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Supreme Court Sides With Doctors Accused of Running Pill Mills


WASHINGTON — The Supreme Court on Monday sided with two doctors convicted of illegally dishing out drugs with no legitimate medical purpose.

The ruling was unanimous, though the justices disagreed on the precise rationale. They were united, nonetheless, in saying that prosecutors needed to prove greater than that the doctors had violated objective standards.

Justice Stephen G. Breyer, writing for six members of the court, said that, as long as doctors were authorized to dispense controlled substances, prosecutors “must prove beyond an inexpensive doubt that the defendant knew that she or he was acting in an unauthorized manner, or intended to achieve this.”

The doctors within the two cases were convicted of illegal drug distribution under the Controlled Substances Act. One, Dr. Xiulu Ruan, was accused of running a clinic in Alabama with a business partner that issued nearly 300,000 prescriptions for controlled substances in somewhat greater than 4 years, making it certainly one of the nation’s leading sources of prescriptions for some sorts of fentanyl drugs.

The opposite, Dr. Shakeel Kahn, was accused of writing prescriptions in Arizona and Wyoming in exchange for payments that roughly tracked the road prices of the drugs. Prosecutors said he had accepted payment in money and private property, including firearms.

The query for the justices was how one can read a phrase in a regulation under the act. The phrase set out an exception to the law’s prohibition for prescriptions that were “issued for a legitimate medical purpose by a person practitioner acting in the standard course of his skilled practice.”

Lawyers for the federal government argued that the exception described an objective standard rooted in established medical norms, while the doctors’ lawyers said that their clients’ subjective understandings and good faith must play a job.

Justice Breyer sided with the second view, writing that he rejected the federal government’s argument that “requiring it to prove that a physician knowingly or intentionally acted not as authorized will allow bad-apple doctors to flee liability by claiming idiosyncratic views about their prescribing authority.”

The Supreme Court sent the case back to the appeals courts to contemplate whether the juries within the two cases had been properly instructed and, if not, whether the errors were harmless.

Justice Samuel A. Alito Jr., writing for 3 members of the court, agreed with Justice Breyer’s bottom line but not his reasoning.

“A physician who makes negligent and even reckless mistakes in prescribing drugs continues to be ‘acting as a physician’ — she or he is just acting as a foul doctor,” Justice Alito wrote.

“The identical can’t be said, nonetheless, when a physician knowingly or purposefully issues a prescription to facilitate ‘addiction and recreational abuse,’” he wrote, quoting an earlier decision.

Justice Alito said he would allow doctors who act “in subjective good faith in prescribing drugs” to invoke the exception to the law.

Kate Nicholson, executive director of the National Pain Advocacy Center, which filed a transient supporting the doctors, said the choice “protects providers from being afraid of unwarranted prosecution and other people in pain from being given access to care.”

Abbe Gluck, a law professor at Yale, said the choice on Monday was “a victory for physicians prescribing revolutionary treatments that they consider serve legitimate medical purposes and may counteract concerns that the court would issue a ruling that will chill physician prescribing and needed pain treatments.”

She cautioned against overreading the selections, Ruan v. United States, No. 20-1410, and Kahn v. United States, No. 21-5261.

“Some may wonder why alleged ‘pill mill’ operators appear to get off the hook, however the court didn’t say that,” Professor Gluck said. “What the court said is that juries must scrutinize whether charged physicians actually believed their behavior was legitimate moderately than using an objective standard of a hypothetical reasonable physician. That will make prosecutions of some outliers difficult, but good government lawyering should smoke out dishonest doctors who are usually not acting as doctors in any respect.”

Jan Hoffman contributed reporting.

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