said that he felt ``stiff'' but that he 
had no pain. Aff. of TFO 1, at 4. As to his pain rating, Registrant 
explained that ``nine is after you had an operation, right after.'' Tr. 
36 (July 13, 2009). After Rix responded, ``Okay so I don't have an 
operation,'' Registrant stated, ``I'd say about seven or eight maybe 
you know * * * Ah without the medicines.'' Id.
    Rix then read one of the form's questions to Registrant: ``Rate 
your pain by circling the number that best describes your pain at its 
worst at the last of the month'' and asked ``is that where I put seven 
or eight?'' Id. at 38. Registrant stated, ``actually no.'' Id. He then 
explained, ``you were helped with medication so.'' Id. Proceeding to 
the next question, which asked about his pain level ``on average,'' Rix 
asked whether that should be ``four.'' Id. Registrant answered, ``Yeah 
five or something like that.'' Id.
    When Registrant asked whether he had pain radiating down his legs, 
Rix replied ``no.'' Id. at 40. Registrant then told Rix that ``I would 
not want to put down good or poor, just fair.'' Id. Next, Registrant 
had Rix bend at his waist and said, ``Okay this is the important thing, 
are you on medicines now?''; Rix answered in the affirmative. Id. at 
43. Registrant then stated: ``Because today you are in no pain bending 
forward because you are on medicines.'' Id.
    When Registrant had Rix bend to one side, he stated that he did not 
have any pain but was ``[j]ust tight.'' Id. at 44. Registrant had Rix 
place his arms on his hips and then turn, at which point Rix again 
reported having ``[t]ightness.'' Id. Registrant then coached Rix: ``No 
use the correct word, pain,'' and explained that tightness ``does not 
qualify pain medicine.'' Id. Rix then reported pain, and Registrant 
commented, ``Don't confuse the inspectors with anything.'' Id.
    Registrant and Rix then discussed the latter's occupation as a 
personal trainer. When Rix asked ``Can we scratch that out[?],'' 
Registrant replied, ``No that's fine * * * but ah you must say that you 
don't do anything, any heavy lifting.'' Id. at 45. Rix then said ``I 
just instruct,'' and Registrant replied, ``Yeah you instruct.'' Id.
    As the appointment neared its end, Rix asked Registrant whether he 
had a referral program and suggested that he could refer people to him. 
Id. at 53. Registrant said ``sure,'' but that ``they have to qualify of 
course.'' Id.
    At the conclusion of the visit, Registrant issued Rix three 
prescriptions: One for 180 oxycodone 30 mg, One for 90 oxycodone 15 mg, 
and one for 30 alprazolam (Xanax) 2 mg. Aff. of TFO 1, at 4. Registrant 
then gave the prescriptions to his wife, who filled them and collected 
$740 from Rix for both the examination and the medication. Id. Ms. 
Bulich indicated that she would pay Rix $20 for each new patient he 
referred. Id.; Tr. 61 (July 13, 2009). In his affidavit, the TFO 
summarized his visit stating that ``[t]he entire process was one in 
which [Registrant] coached or led me into giving answers that would 
qualify me to receive pain medication, not as an examination oriented 
toward determining my medical condition and needs.'' Aff. of TFO 1, at 
4.
    On July 30, 2009, another TFO visited Registrant using the name of 
Keith E. Anderson. Aff. of TFO 2, at 1. On entering the clinic, 
Anderson met M.L.A. and told her that ``Bill'' had referred him. Aff. 
of TFO 2, at 1-2. Anderson brought with him an MRI report and a 
pharmacy profile which were copies of the ones that Rix had received 
from M.L.A. on July 1, 2009, but which were altered to state that they 
were Anderson's. Id. at 2. Another female employee, whose name is 
unknown, then gave Anderson a medical form to complete; however, he 
left much of it blank. Id.
    While in Registrant's office, Registrant asked Anderson what kind 
of accident he had had; Anderson stated that he had been in a car 
accident. Id. Anderson then told Registrant that he wanted his help in 
completing the medical form ``so that [they] would not get in trouble 
with the inspectors.'' Id. As the two discussed the forms, Registrant 
asked Anderson what drugs he had been taking and advised him to stop 
taking Soma and to reduce the amount of Xanax. Id.
    Registrant filled out the form and told Anderson ``you do not lift 
more than 15 pounds'' and that ``no heavy lifting [was] allowed.'' Id. 
He also calculated ``how many oxycodone 30 mg pills he should prescribe 
to be equivalent to the 80 mg pills reflected in the pharmacy 
profile.'' Id. Registrant further ``commented about being careful about 
inspectors who would look at the paperwork.'' Id.
    During the visit, Registrant administered several movement tests on 
Anderson. Id. Anderson stated that ``[w]hen [he] said [he] had `a 
little pain,' or `no pain,' [Registrant] said that `if you had no 
medicines, you would have pain?' '' Id. According to the TFO, ``[t]he 
effect of the conversation was to coach me on how to respond in order 
to receive the pain killers I wanted.'' Id.
    Registrant issued Anderson prescriptions for 60 oxycodone 30 mg, 30 
Xanax 2 mg, and 120 Percocet 10/325 mg. Id. at 2-3. Registrant then 
gave the prescriptions to his wife, who filled the oxycodone and Xanax. 
Id. at 3. However, because the clinic did not have Percocet, Anderson 
was given the prescription to fill elsewhere. Id. Anderson mentioned to 
both Registrant and his wife that he had been referred by ``Bill,'' 
``who `should get a kickback' '' for the referral; Registrant's wife 
noted that she would ``take care of it.'' Id. Anderson paid a total of 
$320 for the visit and the controlled substances. Id.
    On August 6, 2009, Rix returned to SMC, and noted on the medical 
form that he ``felt no pain and no interference with [his] daily 
activities.'' Aff. of TFO 1, at 4-5; Tr. 1 (Aug. 6, 2009). Rix asked 
Registrant what he could put on the form to obtain larger quantities of 
the drugs. Aff. of TFO 1, at 5. Registrant told him that his timing was 
bad because DEA was increasing its scrutiny of pain clinics and even 
sending in undercover operatives. Id.
    Rix and Registrant continued their discussion of the possibility of 
increasing the quantity of the drugs. Registrant told Rix to fill in a 
response to a certain question as ``maybe two or three you know some 
back pain'' so it would support an increase at the next visit. Tr. 14 
(Aug. 6, 2009). Later, Rix sought to confirm that circling two or three 
on the form ``would give us a reason to increase [the medications] a 
little bit.'' Id. at 19. Registrant responded, ``Yeah a little bit but 
not necessarily * * * and in case, depending on the finding in you 
[sic] case you know you need.'' Id. Registrant then stated that Rix did 
``have arthritis,'' ``disk dislocation,'' ``signs of * * * trauma,'' as 
well as ``pressure on the nerves,'' specifically an ``S1 * * * nerve 
root abutment'' that was ``almost a reason for [an] operation.'' Id. at 
20.
    When Rix asked whether he should have an operation, Registrant said 
that he ``wouldn't do it,'' and added that ``general statistics show 
that you should wait as long as you can before the surgery because even 
after the surgery some things don't work out'' and that the surgery is 
done when the ``indication is loss of nerve * * * showing muscle 
atrophy.'' Id. at 20-21. When Rix explained that he had not marked that 
area on the medical form, Registrant replied, ``well I'll put lower 
back pain.'' \6\ Id. at 22. As the TFO stated in his Affidavit, ``it 
was obvious that my

[[Page 4943]]

medical records would contain false information about fictitious 
pain.'' Aff. of TFO 1, at 5.
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    \6\ By that point, Registrant had apparently taken over the task 
of completing the medical form. See Tr. 15 (Aug. 6, 2009), at 15.
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    The visit concluded with Registrant issuing prescriptions for 180 
oxycodone 30 mg pills, 90 oxycodone 15 mg pills, and 30 alprazolam 2 mg 
pills, which Registrant's wife filled for Rix. Id. Rix paid 
Registrant's wife $600 after deducting $20 for referring Anderson. Id.
    On August 19, 2009, Anderson returned to the clinic (eleven days 
before his prescriptions should have run out) and sought more pain 
medication. Aff. of TFO 2, at 3; Tr. 1 (Aug. 19, 2009). Registrant 
advised him to ``[t]ry next week'' because if the police caught him 
with the drugs ``they can make a big issue * * * out of it.'' Tr. 1 
(Aug. 19, 2009). Anderson stated that he would be going to Georgia the 
next day, to which Registrant stated that ``if they catch you on the 
road to Georgia that's even worse.'' Id. at 2. Registrant referred to 
the investigation of Michael Jackson's doctor and stated that there had 
been two recent overdose deaths in Broward County. Id. Registrant also 
expressed his concern that the police would follow Anderson from the 
clinic and stop him. Id. At this visit, Registrant did not write any 
prescriptions and told Anderson that he could come back a few days 
early, but he could not come back as early as he had this time. Aff. of 
TFO 2, at 3; Tr. 4 (Aug. 19, 2009).
    Anderson returned to SMC on August 27, 2009. Aff. of TFO 2, at 3; 
Tr. 1 (Aug. 27, 2009). Anderson stated that he had not gone to Georgia, 
but that he would be leaving for Georgia imminently and that he wanted 
to increase his medications. Tr. 18 (Aug. 27, 2009). Registrant replied 
that it was the ``[w]rong time,'' and that in the aftermath of Michael 
Jackson's death and the two recent overdose deaths in Broward County, 
``they have * * * extra workers inspecting, they got a lot of money 
from the government so they're scrutinizing.'' Id. at 19.
    Anderson told Registrant that he only wanted oxycodone and Xanax, 
but not Soma or Percocet. Id. Anderson further stated that he had run 
out of oxycodone two weeks early and had bought additional oxycodone 
from a friend. Id. at 20-21.
    Notwithstanding Anderson's statement, Registrant neither counseled 
him on the danger of addiction and abuse or that his purchase of 
oxycodone from a friend was illegal. Registrant agreed to give Anderson 
90 oxycodone 30 mg, which was 30 more pills than he had given him the 
previous month, and 60 oxycodone 15 mg, which Anderson had not received 
at his first appointment. Id. at 22. Although Registrant stated that he 
would like to reduce Anderson's consumption of Xanax from 2 mg to 1 mg 
per day, when Anderson stated that he ``would rather have the 2 mill,'' 
Registrant relented and agreed to prescribe the 2 mg strength. Id. at 
23-24.
    Registrant then told Anderson that he needed to complete the 
medical form, and Anderson asked ``[w]hat numbers do I need'' to put 
down for his pain levels. Id. While Registrant told Anderson that he 
should ``[b]e honest,'' Registrant then advised him as to the value of 
the various numbers and agreed to sign after Anderson stated he would 
put down seven or eight for his pain level in the last week. Id. at 25-
26. The visit concluded with Registrant giving Anderson prescriptions 
for 90 oxycodone 30 mg, 60 oxycodone 15 mg, and 30 alprazolam 2 mg, 
which were filled by Registrant's wife and for which he paid $400. Aff. 
of TFO 2, at 4. In his Affidavit, the TFO stated that Registrant did 
not do ``any physical tests for pain response or movement 
restrictions'' at this visit. Id.
    On September 10, 2009, Rix returned to Registrant for the fourth 
time. Aff. of TFO 1, at 5; Tr. 1 (Sept. 10, 2009). Rix told Registrant 
that he had been out of town training to become a stunt man, ``a job 
obviously incompatible with chronic pain.'' Aff. of TFO 1, at 5; Tr. 16 
(Sept. 10, 2009). Registrant laughed and said: ``You better keep a 
secret.'' Tr. 16 (Sept. 10, 2009). Rix then told Registrant that he had 
left the medical form ``blank'' so that ``we can increase the 
medications because last time I didn't fill it out right,'' to which 
Registrant did not directly respond. Id. However, shortly thereafter 
Registrant wrote on the form that Rix stated that he ``ran out of 
medication'' and Registrant offered to increase the prescription for 
oxycodone 30 mg from 180 to 210 pills. Id. at 17. Registrant then 
stated that while he would increase the oxycodone, he would decrease 
the Xanax from 2 mg pills to 1 mg pills because ``that makes [you] look 
reasonable.'' Id. at 18.
    Next, Rix stated that he would refer a female client with knee 
pain. Id. at 19. Registrant stated that low back pain would be more 
``substantial'' and that she could get an MRI done for just $250 at a 
couple of places. Id. Registrant told Rix that a new law passed in 
February would require that she be put on non-controlled substances 
unless she could present a pharmacy profile that showed she was already 
receiving controlled substances. Id. at 19-20.
    Rix replied that the woman had said she had used controlled 
substances and that he had given her several of his oxycodone 15 mg 
pills, which she ``tried'' and reported feeling ``good.'' Id. at 20. 
Registrant did not, however, tell Rix not to share his medication. See 
id. Rix then stated that he had only given the woman five oxycodone 15 
mg pills, that he did not know ``how she took em when she did it,'' and 
that ``she said they helped.'' Id. at 21. Registrant replied, ``No of 
course we will cover you, you know, but the question is does she * * * 
need that much.'' Id.
    Registrant then noticed that Rix had left blank a certain question 
on the medical form and mentioned it to Rix. Id. at 23. Rix responded, 
``No remember you told me last time to leave that blank because I 
filled it out incorrectly where you said it couldn't increase the 
medicines.'' Id. at 24. Registrant replied: ``If you could be thinking, 
insomnia.'' Id. Although Rix stated that he absolutely did not have 
insomnia, Registrant stated, ``With Xanax, let's put down'' insomnia. 
Id.
    Registrant then asked Rix to rate numerically how his pain had 
affected his general activity in the prior week. Id. Rix answered that 
his pain did not interfere, ``but that's where you told me we had to be 
careful because we couldn't increase'' the drugs. Id. Continuing, Rix 
stated that ``I put it didn't interfere at all last time and you said 
you could not increase [the drugs] because it said it does not 
interfere [and] I think you said last time to put three or four.'' 
Registrant responded, ``Okay so three, mood about two?'' Id.
    The conversation then returned to Rix's having gone to a school for 
stunt men and his purported bad back. Registrant stated, ``Oh I'm 
telling you * * * I shouldn't even know about it.'' Id. at 26. 
Registrant then said that ``sometimes there will be people coming in 
here,'' specifically undercover officers. Id. at 28. Laughing, he 
stated that the undercover officers were ``trying to provoke'' him. Id. 
As they continued to discuss Rix's work as a stunt man, Rix assured 
Registrant that he would not do any such work in Florida. Id. 
Registrant then stated that ``they could accuse'' Rix of something and 
that the authorities might say that ``your MRI is fake.'' Id. at 30.
    Registrant then issued Rix prescriptions for 210 oxycodone 30 mg, 
90 oxycodone 15 mg, and 30 Xanax (alprazolam) 1 mg, which were 
dispensed by the former's wife. Aff. of TFO 1, at 5. Rix paid $678 for 
the controlled substances and the visit. Id. at 5-6.
    On January 7, 2010, a Federal Grand Jury indicted Registrant. 
United States v. Algirdas Krisciunas et al., No. 10-60007-CR (S.D. Fla. 
Jan. 7, 2010)

[[Page 4944]]

(Indictment). The indictment charged Registrant with one count of 
conspiring with M.L.A. and M.I.R. (two of the clinic's staff) to 
distribute oxycodone, a controlled substance, ``[f]rom on or before 
June 29, 2009 to on or about September 9, 2009,'' in violation of 21 
U.S.C. 841(a)(1) and 846. Id. The indictment further charged Registrant 
with five counts of dispensing oxycodone (on July 13 and 30, August 6 
and 27, and September 9, 2009), a controlled substance, in violation of 
21 U.S.C. 841(a)(1). Id.
    On March 11, 2010, a Federal Grand Jury issued a superseding 
indictment. United States v. Algirdas Krisciunas and Maria Teresa 
Bulich, Superseding Indictment (S.D. Fla. Mar. 11, 2010), No. 10-60007-
CR-HURLEY(s). The new indictment charged Registrant and his wife with 
conspiring to unlawfully dispense oxycodone; it also charged Registrant 
and his wife with unlawfully dispensing oxycodone on each of the five 
dates as charged in the initial indictment. Id. at 1-3 (citing 21 
U.S.C. 841(a)(1), 846).
    Thereafter, Registrant went to trial. On July 6, 2010, a jury found 
Registrant guilty on all six counts. U.S. v. Algirdas Krisciunas, 
Verdict (July 6, 2010). On October 13, 2010, the District Court entered 
its Judgment adjudicating Registrant guilty on all six counts and 
sentenced him to 97 months imprisonment to be followed by three years 
of supervised release. U.S. v. Algirdas Krisciunas, Judgment (Oct. 13, 
2010).
    Based on Registrant's convictions, on August 20, 2010, the Florida 
Surgeon General ordered the summary suspension of his medical license. 
Order of Emergency Suspension of License, at 2-3 (citing Fla. Stat. 
Sec.  456.074(1)).

Discussion

    Section 304(a) of the CSA provides that a ``registration pursuant 
to section 823 of this title to * * * dispense a controlled substance * 
* * may be suspended or revoked by the Attorney General upon a finding 
that the registrant * * * has been convicted of a felony under this 
subchapter or subchapter II of this chapter * * * relating to any 
substance defined in this subchapter as a controlled substance.'' 21 
U.S.C. 824(a)(2). Section 304(a) further provides that a registration 
may be revoked or suspended where a registrant ``has had his State 
license or registration suspended, revoked, or denied by competent 
State authority and is no longer authorized by State law to engage in 
the * * * dispensing of controlled substances.'' \7\ Id. Sec.  
842(a)(3).
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    \7\ Section 304(a)(4) also provides for the suspension or 
revocation of a registration ``upon a finding that the registrant * 
* * has committed such acts as would render his registration * * * 
inconsistent with the public interest as determined under * * * 
section'' 823(f). 21 U.S.C. 824(a)(4). In light of my finding that 
Registrant has been convicted of six felony counts of violating the 
CSA, I conclude that it is not necessary to discuss the 
applicability of this provision to his misconduct.
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    As found above, the United States District Court has adjudicated 
Registrant guilty of one count of conspiring to unlawfully distribute 
oxycodone, a schedule II controlled substance, in violation of 21 
U.S.C. 846, and five counts of unlawfully dispensing oxycodone, in 
violation of 21 U.S.C. 841(a)(1). Both provisions are felonies under 
the CSA. See 21 U.S.C. 841(b)(1)(C) (except as otherwise provided, 
``[i]n the case of a controlled substance in schedule I or II * * * 
such person shall be sentenced to a term of imprisonment of not more 
than 20 years''); id. Sec.  846 (``Any person who * * * conspires to 
commit any offense defined in this subchapter shall be subject to the 
same penalties as those prescribed for the offense, the commission of 
which was the object of the * * * conspiracy.''). Registrant's 
convictions for these offenses provide reason alone to revoke his 
registration and denied any pending applications. 21 U.S.C. 824(a)(2).
    I further conclude that Registrant's registration should be revoked 
on the ground that the State of Florida has suspended his State medical 
license and thus, he no longer has authority to dispense controlled 
substances in the State. 21 U.S.C. 824(a)(3). The CSA defines the term 
``practitioner'' as a person ``licensed, registered, or otherwise 
permitted, by the United States or the jurisdiction in which he 
practices * * * to distribute, dispense * * * [or] administer * * * a 
controlled substance in the course of professional practice.'' Id. 
Sec.  802(21). Likewise, the CSA limits registration to an applicant 
who is ``authorized to dispense * * * controlled substances under the 
laws of the State in which he practices.'' Id. Sec.  823(f). Based on 
these provisions, DEA has held repeatedly that a practitioner whose 
State authority to dispense controlled substances has been suspended or 
revoked is not entitled to maintain his CSA registration. See John B. 
Freitas, 74 FR 17524, 17525 (2009); Worth S. Wilkinson, 71 FR 30173 
(2006); Stephen J. Graham, 69 FR 11661, 11662 (2004); Dominick A. 
Ricci, 58 FR 51104, 51105 (1993); Bobby Watts, 53 FR 11919, 11920 
(1988). I therefore conclude that Registrant's loss of his State 
authority provides a further ground to revoke his registration and to 
deny any pending application to renew or modify his registration.

Order

    Pursuant to the authority vested in me by 21 U.S.C. 823(f) and 
824(a), as well as by 28 CFR 0.100(b) and 0.104, I order that DEA 
Certificate of Registration, BK4015334, issued to Algirdas J. 
Krisciunas, M.D., be, and it hereby is, revoked. I further order that 
any pending application of Algirdas J. Krisciunas, M.D., to renew or 
modify his registration be, and it hereby is, denied. This Order is 
effective immediately.\8\
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    \8\ For the same reason that I ordered the immediate suspension 
of Registrant's registration, I conclude that the public interest 
requires that this Order be effective immediately. 21 CFR 1316.67.

    Dated: January 18, 2011.
Michele M. Leonhart,
Administrator.
[FR Doc. 2011-1693 Filed 1-26-11; 8:45 am]
BILLING CODE 4410-09-P