The Supreme Court has granted certiorari to a petition that asks whether a physician alleged to have prescribed controlled substances outside the usual course of professional practice may be convicted under Section 841(a)(1) without regard to whether, in good faith, he “reasonably believed” or “subjectively intended” that his prescriptions fall within that course of professional practice.

Dr. Xiulu Ruan practiced medicine as a board-certified interventional pain specialist in Mobile, Alabama. He co-owned a clinic and affiliated pharmacy, and treated patients at those locations.

A grand jury indicted the doctor and his partner on charges of unlawful distribution of controlled substances under 21 U.S.C. 841(a)(1), as well as racketeering conspiracy, health-care fraud conspiracy, wire-fraud conspiracy, and related charges. At trial, the government acknowledged “that there were certainly instances where Dr. Ruan [and his partner] did a really good job for their patients,” and that “[b]y and large their patients were legitimate patients. But the government alleged that some of Ruan’s prescriptions fells outside of professional norms. Ruan argues that the government devoted much of the trial to evidence that invited conviction based on simple malpractice or mere negligence.

At the close of evidence, Ruan asked the district court to provide the jury a good-faith instruction:

Good faith in this context means good intentions and the honest exercise of professional judgment as to the patient’s needs. It means that the Defendant acted in accordance with what he reasonably believed to be proper medical practice.

The district court refused, believing the instruction was “subjective.” It, instead, gave an instruction that allowed conviction if Ruan had acted “outside the usual course of professional medical practice.”

Ruan was convicted on all but two counts and sentenced to 21 years of imprisonment. Seven of the counts of conviction were controlled substance charges. Most of the remaining counts relied on the controlled-substance charges as a predicate. The Eleventh Circuit Court of Appeals affirmed the convictions, saying it was “[b]ound by its [prior] holdings.” Yet it also said that Ruan’s requested instruction would wrongly permit an acquittal based only on his subjective belief.

Ruan, petitioning SCOTUS, argued the existence of a circuit split. That the Second, Fourth, and Sixth Circuits have held that a physician should be acquitted if he “reasonably believed” that his prescription was within the usual course of professional practice. By contrast, the First, Seventh, and Ninth Circuits have held any sincere belief (whether reasonable or not) that a prescription was within the bounds of professional practice is grounds for acquittal because a physician holding such a belief lacks the scienter required for a felony conviction. Ruan argued the Eleventh Circuit didn’t follow either of those approaches, but instead held that his good-faith belief is irrelevant. In other words, in the Eleventh Circuit, there is no room for good-faith mistakes—reasonable or otherwise.

Ruan v. United States