[Federal Register: March 28, 2003 (Volume 68, Number 60)]
[Notices]
[Page 15227-15231]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr28mr03-99]
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DEPARTMENT OF JUSTICE
Drug Enforcement Administration
[Docket No. 00-24]
Robert A. Leslie, M.D., Revocation of Registration
On May 8, 2000, the Deputy Assistant Administrator, Office of
Diversion Control, Drug Enforcement Administration (DEA), issued an
Order to Show Cause to Robert A. Leslie, M.D. (Respondent), proposing
to deny his application for a DEA Certification of Registration
pursuant to 21 U.S.C. 823(f) for reason that such registration would be
inconsistent with the public interest. Specifically, the Order to Show
Cause alleged the following:
(1) On August 17, 1990, Respondent's DEA Certificate of
Registration, ALOO33186, was revoked based in part on findings that:
(a) On or about October 3, 1986, Respondent was convicted in the
Superior Court for the County of Los Angeles, California of eight
counts of unlawfully prescribing, administering, furnishing, or
dispensing controlled substances; and (b) effective March 23, 1990, the
California Board of Medical Quality Assurance suspended Respondent's
license to practice medicine for ninety days and placed his medical
license on probation for five years.
(2) During February 1992, Respondent submitted a new application
for registration. Following a hearing, the then-Administrator of DEA
denied Respondent's application, effective March 15, 1995, noting,
inter alia, that Respondent was either unable or unwilling to discharge
the responsibilities inherent in a DEA registration. Respondent's
petition for review of this decision was denied by the United States
Court of Appeals for the Ninth Circuit on August 5, 1996.
(3) On or about December 13, 1996, Respondent submitted a new
application for a DEA registration. The then-Deputy Administrator
concluded that the previous administrative proceeding was res judicata
for the purposes of the then-current proceeding. Effective June 14,
1999, the Deputy Administrator again denied Respondent's application,
concluding that other than the passage of time, the circumstances
existing at the time of the prior proceeding had not sufficiently
changed to warrant issuance of a DEA registration.
Respondent, acting pro se, filed a timely request for a hearing on
the issues raised in the Order to Show Cause. Following prehearing
procedures, a hearing was held on September 21, 2000, and February 8,
2001, in Los Angeles, California before Administrative Law Judge Mary
Ellen Bittner (Judge Bittner). At the hearing, the Government called
two witnesses to testify and the Respondent testified on his own
behalf. Both parties also introduced documentary evidence. After the
hearing, both parties submitted proposed findings of fact, conclusions
of law, and argument.
On August 2, 2001, Judge Bittner issued her Opinion and Recommended
Ruling, Findings of Fact, Conclusions of Law and Decision recommending
that the Respondent's application be denied. On or around August 17,
2001, the Respondent timely filed exceptions to Judge Bittner's
recommended ruling. Thereafter, Judge Bittner transmitted the record of
these proceedings to the Administrator of the Drug Enforcement
Administration.
On March 4, 2002, the Respondent filed Judge Bittner, a letter (the
March 2002 letter) in which he represented, among other things, that a
provision under California law allows physician assistants to prescribe
certain drugs ``with or without preprinted prescriptions from the
supervising physician.'' The Respondent further requested that Judge
Bittner transmit the additional document to the Deputy Administrator
for consideration. It appears from a review of the record before the
Deputy Administrator that matters involving the role of physician
assistants and the prescribing of controlled substances were litigated.
It is unclear however why the Respondent did not introduce the March
2002 at the hearing or reference its contents in his post-hearing
submissions. Therefore, in rendering his decision in this matter, the
Deputy Administrator has not considered the Respondent's untimely
[[Page 15228]]
submission, as it seeks to introduce evidence not submitted at the
hearing in this matter. See Richard S. Wagner, M.D. 63 FR 6771 (1998).
On August 20, 2002, the Deputy Administrator received from
Government counsel a letter, with attachments, informing that due to an
administrative oversight, DEA Certificate of Registration, BL6652312,
was erroneously issued to the Respondent on February 9, 2000. In light
of the Respondent's current registration status, the question for
resolution now before the Deputy Administrator is whether or not the
Respondent's continued registration with DEA is inconsistent with the
public interest.
The Deputy Administrator finds that the Respondent previously
possessed DEA Certificate of Registration AL0033186. On June 21, 1989,
an Order to Show Cause was issued proposing to revoke that Certificate
of Registration. Robert A. Leslie, M.D. 64 FR 25908 (1999). The
Respondent initially requested a hearing, but later requested the
opportunity ot submit a written statement in lieu of a hearing. Based
on the Government's investigative file and Respondent's written
statement, the then-Acting Administrator revoked Respondent's
registration effective August 17, 1990. See 55 FR 29,278 (July 18,
1990).
In February 1992, Respondent applied for a new DEA registration. An
Order to Show Cause was issued on May 13, 1993, proposing to deny the
application. Following a hearing before Judge Bittner, the then-Deputy
Administrator adopted Judge Bittner's recommended ruling and denied the
Respondent's application for registration, effective March 15, 1995.
See 60 FR 14,004 (1995).
During the 1993 proceeding before Judge Bittner, the record
established that on October 9, 1986, after a jury trial, Respondent was
found guilty in the Municipal Court of Long Beach, California, of eight
misdemeanor counts of unlawfully prescribing, administering,
furnishing, or dispensing controlled substances between July 1985 and
January 1986. The convictions were affirmed on appeal by the Appellate
Department of the Superior Court, State of California, on May 18, 1988.
As a result of these convictions, the California Board of Medical
Quality Assurance (Board), on a date not specified in the record,
revoked the Respondent's medical license. However, the Board stayed the
revocation for five years, suspended Respondent from the practice of
medicine for ninety days, and placed him on probation subject to
various conditions. In response to the Board's decision, the Respondent
sued the Board, but was unsuccessful. The court in which Respondent
brought the action ultimately fined him $10,000 and found that his
appeal was frivolous. In addition, the court found that the Respondent
must ``accept responsibility for his actions.''
As outlined in a prior final order, the then-Deputy Administrator
found at the 1993 hearing, the Respondent attacked his criminal
convictions. See 64 FR 25908 (May 13, 1999). However, Judge Bittner and
the then-Deputy Administrator found that the conviction was res
judicata and that Respondent was therefore prohibited from relitigating
the matter. The agency also found that although he was free to offer
evidence that he would never again engage in the sort of conduct that
resulted in his conviction, Respondent did not avail himself of that
opportunity and offered no evidence of remorse for his misconduct,
efforts at rehabilitation, or recognition of the severity of his
conduct. Judge Bittner and the then-Deputy Administrator therefore
concluded that Respondent was either unwilling or unable to discharge
the responsibilities of a DEA registrant and recommended that his
application be denied. Respondent filed a petition for review of the
1995 final order in the United States Court of Appeals for the Ninth
Circuit. The court denied that petition on August 5, 1996.
On December 13, 1996, Respondent again applied for a DEA
registration, and an Order to Show Cause was issued on December 23,
1997, proposing to deny the application. Following a hearing,
Administrative Law Judge Gail A. Randall recommended that the
application be granted, subject to certain conditions. Judge Randall
found that Respondent had been forthcoming on his registration
application about his convictions and prior DEA proceedings, there were
no new allegations that Respondent had handled controlled substances
improperly after his 1986 conviction, and there had been no complaints
or adverse actions against his medical license since the 1988 Board
proceeding. Judge Randall further found that Respondent had continued
to make valuable contributions to the medical profession; participated
in continuing medical education; there were no restrictions on his
medical license in California; and Respondent had become more
conservative in his approach to prescribing controlled substances.
In the May 13, 1999, Final Order, the then-Deputy Administrator
found that the final order published on March 15, 1995, was res
judicata for purposes of the proceeding before him, and adopted that
final order in its entirety. 64 FR 25908, supra. While the then-Deputy
Administrator adopted the findings of fact and conclusions of law as
set forth, he did not adopt the recommended ruling of the
Administrative Law Judge. Instead, the Deputy Administrator found that
in addition to his criminal conviction and the suspension of his
medical license, the Respondent was unrepentant, and continued to blame
everyone but himself for his unlawful actions. Therefore, the then-
Deputy Administrator concluded that Respondent's registration would not
be consistent with the public interest and denied the application.
On June 29, 1999, Respondent again applied for a DEA registration
to handle controlled substances. That application and the disposition
of the Certificate of Registration that was mistakenly issued to the
Respondent, are the subjects of the instant proceedings.
The Deputy Administrator finds that the Respondent's June 1999
application was forwarded to DEA's Los Angeles office for investigation
because Respondent had answered ``yes'' to questions on the form that
ask whether the applicant has ever been convicted of a crime in
connection with controlled substances, ever surrendered or had adverse
action taken on a federal controlled substance registration, or has
ever had action taken against a state professional license or
controlled substance registration. A DEA Diversion Investigator
testified that on November 24, 1999, she spoke with the Respondent and
asked him why he believed his application should be granted. According
to the investigator, the Respondent attacked the prior DEA and criminal
proceedings in which he had been involved, but did not say anything
that would suggest that he would act responsibly in the future if his
application were granted, nor did he divulge any actions he had taken
that would support his application.
Respondent then wrote a ten-page letter dated November 25, 1999, to
the Diversion Investigator explaining his position with respect to the
1986 conviction and his efforts first to maintain and then to regain
DEA registration. Specifically, the Respondent made various claims
regarding the inadequacy of the 1986 criminal proceedings resulting in
his conviction, as well as his legal representation during those
proceedings. In support of the latter assertion, Respondent offered
into evidence in the instant matter a letter from the State Bar of
California dated
[[Page 15229]]
August 3, 1999, indicating that his attorney ``resigned from the
practice of law with charges pending'' in 1994.
Respondent also contended in the aforementioned letter that his
applications for habeas corpus, coram nobis, and declarative relief
were denied, asserting that he was ``unable to submit an adequate
habeas corpus petition because defense counsel refused to release
[Respondent's] criminal file, although [sic] sued for its return in the
legal malpractice suit, until given an ultimatum to do so by the state
bar, when [Respondent] was no longer in custody.''
With respect to the various DEA proceedings described above, the
Respondent asserted in his letter that his registration was initially
revoked ``without notice or hearing based on false, inadmissible
hearsay evidence given to the agency by the medical board.'' The
Respondent recited numerous additional allegations with respect to
DEA's action against his previous registration, as well as his
applications for registration, which are summarized as follows: DEA
took action against the Respondent's registration because he advised
the agency of the criminal activities taking place at a clinic in Long
Beach; an undercover operative gave false information that Respondent
supplied Schedule II drugs for weight control when in fact he used
Schedule IV drugs; the then-Administrator did not consider all the
pleadings and evidence; no other physician has had a registration
revoked based on a misdemeanor conviction for improperly prescribing
Schedule III drugs; he had three years of training in pharmacology and
was familiar with the drugs he handled; hearsay was improperly
admitted; and the then-Administrator's decision conflicted with those
of the trial judge, the state administrative law judge for the Board,
as well as the Board itself.
The Respondent further contended in his letter that the denial of
his 1992 application was based on his purported failure ``to take
unspecified `rehabilitative' steps.'' With respect to the denial of his
1996 application, Respondent asserted, inter alia, that the then-Deputy
Administrator's order conflicted with the opinion of the administrative
law judge who heard the evidence, and was made on the ``incorrect basis
that in [Respondent's] administrative hearing he failed to offer any
evidence that [he] has been rehabilitated and can handle restricted
substances even on a restricted bas[i]s.''
The Government also presented the testimony of a second Diversion
Investigator from the agency's Los Angeles office. The investigator
testified that on July 13, 2000, DEA personnel seized approximately
13,000 prescriptions from Plaza Pharmacy in Hawthorne, California, in
the course of an investigation unrelated to Respondent. Three of the
seized prescriptions, which were admitted into evidence as Government
exhibits appeared to be written by someone on a preprinted prescription
pad with a caption that read, ``Robert M.D. Clinic.'' The prescriptions
in question also bore the clinic's address as well as the Respondent's
name. One of the prescriptions was issued to a patient hereinafter
identified by his initials ``FU'' and dated January 12, 2000, for
promethazine with codeine (a Schedule IV controlled substance);
prescriptions were also issued to patient ``GB'' and dated January 19,
2000, for forty cephalexinll (a non-controlled drug) and eight ounces
of Phenergan with codeine (a brand name for promethazine); and the
third prescription was issued to a ``JH'' and dated December 27, 1999,
for cephalexin and promethazine with codeine. Further review of the
third prescription reveals the Respondent's previous DEA registration
number, AL0033186, written in the lower left corner of the document. As
noted above, the DEA registration number was revoked, effective August
17, 1990.
The second DEA Diversion Investigator further testified at the
hearing that the handwriting on each of the Plaza Pharmacy
prescriptions appeared to be different, and that the person who signed
each prescription appeared to be someone other than the person who
wrote the patient's name, the medication to be dispensed, and date. The
investigator further testified that the DEA registration number written
on these prescriptions did not appear to be in Respondent's
handwriting.
Respondent testified that he was retained as a physician in the
Robert M.D. Clinic in Hawthorne in December 1999 as a supervisor of
physician assistants, that he did not personally see patients or write
prescriptions, and that he only went to the clinic once or twice per
week to sign charts. The Respondent further testified that he neither
wrote the prescriptions at issue nor authorized anyone else to write
them, and did not know any of the patients to whom the prescriptions
were issued. Respondent also testified that he did not think he signed
the prescriptions because he usually wrote out his whole name when
signing prescriptions and some letters appeared to be missing from the
prescriptions at issue. However, Respondent also acknowledged that
``[i]t might be'' his signature on the prescription for GB, and if so,
he may have signed the prescription in blank, as he would not have
issued the prescription as written. With respect to the prescription to
JH, Respondent testified that the physician signature, instructions,
and the patient's name and address were not in his handwriting.
DEA's investigation did not reveal whether the Respondent actually
issued the above referenced prescriptions. The Deputy Administrator
concurs with Judge Bittner's finding that the record is not sufficient
to determine whether or not Respondent signed the three prescriptions
in evidence. However, Respondent testified that his practice was to
sign ``a bunch of'' blank prescriptions preprinted with his name and
make them available to the clinic's physician assistants, with a
``proviso that they did not prescribe any restricted substances.''
Respondent further testified that he told the physician assistants not
to issue prescriptions for controlled substances, and that a sign
posted in the clinic advised patients that the clinic would not issue
controlled substances prescriptions.
In addition, a part time physician assistant employed at the Robert
M.D. Clinic for two or three months beginning in early August 2000,
testified that she had seen blank pads with prescriptions similar in
appearance to the prescriptions issued to GB and FU. The physician
assistant added that the DEA and license numbers on the prescriptions
were those that the owner of the clinic had told her she would need to
provide to pharmacists in order to have prescriptions filled. The DEA
and license numbers referenced by the physician assistant belonged to
the Respondent. The physician assistant further testified that she was
told by both the clinic owner and Respondent that she could use the
Respondent's DEA number when calling a pharmacy to authorize
prescriptions for medications to treat high blood pressure and
diabetes.
Pursuant to 21 U.S.C. 823(f) and 824(a)(4), the Deputy
Administrator may revoke a DEA Certificate of Registration and deny any
pending application for renewal for such registration, if he determines
that the continued registration would be inconsistent with the public
interest. Section 823(f) requires that the following factors be
considered in determining the public interest:
(1) The recommendation of the appropriate state licensing board or
professional disciplinary authority.
[[Page 15230]]
(2) The applicant's experience in dispensing or conducting research
with respect to controlled substances.
(3) The applicant's conviction record under federal or state laws
relating to the manufacture, distribution, or dispensing of controlled
substances.
(4) Compliance with applicable state, federal, or local laws
relating to controlled substances.
(5) Such other conduct which may threaten the public health or
safety.
These factors are to be considered in the disjunctive; the Deputy
Administrator may rely on any one or a combination of factors and may
give each factor the weight he deems appropriate in determining whether
a registration should be revoked or an application for registration
denied. See Henry J. Schwartz, Jr., M.D., 54 FR 16422 (1989).
Regarding factor one, in 1990, the Board revoked the Respondent's
medical license, stayed the revocation, but suspended his license for
90 days and then placed it on probation for five years. There is no
evidence before the Deputy Administrator demonstrating that
Respondent's medical license is currently restricted in any form.
Nevertheless, state license is a necessary, but not a sufficient
condition for registration, and therefore, this factor is not
dispositive. See e.g., Wesley G. Harline, M.D., 65 FR 5665 (2000);
James C. LaJevice, D.M.D., 64 FR 55962 (1999).
Factors two and four, Respondent's experience is dispensing
controlled substances and compliance with applicable controlled
substance laws are relevant in determining whether Respondent's
continued registration would be inconsistent with the public interest.
Respondent improperly prescribed, administered, or otherwise dispensed
controlled substances in 1985 and 1986. Although the Respondent has
maintained that he has done nothing wrong, a jury convicted him of
eight misdemeanor counts as a result of this conduct, and the judgment
was affirmed on appeal.
In the most recent proceeding, the Respondent, by his own
admission, signed blank prescriptions and made them available to
physician assistants. While there was no evidence presented that
Respondent issued or signed any of the three controlled substance
prescriptions, his pre-signing prescription forms made it possible for
``prescriptions'' to be issued in violation of 21 U.S.C. 829, 841, and
843. Therefore, the Deputy Administrator finds that factors two and
four weigh in favor of a finding that Respondent's continued
registration would be inconsistent with the public interest.
With respect to factor five, the Deputy Administrator concurs with
Judge Bittner that the Respondent continues to argue that his
convictions were improper, continues to blame others for his
misconduct, and refuses to accept responsibility for his actions. In
addition, the Respondent made a practice of making pre-signed
prescriptions available to physician assistants at the Robert, M.D.
Clinic, who were then free to issue those prescriptions with no
supervision from Respondent. The Deputy Administrator further concurs
with Judge Bittner that Respondent knew or should have known that he
would be liable for those prescriptions, but nonetheless appears to
think that posting signs in the clinic and advising physician
assistants not to issue prescriptions for controlled substances absolve
him from liability.
After reviewing the record, Judge Bittner found that based on the
Respondent's refusal to take responsibility for past misconduct and his
irresponsible pre-signing of prescription pads, he continues to be
unwilling or unable to accept the obligations that the Controlled
Substances Act and its implementing regulations impose upon DEA
registrants. Judge Bittner therefore concluded that a preponderance of
the credible evidence in the record established that Respondent's
continued registration would be inconsistent with the public interest,
and recommended that his application be denied. In light of the
subsequent issuance of a Certificate of Registration to the Respondent,
the Deputy Administrator must now determine whether or not that
registration should be continued.
The Respondent filed exceptions to Judge Bittner's recommended
ruling. With respect to findings that he provided blank prescriptions
bearing his signature in violation of 21 U.S.C. 829, 841, and 843, the
Respondent argued that was simply complying with California law which,
according to the Respondent, allows for the establishment of a
prescription protocol between physician and physician assistant. With
respect to pre-signed prescriptions, Respondent further argued that the
protocol he established with his physician assistant did not allow for
the prescribing of controlled substances; the physician assistant must
account for all prescriptions before receiving more prescription
blanks; the Respondent did not put his DEA number on blank
prescriptions given to physician assistants; and that such a policy
would be violative of the equal protection clause of the United States
constitution. The Respondent further argued that ``physician assistants
are allowed to prescribe Schedule III and IV drugs whether or not the
supervising physician has a narcotic registration.''
The Deputy Administrator finds that the Respondent's exceptions
with respect to pre-signed prescriptions lack merit. First, the
Respondent's assertion that he did not place his DEA registration
number on blank prescriptions is of no moment. As noted above,
testimony was offered at the hearing that the Respondent not only left
pre-signed prescriptions with the staff of the Robert M.D. Clinic, but
also authorized the use of his previous DEA number by a physician
assistant. The unlawful practice of pre-signing prescriptions has been
a contributing factor in DEA determinations that a registration is
inconsistent with the public interest. See e.g., Christopher E. Castle,
M.D., 67 FR 71196-97 (2002); James C. Womack, M.D., 67 FR 35137 (2002);
Edward L.C. Broomes, M.D., 61 FR 3946-47 (1996); Jude R. Hayes, M.D.,
59 FR 41785 (1994); Veera Sripinyo, M.D. 56 FR 64809 (1991).
Second, the establishment of a prescription protocol with a
physician assistant does not absolve the Respondent from liability that
arises out of improperly issued prescriptions for controlled
substances. The Respondent's conduct in this regard created a situation
that allowed unauthorized persons to issue prescriptions without
supervision. The Deputy Administrator finds that the Respondent's
counter argument regarding his compliance with the terms of a
prescription protocol is yet another demonstration of his unwillingness
to accept responsibility for his misconduct.
The Deputy Administrator similarly finds no merit in the
Respondent's challenge of the applicability of the 21 U.S.C. 829, 841,
and 843 as they relate to his providing blank, pre-signed prescriptions
to his staff. The referenced statutory provisions address the proper
manner in which prescriptions for controlled substances are to be
issued (section 829) and/or prohibited acts with respect to the
prescribing of controlled substances (sections 841 and 843).
Specifically, section 843(a) states in pertinent part:
It shall be unlawful for any person knowingly or intentionally--
(2) to use in the course of the * * * dispensing of a controlled
substance * * * a registration number which is fictitious, revoked,
suspended, expired, or issued to another person.
The Respondent's action in providing to the staff of the Robert
M.D. Clinic, presigned prescriptions, his giving
[[Page 15231]]
authorization to others to use a revoked DEA number, and the controlled
substances ordered under that number, are clearly conduct and
circumstance contemplated under sections 829, 841 and 843.
The Respondent's remaining argument regarding the hearsay nature of
the presigned prescriptions at issue is similarly without merit.
Despite the Respondent's objections to the admissibility of such
evidence, it is well established that hearsay is admissible in these
proceedings. See Nicholas A. Sychak, d/b/a/ Medicap Pharmacy, 65 FR
75959 (2000); Arthur Sklar, R.Ph., d/b/a King Pharmacy, 54 FR 34627
(1989). ``Hearsay is both admissible, and may, standing by itself,
constitute substantial evidence in support of an administrative
decision.'' Klinestiver v. DEA, 606 F.2d 1128 (D.C. Cir. 1979).
In the DEA Final Order of May 1999, the then-Deputy Administrator
found that any determination regarding the Respondent's fitness to
obtain a DEA Certificate of Registration was contingent, not merely
upon the passage of time, but whether circumstances existing at the
time of the prior proceeding had sufficiently changed to warrant
issuance of such registration. With the additional passage of time, and
the Respondent having obtained a DEA Certificate of Registration
(albeit by way of an administrative error), obviously circumstances
have changed with respect to the Respondent's handling of controlled
substances. The Deputy Administrator also finds it noteworthy that
there is no evidence that Respondent has mishandled controlled
substances under his present registration. Nevertheless, the Deputy
Administrator remains unconvinced that the Respondent possesses the
fitness to maintain that registration.
The Deputy Administrator agrees with Judge Bittner that the
Respondent refuses to take responsibility for his past misconduct. In
addition, the Respondent demonstrated irresponsible conduct by pre-
signing prescription pads and providing his revoked DEA registration
number for the use of his staff.
The Deputy Administrator finds the Respondent's recalcitrance
puzzling. In the face of DEA's repeated concerns regarding his lack of
contrition, the Respondent remains steadfast in his insistence upon
denying any previous wrongdoing. Despite previous findings that his
criminal convictions were res judicata, the Respondent in his support
of his most recent application for registration attempted yet again to
re-litigate his criminal convictions and attack the quality of his
previous legal representation.
In three previous final orders, DEA has essentially provided the
Respondent with a roadmap to reacquiring his DEA registration by
outlining concerns relating to Respondent's previous misconduct and
pointing to his refusal to accept responsibility for such actions. If
the Respondent were to satisfactorily address the agency's concerns,
and conform his conduct accordingly, he would at the very least,
improve his prospects for reacquiring and maintaining a DEA Certificate
of Registration. In the absence of such reassurances, the Deputy
Administrator is left with the conclusion that the Respondent remains
unwilling or unable to accept the obligations that the Controlled
Substances Act and its implementing regulations impose upon DEA
registrants. Therefore, the Deputy Administrator concludes that the
Respondent's continued registration would be inconsistent with the
public interest.
Accordingly, the Deputy Administrator of the Drug Enforcement
Administration, pursuant to the authority vested in him by 21 U.S.C.
823 and 824 and 28 CFR 0.100(b) and 0.014, hereby orders that DEA
Certificate of Registration BL6652312, previously issued to Robert A.
Leslie, M.D., be, and it hereby is, revoked. This order is effective
April 28, 2003.
Dated: March 6, 2003.
John B. Brown III,
Deputy Administrator.
[FR Doc. 03-7390 Filed 3-27-03; 8:45 am]
BILLING CODE 4410-09-M