The doctors’ lawyers appealed their sentences, arguing that the jury should have been able to assess whether they reasonably believed they were operating within professional limits. The government argues that such a standard is not necessary.
The court decision for the doctors was unanimous, but the judges differed 6-3 on the legal justification.
Judge Stephen Brier, who wrote for the majority, said that in order for the prosecution of doctors to be successful, the government “must prove beyond a reasonable doubt that the defendant knowingly or intentionally acted in an unauthorized manner.”
The case of the so-called “pill factory” – coming amid a national opioid crisis – opposes the doctor’s ability to distribute controlled substances to control pain against government pressure to prosecute doctors who prescribe dangerous drugs without medical justification.
The lower courts were divided over the standard to use when determining whether a doctor should be prosecuted. While some courts have said that a doctor’s good faith belief that he or she is acting within medical standards is irrelevant to criminal liability, others say the government must demonstrate that a doctor has knowingly prescribed medication in illegal circumstances. They say the law was not intended to criminalize well-intentioned behavior when a doctor prescribes drugs to treat patients with legitimate medical needs.
Monday’s court ruling will make it less difficult for patients to receive certain treatments. The court in other areas has expressed concern about the excessive use of federal criminal law, which could threaten innocent behavior.
“Today’s decision places the burden on the government in prosecuting doctors for illegally prescribing controlled substances to show not only that the prescription does not serve a legitimate medical purpose, but that the doctor knew so much when they prescribed it,” he said. Steve Vladek, an analyst at CNN’s Supreme Court and a professor at the University of Texas Law School. “In this regard, it probably equips doctors to move forward with strong protection, that they have made a good faith mistake that can help them avoid criminal liability, although perhaps not civil or ethical consequences.
The controversy concerned pain management physician Xiulu Rouen, who ran a medical clinic in Alabama called Physicians Pain Specialists, and Shaquille Khan, who ran a similar practice in Arizona.
Both men were convicted under the Controlled Substances Act, which makes it a crime for any person to “knowingly or intentionally” release a controlled substance and receive long sentences. According to the law, there is an exception for a licensed medical professional who is allowed to dispense some of the prescription drugs, but the prescription must fall within the “usual course of professional practice”.
That is, prescriptions are legal only if they are issued for a legitimate medical purpose.
“Huge national crisis in prescription opioid abuse”
Between January 2011 and May 2015, the Rouen clinic issued nearly 300,000 prescriptions for controlled substances, earning it more than $ 3 million. More than half of the prescribed drugs are the so-called list II drugs, which are among the most dangerous drugs on the market. These include opioids such as fentanyl, hydrocodone, morphine and oxycodone, which can mask pain but also lead to addiction. The clinic was attacked by the FBI and doctors were accused of running a “pill factory” that prescribed controlled substances without a legal medical purpose.
Cannes’s lawyer acknowledged that his practice “does not fit the pattern of consistency one can hope for in a practice that specializes in long-term pain management,” especially since some of his patients sold him drugs.
“Dr. Kahn testified that he would not issue prescriptions to people he knew were selling their drugs,” his lawyers told the court. He was sentenced to 25 years in prison.
Lawrence S. Robbins, Ruan’s lawyer, argued that doctors could not be convicted under the law, whether they “reasonably believed” or “subjectively intended” that the prescriptions fell within normal professional practice.
In other words, Robbins said, the government must prove that doctors did not have a bona fide basis for issuing prescriptions.
The Ministry of Justice, on the other hand, argues that the doctor’s good faith convictions do not completely isolate him from prosecution.
In short, the government noted that there has been a “massive national crisis in opioid abuse over the past 20 years” and that overdose deaths have averaged more than 40 a day, with a total of more than 165,000 such deaths since 1999.
Deputy Attorney General Eric Fagin told judges that doctors’ lawyers “really want this court to transform their (Drug Enforcement Administration) registrations, which are based on the idea that they are actually practicing medicine, into licenses for self-subjective views, violating the general rule that pushing drugs is illegal. ”
He said that “they want to be relieved of any obligation, even with minimal effort, to act as doctors when prescribing dangerous, highly addictive and in some cases lethal doses of drugs to gullible and vulnerable patients.”
This story has been updated with additional information.
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