Background
Evann Herrell, Mark Grenkoski, and Keri McFarlane were licensed doctors who worked at Express Health Care, a clinic that operated as a pill mill. The clinic prescribed high volumes of controlled substances like buprenorphine and benzodiazepines in exchange for cash, often without proper patient screening or medical records. The doctors signed prescriptions for patients they had not seen and falsified records to conceal their practices. They were convicted after a thirty-day jury trial on charges including conspiracy to distribute controlled substances, healthcare fraud, and money laundering.
The court’s reasoning
The court applied the standard from United States v. Ruan, requiring proof that the defendants subjectively knew their prescriptions were not for a legitimate medical purpose. The evidence showed the defendants operated outside the usual course of professional practice by prescribing in abnormal doses, ignoring drug diversion, and falsifying records. The court found the evidence sufficient to support the convictions. Regarding evidentiary challenges, the court held that excluding evidence of the X-waiver rule’s elimination was not an abuse of discretion due to the timeline mismatch. The court also affirmed the admission of hearsay statements offered to show their effect on the listener and the admission of text messages discussing clinic security. The court rejected the argument that the district court erred in denying a severance motion, finding no specific and compelling prejudice.
What it means going forward
The decision reinforces the ability of prosecutors to secure convictions against medical professionals who operate pill mills by prescribing drugs without legitimate medical purpose, even when defendants argue that regulatory changes later occurred.