Today’s Supreme Court unanimously agreed with two doctors convicted of drug trafficking on the basis of opioid prescriptions federal prosecutors considered medically unsuitable. Six justices stated that it is necessary for the government to show that a doctor has “knowingly or deliberately” violated the authorization for the medical use controlled substances. Trois justices differed from the majority’s legal analysis and concluded that a doctor can not be convicted for drug trafficking even if he acts in “good faith”.
It was a decision. Ruan v. United States Both cases are remanded to lower courts to allow them to assess defendants’ claims that juries misunderstood the law sufficiently to grant them new trials. This ruling will have an important impact on existing prosecutions which had long had chilling effects on pain management. Doctors who have prescribed opioids on the basis of a sincere belief they are providing good care now have less reason for concern that they could still face federal charges, which could land them in prison for many decades.
Kate Nicholson (executive director, National Pain Advocacy Center) is thrilled with the decision, which “entirely followed the argument we made during our.” Amicus curiae brief.” Short. RuanIn an email she noted that “doctors who have the authority to prescribe controlled substances cannot be convicted of violating Controlled Substances Act unless they are able to prove their competence.” IntentOr Learn moreThat they’re prescribing unapproved medications.” This requirement is crucial for physicians who are treating pain patients. Without it, they might not be able to meet their needs.
For the Court, the question was to determine how 21 USC-841 should be interpreted. This is a clause in the Controlled Substances Act. It is against the law for anyone to “distribute or distribute” controlled substances, except as permitted by Section 841. The CSA gives doctors registered with Drug Enforcement Administration (DEA the authority to prescribe controlled substances. However, a CSA regulation says that a valid prescription can only be given to a licensed physician for a legitimate medical reason. This is in addition to the normal course of one’s professional practice.
Xiulu Ruan was a Board-certified Alabama pain doctor and was sentenced for violating Section 801 by prescribing opioids outside the normal course of professional medicine practice. He was also required to make a payment of millions in forfeiture and restitution. Shakeelkahn from Casper in Wyoming was sentenced to 25 year imprisonment for the same crime. The prosecution claimed the defendants were legal indistinguishable as drug dealers in both the cases and the defendants contended that they wrote prescriptions in good faith believing that these were medically correct.
The jurors in Ruan’s case were told that a doctor must comply with Section 841 when he “acts in good faith” in his treatment of a patient according to the standards of American medical practice. A doctor is considered to have violated Section 841 if his actions were not legitimately medical or outside of the normal course of medical practice.
Ruan was convicted by the U.S. Court of Appeals, 11th Circuit. Ruan was convicted by the U.S. Court of Appeals for the 11th Circuit.[e]Believe[f]That he has prescribed a controlled substance to a patient is not sufficient defense for Section 841. Citing an earlier ruling, the 11th Circuit stated “whether a defendant acts within the normal course of his profession must be evaluated using an objective standard and not a subjective method.”
The jurors in Kahn’s case were informed that Kahn should be acquitted only if he “acted in good faith” meaning that he attempted to follow the guidelines of a competent physician. The trial court stated that a jury finding Kahn in “good faith” meant the jury had to find Kahn tried to treat patients’ conditions according to generally accepted and recognized standards of medical practice.
Kahn was also convicted on appeal. According to the U.S. Court of Appeals of the 10th Circuit, in order to prove a violation of CSA, Kahn must either “subjectively know” that a prescription was “not for a legitimate medical reason”, or show that he “issued a prescribed that is objectively different from the normal course of professional practice.”
The appeals courts ruled that Ruan and Kahn could be convicted if they did not follow an objective standard for medical care. It was implied that drug trafficking could result in a conviction for a physician even if the doctor believed he was following what a doctor ought to do.
In March’s oral argument, many justices expressed concern at the possibility that a doctor might accidentally be guilty in a series of criminal offenses. These crimes could lead to long sentences up to 20 years for each violation or 20 years to live if it results in death or serious bodily harm) and high fines as much as $1 million. The Court rejected that theory. However, it’s not surprising.
The majority opinion by Justice Stephen Breyer, which was joined by Chief Justice John Roberts and Justices Sonia Sotomayor, Elena Kagan, Neil Gorsuch, and Brett Kavanaugh, concludes that the phrase “knowingly or intentionally” should be read as applying not only to the act of dispensing a controlled substance but also to a doctor’s failure to do so “for a legitimate medical purpose…in the usual course of his professional practice.” Breyer states that, although this interpretation is grammatically questionable, it conforms with “a longstanding presumption traceable to common law that Congress intends for a defendant must possess a mental state culpable” to be guilty.
Breyer points out that medical prescriptions are based on the “fact that the doctor has issued an unauthorizedIt is not the prescription itself that makes the conduct of the patient wrongful. In other words, authorization plays a ‘crucial’ role in separating innocent conduct—and, in the case of doctors, socially beneficial conduct—from wrongful conduct.” Breyer says the “language of §841 (which explicitly includes a ‘knowingly or intentionally’ provision); the crucial role authorization (or lack thereof ) plays in distinguishing morally blameworthy conduct from socially necessary conduct; the serious nature of the crime and its penalties; and the vague, highly general language of the regulation defining the bounds of prescribing authority all support applying normal scienter principles to the ‘except as authorized’ clause.”
Accordingly, the Court concludes that the statute was not knowingly or inadvertently written. mens reaAuthorization is the same.” This means that once the defendant meets the burden to produce evidence that his/her conduct was “authorized,” the Government must show beyond any reasonable doubt that the defendant knew or purposely acted in an illegal manner.
Is that to say that doctors can do whatever they want, as long as they claim that they are complying with the CSA? Breyer says no, as the government still has circumstantial evidence that can “prove” that there was no authorization.
According to the government, “requiring that it proves that a doctor knew or intended to act not as authorized will permit bad-apple physicians to avoid liability by claiming unique views regarding their prescribing power.” Breyer points out that the regulation that defines the doctor’s prescribing power refers to objective criteria like ‘legitimate medicine’ and ‘usual practice’.
Even though a physician may not have met the “objective criteria” to be found guilty of Section 841 violation, his deviations can be considered evidence that he knew the law. “As we have said before,” Breyer writes, “‘the more unreasonable’ a defendant’s ‘asserted beliefs or misunderstandings are,’ especially as measured against objective criteria, ‘the more likely the jury…will find that the Government has carried its burden of proving knowledge.”
Justice Samuel Alito joined Justices Clarence Thomas, Amy Coney Barrett in a concurring opinion. He rejects the claim that the expression “knowingly” or “intentionally” can be used to refer to the CSA authorization for medical uses. He says that the Court’s case involving the Harrison Narcotics Tax Act (predecessor to the CSA) shows that a doctor can’t be convicted for violating Section 841 if he writes prescriptions “in good faith.” Alito agrees with the majority that the appeals courts’ decisions must be reversed and the cases sent back to “for further proceedings.”
Alito also criticizes the majority offenders for defining lack of authorization to be an element rather than recognizing authorization as an affirmative defense. According to Alito, it should fall on the defendant’s shoulders to show that he acted with good faith. This would mean that the prosecution wouldn’t have to prove beyond reasonable doubt this claim.
These differences aside, justices unanimously agreed that the subjective good will of a doctor is crucial. While prosecutors can still introduce testimony indicating that a physician deviated from widely accepted medical practices, the point of such evidence will be to show that the defendant knowingly broke the law, not merely that other doctors would have made different decisions. That distinction is vital, given ongoing scientific and medical debates over how to best treat pain.
“This is the most significant health care decision by the Supreme Court in 50 years,” Lynn Webster, former president of the American Academy of Pain Medicine, says in an email. This is the Court’s inaugural decision in this area. [has]The federal Controlled Substances Act was interpreted and applied to criminal cases involving good-faith defenses in prescribing. In resolving the case, the Court correctly ruled that doctors have the right of a good-faith defence.
Webster points out that doctors can’t be found guilty of merely abiding from the “standard of care”, as set by the government, because the Court has held so. Webster says that this is an egregious misuse of the CSA. “Physicians were afraid to prescribe controlled drugs even if they had an indication, for fear that the government expert might testify it does not meet standard of care. Criminal conduct should not be determined by standard of care. It is considered a civil matter.
Webster believes the Court will make a decision that is “overzealous”.[ness]”lawlessness and the DEA” and the Justice Department. He said that the decision will benefit both prescribers and patients. He says, “This monumental decision will literally save lives.” “Because fewer patients will have to be left by doctors out of fear for their liberty,” he added.