Dr. Nelson Onaro admitted last summer that he wrote illegal prescriptions, though he said he was only thinking of his patients. From a small, brick clinic in Oklahoma, he manufactured hundreds of opioid pills and dozens of fentanyl patches that had no legitimate medical purpose.
“These drugs were prescribed from my own point of view, to help my patients,” Onaro said in court, as he pleaded guilty to involuntarily dealing six drugs. Because he admitted, the doctor’s sentence was likely to be reduced to three years or less.
But he changed his mind in July. In the days leading up to his sentencing, he asked a federal judge to throw out his plea deal, sending his case to trial. To stand a chance of being acquitted, he faces a quadruple charge and is likely to face a stiff sentence.
Why take the risk? A Supreme Court ruling raised the bar for convictions in cases like Onaro’s. In a June decision, the court said prosecutors must prove not only that a prescription was not medically justified — perhaps because it was too large or dangerous, or simply unnecessary — but also that the prescriber knew too much.
Suddenly, Onaro’s state of mind carries more weight in court. Prosecutors did not oppose withdrawing the doctor’s plea to most of his charges, acknowledging in court that he faced “a different legal count” after the Supreme Court’s decision.
The court’s unanimous ruling complicates the Justice Department’s ongoing efforts to hold irresponsible prescribers criminally responsible for the opioid crisis. Previously, lower courts had not considered a prescriber’s intent. Until now, doctors at trial could not defend themselves by arguing that they acted in good faith when they wrote bad prescriptions. Now they can, attorneys say, though it’s not necessarily a get-out-of-jail-free card.
“Basically, the doctors were handcuffed,” Onaro attorney Jack Enlow said. “Now they can take off their handcuffs. But that doesn’t mean they will win the fight.”
Supreme Court judgment in 2012 Rouen v. United States, issued June 27, was overshadowed by the nation-shaking controversy three days earlier, when the court struck down federal abortion rights. But the little-known ruling is now quietly flowing through federal courthouses, where it has emboldened defendants in overprescribing lawsuits and could have a chilling effect on future prosecutions of doctors under the Controlled Substances Act.
In the three months since it was issued, the Ruan At least 15 ongoing cases across 10 states have been decided, according to a KHN review of federal court records. Physicians referred to post-conviction appeals, motions to acquit, new trials, plea reversals, and decisions in unsuccessful attempts to exclude the testimony of a prescription expert, their opinions now irrelevant. The other defendants successfully applied to have their cases delayed Ruan Decisions may be made on their arguments at an upcoming trial or sentencing hearing.
David Rivera, a former Obama-era U.S. attorney who once led an overprescribing prosecution in Middle Tennessee, said he believes doctors have a “great chance” of conviction if they are barred from arguing a good-faith defense or instructed to ignore it. is .
Rivera said the defendants who ran the actual pill mills will still be convicted, even if a second trial is ultimately required. But the Supreme Court has extended a “lifeline” to a narrow group of defendants who “gone with their minds, not their minds,” he said.
“What the Supreme Court is trying to do is divide between a bad doctor and a person who may have a license to practice medicine but is not working as a doctor and a drug dealer,” Rivera said. “A doctor who is sincerely working under the belief that he is doing the right thing, even if he may be terrible at his job and should not be trusted with human life – is still not a criminal.”
The Ruan The decision follows an appeal by two doctors, Xiulu Ruan and Shaquille Kahn, who were convicted separately of running pill mills in Alabama and Wyoming, then sentenced to 21 and 25 years in prison. In both cases, prosecutors relied on a simple technique to make prescriptions a crime: expert witnesses reviewed the defendants’ prescriptions and testified that they were not limited to what a reasonable doctor would do.
But writing the Supreme Court opinion, then-Justice Stephen Breyer emphasized that the burden of proof should not be so easy to overcome, sending both convictions back to lower courts for reconsideration.
Because doctors are allowed and expected to dispense drugs, Breyer wrote, prosecutors must prove not only that they wrote prescriptions without a medical purpose but that they did so “knowingly or intentionally.” Otherwise, courts risk punishing “conduct that is close to the criminal line, but on the permissive side,” Breyer wrote.
To defense attorneys, the unanimous verdict sent an unequivocal message.
“This is a hyperpolarized time in America and especially on the court,” Enlow said. “And yet it was a 9-0 verdict that’s telling Still for sale — or the doctor’s state of mind — that matters.”
Maybe there was nowhere Ruan An even more pressing decision was made in the case of Dr. David Jankowski, a physician from Michigan, who was on trial when the burden of proof shifted beneath his feet.
Jankowski was convicted of federal drug and fraud offenses and faces up to 20 years in prison. In announcing the ruling, the DOJ said the doctor and his clinic supplied people “with no need for medication,” which were “sold on the street to feed the addiction of opioid addicts.”
Defense attorney Anjali Prasad informed this information Ruan The verdict was thrown out before the jury deliberated in the case but after prosecutors argued for weeks that Jankowski’s conduct was not that of a reasonable guide — a legal standard that by itself is not enough to warrant a conviction.
Prasad mentioned Ruan decision on a motion for a new trial, which was denied, and he said he intends to use the decision as the basis for an upcoming appeal. The attorney also said he is in discussions with two other clients about appealing their convictions Ruan.
“My hope is that criminal defense attorneys like myself are more courageous to take their cases to trial and that their clients are 100% prepared to take on the feds, which is no easy task,” Prasad said. “We hashed it out in the courtroom. That’s how we can win.”
Some defendants are trying. So far, there have been a few small victories. And at least one suffered a crushing defeat.
In Tennessee, nurse practitioner Jeffrey Young, accused of trading opioids for sex and notoriety for a reality show pilot, successfully delayed his trial from May to November. Ruan decision, arguing that it would “drastically change the landscape of the government’s battle against regulators.”
Also in Tennessee, Samson Orusa, a doctor and pastor who was convicted last year of giving opioid prescriptions without testing patients, filed a motion for a new trial based on that. Ruan The decision, then persuaded a reluctant judge to delay his sentence for six months to consider it.
And quoted by Dr. Martin Escobar in Ohio Ruan Ruling on eleventh-hour efforts to avoid prison.
Escobar pleaded guilty in January to 54 counts of distribution of a controlled substance, including prescriptions that caused the death of two patients. after Ruan Escobar tried to withdraw his plea, saying he would have gone to trial if he had known prosecutors would have proven his intent.
A week later, on the day Escobar was sentenced, a federal judge denied the motion.
His guilty plea remains.
Escobar got 25 years.
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