Background
Kirsten Ball, a licensed physician, was indicted on one count of conspiracy to distribute oxycodone and twenty counts of distribution under the Controlled Substances Act. She practiced medicine from her home office and prescribed large quantities of oxycodone. After a five-day trial, a jury convicted her of conspiracy and all but one count of distribution. Ball appealed, arguing that the jury instructions failed to accurately state the mens rea required following the Supreme Court’s decision in Ruan v. United States.
The court’s reasoning
The court reviewed the jury instructions de novo to determine if they correctly stated the law. The court explained that while the authorization inquiry is objective, the mens rea requirement is subjective. The government must prove that the defendant subjectively believed her conduct was outside the bounds of professional practice. The court distinguished this case from Smithers and Naum, noting that the instructions here explicitly defined good faith by what the defendant subjectively believed and prohibited conviction for mere negligence. The court rejected Ball’s argument that the possessive pronoun in the regulation required measuring her knowledge against her own idiosyncratic practice, noting that the regulation refers to the profession as a whole.
The law requires both that the prescriptions fell outside the objective bounds of professional practice and that she knew it.
Opinion at 2
What it means going forward
This decision reinforces that physicians can be convicted for unauthorized drug distribution if the government proves they subjectively knew their prescriptions were outside the bounds of professional practice, even if the prescriptions deviated from standard medical care.