[Federal Register Volume 60, Number 14 (Monday, January 23, 1995)]
[Notices]
[Pages 4447-4448]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-1560]



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DEPARTMENT OF JUSTICE
Drug Enforcement Administration
[Docket No. 93-73]


Mukand Lal Arora, M.D.; Revocation of Registration

    On July 29, 1993, the Deputy Assistant Administrator (then 
Director), Office of Diversion Control, Drug Enforcement Administration 
(DEA), directed an Order to Show Cause to Mukand Lal Arora, M.D. 
(Respondent), proposing to revoke his DEA Certificate of Registration, 
AA9610850, as a practitioner under 21 U.S.C. 824(a) (2) and (4), and to 
deny any pending applications under 21 U.S.C. 823(f). The Order to Show 
Cause alleged that Respondent had been convicted of a felony related to 
controlled substances and that his continued registration would be 
inconsistent with the public interest.
    Respondent, through counsel, requested a hearing on the issues 
raised in the Order to Show Cause. The matter was docketed before 
Administrative Law Judge Paul, A. Tenney. Following prehearing 
procedures, a hearing was held in Houston, Texas on April 20, 1994.
    On August 9, 1994, Judge Tenney issued his findings of fact, 
conclusions of law, and recommended ruling in which he recommended that 
the respondent's registration be revoked. Neither party filed 
exceptions to this opinion, and on September 9, 1994, the 
administrative law judge transmitted the record of the proceedings to 
the Deputy Administrator.
    The Deputy Administrator has considered the record in its entirety 
and, pursuant to 21 CFR 1316.67, enters his final order in this matter, 
based on findings of fact and conclusions of law as hereinafter set 
forth.
    Judge Tenney found that Respondent completed medical school in New 
Delhi, India, and subsequently completed a residency and internship in 
Staten Island, New York, and four years of psychiatric training in 
Austin, Texas. In 1980, Respondent started a private medical practice 
in Houston, Texas. Respondent's primary language is Indian-Punjabi, but 
he was taught English in a professional school in India. Respondent is 
licensed to practice medicine in Texas, is primarily engaged in a 
pediatric practice, and has never had his medical license suspended or 
been previously disciplined.
    Judge Tenney found that in 1991, DEA received information from 
local pharmacists regarding Respondent's prescribing practices. DEA 
initiated an investigation using a Houston Police Department officer in 
an undercover capacity. In May 1991, the undercover officer visited 
Respondent's medical office and requested a prescription for either 
Vicodin or Tylenol #4 with codeine, Schedule III controlled substances. 
The visit was monitored and tape-recorded by DEA investigators. The 
undercover officer told Respondent that he needed the medication ``just 
to mellow out at the end of the day''. Respondent asked the undercover 
officer if he was addicted, to which the officer replied, ``no''. 
Respondent asked the undercover officer whether the prescription was 
for backache, to which the officer replied, ``no''. Although Respondent 
did check the undercover officer's blood pressure and chest, he did not 
pursue the nature of the undercover officer's complaint. The undercover 
officer was given a prescription for 30 Vicodin tablets. The undercover 
officer made two subsequent visits to Respondent's office in July 1991, 
each time receiving another prescription for 30 Vicodin tablets without 
giving an indication of any medical purpose and denying any physical 
complaint. During these visits, the undercover officer indicated that 
he loaded trucks for a local newspaper.
    The administrative law judge found that on November 9, 1992, 
Respondent was convicted in the District Court of Harris County, Texas, 
of the felony offense of prescribing a controlled substance without a 
legitimate medical purpose, arising out of one of the aforementioned 
undercover operations. Respondent was sentenced to two years probation, 
fined, and was given a deferred adjudication.
    Respondent contended that the Government transcripts of the 
undercover visits were unreliable. The administrative law judge found 
that although segments of the transcripts of the undercover visits 
indicated that some parts of the conversations were ``inaudible'', the 
Government presented persuasive and credible testimony that the 
transcripts accurately represented the conversations monitored at 
Respondent's medical office. Neither party offered in evidence the 
tapes themselves, which were available at the hearing.
    In his testimony, Respondent asserted that he considered the nature 
of the undercover officer's work--specifically, loading trucks for a 
newspaper--in evaluating the officer's condition and prescribing 
controlled substances. Respondent further stated that he based the 
diagnosis of backache on his visual observation of the undercover 
officer's movement, and that he had not conducted a physical 
examination because the patient was not cooperative. 
[[Page 4448]] Respondent further stated that he understood that when 
the patient asked for drugs in order to ``mellow out'', that the term 
meant ``easing of the pain''.
    Judge Tenney questioned Respondent's credibility based on findings 
that Respondent never learned that the undercover officer ostensibly 
had a job unloading trucks until the second office visit, and thus 
could not provide a justification for prescribing controlled substances 
on the first visit. In addition, although Respondent attributed back 
pain to the undercover officer, which he apparently diagnosed by visual 
observation, there were no attempts at alternative treatment, no record 
of a prior history or specific diagnosis, and no verbal indication of 
pain by the patient. The administrative law judge found that 
Respondent's question of ``[a]re you addicted?'' to the undercover 
officer's statement about wanting to ``mellow out'', indicated that 
Respondent had knowledge of this reference to a street use of Vicodin. 
The administrative law judge found that Respondent did not prescribe 
Vicodin for legitimate medical purpose and in the usual course of 
professional practice.
    The administrative law judge found that Respondent made entries in 
the patient medical record of the undercover officer indicating ``pains 
and aches'', and notations of ``backaches and headaches'', or ``pain in 
the lower back'' due to the fact that the patient ``loads and unloads 
the truck''. The testimony of the Government witnesses and the 
transcriptions of the tapes had no reference to any pain or aches by 
the undercover officer. Judge Tenney concluded that Respondent's 
medical record entries were not consistent with the conversations that 
were monitored, recorded and transcribed.
    Under 21 U.S.C. 824(a)(4), the Deputy Administrator of the Drug 
Enforcement Administration may revoke the registration of a 
practitioner upon a finding that the registrant has committed such acts 
as would render his registration under Section 823 inconsistent with 
the public interest.
    Pursuant to 21 U.S.C. 823(f), ``[i]n determining the public 
interest, the following factors will be considered:
    (1) The recommendation of the appropriate State licensing board or 
professional disciplinary authority.
    (2) The applicant's experience in dispensing, or conducting 
research with respect to controlled substances.
    (3) The applicant's conviction record under Federal or State laws 
relating to the manufacture, distribution, or dispensing of controlled 
substances.
    (4) Compliance with applicable State, Federal, or local laws 
relating to controlled substances.
    (5) Such other conduct which may threaten the public health and 
safety.''
    It is well established that these factors are to be considered in 
the disjunctive, i.e., the Deputy Administrator may properly rely on 
any one or a combination of factors, and give each factor the weight he 
deems appropriate. Henry J. Schwarz, Jr., M.D., 54 FR 16422 (1989).
    Of the stated factors, the administrative law judge found that the 
Government established a prima facie case for revocation under 21 
U.S.C. 823(f) (2), (4), and (5) in that Respondent prescribed 
controlled substances on three occasions, absent a valid medical 
indication; that he violated Federal and State law by prescribing 
controlled substances on three occasions without a legitimate medical 
purpose; and that his conduct in falsifying patient records posed a 
threat to the public health and safety. Judge Tenney found little 
evidence that Respondent attempted to treat a medical condition, in 
that he neglected to learn the patient's medical history or ask the 
patient about his actual physical complaint before prescribing Vicodin. 
Judge Tenney also found that Respondent's conviction and sentence of 
probation and deferred adjudication under Texas law may be considered 
under factor (3).
    Judge Tenney concluded that the preponderance of the evidence 
establishes that Respondent's registration is not in the public 
interest. However, Judge Tenney also recommended that in light of 
Respondent's successful completion of deferred adjudication in the 
state district court, that favorable consideration be given to 
Respondent's application after the passage of one year.
    The Deputy Administrator adopts the findings of fact, conclusions 
of law, and recommended ruling of the administrative law judge in its 
entirety. Based on the foregoing, the Deputy Administrator concludes 
that Respondent's continued registration is inconsistent with the 
public interest. Accordingly, the Deputy Administrator of the Drug 
Enforcement Administration, pursuant to the authority vested in him by 
21 U.S.C. 823 and 824 and 28 CFR 0.100(b) and 0.104, hereby orders that 
DEA Certificate of Registration, AA9610850, issued to Mukand Lal Arora, 
M.D., be and it hereby is, revoked, and any pending applications, be, 
and they hereby are, denied. This order is effective February 22, 1995.

    Dated: January 13, 1995.
Stephen H. Greene.
Deputy Administrator.
[FR Doc. 95-1560 Filed 1-20-95; 8:45 am]
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