Mobile doctor’s Supreme Court win could impact other ‘pill mill’ convictions

Published: Jun. 27, 2022 at 6:51 PM CDT
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MOBILE, Ala. (WALA) - The U.S. Supreme Court’s ruling Monday in favor of a convicted Mobile doctor not only likely will result in a new trial for him but could impact similar convictions, according to the physician’s lawyer.

The high court threw out a conviction of a Mobile doctor who prosecutors alleged prescribed fentanyl and other powerful painkillers without a medically valid reason.

The majority opinion by Justice Stephen Breyer held that when defendant shows he was authorized to dispense drugs – like a doctor with a license to prescribe narcotics – prosecutors must “prove beyond a reasonable doubt that the defendant knew that he or she was acting in an unauthorized manner, or intended to do so.”

The justices sent the case against Dr. Xiulu Ruan back to the Atlanta-based 11th U.S. Circuit Court of Appeals, which likely will instruct a federal judge in Mobile to order a new trial. A spokesman for the U.S. Attorney’s Office in Mobile declined to comment.

A jury convicted Dr. Xiulu Ruan and his partner in the medial practice, Dr. John Patrick Couch, in 2017. A judge sentenced Ruan to 21 years is prison and Couch to 20 years.

Dennis Knizley, the attorney who represented him during the trial, hailed the ruling and said he would argue that his client should be allowed out of prison pending any new trial.

“It was a tremendous victory for Dr. Ruan,” he said. “It essentially reversed all the primary convictions of … the drug distribution cases, which were the foundation for any other cases. So it’s just a stunning victory for Dr. Ruan.”

Couch was not part of the appeal. But the ruling would apply to his conviction, as well.

“I’m hoping that this will all accrue to his benefit,” said Dom Soto, Couch’s court-appointed attorney.

Knizley says it could also impact other doctors who have been convicted, including even some who admitted their guilt.

“There’s a lot of physicians in jail that if they’d had the benefit of this defense would have certainly approached the case differently and may not have entered a plea of guilty,” he said.

The prosecution of Couch and Ruan was one in a string of cases in Mobile and across the country involving pain management doctors accused of using their medical licenses to shield what amounts to drug dealing. Prosecutors at the time described their practice, Physicians’ Pain Specialists of Alabama, as a “pill mill.”

But Knizley said the evidence at trial indicated that the doctors were not just handing out prescriptions to addicts off the street. They were real patients who came to the practice for genuine medical examinations, he said.

The prosecution won the convictions by arguing that the doctors’ drug-prescription practices went beyond what a typical doctor would do. The justices agreed the law requires prosecutors not only to demonstrate that the prescriptions were outside the course of usual practice but that the doctors knew that it was and intentionally evaded the law.

The case, in large part, turned on grammar. Justices had to decide if the phrase “knowingly or intentionally” modified the phrase “except as authorized” that preceded it in the statute. The court ruled that it did.

“This means that once a defendant meets the burden of producing evidence that his or her conduct was ‘authorized,’ the Government must prove beyond a reasonable doubt that the defendant knowingly or intentionally acted in an unauthorized manner,” Breyer wrote.

In addition to the potential for getting out of prison, a substantial sum of money may be at stake. The government seized $15 million worth of assets, including Ruan’s west Mobile home and his automobile collection. Couch surrendered property in Daphne and Orange Beach, along with four vehicles.

Knizley said there is a possibility that the government might have to pay that money back.

“That was forfeited all because it was the fruits of criminal conduct,” he said. “Well, if the convictions are now gonna be set aside and retried, there’s a giant question now about these forfeited proceeds.”

Justice Samuel Alito wrote a concurring opinion, joined by Justice Clarence Thomas and – for the most part – by Justice Amy Coney Barrett. He agreed the doctor’s conviction should be thrown out, on grounds that the judge did not tell jurors that they should consider whether the defendant prescribed the drugs “in food faith.”

Instead, Alito wrote, the majority adopted a “radical new course” by recognizing a “new hybrid” defense.

“The consequences of this innovation are hard to foresee, but the result may well be confusion and disruption,” he wrote. “That risk is entirely unnecessary.”


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