Notice2023-24153
Isaac Sved, M.D.; Decision and Order
Primary source
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Published
November 2, 2023
Issuing agencies
Justice DepartmentDrug Enforcement Administration
Full Text
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<title>Federal Register, Volume 88 Issue 211 (Thursday, November 2, 2023)</title>
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[Federal Register Volume 88, Number 211 (Thursday, November 2, 2023)]
[Notices]
[Pages 75323-75326]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-24153]
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DEPARTMENT OF JUSTICE
Drug Enforcement Administration
[Docket No. 23-17]
Isaac Sved, M.D.; Decision and Order
On December 8, 2022, the Drug Enforcement Administration (DEA or
Government) issued an Order to Show Cause and Immediate Suspension of
Registration (OSC/ISO) to Isaac Sved, M.D. (Respondent) of Buford,
Georgia. OSC/ISO, at 1. The OSC/ISO informed Respondent of the
immediate suspension of his DEA Certificate of Registration, Control
No. BS4103610, pursuant to 21 U.S.C. 824(d), alleging that Respondent's
continued registration constitutes `` `an imminent danger to the public
health or safety.' '' Id. (quoting 21 U.S.C. 824(d)). The OSC/ISO also
proposed the revocation of Respondent's registration, alleging that
Respondent has ``committed such acts as would render [his] registration
inconsistent with the public interest.'' Id. at 1, 4 (citing 21 U.S.C.
823(g)(1),\1\ 824(a)(4)).
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\1\ Effective December 2, 2022, the Medical Marijuana and
Cannabidiol Research Expansion Act, Public Law 117-215, 136 Stat.
2257 (2022) (Marijuana Research Amendments or MRA), amended the
Controlled Substances Act (CSA) and other statutes. Relevant to this
matter, the MRA redesignated 21 U.S.C. 823(f), cited in the OSC/ISO,
as 21 U.S.C. 823(g)(1). Accordingly, this Decision cites to the
current designation, 21 U.S.C. 823(g)(1), and to the MRA-amended CSA
throughout.
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A hearing was held before DEA Administrative Law Judge Teresa A.
Wallbaum (the ALJ) who, on June 20, 2023, issued her Recommended
Rulings, Findings of Fact, Conclusions of Law, and Decision
(Recommended Decision or RD), which recommended revocation of
Respondent's registration. RD, at 27. Respondent did not file
exceptions to the RD. Having reviewed the entire record, the Agency
adopts and hereby incorporates by reference the entirety of the ALJ's
rulings, credibility findings,\2\ findings of fact, conclusions of law,
sanctions analysis, and recommended sanction as found in the RD.
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\2\ The Agency adopts the ALJ's summary of each of the
witnesses' testimonies as well as the ALJ's assessment of each of
the witnesses' credibility. See RD, at 3-17. The Agency agrees with
the ALJ that the Diversion Investigator's testimony, which was
focused on the uncontroversial introduction of documentary evidence
and her contact with the case, was credible in that it was
sufficiently detailed, plausible, and internally consistent. Id. at
4. Further, the Agency agrees with the ALJ that the testimony from
the Government's expert witness, Dr. Steven Lobel, M.D., which was
focused on the Georgia standard of care and Respondent's prescribing
to the patients listed in the OSC/ISO, was credible in that it was
consistent with Georgia statutes governing the prescribing of
controlled substances, especially in the pain management context,
and was clear, direct, substantial, and consistent with regards to
the individual patients. Id. at 4-5. Finally, the Agency agrees with
the ALJ that although Respondent's testimony was credible as to
general facts, including Respondent volunteering information
regarding prior disciplinary actions, on the issue of whether his
prescriptions were within the usual course of professional practice
and for a legitimate medical purpose, Respondent's testimony was not
fully credible in that his interpretations of the Georgia standard
of care were inconsistent with the Georgia state statutes. Id. at 9-
10.
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I. Findings of Fact
Georgia Standard of Care
DEA hired Dr. Lobel to testify as an expert in the standard of care
for the practice of medicine and the prescribing of controlled
substances in the state of Georgia, with a focus on pain management.
RD, at 4; Tr. 105.\3\ Dr. Lobel defined ``standard of care'' as a
``minimum level of competence or care so as not to harm the patient,''
and described how the Georgia standard of care requires a practitioner
to, prior to prescribing controlled substances, obtain a patient's
prior medical records; obtain a medical history, including family
medical history and mental health history; conduct an appropriate
physical examination; obtain a urine drug screen; check the PDMP;
obtain informed consent from the patient; and document all information.
RD, at 11; Tr. 120, 128-129, 134, 136. Further, the physical
examination must be appropriate to the complaint, and for patients who
have spinal pain, the practitioner should also conduct a complete
neurologic exam. RD, at 11; Tr. 129-130. In addition, the Georgia
standard of care requires that a practitioner determine and document
the severity of pain. RD, at 11; Tr. 135-136.
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\3\ During the hearing, both Government counsel and Dr. Lobel
initially referenced a national standard of care established by the
CDC Guidelines, see RD, at 10, but Dr. Lobel ultimately testified
that the Georgia standard of care, upon which this decision is
based, is grounded in the state medical board's publications and
Georgia state statutes, with the CDC Guidelines incorporated to the
extent that they deal with the prescriptions of opioids. RD, at 10;
Tr. 114-115, 119, 125.
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Dr. Lobel testified that under the Georgia standard of care,
opioids ``are not first-line treatment for chronic pain,'' so a
practitioner must ``weigh the risks and benefits at every visit,'' as
well as look out for adverse effects, side effects, and aberrant
behavior. RD, at 11; Tr. 132-133, 136-137. According to Dr. Lobel,
under the Georgia standard of care, a practitioner should consider
taking a patient off of opioids when there is a ``lack of functional
benefit, toxic effects of the medicine where they're having end organ
damage, . . . [or] someone [] showing any signs or symptoms of
addiction,'' and patients
[[Page 75324]]
should be tapered off of opioids if they are not in pain or if they are
abusing the opioid prescription. RD, at 11-12; Tr. 140, 146-147.
Regarding the relevant red flags of abuse and diversion, Dr. Lobel
testified that under the Georgia standard of care, there is never a
legitimate medical purpose for prescribing the ``Holy Trinity'' because
``[e]ach medicine synergistically affects the other to augment a high''
and it produces ``respiratory drive'' as a side effect. RD, at 12; Tr.
148-149, 173. Moreover, Dr. Lobel testified that duplicative therapies,
that is, prescriptions for the same drugs in different strengths at
high quantities, are not legitimate medical practice and fall out of
the standard of care, with Dr. Lobel differentiating between
prescribing ``two dose units of the same medication to get a higher
dose unit at high quantities'' and prescribing a separate daytime and
nighttime pain medicine. RD, at 12; Tr. 109, 149-151.\4\
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\4\ Dr. Lobel testified that although Georgia law does not
specifically prohibit prescribing the ``Holy Trinity'' or
duplicative therapies, the standard of care described comes from the
state medical board. RD, at 12 n.10; Tr. 173, 290.
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Respondent
In 2010, Respondent began a family medicine and pain management
practice in Atlanta.\5\ RD, at 5; Tr. 335-336, 347, 363, 372.
Respondent testified that most of his patients are ``hard-working blue-
collar workers'' and ``laborers'' and that his patients prefer short-
acting opioids because they do not make them as drowsy as long-acting
opioids, therefore allowing the patients to control their pain but
still be able to work. RD, at 6; Tr. 343-345, 376-377. Respondent
testified that his patients also worry about ``cost-effectiveness''
because ``they don't have great insurance . . . [and] they can't really
afford to do physical therapy.'' RD, at 7; Tr. 348.
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\5\ Respondent testified that although he is not board-certified
in pain management, he has completed many hours of training. RD, at
5; Tr. 372. Specifically, he ``took specialized courses offered by .
. . the American Academy of Pain Management.'' RD, at 5; Tr. 347.
Respondent is also a member of the American Academy of Pain
Physicians, Integrative Pain Management, and performs immigration
physicals. RD, at 6; Tr. 347, 363.
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Respondent testified that he has seen many of his pain patients
since 2010 or 2012 and that he started these patients on lower doses of
opioids that increased over time with changes in drugs and dosages. RD,
at 7; Tr. 345. Respondent testified that he ``do[es] the rational
thoughts as to why [he] prescribe[s] these medications. [He] do[es not]
willy-nilly prescribe 120 doses of anything without thinking it
through.'' RD, at 7; Tr. 345-346. According to Respondent, he is ``kind
of old school'' and ``spend[s] more time talking to [patients],
examining them, and counseling them than writing notes.'' RD, at 7; Tr.
346.
Regarding opioids, Respondent acknowledged that an opioid
prescription must be medically necessary. RD, at 7; Tr. 378. Respondent
testified that he does ``everything [he is] supposed to do as far as
the Georgia requirements for pain management,'' but that he does not
``always write them down because . . . most of [his] practice is to
take care of the patients and not write paper.'' RD, at 8; Tr. 350, see
also Tr. 375, 376. Respondent also testified that although he sometimes
``missed'' information in his notes, all of the patient information is
documented in patient files in an ``abbreviated form.'' RD, at 8; Tr.
375-376.
Regarding the prescription of the ``Holy Trinity,'' Respondent
acknowledged that it is a dangerous combination, but testified that
``if [patients] failed other muscle relaxants, I usually have to go to
. . . the one that seems to work the best.'' RD, at 8; Tr. 351, 353.
Respondent asserted that he discusses the risk of combination
prescriptions with patients. RD, at 8; 355-356. Respondent testified
that he uses an application on his phone called Medscape to check for
interactions between medications. RD, at 9; Tr. 354-355.\6\ Ultimately,
Respondent testified that his job is ``to make people feel healthy and
good.'' RD, at 9; Tr. 360.
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\6\ Regarding the combination of oxycodone, Soma, and Xanax, the
``Holy Trinity'', Respondent testified that the Medscape application
reports three interactions of those drugs and says to ``monitor
closely'' but does not say ``severe adverse reaction.'' RD, at 9;
Tr. 355.
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Respondent testified that he is familiar with and adheres to the
Georgia standard of care, as found in the laws published by the Georgia
medical board website. RD, at 9; Tr. 338, 365-369. Regarding the
patients listed in the OSC/ISO, Respondent testified that his patients
were ``fully informed as to the nature of [his] proposals'' and that
his prescriptions were within the standard of care, with his patients
receiving ``more medical benefit than risk.'' RD, at 9; 365-366.
Respondent also denied running a ``pill mill'' or having any
arrangement with his patients regarding selling the controlled
substance prescriptions and denied knowingly or directly profiting from
any diversion, and according to Respondent, none of his patients have
been arrested for diversion. RD, at 9; Tr. 342, 364-365.
The Patients
Patient J.W.
On at least three occasions, Respondent issued prescriptions to
Patient J.W. that in combination formed the ``Holy Trinity.''
Specifically, on May 15, 2022, June 12, 2022, and July 17, 2022,
Respondent prescribed 30 mg oxycodone, 2 mg alprazolam, and 350 mg
carisoprodol. RD, at 13; Tr. 109, 274, 277, 280; GX 2, at 14-15, 17-18,
20-21. On each date, Respondent also prescribed a second opioid,
Percocet, a brand name for oxycodone/acetaminophen, a schedule II
opioid. RD, at 13; Tr. 274, 277, 280; GX 2, at 14, 17, 20. Because
there was no documentation justifying prescribing the ``Holy Trinity,''
Dr. Lobel concluded, and the Agency agrees, that the prescriptions were
not issued within the Georgia standard of care. RD, at 13; Tr. 275,
277, 280-282; GX 2, at 16, 19, 22. Accordingly, the ALJ found, and the
Agency agrees, that the prescriptions were not issued for a legitimate
medical purpose by a practitioner acting in the usual course of
professional practice. RD, at 13.
Patient S.D.
On at least three occasions, Respondent issued prescriptions to
Patient S.D. that in combination formed the ``Holy Trinity.''
Specifically, on April 27, 2022, May 25, 2022, and June 22, 2022,
Respondent prescribed 30 mg oxycodone, 2 mg alprazolam, and 350 mg
carisoprodol. RD, at 13-14; Tr. 265, 268-269, 270; GX 3, at 213, 217,
219. Moreover, on each date, Respondent also prescribed Percocet and
Valium, a brand name for diazepam, a schedule IV benzodiazepine,
forming a ``double'' ``Holy Trinity'' because there were two opioids
and two benzodiazepines in combination with the carisoprodol. RD, at
14; Tr. 265, 268-270, 272; GX 3, at 213, 217, 219. Because there was no
documentation justifying the prescriptions, Dr. Lobel concluded, and
the Agency agrees, that the prescriptions were not issued within the
Georgia standard of care. RD, at 14; Tr. 266, 267, 269, 271.
Accordingly, the ALJ found, and the Agency agrees, that the
prescriptions were not issued for a legitimate medical purpose by a
practitioner acting in the usual course of professional practice. RD,
at 14.
Patient T.J.
On at least three occasions, Respondent issued prescriptions to
Patient T.J. that in combination formed the ``Holy Trinity.''
Specifically, on May 9, 2022, June 6, 2022, and June 30, 2022,
Respondent prescribed 30 mg
[[Page 75325]]
oxycodone, 2 mg alprazolam, and 350 mg carisoprodol. RD, at 14-15; Tr.
259, 261, 263; GX 4, at 190, 192, 195. Because there was no
documentation justifying prescribing the ``Holy Trinity,'' Dr. Lobel
concluded, and the Agency agrees, that the prescriptions were not
issued within the Georgia standard of care. RD, at 15; Tr. 260, 262,
264.\7\ Accordingly, the ALJ found, and the Agency agrees, that the
prescriptions were not issued for a legitimate medical purpose by a
practitioner acting in the usual course of professional practice. RD,
at 15.
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\7\ Dr. Lobel testified that the documentation for the June 30,
2022, prescriptions did not support prescribing the ``Holy
Trinity,'' but the Government did not elicit any testimony regarding
the adequacy of the documentation for the other two dates for
Patient T.J. RD, at 15 n.15; Tr. 263.
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Patient A.A.
On at least three occasions, Respondent issued prescriptions to
Patient A.A. that were therapeutically duplicative. Specifically, on
April 11, 2022, June 6, 2022, and July 6, 2022, Respondent prescribed
30 mg oxycodone and Percocet. RD, at 15; Tr. 245, 250-251, 255; GX 5,
at 63, 64, 66. As Dr. Lobel testified, oxycodone and Percocet are both
immediate release opioids and so prescribing them in combination is
therapeutic duplication. RD, at 15; Tr. 245-246, 250-251, 257. Because
there was no documentation justifying the therapeutic duplication, Dr.
Lobel concluded, and the Agency agrees, that the prescriptions were not
issued within the Georgia standard of care. RD, at 15; Tr. 246, 249,
251, 253, 256-258; GX 5, at 37, 38, 40. Accordingly, the ALJ found, and
the Agency agrees, that the prescriptions were not issued for a
legitimate medical purpose by a practitioner acting in the usual course
of professional practice. RD, at 15-16.
Patient L.B.
On at least three occasions, Respondent issued prescriptions to
Patient L.B. that were therapeutically duplicative. Specifically, on
May 15, 2022, June 12, 2022, and July 10, 2022, Respondent prescribed
30 mg oxycodone and Percocet. RD, at 16; Tr. 221, 235, 238-239, 241-
242; GX 6, at 35, 37, 39. Because there was no documentation justifying
the therapeutic duplication, Dr. Lobel concluded, and the Agency
agrees, that the prescriptions were not issued within the Georgia
standard of care. RD, at 16; Tr. 236, 239 241; GX 5, at 36, 38, 40.
Accordingly, the ALJ found, and the Agency agrees, that the
prescriptions were not issued for a legitimate medical purpose by a
practitioner acting in the usual course of professional practice. RD,
at 16.
Patient A.T.
On at least three occasions, Respondent issued prescriptions to
Patient A.T. that were therapeutically duplicative. Specifically, on
April 6, 2022, May 4, 2022, and June 2, 2022, Respondent prescribed 30
mg oxycodone and Percocet. RD, at 16; Tr. 220-221, 225, 226, 228-229;
GX 7, at 86, 87, 88. Because there was no documentation justifying the
therapeutic duplication, Dr. Lobel concluded, and the Agency agrees,
that the prescriptions were not issued within the Georgia standard of
care. RD, at 16-17; Tr. 221-222, 226-227, 231; GX 7, at 31-33.
Accordingly, the ALJ found, and the Agency agrees, that the
prescriptions were not issued for a legitimate medical purpose by a
practitioner acting in the usual course of professional practice. RD,
at 17.
I. Discussion
A. The Five Public Interest Factors
Under 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 as would render his registration under section 823 of this title
inconsistent with the public interest as determined under such
section.'' 21 U.S.C. 824(a). In making the public interest
determination, the CSA requires consideration of the following factors:
(A) The recommendation of the appropriate State licensing board or
professional disciplinary authority.
(B) The [registrant's] experience in dispensing, or conducting
research with respect to controlled substances.
(C) The [registrant's] conviction record under Federal or State
laws relating to the manufacture, distribution, or dispensing of
controlled substances.
(D) Compliance with applicable State, Federal, or local laws
relating to controlled substances.
(E) Such other conduct which may threaten the public health and
safety. 21 U.S.C. 823(g)(1).
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).
The Government has the burden of proof in this proceeding. 21 CFR
1301.44. While the Agency has considered all of the public interest
factors in 21 U.S.C. 823(g)(1), the Government's evidence in support of
its prima facie case for revocation of Respondent's registration is
confined to Factors B and D. RD, at 18; see also RD, at 18 n.20
(finding that Factors A, C, and E do not weigh for or against
revocation).
Having reviewed the record and the RD, the Agency agrees with the
ALJ, adopts the ALJ's analysis, and finds that the Government's
evidence satisfies its prima facie burden of showing that Respondent's
continued registration would be ``inconsistent with the public
interest.'' 21 U.S.C. 824(a)(4). RD, at 17-23.
B. Factors B and D
Evidence is considered under Public Interest Factors B and D when
it reflects compliance (or non-compliance) with laws related to
controlled substances and experience dispensing controlled substances.
See Sualeh Ashraf, M.D., 88 FR 1095, 1097 (2023); Kareem Hubbard, M.D.,
87 FR 21156, 21162 (2022). DEA regulations require that for a
prescription for a controlled substance to be effective, it must be
issued for a legitimate medical purpose by an individual practitioner
acting in the usual course of professional practice. 21 CFR 1306.04(a);
see also 21 U.S.C. 829. Georgia state law too provides that a
practitioner may only issue prescriptions while acting in the usual
course of his professional practice and for a legitimate medical
purpose. Ga. Code Ann. section 16-13-41(f)(2), (3).
In the current matter, the Agency agrees with the ALJ's analysis
that Respondent's treatment of the six patients described above fell
below the Georgia standard of care and thus violated Federal and State
law because, as detailed above, Respondent continually prescribed the
``Holy Trinity'' and duplicative therapies while failing to establish a
medical justification for the prescriptions; as such, Respondent's
prescribing was not within the usual course of professional practice
and not for a legitimate medical purpose.\8\ RD, at 20-21. As
[[Page 75326]]
Respondent's conduct displays clear violations of the Federal and State
regulations described above, the Agency agrees with the ALJ and hereby
finds that Respondent violated 21 U.S.C. 829; 21 CFR 1306.04(a); and
Ga. Code Ann. section 16-13-41(f)(2), (3). Id. Accordingly, the Agency
agrees with the ALJ and finds that Factors B and D weigh in favor of
revocation of Respondent's registration and thus finds Respondent's
continued registration to be inconsistent with the public interest in
balancing the factors of 21 U.S.C. 823(g)(1). Id. at 23.
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\8\ The Agency also agrees with the ALJ's conclusion that none
of Respondent's arguments--including, among others, that the case
was initially based on unfounded criminal allegations; that the
patients suffered no injuries as a result of Respondent's treatment;
that the Government's case was only an attack on Respondent's
recordkeeping; that both public and private insurance companies saw
fit to cover Respondent's treatments; and that none of Respondent's
patients engaged in illicit activity--refute this analysis. RD, at
21-23.
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III. Sanction
Where, as here, the Government has established sufficient grounds
to revoke Respondent's registration, the burden shifts to the
registrant to show why he can be entrusted with the responsibility
carried by a registration. Garret Howard Smith, M.D., 83 FR 18882,
18910 (2018). When a registrant has committed acts inconsistent with
the public interest, he must both accept responsibility and demonstrate
that he has undertaken corrective measures. Holiday CVS, L.L.C., dba
CVS Pharmacy Nos 219 and 5195, 77 FR 62316, 62339 (2012) (internal
quotations omitted). Trust is necessarily a fact-dependent
determination based on individual circumstances; therefore, the Agency
looks at factors such as the acceptance of responsibility, the
credibility of that acceptance as it relates to the probability of
repeat violations or behavior,\9\ the nature of the misconduct that
forms the basis for sanction, and the Agency's interest in deterring
similar acts. See, e.g., Robert Wayne Locklear, M.D., 86 FR 33738,
33746 (2021).
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\9\ The record shows that in 2006, Respondent entered into a
Memorandum of Understanding (MOU) with DEA in which Respondent
admitted to prescribing controlled substances arguably in violation
of generally accepted standard practices and Federal regulations;
prescribing a large number of narcotics, with over half of his 1,500
patients prescribed narcotics; and keeping samples of controlled
substances at an unregistered location. RD, at 3; Tr. 24; GX 12.
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Here, the Agency agrees with the ALJ that ``Respondent's hearing
testimony and post-hearing arguments constitute a blanket denial of any
wrongdoing.'' RD, at 25. Notably, Respondent testified that he did
``everything [he is] supposed to do as far as the Georgia requirements
for pain management'' and that ``[t]his hobgoblin of a drug problem
exists primarily in the mind of an easily excitable DEA.'' Id. at 24-
25; Tr. 350; Respondent's Post-Hearing Brief, at 6. As stated by the
ALJ, ``Respondent's testimony and argument simply cannot be reconciled
with the record evidence.'' RD, at 25. As such, and because Respondent
made no admittance of any wrongdoing on his part, the Agency agrees
with the ALJ and finds that Respondent failed to unequivocally accept
responsibility. Id.
When a registrant fails to make the threshold showing of acceptance
of responsibility, the Agency need not address the registrant's
remedial measures. Ajay S. Ahuja, M.D., 84 FR 5479, 5498 n.33 (2019)
(citing Jones Total Health Care Pharmacy, L.L.C. & SND Health Care,
L.L.C., 81 FR 79188, 79202-03 (2016)); Daniel A. Glick, D.D.S., 80 FR
74800, 74801, 74810 (2015). Even so, in the current matter, Respondent
did not present any evidence of remedial measures, and the Agency thus
agrees with the ALJ that ``[Respondent's] failure to put forth any
evidence of steps he has taken to avoid similar misconduct in the
future shows that he cannot be entrusted with a [registration].'' RD,
at 26.
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 at 74810. In this case, the
Agency agrees with the ALJ that ``failing to impose a significant
sanction against Respondent would send the wrong message to registrants
that the Agency does not take seriously a registrant who repeatedly
prescribes dangerous drug cocktails and combinations.'' RD, at 26.
Regarding Respondent in particular, ``[g]iven Respondent's cavalier
attitude regarding the standard of care, specific deterrence is
necessary.'' Id. Moreover, the Agency agrees with the ALJ that
Respondent's actions were egregious because Respondent not only ignored
his obligations to issue prescriptions within the standard of care and
instead prescribed combinations that he knew to be dangerous to his
patients, but he also endangered the community at large given the risk
of diversion when prescribing such combinations. Id.
In sum, Respondent has not offered any credible evidence on the
record to rebut the Government's case for revocation of his
registration and Respondent has not demonstrated that he can be
entrusted with the responsibility of registration. RD, at 27.
Accordingly, the Agency will order that Respondent's registration be
revoked.
Order
Pursuant to 28 CFR 0.100(b) and the authority vested in me by 21
U.S.C. 824(a), I hereby revoke DEA Certificate of Registration No.
BS4103610 issued to Isaac Sved, M.D. Further, pursuant to 28 CFR
0.100(b) and the authority vested in me by 21 U.S.C. 823(g)(1), I
hereby deny any pending applications of Isaac Sved, M.D., to renew or
modify this registration, as well as any other pending application of
Isaac Sved, M.D., for additional registration in Georgia. This Order is
effective December 4, 2023.
Signing Authority
This document of the Drug Enforcement Administration was signed on
October 25, 2023, by Administrator Anne Milgram. That document with the
original signature and date is maintained by DEA. For administrative
purposes only, and in compliance with requirements of the Office of the
Federal Register, the undersigned DEA Federal Register Liaison Officer
has been authorized to sign and submit the document in electronic
format for publication, as an official document of DEA. This
administrative process in no way alters the legal effect of this
document upon publication in the Federal Register.
Heather Achbach,
Federal Register Liaison Officer, Drug Enforcement Administration.
[FR Doc. 2023-24153 Filed 11-1-23; 8:45 am]
BILLING CODE 4410-09-P
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