In 2022, the Supreme Court decided the case of Ruan v. United States, which involved federal criminal charges brought against doctors’ distributing controlled substances. That may sound simple enough, but Ruan is a complex case, hinging on statutory interpretation of 21 U.S.C. § 841 and the legal requirement of mens rea—that is, criminal intent. Like many Supreme Court opinions, a quick read won’t give you a clear picture of how it will actually impact doctors who prescribe controlled substances, like painkillers, for legitimate medical purposes. So, let the attorneys at Fishwick & Associates PLC help demystify Ruan and how it impacts doctors who have been accused by the federal government of distributing controlled substances.
The Facts of Ruan
Two medical doctors had been charged with and convicted of violating a federal law that makes it a crime to “knowingly or intentionally” distribute a controlled substance except under authorized circumstances, which includes doctors dispensing prescriptions for legitimate medical needs (think opioids like OxyContin). At their separate trials, which were combined into one case on appeal, both doctors asked that the juries be instructed that each doctor had to believe, in his own mind, that he was dispensing an authorized prescription. Instead, the juries were given instructions to evaluate whether the doctors’ actions were “in the usual course of [their] professional practice” and “in accordance with what a reasonable physician should believe to be proper medical practice.” In other words, even if the doctor believed it was a legitimate medical action to dispense the prescription, if most doctors believed otherwise, then the jury should find this doctor guilty.
The juries found each of the doctors guilty, and each was sentenced to upwards of twenty years in prison. Both doctors appealed, contesting the jury instructions used. They believed that they should have been evaluated based on their own subjective belief that the prescriptions they dispensed were authorized, not the more objective standard of what a “reasonable physician” would think. The 11th Circuit Court of Appeals affirmed the convictions, so the doctors appealed to the Supreme Court.
What Did the Supreme Court Say?
In a rare, unanimous decision, the Supreme Court sided with the doctors. To understand why, you first need to know what, exactly, 21 U.S.C. § 841 makes illegal. In relevant part, it says:
(a) Unlawful acts
Except as authorized by this subchapter, it shall be unlawful for any person knowingly or intentionally—
(1) to manufacture, distribute, or dispense, or possess with intent to manufacture, distribute, or dispense, a controlled substance; or
(2) to create, distribute, or dispense, or possess with intent to distribute or dispense, a counterfeit substance.
The Supreme Court said that “knowingly or intentionally” applied to “except as authorized.” This means that in a prosecution for illegally prescribing controlled substances, the federal prosecution must prove beyond a reasonable doubt that the defendant knowingly or intentionally acted in an unauthorized manner. In other words, it is not enough to show that the doctor’s actions were unusual, unreasonable, or merely determined by another doctor to be outside the bounds of medical practice.
How Does This Impact White Collar Drug Cases?
Going forward, when a doctor is prosecuted for illegally distributing pills, the prosecutor will have to prove that the specific doctor in the case knew that what they were doing was not within the bounds of legitimate medical practice and thus within the authorized exception to the prohibition on distributing controlled substances.
This is good news for doctors, especially those who have been accused of peddling drugs to patients for illicit reasons. This will make it harder for the government to prosecute such cases so long as the doctor has a genuine belief that they are prescribing medications to genuinely ease the pain of their patients.
But having such belief will not necessarily shield a doctor defendant. After all, evidence of genuine belief is difficult to come by, and a jury does not have to accept a doctor’s testimony that they genuinely believed that they were prescribing medications within accepted bounds of medical practice. For instance, in Ruan, the Supreme Court noted that an expert witness’s evidence regarding a doctor’s standard of care could have been weighed by the jury to conclude that the doctors subjectively believed their conduct was not in accord with the appropriate standard of care.
Ruan is thus not a get-out-of-jail-free card for doctors facing federal criminal charges for distributing controlled substances through their prescriptions. These are still very serious charges, and the importance of having experienced attorneys to guide you through the process of defending a white collar crime cannot be overstated.
Are You a Doctor Charged With or Being Investigated For Distributing Controlled Substances? Contact Fishwick & Associates to Discuss Your Legal Options
Prescribing a controlled substance without a legitimate medical purpose is a serious charge, and the penalties can be severe, often involving hefty fines and incarceration. If you or a loved one find themselves under investigation for, or being criminally charged with, distributing a controlled substance, do not hesitate to seek legal counsel! To schedule your confidential consultation, complete our online contact form or call us at 540-345-5890.
References
Xiulu Ruan v. United States, 142 S. Ct. 2370.
United States v. Xiulu Ruan, 56 F.4th 1291 (11th Cir. 2023).
21 U.S.C. § 841.