Doctors rush to use Supreme Court decision to avoid opioid charges

Dr. Nelson Onaro admitted last summer that he had written illegal prescriptions, though he said he was only thinking of his patients. From a small, brick-and-mortar clinic in Oklahoma, he dispensed hundreds of opioid pills and dozens of fentanyl patches for no legitimate medical purpose.

“Those drugs were prescribed to help my patients, from my own perspective,” Onaro said in court, as he reluctantly pleaded guilty to six counts of drug dealing. Because he confessed, the doctor was likely to receive a prison sentence of three years or less.

But Onaro changed his mind in July. In the days leading up to his sentencing, he asked a federal judge to scrap his plea deal, sending his case to trial. For a chance at clemency, he would face four times the charges and the possibility of a harsher sentence.

Why take the risk? A Supreme Court ruling has raised the bar for conviction in a case like Onaru’s. In a June ruling, the court said prosecutors must prove not only that the prescription was not medically justified — possibly because it was too large or dangerous, or simply unnecessary — but also that The prescriber knew as much.

Suddenly, Onaru’s mental state carries more weight in court. Prosecutors did not oppose the doctor withdrawing his plea from most of his charges, acknowledging in court filings that he faces “a different legal calculus” after the Supreme Court ruling.

The court’s unanimous decision complicates the Justice Department’s ongoing efforts to hold irresponsible prescribers criminally responsible for fueling the opioid crisis. Previously, lower courts had not considered the proposer’s intent. So far, trial doctors have mostly been unable to defend themselves by arguing that they were acting in good faith when they wrote the wrong prescriptions. Now they can, attorneys say, though that’s not necessarily a get-out-of-jail-free card.

“Essentially, the doctors were handcuffed,” said Onaru’s attorney, Zach Enlow. “Now they can take off their handcuffs. But that doesn’t mean they’re going to win the fight.

The decision of the Supreme Court Rowan v. United StatesIssued on June 27, it overshadowed the controversy that rocked the country three days earlier, when the court struck down federal abortion rights. But the little-known ruling is now quietly trickling through federal courts, where it has emboldened defendants in more rhetorical lawsuits and could have a chilling effect on future lawsuits against doctors under the Controlled Substances Act. Is.

Within three months of its issuance, Rowan At least 15 ongoing cases in 10 states have been decided, according to a KHN review of federal court records. Doctors cited the verdict in post-conviction appeals, acquittal motions, new trials, reversals of pleas, and unsuccessful attempts to exclude the prescribing expert’s testimony, arguing that their opinions were now irrelevant. . Other defendants have successfully requested delays in their cases. Rowan The verdict may be included in their arguments at future trials or sentencing hearings.

David Rivera, a former Obama-era U.S. attorney who once led an overdose prosecution in Middle Tennessee, said he believes doctors have a “great chance” of overturning the convictions if they have good faith. The defense is prohibited from being discussed or the jury is instructed to ignore one. .

Rivera said the defendants who ran the actual pill mills would still be convicted, even if a second trial was eventually required. But the Supreme Court has extended a “lifeline” to a narrow group of defendants who said “with their hearts, not their minds.”

“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 practicing as a doctor,” Rivera said. And he’s a drug dealer.” “A doctor who is acting under the honest belief that he is doing the right thing, even if he is terrible at his job and should not be trusted with human lives – that is still not criminal.”

gave Rowan The decision came as a result of appeals by two doctors, Zulu Ruan and Shaquille Kahn, who were convicted of operating pill mills in Alabama and Wyoming, respectively, and sentenced to 21 and 25 years in prison. In both cases, prosecutors relied on a common tactic to incriminate the prescriptions: expert witnesses examined the defendants’ prescriptions and testified that they were far outside of what a reasonable doctor would do.

But writing the Supreme Court opinion, then-Justice Stephen Breyer insisted 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 also that they did so “knowingly or knowingly.” “What Otherwise, courts risk punishing “conduct that is close to the criminal line, but on the permissive side,” Breyer wrote.

The unanimous verdict sent an unequivocal message to defense lawyers.

“This is a hyper-polarized time in America and especially on the court,” Enloe said. “And yet it was a 9-0 ruling that mens rea — or the doctor’s state of mind — that matters.”

Maybe there was nowhere. Rowan A more pressing decision than the case of Dr. David Jankowski, a Michigan physician who was on trial when the burden of evidence shifted from under his feet.

Jankowski was convicted of federal drug and fraud offenses and sentenced to 20 years in prison. In announcing the decision, the DOJ said the doctor and his clinic supplied people “with no need for drugs,” which were “sold on the street to feed opioid addicts.”

Defense counsel Anjali Prasad said Rowan The verdict was dropped before the jury deliberated in the case, but after prosecutors spent weeks arguing that Jankowski’s behavior did not amount to a reasonable prescription — a legal standard that is no longer sufficient by itself to convict.

Prasad quoted. Rowan decision in a motion for a new trial, which was denied, and said she intended to use the decision as the basis for a future appeal. The attorney also said she is in discussions with two other clients about appealing their convictions. Rowan.

“My hope is that criminal defense lawyers like me will be more motivated to take their cases to trial and have their clients 100% ready to fight the feds, which is no easy task,” Prasad said. . “We took it out in the courtroom. We can prevail that way.”

Some suspects are trying. So far, a few have achieved small wins. And at least one suffered a crushing defeat.

In Tennessee, nurse practitioner Jeffrey Young, accused of trading opioids for sex and defamation for a reality show pilot, successfully postponed his trial from May to November. Rowan The decision, arguing that “it will radically change the landscape of the government’s battle against proposers.”

Also in Tennessee, Samson Orosa, a doctor and pastor convicted last year of prescribing opioids without examining patients, filed a motion for a new trial based on that. Rowan The decision, then, prompted a reluctant judge to delay his sentence for six months to consider it.

And cited by Dr. Martin Escobar in Ohio. Rowan Ruler in eleventh hour attempt to escape jail.

Escobar pleaded guilty in January to 54 counts of distribution of a controlled substance, including the prescriptions that caused the deaths of two patients. after the Rowan After the verdict, Escobar tried to withdraw his plea, saying he would have gone to trial if he had known that prosecutors had to prove their intent.

A week later, on the day Escobar was sentenced, a federal judge denied the motion.

His criminal plea was pending.

Escobar turns 25.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three major operating programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information on health issues to the nation.

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