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Supreme Court Sides With Doctors Accused of Running Pill Mills

WASHINGTON — The Supreme Court on Monday on the side of two doctors convicted of illegally supplying drugs without a legitimate medical purpose.

The verdict was unanimous, although the judges disagreed on the exact reason. However, they agreed that prosecutors had to prove more than that the doctors had violated objective standards.

Judge Stephen G. Breyer, writing for six members of the court, said that as long as physicians were authorized to dispense controlled substances, prosecutors “must prove beyond reasonable doubt that the defendant knew that he or she was on an illicit drug.” way acted. , or was intended to do so.”

The doctors in the two cases have been convicted of illegally distributing drugs under the Controlled Substances Act. One, Dr. Xiulu Ruan, was accused of running a clinic in Alabama with a business partner that dispensed nearly 300,000 prescriptions for controlled substances in just over four years, making it one of the country’s leading sources for prescriptions for some types of fentanyl drugs.

The other, Dr. Shakeel Kahn, was charged with writing prescriptions in Arizona and Wyoming in exchange for payments that roughly tracked street drug prices. Prosecutors said he had accepted payment in cash and personal property, including firearms.

The question before the judges was how to read a sentence in an ordinance under the law. The phrase was an exception to the law’s prohibition on prescriptions “issued for a legitimate medical purpose by an individual practitioner acting in the ordinary course of his professional practice.”

Government lawyers argued that the exception described an objective standard rooted in established medical standards, while the doctors’ lawyers said their clients’ subjective understanding and good faith must play a role.

Judge Breyer sided with the second view, writing that he rejected the government’s argument that “requiring proof that a physician knowingly or intentionally failed to act as authorized will allow bad apple doctors to escape liability.” by claiming idiosyncratic views of their prescribing powers.”

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

Judge Samuel A. Alito Jr., writing for three members of the court, agreed with Judge Breyer’s argument, but not his reasoning.

“A physician who makes negligent or even reckless mistakes in prescribing drugs is still acting like a physician—he or she is simply acting like a bad doctorJudge Alito wrote.

“The same cannot be said, however, when a physician knowingly or purposefully issues a prescription to facilitate ‘addiction and recreational abuse,'” he wrote, citing a previous decision.

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

Kate Nicholson, executive director of the National Pain Advocacy Center, who submitted a letter support the doctorssaid the decision “protects health care providers from fear of unwarranted persecution and people who are in pain from accessing care.”

Abbe Gluck, a law professor at Yale, said Monday’s decision was “a victory for doctors prescribing innovative treatments they believe serve legitimate medical purposes and should allay concerns that the court would rule.” which would reduce physician prescribing and require pain treatments.” †

She warned against reading the decisions, Ruan v. United States, no. 20-1410, and Kahn v. United States, no. 21-5261.

“Some may wonder why alleged ‘pill mill’ operators seem to be getting off the hook, but the court hasn’t said so,” Professor Gluck said. “What the court said is that juries should investigate whether the indicted doctors are actually” believed their behavior to be legitimate rather than using an objective standard of a hypothetically reasonable physician. That may complicate prosecution of some outliers, but good government attorneys should weed out dishonest doctors who don’t act as doctors at all.”

Jan Hoffman reporting contributed.

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