Opinion | Can You Be Held Liable for Prescribing Opioids in Good Faith?


Earlier this month, the Supreme Court heard oral arguments in a case that would affect how doctors can treat patients where opioids are involved. threshold question Ruan vs United StatesWhich came from the U.S. Court of Appeals for the Eleventh Circuit to the Supreme Court, when the care a doctor provides to patients crosses the threshold into a criminal act where the doctor is prescribing opioids.

Ziulu Ruan, MD, practiced medicine in Alabama as a board-certified pain specialist, and was indicted in 2016 for illegal distribution of opioids. jury in trial court convicted ruan And other physicians did not allow doctors to claim a defense of “good faith” based on a decision in their practice where they honestly prescribed opioids under the belief that it was the medically right thing to do. Once the case reached the Eleventh Circuit on appeal, Ruan was essentially doomed, as the federal appellate circuit does not defend a good faith defense in such cases. He lost and appealed to the Supreme Court on a writ of certiorari, a court process seeking judicial review of a lower court’s decision.

John Brennan, JD, A criminal defense attorney from New Jersey, explains that the core of the question posed before the court in this case is what is and is not an appropriate medical judgment:

“The argument of the doctors involved in the case was that the Supreme Court should look into the good faith of doctors prescribing opioids. In a situation where a doctor actually believes that it is within their common practice to write an opioid prescription, that it should not be viewed as a criminal act and that they should not be convicted of unlawful distribution under the Controlled Substances Act,

In recent oral arguments, Supreme Court justices seemed to overturn the Eleventh Circuit and lean in favor of convicted doctors. However, agreeing on the notion of reasonable belief and subjective intent is going to be difficult as they can be a bit slippery.

Three judges – Brett Kavanaugh, Neil Gorsuch, and Chief Justice John Roberts – each expressed concern for doctors who would be on the wrong side of a close professional judgment call, pointing out that doing so could lead to decades in prison. . When Justice Clarence Thomas asked whether the regulatory standards set forth on the issue were insufficiently clear, Ruan’s counsel responded that the elements of willful and willful wrongful prescribing were left to states and administrative boards, as this There is no clear federal guidance on the issue.

For judges, it will inevitably come down to the question of proper professional practice, which can be difficult to pin down in medicine. At least by the nature and tone of the inquiry on oral reasoning, judges are not inclined to view the Controlled Substances Act as a restricted way in the Eleventh Circuit. While a reasonable good faith defense is going to be a real challenge to the court, the outcome here depends, as it is, on intelligent and balanced enforcement of the Controlled Substances Act.

The importance of this matter and the underlying issue – the opioid crisis – cannot be overstated. recently position paper It has been made clear by the American Medical Association that the nation’s opioid and drug overdose epidemic is getting worse, with more metrics than previously estimated. The verdict in this case could affect its trajectory.

While both the Alabama Federal Court jury and the Eleventh Circuit indicted Ruan for violating provisions of the Controlled Substances Act, among other statutes, the bigger question goes far beyond any doctor’s wrongdoing to prescribe opioids. may be inspired for financial gain,

Simply put, a doctor’s ability to properly practice medicine will be limited by his inability to make judgment calls. If doctors fear heavy penalties for honest mistakes, they would be in favor of not treating. Therefore, if the Court’s ruling sets a highly restrictive policy aimed at the small number of physicians motivated by their own self-interest, it may be patients in pain who suffer longer.

Will the Supreme Court here overturn the Eleventh Circuit? They absolutely should, in my opinion. While the availability of opioids may seem counterintuitive in a national opioid crisis, it is neither a legal nor a medical issue presented in this case. Having a controlled substance act without a good defense makes no sense from a legal or practical point of view. If the Supreme Court does not overturn the Eleventh Circuit, they are essentially saying that the binary between good doctors and illegal pellet millers is always clear.

We may still be against pill mill doctors but agree that, in all jurisdictions, doctors are required to have the legal capacity to follow their best medical judgment whether or not to prescribe what they think is appropriate. If doctors are overly intimidated by the legal consequences of the alleged misinterpretation—which could be a consequence of the current ruling in the Eleventh Circuit—patients with chronic pain will suffer unnecessarily. In addition to being fundamentally unreasonable, it is also a typical medical argument for any court to hold that physicians should still be convicted of unlawful distribution of controlled substances if they sincerely believe that they practice. were prescribing the drugs under acceptable standards.

Aaron Solomon, JD, Chief Legal Analyst for Esquire Digital and editor of Today’s Esquire, He has taught entrepreneurship at McGill University and the University of Pennsylvania, and was selected for the Fastcase 50, recognizing the world’s top 50 legal innovators.

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