Alabama Doctors' Pill Mill Convictions Get U.S. Supreme Court Review
Thursday, December 9, 2021
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On November 5, 2021, the U.S. Supreme Court agreed to hear the appeals of two doctors who were convicted of running a massive opioid "pill mill" operation at their Alabama clinic known as "Pain Specialists of Alabama." An Alabama federal jury found both doctors guilty in 2017 of prescribing opioids in violation of the federal Controlled Substances Act and they were sentenced to 21 and 25 years in prison. Between the two doctors they wrote 66,892 prescriptions in 2014, and grossed $20 million between 2012 and 2015, prosecutors said.
To read the press release from the Department of Justice (DOJ), click here.
A "Good Faith" Defense?
The question before the Supreme Court involves whether a physician charged with prescribing medication in violation of the Controlled Substances Act may assert a "good faith" defense, according to the petition. Did it matter if the doctors knowingly acted outside the scope of practice in prescribing large amounts of opioids like oxycodone to patients? That is the question.
Federal appeals courts seem divided on the issue. Some courts hold that doctors cannot be convicted for writing prescriptions they "sincerely" believe are within the bounds of their legitimate medical practice (a subjective standard); others hold that the belief of the physicians must be reasonable (an objective standard). Still, other courts hold that the doctor's beliefs are irrelevant. The problem with the first theory is that any time a physician testified that they sincerely thought their prescriptions were within the bounds of their professional practice, no matter how ludicrous, this would be a valid defense. (You may want to call this the "Carl Rittenhouse defense.")
In their appeals, both doctors said they acted within professional norms, that they were prevented from mounting a “good faith” defense by the court, and they did not intend any harm to patients. Additionally, they claim that the juries in their cases should have been instructed that prosecutors had to prove they intended to act outside the bounds of normal professional practice in order to find them guilty, according to the appeals.
Replying in a brief, the United States rejected the doctor's arguments, saying the appeals court correctly recognized that a physician's conduct "must be evaluated based on an objective standard, not a subjective standard." The DOJ said that there was overwhelming evidence that doctors acted more “as large-scale pushers — not as physicians.” Click here to read the United State's brief in opposition.
To view the Court's order in the case of Ruan v. United States, case number 20-1410, in the U.S. Supreme Court, click here.
Law Enforcement Raids on Physicians, Pharmacists, Nurses and Other Health Providers Will Continue.
According to the U.S. Drug Enforcement Administration (DEA), investigations against pill mill operations are ongoing. Additional arrests of co-conspirators, including other doctors and health providers, are forthcoming. If you are a physician, pharmacist, nurse, or other health provider, ensure you are taking measures to protect yourself and your practice. To see a prior blog I wrote on the steps pain management physicians can take to stay out of trouble, click here.
Contact a Health Law Attorney Experienced in DEA Cases.
At The Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, health care clinics, pain management clinics, pharmacists, pharmacies, and any other health care provider. We defend pain management physicians, clinics and pharmacists in state license investigations, in administrative hearings, and in DEA actions. The services we provide include reviewing and negotiating contracts, business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, Medicare and Medicaid audits, commercial litigation, and administrative hearings. It includes defense in federal or state court and defense in federal or state administrative hearings.
To contact The Health Law Firm, please call (407) 331-6620 or (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
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