In a unanimous opinion, the U.S. Supreme Court recently issued a ruling vacating and remanding two lower court cases involving medical doctors convicted of prescribing opioids in violation of 21 U. S. C. §841. The issue before the High Court was whether the jury instructions in both cases accurately described the mens rea (or state of mind) required to find the defendants guilty. The ruling makes it clear that the “knowingly or intentionally” mens rea found in part of the applicable statute also applies to the statute’s “except as authorized” clause.
Xiula Ruan v. United States
Xiulu Ruan v. United States, 966 F. 3d 1101 and 989 F. 3d 806 came before the court on appeal from two separate lower appeals courts. In those cases, medical doctors Xiulu Ruan and Shakeel Kahn were both tried and convicted (in separate cases) of violating 21 U. S. C. §841, which reads, in pertinent part, as follows:
“Except as authorized by this subchapter, it shall be unlawful for any person knowingly or intentionally—
- to manufacture, distribute, or dispense, or possess with intent to manufacture, distribute, or dispense, a controlled substance;
Federal regulations allow a medical doctor who is licensed to prescribe controlled substances to do so but only if the prescription is “issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.”
Both Ruan and Kahn were accused of running “pill mills” that routinely distributed opioid prescriptions to patients without properly establishing the need for strong narcotic pain medication. Ruan, who practiced in Alabama, was convicted, and sentenced to 21 years in prison. Kahn, who practiced in Arizona and then Wyoming, was convicted and sentenced to 25 years in prison. Both convictions were affirmed by the respective Courts of Appeals.
What Was the Issue Before the High Court?
Both Ruan and Kahn appealed their convictions. At issue for the U.S. Supreme Court was whether the jury instructions used in both jury trials correctly and adequately described the government’s burden of proof required for a conviction. To decide the jury instruction issue, the Court had to decide a fundamental question involving the underlying statute. Specifically, for the prosecution to prove that a doctor’s dispensation of drugs via prescription falls within the statute’s prohibition and outside the authorization exception, is it sufficient for the Government to prove that a prescription was in fact not authorized, or must the Government prove that the doctor knew or intended that the prescription was unauthorized? In other words, must the prosecution prove that a doctor knowingly or intentionally issued an unauthorized prescription or just that a doctor issued an unauthorized prescription?
Both sides agree that the standard for an authorized prescription is found within the federal regulations which state that “to be effective,” a prescription “must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.” The government argued that both defendants issued prescriptions that did not meet the definition of “authorized.” Both doctors argued that their prescriptions were authorized but even if they were not, they did not knowingly or intentionally write unauthorized prescriptions.
The Jury Instructions
Both defendants contested the proposed jury instructions at trial. In Ruan’s trial, the jury instruction accepted by the court (over his objection) instructed the jury that a doctor acts lawfully when “in good faith as part of his medical treatment of a patient in accordance with the standard of medical practice generally recognized and accepted in the United States” and that a doctor violates §841 when “the doctor’s actions were either not for a legitimate medical purpose or were outside the usual course of professional medical practice.” The jury instructions used in Kahn’s trial were similar and also used over his objection.
The High Court was faced with deciding whether “knowingly and intentionally” (the mens rea) included in the first sentence of 21 U. S. C. §841 applies only to the words that follow or also to the phrase that precedes it.
What Did the U.S. Supreme Court Decide and What Does It Mean?
The Justices held that the “knowingly or intentionally” mens rea does apply to the statute’s “except as authorized” clause. In practical terms, that means that once a medical doctor has proven that the conduct in question (writing controlled substance prescriptions) was “authorized,” by virtue of the fact that the doctor had the necessary license to write the prescriptions, the prosecution must prove beyond a reasonable doubt that the doctor knowingly or intentionally acted in an unauthorized manner. Both cases were remanded back to the lower courts to determine if the jury instructions used complied with the mens rea standard as interpreted by the Supreme Court.
Get Help from Experienced Florida Federal Criminal Defense Attorney
If you are a medical doctor who is under investigation for illegally prescribing controlled substances in violation of §841, or who has formally been charged with a criminal offense, you need an experienced federal criminal defense attorney on your side immediately.
Call us at 407-755-7675, chat with us online, or submit our online form today. Because we understand that time is of the essence when federal law enforcement authorities are investigating you, our calls are answered 24 hours a day, allowing you to schedule an appointment as soon as possible to discuss your legal options.