[Federal Register Volume 69, Number 29 (Thursday, February 12, 2004)]
[Notices]
[Pages 7018-7022]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-3127]


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DEPARTMENT OF JUSTICE

Drug Enforcement Administration


Mark Wade, M.D.; Revocation of Registration

     On October 4, 2002, the Deputy Assistant Administrator, Office of 
Diversion Control, Drug Enforcement Administration (DEA), issued an 
Order to Show Cause to Mark Wade, M.D. (Respondent) at his registered 
location in Memphis, Tennessee. The Order to Show Cause notified the 
Respondent of an opportunity to show cause as to why DEA should not 
revoke his DEA Certificate of Registration, AW1747166, and deny any 
pending applications for modification or renewal of that registration, 
pursuant to 21 U.S.C. 824(a)(4) and 823(f), for reason that the 
Respondent's registration was inconsistent with the public interest.
     The Acting Deputy Administrator's review of the investigative file 
reveals that the Order to Show Cause was received on behalf of the 
Respondent on October 17, 2002. By letter dated October 28, 2002, the 
Respondent directed a letter to the Hearing Clerk of the Office of 
Administrative Law Judges notifying of his desire to waive his right to 
a hearing in the matter. The Respondent also requested that the DEA 
Administrator forgo revocation proceedings based on the anticipated 
surrender of his DEA Certificate of Registration as part of a 
sentencing proceeding in Federal court scheduled for January 9, 2003. 
There is however, no information in the investigative file that the 
Respondent has surrendered his DEA registration.
     Therefore, finding that the Respondent has requested the waiver of 
his right to a hearing and after considering material from the 
investigative file in this matter, the Acting Deputy Administrator now 
enters her final order without a hearing pursuant to 21 CFR 1301.43(e) 
and 1301.46.
     A review of the investigative file reveals that on or about 
September 19, 1995, the Tennessee Board of Medical Examiners (Tennessee 
Board) adopted a policy statement titled, ``Management of Prescribing 
with Emphasis on Addictive and Dependence-Producing Drugs.'' Step One 
advises: ``First and foremost, before [prescribing any drug], start 
with a diagnosis which is supported by history and physical findings, 
and by the results of any appropriate tests'' and ``do a workup 
sufficient to support a diagnosis including all necessary tests.'' Step 
Three of the policy statement specifies that ``Before beginning a 
regimen of controlled drugs, [a determination should be made] through 
trial or a documented history that non-addictive modalities are not 
appropriate or they do not work.'' Step Four of the policy statement 
cautions prescribing physicians to make sure they ``are not dealing 
with a drug-seeking patient.''
     On September 13, 2000, the Tennessee Board adopted a Position 
Statement titled, ``Prerequisites to Prescribing Drugs In Person, 
Electronically, Or Over the Internet.'' In its adoption of the position 
statement, the Board outlined its interpretation of Tennessee Code 
Annotated, Sections 63-6-214(b)(1), (4), and (12). The Tennessee 
Board's statement posits in relevant part, that ``it shall be a prima 
facie violation of T.C.A. 63-6-214(b)(1), (4), and (12) for a physician 
to prescribe or dispense any drug to any individual, whether in person 
or by electronic means or over the Internet or over telephone lines, 
unless the physician has first done and appropriately documented, for 
the person to whom a prescription is to be issued or drugs dispensed, 
all of the following:
     (a) Performed an appropriate history and physical examination;
     (b) Made a diagnosis based upon the examinations and all 
diagnostic and laboratory tests consistent with good medical care; and
     (c) Formulated a therapeutic plan, and discussed it, along with 
the basis for it and the risks and benefits of various treatment 
options, a part of which might

[[Page 7019]]

be the prescription or dispensing drug, with the patient; and
     (d) Insured the availability of the physician or coverage for the 
patient for follow-up care.''
    The Acting Deputy Administrator's review of the investigative file 
reveals that William Stallknecht (Mr. Stallknecht), a pharmacist, was 
part owner and operator of Pill Box Pharmacy (hereinafter referred to 
as Pill Box), a drug store concern with two locations in San Antonio, 
Texas. Included among the business operations of Pill Box was a Web-
based pharmacy with an Internet address of ``thepillbox.com,'' as well 
as a related Web-based physician referral service which operated under 
a separate Internet address.
    DEA's investigation further revealed that following launch of his 
Internet Web sites, Mr. Stallknecht then contracted with various 
physicians around the country to conduct customer consultations. A 
review of the investigative file further reveals that by 1998 or 1999, 
Pill Box extended its Internet service to controlled substances. 
Customers reportedly logged on to ``thepillbox.com'' Web site and 
requested a physician consultation. Customers were then provided 
questionnaires to complete and could request a physician consultation 
via e-mail from the linked Web site, PHYSICIAN REFERRAL 2000, or by a 
direct phone call to Pill Box employee, Brian Hildebrand (Mr. 
Hildebrand). The customer would then be given a physician's telephone 
number and instructed to contact the physician at a specific time and 
date. The patient would telephonically contact the physician who in 
turn would prescribe controlled substances for the customer after a 
brief telephonic conversation, usually lasting ten (10) minutes or 
less. These consultations did not include face-to-face physician-
patient interaction, a physical exam or any medical tests. Following 
these brief consultations, the requested drug(s) would then be 
dispensed and shipped to the customer by Pill Box.
    DEA's investigation further revealed that when a Pill Box 
contracting physician received a customer questionnaire, he would issue 
prescriptions, generally for hydrocodone or a brand of hydrocodone, as 
well as diazepam. In most cases, the Pill Box contracting physician 
issued 100 dosage units of hydrocodone with three refills, lesser 
amounts of Valium (with three refills), propoxyphene (both Schedule IV 
controlled substances), or a similar drug.
    The contracting physician would then send the prescriptions by 
facsimile to the Pill Box location and the pharmacy would dispense the 
drugs by overnight mail pursuant to the contracting physician's 
prescription. Payment for the physician consultation, prescription 
drugs, and shipping costs were all collected by the Pill Box via credit 
card, money order, cash, or C.O.D. from the customer. DEA's 
investigation further revealed that Pill Box collected approximately 
$100.00 in physician consultation fees from each customer and the 
pharmacy in turn made payments (or rebates as they were also called) to 
contracting physicians based upon the number of prescriptions 
authorized by the physician.
    The Acting Deputy Administrator finds that the Respondent has been 
registered as a practitioner with DEA since 1986, and has practiced 
medicine in California (1986-1988), Louisiana (1988-1992), Florida 
(1992-1995), and Arizona (1995-1999). The Respondent is currently 
registered with DEA at a location in Memphis, Tennessee, and is also 
licensed to practice medicine in that State. At the time of DEA's 
investigation, the Respondent was a salaried employee at a cardiology 
practice located in Memphis, where he earned a gross salary of roughly 
$300,000 per year.
    In response to information regarding the possible unlawful 
distribution of controlled substances by Pill Box, on June 12, 2001, 
law enforcement officers executed a Federal search of one of the 
pharmacy's San Antonio locations. Computer records seized from the 
pharmacy revealed that from January 1, 2000 through June 12, 2001, the 
Respondent authorized a total of approximately 21,199 prescriptions 
through Pill Box's Internet referral operation. Approximately 14,029 of 
those prescriptions were for brand name Schedule III controlled 
substances, including, Lorcet, Lortab, Vicodin and Zydone, as well as 
generic hydrocodone products. Approximately 1,113 of those 
prescriptions were for Valium.
    In furtherance of its investigations of Pill Box and the 
Respondent, on September 12, 2001, the Respondent was interviewed in 
San Antonio, Texas by a representative of the United States Attorney's 
Office, agents from the Criminal Investigation Unit of the Internal 
Revenue Service (IRS) and DEA Diversion Investigators. During the 
course of the interview, the Respondent disclosed that in 1999, he, 
along with his family (wife and child) moved from Phoenix, Arizona to 
Memphis, Tennessee. The Respondent stated that the move was prompted in 
part by an unsuccessful and financially strapped medical practice group 
in Phoenix (that later went bankrupt), and the Respondent's desire to 
improve the financial situation of he and his family. DEA's 
investigation revealed that at the time the Respondent moved to 
Memphis, he was in debt to the IRS for about $131,000, and he had also 
incurred substantial credit card debt.
    The Respondent further disclosed that in or around September or 
October of 1999, he found the Pill Box Web site and his attention was 
drawn to the pharmacy's solicitation of physicians to conduct 
consultations for customers. The Respondent subsequently responded to 
the request, and a few months later, he was contacted by Mr. Hildebrand 
concerning customer consultations for Pill Box. Following a discussion 
regarding the pharmacy's consultation procedure, the Respondent decided 
to join Pill Box as a consulting physician.
    The Respondent further disclosed during the September 12, 2002, 
interview with law enforcement personnel that he saw his association 
with Pill Box as a ``moonlighting'' opportunity, and that he hoped 
thereby to be able to pay off the indebtedness he had incurred. 
Although he indicated his then understanding that the practice was 
legal, DEA's investigation revealed that the Respondent nevertheless 
did not consult with anyone, including the Tennessee Medical Board, 
with questions about the legality of Internet consultations or 
prescribing for Internet-based pharmacies.
    Sometime within the first week of January, 2000, the Respondent 
conducted his first telephone consultation on behalf of Pill Box. The 
consultations were carried out at his residence, where Respondent had a 
separate telephone line installed for that purpose. The Respondent 
typically conducted consultations during the evenings after working 
during the day at his cardiology practice. Shortly thereafter, the 
Respondent began issuing prescriptions for controlled substances to 
Internet customers.
    During the September 12, 2002, interview, the Respondent admitted 
being aware that a high percentage of the prescriptions he authorized 
were for hydrocodone products, but added however, that the people for 
whom the prescriptions were issued were ``between doctors or 
insurance'', and he thought that they had a genuine need for these 
drugs. The Respondent further added that he turned down a number of 
people he thought were ``bogus.''
    The Respondent further disclosed to law enforcement personnel that 
he first

[[Page 7020]]

became aware of possible ``problems'' in the operation of Pill Box in 
early 2001: He recalled hearing from Mr. Hildebrand that another 
Internet referring physician for Pill Box was being investigated. The 
investigative file however does not disclose the source of the 
purported investigation. The Respondent also voiced concerns that 
stemmed from complaints that he received from customers who stated that 
they had not received the drugs he had prescribed and his suspicion 
that Mr. Hildebrand was using Respondent's name for other prescriptions 
not authorized by the Respondent. The Respondent informed law 
enforcement personnel that he terminated his relationship with Pill Box 
on February 5, 2001.
    The Respondent further divulged that following the termination of 
his business relationship with Pill Box, he went on to perform paid 
consultations for three other Web-based pharmacies located in Florida, 
Oklahoma, and Alabama. Each of the referenced pharmacies, like Pill 
Box, facilitated the purchase of various drugs over the Internet by 
visitors to their respective Web sites. With respect to the Oklahoma-
based Internet site, the Respondent told law enforcement authorities 
that the pharmacist at that location agreed to accept faxed 
prescriptions from the Respondent. However the arrangement was 
discontinued in March 2001, when the Respondent was informed by the 
pharmacist that the latter was under investigation.
    DEA's investigation further revealed that the Respondent did not 
perform an examination of any of the patients to whom he authorized 
controlled substances through Pill Box, or any of the other online 
pharmacies for which he provided consultations. Conversely, the 
Respondent stated during his September 2001 interview with law 
enforcement personnel that he typically spent thirty to forty-five 
minutes with a new patient in his cardiology practice, excluding time 
spent by office personnel taking a patient's weight, blood pressure, 
and pulse. The Respondent added that a typical visit with an 
established cardiology patient would be fifteen to twenty minutes. The 
Respondent further contrasted his practice of cardiology with Internet 
prescribing in that the services he provided to the internet customers 
was meant only to be an interim measure.
    The Respondent further informed law personnel that he once told Mr. 
Hildebrand that he did not want consultations scheduled with customers 
from Memphis, Tennessee because the Internet practice would be in 
conflict with the Respondent's regular medical practice. The Respondent 
further requested that Mr. Hildebrand not schedule the Respondent's 
consultations with any customers in the State of Tennessee so as to 
reduce his chance of ``getting into trouble'' with the state's medical 
board.
    The investigative file further reveals that in or around May 2000, 
the Respondent was notified by an investigator for the Illinois Medical 
Board that it was illegal for the Respondent to prescribe drugs to 
patients in Illinois since the Respondent was not licensed to practice 
medicine there. The Respondent later sent a letter to the Illinois 
Medical Board stating that he would refrain from prescribing to 
patients in that State. The investigative file further reveals that the 
Respondent was informed by Mr. Hildebrand that other States such as 
Kansas were ``cracking down,'' apparently on Internet-based prescribing 
practices. As a result, the Respondent included Kansas as a State from 
which he would not accept customer consultations on behalf of online 
pharmacies.
    On March 25, 2002, DEA's San Antonio District Office received a 
written complaint statement and other documents regarding the 
Respondent and Pill Box Pharmacy from ``NH'', an individual apparently 
recovering from drug addiction. NHG informed DEA that she and her 
daughter, ``AB'' had obtained via the Internet and telephonic 
consultations, controlled substances (specifically Lortab) from the 
Respondent and other Pill Box contracting physicians. NH further 
divulged that appointments for physician consultations were arranged by 
Mr. Hildebrand and prescriptions were then dispensed by Pill Box. With 
respect to repayment arrangements for requested medications, NH wrote: 
``In the beginning[,] you could use Visa, MasterCard, etc., but later 
patients were told that this created a paper trail, therefore [Mr. 
Hildebrand] could no longer accept anything but money orders.'' DEA 
received further information that NH and AB have since undergone a drug 
rehabilitation program after becoming addicted to the controlled 
substances, including those received from Pill Box.
    By letter dated December 20, 2001, the DEA San Antonio District 
Office was informed by ``NB'' that her son ``PB'' had received more 
than 100 dosage units of hydrocodone (Lortab) with two refills from a 
prescription authorized by ``Dr. William Dale'', and the prescriptions 
were filled by Pill Box. At the time PB received the prescription in 
question, he resided in Birmingham, Alabama. There is no information in 
the investigative file that the Respondent was either licensed to 
practice medicine in Alabama or treated patients from that State. The 
letter of NB went on to generally describe PB's resulting drug 
addiction requiring hospitalization in an intensive care unit, and 
subsequent care at a mental care facility. The letter further disclosed 
that controlled substances received by PB eventually led to his 
overdose of the drugs, and NB described PB as having ``damaged brain 
cells'' and an ``uncertain prognosis.'' A review of prescription 
information obtained by DEA from Pill Box revealed that on three 
separate occasions from January to March 2001, the Respondent 
authorized prescriptions for PB, each for 100 tablets of Lortab. These 
controlled substances were subsequently delivered to PB by Pill Box.
    The investigative file contains several additional instances where 
individuals contacted DEA regarding difficulties they experienced 
(i.e., drug abuse, dependency and addition) after obtaining controlled 
substances authorized by the Respondent, and other Internet referring 
physicians affiliated with Pill Box.
    The Acting Deputy Administrator's review of the investigative file 
further reveals a copy of a plea agreement listing the Respondent as a 
defendant in a criminal action before the United States District Court 
for the Western District of Texas. The plea agreement, which was signed 
by the Respondent on October 4, 2002, set forth certain stipulations of 
fact agreed upon by the parties, including findings that in 2000, the 
Respondent began prescribing controlled substances for Pill Box' 
Internet referral customers, who lived throughout the continental 
United States and abroad, with ``no face-to-face contact with these 
customers''; and, that in the course of a conspiracy with Pill Box and 
William Stallknecht, and in relation to illegal prescriptions which 
were filled by the pharmacy, the Respondent received a sum in excess of 
$27,858.30 which constituted proceeds of the illegal dispensing of 
42,750 dosages units of diazepam.
     The plea agreement further referenced the Respondent's agreement 
to waive indictment, and plead guilty to a charge set forth in a 
criminal information, specifically, conspiracy to dispense Schedule IV 
controlled substances in violation of 21 U.S.C., sections 846, 
841(a)(1) and 841(b)(1)(D)(2). The Respondent also agreed to forfeit 
and surrender is DEA Certificate of Registration at the time of 
sentencing on the above referenced charge. However,

[[Page 7021]]

there is no information in the investigative file regarding the 
imposition of any sentence upon the Respondent.
     Pursuant to 21 U.S.C. 823(f) and 824(a)(4), the Acting Deputy 
Administrator may revoke a DEA Certificate of Registration and deny any 
pending application for renewal of such registration, if she determines 
that the continued registration would be inconsistent with the public 
interest. Section 823(f) requires that the following factors be 
considered in determining the public interest:
     (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 or 
safety.
     These factors are to be considered in the disjunctive; the Acting 
Deputy Administrator may rely on one or a combination of factors and 
may give each factor the weight she deems appropriate in determining 
whether a registration should be revoked or an application for 
registration denied. See Henry J. Schwartz, Jr., M.D., 54 FR 16422 
(1989).
     In this case, the Acting Deputy Administrator finds factors two, 
three, four and five relevant to a determination of whether the 
Respondent's continued registration remains consistent with the public 
interest.
     With regard to factor one, the recommendation of the appropriate 
State licensing board or professional disciplinary authority, there is 
no evidence in the investigative file that the Respondent has been the 
subject of a State disciplinary proceeding, nor is there evidence 
demonstrating that Respondent's medical license or State controlled 
substance authority are currently restricted in any form. Nevertheless, 
State licensure is a necessary, but no sufficient condition for 
registration, and therefore, this factor is not dispositive. See e.g., 
Wesley G. Harline, M.D., 65 FR 5665 (2000) James C. LaJevic, D.M.D., 64 
FR 55962 (1999).
     With regard to factors two and four, the Acting Deputy 
Administrator finds that the primary conduct at issue in this 
proceeding (i.e., the unlawful authorization of controlled substance 
prescriptions for use by Internet customers) relates to both the 
Respondent's experience in dispensing controlled substances, as well as 
his compliance with applicable State, Federal, or local laws relating 
to controlled substances. Therefore, the Acting Deputy Administrator 
combines these factors under 21 u.S.C. 823(f)(2) and (4). See, Service 
Pharmacy, Inc., 61 FR 10791, 10795 (1996).
     A DEA registration authorizes a physician to prescribe or dispense 
controlled substances only within the usual course of his or her 
professional practice. For a prescription to have been issued within 
the course of a practitioner's professional practice, it must have been 
written for a legitimate medical purpose within the context of a valid 
physician-patient relationship. Paul J. Caragine, Jr., 63 FR 51592, 
51600 (1998). Legally, there is absolutely no difference between the 
sale of an illicit drug on the street and the illicit dispensing of a 
licit drug by means of a physician's prescription. See Floyd A. 
Santner, M.D., 55 FR 37581 (1990).
    Factors two and four are relevant to the Respondent's authorization 
of more than 14,000 prescriptions for Schedule III and IV controlled 
substances from January 1, 2000 through June 12, 2001. The Acting 
Deputy Administrator concludes from a review of the recor4d that the 
Respondent did not establish a valid physician-patient relationship 
with internet customers to whom he prescribed controlled substances. 
See, Abel J. Sands, M.D., 59 FR 781 (1994). DEA has previously found 
that prescriptions issued through a pharmacy Internet Web site are not 
considered as having been issued in the usual course of medical 
practice, in violation of 21 CFR 1306.04. Rick Joe Nelson, 66 FR 30752 
(2001). The Acting Deputy Administrator also finds that the 
Respondent's actions in this regard were not in compliance with State 
law as his issuance of controlled substance prescriptions to internet 
customers violated Tennessee State law. T.C.A. 63-6-214(b)(1), (4) and 
(12).
    In the instant case, the Respondent conducted scant consultations 
(some lasting as little as five minutes) on behalf of a pharmacy that 
offered access to controlled substances over the Internet. These 
prescriptions were authorized without the benefit of face-to-face 
physician-patient contact, physical exam or medical test. There is no 
information in the investigative file demonstrating that the Respondent 
even took the time corroborate responses to questionnaires that were 
submitted by Pill Box's customers. Most, if not all of these customers 
were outside of the area where the Respondent's primary medical 
practice was located. Here, it is clear that the issuance of controlled 
substance prescriptions to persons whom the prescribing physician has 
not established a valid physician-patient relationship is a radical 
departure from the normal course of professional practice.
    With regard to factor three, applicant's conviction record under 
Federal or State laws relating to the dispensing of controlled 
substances, the record reveals that the Respondent has been convicted 
of a felony related to controlled substances. On October 4, 2002, the 
Respondent entered into a plea agreement on a Federal charge of 
conspiracy to dispense Schedule IV controlled substances in violation 
of 21 U.S.C. 846, 841(a)(1) and 841(b)(1)(D)(2). DEA has previously 
held that guilty pleas to charges related to unlawful handling of 
controlled substances are applicable to a finding under factor three. 
Trudy J. Nelson, M.D., 66 FR 52941 (2001); John C. Turley, III, M.D., 
62 FR 14948 (1997); Yu-To Hsu, M.D., 62 FR 12840 (1997).
    Regarding factor five, such other conduct which may threaten the 
public health or safety, the Acting Deputy Administrator finds this 
factor relevant to the Respondent's continued prescribing to Internet 
customers, at a time when the Tennessee Medical Board adopted a policy 
statement and a position statement designed to assist licensed 
practitioners in the proper prescribing of dangerous controlled drugs. 
Ironically, the Respondent is currently licensed to practice medicine 
in a jurisdiction which sought to specifically address the proper 
procedures for the issuance of prescriptions through electronic means 
(i.e., via the Internet). While the record is unclear as to whether the 
Tennessee Board's position statements on proper prescribing practices 
were ever disseminated to the State's licensed physicians, the 
Respondent demonstrated clearly that he possessed some knowledge of the 
possible unlawful nature of his conduct, as evidenced by his statements 
to law enforcement authorities of his desire to avoid legal 
entanglements with the Tennessee Board. Factor five is further relevant 
to the Respondent's continued authorization of prescriptions for 
Internet customers even while receiving warnings from authorities in 
Illinois and Kansas that the practice may be subject to restriction in 
those jurisdictions. Factor five is also relevant to Respondent's 
continued Internet consultations despite receiving information that 
another Pill Box consulting physician as well as a

[[Page 7022]]

pharmacist in Oklahoma were under investigation for participating in 
Internet drug distribution ventures. Despite the Respondent's 
demonstrated awareness of the legal prohibitions surrounding his 
prescribing on behalf of online pharmacies, there is no evidence in the 
record that he ever sought guidance from the Tennessee Board or from 
any law enforcement entity regarding the appropriateness of such 
prescribing.
    The Acting Deputy Administrator is deeply concerned about the 
increased risk of diversion which accompanies Internet controlled 
substance transactions. Given the nascent practice of cyber-
distribution of controlled drugs to faceless individuals, where 
interaction between individuals is limited to information on a computer 
screen or credit card, it is virtually impossible to insure that these 
highly addictive, and sometimes dangerous products will reach the 
intended recipient, and if so, whether the person purchasing these 
products has an actual need for them. It is against this backdrop that 
the Acting Deputy Administrator finds factor five relevant to 
complaints received by the Respondent that Pill Box customers had not 
received drugs that he authorized, and relevant to information received 
by the Respondent that a Pill Box employee may have used the 
Respondent's name for prescriptions not authorized.
    Factor five is further relevant to the Respondent's apparent role 
in exacerbating drug abuse and addition on the part of customers that 
received controlled substances through Internet consultations. As noted 
above, DEA received letters on behalf of individuals who became 
severely impaired by controlled substances authorized by the Respondent 
and distributed by Pill Box. The ramifications of obtaining dangerous 
and highly addictive drugs with the ease of logging on to a computer 
and the use of a credit card are disturbing and immense, particularly 
when one considers the growing problem of the abuse of prescription 
drugs in the United States.
    In a 2001 report, the National Clearinghouse for Alcohol and Drug 
Information estimated that 4 million Americans ages 12 and older had 
acknowledged misusing prescription drugs. That accounts for 2% to 4% of 
the population--a rate of abuse that has quadrupled since 1980. 
Prescription drug abuse--typically of painkillers, sedatives and mood-
altering drugs--accounts for one-third of all illicit drug use in the 
United States. Article by Melissa Healy, The Los Angeles Times, 
December 1, 2003.
    The Acting Deputy Administrator finds that with respect to Internet 
transactions involving controlled substances, the horrific untold 
stories of drug abuse, addiction and treatment are the unintended, but 
foreseeable consequence of providing highly addictive drugs to the 
public without oversight. The closed system of distribution, brought 
about by the enactment of the Controlled Substances Act, is completely 
compromised when individuals can easily acquire controlled substances 
without regard to age or health status. Such lack of oversight 
describes Pill Box's practice of distributing controlled substances to 
indistinct Internet customers, and the Respondent's authorization of 
those drugs on behalf of the pharmacy. Therefore, the Respondent's 
actions in contributing to the abuse of controlled substances by 
customers of Pill Box is relevant under factor five and further 
supports the revocation of his DEA Certificate of Registration.
    Factor five is further relevant to the Respondent's participation 
in pharmacy Internet business ventures after terminating his business 
relationship with Pill Box. As noted above, the Respondent demonstrated 
some knowledge that his prescribing on behalf of Internet pharmacies 
was unlawful. Nevertheless, following the termination of his business 
relationship with Pill Box, the Respondent actively sought to associate 
himself with other similar ventures, and admitted to providing 
consultations to Internet referral customers on behalf of online 
pharmacies in Florida, Oklahoma and Alabama.
    It appears that the Respondent's actions in this regard were 
motivated purely by profit. In his selfish pursuit of financial gain, 
the Respondent demonstrated a cavalier disregard for controlled 
substance laws and regulations and a disturbing indifference to the 
health and safety of customers who purchased dangerous drugs through 
the Internet. Such demonstrated lack of character and adherence to the 
responsibilities inherent in a DEA registration show in no uncertain 
terms that the Respondent's continued registration with DEA would be 
inconsistent with the public interest.
    Accordingly, the Acting Deputy Administrator of the Drug 
Enforcement Administration, pursuant to the authority vested in her by 
21 U.S.C. 823 and 824 and 28 CFR 0.100(b) and 0.104, hereby orders that 
DEA Certificate of Registration AW174166, previously issued to Mark 
Wade, M.D., be, and it hereby is, revoked. This order is effective 
March 15, 2004.

    Dated: January 20, 2004.
Michelle M. Leonhart,
Acting Deputy Administrator.
[FR Doc. 04-3127 Filed 2-11-04; 8:45 am]
BILLING CODE 4410-09-M