[Federal Register Volume 84, Number 94 (Wednesday, May 15, 2019)]
[Notices]
[Pages 21808-21809]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-10015]



[[Page 21808]]

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DEPARTMENT OF JUSTICE

Drug Enforcement Administration


Raquel Skidmore, M.D.; Decision and Order

    On December 14, 2018, the Assistant Administrator, Diversion 
Control Division, Drug Enforcement Administration (hereinafter, DEA or 
Government), issued an Order to Show Cause to Raquel Skidmore, M.D. 
(hereinafter, Registrant), of Panama City, Florida. Order to Show Cause 
(hereinafter, OSC), at 1. The OSC proposes the revocation of 
Registrant's Certificate of Registration on the ground that she does 
``not have authority to handle controlled substances in the State of 
Florida, the state in which . . . [she is] registered with the DEA.'' 
Id. (citing 21 U.S.C. 823(f) and 824(a)(3)).
    Regarding jurisdiction, the OSC alleges that Registrant holds DEA 
Certificate of Registration No. BS7985623 at the registered address of 
Gulf Coast Holistic and Primary Care, 219 Forest Park Circle, Panama 
City, Florida 32405. OSC, at 1. It alleges that this registration 
authorizes Registrant to dispense controlled substances in schedules II 
through V as a practitioner. Id. The OSC alleges that this registration 
expires on February 29, 2020. Id.
    The substantive ground for the proceeding, as alleged in the OSC, 
is that Registrant is ``without authority to handle controlled 
substances in Florida, the state in which . . . [she is] registered 
with the DEA.'' Id. Specifically, the OSC alleges that the Florida 
Department of Health issued an ``Order of Emergency Restriction of 
License'' on April 5, 2018. Id. This Order, according to the OSC, 
immediately restricted Registrant's ``license to practice in areas of 
critical need'' because her ``continued practice of medicine would 
constitute `an immediate, serious danger to the health, safety, or 
welfare of the citizens of Florida.' '' Id. at 1-2. On July 5, 2018, 
the OSC alleges, ``the Florida Board of Medicine adopted the findings 
of fact in the Order of Emergency Restriction and issued a Final Order 
revoking . . . [Registrant's] license to practice medicine in the State 
of Florida.'' Id. at 2.
    The Show Cause Order notifies Registrant of her right to request a 
hearing on the allegations or to submit a written statement while 
waiving her right to a hearing, the procedures for electing each 
option, and the consequences for failing to elect either option. Id. at 
2 (citing 21 CFR 1301.43). The OSC also notifies Registrant of the 
opportunity to submit a corrective action plan. OSC, at 3 (citing 21 
U.S.C. 824(c)(2)(C)).

Adequacy of Service

    In a Declaration dated February 26, 2019, a Diversion Investigator 
(hereinafter, DI) assigned to the Miami Field Division, Tallahassee 
Resident Office, describes herself as the ``lead DI assigned'' to the 
matter involving Registrant. Request for Final Agency Action dated 
February 28, 2019 (hereinafter, RFAA), App. 4, at 1. The DI states that 
she and a Group Supervisor found Registrant's registered office address 
``abandoned'' when they visited it on November 14, 2018. Id. at 2. 
According to the DI, the ``building manager . . . stated that 
Registrant had not been at the registered location for well over a 
year, and that she had heard Registrant had left the country.'' Id. 
Registrant's Facebook account indicates that she ``now resides in St. 
Thomas, U.S. Virgin Islands.'' Id. at 3.
    The DI states that she tried to serve the OSC on Registrant in five 
different ways: (1) By emailing it to Registrant's registered email 
address; (2) by contacting the attorney who represented Registrant 
before the Florida Board of Medicine; (3) by utilizing Registrant's 
Facebook page to contact Registrant's husband; (4) by sending the OSC 
registered mail to Registrant's registered address; and (5) by sending 
a ``private message through Facebook to Registrant.'' Id. at 2. The DI 
states that, on January 24, 2019, she ``finally received an email 
response from Registrant, which indicated she had received and 
reviewed'' the OSC. Id.

    I don't communicate through phone, I communicate through email. 
Anything you want to tell me it has to be through this email. I lost 
my license very unfairly, I lost my job and couldn't afford a lawyer 
anymore. I would love to go to that hearing in February but I can't 
even afford a plane ticket. What do you want from me?

Id. at Exh. 1, at 2.
    In its RFAA, the Government represents that ``more than thirty days 
have passed since the . . . [OSC] was served on . . . [Registrant] and 
no request for hearing has been received by DEA.\1\ RFAA, at 1. The 
Government requests that Registrant's ``Certificate of Registration as 
a practitioner be revoked, based on . . . [her] lack of state 
authority.'' Id. at 5.
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    \1\ The Government also represents that DEA has not received 
``any other correspondence of [sic] filing'' from Registrant. RFAA, 
at 3.
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    Based on the DI's Declaration, the Government's written 
representations, and my review of the record, I find that the 
Government accomplished service of the OSC on Registrant on or before 
January 24, 2019. I also find that more than 30 days have now passed 
since the Government accomplished service of the OSC. Further, based on 
the Government's written representations, I find that neither 
Registrant, nor anyone purporting to represent her, requested a 
hearing, submitted a written statement while waiving Registrant's right 
to a hearing, or submitted a corrective action plan. Accordingly, I 
find that Registrant has waived her right to a hearing and her right to 
submit a written statement and corrective action plan. 21 CFR 
1301.43(d) and 21 U.S.C. 824(c)(2)(C). I, therefore, issue this 
Decision and Order based on the record submitted by the Government, 
which constitutes the entire record before me. 21 CFR 1301.43(e).

Findings of Fact

Registrant's DEA Registration

    Registrant is the holder of DEA Certificate of Registration No. 
BS7985623 at the registered address of Gulf Coast Holistic and Primary 
Care, 219 Forest Park Circle, Panama City, Florida 32405. RFAA, App. 5, 
at 2. Pursuant to this registration, Registrant is authorized to 
dispense controlled substances in schedules II through V as a 
practitioner. Id. Registrant's registration expires on February 29, 
2020 and is ``in an active pending status.'' Id. at 1.

The Status of Registrant's State License

    On April 5, 2018, the Florida Department of Health issued an Order 
of Emergency Restriction of License No. ACN 244 (hereinafter, Emergency 
Restriction). RFAA, App. 2, at 1. According to the Emergency 
Restriction, Registrant suffered a severe manic episode on February 19, 
2017 that involved her jumping out of her bathroom window, running 
naked through the streets, and screaming that she was god and was going 
to save the world. Id. at 2. The Emergency Restriction also states that 
Registrant grabbed her infant grandchild and claimed that the infant 
was her deceased grandmother. Id. According to the Emergency 
Restriction, Registrant believed that ``her manic episode may have been 
the result of the stressors involved with practicing medicine,'' 
admitted to smoking approximately one ``bowl'' of marijuana every day 
for about the last two years, and ``submitted hair and urine samples 
for toxicology screening.'' \2\ Id. at 3.
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    \2\ The toxicological tests of Registrant's hair and urine 
samples indicated the presence of marijuana. Id. at 3. According to 
the Emergency Restriction, Registrant ``does not have a valid order 
for medical marijuana. Id.

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[[Page 21809]]

    The Emergency Restriction states that, as of the date of the 
Emergency Restriction, Registrant ``has failed to enter into a contract 
with . . . [the Professionals Resource Network, (hereinafter, PRN)] 
that encompasses the necessary treatment to address . . . 
[Registrant's] psychiatric and substance abuse issues.'' Id. at 4. It 
concludes that (1) Registrant ``is not capable of caring for patients 
in a manner that is correct and safe;'' (2) Registrant's continued 
unrestricted practice as a physician presents an immediate, serious 
danger to the health, welfare, and safety of the public;'' (3) ``there 
is a significant likelihood that . . . [Registrant's] inability to 
practice medicine with reasonable skill and safety to patients will 
continue without appropriate treatment and monitoring;'' and that (4) 
there are no less restrictive means, other than the terms of . . . [the 
Emergency Restriction], that will adequately protect the public from . 
. . [Registrant's] continued unrestricted practice of medicine.'' Id. 
at 4-5. The Emergency Restriction orders the immediate restriction of 
Registrant's medical license ``until PRN or a PRN-approved evaluator 
notifies the Department that she is safe to resume the practice of 
medicine.'' Id. at 7.
    On July 2, 2018, the Florida Board of Medicine denied all of the 
Exceptions that Registrant filed concerning the Emergency Restriction, 
adopted the Emergency Restriction's findings of fact, and revoked 
Registrant's license to practice medicine in the State of Florida. 
Final Order of the Florida Board of Medicine (filed date: July 5, 2018) 
(hereinafter, Final Order), at 2-6.
    According to Florida's online records, of which I take official 
notice, Registrant's license is still revoked.\3\ Florida Board of 
Medicine Lookup, https://flboardofmedicine.gov/ (last visited May 3, 
2019). Florida's online records show that Registrant's medical license 
remains revoked and that she is not authorized in Florida to prescribe 
controlled substances. Id.
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    \3\ Under the Administrative Procedure Act, an agency ``may take 
official notice of facts at any stage in a proceeding--even in the 
final decision.'' United States Department of Justice, Attorney 
General's Manual on the Administrative Procedure Act 80 (1947) (Wm. 
W. Gaunt & Sons, Inc., Reprint 1979). Pursuant to 5 U.S.C. 556(e), 
``[w]hen an agency decision rests on official notice of a material 
fact not appearing in the evidence in the record, a party is 
entitled, on timely request, to an opportunity to show the 
contrary.'' Accordingly, Registrant may dispute my finding by filing 
a properly supported motion for reconsideration within 15 calendar 
days of the date of this Order. Any such motion shall be filed with 
the Office of the Administrator and a copy shall be served on the 
Government. In the event Registrant files a motion, the Government 
shall have 15 calendar days to file a response.
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    Accordingly, I find that Registrant currently is neither licensed 
to engage in the practice of medicine nor registered to dispense 
controlled substances in Florida, the State in which she is registered 
with the DEA.

Discussion

    Pursuant to 21 U.S.C. 824(a)(3), the Attorney General is authorized 
to suspend or revoke a registration issued under section 823 of the 
Controlled Substances Act (hereinafter, 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 71,371 (2011), pet. for rev. denied, 481 Fed. Appx. 826 
(4th Cir. 2012); Frederick Marsh Blanton, M.D., 43 FR 27,616, 27,617 
(1978).
    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., Hooper, supra, 76 
FR at 71,371-72; Sheran Arden Yeates, M.D., 71 FR 39,130, 39,131 
(2006); Dominick A. Ricci, M.D., 58 FR 51,104, 51,105 (1993); Bobby 
Watts, M.D., 53 FR 11,919, 11,920 (1988); Blanton, supra, 43 FR at 
27,617.
    According to Florida statute, ``A practitioner, in good faith and 
in the course of his or her professional practice only, may prescribe, 
administer, [or] dispense . . . a controlled substance.'' Fla. Stat. 
Ann. Sec.  893.05(1)(a) (West, Westlaw current with chapters from the 
2019 First Regular Session of the 26th Legislature in effect through 
April 26, 2019). Further, ``practitioner,'' as defined by Florida 
statute, includes ``a physician licensed under chapter 458.'' Fla. 
Stat. Ann. Sec.  893.02(23) (West, Westlaw current with chapters from 
the 2019 First Regular Session of the 26th Legislature in effect 
through April 26, 2019).\4\
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    \4\ Chapter 458 concerns medical practice and addresses, among 
other things, the licensure of physicians.
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    Here, the undisputed evidence in the record is that Registrant 
currently lacks authority to practice medicine in Florida. As already 
discussed, a physician must be a licensed practitioner to dispense a 
controlled substance in Florida. Thus, since Registrant lacks authority 
to practice medicine in Florida and, therefore, is not authorized to 
handle controlled substances in Florida, I 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 order that DEA Certificate of Registration No. 
BS7985623 issued to Raquel Skidmore, M.D., be, and it hereby is, 
revoked. This Order is effective June 14, 2019.

    Dated: May 3, 2019.
Uttam Dhillon,
Acting Administrator.
[FR Doc. 2019-10015 Filed 5-14-19; 8:45 am]
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