82 FR 11058 - Paul E. Pilgram, M.D.; Decision and Order

DEPARTMENT OF JUSTICE
Drug Enforcement Administration

Federal Register Volume 82, Issue 32 (February 17, 2017)

Page Range		11058-11060
FR Document		2017-03223

Federal Register, Volume 82 Issue 32 (Friday, February 17, 2017)

[Federal Register Volume 82, Number 32 (Friday, February 17, 2017)]
[Notices]
[Pages 11058-11060]
From the Federal Register Online [www.thefederalregister.org]
[FR Doc No: 2017-03223]

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DEPARTMENT OF JUSTICE

Drug Enforcement Administration

Paul E. Pilgram, M.D.; Decision and Order

On November 29, 2016, the Assistant Administrator, Diversion
Control Division, Drug Enforcement Administration (DEA), issued an
Order to Show Cause to Paul E. Pilgram,\1\ M.D. (Registrant), of West
Jordan, Utah. The Show Cause Order proposed the revocation of
Registrant's DEA Certificate of Registration, on the ground that he
does not have authority to handle controlled substances in Utah, the
State in which he is registered with the Agency. Show Cause Order, at 1
(citing 21 U.S.C. 824(a)(3)).
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\1\ Registrant's name in the Order to Show Cause is spelled
``Pilgrim''; however, all other documents in the record, including
Registrant's Certificate of Registration, use the correct spelling
(Pilgram).
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As the jurisdictional basis for the proceeding, the Show Cause
Order alleged that Registrant is registered as a practitioner in
schedules II through V under DEA registration No. AP1393038, at the
registered address of 1561 West 7000 South, Suite 200, West Jordan,
Utah. Id. The Order alleged that Registrant's registration does not
expire until March 31, 2017. Id.
The Show Cause Order then alleged that on October 17, 2016, the
State of Utah revoked Registrant's authority to prescribe and
administer controlled substances and that he is ``without authority to
handle controlled substances in . . . the [S]tate in which [he is]
registered with the'' Agency. Id. The Order then asserted that as a
consequence of the loss of his state authority, ``DEA must revoke'' his
registration. Id. (citing 21 U.S.C. 802(21), 823(f) and 824(a)(3)). The
Show Cause Order also notified Registrant of his right to request a
hearing on the allegations, or to submit a written statement in lieu of
a hearing, the procedure for electing either option, and the
consequence for failing to do elect either option. Id. at 2 (citing 21
CFR 1301.43). The Order further notified Registrant of his right to
submit a corrective action plan. Id. at 2-3 (citing 21 U.S.C.
824(c)(2)(C)).
On December 6, 2016, a Diversion Investigator (DI) from the DEA
Salt Lake City District Office effected service by hand-delivery of a
copy of the Show Cause Order to Registrant at his registered address of
1561 West 7000 South, Suite 200, West Jordan, Utah. GX 2, at 1-2
(Declaration of Diversion Investigator). According to the Government,
since the date of service of

[[Page 11059]]

the Show Cause Order, the Agency ``has not received a request for
hearing or any other reply from'' Registrant. Request for Final Agency
Action (RFFA), at 2.
On January 10, 2017, the Government forwarded this matter to my
Office for final agency action along with an evidentiary record. RFFA,
at 1. Based upon the Government's representation and my review of the
record, I find that more than 30 days have now passed since the date of
service of the Show Cause Order, and that neither Registrant, nor
anyone purporting to represent him, has requested a hearing or
submitted a written statement in lieu of a hearing. I therefore find
that Registrant has waived his right to a hearing or to submit a
written statement in lieu of a hearing, and issue this Decision and
Order based on relevant evidence contained in the record submitted by
the Government. 21 CFR 1301.43(d) & (e). I make the following findings
of fact. Id. Sec. 1301.43(e).

Findings of Fact

Registrant is the holder of Certificate of Registration AP1393038,
pursuant to which he is authorized to dispense controlled substances in
schedules II through V as a practitioner, at the registered address of
1561 West 7000 South, Suite 200, West Jordan, Utah. GX 2. His
registration does not expire until March 31, 2017. Id.
On October 17, 2016, the Utah Division of Occupational and
Professional Licensing, Department of Commerce (the Division), issued
an order revoking Registrant's license to prescribe and administer
controlled substances in the State. GX 3, at 2. Therein, the Division
adopted the recommended order of the Utah Physicians Licensing Board
(Physician's Board), which the latter issued following a hearing it
held on August 24-25, 2016 at which Registrant was represented by
counsel. Id. at 5.
The Physician's Board found that Registrant ``did not [ ] meet the
standard of care of the profession for pain management patients'' and
failed to follow the Model Policy for the Use of Controlled Substances
for the Treatment of Pain (2004) in his treatment of nine patients. As
support for its finding, the Board specifically cited: (1) ``[t]he
inadequacy of the documented evaluation of the patients,'' (2) ``[t]he
failure to obtain or document informed consent as to major risks of the
high opioid regimes,'' (3) ``[t]he perfunctory consideration or
enforcement of agreements for treatment,'' (4) ``[t]he improperly low
level of consultation with other health and mental professionals
[sic]),'' and (5) ``[t]he failure to maintain accurate and complete
medical records.'' Id. at 6-7. The Board further found that Registrant
``failed to demonstrate a legitimate medical purpose for his
prescribing practices, [that] there was an absence of sound clinical
judgment on [his] part . . . and the pattern of prescribing practices
was not based on clear documentation of unrelieved pain.'' Id. at 7.
The Board then made detailed findings with respect to nine patients.
Id. at 8-26.
The Physician's Board thus concluded that Registrant had engaged in
unprofessional conduct:

by failing, as a prescribing practitioner, to follow the Model
Policy for the Use of Controlled Substances for the Treatment of
Pain, 2004 [ ], in [his]evaluation of the patient, obtaining or
documenting informed consent, giving more than perfunctory
consideration to, or enforcement of, agreements for treatment,
conducting periodic reviews, consultation with other medical
specialists, maintaining accurate and complete medical records, and
complying with the state laws referenced in [its] conclusions.

Id. at 27 (citing Utah Admin. Code r. 156-1-501(6)).\2\ The Board
further concluded that ``[t]he prescribing of controlled substances by
[Registrant] on too many occasions did not have a legitimate medical
purpose, did not show sound clinical judgment and was not based on
clear documentation of unrelieved pain.'' Id. at 28.\3\
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\2\ As for Registrant's conduct after the Board adopted its 2013
Model Policy on the Use of Opioids Analgesics in the Treatment of
Chronic Pain, the Board also found that he engaged in unprofessional
conduct. GX 3, at 28 (citing Utah Admin. Code r. 156-1-501(7)).
\3\ Under the Division's rules, ``unprofessional conduct''
includes: ``failing, as a prescribing practitioner, to follow the
`Model Policy for the Use of Controlled Substances for the Treatment
of Pain,' 2004, established by the Federation of State Medical
Boards,'' and ``failing, as a prescribing practitioner, to follow
the `Model Policy on the Use of Opioid Analgesics in the Treatment
of Chronic Pain,' July 2013, adopted by the Federation of State
Medical Boards.'' Utah Admin. Code r. 156-1-501(6) and (7) (2016).
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The Board thus recommended that Registrant's state ``license to
prescribe and administer controlled substances . . . be revoked.'' Id.
at 29. On October 17, 2016, the Division adopted the Board's factual
findings, legal conclusions and recommended order ``in its entirety.''
Id. at 2, 4. According to the online records of the Utah Division of
Occupational and Professional Licensing of which I take official
notice, Registrant's controlled substance license remains revoked as of
the date of this Decision and Order. \4\ See also https://secure.utah.gov/llv/search/index.html. I therefore find that Registrant
is without authority to dispense controlled substances under the laws
of Utah, the State in which he holds his registration.
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\4\ In accordance with the Administrative Procedure Act (APA),
an agency ``may take official notice of facts at any stage in a
proceeding--even in the final decision.'' U.S. Dept. of Justice,
Attorney General's Manual on the Administrative Procedure Act 80
(1947) (Wm. W. Gaunt & Sons, Inc., Reprint 1979). In accordance with
the APA and DEA's regulations, Respondent is ``entitled on timely
request to an opportunity to show to the contrary.'' 5 U.S.C.
556(e); see also 21 CFR 1316.59(e). To allow Respondent the
opportunity to refute the facts of which I take official notice,
Respondent may file a motion for reconsideration within 15 calendar
days of the date of service of this Order which shall commence on
the date this Order is mailed.
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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 (CSA), ``upon a finding that the registrant .
. . has had his State license . . . suspended [or] revoked . . . by
competent State authority and is no longer authorized by State law to
engage in the . . . dispensing of controlled substances.'' Moreover,
DEA has 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, 76 FR 71371 (2011), pet. for rev. denied,
481 Fed. Appx. 826 (4th Cir. 2012); Frederick Marsh Blanton, 43 FR
27616 (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 Act, 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

[[Page 11060]]

in which he practices medicine. See, e.g., Hooper, 76 FR at 71371-72;
Sheran Arden Yeates, M.D., 71 FR 39130, 39131 (2006); Dominick A.
Ricci, 58 FR 51104, 51105 (1993); Bobby Watts, 53 FR 11919, 11920
(1988); Blanton, 43 FR at 27616.
Because Registrant currently lacks authority to handle controlled
substances in Utah, the State in which he holds his DEA registration,
he is not entitled to maintain his registration. Accordingly, I will
order that his registration be revoked.

Order

Pursuant to the authority vested in me by 21 U.S.C. 824(a), as well
as 28 CFR 0.100(b), I order that DEA Certificate of Registration
AP1393038, issued to Paul E. Pilgram, M.D., be, and it hereby is,
revoked. Pursuant to the authority vested in me by 21 U.S.C. 823(f), as
well as 28 CFR 0.100(b), I further order that any pending application
of Paul E. Pilgram, M.D., to renew or modify this registration, be, and
it hereby is, denied. This Order is effective immediately.\5\
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\5\ Based on the extensive findings of the Utah Division of
Occupational and Professional Licensing, I find that the public
interest necessitates that this Order be effective immediately. 21
CFR 1316.67.

Dated: February 9, 2017.
Chuck Rosenberg,
Acting Administrator.
[FR Doc. 2017-03223 Filed 2-16-17; 8:45 am]
BILLING CODE 4410-09-P

11058 Federal Register / Vol. 82, No. 32 / Friday, February 17, 2017 / Notices

Findings of Fact This rule derives from the text of two DEPARTMENT OF JUSTICE
provisions of the CSA. First, Congress
Registrant is the holder of DEA defined ‘‘the term ‘practitioner’ [to] Drug Enforcement Administration
Certificate of Registration No. mean[ ] a . . . physician . . . or other
BD3577965, pursuant to which he is Paul E. Pilgram, M.D.; Decision and
person licensed, registered or otherwise
authorized to dispense controlled Order
permitted, by . . . the jurisdiction in
substances in schedules II through V, as
which he practices . . . to distribute, On November 29, 2016, the Assistant
a practitioner, at the registered address
dispense, [or] administer . . . a Administrator, Diversion Control
of Women’s Pavilion of South
controlled substance in the course of Division, Drug Enforcement
Mississippi, 6524 U.S. Highway 98, Administration (DEA), issued an Order
Hattiesburg, Mississippi. GX 1 professional practice.’’ 21 U.S.C.
802(21). Second, in setting the to Show Cause to Paul E. Pilgram,1 M.D.
(Certificate of Registration). His (Registrant), of West Jordan, Utah. The
registration does not expire until June requirements for obtaining a
practitioner’s registration, Congress Show Cause Order proposed the
30, 2017. Id. revocation of Registrant’s DEA
directed that ‘‘[t]he Attorney General
On July 8, 2016, Registrant voluntarily Certificate of Registration, on the ground
surrendered his medical license to the shall register practitioners . . . if the
that he does not have authority to
Mississippi State Board of Medical applicant is authorized to dispense . . .
handle controlled substances in Utah,
Licensure (Medical Board), stating in a controlled substances under the laws of the State in which he is registered with
letter to the Board’s President that he the State in which he practices.’’ 21 the Agency. Show Cause Order, at 1
was relinquishing his right to practice U.S.C. 823(f). Because Congress has (citing 21 U.S.C. 824(a)(3)).
medicine. GX 3, at 2. On July 13, 2016, clearly mandated that a practitioner As the jurisdictional basis for the
the Medical Board issued a possess state authority in order to be proceeding, the Show Cause Order
memorandum to various governmental deemed a practitioner under the Act, alleged that Registrant is registered as a
and private entities informing them that DEA has held repeatedly that revocation practitioner in schedules II through V
Registrant had voluntarily surrendered of a practitioner’s registration is the under DEA registration No. AP1393038,
his medical license effective July 12, appropriate sanction whenever he is no at the registered address of 1561 West
2016. Id. at 3. As Registrant neither longer authorized to dispense controlled 7000 South, Suite 200, West Jordan,
responded to the Show Cause Order nor substances under the laws of the State Utah. Id. The Order alleged that
submitted any evidence to show that his in which he practices medicine. See, Registrant’s registration does not expire
state license has been reinstated, I find e.g., Hooper, 76 FR at 71371; Sheran until March 31, 2017. Id.
that he does not possess authority to Arden Yeates, M.D., 71 FR 39130, 39131 The Show Cause Order then alleged
dispense controlled substances in (2006); Dominick A. Ricci, 58 FR 51104, that on October 17, 2016, the State of
Mississippi, the State in which he is 51105 (1993); Bobby Watts, 53 FR Utah revoked Registrant’s authority to
registered with the DEA. 11919, 11920 (1988); Blanton, 43 FR at prescribe and administer controlled
27616. substances and that he is ‘‘without
Discussion authority to handle controlled
By virtue of the surrender of his substances in . . . the [S]tate in which
Pursuant to 21 U.S.C. 824(a)(3), the
medical license, Registrant currently [he is] registered with the’’ Agency. Id.
Attorney General is authorized to
lacks authority to dispense controlled The Order then asserted that as a
suspend or revoke a registration issued
under section 823 of the Controlled substances in Mississippi, the State in consequence of the loss of his state
Substances Act (CSA), ‘‘upon a finding which he holds his DEA registration, authority, ‘‘DEA must revoke’’ his
that the registrant . . . has had his State and he is not entitled to maintain his registration. Id. (citing 21 U.S.C.
license . . . suspended [or] revoked registration. Accordingly, I will order 802(21), 823(f) and 824(a)(3)). The Show
. . . by competent State authority and is that his registration be revoked. Cause Order also notified Registrant of
no longer authorized by State law to his right to request a hearing on the
Order allegations, or to submit a written
engage in the . . . dispensing of
controlled substances.’’ DEA has also Pursuant to the authority vested in me statement in lieu of a hearing, the
long held that the possession of by 21 U.S.C. 824(a), as well as 28 CFR procedure for electing either option, and
authority to dispense controlled 0.100(b), I order that DEA Certificate of the consequence for failing to do elect
substances under the laws of the State Registration BD3577965, issued to Lee either option. Id. at 2 (citing 21 CFR
in which a practitioner engages in 1301.43). The Order further notified
B. Drake, M.D., be, and it hereby is,
professional practice is a fundamental Registrant of his right to submit a
revoked. Pursuant to the authority
condition for obtaining and maintaining corrective action plan. Id. at 2–3 (citing
vested in me by 21 U.S.C. 823(f), as well
a practitioner’s registration. See, e.g., 21 U.S.C. 824(c)(2)(C)).
as 28 CFR 0.100(b), I further order that On December 6, 2016, a Diversion
James L. Hooper, 76 FR 71371 (2011), any pending application of Lee B.
pet. for rev. denied, 481 Fed. Appx. 826 Investigator (DI) from the DEA Salt Lake
Drake, M.D., to renew or modify his City District Office effected service by
(4th Cir. 2012); Frederick Marsh registration, be, and it hereby is, denied.
Blanton, 43 FR 27616 (1978). Thus, the hand-delivery of a copy of the Show
This Order is effective March 20, 2017. Cause Order to Registrant at his
Agency has further held that ‘‘ ‘the
controlling question is not whether a Dated: February 9, 2017. registered address of 1561 West 7000
practitioner’s license to practice South, Suite 200, West Jordan, Utah. GX
mstockstill on DSK3G9T082PROD with NOTICES

Chuck Rosenberg,
medicine in the state is suspended or 2, at 1–2 (Declaration of Diversion
Acting Administrator.
revoked; rather[,] it is whether the Investigator). According to the
[FR Doc. 2017–03222 Filed 2–16–17; 8:45 am] Government, since the date of service of
Respondent is currently authorized to
BILLING CODE 4410–09–P
handle controlled substances in the 1 Registrant’s name in the Order to Show Cause
[S]tate.’ ’’ Hooper, 76 FR at 71371 is spelled ‘‘Pilgrim’’; however, all other documents
(quoting Anne Lazar Thorn, 62 FR in the record, including Registrant’s Certificate of
12847, 12848 (1997)). Registration, use the correct spelling (Pilgram).

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11060 Federal Register / Vol. 82, No. 32 / Friday, February 17, 2017 / Notices

in which he practices medicine. See, ACTION: 60-Day notice. permitting electronic submission of
e.g., Hooper, 76 FR at 71371–72; Sheran responses.
Arden Yeates, M.D., 71 FR 39130, 39131 SUMMARY: The Department of Justice
(2006); Dominick A. Ricci, 58 FR 51104, (DOJ), Federal Bureau of Investigation Overview of This Information
51105 (1993); Bobby Watts, 53 FR (FBI), Criminal Justice Information Collection
11919, 11920 (1988); Blanton, 43 FR at Services Division (CJIS), will be 1. Type of Information Collection:
27616. submitting the following information Extension of a currently approved
Because Registrant currently lacks collection request to the Office of collection.
authority to handle controlled Management and Budget (OMB) for 2. The Title of the Form/Collection:
substances in Utah, the State in which review and approval in accordance with Age, Sex, Race, and Ethnicity of Persons
he holds his DEA registration, he is not the Paperwork Reduction Act of 1995. Arrested Under 18 Years of Age; and
entitled to maintain his registration. DATES: Comments are encouraged and Age, Sex, Race, and Ethnicity of Persons
Accordingly, I will order that his will be accepted for 60 days until April Arrested 18 Years of Age and Over.
registration be revoked. 18, 2017. 3. The agency form number, if any,
Order FOR FURTHER INFORMATION CONTACT: All and the applicable component of the
comments, suggestions, or questions Department sponsoring the collection:
Pursuant to the authority vested in me
regarding additional information, to The form number is 1–708 and 1–708a.
by 21 U.S.C. 824(a), as well as 28 CFR
include obtaining a copy of the The applicable component within the
0.100(b), I order that DEA Certificate of
proposed information collection Department of Justice is the Criminal
Registration AP1393038, issued to Paul
E. Pilgram, M.D., be, and it hereby is, instrument with instructions, should be Justice Information Services Division, in
revoked. Pursuant to the authority directed to Mrs. Amy C. Blasher, Unit the Federal Bureau of Investigation.
vested in me by 21 U.S.C. 823(f), as well Chief, Federal Bureau of Investigation, 4. Affected public who will be asked
as 28 CFR 0.100(b), I further order that Criminal Information Services Division, or required to respond, as well as a brief
any pending application of Paul E. Module E–3, 1000 Custer Hollow Road, abstract:
Pilgram, M.D., to renew or modify this Clarksburg, West Virginia 26306; Primary: City, county, state, tribal and
registration, be, and it hereby is, denied. facsimile (304) 625–3566. federal law enforcement agencies.
This Order is effective immediately.5 Abstract: Under Title 28, U.S. Code,
SUPPLEMENTARY INFORMATION: Written
Section 534, Acquisition, Preservation,
Dated: February 9, 2017. comments and suggestions from the and Exchange of Identification Records;
Chuck Rosenberg, public and affected agencies concerning and Appointment of Officials, 1930, this
Acting Administrator. the proposed collection of information collection requests the number of arrests
[FR Doc. 2017–03223 Filed 2–16–17; 8:45 am] are encouraged. Your comments should from from city, county, state, tribal, and
BILLING CODE 4410–09–P
address one or more of the following federal law enforcement agencies in
four points: order for the FBI UCR Program to serve
—Evaluate whether the proposed as the national clearinghouse for the
DEPARTMENT OF JUSTICE collection of information is necessary collection and dissemination of arrest
for the proper performance of the data and to publish these statistics in
Federal Bureau of Investigation functions of the Federal Bureau of Crime in the United States.
[OMB Number 1110–0005] Investigation, including whether the 5. An estimate of the total number of
information will have practical utility; respondents and the amount of time
Agency Information Collection —Evaluate the accuracy of the agency’s estimated for an average respondent to
Activities; Proposed eCollection estimate of the burden of the respond: There are approximately
eComments Requested; Extension proposed collection of information, 11,791 law enforcement agency
Without Change, of a Currently including the validity of the respondents; calculated estimates
Approved Collection; Age, Sex, Race, methodology and assumptions used; indicate 12 minutes for form 1–708a and
and Ethnicity of Persons Arrested —Evaluate whether and if so how the 15 minutes for form 1–708 per month.
Under 18 Years of Age; Age, Sex Race, quality, utility, and clarity of the The total annual burden hours per
and Ethnicity of Persons Arrested 18 information to be collected can be respondent is 5 hours and 24 minutes.
Years of Age and Over enhanced; and Total Annual Hour Burden: 15
AGENCY: Federal Bureau of —Minimize the burden of the collection minutes + 12 minutes × 12 months =
Investigation, Department of Justice. of information on those who are to 324 / 60 = 5 hours and 24 minutes.
respond, including through the use of 6. An estimate of the total public
5 Based on the extensive findings of the Utah
appropriate automated, electronic, burden (in hours) associated with the
Division of Occupational and Professional mechanical, or other technological collection: There are approximately
Licensing, I find that the public interest necessitates
that this Order be effective immediately. 21 CFR collection techniques or other forms 63,671 hours, annual burden, associated
1316.67. of information technology, e.g., with this information collection.
mstockstill on DSK3G9T082PROD with NOTICES

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Document Created: 2017-02-17 00:29:04
Document Modified: 2017-02-17 00:29:04

Category		Regulatory Information
Collection		Federal Register
sudoc Class		AE 2.7: GS 4.107: AE 2.106:
Publisher		Office of the Federal Register, National Archives and Records Administration
Section		Notices
FR Citation		82 FR 11058

82 FR 11058 - Paul E. Pilgram, M.D.; Decision and Order

DEPARTMENT OF JUSTICEDrug Enforcement Administration

Federal Register Volume 82, Issue 32 (February 17, 2017)

DEPARTMENT OF JUSTICE
Drug Enforcement Administration