Supreme Court sides with doctors challenging their convictions in opioid ‘pill mill’ case

Lawyers for the doctors appealed their convictions, arguing that a jury should have been able to consider whether they reasonably believed they were acting within professional boundaries. The government had argued that such a standard was unnecessary.

The court’s decision for the doctors was unanimous, but the judges differed 6-3 on the legal justification.

Judge Stephen Breyer, writing for the majority, said that for the doctors to be prosecuted successfully, the government ‘must prove beyond a reasonable doubt that the defendant knowingly or intentionally acted in an unauthorized manner’ .

The so-called ‘pill mill’ case – which comes amid a national opioid crisis – pits a doctor’s ability to dispense controlled substances for pain management against government pressure to sue doctors who prescribe dangerous drugs without medical justification.

Lower courts are divided on the standard to use in determining whether a doctor should be charged with criminal liability. While some courts have said that a doctor’s good faith belief that he was acting according to medical standards is irrelevant to criminal liability, others have said the government must show that a doctor knowingly prescribes drugs under illegal circumstances. They say the law was not meant to criminalize well-intentioned conduct when a doctor prescribes drugs to treat patients with legitimate medical needs.

Monday’s court opinion will make it less difficult for patients to receive certain treatments. The court in other areas has expressed concern over the overuse of federal criminal law that could threaten innocent conduct.

“Today’s decision places the onus on the government when it prosecutes doctors for wrongly prescribing controlled substances, to show not only that the prescription did not serve a legitimate medical purpose, but that the doctor in knew as much when he wrote it,” said Steve Vladeck, CNN Supreme Court analyst and professor at the University of Texas School of Law. “In this regard, it likely arms physicians in the future with a strong defense that they erred in good faith, which might help them avoid criminal liability, but perhaps not the civil or ethical repercussions. .”

The dispute involved pain management physician Xiulu Ruan, who operated a medical clinic in Alabama called Physicians Pain Specialists, as well as Shakeel Kahn, who ran a similar practice in Arizona.

Both men were convicted under the Controlled Substances Act, which makes it a crime to anyone who “knowingly or intentionally” distributes a controlled substance and received lengthy sentences. Under the law, there is an exception for a licensed healthcare professional who is authorized to dispense some of the prescription drugs, but the prescription must be within “the usual course of professional practice”.

In other words, prescriptions are only lawful if they are issued for a legitimate medical purpose.

A ‘Massive National Crisis of Prescription Opioid Abuse’

Between January 2011 and May 2015, Ruan’s clinic issued nearly 300,000 prescriptions for controlled substances, earning him more than $3 million. More than half of the drugs prescribed were so-called Schedule II drugs, which are among the most dangerous drugs on the market. They include opioids such as fentanyl, hydrocodone, morphine, and oxycodone, which can mask pain but also be addictive. The clinic was raided by the FBI and the doctors were accused of running a “pill mill” that prescribed controlled substances for no legitimate medical purpose.

A lawyer for Kahn acknowledged that his practice “did not live up to the pattern of consistency one would expect from a practice specializing in long-term pain management”, particularly because some of his patients were selling the drugs.

“Dr. Kahn testified that he would not have issued prescriptions to people he knew were selling their drugs,” his attorneys told the court. He was sentenced to 25 years in prison.

Lawrence S. Robbins, a Ruan lawyer, argued that doctors cannot be convicted under the law regardless of whether they “reasonably believed” or “subjectively intended” that the prescriptions fell within the scope of the law. usual course of professional practice.

In other words, Robbins said, the government must prove that doctors had no good faith basis for issuing prescriptions.

The Justice Department, on the other hand, argued that a doctor’s good faith beliefs do not completely insulate him from prosecution.

In memoirs, the government noted that over the past 20 years there has been a “massive national crisis of prescription opioid abuse”, and that deaths from overdoses average more than 40 per day with a total of more than 165,000 deaths since 1999.

Deputy Solicitor General Eric Feigin told the judges that the lawyers for the doctors “are really asking this Court to turn their (Drug Enforcement Administration) records, which are based on the idea that they actually practice medicine, into licenses for, to their own subjective opinions, violate the general rule that the sale of drugs is illegal.”

He said, “They want to be free from any obligation even to undertake the slightest effort to act like doctors when prescribing dangerous, highly addictive and, in one case, lethal doses of drugs to unsuspecting and vulnerable patients. “.

This story has been updated with additional information.