[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]
-----------------------------------------------------------------------
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]
BILLING CODE 4410-09-M