83 FR 14043 - Angela L. Lorenzo, P.A.: Decision and Order

DEPARTMENT OF JUSTICE
Drug Enforcement Administration

Federal Register Volume 83, Issue 63 (April 2, 2018)

Page Range		14043-14045
FR Document		2018-06618
Federal Register, Volume 83 Issue 63 (Monday, April 2, 2018)
[Federal Register Volume 83, Number 63 (Monday, April 2, 2018)]
[Notices]
[Pages 14043-14045]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-06618]


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DEPARTMENT OF JUSTICE

Drug Enforcement Administration


Angela L. Lorenzo, P.A.: Decision and Order

    On December 18, 2017, the Acting Assistant Administrator, Diversion 
Control Division, Drug Enforcement Administration (DEA), issued an 
Order to Show Cause to Angela L. Lorenzo, P.A. (Registrant), of Las 
Vegas, Nevada. The Show Cause Order proposed the revocation of 
Registrant's Certificate of Registration No. ML0901985 on the ground 
that she lacks ``authority to handle controlled substances in the State 
of Nevada, the State in which [she is] registered with the DEA.'' Order 
to Show Cause, Government Exhibit (GX) A-3, at 1 (citing 21 U.S.C. 
824(a)(3)).\1\ For the same reason, the Order also proposed the denial 
of any of Registrant's ``pending applications for a new registration or 
for renewal.'' Id.
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    \1\ The Show Cause Order also proposed that Registrant's DEA 
registration should be revoked because she ``committed acts which 
render [her] registration inconsistent with the public interest.'' 
GX 3, at 1 (citing 21 U.S.C. 823(f), 824(a)(4)). However, the 
Government did not include evidence to support this allegation with 
its Request for Final Agency Action (RFFA). Instead, the Government 
requested ``leave to supplement its [R]equest to include the grounds 
for revocation under 21 U.S.C. 823(f), 824(a)(4)'' should Registrant 
``regain her Nevada state license during the pendency of this 
Request for Final Agency Action.'' RFFA at 1 n.1. The Government has 
not filed a request to supplement its RFFA, apparently because 
Registrant has not regained her Nevada state medical license. 
Accordingly, I do not consider the Government's public interest 
allegation.
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    With respect to the Agency's jurisdiction, the Show Cause Order 
alleged that Registrant is registered as a practitioner in schedules II 
through V, pursuant to DEA Certificate of Registration No. ML0901985, 
at the address of 811 N Buffalo Road, Suite 113, Las Vegas, Nevada. Id. 
at 1-2. The Order also alleged that this registration

[[Page 14044]]

does not expire until March 31, 2018. Id.at 2.
    As substantive grounds for the proceeding, the Show Cause Order 
alleged that on September 29, 2017, the Nevada State Board of Medical 
Examiners (hereinafter NSBME) ``issued an Order of Summary Suspension 
immediately and indefinitely suspending [her] license to practice 
medicine in the State of Nevada.'' Id. The Order alleged that, ``[a]s a 
result, [she is] currently without authority to practice medicine or 
handle controlled substances in the State of Nevada, the [S]tate in 
which [she is] registered with the DEA.'' Id. Based on her ``lack of 
authority to handle controlled substances in the State of Nevada,'' the 
Order asserted that ``DEA must revoke'' her registration. Id. (citing 
21 U.S.C. 823(f), 824(a)(3)).
    The Show Cause Order notified Registrant of her 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 elect either option. Id. at 4 (citing 21 CFR 
1301.43). The Show Cause Order also notified Registrant of her right to 
submit a corrective action plan. Id. at 4-5 (citing 21 U.S.C. 
824(c)(2)(C)).
    The Government states that on December 19, 2017, a Data Analyst in 
DEA's Office of Chief Counsel sent a copy of the Show Cause Order by 
first-class mail to (1) the post office box address provided by 
Registrant as the ``mail to'' address on her DEA registration, P.O. Box 
36190, Las Vegas, Nevada, and (2) her registered address of 911 N 
Buffalo Road, Suite 113, Las Vegas, Nevada. Government's ``Request for 
Final Agency Action'' (RFFA), at 2 n.2, 3; GX B (Declaration of Data 
Analyst) at 1-2. The Government also states that only the mailing to 
the registered address was returned as undeliverable. See id. Also, on 
December 19, 2017, a Diversion Investigator (DI) ``emailed a copy of 
the [Show Cause Order] to'' the ``contact email'' address that 
Registrant had provided to the Agency on her DEA registration without 
receiving ``any error messages indicating that the email was not 
successfully sent'' or ``any notifications that the email was 
undeliverable.'' RFFA, at 3; GX A (Declaration of the Diversion 
Investigator), at 2.\2\ Based on these facts, I find that the 
Government's attempts to serve Registrant with the Show Cause Order 
satisfied its obligation under the Due Process Clause ``to provide 
`notice reasonably calculated, under all circumstances, to apprise 
interested parties of the pendency of the action and afford them an 
opportunity to present their objections.' '' Emilio Luna, M.D., 77 FR 
4829, 4829 (2012) (quoting Jones v. Flowers, 547 U.S. 220, 226 (2006) 
(quoting Mullane v. Central Hanover Bank & Trust Co., 339 U.S. 306, 314 
(1950))).
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    \2\ On December 19, 2017, Government counsel represents that he 
``provided'' a copy of the Show Cause Order to the attorney 
representing Registrant in the underlying NSBME proceeding. RFFA, at 
2 n.3. On January 4, 2018, that attorney emailed Government counsel 
``to advise [him] that, as of today, I no longer represent Ms. 
Lorenzo . . . but she is advised of her obligation to respond to the 
Order to Show Cause.'' RFFA, at 2 n.3; GX C (copy of email from 
Registrant's former attorney to Government counsel).
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    On February 1, 2018, the Government forwarded its Request for Final 
Agency Action and an evidentiary record to my Office. Therein, the 
Government represents that it has received neither a hearing request 
nor a written statement from Registrant regarding the Show Cause Order. 
RFFA, at 2. Based on the Government's representation and the record, I 
find that more than 30 days have passed since the Order to Show Cause 
was served on Registrant, and she has neither requested a hearing nor 
submitted a written statement in lieu of a hearing. See 21 CFR 
1301.43(d). Accordingly, I find that Registrant has waived her right to 
a hearing or to submit a written statement and issue this Decision and 
Order based on relevant evidence submitted by the Government. I make 
the following findings.

Findings of Fact

    Registrant is a physician's assistant who is registered as a 
practitioner in schedules II-V pursuant to Certificate of Registration 
No. ML0901985,\3\ at the address of 911 N Buffalo Rd., Ste. 113, Las 
Vegas, Nevada.\4\ Her registration does not expire until March 31, 
2018. See supra footnote 3.
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    \3\ The RFFA did not attach a copy of Registrant's DEA 
Certificate of Registration. However, I take official notice that 
the Agency's registration records show that Registrant obtained a 
registration as a mid-level practitioner-physician assistant on 
December 19, 2002, in schedules II through V, and last renewed her 
registration on April 15, 2015. According to the Agency's records, 
she has not submitted an application for renewal of her 
registration.
     Under 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, Registrant 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).
    \4\ The Show Cause Order states that the registered address is 
at 811 N Buffalo Road, Suite 113, Las Vegas, Nevada, even though the 
DEA registration shows a registrant address at 911 N Buffalo Road. 
In addition, the top of the Show Cause Order was addressed to 
Registrant at 911 N Buffalo Road, consistent with the registration. 
Accordingly, I find that Registrant's address is 911 N Buffalo Road, 
Suite 113, Las Vegas, Nevada, and I deem the Show Cause Order's 
reference to 811 N Buffalo Road a scrivener's error.
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    On September 28, 2017, the Investigative Committee (IC) of the 
NSBME issued an ``Order of Summary Suspension'' to Registrant that 
``IMMEDIATELY SUSPENDS [her] license to practice medicine.'' GX A-1, at 
1. Specifically, the IC suspended Registrant's license to practice 
medicine in the State of Nevada because ``the health, safety and 
welfare of the public is at imminent risk of harm by [Registrant's] 
continued performance of medical services without supervision, 
including the prescription of controlled substances, . . . her 
dishonest conduct, and . . . her continued refusal to comply with the 
lawful Orders of the [NSBME].'' Id. at 2.\5\ In light of the passage of 
time since the effective date of the Order, I have queried the NSBME 
website regarding the status of Registrant's medical license, and I 
take official notice that Registrant's Nevada medical license remains 
suspended as of the date of this decision.\6\
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    \5\ In its Order, the IC found, inter alia, that on September 6, 
2017, ``IC staff personally notified [Registrant] at her offices 
located at 911 N Buffalo Drive, Suite 113, Las Vegas, NV'' that she 
was prohibited under Nevada law ``from performing medical services 
until she obtained a supervising physician licensed and approved'' 
by the NSBME. Id. at 2. Although Registrant advised the IC on 
September 6, 2017 ``verbally and in writing that she would cease 
practicing,'' on September 11, 2017, she nevertheless wrote a 
prescription for Phentermine, a [s]chedule IV controlled 
substance.'' Id. The IC found that this conduct demonstrated that 
Registrant ``perform[ed] medical services, including the 
prescription of controlled substances,'' (1) in violation of Nevada 
law's requirement of physician supervision and (2) in ``direct 
contradiction to her prior written statement . . . on September 6, 
2017.'' Id.
    \6\ I take official notice under the authority set forth supra 
in footnote 3.
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    Thus, I find that that the IC's Order suspending Registrant from 
practicing medical services, which it stated includes dispensing 
controlled substances, independently bars Registrant from dispensing 
controlled substances in Nevada. Accord Nev. Rev. Stat. Sec. Sec.  
630.160 (2015) (``Every person desiring to practice medicine must, 
before beginning to practice, procure from the [NSBME] a license 
authorizing the person to practice.''); 630.020 (defining ``[p]ractice 
of medicine'' to include prescribing). Based on the above, I find that 
Registrant does not currently have authority under the laws

[[Page 14045]]

of Nevada to dispense controlled substances.\7\
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    \7\ Registrant's DEA registration information states that 
Registrant had a Nevada Controlled Substance License No. CS12166, 
but that it expired on October 31, 2016. I have queried the NSBME 
website regarding the status of Registrant's controlled substance 
license, and I take official notice (see supra footnote 3) that 
Nevada's online list of holders of active controlled substance 
licenses does not include Registrant by name or by her Nevada 
controlled substance registration number.
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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 Title 
21, ``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.'' With respect to a practitioner, 
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 registration. See, e.g., 
James L. Hooper, 76 FR 71371 (2011), pet. for rev. denied, 481 Fed. 
Appx. 826 (4th Cir. 2012); see also Frederick Marsh Blanton, 43 FR 
27616 (1978) (``State authorization to dispense or otherwise handle 
controlled substances is a prerequisite to the issuance and maintenance 
of a Federal controlled substances registration.'').
    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 [s]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 she 
is no longer authorized to dispense controlled substances under the 
laws of the State in which she engages in professional practice. See, 
e.g., Calvin Ramsey, 76 FR 20034, 20036 (2011); 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 27616 
(1978).
    Thus, ``the controlling question'' in a proceeding brought under 21 
U.S.C. 824(a)(3) is whether the holder of a practitioner's registration 
``is currently authorized to handle controlled substances in the 
[S]tate,'' Hooper, 76 FR at 71371 (quoting Anne Lazar Thorn, 62 FR 
12847, 12848 (1997)). Here, Registrant is no longer currently 
authorized to dispense controlled substances in Nevada, the State in 
which she is registered with the Agency. I will therefore revoke her 
DEA registration, deny any pending application to modify her 
registration, or any pending application for any other registration in 
Nevada.

Order

    Pursuant to the authority vested in me by 21 U.S.C. 823(f) and 
824(a), as well as 28 CFR 0.100(b), I order that DEA Certificate of 
Registration No. ML0901985, issued to Angela L. Lorenzo, P.A., be, and 
it hereby is, revoked. I further order that any pending application of 
Angela L. Lorenzo to renew or modify the above registration, or any 
pending application of Angela L. Lorenzo for any other registration in 
the State of Nevada, be, and it hereby is, denied. This Order is 
effective immediately.\8\
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    \8\ For the same reasons that led the NSBME to suspend 
Registrant's license, I find that the public interest necessitates 
that this Order be effective immediately. 21 CFR 1316.67.

    Dated: March 24, 2018.
Robert W. Patterson,
Acting Administrator.
[FR Doc. 2018-06618 Filed 3-30-18; 8:45 am]
 BILLING CODE 4410-09-P
Federal Register / Vol. 83, No. 63 / Monday, April 2, 2018 / Notices 14043

doing, and [that he] failed to adequately no physical exams documented in the hereby is, revoked. I further order that
document ongoing examinations and medical records’’ and ‘‘[t]here is no any pending application of Bernard
treatment planning . . . and/or he failed documentation in R.H.’s medical Wilberforce Shelton to renew or modify
to perform these professional functions records demonstrating a legitimate the above registration, as well as any
altogether.’’ GX 33, at 6 (D.S.), 8 (A.L.), medical justification . . . for other pending application for
11 (R.H.). [Registrant’s] prescribing’’ the registration be, and it hereby is, denied.
With respect to D.S., Dr. Chambers ‘‘dangerous combination[s]’’ of This Order is effective immediately.17
found that over the two-year period narcotics, benzodiazepines, and Dated: March 24, 2018.
between January 2014 and February carisoprodol to R.H. GX 33, at 10. Dr. Robert W. Patterson,
2016, there was no evidence in the Chambers also found that R.H.’s urine
Acting Administrator.
patient file that Registrant performed drug screens showed the presence of
physical exams other than to take vital [FR Doc. 2018–06617 Filed 3–30–18; 8:45 am]
controlled substances including
signs and that his treatment plan was amphetamines and benzodiazepines BILLING CODE 4410–09–P

essentially non-existent. He also found that Registrant did not prescribe to him
that D.S.’s chart contained multiples and that Registrant had also
notations that she was suffering from DEPARTMENT OF JUSTICE
documented that R.H. was
addiction but no evidence that overmedicating with respect to Valium. Drug Enforcement Administration
Registrant addressed this with her. Most However, R.H.’s medical record
significantly, as Dr. Chambers observed, contains no indication that Registrant Angela L. Lorenzo, P.A.: Decision and
D.S. provided multiple aberrational resolved these red flags. Order
drug tests which included: (1) The Accordingly, I agree with Dr.
presence of controlled substances which Chambers that Registrant lacked a On December 18, 2017, the Acting
he did not prescribe on six occasions, legitimate medical purpose and acted Assistant Administrator, Diversion
including methadone, buprenorphine, outside of the usual course of Control Division, Drug Enforcement
cocaine, and amphetamines; (2) the non- professional practice when he issued Administration (DEA), issued an Order
presence of controlled substances the various controlled substance to Show Cause to Angela L. Lorenzo,
(oxycodone and morphine) which he prescriptions identified above to D.S., P.A. (Registrant), of Las Vegas, Nevada.
had prescribed on two occasions; and A.L., and R.H. 21 CFR 1306.04(a); 21 The Show Cause Order proposed the
(3) the presence of oxycodone above the U.S.C. 841(a)(1). I also agree with Dr. revocation of Registrant’s Certificate of
recommended therapeutic range on four Chambers that Registrant’s prescribing Registration No. ML0901985 on the
occasions. Yet there is no evidence that to D.S., A.L. and R.H. violated Mich. ground that she lacks ‘‘authority to
Registrant addressed any of these Comp. Laws § 333.7401(1) and did not handle controlled substances in the
aberrational test results with D.S. comply with the Michigan Guidelines. State of Nevada, the State in which [she
As for A.L., Dr. Chambers found that I thus conclude that Registrant’s is] registered with the DEA.’’ Order to
‘‘for the most part,’’ Registrant did not multiple violations of 21 CFR 1306.04 Show Cause, Government Exhibit (GX)
document the performance of a physical (a), 21 U.S.C. 841(a)(1), and Mich. A–3, at 1 (citing 21 U.S.C. 824(a)(3)).1
exam and there is no documentation in Comp. Laws § 333.7401(1) are egregious For the same reason, the Order also
the patient file to support Registrant’s and support the conclusion that he ‘‘has proposed the denial of any of
prescribing of the combinations of committed such acts as would render Registrant’s ‘‘pending applications for a
narcotics, benzodiazepines, and his registration . . . inconsistent with new registration or for renewal.’’ Id.
carisoprodol that he did. GX 33, at 7. the public interest.’’ 21 U.S.C. With respect to the Agency’s
Moreover, A.L.’s MAPS report showed 824(a)(4).16 I therefore conclude that the jurisdiction, the Show Cause Order
that she had seen eight other providers Government’s evidence with respect to alleged that Registrant is registered as a
in the year prior to her first visit with Factors Two and Four makes out a practitioner in schedules II through V,
Registrant and that she had obtained prima facie case for revoking his pursuant to DEA Certificate of
controlled substances on 50 occasions 15 existing registration and denying any Registration No. ML0901985, at the
which included hydrocodone, applications for a new registration. As address of 811 N Buffalo Road, Suite
oxymorphone, oxycodone, morphine, Registrant has waived his right to a 113, Las Vegas, Nevada. Id. at 1–2. The
diazepam, alprazolam and amphetamine hearing or to submit a written statement Order also alleged that this registration
based on prescriptions issued by these of position, there is no evidence to
providers. Moreover, at her first visit refute the conclusion that his 17 Based on the egregious nature of Respondent’s
with Registrant, A.L. reported that she registration is inconsistent with the prescribing violations, I conclude that the public
was taking the Trinity of oxycodone, public interest. I will therefore order interest necessitates that this Order be effective
Xanax, and Soma, and while at one that Registrant’s remaining registration immediately. 21 CFR 1316.67.
1 The Show Cause Order also proposed that
point, Registrant even documented that be revoked and that any pending Registrant’s DEA registration should be revoked
A.L. stated that she was buying drugs off application be denied. because she ‘‘committed acts which render [her]
the street, Registrant did not address registration inconsistent with the public interest.’’
this aberrant behavior. Moreover, as Dr. Order GX 3, at 1 (citing 21 U.S.C. 823(f), 824(a)(4)).
Chambers observed, her chart is devoid Pursuant to the authority vested in me However, the Government did not include evidence
to support this allegation with its Request for Final
of evidence that she was monitored by 21 U.S.C. 823(f) and 824(a), as well Agency Action (RFFA). Instead, the Government
through the use of urine drug screens. as 28 CFR 0.100(b), I order that DEA requested ‘‘leave to supplement its [R]equest to
daltland on DSKBBV9HB2PROD with NOTICES

See GXs 18–20. Certificate of Registration No. include the grounds for revocation under 21 U.S.C.
With respect to R.H., Dr. Chambers FS6457407 issued to Bernard 823(f), 824(a)(4)’’ should Registrant ‘‘regain her
Nevada state license during the pendency of this
found that ‘‘[f]or the most part there are Wilberforce Shelton, M.D., be, and it Request for Final Agency Action.’’ RFFA at 1 n.1.
The Government has not filed a request to
15 In some instances, she obtained the controlled 16 This provides a separate and independent supplement its RFFA, apparently because
substances through a refill of a previously issued ground from the finding that he does not currently Registrant has not regained her Nevada state
prescription. See, e.g., GX 18, at 32 (alprazolam possess state authority for revoking his registration medical license. Accordingly, I do not consider the
refill); id. at 33–34 (refills of hydrocodone). and denying his application. Government’s public interest allegation.

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14044 Federal Register / Vol. 83, No. 63 / Monday, April 2, 2018 / Notices

does not expire until March 31, 2018. I find that the Government’s attempts to does not expire until March 31, 2018.
Id.at 2. serve Registrant with the Show Cause See supra footnote 3.
As substantive grounds for the Order satisfied its obligation under the On September 28, 2017, the
proceeding, the Show Cause Order Due Process Clause ‘‘to provide ‘notice Investigative Committee (IC) of the
alleged that on September 29, 2017, the reasonably calculated, under all
Nevada State Board of Medical NSBME issued an ‘‘Order of Summary
circumstances, to apprise interested
Examiners (hereinafter NSBME) ‘‘issued Suspension’’ to Registrant that
parties of the pendency of the action
an Order of Summary Suspension and afford them an opportunity to ‘‘IMMEDIATELY SUSPENDS [her]
immediately and indefinitely present their objections.’ ’’ Emilio Luna, license to practice medicine.’’ GX A–1,
suspending [her] license to practice M.D., 77 FR 4829, 4829 (2012) (quoting at 1. Specifically, the IC suspended
medicine in the State of Nevada.’’ Id. Jones v. Flowers, 547 U.S. 220, 226 Registrant’s license to practice medicine
The Order alleged that, ‘‘[a]s a result, (2006) (quoting Mullane v. Central in the State of Nevada because ‘‘the
[she is] currently without authority to Hanover Bank & Trust Co., 339 U.S. health, safety and welfare of the public
practice medicine or handle controlled 306, 314 (1950))). is at imminent risk of harm by
substances in the State of Nevada, the On February 1, 2018, the Government [Registrant’s] continued performance of
[S]tate in which [she is] registered with forwarded its Request for Final Agency medical services without supervision,
the DEA.’’ Id. Based on her ‘‘lack of Action and an evidentiary record to my including the prescription of controlled
authority to handle controlled Office. Therein, the Government substances, . . . her dishonest conduct,
substances in the State of Nevada,’’ the represents that it has received neither a and . . . her continued refusal to
Order asserted that ‘‘DEA must revoke’’ hearing request nor a written statement comply with the lawful Orders of the
her registration. Id. (citing 21 U.S.C. from Registrant regarding the Show [NSBME].’’ Id. at 2.5 In light of the
823(f), 824(a)(3)). Cause Order. RFFA, at 2. Based on the passage of time since the effective date
The Show Cause Order notified Government’s representation and the of the Order, I have queried the NSBME
Registrant of her right to request a record, I find that more than 30 days website regarding the status of
hearing on the allegations or to submit have passed since the Order to Show
a written statement in lieu of a hearing, Registrant’s medical license, and I take
Cause was served on Registrant, and she official notice that Registrant’s Nevada
the procedure for electing either option, has neither requested a hearing nor
and the consequence for failing to elect medical license remains suspended as
submitted a written statement in lieu of
either option. Id. at 4 (citing 21 CFR of the date of this decision.6
a hearing. See 21 CFR 1301.43(d).
1301.43). The Show Cause Order also Accordingly, I find that Registrant has Thus, I find that that the IC’s Order
notified Registrant of her right to submit waived her right to a hearing or to suspending Registrant from practicing
a corrective action plan. Id. at 4–5 submit a written statement and issue medical services, which it stated
(citing 21 U.S.C. 824(c)(2)(C)). this Decision and Order based on includes dispensing controlled
The Government states that on relevant evidence submitted by the substances, independently bars
December 19, 2017, a Data Analyst in Government. I make the following Registrant from dispensing controlled
DEA’s Office of Chief Counsel sent a findings. substances in Nevada. Accord Nev. Rev.
copy of the Show Cause Order by first- Stat. §§ 630.160 (2015) (‘‘Every person
class mail to (1) the post office box Findings of Fact
desiring to practice medicine must,
address provided by Registrant as the Registrant is a physician’s assistant before beginning to practice, procure
‘‘mail to’’ address on her DEA who is registered as a practitioner in from the [NSBME] a license authorizing
registration, P.O. Box 36190, Las Vegas, schedules II–V pursuant to Certificate of the person to practice.’’); 630.020
Nevada, and (2) her registered address Registration No. ML0901985,3 at the (defining ‘‘[p]ractice of medicine’’ to
of 911 N Buffalo Road, Suite 113, Las address of 911 N Buffalo Rd., Ste. 113, include prescribing). Based on the
Vegas, Nevada. Government’s ‘‘Request Las Vegas, Nevada.4 Her registration
for Final Agency Action’’ (RFFA), at 2 above, I find that Registrant does not
n.2, 3; GX B (Declaration of Data she is advised of her obligation to respond to the
currently have authority under the laws
Analyst) at 1–2. The Government also Order to Show Cause.’’ RFFA, at 2 n.3; GX C (copy
of email from Registrant’s former attorney to addressed to Registrant at 911 N Buffalo Road,
states that only the mailing to the Government counsel). consistent with the registration. Accordingly, I find
registered address was returned as 3 The RFFA did not attach a copy of Registrant’s that Registrant’s address is 911 N Buffalo Road,
undeliverable. See id. Also, on DEA Certificate of Registration. However, I take Suite 113, Las Vegas, Nevada, and I deem the Show
December 19, 2017, a Diversion official notice that the Agency’s registration records Cause Order’s reference to 811 N Buffalo Road a
Investigator (DI) ‘‘emailed a copy of the show that Registrant obtained a registration as a scrivener’s error.
mid-level practitioner-physician assistant on 5 In its Order, the IC found, inter alia, that on
[Show Cause Order] to’’ the ‘‘contact December 19, 2002, in schedules II through V, and September 6, 2017, ‘‘IC staff personally notified
email’’ address that Registrant had last renewed her registration on April 15, 2015. [Registrant] at her offices located at 911 N Buffalo
provided to the Agency on her DEA According to the Agency’s records, she has not Drive, Suite 113, Las Vegas, NV’’ that she was
registration without receiving ‘‘any error submitted an application for renewal of her prohibited under Nevada law ‘‘from performing
registration. medical services until she obtained a supervising
messages indicating that the email was Under the Administrative Procedure Act (APA), physician licensed and approved’’ by the NSBME.
not successfully sent’’ or ‘‘any an agency ‘‘may take official notice of facts at any Id. at 2. Although Registrant advised the IC on
notifications that the email was stage in a proceeding—even in the final decision.’’ September 6, 2017 ‘‘verbally and in writing that she
undeliverable.’’ RFFA, at 3; GX A U.S. Dept. of Justice, Attorney General’s Manual on would cease practicing,’’ on September 11, 2017,
the Administrative Procedure Act 80 (1947) (Wm. she nevertheless wrote a prescription for
(Declaration of the Diversion W. Gaunt & Sons, Inc., Reprint 1979). In accordance Phentermine, a [s]chedule IV controlled substance.’’
Investigator), at 2.2 Based on these facts,
daltland on DSKBBV9HB2PROD with NOTICES

with the APA and DEA’s regulations, Registrant is Id. The IC found that this conduct demonstrated
‘‘entitled on timely request to an opportunity to that Registrant ‘‘perform[ed] medical services,
2 On December 19, 2017, Government counsel show to the contrary.’’ 5 U.S.C. 556(e); see also 21 including the prescription of controlled
represents that he ‘‘provided’’ a copy of the Show CFR 1316.59(e). substances,’’ (1) in violation of Nevada law’s
Cause Order to the attorney representing Registrant 4 The Show Cause Order states that the registered requirement of physician supervision and (2) in
in the underlying NSBME proceeding. RFFA, at 2 address is at 811 N Buffalo Road, Suite 113, Las ‘‘direct contradiction to her prior written statement
n.3. On January 4, 2018, that attorney emailed Vegas, Nevada, even though the DEA registration . . . on September 6, 2017.’’ Id.
Government counsel ‘‘to advise [him] that, as of shows a registrant address at 911 N Buffalo Road. 6 I take official notice under the authority set forth

today, I no longer represent Ms. Lorenzo . . . but In addition, the top of the Show Cause Order was supra in footnote 3.

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Federal Register / Vol. 83, No. 63 / Monday, April 2, 2018 / Notices 14045

of Nevada to dispense controlled Yeates, M.D., 71 FR 39130, 39131 and Budget (OMB) for review and
substances.7 (2006); Dominick A. Ricci, 58 FR 51104, approval for use in accordance with the
51105 (1993); Bobby Watts, 53 FR Paperwork Reduction Act (PRA) of
Discussion
11919, 11920 (1988); Blanton, 43 FR 1995. Public comments on the ICR are
Pursuant to 21 U.S.C. 824(a)(3), the 27616 (1978). invited.
Attorney General is authorized to Thus, ‘‘the controlling question’’ in a DATES: The OMB will consider all
suspend or revoke a registration issued proceeding brought under 21 U.S.C. written comments that agency receives
under section 823 of Title 21, ‘‘upon a 824(a)(3) is whether the holder of a on or before May 2, 2018.
finding that the registrant . . . has had practitioner’s registration ‘‘is currently ADDRESSES: A copy of this ICR with
his State license . . . suspended [or] authorized to handle controlled applicable supporting documentation;
revoked . . . by competent State substances in the [S]tate,’’ Hooper, 76 including a description of the likely
authority and is no longer authorized by FR at 71371 (quoting Anne Lazar Thorn, respondents, proposed frequency of
State law to engage in the . . . 62 FR 12847, 12848 (1997)). Here, response, and estimated total burden
dispensing of controlled substances.’’ Registrant is no longer currently may be obtained free of charge from the
With respect to a practitioner, DEA has authorized to dispense controlled RegInfo.gov website at http://
long held that the possession of substances in Nevada, the State in www.reginfo.gov/public/do/PRAView
authority to dispense controlled which she is registered with the Agency. ICR?ref_nbr=201711-1219-001 (this link
substances under the laws of the State I will therefore revoke her DEA will only become active on the day
in which a practitioner engages in registration, deny any pending following publication of this notice) or
professional practice is a fundamental application to modify her registration, by contacting Michel Smyth by
condition for obtaining and maintaining or any pending application for any other telephone at 202–693–4129 (this is not
a registration. See, e.g., James L. Hooper, registration in Nevada. a toll-free number) or by email at DOL_
76 FR 71371 (2011), pet. for rev. denied,
Order PRA_PUBLIC@dol.gov.
481 Fed. Appx. 826 (4th Cir. 2012); see Submit comments about this request
also Frederick Marsh Blanton, 43 FR Pursuant to the authority vested in me by mail to the Office of Information and
27616 (1978) (‘‘State authorization to by 21 U.S.C. 823(f) and 824(a), as well Regulatory Affairs, Attn: OMB Desk
dispense or otherwise handle controlled as 28 CFR 0.100(b), I order that DEA Officer for DOL–MSHA Office of
substances is a prerequisite to the Certificate of Registration No. Management and Budget, Room 10235,
issuance and maintenance of a Federal ML0901985, issued to Angela L. 725 17th Street NW, Washington, DC
controlled substances registration.’’). Lorenzo, P.A., be, and it hereby is,
This rule derives from the text of two 20503; by Fax: 202–395–5806 (this is
revoked. I further order that any not a toll-free number); or by email:
provisions of the CSA. First, Congress pending application of Angela L.
defined ‘‘the term ‘practitioner’ [to] OIRA_submission@omb.eop.gov.
Lorenzo to renew or modify the above Commenters are encouraged, but not
mean[] a . . . physician . . . or other registration, or any pending application
person licensed, registered or otherwise required, to send a courtesy copy of any
of Angela L. Lorenzo for any other comments by mail or courier to the U.S.
permitted, by . . . the jurisdiction in registration in the State of Nevada, be,
which he practices . . . to distribute, Department of Labor-OASAM, Office of
and it hereby is, denied. This Order is the Chief Information Officer, Attn:
dispense, [or] administer . . . a effective immediately.8
controlled substance in the course of Departmental Information Compliance
professional practice.’’ 21 U.S.C. Dated: March 24, 2018. Management Program, Room N1301,
802(21). Second, in setting the Robert W. Patterson, 200 Constitution Avenue NW,
requirements for obtaining a Acting Administrator. Washington, DC 20210; or by email:
practitioner’s registration, Congress [FR Doc. 2018–06618 Filed 3–30–18; 8:45 am]
DOL_PRA_PUBLIC@dol.gov.
directed that ‘‘[t]he Attorney General BILLING CODE 4410–09–P
FOR FURTHER INFORMATION CONTACT:
shall register practitioners . . . if the Michel Smyth by telephone at 202–693–
applicant is authorized to dispense . . . 4129 (this is not a toll-free number) or
controlled substances under the laws of DEPARTMENT OF LABOR by email at DOL_PRA_PUBLIC@dol.gov.
the State in which [s]he practices.’’ 21 SUPPLEMENTARY INFORMATION: This ICR
U.S.C. 823(f). Because Congress has Agency Information Collection seeks PRA authority for the Performance
clearly mandated that a practitioner Activities; Submission for OMB Reports for Mine Safety and Health
possess state authority in order to be Review; Comment Request; Mine Administration Grants information
deemed a practitioner under the Act, Safety and Health Administration Grant collection. Mine Safety and Health
DEA has held repeatedly that revocation Performance Reports Office of the Administration grantees are required by
of a practitioner’s registration is the Secretary DOL regulations to submit project and
appropriate sanction whenever she is no final reports.
longer authorized to dispense controlled ACTION:Notice of availability; request A grantee submits a technical project
substances under the laws of the State for comments. report to the MSHA no later than 30
in which she engages in professional days after quarterly deadlines. A
practice. See, e.g., Calvin Ramsey, 76 FR SUMMARY: The Department of Labor technical project report provides both
20034, 20036 (2011); Sheran Arden (DOL) is submitting the Mine Safety and quantitative and qualitative information
Health Administration sponsored and a narrative assessment of
7 Registrant’s DEA registration information states information collection request (ICR) performance for the preceding three-
daltland on DSKBBV9HB2PROD with NOTICES

that Registrant had a Nevada Controlled Substance proposal titled, ‘‘Mine Safety and Health month period. This includes the current
License No. CS12166, but that it expired on October Administration Grant Performance
31, 2016. I have queried the NSBME website grant progress against the overall grant
regarding the status of Registrant’s controlled
Reports,’’ to the Office of Management goals. Between reporting dates, the
substance license, and I take official notice (see grantee informs MSHA of significant
supra footnote 3) that Nevada’s online list of 8 For the same reasons that led the NSBME to

holders of active controlled substance licenses does suspend Registrant’s license, I find that the public
developments or problems affecting the
not include Registrant by name or by her Nevada interest necessitates that this Order be effective organization’s ability to accomplish the
controlled substance registration number. immediately. 21 CFR 1316.67. work.

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Document Created: 2018-11-01 09:08:10
Document Modified: 2018-11-01 09:08:10
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		83 FR 14043
83 FR 14043 - Angela L. Lorenzo, P.A.: Decision and Order

DEPARTMENT OF JUSTICEDrug Enforcement Administration

Federal Register Volume 83, Issue 63 (April 2, 2018)

DEPARTMENT OF JUSTICE
Drug Enforcement Administration
