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Doctors“ “pill mill“ convictions partially tossed after U.S. Supreme Court ruling


A view of the U.S. Supreme Court building on the first day of the court’s new term in Washington, U.S. October 3, 2022. REUTERS/Jonathan Ernst/File Photo

A federal appeals court on Thursday overturned key parts of the convictions of two Alabama doctors accused of running a massive “pill mill” after the U.S. Supreme Court in June made it harder to prosecute physicians for illegally prescribing addictive drugs like opioids.

The Atlanta-based 11th U.S. Circuit Court of Appeals overturned the convictions of Xiulu Ruan and John Couch for unlawfully dispensing controlled substances after finding that under a Supreme Court ruling in June in Ruan’s case, jurors were wrongly instructed on how to determine their guilt.

But the three-judge panel declined to disturb their other convictions for conspiring to violate the Controlled Substances Act, commit racketeering and accept kickbacks from a bankrupt opioid drug manufacturer, Insys Therapeutics Inc.

Prosecutors must now decide whether to retry Ruan and Couch or move straight to resentencing on their remaining convictions. Ruan was serving a 21-year prison term and Couch was sentenced to 20 years.

Domingo Soto, Couch’s lawyer, said he was considering his options including pursuing a further appeal. Lawrence Robbins, Ruan’s lawyer, declined to comment. Prosecutors did not respond to requests for comment.

Prosecutors said Ruan and Couch misused their medical licenses to unlawfully prescribe addictive, powerful opioid painkillers without a medical necessity through a clinic in Mobile, Alabama that issued nearly 300,000 controlled-substance prescriptions from 2011 to 2015.

Prosecutors said they also received kickbacks from Insys to prescribe its fentanyl spray Subsys. Insys’ founder, John Kapoor, and other executives were later convicted of conspiring to bribe them and other doctors to prescribe Subsys.

After the 11th Circuit largely upheld their 2017 trial convictions, Ruan appealed to the Supreme Court, arguing his trial was unfair because jurors were not required to consider whether he had a “good faith” reason to believe his numerous opioid prescriptions were medically valid.

The Supreme Court in June sided with Ruan, finding that once defendants produce evidence that they were authorized to dispense controlled substances like opioids, prosecutors must prove they knew they were acting in an unauthorized manner.

The justices, though, left it to the 11th Circuit to decide whether any mistakes in the jury instructions warranted reversing his conviction.