Note:  These Minutes are provided for informational purposes only.
If you would like to obtain an official copy of the Minutes, please contact
the State Board of Pharmacy at 614-466-4143 for instructions and fee information.

 

Ohio State Board of Pharmacy   77 South High Street, Room 1702   Columbus, Ohio 43215-6126
telephone:  614-466-4143                  fax:  614-752-4836                email:  exec@bop.state.oh.us

 

Minutes Of The Meeting

Ohio State Board of Pharmacy

Columbus, Ohio

September 5, 6, 7, 2000

 

TUESDAY, SEPTEMBER 5, 2000

 

  8:10 a.m.      ROLL CALL

 

The State Board of Pharmacy convened in Room 1914, Vern Riffe Center for Govern­ment and the Arts, 77 South High Street, Columbus, Ohio with the following members present:

 

Suzanne L. Neuber, R.Ph. (President); Ann D. Abele, R.Ph.; Suzanne R. Eastman, R.Ph.; Robert P. Giacalone, R.Ph.; Lawrence J. Kost, R.Ph.; and James E. Turner, R.Ph.

 

Also present were William T. Winsley, Executive Director; Timothy Benedict, Assistant Executive Director; Mark Keeley, Legislative Affairs Administrator; David Rowland, Legal Affairs Administrator; and Sally Ann Steuk, Assistant Attorney General.

  8:27 a.m.

After discussion of items not requiring any official action by the Board, Mr. Winsley reported that August reciprocity candidate Sapna Patria had successfully completed the Test of Spoken English (TSE) and that her license had been issued pursuant to the Board’s instructions.

  8:28 a.m.

RES. 2001-026   Mr. Benedict then reviewed a request from John Tekulve R.Ph. for a review of the 48-hour urine testing requirement in his Board Order.  After discussion, Ms. Abele moved that Mr. Tekulve’s Order be revised to remove the requirement that his urine be analyzed by the laboratory within 48 hours of the time it is drawn and that he be issued the following revised Board Order:

 

AMENDED ORDER OF THE STATE BOARD OF PHARMACY

(Docket No. D-980127-032)

 

In The Matter Of:

 

JOHN PAUL TEKULVE, R.Ph.

6702 Merwin Avenue

Cincinnati, Ohio 45227

(R.Ph. No. 03-3-21594)

 

INTRODUCTION

 

THE MATTER OF JOHN PAUL TEKULVE CAME TO HEARING ON APRIL 6, 1998, BEFORE THE FOLLOWING MEMBERS OF THE BOARD: JOSEPH J. MASLAK, R.Ph. (presiding); DIANE C. ADELMAN, R.Ph.; JOHN L. HANNA, R.Ph.; SUZANNE L. NEUBER, R.Ph.; RUTH A. PLANT, R.Ph.; AND NICHOLAS R. REPKE, PUBLIC MEMBER.

 

JOHN PAUL TEKULVE WAS REPRESENTED BY CHARLES J. TEKULVE, AND THE STATE OF OHIO WAS REPRESENTED BY SALLY ANN STEUK, ASSISTANT ATTORNEY GENERAL.

 

SUMMARY OF EVIDENCE

 

(A)      Testimony

 

State's Witnesses:

 

(1)       Elaine Jones, R.Ph., Ohio State Board of Pharmacy

(2)       Detective Rick Hahn, Cincinnati Police Department, Drug Diversion Unit

 

Respondent's Witnesses:

 

(1)       John Paul Tekulve, Respondent

 

(B)      Exhibits

 

State's Exhibits:

 

(1)       Exhibit 1--Copy of three-page Summary Suspension Order/Notice of Opportunity for Hearing letter dated January 27, 1998.

(2)       Exhibit 1A--Copy of Hearing Request letter dated February 3, 1997 (sic 1998).

(3)       Exhibit 1B--Copy of Hearing Schedule letter dated February 5, 1998.

(4)       Exhibit 1C--Copy of Pharmacist File Front Sheet of John Paul Tekulve showing original date of registration as October 16, 1996; and two-page copy of Renewal Application for Intern License, for a license to practice pharmacy as an intern in Ohio from September 15, 1996, to September 15, 1997, of John Paul Tekulve dated August 13, 1996.

(5)       Exhibit 2

 

 

(6)       Exhibit 3-

 

 

 

(7)       Exhibit 4

 

(8)       Exhibit 4A

 

(9)       Exhibit 5

 

(10)     Exhibit 6

 

(11)     Exhibit 7

(12)     Exhibit 8

 

 

(13)     Exhibit 9

 

(14)     Exhibit 10

 

(15)     Exhibit 11

 

(16)     Exhibit 12

 

(17)     Exhibit 13

 

Respondent's Exhibits:

 

(1)       None

 

FINDINGS OF FACT

 

After having heard the testimony, considered the evidence, observed the demeanor of the witnesses, and weighed their credibility, the State Board of Pharmacy finds the following to be fact:

 

(1)       Records of the Board of Pharmacy indicate that John Paul Tekulve was originally licensed in the state of Ohio on October 16, 1996, pursuant to examination, and on January 27, 1998, his license was summarily suspended in accordance with Section 3719.121(C) of the Ohio Revised Code.

 

(2)      

 

 

 

 

 

 

 

(3)       John Paul Tekulve did, on or about July 18, 1997, knowingly obtain, possess, and/or use a controlled substance when the conduct was not in accordance with Chapters 3719., 4729., and 4731. of the Ohio Revised Code, to wit: John Paul Tekulve obtained and possessed marijuana, a schedule I controlled substance.  Further, John Paul Tekulve admitted on numerous occasions of marijuana use.  Such conduct is in violation of Section 2925.11 of the Ohio Revised Code.

 

(4)       John Paul Tekulve is addicted to or abusing liquor or drugs or impaired physically or mentally to such a degree as to render him unfit to practice pharmacy, to wit: John Paul Tekulve arrived at the pharmacy to begin his shift unexplainably late on several occasions; John Paul Tekulve committed numerous errors while practicing pharmacy during the chosen time period of October 28, 1996, through August 4, 1997; and John Paul Tekulve has used the pharmacy’s telephone to make arrangements to obtain marijuana.

 

CONCLUSIONS OF LAW

 

(1)      

 

 

(2)       Upon consideration of the record as a whole, the State Board of Pharmacy concludes that paragraphs (2) through (4) of the Findings of Fact constitute being guilty of dis­honesty and unprofessional conduct in the practice of pharmacy as provided in Divi­sion (A)(2) of Section 4729.16 of the Ohio Revised Code.

 

(3)       Upon consideration of the record as a whole, the State Board of Pharmacy concludes that paragraph (4) of the Findings of Fact constitutes being addicted to or abusing liquor or drugs or impaired physically or mentally to such a degree as to render him unfit to practice pharmacy as provided in Division (A)(3) of Section 4729.16 of the Ohio Revised Code.

 

(4)       Upon consideration of the record as a whole, the State Board of Pharmacy concludes that paragraphs (2) and (3) of the Findings of Fact constitute being guilty of willfully violating, conspiring to violate, attempting to violate, or aiding and abetting the violation of provisions of Chapter 2925. of the Revised Code as provided in Division (A)(5) of Section 4729.16 of the Ohio Revised Code.

 

ACTION OF THE BOARD

 

Pursuant to Section 3719.121 of the Ohio Revised Code, the State Board of Pharmacy hereby removes the Summary Suspension Order issued January 27, 1998.

 

Pursuant to Section 4729.16 of the Ohio Revised Code, the State Board of Pharmacy takes the following actions in the matter of John Paul Tekulve:

 

(A)      On the basis of the Findings of Fact and Conclusions of Law set forth above, the State Board of Pharmacy hereby suspends the pharmacist identification card, No. 03-3-21594, held by John Paul Tekulve indefinitely and such suspension is effective as of the date of the mailing of this Order.  Pursuant to Rule 4729-9-01(F) of the Ohio Administrative Code, John Paul Tekulve may not be employed by or work in a facility licensed by the Board of Pharmacy to possess or distribute dangerous drugs during such period of suspension.

 

(B)      November, 1999, or thereafter, the Board will consider any petition filed by John Paul Tekulve for a hearing, pursuant to Revised Code Chapter 119., regarding the reinstatement of his license to practice pharmacy in Ohio.  The Board will consider the reinstatement of the license only if the following conditions have been met:

 

(1)       John Paul Tekulve must enter into a new contract with a treatment provider acceptable to the Board for a period of not less than five years from the effective date of this Order and, upon signing, submit a copy of the contract to the Board office.  The contract must provide that:

 

(a)       Random, observed urine samples shall be provided to, and conducted in, a certified Ohio Department of Alcohol and Drug Addiction Service (ODADAS) facility at least once a month for one year, and once every three months for the remaining four years.  Each urine screen must comply to the following standards:

 

(i)        The samples must be given within eight hours of random notification.

 

(ii)       Chain of custody must be maintained and docu­mented for each sample/screen.

 

(iii)     Reports must include testing the sample for alcohol and marijuana and must also report testing for creatinine or specific gravity of the sample as the dilutional standard.

 

(iv)      Sample analysis and reports must be completed within forty-eight (48) hours from the urine collection time.

 

(b)       Regular attendance, at least three times per week, at an Alcoholics Anonymous, Narcotics Anonymous, and/or similar support group meetings, and at meetings of a professional support group, is required during outpatient treatment and/or during aftercare; and

 

(c)        The program shall immediately report to the Board of Pharmacy any positive urine screens and/or other violations of the contract.

 

(2)       John Paul Tekulve must take and successfully complete the juris­prudence examination offered by the Board prior to petitioning the Board for reinstatement.

 

(3)       John Paul Tekulve must provide, at the time of petitioning the Board for reinstatement, written documentation from his treatment provider regarding compliance with the program pursuant to the contract including all urine drug screen reports.

 

Division (B) of Section 4729.16 of the Ohio Revised Code provides: “Any individual whose identification card is revoked, suspended, or refused, shall return his identification card and certificate of registration to the offices of the state board of pharmacy within ten days after receipt of notice of such action.”  The certificate and identification card should be forwarded by certified mail, return receipt requested.

 

THIS ORDER WAS APPROVED BY A VOTE OF THE STATE BOARD OF PHARMACY.

 

MOTION CARRIED.

 

SO ORDERED.

 

The motion was seconded by Mr. Giacalone and approved by the Board (Aye-5/Nay-0).

  8:33 a.m.

Ms. Eastman and Mr. Winsley reported on their recent attendance at the National Association of Chain Drug Stores (NACDS) meeting in San Diego.

  8:50 a.m.

Ms. Abele moved that the Board go into Executive Session for the purpose of the investigation of complaints regarding licensees and registrants pursuant to Section 121.22(G)(1) of the Revised Code and for the purpose of conferring with an attorney for the Board regarding pending or imminent court action pursuant to Section 121.22(G)(3) of the Revised Code.  The motion was seconded by Ms. Eastman and a roll call vote was conducted by President Neuber as follows: Abele-Yes, Eastman-Yes, Giacalone-Yes, Kost-Yes, and Turner-Yes.

10:30 a.m.

The Executive Session ended and the meeting was opened to the public.  The Board took a brief recess.

10:42 a.m.

Mrs. Teater arrived and the meeting resumed.

10:45 a.m.

Ms. Abele reported on the recent activities of the Nursing Board Prescribing committees.  She also distributed copies of the annual report from the APN Pilot Program at the University of Cincinnati that she recently received.

 

Mr. Benedict had no report from the Medical Board Prescribing Committee.

11:00 a.m.

RES. 2001-027   Mr. Benedict, Mr. Keeley, and Mr. Winsley reviewed pending legislation with the Board.  After discussion, it was the consensus of the members present that the Board was in favor of the concept in House Bill 674 of a universal insurance prescription card and that the Board should actively support this bill.  It was noted that this was in concert with a recent resolution of the National Association of Boards of Pharmacy (NABP) at its annual meeting in May.

11:15 a.m.

The Board was joined by Douglas Graff, Esq. representing RxMadeSimple.com to discuss this company’s plan for electronic prescription transmission.  After an extended discussion with Mr. Graff, the Board tabled any decision on the program pending receipt of a revised confidentiality statement.

11:45 a.m.

The Board took a recess for lunch.

  1:08 p.m.

The Board meeting resumed in Room 1914, Vern Riffe Center for Government and the Arts, 77 South High Street, Columbus, Ohio with all members present except Diane Adelman and Amonte Littlejohn.

  1:15 p.m.

RES. 2001-028   Mr. Benedict then presented a request from George Brown, R.Ph. asking for a waiver from the requirements of Administrative Code Rule 4729-5-11(A) to allow him to serve as responsible pharmacist at more than one location.  After discussion, Ms. Eastman moved that the request be approved for the following two locations for one year:

 

Samaritan Hospital Pharmacy; Ashland, Ohio (02-0030000)

Peoples Hospital Pharmacy; Mansfield, Ohio (02-1012750)

 

The motion was seconded by Mr. Giacalone and approved by the Board (Aye-5/Nay-0/­Abstain-1[Abele]).

  1:16 p.m.

The Board took a brief recess.

  1:28 p.m.

The Board was joined by Assistant Attorney General Sally Ann Steuk for the purpose of conducting an adjudication hearing in accordance with Ohio Revised Code Chapters 119. and 4729. in the matter of Dennis Paul Thompson; Niles, Ohio.

  1:44 p.m.

Mr. Littlejohn arrived and joined the meeting in progress.  President Neuber announced that Mr. Littlejohn would not participate in the remainder of the hearing, nor would he participate in the deliberations.

  1:55 p.m.

The hearing ended and the record was closed.  The Board took a brief recess.

  2:06 p.m.

The meeting resumed.  At the request of Mr. Giacalone, the Board began a discussion of the continuing pharmacy education (CPE) rules contained in Chapter 4729-7 of the Ohio Administrative Code.

  3:12 p.m.

The discussion on the CPE rules was continued until the October meeting to allow the Board members to consider the issues discussed and to review documentation received during the discussion.  The Board took a brief recess.

  3:29 p.m.

Ms. Abele moved that the Board go into Executive Session for the purpose of the investigation of complaints regarding licensees and registrants pursuant to Section 121.22(G)(1) of the Revised Code.  The motion was seconded by Mr. Kost and a roll call vote was conducted by President Neuber as follows: Abele-Yes, Eastman-Yes, Giacalone-Yes, Kost-Yes, Littlejohn-Yes, Teater-Yes, and Turner-Yes.

  3:55 p.m.

RES. 2001-029   The Executive Session ended and the meeting was opened to the public.  Mr. Littlejohn then moved that, pursuant to Section 3719.121 of the Revised Code, the Board summarily suspend the license to practice pharmacy belonging to Bruce Franken, R.Ph. (03-2-15485) due to the fact that a continuation of his professional practice presents a danger of immediate and serious harm to others.  The motion was seconded by Mrs. Teater and approved by the Board (Aye-7/Nay-0).

  4:00 p.m.

RES. 2001-030   Ms. Eastman then moved that the Board adopt the following Order in the matter of Dennis Paul Thompson:

 

ORDER OF THE STATE BOARD OF PHARMACY

(Docket No. D-000711-002)

 

In The Matter Of:

 

DENNIS PAUL THOMPSON

343 Trumbull Drive

Niles, Ohio 44446

(D.O.B. 07/26/1943)

 

INTRODUCTION

 

THE MATTER OF DENNIS PAUL THOMPSON CAME FOR HEARING ON SEPTEMBER 5, 2000, BEFORE THE FOLLOWING MEMBERS OF THE BOARD: SUZANNE L. NEUBER, R.Ph. (presiding); ANN D. ABELE, R.Ph.; SUZANNE R. EASTMAN, R.Ph.; ROBERT P. GIACALONE, R.Ph.; LAWRENCE J. KOST, R.Ph.; DOROTHY S. TEATER, PUBLIC MEMBER; AND JAMES E. TURNER, R.Ph.

 

DENNIS PAUL THOMPSON WAS NOT PRESENT, NOR WAS HE REPRESENTED BY COUNSEL, AND THE STATE OF OHIO WAS REPRESENTED BY SALLY ANN STEUK, ASSISTANT ATTORNEY GENERAL.

 

SUMMARY OF EVIDENCE

 

(A)      Testimony

 

State's Witnesses:

 

(1)       George Pavlich, Ohio State Board of Pharmacy

 

Respondent's Witnesses:

 

(1)       None

 

(B)      Exhibits

 

State's Exhibits:

 

(1)       Exhibit 1--Copy of two-page Proposal to Deny/Notice of Opportunity for Hearing letter dated July 11, 2000.

(2)       Exhibit 1A--Two-page letter from Dennis Paul Thompson dated August 1, 2000.

(3)       Exhibit 1B--Copy of Hearing Schedule letter dated August 10, 2000.

(4)       Exhibit 1C--Application for Examination as a Pharmacist of Dennis Paul Thompson signed and notarized on May 30, 2000, and attached statement of Dennis Paul Thompson regarding Section 5 of the application.

(5)       Exhibit 2--Copy of seven-page Order of the State Board of Pharmacy, Docket No. D-870604-119, dated August 21, 1987.

(6)       Exhibit 3--Copy of seven-page Order of the State Board of Pharmacy, Docket No. D-880517-223, in the matter of Dennis Paul Thompson dated August 22, 1988.

(7)       Exhibit 4--Copy of six-page Order of the State Board of Pharmacy, Docket No. D-890309-103, in the matter of Dennis Paul Thompson dated June 30, 1989.

(8)       Exhibit 5--Copy of six-page Order of the State Board of Pharmacy, Docket No. D-900227-064, in the matter of Dennis Paul Thompson dated June 29, 1990.

(9)       Exhibit 6--Copy of six-page Order of the State Board of Pharmacy, Docket No. D-911220-086, in the matter of Dennis Paul Thompson dated July 1, 1992.

(10)     Exhibit 7--Copy of three-page Order of the State Board of Pharmacy, Docket No. D-940902-014, in the matter of Dennis Paul Thompson dated April 27, 1995.

 

Respondent's Exhibits:

 

(1)       None

 

FINDINGS OF FACT

 

After having heard the testimony, observed the demeanor of the witness, considered the evidence, and weighed the credibility of each, the State Board of Pharmacy finds the following to be fact:

 

(1)       On July 11, 2000, Dennis Paul Thompson was notified by letter of his right to
a hearing, his rights in such hearing, and his right to submit his contentions in writing.

 

(2)       As demonstrated by return receipt of July 19, 2000, Dennis Paul Thompson received the letter of July 11, 2000, informing him of the allegations against him, and his rights.

 

(3)       Dennis Paul Thompson responded to the letter of July 11, 2000, by submitting his contentions in writing, letter dated August 1, 2000.

 

(4)       Records of the State Board of Pharmacy indicate that Dennis Paul Thompson submitted an application for examination as a pharmacist on or about June 1, 2000. Dennis Paul Thompson included a note with his application regarding Section 5 of the application which states: “On December 10, 1986, I was convicted of 16 counts of aggravated drug trafficking, a third degree felony, and two counts of illegal processing of drug documents, third and fourth degree felonies.  The jurisdiction was Court of Common Pleas of Mahoning County, Case number 86-CR-223.  On July 9, 1991, records of convictions were expunged by the Court of Common Pleas of Mahoning County.”  Such conduct constitutes being convicted of a felony, being convicted of violating any state or federal pharmacy or drug law; and/or not being of good moral character and habits within the meaning of Rule 4729-5-04 of the Ohio Administrative Code.

 

(5)       Records further indicate that Dennis Paul Thompson was originally licensed to practice pharmacy in the State of Ohio on June 21, 1971; and, on August 21, 1987, Dennis Paul Thompson’s license was revoked.  Such conduct constitutes having been disciplined by the Ohio State Board of Pharmacy pursuant to Sec­tion 4729.16 of the Revised Code within the meaning of Rule 4729-5-04 of the Ohio Administrative Code.

 

(6)       Since the revocation of his license in August of 1987, Dennis Paul Thompson has applied for licensure by examination on five separate occasions and his applications were denied on each occasion.

 

CONCLUSIONS OF LAW

 

(1)       Upon consideration of the record as a whole, the State Board of Pharmacy concludes that paragraph (4) of the Findings of Fact constitutes having been convicted of a felony as provided in paragraph (A) of Rule 4729-5-04 of the Ohio Administrative Code.

 

(2)       Upon consideration of the record as a whole, the State Board of Pharmacy concludes that paragraph (4) of the Findings of Fact constitutes having been convicted of violating any state or federal pharmacy or drug law as provided in paragraph (B) of Rule 4729-5-04 of the Ohio Administrative Code.

 

(3)       Upon consideration of the record as a whole, the State Board of Pharmacy concludes that paragraph (4) of the Findings of Fact constitutes not being of good moral character and habits as provided in paragraph (C) of Rule 4729-5-04 of the Ohio Administrative Code.

 

(4)       Upon consideration of the record as a whole, the State Board of Pharmacy concludes that paragraph (5) of the Findings of Fact constitutes having been disciplined by the Ohio State Board of Pharmacy pursuant to Section 4729.16 of the Revised Code as provided in paragraph (E) of Rule 4729-5-04 of the Ohio Administrative Code.

 

ACTION OF THE BOARD

 

Pursuant to Section 4729.08 of the Ohio Revised Code and Rule 4729-5-04 of the Ohio Administrative Code, and on the basis of the foregoing Findings of Fact and Conclusions of Law, the State Board of Pharmacy hereby denies the issuance of a certificate of regis­tration or an identification card and, therefore, denies the Application for Examination as a Pharmacist submitted by Dennis Paul Thompson on or about June 1, 2000.  Further, Dennis Paul Thompson may not submit an Application for Examination as a Pharmacist prior to twenty-five years from the effective date of this Order.

 

THIS ORDER WAS APPROVED BY A VOTE OF THE STATE BOARD OF PHARMACY.

MOTION CARRIED.

SO ORDERED.

 

The motion was seconded by Mr. Kost and approved by the Board (Aye-6/Nay-0/­Abstain-1[Littlejohn]).

  4:02 p.m.

The Board meeting was recessed until Wednesday, September 6, 2000.

 

 

wednesday, September 6, 2000

 

  9:00 a.m.      ROLL CALL

 

The State Board of Pharmacy convened in Room 1914, Vern Riffe Center for Govern­ment and the Arts, 77 South High Street, Columbus, Ohio with the following members present:

 

Suzanne L. Neuber, R.Ph. (President); Ann D. Abele, R.Ph.; Suzanne R. Eastman, R.Ph.; Robert P. Giacalone, R.Ph.; Lawrence J. Kost, R.Ph.; Dorothy S. Teater, Public Member; and James E. Turner, R.Ph.

 

  9:03 a.m.

The Board was joined by Assistant Attorney General Sally Ann Steuk for the purpose of conducting an adjudication hearing in accordance with Ohio Revised Code Chapters 119. and 4729. in the matter of Joseph R. Tabler, R.Ph.; Cincinnati, Ohio.

10:32 a.m.

The hearing ended and the record was closed.  The Board took a brief recess.

10:53 a.m.

The meeting resumed.  The Board was joined by Assistant Attorney General Sally Ann Steuk for the purpose of conducting an adjudication hearing in accordance with Ohio Revised Code Chapters 119. and 4729. in the matter of Randall T. Lynn; Cincinnati, Ohio.

11:55 a.m.

The hearing was recessed for lunch.  President Neuber announced that the hearing would resume following the Board’s 1:00 p.m. meeting with the reciprocity candidates.

  1:00 p.m.

The Board reconvened in Room 1919, Vern Riffe Center for Government and the Arts, 77 South High Street, Columbus, Ohio, for the purpose of meeting with the candidates for licensure by reciprocity with the following members present:

 

Suzanne L. Neuber, R.Ph. (President); Ann D. Abele, R.Ph.; Suzanne R. Eastman, R.Ph.; Robert P. Giacalone, R.Ph.; Lawrence J. Kost, R.Ph.; Dorothy S. Teater, Public Member; and James E. Turner, R.Ph.

 

RES. 2001-031   Following presentations by Board members and self-introductions by the candidates for licensure by reciprocity, Ms. Eastman moved that the Board approve the following candidates for licensure.  The motion was seconded by Mrs. Teater and approved by the Board (Aye-6/Nay-0).

 

Melissa Ann Angell

 

03-1-24399

 

North Carolina

Meredith Jeanne Aull

 

03-1-24376

 

New York

Donghi Baik

 

03-1-24384

 

Texas

Cassandra Burke Calderon

 

03-1-24358

 

North Carolina

Allison May Chung

 

03-1-23462

 

Maryland

Brad Vincent Cibik

 

03-1-24371

 

Michigan

Margaret Anne Dowell

 

03-1-24357

 

Indiana

Jeffrey Paul Gonzales

 

03-1-24388

 

Idaho

Fanar W. Jwaida

 

03-1-24386

 

Michigan

Nancy Elizabeth Krause

 

03-1-24363

 

Pennsylvania

Pratibha Shankar Muniyappa