[Federal Register Volume 86, Number 233 (Wednesday, December 8, 2021)]
[Notices]
[Pages 69681-69685]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-26533]


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DEPARTMENT OF JUSTICE

Drug Enforcement Administration


Tamika Mayo, M.D.; Decision and Order

    On July 23, 2019, the Assistant Administrator, Diversion Control 
Division, Drug Enforcement Administration (hereinafter, DEA or 
Government), issued an Order to Show Cause (hereinafter, OSC) to Tamika 
Mayo, M.D. (hereinafter, Respondent), of Baton Rouge, Louisiana. 
Request for Final Agency Action (hereinafter, RFAA), Exhibit 
(hereinafter RFAAX) A (OSC), at 1 and 5. The OSC proposed to revoke 
Respondent's DEA Certificate of Registration, Control No. BM7946835 and 
to deny any pending applications for a new registration or for renewal 
pursuant to 21 U.S.C. 824(a)(4) and 823(f), because Respondent had 
``committed acts which render [her] registration inconsistent with the 
public interest.'' Id. at 1.
    The OSC alleged that Respondent had issued thousands of 
prescriptions for controlled substances in Louisiana during periods 
when her Louisiana Controlled Dangerous Substance (hereinafter, CDS) 
license was expired. Id. at 2-3. Specifically, the OSC alleged that 
between September 1, 2016, and January 17, 2017, Respondent issued over 
1,850 prescriptions for controlled substances while her CDS license was 
expired; between September 1, 2017, and June 13, 2018, Respondent 
issued over 1,730 prescriptions for controlled substances while her CDS 
license was expired; and between September 1, 2018, and February 15, 
2019, Respondent issued over 400 prescriptions for controlled 
substances while her CDS license was expired. Id. According to the OSC, 
because Respondent was not authorized to issue prescriptions for 
controlled substances during these periods, the prescriptions were 
issued in violation of state and federal law. Id. at 3 (citing La. 
Stat. Sec. Sec.  40:967(A)(1)(a) & 40:973; La. Admin. Code tit. 46, 
Sec. Sec.  2705 & 2707(B)(3)-(4); 21 U.S.C. 841(a)(1); 21 CFR 1306.03 & 
1306.04). The OSC concluded that ``[b]y issuing more than 3,900 
prescriptions for controlled substances without state authorization, 
and therefore in violation of state and federal law, [Respondent has] 
committed such acts as would render [her] continued registration 
inconsistent with the public interest.'' Id. (citing 21 U.S.C. 
824(a)(4) & 823(f)(2) & (4)).
    The OSC notified Respondent of the right to request a hearing on 
the allegations or to submit a written statement, while waiving the 
right to a hearing, the procedures for electing each option, and the 
consequences for failing to elect either option. Id. at 4 (citing 21 
CFR 1301.43). The OSC also notified Respondent of the opportunity to 
submit a corrective action plan. Id. at 4-5 (citing 21 U.S.C. 
824(c)(2)(C)).
    By letter dated August 17, 2019, Respondent offered an explanation 
in response to the allegations and stated that she was ``not waving 
[sic] [her] right to a hearing.'' RFAAX B. On August 20, 2019, 
Administrative Law Judge Mark M. Dowd (hereinafter, the ALJ) issued an 
Order Directing Clarification, in which the ALJ instructed Respondent, 
if she was seeking a hearing, to ``submit a document affirmatively and 
unconditionally requesting a hearing'' and stated that if the new 
document was timely filed, the initial filing would be deemed a timely 
hearing request. RFAAX C, at 3. By email dated August 27, 2019, 
Respondent requested a hearing. RFAAX D. On August 28, 2019, the ALJ 
issued an Order for Prehearing Statements. RFAAX E, at 1. The 
Government timely filed its prehearing statement on September 9, 2019. 
Id. at 2. On September 30, 2019, the ALJ

[[Page 69682]]

issued an Order Terminating Proceedings, in which the ALJ found that 
based on Respondent's failure to comply with the Order for Prehearing 
Statements, ``Respondent has implicitly withdrawn her request for a 
hearing'' and ordered the proceedings terminated. Id. at 4. The ALJ 
noted that Respondent had contacted the Office of Administrative Law 
Judges on September 20, 2019, and in response she had received: 
Specific instructions on where to call if she had questions, an 
additional copy of the Order for Prehearing Statements and an 
additional request for Respondent to provide a phone number where she 
could be reached for the conference, which she never provided. Id. at 
2. On October 2, 2019, Respondent sent multiple emails to the Tribunal 
offering an explanation and requesting that the proceedings be 
reopened. ALJX 13-17. However, on October 2, 2019, the ALJ issued an 
Order Denying Respondent's Request to Reopen These Proceedings, in 
which the ALJ found that Respondent had not demonstrated sufficient 
good cause to reopen the matter. RFAAX F, at 4. I have reviewed and 
agree with the procedural rulings of the ALJ.
    On March 30, 2020, the Government forwarded its RFAA, along with 
the evidentiary record for this matter, to my office. Having considered 
the record in its entirety, I find that the record established, by 
substantial evidence, that Respondent committed acts that render her 
continued registration inconsistent with the public interest. 
Accordingly, I conclude that the appropriate sanction is to revoke 
Respondent's DEA registration and to deny any pending applications for 
renewal or new registration in Louisiana. I make the following findings 
of fact.

I. Findings of Fact

A. Respondent's DEA Registration

    Respondent is registered with the DEA as a practitioner authorized 
to handle controlled substances in schedules II-V under DEA 
registration number BM7946835 at 4336 North Blvd., Suite 101, Baton 
Rouge, LA 70806. RFAAX G-1. Respondent filed a renewal of her DEA 
registration ``on or about December 5, 2019.'' RFAAX G, at 1.\1\
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    \1\ It appears from Agency records that Respondent's 
registration is in retired status, although it is unclear exactly 
what precipitated that status. Regardless, the fact that a 
registration has expired during the pendency of an OSC does not 
impact my jurisdiction or prerogative under the Controlled 
Substances Act (hereinafter, CSA) to adjudicate the OSC to finality. 
Jeffrey D. Olsen, M.D., 84 FR 68474 (2019). Adjudicating this matter 
to finality will create an official record the Agency can use in any 
future interactions with Respondent. As additionally noted in Olsen, 
``a final adjudication is a public record of the Agency's 
expectations for current and prospective members of that 
community,'' and adjudications inform stakeholders, such as 
legislators and the public, about the Agency's work and allow them 
to provide feedback to the Agency, thereby helping shape how the 
Agency carries out its responsibilities under the CSA. Id. 
Adjudicating this matter to finality will create a public record to 
educate current and prospective registrants about the Agency's 
expectations regarding the responsibilities of registrants under the 
CSA and allow stakeholders to provide feedback regarding the 
Agency's enforcement priorities and practices.
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B. Government's Case

    The Government's RFAA includes 18 attached exhibits consisting of 
copies of hearing procedural documents and orders, a declaration from a 
DEA Diversion Investigator (hereinafter, DI), a copy of Respondent's 
DEA certificate of registration, various documents pertaining to the 
status of Respondent's Louisiana CDS license, and various prescription 
records from Respondent. See RFAAX A-G-11.
    In a Declaration dated February 27, 2020, a DI assigned to the New 
Orleans Field Division described the service of the OSC on Respondent 
as well as the investigation activities involved in the current matter, 
including the collection of the Government's exhibits. RFAAX G, at 1-4.
    On November 3, 2016, the Louisiana Board of Pharmacy (hereinafter, 
the Board) provided Respondent with a Termination Notice, notifying her 
that her CDS license had been terminated because she had failed to 
renew her license within 30 days after its expiration on September 1, 
2016. RFAAX G-3. Respondent's CDS license remained in an expired status 
until it was renewed, effective January 17, 2017. RFAAX G-2 (Expiration 
Summary Memo from the Louisiana Board of Pharmacy, dated June 27, 
2019).\2\ Nonetheless, from September 1, 2016, to January 17, 2017, 
Respondent issued approximately 1,850 prescriptions for controlled 
substances in the State of Louisiana. RFAAX G-6 and G-9.
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    \2\ According to the Expiration Summary Memo, the Board was only 
able to verify periods of expiration after 2007 because prior to 
2007, the CDS program was overseen by another agency. Id.
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    On November 3, 2017, the Board provided Respondent with a second 
Termination Notice, notifying her that her CDS license had been 
terminated, because she had failed to renew her license within 30 days 
after its expiration on September 1, 2017. RFAAX G-4. Respondent's CDS 
licensed remained in an expired status until it was renewed, effective 
June 13, 2018. RFAAX G-2. Nonetheless, from September 1, 2017, to June 
13, 2018, Respondent issued approximately 1,730 prescriptions for 
controlled substances in the State of Louisiana. RFAAX G-7 and G-10.
    On November 6, 2018, the Board provided Respondent with a third 
Termination Notice, notifying her that her CDS license had been 
terminated because she had failed to renew her license within 30 days 
after its expiration on September 1, 2018. RFAAX G-5. Respondent's CDS 
licensed remained in an expired status until it was renewed, effective 
February 15, 2019. RFAAX G-2. Nonetheless, from September 1, 2018, to 
February 15, 2019, Respondent issued approximately 400 prescriptions 
for controlled substances in the State of Louisiana. RFAAX G-8 and G-
11.

II. Discussion

A. Government's Position

    In its RFAA, the Government sought to revoke Respondent's DEA 
registration and to deny any pending applications for renewal or 
modification of Respondent's DEA registration because Respondent 
``[had] committed acts which render her continued registration 
inconsistent with the public interest, in violation of 21 U.S.C. 824(a) 
and 823(f).'' RFAA, at 1. Specifically, the Government argued that 
Respondent had repeatedly violated state and federal law by issuing 
thousands of prescriptions for controlled substances while she lacked 
the authority to do so due to the expiration of her Louisiana CDS 
license. Id. at 7-11. The Government concluded its RFAA by requesting 
that Respondent's DEA registration be revoked and that any pending 
applications for modification or renewal of Respondent's DEA 
registration be denied. Id. at 11.

B. Respondent's Position

    The only statements from Respondent regarding the allegations 
appear in the initial letter that Respondent submitted in response to 
the OSC, which offers some explanation as to her misconduct, but offers 
no supporting evidence or ability for me to assess the credibility of 
her unsworn statements. See RFAAX B. In her letter, Respondent stated 
that, as to the first period when she was issuing prescriptions while 
her license was expired, she was under a lot of stress due to an 
ongoing divorce and from working two jobs. Id. Respondent stated that 
she did not know that her license was expired, and that ``when [she] 
was notified in early 2017 that the license had expired, [she] 
immediately got it renewed.'' Id. As to the second period

[[Page 69683]]

when she was issuing prescriptions while her license was expired, 
Respondent stated that due to personal family issues, ``[she] wasn't 
even thinking about the CDS license since [she] knew [she] had just 
gotten it renewed in the early part of the year 2017.'' Id. Respondent 
again stated that she did not realize her license was expired, and that 
as soon as she was notified in early 2018 that the license was expired, 
she immediately got it renewed. Id. Respondent did not offer an 
explanation as to the third period when she was issuing prescriptions 
while her license was expired. Id.
    Respondent noted that she has practiced medicine in Louisiana for 
20 years, she has never had a problem with her CDS license, her medical 
license has never expired, and her DEA license has never expired. Id. 
Respondent stated that her misconduct was unintentional and that 
because ``[she] was commuting and not in the office every day, [she] 
missed the renewal dates.'' Id. Respondent also noted that she was 
``under horrible levels of stress'' and apologized for ``the license 
having expired'', stating that it would ``never happen again.'' 
Respondent concluded her letter by describing corrective action that 
she had taken, specifically that she had ``logged the expiration date 
in several places, even on [her] personal cell phone'' and that she was 
``renewing on the date that [she receives] the renewal letter.'' Id. 
Respondent also stated that she had already completed the most recent 
renewal in July 2019. Id. Finally, Respondent stated that she was ``not 
waving [sic] [her] right to a hearing'' and that ``[i]f the DEA 
wish[ed] to pursue [the matter] after [her] explanation, [she] still 
would like to come to a hearing.'' Id.
    As for Respondent's failure to comply with the Order for Prehearing 
Statements that led to the termination of the proceedings without a 
hearing, Respondent offered some explanation in her subsequent emails 
to the Tribunal, in which she requested that the proceedings be 
reopened. See ALJX 13-17. Specifically, Respondent stated that she did 
not realize that she had to provide additional documents, noting that 
she did not have a lawyer and was unfamiliar with the course of the 
proceedings. ALJX 17.
    I do not find this explanation regarding her noncompliance with the 
proceedings to be persuasive. As the ALJ noted in the Order Denying 
Respondent's Request to Reopen These Proceedings, the Respondent was 
given clear instructions in the Order for Prehearing Statements to file 
a Prehearing Statement, as well as the logistics and deadlines for 
doing so. RFAAX F, at 2-3; see also ALJX 5. Further, ``the Respondent's 
argument that she does not have a lawyer and is not familiar with these 
proceedings does not provide sufficient cause for her failure to file a 
Prehearing Statement.'' RFAAX F, at 3; see also ALJX 17. There was also 
ample evidence that the instructions to provide a telephone number were 
clear and that the date to file a prehearing statement was clear. See 
ALJX 5, at 2-4. Respondent also was in receipt of the Government's 
Prehearing Statement, so it would be difficult for her to credibly 
argue ignorance as to what a prehearing statement was. See ALJX 6 
(Email: Government's Pre-Hearing Statement).
    Respondent's statements in her hearing request notably do not 
refute the allegations in the OSC; therefore, I find that the facts in 
the record remain uncontested.

C. Analysis

    Under Section 304 of the CSA, ``[a] registration . . . to . . . 
dispense a controlled substance . . . may be suspended or revoked by 
the Attorney General upon a finding that the registrant . . . has 
committed such acts that would render his [or her] 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,'' defined in 21 U.S.C. 802(21) to include a 
``physician,'' Congress directed the Attorney General to consider the 
following factors in making the public interest determination:
    (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. 21 U.S.C. 823(f).
    The DEA considers these public interest factors in the disjunctive. 
Robert A. Leslie, M.D., 68 FR 15227, 15230 (2003). Each factor is 
weighed on a case-by-case basis. Morall v. Drug Enf't Admin., 412 F.3d 
165, 173-74 (D.C. Cir. 2005). Any one factor, or combination of 
factors, may be decisive. David H. Gillis, M.D., 58 FR 37507, 37508 
(1993). Thus, there is no need to enter findings on each of the 
factors. Hoxie v. Drug Enf't Admin., 419 F.3d 477, 482 (6th Cir. 2005). 
Furthermore, there is no requirement to consider a factor in any given 
level of detail. Trawick v. Drug Enf't Admin., 861 F.2d 72, 76-77 (4th 
Cir. 1988). The balancing of the public interest factors ``is not a 
contest in which score is kept; 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. . . .'' Jayam Krishna-
Iyer, M.D., 74 FR 459, 462 (2009). When deciding whether registration 
is in the public interest, the DEA must consider the totality of the 
circumstances. See generally Joseph Gaudio, M.D., 74 FR 10083, 10094-95 
(2009) (basing sanction on all evidence on record).
    The Government has the burden of proving that the requirements for 
revocation of a DEA registration in 21 U.S.C. 824(a) are satisfied. 21 
CFR 1301.44(e). When the Government has met its prima facie case, the 
burden then shifts to the Respondent to show that revoking registration 
would not be appropriate, given the totality of the facts and 
circumstances on the record. Med. Shoppe-Jonesborough, 73 FR 364, 387 
(2008).
    While I have considered all of the public interest factors,\3\ the 
Government's case invoking the public interest factors of 21 U.S.C. 
823(f) seeks revocation of Respondent's registration based solely under 
Public Interest Factors Two and Four. I find that the Government's 
evidence with respect to Factors Two and Four satisfies its prima

[[Page 69684]]

facie burden of showing that Respondent's continued registration would 
be ``inconsistent with the public interest.'' 21 U.S.C. 824(a)(4). 
Specifically, I find that the record contains substantial evidence that 
Respondent violated both Louisiana state law and federal law when she 
issued thousands of prescriptions for controlled substances in 
Louisiana during periods when she lacked state authorization to do so. 
I further find that Respondent failed to provide evidence to rebut the 
Government's prima facie case.
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    \3\ As to Factor One, there is no evidence in the record of any 
recommendation from Respondent's state licensing board or 
professional disciplinary authority. 21 U.S.C. 823(f)(1). ``The fact 
that the record contains no evidence of a recommendation by a state 
licensing board does not weigh for or against a determination as to 
whether continuation of Respondent's DEA certification is consistent 
with the public interest.'' Roni Dreszer, M.D., 76 FR 19434, 19444 
(2011).
    As to Factor Three, there is no evidence in the record that 
Respondent has been convicted of an offense under either federal or 
state law ``relating to the manufacture, distribution, or dispensing 
of controlled substances.'' 21 U.S.C. 823(f)(3). However, as Agency 
cases have noted, there are a number of reasons why a person who has 
engaged in criminal misconduct may never have been convicted of an 
offense under this factor, let alone prosecuted for one. Dewey C. 
MacKay, M.D., 75 FR 49956, 49973 (2010). Agency cases have therefore 
found that ``the absence of such a conviction is of considerably 
less consequence in the public interest inquiry'' and is therefore 
not dispositive. Id.
    As to Factor Five, the Government's allegations fit squarely 
within the parameters of Factors Two and Four and do not raise 
``other conduct which may threaten the public health and safety.'' 
21 U.S.C. 823(f)(5). Accordingly, Factor Five does not weigh for or 
against Respondent.
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1. Factors Two and Four
    The DEA often analyzes Factors Two and Four together. See, e.g., 
Fred Samimi, M.D., 79 FR 18698, 18709 (2014); John V. Scalera, M.D., 78 
FR 12092, 12098 (2013). Under Factor Two, the DEA analyzes a 
registrant's ``experience in dispensing controlled substances.'' 21 
U.S.C. 823(f)(2). Factor Two analysis focuses on a registrant's acts 
that are inconsistent with the public interest, rather than on a 
registrant's neutral or positive acts and experience. Randall L. Wolff, 
M.D., 77 FR 5106, 5121 n.25 (2012) (explaining that ``every registrant 
can undoubtedly point to an extensive body of legitimate prescribing 
over the course of [the registrant's] professional career'' (quoting 
Jayam Krishna-Iyer, M.D., 74 FR 459, 463 (2009))). Similarly, under 
Factor Four, the DEA analyzes an applicant's compliance with federal 
and state controlled substance laws. 21 U.S.C. 823(f)(4). The Factor 
Four analysis focuses on violations of state and federal laws and 
regulations concerning controlled substances. Volkman v. Drug Enf't 
Admin., 567 F.3d 215, 223-24 (6th Cir. 2009) (citing Gonzales v. 
Oregon, 546 U.S. 243, 272, 274 (2006)); Gaudio, 74 FR 10090-91.
    In this case, Respondent dispensed thousands of prescriptions 
without a controlled substance license in violation of both state and 
federal law. Although there are not specific allegations regarding the 
legitimacy of these prescriptions, I find that dispensing controlled 
substances without a license constitutes negative dispensing experience 
and weighs against Respondent's continued registration. In fact, during 
one year, Respondent's CDS had lapsed for 9 months--the majority of the 
year.
    Regarding Factor Four, the Government alleged that Respondent 
repeatedly violated state and federal laws related to controlled 
substances by issuing thousands of prescriptions for controlled 
substances in Louisiana during periods when her Louisiana CDS license 
was expired. OSC, at 2-3 (citing La. Stat. Sec. Sec.  40:967(A)(1)(a) & 
40:973; La. Admin. Code tit. 46, Sec. Sec.  2705 & 2707(B)(3)-(4); 21 
U.S.C. 841(a)(1); 21 CFR 1306.03 & 1306.04). According to Louisiana 
statute, ``[e]very person who conducts research with, manufactures, 
distributes, procures, possesses, prescribes, or dispenses any 
controlled dangerous substance within this state . . . shall obtain a 
controlled dangerous substance license issued by the Louisiana Board of 
Pharmacy in accordance with the rules and regulations promulgated by 
the board prior to engaging in such activity.'' La. Stat. Ann. Sec.  
40:973(A)(1) (West 2021). Moreover, Louisiana law states that ``[a] 
licensee shall not engage in any activity requiring a valid CDS license 
while his license is expired.'' \4\ La. Admin. Code tit. 46, Sec.  
2707(B)(3) (2021). As for federal law, ``[a] prescription for a 
controlled substance to be effective must be issued for a legitimate 
medical purpose by an individual practitioner acting in the usual 
course of his professional practice.'' 21 CFR 1306.04(a). Further, 
federal law defines an ``individual practitioner'' as ``a physician . . 
. licensed, registered, or otherwise permitted by . . . the 
jurisdiction in which he/she practices, to dispense a controlled 
substance in the course of professional practice.'' 21 CFR 1300.01(b). 
Additionally, federal law states that ``[a] prescription for a 
controlled substance may be issued only by an individual practitioner 
who is . . . authorized to prescribe controlled substances by the 
jurisdiction in which he is licensed to practice his profession.'' 21 
CFR 1306.03(a)(1).
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    \4\ The Government argues that under state law, the period of 
expiration during which a Louisiana practitioner cannot prescribe 
includes the 30 day renewal window because the license has 
technically expired. See RFAA, at 9. This position is supported by 
the plain language of the statute and the Louisiana Board of 
Pharmacy's memorandum to DEA, in which it included the initial 30-
day window in the listed periods of expiration for Respondent's CDS. 
See RFAAX G-2.
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    Respondent issued thousands of prescriptions for controlled 
substances in Louisiana during three separate periods when her 
Louisiana CDS license was expired. Thus, I find that Respondent 
violated both federal and Louisiana state law related to controlled 
substances. See Lisa Hamilton, N.P., 84 FR 71465, 71472 (2019) (finding 
that prescriptions issued during the lapse of the respondent's 
Massachusetts Controlled Substances Registration violated state and 
federal law). In this case, given the repeated and extensive nature of 
Respondent's violations of federal and state law related to controlled 
substances, I find that Factors Two and Four weigh against Respondent 
such that I find Respondent's continued registration to be inconsistent 
with the public interest and, therefore, that a ground for revocation 
exists under 21 U.S.C. 824(a)(4). Where, as here, the Government has 
met its prima facie burden of showing that a ground for revocation 
exists, the burden shifts to the Respondent to show why she can be 
entrusted with a registration. See Jeffrey Stein, M.D., 84 FR 46968, 
46972 (2019).

III. Sanction

    The Government has established grounds to deny a registration; 
therefore, I will review any evidence and argument the Respondent 
submitted to determine whether or not the Respondent has presented 
``sufficient mitigating evidence to assure the Administrator that [she] 
can be trusted with the responsibility carried by such a 
registration.'' Samuel S. Jackson, D.D.S., 72 FR 23848, 23853 (2007) 
(quoting Leo R. Miller, M.D., 53 FR 21931, 21932 (1988)). ```Moreover, 
because ``past performance is the best predictor of future 
performance,'' ALRA Labs, Inc. v. Drug Enf't Admin., 54 F.3d 450, 452 
(7th Cir. 1995), [the Agency] has repeatedly held that where a 
registrant has committed acts inconsistent with the public interest, 
the registrant must accept responsibility for [the registrant's] 
actions and demonstrate that [registrant] will not engage in future 
misconduct.' '' Jayam Krishna-Iyer, 74 FR 459, 463 (2009) (quoting 
Medicine Shoppe, 73 FR 364, 387 (2008)); see also Samuel S. Jackson, 
D.D.S., 72 FR 23853; John H. Kennnedy, M.D., 71 FR 35705, 35709 (2006); 
Prince George Daniels, D.D.S., 60 FR 62884, 62887 (1995). The issue of 
trust is necessarily a fact-dependent determination based on the 
circumstances presented by the individual respondent; therefore, the 
Agency looks at factors, such as the acceptance of responsibility and 
the credibility of that acceptance as it relates to the probability of 
repeat violations or behavior and the nature of the misconduct that 
forms the basis for sanction, while also considering the Agency's 
interest in deterring similar acts. See Arvinder Singh, M.D., 81 FR 
8247, 8248 (2016).

A. Acceptance of Responsibility

    As previously discussed, Respondent effectively waived her right to 
a hearing and therefore there is no credible evidence on the record 
regarding acceptance of responsibility for me to consider. Even if I 
could consider the

[[Page 69685]]

initial letter she submitted in response to the OSC, it does not 
demonstrate sufficient acceptance of responsibility or remedial 
measures that would aid me in entrusting Respondent with a 
registration. See RFAAX B. In her letter, Respondent offers some 
explanation as to why she repeatedly failed to renew her Louisiana CDS 
license in a timely manner, and while the stressful circumstances that 
she described certainly garner sympathy, Respondent did not 
unequivocally acknowledge her own error in failing to keep track of the 
status of her CDS license, which was essential to her ability to 
lawfully prescribe controlled substances. Id.
    Respondent stated in her letter that she had logged the expiration 
date for her CDS license in multiple places, that going forward, she 
would renew on the date she receives the renewal letter, and that she 
had already completed the most recent renewal in July 2019. RFAAX B. 
However, Respondent has not provided any supporting documentation as to 
these statements. The fact that she repeatedly allowed this lapse to 
happen year-after-year, does not demonstrate confidence in her future 
compliance. Moreover, Respondent's errors regarding the prehearing 
process--errors that ultimately led to the termination of the 
proceedings--do not inspire confidence that she has improved upon the 
underlying issue of responsibility regarding her professional 
licensure.

B. Specific and General Deterrence

    In addition to acceptance of responsibility, the Agency considers 
both specific and general deterrence when determining an appropriate 
sanction. Daniel A. Glick, D.D.S., 80 FR 74800, 74810 (2015). Specific 
deterrence is the DEA's interest in ensuring that a registrant complies 
with the laws and regulations governing controlled substances in the 
future. Id. General deterrence concerns the DEA's responsibility to 
deter conduct similar to the proven allegations against the respondent 
for the protection of the public at large. Id. In this case, I believe 
revocation of her DEA registration would deter Respondent and the 
general registrant community from ignoring the serious state and 
federal requirements to have specific licensure in order to be 
entrusted with the responsibility of issuing prescriptions for 
controlled substances.

C. Egregiousness

    The Agency also looks to the egregiousness and the extent of the 
misconduct as significant factors in determining the appropriate 
sanction. Garrett Howard Smith, M.D., 83 FR 18910 (collecting cases). 
Although Respondent's actions in failing to renew her CDS might seem 
minor or transactional, the extent of the misconduct was not. She 
issued thousands of prescriptions for controlled substances in 
Louisiana during three separate periods when her Louisiana CDS license 
was expired, with these three separate periods occurring successively 
and each ranging from 4 to 9 months. The record evidence demonstrates 
that Respondent had been given timely notice via letter that her 
license was terminated because she had failed to renew it within 30 
days after its expiration date, and Respondent did not provide any 
documentation or explanation to support her claim that she was not made 
aware until much later. See RFAAX B and G-2-G-11. Moreover, the 
multiple and successive occurrences suggest that Respondent did not 
take sufficient measures to ensure that her mistake would not be 
repeated.
    As discussed above, to maintain a registration when grounds for 
revocation exist, a respondent must convince the Administrator that her 
acceptance of responsibility is sufficiently credible to demonstrate 
that the misconduct will not reoccur and that she can be entrusted with 
a registration. I find that Respondent has not met this burden. 
Respondent has not offered any credible evidence on the record to rebut 
the Government's case for revocation. Further, Respondent's description 
of corrective measures was unsupported by evidence, and given 
Respondent's subsequent errors regarding the prehearing process, 
Respondent has not demonstrated that she can be trusted with the 
responsibility of registration at this time. Accordingly, I will order 
the revocation of Respondent's certificate of registration.

Order

    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 revoke DEA Certificate of 
Registration No. BM7946835 issued to Tamika Mayo, M.D. 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 
Tamika Mayo, M.D. to renew or modify this registration, as well as any 
other pending application of Tamika Mayo, M.D. for registration in 
Louisiana. This Order is effective January 7, 2022.

Anne Milgram,
Administrator.
[FR Doc. 2021-26533 Filed 12-7-21; 8:45 am]
BILLING CODE 4410-09-P