Xiulu Ruan (a Board-certified Alabama Pain Specialist) was sentenced for prescribing opioid painkillers “outside of the usual course in professional medical practice.” His conviction was upheld by an appeals court. The court said that it didn’t matter whether Ruan believed he was following the prescribed procedures.
The ruling that is being heard by the Supreme Court on Tuesday conflates negligence and criminal liability. This allows for the Drug Enforcement Administration, (DEA), to overthrow state medical regulators. And encourages prosecutions of those who chill pain treatment. Doctors already under intense pressure to reduce opioid prescribing will feel even greater pressure to prioritize drug control over pain control if the ruling is upheld.
Ruan was tried in the battle of experts. While defense witnesses described him as an experienced physician who tried his best to help patients in desperate need, prosecution witnesses described him as reckless and blind to any “red flags”, which could indicate abuse of or diversion of drugs.
Dueling interpretations and mistakes of Ruan’s actions were part of some of the disagreement. There were ongoing disputes about issues like the benefits and risks of opioid long-term therapy for chronic pain. And more broadly, how do you balance patient’s needs with the government’s request that physicians not abuse pain medication?
This demand places doctors in difficult situations, as pain cannot always be objectively confirmed. They can trust their patients and some will profit from that trust. However, if doctors treat their patients in a suspicious manner, many people will be suffering unnecessary pain that could have been treated safely and effectively.
Medical professionals are now faced with regulatory sanctions and potential malpractice lawsuits. Criminal prosecution is a possibility because doctors could lose their freedom if they take decisions the DEA considers medically inadvisable.
In the past, criminal sanctions were reserved for those who knew or should have known that they are breaking the law. The U.S. Court of Appeals, 11th Circuit, however, ruled that a doctor’s good faith belief that he dispensed a controlled drug in his normal practice does not affect the issue of whether he has violated the Controlled Substances Act.
Ruan’s arguments that he had the right to a jury instructions precluding a guilt verdict were rejected by the 11th Circuit. This was based on the fact that the evidence showed that he believed his prescriptions were for a legitimate medical purpose, and that he was simply “acting in his usual professional practice,” which is required by CSA regulations. The appeals court ruled that Ruan can be sentenced to decades in prison, even though he did not intend to violate those vague standards.
Obstacles that can be nearly as difficult for doctors who are defending themselves in court against CSA allegations from other circuits. A case that was consolidated in Ruan’s also amounted to good faith. The court stated to the jury that it meant that the defendants tried to practice proper medicine according to what they believed to be reasonable.
Although this standard is acceptable in malpractice suits, it doesn’t meet the criteria for criminal prosecutions. Even worse, the U.S. Court of Appeals, 10th Circuit, considered the same case and decided that it did not matter if a prescription had been written “in the usual course of professional practise.” This must be determined objectively.
In a supporting Ruan’s appeal brief, two professors of health law note that the uncertainty around which practices could lead to federal prosecution hurts physicians as well as patients. This is yet another reason for doctors to abandon or turn away patients already suffering from the systematic crackdown on pain medications, and sacrifice their welfare in the name of the war against drugs.
© Copyright 2022 by Creators Syndicate Inc.