SUBJECT:

Stella Remedies Lively,

Petitioner,

The Inspector General

DECISION

This matter is before me on the Inspector General's (I.G.'s) Motion for Summary Affirmance of the I.G.'s determination to exclude Stella Remedies Lively, Petitioner, from participation in Medicare, Medicaid, and all other federal health care programs for a period of five years. The I.G.'s Motion and determination to exclude Petitioner are based on the terms of section 1128(a)(2) of the Social Security Act (Act), 42 U.S.C. � 1320a-7(a)(2), and arise from Petitioner's state-court conviction of an offense relating to patient abuse. As will appear more fully below, the undisputed facts in this case require the imposition of a mandatory five-year exclusion. For that reason, I grant the I.G.'s Motion for Summary Affirmance.

I. Procedural Background

In October 2002, an infirm 84-year-old man, who will be identified in these pages as V.M., was a resident and patient of the Shreveport Healthcare Center in Shreveport, Louisiana. His family had hired Stella Remedies Lively, Petitioner, as a "sitter" for V.M.: her duties were to attend him at the facility and to provide to him a variety of services typical of those offered by nursing homes: bathing V.M., dressing him, grooming him, feeding him, and transporting him about within the facility. V.M. was incapable of performing those activities for himself.

On August 17, 2004, Petitioner appeared with counsel in the First Judicial District Court, Caddo Parish, Louisiana. She appeared there to plead guilty to an attack on V.M. which had occurred in early October 2002. The attack had been witnessed by certified nursing assistant (CNA) Penelope Gray, an employee of the nursing home, who described Petitioner's slapping V.M. and placing her knee on his chest when he declined to be fed. The specific crime to which she pleaded guilty was the misdemeanor offense of "Simple Battery of the Infirm," in violation of LA. REV. STAT. ANN. � 14:35.2.

Petitioner's guilty plea was accepted, and sentence was imposed immediately pursuant to Louisiana's statutory plan for the suspension and deferral of sentences in misdemeanor prosecutions, LA. CODE CRIM. PRO. ANN. Art. 894(B). Petitioner was required to attend anger-management training and to pay a fine of $300 and costs; a jail term of 30 days was suspended and she was placed on six months' supervised probation. Pursuant to the statutory plan cited above, Petitioner's conviction was set aside, and all charges against her were dismissed, on April 4, 2005.

As mandated by the terms of section 1128(a)(2) of the Act, the I.G. began the process of excluding Petitioner from participation in Medicare, Medicaid, and all other federal health care programs. Section 1128(a)(2) of the Act dictates the mandatory exclusion, for a term of not less than five years, of "(a)ny individual or entity that has been convicted, under Federal or State law, of a criminal offense relating to neglect or abuse of patients in connection with the delivery of a health care item or service." The I.G. notified Petitioner of her exclusion for the mandatory minimum period of five years by letter on March 31, 2005.

Acting through counsel, Petitioner timely sought review of the I.G.'s action by letter dated April 4, 2005. I convened a telephonic prehearing conference on June 14, 2005, pursuant to 42 C.F.R. � 1005.6. My purpose in doing so was to discuss the issues presented by the case with both parties, and explore with them the procedures best suited for addressing those issues. The parties agreed that the case likely could be decided on written submissions, and I established a schedule for the submission of documents and briefs. The details of the conference and the schedule established in it are set out in my Order of June 15, 2005.

All briefing is now complete, but Petitioner's failure to comply with the terms of Paragraph 2(d) of that Order required me to extend the date for closing the record in this case by my Order Closing Record of October 24, 2005. Nevertheless, this Decision is issued in compliance with 42 C.F.R. � 1005.20(c) based on the original "record close date," September 20, 2005.

There are three groups of proffered exhibits in this case. The first group is made up of Joint Exhibits (J. Exs.) 1, 2, 3, 6, 7, 8 and 9, and all are admitted to the record of this case with that designation. ⁽¹⁾ The second group is made up of I.G.'s Exhibits (I.G. Exs.) 4 and 5; Petitioner has raised no objection to these exhibits, and they are admitted. The third group comprises Petitioner's Exhibits (P. Exs.) 1 and 2 to which no objection has been raised by the I.G. They, too, are admitted.

II. Issues

The legal issues before me are limited to those set out at 42 C.F.R. � 1001.2007(a)(1). In the specific context of this record they are:

1. Whether the I.G. has a basis for excluding Petitioner from participating in Medicare, Medicaid, and all other federal health care programs pursuant to section 1128(a)(2) of the Act; and

2. Whether the proposed five-year period of exclusion is unreasonable.

The standard of proof is a preponderance of the evidence. Petitioner bears the burden of proof and persuasion on any affirmative defenses or mitigating factors and the I.G. bears the burden on all other issues. 42 C.F.R. �1005.15(b) and (c).

The controlling authorities require that both issues be resolved in favor of the I.G.'s position. Section 1128(a)(2) of the Act mandates Petitioner's exclusion since her predicate conviction has been established. A five-year period of exclusion is the minimum period established by section 1128(c)(3)(B) of the Act, 42 U.S.C. � 1320a-7(c)(3)(B), and is therefore reasonable as a matter of law.

III. Controlling Statutes and Regulations

Section 1128(a)(2) of the Act, 42 U.S.C. � 1320a-7(a)(2), requires the mandatory exclusion from participation in Medicare, Medicaid, and all other federal health care programs of any "individual or entity that has been convicted, under Federal or State law, of a criminal offense relating to neglect or abuse of patients in connection with the delivery of a health care item or service." The terms of section 1128(a)(2) are restated in regulatory language at 42 C.F.R. � 1001.101(b). This statutory provision makes no distinction between felony convictions and misdemeanor convictions as predicates for mandatory exclusion.

The Act defines "conviction" as including those circumstances "when a judgment of conviction has been entered against the individual . . . by a . . . State . . . court, regardless of whether . . . the judgment of conviction or other record relating to criminal conduct has been expunged," section 1128(i)(1) of the Act; "when there has been a finding of guilt against the individual . . . by a . . . State . . . court," section 1128(i)(2) of the Act; "when a plea of guilty . . . by the individual . . . has been accepted by a . . . State . . . court," section 1128(i)(3) of the Act; or "when the individual . . . has entered into participation in a . . . deferred adjudication . . . program where judgment of conviction has been withheld," section 1128(i)(4) of the Act, 42 U.S.C. �� 1320a-7(i)(1)-(4). These definitions are repeated at 42 C.F.R. � 1001.2.

An exclusion based on section 1128(a)(2) is mandatory and the I.G. must impose it for a minimum period of five years. Section 1128(c)(3)(B) of the Act, 42 U.S.C. � 1320a-7(c)(3)(B). The regulatory language of 42 C.F.R. � 1001.102(a) affirms the statutory provision. Although the minimum mandatory period of exclusion is subject to enhancement in some limited circumstances and on proof of carefully-defined aggravating factors set out at 42 C.F.R. � 1001.102(b), in this case, the I.G. has not sought to enhance the five-year mandatory minimum period by offering to prove any of them. For that reason, I may not inquire into the existence or significance of any of the specific aggravating or mitigating factors set out at 42 C.F.R. � 1001.102(b) and (c).

IV. Findings and Conclusions

I find and conclude as follows:

1. On her plea of guilty on August 17, 2004, in the First Judicial District Court, Caddo Parish, Louisiana, Petitioner was convicted of the misdemeanor offense of "Simple Battery of the Infirm," in violation of LA. REV. STAT. ANN. � 14:35.2. J. Exs. 6, 7; I.G. Exs. 4, 5; P. Ex. 1.

2. Judgment of conviction and sentence were pronounced and imposed on Petitioner in the First Judicial District Court on August 17, 2004. J. Exs. 6, 7; P. Ex. 1.

3. On March 31, 2005, the I.G. notified Petitioner that she was to be excluded from participation in Medicare, Medicaid, and all other federal health care programs for a period of five years, based on the authority set out in section 1128(a)(2) of the Act.

4. Petitioner's conviction was set aside, and her prosecution under the statute cited above in Finding 1 was dismissed, on April 4, 2005, pursuant to LA. CODE CRIM. PRO. ANN. Art. 894(B). J. Ex. 1.

5. On April 4, 2005, Petitioner perfected her appeal from the I.G.'s action by filing a timely hearing request in compliance with 42 C.F.R. � 1005.2(c).

6. The plea, conviction, and sentence described above in Findings 1, 2, and 4 constitute a "conviction" within the meanings of sections 1128(a)(2) and 1128(i)(1), (2), (3) and (4) of the Act, and 42 C.F.R. � 1001.2

7. The infirm person upon whom Petitioner committed the battery of which she was convicted was V.M., who was then a patient and resident of the Shreveport Healthcare Center, Shreveport, Louisiana, and who was then and there under Petitioner's care as a patient. I.G. Exs. 1-3.

8. Petitioner committed the battery upon V.M. described in Findings 1 and 7 in connection with the delivery to him of a health care service, viz. feeding him.

9. There is a nexus and a common-sense relationship between the criminal offense of which Petitioner was convicted, as noted above in Findings 1, 2, and 4, and abuse of a patient, viz. V.M., in connection with the delivery of a health care item or service. I.G. Exs. 4, 5; P. Ex. 1.

10. By reason of her conviction of a criminal offense relating to neglect or abuse of a patient in connection with the delivery of a health care service, Petitioner was subject to, and the I.G. was required to impose, a period of exclusion from participation in Medicare, Medicaid, and all other federal health care programs. Section 1128(a)(2) of the Act.

11. The I.G. properly and reasonably set the period of Petitioner's exclusion at five years, the minimum mandatory period provided by law. Section 1128(c)(3)(B) of the Act; 42 C.F.R. �� 1001.102(a) and 1001.2007(a)(2).

12. There are no disputed issues of material fact and summary disposition is therefore appropriate in this matter. Carrier Mills Nursing Home, DAB No. 1883 (2003).

V. Discussion

The essential elements necessary to support an exclusion based on section 1128(a)(2) of the Act are: (1) the individual to be excluded must have been convicted of a criminal offense; (2) the conviction must have been related to the neglect or abuse of patients; and, (3) the patient neglect or abuse to which an excluded individual's conviction related must have occurred in connection with the delivery of a health care item or service. Neitra Maddox, DAB CR1218 (2004); Maureen T. Kehoe, DAB CR673 (2000); Gabriel S. Orzame, M.D., DAB CR587 (1999); Ann M. MacDonald, DAB CR519 (1998); Anthony A. Tommasiello, DAB CR282 (1993). ⁽²⁾

As a general proposition, it is the law of this forum that "abuse" includes ". . . those situations where a party willfully mistreats another person." Rosette Elliott, DAB CR84 (1990). More specifically, a conviction of battery committed against a patient in the course of providing health care services to that patient constitutes a conviction related to abuse that occurred in connection with the delivery of a health care item or service. Anthony W. Underhill, DAB CR231 (1992).

The parties agree on the factual and procedural foundations of this case. They agree that Petitioner was employed as a "sitter" for V.M., an 84-year-old infirm resident of the Shreveport Healthcare Center, in Shreveport, Louisiana. Petitioner asserts, and CMS does not contest, that Petitioner was privately employed and paid by V.M's family to provide a variety of health care services to him, including "bathing, dressing, grooming, transporting within the facility, and feeding."

They agree that on August 17, 2004, Petitioner appeared with counsel in Louisiana's First Judicial District Court, Caddo Parish, and pleaded guilty to Count 2 of an Amended Bill of Information filed against her on March 25, 2004. They agree that the misdemeanor offense to which Petitioner pleaded guilty was "Simple Battery of the Infirm," a violation of LA. REV. STAT. ANN. � 14:35.2. They agree, and the record conclusively demonstrates, that there was a factual basis for Petitioner's guilty plea, that her guilty plea was accepted by the court, and that Petitioner was convicted and sentenced on her plea the same day, August 17, 2004. J. Exs. 6, 7; I.G. Exs. 4, 5; P. Ex. 1. The facts on which the parties agree fully satisfy the three essential elements requisite to support the I.G.'s proposed exclusion.

The first essential element, the requirement that Petitioner have been "convicted," is satisfied by the trial court's acceptance of the guilty plea to the misdemeanor criminal offense of "Simple Battery of the Infirm" and by the trial court's finding of her guilt based on that plea. P. Ex. 1, at 11. These events meet the statutory and regulatory definitions of "conviction" at sections 1128(i)(2) and (3) of the Act and at 42 C.F.R. � 1001.2.

The second and third essential elements are established on the face of the Amended Bill of Information, I.G. Ex. 4. Their presence is demonstrated further by the Affidavit underlying the Bill of Information, I.G. Ex. 5, and further still in the transcript of Petitioner's plea and sentence proceedings, P. Ex 1. The victim of the battery, V.M., was plainly a "patient," both of the facility where he resided and of Petitioner, who had been hired by his family to care for him. I find that V.M.'s status as a "patient" has been established in compliance with the standard enunciated in Bruce Lindberg, D.C., DAB No. 1386 (1993). Petitioner's attack on V.M. was inarguably and by definition an act of abuse, and I find that the abuse occurred in the course of delivery of the specific health care service of feeding. Underhill, DAB CR231; Elliott, DAB CR84. I find that there is a manifest and substantial nexus or common-sense connection between the abuse and the delivery of a health care item or service. Lindberg, DAB No. 1386; Maddox, DAB CR1218; Kehoe, DAB CR673; Orzame, DAB CR587.

Petitioner denies neither the operant facts set out above nor their relationship to the delivery of health care items and services to V.M. Instead she challenges the proposition that she has been "convicted," and bases her challenge on events subsequent to the proceedings on August 17, 2004. The I.G. concedes those events; it is thus uncontested that on April 4, 2005, Petitioner's conviction was set aside and all charges against her were dismissed, presumably--although not explicitly--pursuant to Louisiana's statutory plan for deferral of sentencing in misdemeanor cases, LA. CODE CRIM. PRO. ANN. Art. 894(B). J. Ex. 1. Her guilty plea was offered and accepted with the explicit invocation of that statutory provision. P. Ex. 1, at 2, 4, 8-9, 12. Thus, Petitioner denies that the proceedings in which she was involved resulted in a "conviction" that would subject her to mandatory exclusion.

Petitioner's argument simply fails to take account of two additional statutory definitions of "conviction." Both sections 1128(i)(1) and 1128(i)(4) of the Act define "conviction" to include the circumstances of Petitioner's case. Section 1128(i)(1) includes any situation where judgment of conviction has been entered "regardless of whether . . . the judgment of conviction or other record relating to criminal conduct has been expunged." Petitioner has been "convicted" by this definition. Paul W. Williams, Jr., et al., DAB No. 1785 (2001); Larry White, R.Ph., DAB No. 1346 (1992). Section 1128(i)(4) includes any situation "when the individual . . . has entered into participation in a . . . deferred adjudication . . . program where judgment of conviction has been withheld." This definition applies as well. Mark K. Mileski, DAB No. 1945 (2004); Carolyn Westin, DAB No. 1381 (1993); aff'd, Westin v. Shalala, 845 F. Supp. 1446 (D. Kan. 1994).

There are at least two decisions in this forum that directly examine Louisiana's deferred-sentence program, and Petitioner does not discuss them, either. Louisiana establishes its deferral program in separate statutory provisions: LA. CODE CRIM. PRO. ANN. Art. 893 applies to felonies, and LA. CODE CRIM. PRO. ANN. Art. 894 applies to misdemeanors; it will be recalled that Petitioner's misdemeanor conviction was set aside pursuant to LA. CODE CRIM. PRO. ANN. Art. 894. The effect of that specific statutory section was debated in Jeanne Hebert, DAB CR195 (1992), with the resultant holding that for purposes of section 1128(i)(1) of the Act, the fact that " . . . judgment was subsequently expunged because she complied with the terms of her probation does not nullify the original conviction for purposes of determining whether she should be excluded from the Medicare and Medicaid programs." The felony provisions of LA. CODE CRIM. PRO. ANN. Art. 893 received similar scrutiny in Mark Zweig, M.D., DAB CR563 (1999), with similar result in the context of section 1128(i)(4) of the Act. See also, Williams, DAB No. 1785.

The fact that Petitioner tendered her guilty plea under the rubric of Alford v. North Carolina, 400 U.S. 25 (1970), is of no significance in this litigation. Convictions based on "Alford pleas" have without exception been held sufficient predicate convictions in exclusion proceedings based on section 1128(a) of the Act. Charles D. Howard, M.D., DAB CR1362 (2005); Charles Philip Colosimo, DAB CR1225 (2004); John Y. Salinas, M.D., DAB CR1117 (2003); Ethel Ann Arita, DAB CR1052 (2003); Steven Alonzo Henry, M.D., DAB CR638 (2000). That rule has been in force at least since Raymond R. Valoso, M.D., DAB CR124 (1991) and Kenneth Krulevitz, M.D., DAB CR24 (1989), and it has been invoked specifically in misdemeanor convictions for patient abuse based on "Alford pleas." Michelle L. Thomas, DAB CR569 (1999); Gloria Phillips, DAB CR277 (1993). A defendant's tactical reluctance--for whatever reasons--to admit the acts constituting the offense has no diminishing effect on the conviction resulting from the guilty plea. ⁽³⁾ Insofar as Petitioner herself now seeks to obscure or elude her concession that she faced likely conviction on the strength of eyewitness testimony to her attack on V.M., she is bound by the facts established by her conviction on her guilty plea. Susan Malady, R.N., DAB No. 1816 (2002); Theodore Sabot, M.D., DAB CR1160 (2004); Dirk G. Wood, M.D., DAB CR1068 (2003). Any form of collateral attack on predicate convictions in exclusion proceedings is precluded by regulation at 42 C.F.R. � 1001.2007(d), and that preclusion has been affirmed repeatedly by the Board. Malady, DAB No. 1816; Dr. Frank R. Pennington, M.D., DAB No. 1786 (2001); Joann Fletcher Cash, DAB No. 1725 (2000); Paul R. Scollo, D.P.M., DAB No. 1498 (1994); Chander Kachoria, R.Ph., DAB No. 1380 (1993).

Without arguing the point beyond the bare recitation of it, Petitioner also observes that she was promised by the state prosecutor that her guilty plea would have no consequences on her future "employment with a Medicaid-Medicare supported facility." P. Brief at 6, 7. That purported assurance may have seemed clear to Petitioner's counsel at one point in the plea hearing, P. Ex. 1, at 3, but it is very far from clear that either the prosecutor or the trial court understood the assurance as quite so definite:

MR. SUTTON (Counsel for Petitioner): For the record, also part of the agreement with the State was that Ms. Lively's employment while she is under probation and conducting the anger management will not be affected.

MR. TRAVIS (Assistant District Attorney): That's correct, Your Honor.

MR. SUTTON: She can continue to work at any Medicaid facility.

THE COURT: All right.

MR. TRAVIS: Well, I think it is more specifically that she is able to sit for Mr. (V.M.), wherever he is.

MR. SUTTON: Yeah, wherever he may be.

MR. TRAVIS: Right.

P. Ex. 1, at 9.

Whatever the scope of the assurance elicited by defense counsel and given by the state prosecutor, it is patent that any such assurance was not the prosecutor's to give, and defense counsel in the exercise of reasonable care would have known that it was not. At the first level of examination, it is obvious that since no federal authorities were party to the purported assurance, no federal sanction could legitimately have been renounced, suspended, or remitted by it. Robert C. Mohr, M.D., DAB CR292 (1993); Anthony Accaputo, Jr., DAB CR249 (1993). At the second level, it should be equally plain that no federal authority could legitimately have been party to such an assurance, since the exclusion provisions of section 1128(a)(2) are mandatory and the I.G. cannot waive them as part of a plea bargain. Elsbeth Barnes, DAB CR340 (1994); Baron L. Curtis, DAB CR122 (1991). That Petitioner may have been advised by her attorney, and that she may have believed, that her guilty plea and conviction would have no repercussions on her participation in protected health programs was simply the upshot of imperfect legal research and ill-informed advice. The responsibility for that research and advice lies entirely with Petitioner and her attorney, and in no wise restricts the I.G.'s mandatory authority to exclude. As Administrative Law Judge Anne E. Blair wrote in Steven Caplan, R. Ph., DAB CR1112 (2003):

I suspect the criminal defense bar is largely unaware that one of the factors in medically-related cases that must be considered before the client pleads to a crime is the potential for the client to lose his or her career due to the possibility of being excluded from federal health care programs.

Caplan, DAB CR1112, at 9.

The awkward aspect of this situation, of course, is that at least one of the attorneys in court on August 17, 2004, was perfectly aware of "one of the factors in medically-related cases that must be considered before the client pleads to a crime." That much is obvious from the fact that exclusion was discussed at all. But no matter what the scope or depth of the attorneys' and trial court's understanding of the exclusion remedy may have been, neither any of them individually nor all of them in concert possessed the authority to promise its waiver contrary to federal law and regulation. Heckler v. Community Health Services, 467 U.S. 51 (1984).

Once a predicate conviction within the purview of section 1128(a) of the Act has been demonstrated, application of the section and exclusion is mandatory. Mileski, DAB No. 1945; Salvacion Lee, M.D., DAB No. 1850 (2002); Lorna Fay Gardner, DAB No. 1733 (2000). Since the five-year period of exclusion proposed in this case is the irreducible minimum required by section 1128(c)(3)(B) of the Act, it is as a matter of law not unreasonable. 42 C.F.R. � 1001.2007(a)(2). Neither I nor the Board may reduce it. Mileski, DAB No. 1945; Lee, DAB No. 1850.

VI. Summary Affirmance Is Appropriate in This Case.

Pursuant to section 1128(f) of the Act, a person subject to exclusion has a right to reasonable notice and an opportunity for a hearing. The right to hearing before an Administrative Law Judge (ALJ) is accorded to a sanctioned party by 42 C.F.R. � 1005.2 and the rights of both the sanctioned party and the I.G. to participate in a hearing are specified in 42 C.F.R. � 1005.3. Either or both parties may waive appearance at an oral hearing and submit only documentary evidence and written argument for the ALJ's consideration. 42 C.F.R. � 1005.6(b)(5). The ALJ may also resolve a case, in whole or in part, by summary judgment or summary affirmance. 42 C.F.R. � 1005.4(b)(12). Summary affirmance is appropriate and no hearing is required when either there are no disputed issues of material fact and the only questions that must be decided involve application of law to the undisputed facts, or when the moving party must prevail as a matter of law even if all disputed facts are resolved in favor of the party against whom the motion is made. A party opposing summary affirmance must allege facts which, if true, would refute the facts relied upon by the moving party. See, e.g., Fed. R. Civ. P. 56; Garden City Medical Clinic, DAB No. 1763 (2001); Everett Rehabilitation and Medical Center, DAB No. 1628, at 3 (1997) (in-person hearing required where non-movant shows there are material facts in dispute that require testimony); Thelma Walley, DAB No. 1367 (1992); see also, New Millennium CMHC, DAB CR672 (2000); New Life Plus Center, DAB CR700 (2000).

As I have pointed out above, there are no genuine issues of material fact in dispute in this case and summary affirmance is appropriate.

VII. Conclusion

For the reasons set out above, the I.G.'s Motion for Summary Affirmance is GRANTED. The I.G.'s exclusion of Petitioner Stella Remedies Lively from participation in Medicare, Medicaid, and all other federal health care programs for a period of five years, pursuant to the terms of section 1128(a)(2) of the Act, 42 U.S.C. � 1320a-7(a)(2), is thereby sustained.

Richard J. Smith

Administrative Law Judge

1. J. Ex. 1 purports to be the court order setting aside Petitioner's conviction and dismissing the charges against her. Because it has been submitted by both parties jointly and is presumably objectionable to neither, and because it does not alter the findings and conclusions I announce here, I have admitted it and treat it arguendo as authentic. In its present form, however, it could not withstand an objection to its authenticity and completeness. It is a one-page document without a court clerk's filing stamp. It bears neither a judge's signature nor a signature line. It is without a court clerk's attestation of authenticity, and without its obviously-missing second page. The last line on the document is incomplete, and bears a hand-entered date of April 4, 2005. The last docket entries appearing in this record as J. Exs. 6 and 7 are dated August 17, 2004 and thus contain no reference to it. There is absolutely nothing about J. Ex. 1 as it appears in this record to assure its examiner that it was ever signed by anyone, or filed anywhere, at any time. It may occur to the I.G. that if cases are to be decided on a documentary record, then minimal attention to the documents involved would not be misplaced.

2. The Departmental Appeals Board (Board) has from time to time characterized the first essential element as having two distinct parts: the first part requiring a "conviction," and the second part requiring that the "conviction" have been "of a criminal offense." Narendra M. Patel, M.D., DAB No. 1736 (2000); Janet Wallace, L.P.N., DAB No. 1326 (1992).

3. While I do not purpose to look behind the fact of Petitioner's conviction, it is to be observed that Louisiana courts adhere strictly to the warning pronounced in Alford v. North Carolina, supra, that a valid "Alford plea" demands that the record contain "strong evidence of actual guilt." Alford, 400 U.S., at 38. See Louisiana v. Villareal, 759 So.2d 126 (La. App. 5 Cir. 2000); Louisiana v. Bailey, 639 So.2d 860 (La. App. 5 Cir. 1994). The record of Petitioner's plea more than satisfies the most demanding reading of this requirement. P. Ex. 1, at 10.