Ruan v. United States

142 S. Ct. 2370 (2022)

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Nature of the Case

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Facts

Xiulu Ruan (D) and Shakeel Kahn (D), are both doctors who possess licenses permitting them to prescribe controlled substances. P separately charged them with unlawfully dispensing and distributing drugs in violation of §841. Each proceeded to a jury trial, and each was convicted of the charges. Ds argued that their dispensation of drugs was lawful because the drugs were dispensed pursuant to valid prescriptions. “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.” 21 CFR §1306.04(a). P argued that Ds’ prescriptions failed to comply with this standard. Ds argued that their prescriptions did comply, and that, even if not, Ds did not knowingly deviate or intentionally deviate from the standard. Ruan (D) asked for a jury instruction that would have required Pt to prove that he subjectively knew that his prescriptions fell outside the scope of his prescribing authority. The Court, however, rejected this request. The court instructed that a doctor acts lawfully when he prescribes “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.” '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.” Ruan (D) was convicted by the jury and sentenced to over 20 years in prison and ordered to pay millions of dollars in restitution and forfeiture. The Eleventh Circuit affirmed holding that a doctor’s “subjectiv[e] belie[f] that he is meeting a patient’s medical needs by prescribing a controlled substance” is not a “complete defense” to a §841 prosecution. The court said, “‘[w]hether a defendant acts in the usual course of his professional practice must be evaluated based on an objective standard, not a subjective standard.’” In Kahn’s (D) the court instructed the jury that it should not convict if it found that Kahn (D) acted in “good faith,” defined as “an attempt to act in accordance with what a reasonable physician should believe to be proper medical practice.” The court added that to find “good faith,” the jury must conclude that Kahn “acted in an honest effort to prescribe for patients’ medical conditions in accordance with generally-recognized and accepted standards of practice.” Ds both appealed.