Dzung Ahn Pham, a former licensed physician, was charged with conspiring with a pharmacist to prescribe and distribute over 150,000 narcotic pills to patients over a six-year period. In October 2022, Pham entered a plea agreement to the conspiracy count, admitting that he acted with the intent to issue prescriptions outside the usual course of professional medical practice and without a legitimate medical purpose. Shortly before his sentencing, Pham filed a motion to withdraw his plea under Federal Rule of Criminal Procedure 11, arguing that the plea was not knowing and voluntary. He contended that the Supreme Court's decision in Ruan v. United States, which required the government to prove a defendant knew they were acting without authorization, was not adequately reflected in his plea colloquy because the word 'unauthorized' was never explicitly used. Pham maintained that while he knew the prescriptions were not for a legitimate medical purpose, he believed he still possessed the legal authority to write them. The district court denied the motion, and Pham appealed.
The Ninth Circuit addressed whether Pham's plea was involuntary under the standard set by Ruan v. United States. The court explained that Ruan requires the government to prove that a defendant knew they were acting in an unauthorized manner, or intended to do so. While Ruan clarified that the statute's mens rea applies to the element of authorization, the court found that Pham's specific admissions in the plea agreement and colloquy satisfied this burden. Pham admitted to knowingly and intentionally issuing prescriptions outside the usual course of professional practice and without a legitimate medical purpose. The court reasoned that these admissions inherently proved he knew he was acting without authorization, as the regulation defining 'authorized' prescriptions explicitly requires them to be issued for a legitimate medical purpose in the usual course of practice. The court rejected Pham's argument that the failure to use the specific word 'unauthorized' rendered the plea invalid, noting that the substance of his admission covered the requisite knowledge. The court also reviewed other circuit decisions applying Ruan, finding that admitting to acting outside the usual course of practice and without a legitimate purpose is consistent with the requirement to prove knowledge of unauthorized conduct.
The decision affirms Pham's conviction for conspiracy to distribute controlled substances and his original sentence of 151 months. It clarifies that for defendants entering guilty pleas, admitting to acting outside the usual course of professional practice and without a legitimate medical purpose is sufficient to satisfy the Ruan mens rea requirement, even if the specific term 'unauthorized' is not used in the colloquy. The ruling limits the ability of defendants to withdraw pleas based on the argument that they believed they had authority to prescribe, provided they admitted to the lack of a legitimate medical purpose.
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