Lewisville Medical Pharmacy; Decision and Order, 59456-59460 [2022-21276]
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suspend or revoke a registration issued
under section 823 of the CSA ‘‘upon a
finding that the registrant . . . has had
his State license or registration
suspended . . . [or] revoked . . . by
competent State authority and is no
longer authorized by State law to engage
in the . . . dispensing of controlled
substances.’’ With respect to a
practitioner, the DEA has also long held
that the possession of authority to
dispense controlled substances under
the laws of the state in which a
practitioner engages in professional
practice is a fundamental condition for
obtaining and maintaining a
practitioner’s registration. See, e.g.,
James L. Hooper, M.D., 76 FR 71371
(2011), pet. for rev. denied, 481 F. App’x
826 (4th Cir. 2012); Frederick Marsh
Blanton, M.D., 43 FR 27616, 27617
(1978).3
According to California statute,
‘‘dispense’’ means ‘‘to deliver a
controlled substance to an ultimate user
or research subject by or pursuant to the
lawful order of a practitioner, including
the prescribing, furnishing, packaging,
labeling, or compounding necessary to
prepare the substance for that delivery.’’
Cal. Health & Safety Code § 11010 (West
2022). Further, a ‘‘practitioner’’ means a
person ‘‘licensed, registered, or
otherwise permitted, to distribute,
dispense, conduct research with respect
to, or administer, a controlled substance
in the course of professional practice or
research in this state.’’ Id. at § 11026(c).
Here, the undisputed evidence in the
record is that Registrant currently lacks
authority to practice medicine in
California. As discussed above, a
physician must be a licensed
practitioner to dispense a controlled
substance in California. Thus, because
Registrant currently lacks authority to
practice medicine in California and,
therefore, is not currently authorized to
handle controlled substances in
California, Registrant is not eligible to
maintain a DEA registration.
Accordingly, the Agency will order that
Registrant’s DEA registration be
revoked.
Order
Pursuant to 28 CFR 0.100(b) and the
authority vested in me by 21 U.S.C.
824(a), I hereby revoke DEA Certificate
of Registration No. AB1253880 issued to
Thomas Blair, M.D. Further, pursuant to
28 CFR 0.100(b) and the authority
vested in me by 21 U.S.C. 823(f), I
hereby deny any pending applications
of Thomas Blair, M.D., to renew or
modify this registration, as well as any
other pending application of Thomas
Blair, M.D., for additional registration in
California. This Order is effective
October 31, 2022.
Signing Authority
This document of the Drug
Enforcement Administration was signed
on September 26, 2022, by
Administrator Anne Milgram. That
document with the original signature
and date is maintained by DEA. For
administrative purposes only, and in
compliance with requirements of the
Office of the Federal Register, the
undersigned DEA Federal Register
Liaison Officer has been authorized to
sign and submit the document in
electronic format for publication, as an
official document of DEA. This
administrative process in no way alters
the legal effect of this document upon
publication in the Federal Register.
Heather Achbach,
Federal Register Liaison Officer, Drug
Enforcement Administration.
[FR Doc. 2022–21274 Filed 9–29–22; 8:45 am]
BILLING CODE 4410–09–P
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3 This
rule derives from the text of two provisions
of the CSA. First, Congress defined the term
‘‘practitioner’’ to mean ‘‘a physician . . . or other
person licensed, registered, or otherwise permitted,
by . . . the jurisdiction in which he practices . . . ,
to distribute, dispense, . . . [or] administer . . . a
controlled substance in the course of professional
practice.’’ 21 U.S.C. 802(21). Second, in setting the
requirements for obtaining a practitioner’s
registration, Congress directed that ‘‘[t]he Attorney
General shall register practitioners . . . if the
applicant is authorized to dispense . . . controlled
substances under the laws of the State in which he
practices.’’ 21 U.S.C. 823(f). Because Congress has
clearly mandated that a practitioner possess state
authority in order to be deemed a practitioner under
the CSA, the DEA has held repeatedly that
revocation of a practitioner’s registration is the
appropriate sanction whenever he is no longer
authorized to dispense controlled substances under
the laws of the state in which he practices. See, e.g.,
James L. Hooper, 76 FR at 71371–72; Sheran Arden
Yeates, M.D., 71 FR 39130, 39131 (2006); Dominick
A. Ricci, M.D., 58 FR 51104, 51105 (1993); Bobby
Watts, M.D., 53 FR 11919, 11920 (1988); Frederick
Marsh Blanton, 43 FR at 27617.
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DEPARTMENT OF JUSTICE
Drug Enforcement Administration
[Docket No. 21–24]
Lewisville Medical Pharmacy; Decision
and Order
I. Introduction
On June 9, 2021, the United States
Department of Justice, Drug
Enforcement Administration
(hereinafter, Agency) issued an Order to
Show Cause and Immediate Suspension
of Registration (hereinafter collectively,
OSC) to Lewisville Medical Pharmacy
(hereinafter, Respondent) of Lewisville,
Texas. OSC, at 1–2, 11. The OSC
immediately suspended, and proposed
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the revocation of, Respondent’s Drug
Enforcement Administration
(hereinafter, DEA) registration No.
FL2190332, pursuant to 21 U.S.C.
824(d) and (a)(4), respectively, ‘‘because
. . . [Respondent’s] continued
registration constitutes ‘an imminent
danger to the public health or safety’ ’’
and ‘‘because . . . [Respondent’s]
continued registration is inconsistent
with the public interest, as that term is
defined in 21 U.S.C. 823(f).’’ Id. at 1.
The OSC more specifically alleged that,
according to Respondent’s ‘‘dispensing
information’’ from at least March 2,
2018, through at least March 20, 2021,
Respondent ‘‘repeatedly filled
prescriptions for Schedule III through V
controlled substances in the face of
obvious and unresolved red flags of
drug abuse and diversion [hereinafter,
red flags], and therefore, in violation of
both federal and Texas law,’’ including
21 CFR 1306.04(a) and Texas Health &
Safety Code § 481.074(a).1 Id. at 2. The
OSC includes allegations about pattern
prescribing (which it defines as
prescribing the same controlled
substance in identical or substantially
similar quantities to multiple
individuals indicating a lack of
individualized therapy), distance
(which it defines as traveling
abnormally long distances to fill a
controlled substance prescription), cash
payment (which it defines as a common
red flag of abuse and diversion as it
permits an individual to avoid scrutiny
associated with the use of insurance as
part of the payment process), and shared
address (which it defines as multiple
persons with the same address
presenting the same or substantially
similar controlled substance
prescriptions from the same
practitioner) red flags.2 Id. at 4–10.
Respondent timely requested a
hearing. Recommended Rulings,
Findings of Fact, Conclusions of Law,
and Decision of the Administrative Law
1 The Agency is only adjudicating controlled
substance prescriptions in the record that are dated
on or after September 16, 2018. See 22 TAC
§ 291.29 (effective September 16, 2018).
2 The phrase ‘‘red flag’’ is used in the record
before the Agency with varying accuracy. The
testimony of the Government’s expert accurately
defines the phrase and a Texas pharmacist’s
obligation when presented with a controlled
substance prescription, that is, consistent with
federal law. See, e.g., Tr. 555–56; infra, section II.A.
The use of the phrase in Respondent’s case, on the
other hand, is not always fully accurate. Infra,
section II.B. When Respondent’s case accurately
acknowledges circumstances that are red flags, it
rarely states a Texas pharmacist’s ensuing
obligation accurately. Id. When Respondent uses
the phrase when questioning the Government’s
expert, the context out of which the expert responds
is an accurate understanding of the phrase
regardless of what Respondent meant by its
question.
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Judge (hereinafter, RD), at 1. DEA
Administrative Law Judge Paul E.
Soeffing (hereinafter, ALJ) conducted a
four-day video teleconference hearing
from November 15 through 18, 2021. Id.
On April 1, 2022, the ALJ issued his RD,
recommending revocation of
Respondent’s registration.3 Id. at 57.
Having thoroughly analyzed the
record and applicable law, the Agency
summarizes its findings and
conclusions: (1) the Diversion Control
Division (hereinafter, Government)
presented a prima facie case, (2)
Respondent attempted, but failed, to
rebut the Government’s prima facie
case, and (3) substantial record
evidence, including the testimony of the
Government’s expert witness and large
portions of the testimony of
Respondent’s owner and Pharmacist-inCharge (hereinafter, PIC), shows
Respondent’s violations of applicable
law, violations against a foundation of
the Controlled Substances Act
(hereinafter, CSA). Accordingly, the
Agency will revoke Respondent’s
registration. Infra, Order.
II. Findings 4
A. The Government’s Case
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The Government’s principal case
presented two witness—a Diversion
Investigator and its expert, Diane
Ginsburg, Ph.D., whom the ALJ
accepted, without objection, as an
expert in Texas retail pharmacy practice
and Texas pharmacy practice.5 Tr. 21–
85 (DI testimony), id. at 85–559 (Dr.
Ginsburg testimony). Having thoroughly
analyzed the record and applicable law,
the Agency agrees with the RD and finds
that Dr. Ginsburg ‘‘presented credible
testimony that was internally consistent
and logically persuasive, . . . [and] an
objective analysis . . . [admitting] times
where . . . she may not have identified
a red flag.’’ RD, at 18. The Agency agrees
with the RD and affords Dr. Ginsburg’s
testimony ‘‘significant weight’’ in this
adjudication. Id.
The Agency finds that Dr. Ginsburg’s
testimony about the red flags alleged in
the OSC constitutes a portion of the
substantial record evidence that
Respondent filled controlled substance
prescriptions exhibiting red flags
without documenting the resolution of
those red flags, thereby violating
3 Neither
party filed exceptions to the RD.
Agency incorporates the parties’
Stipulations and accepts them as fact. RD, at 2–3.
The first and second stipulations address
Respondent’s DEA registration and its status. Id. at
2.
5 In rebuttal, the Government presented one
witness, the undercover Task Force Officer. Tr.
850–95.
4 The
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applicable legal requirements.6 E.g., Tr.
108–120, 122–56, 169–90, 219–57, 261–
72, 277–86, 506, 518, 553, 556; accord,
e.g., RD, at 8–11, 13–18, 34–37, 41–45,
47–48.
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when there is no red flag on a controlled
substance prescription, there is
‘‘nothing to document,’’ and (4)
Respondent filled controlled substance
prescriptions without documented
resolution of the red flags on them.9
E.g., Tr. 654–56, 664–79, 714–32, 738–
53, 758–75, 779–85; see also, e.g.,
Respondent’s Closing Brief with
Proposed Findings of Fact and
Conclusions of Law (hereinafter, Resp
Posthearing), at 1–2 (‘‘With a few
exceptions, . . . [Respondent] denies
such red flags were present for the
prescriptions at issue.’’); RD, at 33 n.33,
40–51, 53–54.
B. The Respondent’s Case
Respondent’s owner and PIC, whom
Respondent characterized as ‘‘an expert
on Texas pharmacy law and practice,’’
was the only witness Respondent
presented.7 Respondent’s Prehearing
Statement, at 4; Tr. 561–849.8 Having
thoroughly analyzed the record and
applicable law, the Agency finds that
Respondent’s owner and PIC is the
witness with the most at stake in this
adjudication. The Agency finds that,
while the testimony of Respondent’s
owner and PIC does include reliable
statements, it also includes statements
that lack credibility, are implausible,
and/or are not persuasive. The Agency
finds that the testimony of Respondent’s
owner and PIC must be considered with
much caution, and where his testimony
conflicts with credible record evidence
or applicable law, the Agency does not
credit it. Supra, section II; infra,
sections III, IV.B., and V; see also RD,
at 27.
The Agency finds substantial record
evidence that (1) the testimony of
Respondent’s owner and PIC includes
his unsupported and previously
undocumented statements justifying, in
retrospect, the legitimacy of controlled
substance prescriptions that Respondent
filled, (2) the testimony of Respondent’s
owner and PIC includes his ensuing
conclusions that there is no red flag on
those controlled substance
prescriptions, (3) the testimony of
Respondent’s owner and PIC includes
his admissions that he did not
document the existence or resolution of
any red flag on those controlled
substance prescriptions since, according
to him, there were no red flags on the
controlled substance prescriptions and,
According to the CSA, ‘‘Except as
authorized by this subchapter, it shall
be unlawful for any person knowingly
or intentionally . . . to . . . distribute,
. . . dispense, or possess with intent to
. . . distribute[ ] or dispense, a
controlled substance.’’ 21 U.S.C.
841(a)(1). The CSA’s implementing
regulations state that a lawful controlled
substance order or prescription is one
that is ‘‘issued for a legitimate medical
purpose by an individual practitioner
acting in the usual course of his
professional practice’’ and that, while
the ‘‘responsibility for the proper
prescribing and dispensing of controlled
substances is upon the prescribing
practitioner,’’ a ‘‘corresponding
responsibility rests with the pharmacist
who fills the prescription.’’ 21 CFR
1306.04(a); The Pharmacy Place, 86 FR
21008, 21012–14, 21034–35 (2021)
(requisite scienter under 21 CFR
1306.04(a)).
The OSC is addressed to Respondent
at its registered address in Texas.
Therefore, the Agency also evaluates
Respondent’s actions according to Texas
law, including the applicable Texas
6 Dr. Ginsburg testified that a ‘‘red flag is
something that would raise suspicion or cause you
concern related to a medication and certainly there
are those that have been identified, as well as types
of things that are considered red flags, federally, as
well as within our State that pharmacists are aware
of’’ and that the ‘‘obligation is to verify validity and
then to document the resolution of that red flag.’’
Tr. 555–56; see also RD, at 41.
7 At the hearing, however, Respondent did not
proffer its owner and PIC as an expert.
Respondent’s owner and PIC testified that he is
‘‘legally responsible’’ for ensuring that Respondent,
its operations, its policies, and ‘‘everything’’ go
‘‘according to the rule and the law.’’ Tr. 564. He
also testified that he filled the controlled substance
prescriptions at issue in this adjudication. Tr. 848.
8 As the parties’ closing briefs do not challenge
any of the ALJ’s pre-hearing or hearing rulings, and
as neither party filed exceptions, the Agency need
not address, and does not address, any of those
rulings in this Decision/Order.
9 ‘‘[A] corresponding responsibility rests with the
pharmacist who fills the prescription.’’ 21 CFR
1306.04(a).
The testimony of Respondent’s owner and PIC
about ‘‘red flags’’ and ‘‘potential red flags’’ is not
fully accurate. He testified at length on multiple
occasions about why, in his view, there is no red
flag on a given controlled substance prescription at
issue in this proceeding. E.g., infra, sections II.B.,
III., and IV.B. His testimony lacks legal and factual
credibility particularly because Texas law explicitly
lists and clearly articulates what red flags are,
making the identification of red flags on controlled
substance prescriptions a process largely devoid of
professional analysis or judgment, and because the
applicable standard of practice requires the
resolution of those red flags and the documentation
of the red flags’ resolutions before the controlled
substance prescription is filled. Supra, section II.A.;
infra, sections III and IV.B.
10 See also 22 TAC § 291.33 (Texas drug
utilization review requirement); RD, at 34–35.
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III. Texas Pharmacists’ Professional
Responsibility 10
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pharmacists’ professional
responsibilities.11
During the period alleged in the OSC,
Texas law specifically addressed
pharmacists’ professional
responsibilities concerning red flags.
First, according to Texas law,
pharmacists ‘‘shall make every
reasonable effort to ensure that any
prescription drug order . . . has been
issued for a legitimate medical purpose
by a practitioner in the course of
medical practice.’’ 22 TAC § 291.29(b);
The Pharmacy Place, 86 FR at 21012.
Further, according to Texas law, a
‘‘pharmacist shall make every
reasonable effort to prevent
inappropriate dispensing due to
fraudulent, forged, invalid, or medically
inappropriate prescriptions in violation
of a pharmacist’s corresponding
responsibility’’ and lists ‘‘red flag
factors’’ that are ‘‘relevant to preventing
the non-therapeutic dispensing of
controlled substances’’ that ‘‘shall be
considered by evaluating the totality of
the circumstances rather than any single
factor.’’ 22 TAC § 291.29(f); The
Pharmacy Place, 86 FR at 21012; see
also Resp Posthearing, at 2–3, 4. A
pharmacy’s ‘‘dispens[ing]’’ a
‘‘reasonably discernible pattern of
substantially identical prescriptions for
the same controlled substance . . . for
numerous persons, including a lack of
individual drug therapy in prescriptions
issued by the practitioner’’ is the first
red flag listed. 22 TAC § 291.29(f)(1).
Other red flags explicitly identified in
Texas law that are relevant to this
proceeding are ‘‘multiple persons with
the same address [who] present
substantially similar controlled
substance prescriptions from the same
practitioner’’ and ‘‘persons [who]
consistently pay for controlled
substances with cash or cash
equivalents more often than through
insurance.’’ 22 TAC § 291.29(f)(11) and
(12).
Dr. Ginsburg’s testimony, including
her explanations of the standard of
practice of Texas pharmacies and Texas
pharmacists’ professional
responsibilities, is consistent with this
legal analysis and states that the
applicable standard of practice is for the
resolution of red flags to be documented
before the controlled substance
prescription is filled. Supra, section
II.A.; e.g., Tr. 228, 506, 518, 553, 556;
accord id. at 588 (Respondent’s owner
and PIC testifying about the duty to
document the resolution of a red flag).
11 See Gonzales v. Oregon, 546 U.S. 243, 269–71
(2006); see also OSC, at 2–3.
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IV. Discussion
A. The Controlled Substances Act
Under Section 304 of the CSA, ‘‘[a]
registration . . . to . . . distribute[ ] or
dispense a controlled substance . . .
may be suspended or revoked by the
Attorney General upon a finding that
the registrant . . . has committed such
acts as would render his registration
under section 823 of this title
inconsistent with the public interest as
determined by such section.’’ 21 U.S.C.
824(a)(4). In the case of a ‘‘practitioner,’’
which is defined in 21 U.S.C. 802(21) to
include a ‘‘pharmacy,’’ Congress
directed the Attorney General to
consider five factors in making the
public interest determination. 21 U.S.C.
823(f)(1–5). The five factors are
considered in the disjunctive. Robert A.
Leslie, M.D., 68 FR 15227, 15230 (2003).
According to Agency decisions, the
Agency ‘‘may rely on any one or a
combination of factors and may give
each factor the weight [it] deems
appropriate in determining whether’’ to
revoke a registration. Id.; see also Jones
Total Health Care Pharmacy, LLC v.
Drug Enf’t Admin., 881 F.3d 823, 830
(11th Cir. 2018) (citing Akhtar-Zaidi v.
Drug Enf’t Admin., 841 F.3d 707, 711
(6th Cir. 2016); MacKay v. Drug Enf’t
Admin., 664 F.3d 808, 816 (10th Cir.
2011); Volkman v. U. S. Drug Enf’t
Admin., 567 F.3d 215, 222 (6th Cir.
2009); Hoxie v. Drug Enf’t Admin., 419
F.3d 477, 482 (6th Cir. 2005). Moreover,
while the Agency is required to consider
each of the factors, it ‘‘need not make
explicit findings as to each one.’’
MacKay, 664 F.3d at 816 (quoting
Volkman, 567 F.3d at 222); see also
Hoxie, 419 F.3d at 482. ‘‘In short, . . .
the Agency is not required to
mechanically count up the factors and
determine how many favor the
Government and how many favor the
registrant. Rather, it is an inquiry which
focuses on protecting the public
interest; what matters is the seriousness
of the registrant’s misconduct.’’ Jayam
Krishna-Iyer, M.D., 74 FR 459, 462
(2009). Accordingly, as the Tenth
Circuit has recognized, findings under a
single factor can support the revocation
of a registration. MacKay, 664 F.3d at
821.
According to DEA regulations, ‘‘[a]t
any hearing for the revocation . . . of a
registration, the . . . [Government] shall
have the burden of proving that the
requirements for such revocation . . .
pursuant to . . . 21 U.S.C. [§ ] 824(a)
. . . are satisfied.’’ 21 CFR 1301.44(e).
In this matter, while all of the 21
U.S.C. 823(f) Factors have been
considered, the Government’s evidence
in support of its prima facie case is
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confined to Factors Two and Four.12
Government’s Proposed Findings of Fact
and Conclusions of Law, at 18. The
Government presented a prima facie
case based on Factors Two and Four,
and portions of the testimony of
Respondent’s owner and PIC actually
admit, even if unintentionally, to
foundational violations of federal law.
21 CFR 1306.04(a), supra, sections II.A.,
II.B., and III. Accordingly, the Agency
finds that Respondent’s continued
registration is inconsistent with the
public interest. 21 U.S.C. 824(a)(4) and
823(f)(2) and (f)(4).
B. Factors Two and/or Four—The
Respondent’s Experience in Dispensing
Controlled Substances and Compliance
With Applicable Laws Related to
Controlled Substances
Allegation That Respondent’s
Registration Is Inconsistent With the
Public Interest
According to the CSA’s implementing
regulations, a lawful prescription for
controlled substances is one that is
‘‘issued for a legitimate medical purpose
by an individual practitioner acting in
the usual course of his professional
practice.’’ 21 CFR 1306.04(a); see
Gonzales v. Oregon, 546 U.S. 243, 274
(2006); see also Tex. Health & Safety
Code § 481.074.
Respondent engaged a skillful team
and defended itself against the OSC’s
allegations. As already noted, the record
evidence, including testimony of
Respondent’s owner and PIC, contains
substantial evidence of violations of
applicable law. Those violations go to
the heart of this Agency’s law
enforcement mission. Supra, sections
II.A., II.B., and III; infra, sections IV.B.
and V.
Having thoroughly analyzed the
record and applicable law, the Agency
finds substantial record evidence,
including testimony and admissions of
Respondent’s owner and PIC, that (1)
Respondent filled controlled substance
prescriptions containing red flags,
including red flags explicitly listed in
Texas law, such as pattern prescribing,
cash payment, distance, and shared
address and (2) Respondent filled these
controlled substance prescriptions
without resolving, and documenting the
resolution of, the red flags on them.13
12 Neither Respondent nor the Government argues
that it offered evidence relevant to Factors One,
Three, or Five. Although the Agency considered
Factors One, Three, and Five, it finds that none of
them is relevant to this adjudication, as the RD
recommends. RD, at 30, n.32.
13 E.g., Government Exhibit (hereinafter, GX) 3, at
3 (customer AC, February 29, 2020, pattern
prescribing); GX 3, at 6 (customer AC, October 6,
2020, pattern prescribing); GX 4, at 4 (customer AM,
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Supra, sections II.A., II.B., and III.
Indeed, Respondent’s owner and PIC
repeatedly denied that controlled
substance prescriptions at issue in this
proceeding even included a red flag.
Supra, section II.B. Substantial record
evidence of any one of the founded
controlled substance prescription
violations is sufficient for the Agency to
revoke Respondent’s registration.
Prior Agency decisions consistently
find that controlled substance
prescriptions with these red flags are so
suspicious as to support a finding that
the pharmacists who filled them
violated their corresponding
responsibility due to actual knowledge
of, or willful blindness to, the
prescriptions’ illegitimacy. 21 CFR
1306.04(a); see also, e.g., Tex. Health &
Safety Code §§ 481.074, 481.128; The
Pharmacy Place, 86 FR at 21013
(collecting Agency decisions).14 Indeed,
September 21, 2020, pattern prescribing); GX 5, at
2 (customer AR, July 8, 2020, pattern prescribing);
GX 12, at 2 (customer DG, July 13, 2019, distance);
GX 15, at 2 (customer FL, June 22, 2020, pattern
prescribing); GX 16, at 3 (customer FA, August 3,
2020, pattern prescribing); GX 17, at 2 (customer
GG, August 5, 2020, pattern prescribing); GX 18, at
2 (customer IS, March 8, 2019, pattern prescribing);
GX 18, at 5 (customer IS, March 29, 2019, pattern
prescribing); GX 18, at 8 (customer IS, January 6,
2020, pattern prescribing); GX 18 at 11 (customer
IS, September 3, 2020, pattern prescribing); GX 19,
at 2 (customer IS, October 5, 2020, pattern
prescribing); GX 20, at 109 (customer IG, October
12, 2020, pattern prescribing); GX 21, at 3 (customer
IG, September 22, 2020, pattern prescribing); GX 22,
at 2 (customer JB, February 7, 2019, distance); GX
22, at 4 (customer JB, May 16, 2019, distance); GX
22, at 6 (customer JB, March 20, 2020, distance); GX
23, at 2 (customer JS, July 8, 2020, pattern
prescribing); GX 24, at 3 (customer JR, October 8,
2020, pattern prescribing); GX 25, at 2 (customer JC,
January 23, 2020, shared address and pattern
prescribing with customer AL, January 23, 2020)
alone and in conjunction with GX 60, at 1 (shared
address); GX 26, at 3 (customer JL, July 24, 2020,
pattern prescribing); GX 31, at 3 (customer LO,
October 7, 2020, pattern prescribing) alone and in
conjunction with GX 50, at 1 (cash); GX 35, at 3
(customer MO, July 8, 2020, pattern prescribing);
GX 37, at 2 (customer MN, August 26, 2020, pattern
prescribing); GX 41, at 5 (customer PG, January 4,
2020, pattern prescribing) alone and in conjunction
with GX 56, at 1 (cash); GX 41, at 8 (customer PG,
March 3, 2020, pattern prescribing) alone and in
conjunction with GX 56, at 1 (cash); GX 42, at 5
(customer RT, February 11, 2020, pattern
prescribing); GX 45, at 2 (customer TS, February 20,
2020, distance); GX 46, at 18 (customer YG, January
15, 2019, pattern prescribing) alone and in
conjunction with GX 51, at 1 (cash); and GX 46, at
24 (customer YG, February 29, 2020, pattern
prescribing) alone and in conjunction with GX 51,
at 1 (cash).
14 Agency decisions have consistently found that
prescriptions with the same red flags at issue here
were so suspicious as to support a finding that the
pharmacists who filled them violated the Agency’s
corresponding responsibility rule due to actual
knowledge of, or willful blindness to, the
prescriptions’ illegitimacy. 21 CFR 1306.04(a); see,
e.g., Morning Star Pharmacy and Medical Supply 1,
85 FR 51045, 51061 (2020) (pattern prescribing;
distance; cash payments; high doses/quantities of
high-alert controlled substances); Pharmacy Doctors
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the testimony of Respondent’s owner
and PIC, during which he spoke at
length about why red flags, that are
explicitly listed in Texas law as such,
are not red flags, is record evidence that
Respondent was willfully blind to red
flags on the prescriptions it filled.
Supra, section II.B. Accordingly, the
Agency finds that there is substantial
record evidence of violations of
applicable law and, therefore, that it is
appropriate to sanction Respondent for
these violations. Supra, sections II, III,
and IV.
Summary of Factors Two and Four
Respondent did not successfully rebut
the Government’s prima facie case,
established by substantial record
evidence, that it violated applicable law
by filling controlled substance
prescriptions without resolving and
documenting the resolution of the red
flags on them. 21 CFR 1306.04(a), 22
TAC § 291.29. Accordingly, the Agency
finds that Respondent violated
applicable law, supporting the
revocation of its registration. 21 U.S.C.
824(a)(4).
V. Sanction
Where, as here, the Government has
met its prima facie burden of showing
that Respondent’s continued registration
is inconsistent with the public interest
due to its numerous violations
pertaining to controlled substances, the
burden shifts to the Respondent to show
why it can be entrusted with a
registration. Garrett Howard Smith,
M.D., 83 FR 18,882 (2018). Moreover, as
past performance is the best predictor of
future performance, DEA
Administrators have required that a
registrant who has committed acts
inconsistent with the public interest
must accept responsibility for those acts
and demonstrate that it will not engage
in future misconduct. Id. A registrant’s
acceptance of responsibility must be
unequivocal. Id. In addition, a
registrant’s candor during the
investigation and hearing has been an
important factor in determining
acceptance of responsibility and the
appropriate sanction. Id. In addition,
DEA Administrators have found that the
Enterprises d/b/a Zion Clinic Pharmacy, 83 FR
10876, 10898 (2018), pet. for rev. denied, 789 F.
App’x 724 (11th Cir. 2019) (long distances; pattern
prescribing; cash payments); Hills Pharmacy, 81 FR
49816, 49836–39 (2016) (multiple customers
presenting prescriptions written by the same
prescriber for the same drugs in the same quantities;
customers with the same last name and street
address presenting similar prescriptions on the
same day; long distances); The Medicine Shoppe, 79
FR 59504, 59507, 59512–13 (2014) (unusually large
quantity of a controlled substance; pattern
prescribing).
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59459
egregiousness and extent of the
misconduct are significant factors in
determining the appropriate sanction.
Id. DEA Administrators have also
considered the need to deter similar acts
by the respondent and by the
community of registrants. Id.
Regarding these matters, there is no
record evidence that Respondent, or its
owner and PIC, takes responsibility, let
alone unequivocal responsibility, for the
founded violations.15 Instead, the
testimony of Respondent’s owner and
PIC is replete with unsupported and
undocumented assertions about why
controlled substance prescriptions
evidencing what Texas law labels as
‘‘red flag factors’’ are not red flags at all,
typically then followed by the
incantation that, if there is no red flag,
there is nothing to document. Supra,
sections II.B. and IV.B; see also Tr. 793
(testimony of Respondent’s owner and
PIC regarding a prescription that,
according to the customer’s profile,
shows ‘‘a pretty bad drug interaction,’’
and his assertion that ‘‘you don’t
necessarily have to document that’’
while acknowledging that ‘‘I know we
say document, document, but a lot of
things are expected as a plan of care for
patients that are very important that are
not documented’’) in conjunction with
22 TAC § 291.33(c)(2)(A)(ii); Tr. 805
(testimony of Respondent’s owner and
PIC that ‘‘there was really nothing to
document because, typically, with red
flags, the things we want to document
is if you think the prescription is
fraudulent’’); id. at 815 (testimony of
Respondent’s owner and PIC that a
controlled substance prescription for
codeine cough syrup is medicine for a
‘‘communicable disease, . . . I don’t
think any pharmacist would really see
that as a red flag’’) in conjunction with
22 TAC § 291.29(f)(3) (listing
prescriptions for cough syrups
containing codeine, a treatment for a
communicable disease, Tr. 823, as a
‘‘red flag factor’’). The Agency finds that
most of the testimony of Respondent’s
owner and PIC evidences, at best, a deep
15 Respondent’s owner and PIC ‘‘accept[ed]
responsibility’’ for putting a customer’s ID address
as the main address in the patient profile instead
of the customer’s local, Texas, address. Tr. 763–64.
While this testimony might sound like an
acceptance of responsibility, it is not the requisite
acceptance of responsibility required by past
Agency decisions. The Agency interprets this
testimony as a way for Respondent’s owner and PIC
to minimize the illegality of Respondent’s actions
by highlighting that the particular customer was in
the military and, for that reason, had multiple
addresses, and by stating his ‘‘understanding’’ that
the customer was ‘‘living locally’’ when he
presented the controlled substance prescription
instead of resolving and documenting the resolution
of the red flag. Id.
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and endemic misunderstanding of Texas
and federal law.
Testimony of Respondent’s owner and
PIC about what he is ‘‘doing differently
regarding documentation now,’’ given
the OSC, may sound like it describes
Respondent’s proposed remedial
measures, but it does not.16 Tr. 845. The
testimony of Respondent’s owner and
PIC in response to this question starts
with his statement that he has ‘‘changed
a few things’’ with ‘‘rules to go above
and beyond what is required.’’ Id. He
testified that, ‘‘in a lot of cases where
patients are coming from far,’’ he ‘‘will
document more than I like to document
just so that way the situations like this
is prevented,’’ elaborating that he told
all of his employees that ‘‘what we need
is the local address’’ noted as the
‘‘primary address.’’ 17 Tr. 846–47. This
testimony appears to be more indicative
of an attempt to avoid law enforcement
attention in the future rather than of an
accurate understanding of Texas and
federal legal requirements, to recognize,
resolve, and document the resolution of
red flags, and a commitment to comply
with them.
In sum, the record supports the
imposition of a sanction because
Respondent, through its owner and PIC,
did not unequivocally accept
responsibility and because Respondent,
through its owner and PIC, has not
convinced the Agency that it can be
entrusted with a registration.
The interests of specific and general
deterrence weigh in favor of revocation.
The testimony of Respondent’s owner
and PIC repeatedly denied the existence
of any legal violations, let alone
accepted unequivocal responsibility for
them. See, e.g., supra, sections II.B.,
IV.B., and V. Respondent, through its
owner and PIC, has not convinced the
Agency that it understands that its
controlled substance prescription filling
fell short of the applicable legal
standards and that this substandard
controlled substance prescription filling
has serious negative ramifications for
16 In any event, actual remedial measures are
insufficient without an unequivocal acceptance of
responsibility. Brenton D. Wynn, M.D., 87 FR
24,228, 24,261 (2022); see also Michael T. Harris,
M.D., 87 FR 30,276, 30,278 (2022) (collecting
Agency decisions).
17 Respondent’s owner and PIC also testified in
response to this question that he now documents
the ‘‘BMIs’’ (body mass indexes) of customers who
present phentermine prescriptions to be filled,
elaborating ‘‘just so we know on our own that the
doctor’s doing the right thing and also that the
patients really need the medication.’’ Tr. 845. He
testified that he now will also ask the doctor for the
patient’s BMI and document it. Id. at 845–46. Even
if this BMI-related testimony constitutes remedial
measures, which it does not, remedial measures are
insufficient without an unequivocal acceptance of
responsibility.
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the health, safety, and medical care of
individuals who come to it with
controlled substance prescriptions. See,
e.g., Garrett Howard Smith, M.D., 83 FR
18,882, 18,910 (2018) (collecting cases)
(‘‘The egregiousness and extent of the
misconduct are significant factors in
determining the appropriate sanction.’’).
As such, it is not reasonable to believe
that Respondent’s future controlled
substance prescription filling and
recordkeeping will comply with legal
requirements. Further, given the
foundational nature and vast number of
Respondent’s violations, a sanction less
than revocation would send a message
to the existing and prospective
registrant community that compliance
with the law is not a condition
precedent to maintaining a registration.
Accordingly, I shall order the sanction
the Government requested, as contained
in the Order below.
Order
Pursuant to 28 CFR 0.100(b) and the
authority vested in me by 21 U.S.C.
824(a)(4) and 21 U.S.C. 823(f), I hereby
revoke DEA Certificate of Registration
No. FL2190332 issued to Lewisville
Medical Pharmacy. Further, pursuant to
28 CFR 0.100(b) and the authority
vested in me by 21 U.S.C. 824(a) and 21
U.S.C. 823(f), I hereby deny any pending
application of Lewisville Medical
Pharmacy to renew or modify this
registration, as well as any other
pending application of Lewisville
Medical Pharmacy for registration in
Texas. This Order is effective October
31, 2022.
Signing Authority
This document of the Drug
Enforcement Administration was signed
on September 26, 2022, by
Administrator Anne Milgram. That
document with the original signature
and date is maintained by DEA. For
administrative purposes only, and in
compliance with requirements of the
Office of the Federal Register, the
undersigned DEA Federal Register
Liaison Officer has been authorized to
sign and submit the document in
electronic format for publication, as an
official document of DEA. This
administrative process in no way alters
the legal effect of this document upon
publication in the Federal Register.
Heather Achbach,
Federal Register Liaison Officer, Drug
Enforcement Administration.
[FR Doc. 2022–21276 Filed 9–29–22; 8:45 am]
BILLING CODE 4410–09–P
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DEPARTMENT OF JUSTICE
Federal Bureau of Investigation
[OMB Number 1110–0006]
Agency Information Collection
Activities; Proposed eCollection;
eComments Requested; Law
Enforcement Officers Killed or
Assaulted: Extension of a Currently
Approved Collection
Federal Bureau of
Investigation, Department of Justice.
ACTION: 30-day notice.
AGENCY:
The Criminal Justice
Information Services (CJIS) Division,
Federal Bureau of Investigation (FBI),
Department of Justice (DOJ) will be
submitting the following information
collection request to the Office of
Management and Budget (OMB) for
review and approval in accordance with
the Paperwork Reduction Act of 1995.
DATES: The Department of Justice
encourages public comment and will
accept input until October 31, 2022.
FOR FURTHER INFORMATION CONTACT: If
you have additional comments
especially on the estimated public
burden or associated response time,
suggestions, or need a copy of the
proposed information collection
instrument with instructions or
additional information, please contact
Mr. Edward Abraham, Unit Chief,
Module D–1, Criminal Justice
Information Services Division, Federal
Bureau of Investigation, 1000 Custer
Hollow Road, Clarksburg, West Virginia
26306, phone number 304–625–4830.
Written comments and
recommendations for the proposed
information collection should be sent
within 30 days of publication of this
notice to www.reginfo.gov/public/do/
PRAMain. Find this particular
information collection by selecting
‘‘Currently under 30-day Review—Open
for Public Comments’’ or by using the
search function.
SUPPLEMENTARY INFORMATION: Written
comments and suggestions from the
public and affected agencies concerning
the proposed collection of information
are encouraged. Your comments should
address one or more of the following
four points:
• Evaluate whether the proposed
collection of information is necessary
for the proper performance of the
functions of the agency, including
whether the information will have
practical utility;
• Evaluate the accuracy of the
agency’s estimate of the burden of the
proposed collection of information,
SUMMARY:
E:\FR\FM\30SEN1.SGM
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Agencies
[Federal Register Volume 87, Number 189 (Friday, September 30, 2022)]
[Notices]
[Pages 59456-59460]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-21276]
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DEPARTMENT OF JUSTICE
Drug Enforcement Administration
[Docket No. 21-24]
Lewisville Medical Pharmacy; Decision and Order
I. Introduction
On June 9, 2021, the United States Department of Justice, Drug
Enforcement Administration (hereinafter, Agency) issued an Order to
Show Cause and Immediate Suspension of Registration (hereinafter
collectively, OSC) to Lewisville Medical Pharmacy (hereinafter,
Respondent) of Lewisville, Texas. OSC, at 1-2, 11. The OSC immediately
suspended, and proposed the revocation of, Respondent's Drug
Enforcement Administration (hereinafter, DEA) registration No.
FL2190332, pursuant to 21 U.S.C. 824(d) and (a)(4), respectively,
``because . . . [Respondent's] continued registration constitutes `an
imminent danger to the public health or safety' '' and ``because . . .
[Respondent's] continued registration is inconsistent with the public
interest, as that term is defined in 21 U.S.C. 823(f).'' Id. at 1. The
OSC more specifically alleged that, according to Respondent's
``dispensing information'' from at least March 2, 2018, through at
least March 20, 2021, Respondent ``repeatedly filled prescriptions for
Schedule III through V controlled substances in the face of obvious and
unresolved red flags of drug abuse and diversion [hereinafter, red
flags], and therefore, in violation of both federal and Texas law,''
including 21 CFR 1306.04(a) and Texas Health & Safety Code Sec.
481.074(a).\1\ Id. at 2. The OSC includes allegations about pattern
prescribing (which it defines as prescribing the same controlled
substance in identical or substantially similar quantities to multiple
individuals indicating a lack of individualized therapy), distance
(which it defines as traveling abnormally long distances to fill a
controlled substance prescription), cash payment (which it defines as a
common red flag of abuse and diversion as it permits an individual to
avoid scrutiny associated with the use of insurance as part of the
payment process), and shared address (which it defines as multiple
persons with the same address presenting the same or substantially
similar controlled substance prescriptions from the same practitioner)
red flags.\2\ Id. at 4-10.
---------------------------------------------------------------------------
\1\ The Agency is only adjudicating controlled substance
prescriptions in the record that are dated on or after September 16,
2018. See 22 TAC Sec. 291.29 (effective September 16, 2018).
\2\ The phrase ``red flag'' is used in the record before the
Agency with varying accuracy. The testimony of the Government's
expert accurately defines the phrase and a Texas pharmacist's
obligation when presented with a controlled substance prescription,
that is, consistent with federal law. See, e.g., Tr. 555-56; infra,
section II.A. The use of the phrase in Respondent's case, on the
other hand, is not always fully accurate. Infra, section II.B. When
Respondent's case accurately acknowledges circumstances that are red
flags, it rarely states a Texas pharmacist's ensuing obligation
accurately. Id. When Respondent uses the phrase when questioning the
Government's expert, the context out of which the expert responds is
an accurate understanding of the phrase regardless of what
Respondent meant by its question.
---------------------------------------------------------------------------
Respondent timely requested a hearing. Recommended Rulings,
Findings of Fact, Conclusions of Law, and Decision of the
Administrative Law
[[Page 59457]]
Judge (hereinafter, RD), at 1. DEA Administrative Law Judge Paul E.
Soeffing (hereinafter, ALJ) conducted a four-day video teleconference
hearing from November 15 through 18, 2021. Id. On April 1, 2022, the
ALJ issued his RD, recommending revocation of Respondent's
registration.\3\ Id. at 57.
---------------------------------------------------------------------------
\3\ Neither party filed exceptions to the RD.
---------------------------------------------------------------------------
Having thoroughly analyzed the record and applicable law, the
Agency summarizes its findings and conclusions: (1) the Diversion
Control Division (hereinafter, Government) presented a prima facie
case, (2) Respondent attempted, but failed, to rebut the Government's
prima facie case, and (3) substantial record evidence, including the
testimony of the Government's expert witness and large portions of the
testimony of Respondent's owner and Pharmacist-in-Charge (hereinafter,
PIC), shows Respondent's violations of applicable law, violations
against a foundation of the Controlled Substances Act (hereinafter,
CSA). Accordingly, the Agency will revoke Respondent's registration.
Infra, Order.
II. Findings 4
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\4\ The Agency incorporates the parties' Stipulations and
accepts them as fact. RD, at 2-3. The first and second stipulations
address Respondent's DEA registration and its status. Id. at 2.
---------------------------------------------------------------------------
A. The Government's Case
The Government's principal case presented two witness--a Diversion
Investigator and its expert, Diane Ginsburg, Ph.D., whom the ALJ
accepted, without objection, as an expert in Texas retail pharmacy
practice and Texas pharmacy practice.\5\ Tr. 21-85 (DI testimony), id.
at 85-559 (Dr. Ginsburg testimony). Having thoroughly analyzed the
record and applicable law, the Agency agrees with the RD and finds that
Dr. Ginsburg ``presented credible testimony that was internally
consistent and logically persuasive, . . . [and] an objective analysis
. . . [admitting] times where . . . she may not have identified a red
flag.'' RD, at 18. The Agency agrees with the RD and affords Dr.
Ginsburg's testimony ``significant weight'' in this adjudication. Id.
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\5\ In rebuttal, the Government presented one witness, the
undercover Task Force Officer. Tr. 850-95.
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The Agency finds that Dr. Ginsburg's testimony about the red flags
alleged in the OSC constitutes a portion of the substantial record
evidence that Respondent filled controlled substance prescriptions
exhibiting red flags without documenting the resolution of those red
flags, thereby violating applicable legal requirements.\6\ E.g., Tr.
108-120, 122-56, 169-90, 219-57, 261-72, 277-86, 506, 518, 553, 556;
accord, e.g., RD, at 8-11, 13-18, 34-37, 41-45, 47-48.
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\6\ Dr. Ginsburg testified that a ``red flag is something that
would raise suspicion or cause you concern related to a medication
and certainly there are those that have been identified, as well as
types of things that are considered red flags, federally, as well as
within our State that pharmacists are aware of'' and that the
``obligation is to verify validity and then to document the
resolution of that red flag.'' Tr. 555-56; see also RD, at 41.
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B. The Respondent's Case
Respondent's owner and PIC, whom Respondent characterized as ``an
expert on Texas pharmacy law and practice,'' was the only witness
Respondent presented.\7\ Respondent's Prehearing Statement, at 4; Tr.
561-849.\8\ Having thoroughly analyzed the record and applicable law,
the Agency finds that Respondent's owner and PIC is the witness with
the most at stake in this adjudication. The Agency finds that, while
the testimony of Respondent's owner and PIC does include reliable
statements, it also includes statements that lack credibility, are
implausible, and/or are not persuasive. The Agency finds that the
testimony of Respondent's owner and PIC must be considered with much
caution, and where his testimony conflicts with credible record
evidence or applicable law, the Agency does not credit it. Supra,
section II; infra, sections III, IV.B., and V; see also RD, at 27.
---------------------------------------------------------------------------
\7\ At the hearing, however, Respondent did not proffer its
owner and PIC as an expert. Respondent's owner and PIC testified
that he is ``legally responsible'' for ensuring that Respondent, its
operations, its policies, and ``everything'' go ``according to the
rule and the law.'' Tr. 564. He also testified that he filled the
controlled substance prescriptions at issue in this adjudication.
Tr. 848.
\8\ As the parties' closing briefs do not challenge any of the
ALJ's pre-hearing or hearing rulings, and as neither party filed
exceptions, the Agency need not address, and does not address, any
of those rulings in this Decision/Order.
---------------------------------------------------------------------------
The Agency finds substantial record evidence that (1) the testimony
of Respondent's owner and PIC includes his unsupported and previously
undocumented statements justifying, in retrospect, the legitimacy of
controlled substance prescriptions that Respondent filled, (2) the
testimony of Respondent's owner and PIC includes his ensuing
conclusions that there is no red flag on those controlled substance
prescriptions, (3) the testimony of Respondent's owner and PIC includes
his admissions that he did not document the existence or resolution of
any red flag on those controlled substance prescriptions since,
according to him, there were no red flags on the controlled substance
prescriptions and, when there is no red flag on a controlled substance
prescription, there is ``nothing to document,'' and (4) Respondent
filled controlled substance prescriptions without documented resolution
of the red flags on them.\9\ E.g., Tr. 654-56, 664-79, 714-32, 738-53,
758-75, 779-85; see also, e.g., Respondent's Closing Brief with
Proposed Findings of Fact and Conclusions of Law (hereinafter, Resp
Posthearing), at 1-2 (``With a few exceptions, . . . [Respondent]
denies such red flags were present for the prescriptions at issue.'');
RD, at 33 n.33, 40-51, 53-54.
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\9\ ``[A] corresponding responsibility rests with the pharmacist
who fills the prescription.'' 21 CFR 1306.04(a).
The testimony of Respondent's owner and PIC about ``red flags''
and ``potential red flags'' is not fully accurate. He testified at
length on multiple occasions about why, in his view, there is no red
flag on a given controlled substance prescription at issue in this
proceeding. E.g., infra, sections II.B., III., and IV.B. His
testimony lacks legal and factual credibility particularly because
Texas law explicitly lists and clearly articulates what red flags
are, making the identification of red flags on controlled substance
prescriptions a process largely devoid of professional analysis or
judgment, and because the applicable standard of practice requires
the resolution of those red flags and the documentation of the red
flags' resolutions before the controlled substance prescription is
filled. Supra, section II.A.; infra, sections III and IV.B.
---------------------------------------------------------------------------
III. Texas Pharmacists' Professional Responsibility 10
---------------------------------------------------------------------------
\10\ See also 22 TAC Sec. 291.33 (Texas drug utilization review
requirement); RD, at 34-35.
---------------------------------------------------------------------------
According to the CSA, ``Except as authorized by this subchapter, it
shall be unlawful for any person knowingly or intentionally . . . to .
. . distribute, . . . dispense, or possess with intent to . . .
distribute[ ] or dispense, a controlled substance.'' 21 U.S.C.
841(a)(1). The CSA's implementing regulations state that a lawful
controlled substance order or prescription is one that is ``issued for
a legitimate medical purpose by an individual practitioner acting in
the usual course of his professional practice'' and that, while the
``responsibility for the proper prescribing and dispensing of
controlled substances is upon the prescribing practitioner,'' a
``corresponding responsibility rests with the pharmacist who fills the
prescription.'' 21 CFR 1306.04(a); The Pharmacy Place, 86 FR 21008,
21012-14, 21034-35 (2021) (requisite scienter under 21 CFR 1306.04(a)).
The OSC is addressed to Respondent at its registered address in
Texas. Therefore, the Agency also evaluates Respondent's actions
according to Texas law, including the applicable Texas
[[Page 59458]]
pharmacists' professional responsibilities.\11\
---------------------------------------------------------------------------
\11\ See Gonzales v. Oregon, 546 U.S. 243, 269-71 (2006); see
also OSC, at 2-3.
---------------------------------------------------------------------------
During the period alleged in the OSC, Texas law specifically
addressed pharmacists' professional responsibilities concerning red
flags. First, according to Texas law, pharmacists ``shall make every
reasonable effort to ensure that any prescription drug order . . . has
been issued for a legitimate medical purpose by a practitioner in the
course of medical practice.'' 22 TAC Sec. 291.29(b); The Pharmacy
Place, 86 FR at 21012. Further, according to Texas law, a ``pharmacist
shall make every reasonable effort to prevent inappropriate dispensing
due to fraudulent, forged, invalid, or medically inappropriate
prescriptions in violation of a pharmacist's corresponding
responsibility'' and lists ``red flag factors'' that are ``relevant to
preventing the non-therapeutic dispensing of controlled substances''
that ``shall be considered by evaluating the totality of the
circumstances rather than any single factor.'' 22 TAC Sec. 291.29(f);
The Pharmacy Place, 86 FR at 21012; see also Resp Posthearing, at 2-3,
4. A pharmacy's ``dispens[ing]'' a ``reasonably discernible pattern of
substantially identical prescriptions for the same controlled substance
. . . for numerous persons, including a lack of individual drug therapy
in prescriptions issued by the practitioner'' is the first red flag
listed. 22 TAC Sec. 291.29(f)(1). Other red flags explicitly
identified in Texas law that are relevant to this proceeding are
``multiple persons with the same address [who] present substantially
similar controlled substance prescriptions from the same practitioner''
and ``persons [who] consistently pay for controlled substances with
cash or cash equivalents more often than through insurance.'' 22 TAC
Sec. 291.29(f)(11) and (12).
Dr. Ginsburg's testimony, including her explanations of the
standard of practice of Texas pharmacies and Texas pharmacists'
professional responsibilities, is consistent with this legal analysis
and states that the applicable standard of practice is for the
resolution of red flags to be documented before the controlled
substance prescription is filled. Supra, section II.A.; e.g., Tr. 228,
506, 518, 553, 556; accord id. at 588 (Respondent's owner and PIC
testifying about the duty to document the resolution of a red flag).
IV. Discussion
A. The Controlled Substances Act
Under Section 304 of the CSA, ``[a] registration . . . to . . .
distribute[ ] or dispense a controlled substance . . . may be suspended
or revoked by the Attorney General upon a finding that the registrant .
. . has committed such acts as would render his registration under
section 823 of this title inconsistent with the public interest as
determined by such section.'' 21 U.S.C. 824(a)(4). In the case of a
``practitioner,'' which is defined in 21 U.S.C. 802(21) to include a
``pharmacy,'' Congress directed the Attorney General to consider five
factors in making the public interest determination. 21 U.S.C.
823(f)(1-5). The five factors are considered in the disjunctive. Robert
A. Leslie, M.D., 68 FR 15227, 15230 (2003).
According to Agency decisions, the Agency ``may rely on any one or
a combination of factors and may give each factor the weight [it] deems
appropriate in determining whether'' to revoke a registration. Id.; see
also Jones Total Health Care Pharmacy, LLC v. Drug Enf't Admin., 881
F.3d 823, 830 (11th Cir. 2018) (citing Akhtar-Zaidi v. Drug Enf't
Admin., 841 F.3d 707, 711 (6th Cir. 2016); MacKay v. Drug Enf't Admin.,
664 F.3d 808, 816 (10th Cir. 2011); Volkman v. U. S. Drug Enf't Admin.,
567 F.3d 215, 222 (6th Cir. 2009); Hoxie v. Drug Enf't Admin., 419 F.3d
477, 482 (6th Cir. 2005). Moreover, while the Agency is required to
consider each of the factors, it ``need not make explicit findings as
to each one.'' MacKay, 664 F.3d at 816 (quoting Volkman, 567 F.3d at
222); see also Hoxie, 419 F.3d at 482. ``In short, . . . the Agency is
not required to mechanically count up the factors and determine how
many favor the Government and how many favor the registrant. Rather, it
is an inquiry which focuses on protecting the public interest; what
matters is the seriousness of the registrant's misconduct.'' Jayam
Krishna-Iyer, M.D., 74 FR 459, 462 (2009). Accordingly, as the Tenth
Circuit has recognized, findings under a single factor can support the
revocation of a registration. MacKay, 664 F.3d at 821.
According to DEA regulations, ``[a]t any hearing for the revocation
. . . of a registration, the . . . [Government] shall have the burden
of proving that the requirements for such revocation . . . pursuant to
. . . 21 U.S.C. [Sec. ] 824(a) . . . are satisfied.'' 21 CFR
1301.44(e).
In this matter, while all of the 21 U.S.C. 823(f) Factors have been
considered, the Government's evidence in support of its prima facie
case is confined to Factors Two and Four.\12\ Government's Proposed
Findings of Fact and Conclusions of Law, at 18. The Government
presented a prima facie case based on Factors Two and Four, and
portions of the testimony of Respondent's owner and PIC actually admit,
even if unintentionally, to foundational violations of federal law. 21
CFR 1306.04(a), supra, sections II.A., II.B., and III. Accordingly, the
Agency finds that Respondent's continued registration is inconsistent
with the public interest. 21 U.S.C. 824(a)(4) and 823(f)(2) and (f)(4).
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\12\ Neither Respondent nor the Government argues that it
offered evidence relevant to Factors One, Three, or Five. Although
the Agency considered Factors One, Three, and Five, it finds that
none of them is relevant to this adjudication, as the RD recommends.
RD, at 30, n.32.
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B. Factors Two and/or Four--The Respondent's Experience in Dispensing
Controlled Substances and Compliance With Applicable Laws Related to
Controlled Substances
Allegation That Respondent's Registration Is Inconsistent With the
Public Interest
According to the CSA's implementing regulations, a lawful
prescription for controlled substances is one that is ``issued for a
legitimate medical purpose by an individual practitioner acting in the
usual course of his professional practice.'' 21 CFR 1306.04(a); see
Gonzales v. Oregon, 546 U.S. 243, 274 (2006); see also Tex. Health &
Safety Code Sec. 481.074.
Respondent engaged a skillful team and defended itself against the
OSC's allegations. As already noted, the record evidence, including
testimony of Respondent's owner and PIC, contains substantial evidence
of violations of applicable law. Those violations go to the heart of
this Agency's law enforcement mission. Supra, sections II.A., II.B.,
and III; infra, sections IV.B. and V.
Having thoroughly analyzed the record and applicable law, the
Agency finds substantial record evidence, including testimony and
admissions of Respondent's owner and PIC, that (1) Respondent filled
controlled substance prescriptions containing red flags, including red
flags explicitly listed in Texas law, such as pattern prescribing, cash
payment, distance, and shared address and (2) Respondent filled these
controlled substance prescriptions without resolving, and documenting
the resolution of, the red flags on them.\13\
[[Page 59459]]
Supra, sections II.A., II.B., and III. Indeed, Respondent's owner and
PIC repeatedly denied that controlled substance prescriptions at issue
in this proceeding even included a red flag. Supra, section II.B.
Substantial record evidence of any one of the founded controlled
substance prescription violations is sufficient for the Agency to
revoke Respondent's registration.
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\13\ E.g., Government Exhibit (hereinafter, GX) 3, at 3
(customer AC, February 29, 2020, pattern prescribing); GX 3, at 6
(customer AC, October 6, 2020, pattern prescribing); GX 4, at 4
(customer AM, September 21, 2020, pattern prescribing); GX 5, at 2
(customer AR, July 8, 2020, pattern prescribing); GX 12, at 2
(customer DG, July 13, 2019, distance); GX 15, at 2 (customer FL,
June 22, 2020, pattern prescribing); GX 16, at 3 (customer FA,
August 3, 2020, pattern prescribing); GX 17, at 2 (customer GG,
August 5, 2020, pattern prescribing); GX 18, at 2 (customer IS,
March 8, 2019, pattern prescribing); GX 18, at 5 (customer IS, March
29, 2019, pattern prescribing); GX 18, at 8 (customer IS, January 6,
2020, pattern prescribing); GX 18 at 11 (customer IS, September 3,
2020, pattern prescribing); GX 19, at 2 (customer IS, October 5,
2020, pattern prescribing); GX 20, at 109 (customer IG, October 12,
2020, pattern prescribing); GX 21, at 3 (customer IG, September 22,
2020, pattern prescribing); GX 22, at 2 (customer JB, February 7,
2019, distance); GX 22, at 4 (customer JB, May 16, 2019, distance);
GX 22, at 6 (customer JB, March 20, 2020, distance); GX 23, at 2
(customer JS, July 8, 2020, pattern prescribing); GX 24, at 3
(customer JR, October 8, 2020, pattern prescribing); GX 25, at 2
(customer JC, January 23, 2020, shared address and pattern
prescribing with customer AL, January 23, 2020) alone and in
conjunction with GX 60, at 1 (shared address); GX 26, at 3 (customer
JL, July 24, 2020, pattern prescribing); GX 31, at 3 (customer LO,
October 7, 2020, pattern prescribing) alone and in conjunction with
GX 50, at 1 (cash); GX 35, at 3 (customer MO, July 8, 2020, pattern
prescribing); GX 37, at 2 (customer MN, August 26, 2020, pattern
prescribing); GX 41, at 5 (customer PG, January 4, 2020, pattern
prescribing) alone and in conjunction with GX 56, at 1 (cash); GX
41, at 8 (customer PG, March 3, 2020, pattern prescribing) alone and
in conjunction with GX 56, at 1 (cash); GX 42, at 5 (customer RT,
February 11, 2020, pattern prescribing); GX 45, at 2 (customer TS,
February 20, 2020, distance); GX 46, at 18 (customer YG, January 15,
2019, pattern prescribing) alone and in conjunction with GX 51, at 1
(cash); and GX 46, at 24 (customer YG, February 29, 2020, pattern
prescribing) alone and in conjunction with GX 51, at 1 (cash).
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Prior Agency decisions consistently find that controlled substance
prescriptions with these red flags are so suspicious as to support a
finding that the pharmacists who filled them violated their
corresponding responsibility due to actual knowledge of, or willful
blindness to, the prescriptions' illegitimacy. 21 CFR 1306.04(a); see
also, e.g., Tex. Health & Safety Code Sec. Sec. 481.074, 481.128; The
Pharmacy Place, 86 FR at 21013 (collecting Agency decisions).\14\
Indeed, the testimony of Respondent's owner and PIC, during which he
spoke at length about why red flags, that are explicitly listed in
Texas law as such, are not red flags, is record evidence that
Respondent was willfully blind to red flags on the prescriptions it
filled. Supra, section II.B. Accordingly, the Agency finds that there
is substantial record evidence of violations of applicable law and,
therefore, that it is appropriate to sanction Respondent for these
violations. Supra, sections II, III, and IV.
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\14\ Agency decisions have consistently found that prescriptions
with the same red flags at issue here were so suspicious as to
support a finding that the pharmacists who filled them violated the
Agency's corresponding responsibility rule due to actual knowledge
of, or willful blindness to, the prescriptions' illegitimacy. 21 CFR
1306.04(a); see, e.g., Morning Star Pharmacy and Medical Supply 1,
85 FR 51045, 51061 (2020) (pattern prescribing; distance; cash
payments; high doses/quantities of high-alert controlled
substances); Pharmacy Doctors Enterprises d/b/a Zion Clinic
Pharmacy, 83 FR 10876, 10898 (2018), pet. for rev. denied, 789 F.
App'x 724 (11th Cir. 2019) (long distances; pattern prescribing;
cash payments); Hills Pharmacy, 81 FR 49816, 49836-39 (2016)
(multiple customers presenting prescriptions written by the same
prescriber for the same drugs in the same quantities; customers with
the same last name and street address presenting similar
prescriptions on the same day; long distances); The Medicine Shoppe,
79 FR 59504, 59507, 59512-13 (2014) (unusually large quantity of a
controlled substance; pattern prescribing).
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Summary of Factors Two and Four
Respondent did not successfully rebut the Government's prima facie
case, established by substantial record evidence, that it violated
applicable law by filling controlled substance prescriptions without
resolving and documenting the resolution of the red flags on them. 21
CFR 1306.04(a), 22 TAC Sec. 291.29. Accordingly, the Agency finds that
Respondent violated applicable law, supporting the revocation of its
registration. 21 U.S.C. 824(a)(4).
V. Sanction
Where, as here, the Government has met its prima facie burden of
showing that Respondent's continued registration is inconsistent with
the public interest due to its numerous violations pertaining to
controlled substances, the burden shifts to the Respondent to show why
it can be entrusted with a registration. Garrett Howard Smith, M.D., 83
FR 18,882 (2018). Moreover, as past performance is the best predictor
of future performance, DEA Administrators have required that a
registrant who has committed acts inconsistent with the public interest
must accept responsibility for those acts and demonstrate that it will
not engage in future misconduct. Id. A registrant's acceptance of
responsibility must be unequivocal. Id. In addition, a registrant's
candor during the investigation and hearing has been an important
factor in determining acceptance of responsibility and the appropriate
sanction. Id. In addition, DEA Administrators have found that the
egregiousness and extent of the misconduct are significant factors in
determining the appropriate sanction. Id. DEA Administrators have also
considered the need to deter similar acts by the respondent and by the
community of registrants. Id.
Regarding these matters, there is no record evidence that
Respondent, or its owner and PIC, takes responsibility, let alone
unequivocal responsibility, for the founded violations.\15\ Instead,
the testimony of Respondent's owner and PIC is replete with unsupported
and undocumented assertions about why controlled substance
prescriptions evidencing what Texas law labels as ``red flag factors''
are not red flags at all, typically then followed by the incantation
that, if there is no red flag, there is nothing to document. Supra,
sections II.B. and IV.B; see also Tr. 793 (testimony of Respondent's
owner and PIC regarding a prescription that, according to the
customer's profile, shows ``a pretty bad drug interaction,'' and his
assertion that ``you don't necessarily have to document that'' while
acknowledging that ``I know we say document, document, but a lot of
things are expected as a plan of care for patients that are very
important that are not documented'') in conjunction with 22 TAC Sec.
291.33(c)(2)(A)(ii); Tr. 805 (testimony of Respondent's owner and PIC
that ``there was really nothing to document because, typically, with
red flags, the things we want to document is if you think the
prescription is fraudulent''); id. at 815 (testimony of Respondent's
owner and PIC that a controlled substance prescription for codeine
cough syrup is medicine for a ``communicable disease, . . . I don't
think any pharmacist would really see that as a red flag'') in
conjunction with 22 TAC Sec. 291.29(f)(3) (listing prescriptions for
cough syrups containing codeine, a treatment for a communicable
disease, Tr. 823, as a ``red flag factor''). The Agency finds that most
of the testimony of Respondent's owner and PIC evidences, at best, a
deep
[[Page 59460]]
and endemic misunderstanding of Texas and federal law.
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\15\ Respondent's owner and PIC ``accept[ed] responsibility''
for putting a customer's ID address as the main address in the
patient profile instead of the customer's local, Texas, address. Tr.
763-64. While this testimony might sound like an acceptance of
responsibility, it is not the requisite acceptance of responsibility
required by past Agency decisions. The Agency interprets this
testimony as a way for Respondent's owner and PIC to minimize the
illegality of Respondent's actions by highlighting that the
particular customer was in the military and, for that reason, had
multiple addresses, and by stating his ``understanding'' that the
customer was ``living locally'' when he presented the controlled
substance prescription instead of resolving and documenting the
resolution of the red flag. Id.
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Testimony of Respondent's owner and PIC about what he is ``doing
differently regarding documentation now,'' given the OSC, may sound
like it describes Respondent's proposed remedial measures, but it does
not.\16\ Tr. 845. The testimony of Respondent's owner and PIC in
response to this question starts with his statement that he has
``changed a few things'' with ``rules to go above and beyond what is
required.'' Id. He testified that, ``in a lot of cases where patients
are coming from far,'' he ``will document more than I like to document
just so that way the situations like this is prevented,'' elaborating
that he told all of his employees that ``what we need is the local
address'' noted as the ``primary address.'' \17\ Tr. 846-47. This
testimony appears to be more indicative of an attempt to avoid law
enforcement attention in the future rather than of an accurate
understanding of Texas and federal legal requirements, to recognize,
resolve, and document the resolution of red flags, and a commitment to
comply with them.
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\16\ In any event, actual remedial measures are insufficient
without an unequivocal acceptance of responsibility. Brenton D.
Wynn, M.D., 87 FR 24,228, 24,261 (2022); see also Michael T. Harris,
M.D., 87 FR 30,276, 30,278 (2022) (collecting Agency decisions).
\17\ Respondent's owner and PIC also testified in response to
this question that he now documents the ``BMIs'' (body mass indexes)
of customers who present phentermine prescriptions to be filled,
elaborating ``just so we know on our own that the doctor's doing the
right thing and also that the patients really need the medication.''
Tr. 845. He testified that he now will also ask the doctor for the
patient's BMI and document it. Id. at 845-46. Even if this BMI-
related testimony constitutes remedial measures, which it does not,
remedial measures are insufficient without an unequivocal acceptance
of responsibility.
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In sum, the record supports the imposition of a sanction because
Respondent, through its owner and PIC, did not unequivocally accept
responsibility and because Respondent, through its owner and PIC, has
not convinced the Agency that it can be entrusted with a registration.
The interests of specific and general deterrence weigh in favor of
revocation. The testimony of Respondent's owner and PIC repeatedly
denied the existence of any legal violations, let alone accepted
unequivocal responsibility for them. See, e.g., supra, sections II.B.,
IV.B., and V. Respondent, through its owner and PIC, has not convinced
the Agency that it understands that its controlled substance
prescription filling fell short of the applicable legal standards and
that this substandard controlled substance prescription filling has
serious negative ramifications for the health, safety, and medical care
of individuals who come to it with controlled substance prescriptions.
See, e.g., Garrett Howard Smith, M.D., 83 FR 18,882, 18,910 (2018)
(collecting cases) (``The egregiousness and extent of the misconduct
are significant factors in determining the appropriate sanction.''). As
such, it is not reasonable to believe that Respondent's future
controlled substance prescription filling and recordkeeping will comply
with legal requirements. Further, given the foundational nature and
vast number of Respondent's violations, a sanction less than revocation
would send a message to the existing and prospective registrant
community that compliance with the law is not a condition precedent to
maintaining a registration.
Accordingly, I shall order the sanction the Government requested,
as contained in the Order below.
Order
Pursuant to 28 CFR 0.100(b) and the authority vested in me by 21
U.S.C. 824(a)(4) and 21 U.S.C. 823(f), I hereby revoke DEA Certificate
of Registration No. FL2190332 issued to Lewisville Medical Pharmacy.
Further, pursuant to 28 CFR 0.100(b) and the authority vested in me by
21 U.S.C. 824(a) and 21 U.S.C. 823(f), I hereby deny any pending
application of Lewisville Medical Pharmacy to renew or modify this
registration, as well as any other pending application of Lewisville
Medical Pharmacy for registration in Texas. This Order is effective
October 31, 2022.
Signing Authority
This document of the Drug Enforcement Administration was signed on
September 26, 2022, by Administrator Anne Milgram. That document with
the original signature and date is maintained by DEA. For
administrative purposes only, and in compliance with requirements of
the Office of the Federal Register, the undersigned DEA Federal
Register Liaison Officer has been authorized to sign and submit the
document in electronic format for publication, as an official document
of DEA. This administrative process in no way alters the legal effect
of this document upon publication in the Federal Register.
Heather Achbach,
Federal Register Liaison Officer, Drug Enforcement Administration.
[FR Doc. 2022-21276 Filed 9-29-22; 8:45 am]
BILLING CODE 4410-09-P