Dr. Michael Fletcher, a physician at Interventional Pain Specialists in Crestview Hills, Kentucky, was charged with conspiracy and distribution of controlled substances for prescribing opioids to patients Charles Hickman and Steven Kasselmann in 2016. Evidence showed Dr. Fletcher routinely prescribed high volumes of opioids without personally examining patients or obtaining necessary medical records, despite knowing signs of substance abuse among his patients. After his initial attorneys withdrew, Dr. Fletcher proceeded pro se for nine months following a valid waiver of counsel. He later attempted to retain attorney Alan Statman, but a conflict of interest arose. During a hearing regarding the conflict, Dr. Fletcher decided to proceed pro se again without a new colloquy. He was convicted on three distribution counts and sentenced to probation. On appeal, he challenged the sufficiency of the evidence, the validity of his second waiver of counsel, and claimed a due process violation because he had secretly relied on advice from a disbarred attorney, Eric Deters, during his self-representation.
The Sixth Circuit addressed three primary issues. First, regarding sufficiency of the evidence, the court applied the standard of whether any rational trier of fact could find the essential elements beyond a reasonable doubt. The court held that even excluding the challenged medical records, sufficient evidence existed. Expert testimony established that Dr. Fletcher's prescriptions lacked a legitimate medical purpose. Furthermore, the court found that Dr. Fletcher knowingly or intentionally acted in an unauthorized manner. This state of mind was inferred from circumstantial evidence showing he was aware of a high probability that his prescriptions were being distributed without a legitimate purpose. Dr. Fletcher had a reputation for signing 'stacks' of prescriptions, ignored red flags like patients 'nodding out' in the lobby, and admitted to colleagues that the volume was 'crazy' but did not act on the risks. This 'deliberate closing of eyes' to obvious warnings satisfied the knowledge element under Ruan v. United States. Second, concerning the waiver of counsel, the court analyzed whether Dr. Fletcher's second waiver was knowing, voluntary, and intelligent. Although the district court did not conduct a new Bench Book-style colloquy, the Sixth Circuit found the waiver valid based on the totality of the circumstances. Dr. Fletcher had already represented himself successfully for nine months, filed motions, and reviewed discovery. His confident statements at the June 6 hearing, where he explicitly stated he did not 'want or need a lawyer,' demonstrated an unequivocal waiver. The court noted that a second colloquy is not always required for experienced pro se defendants who understand the dangers of self-representation. Third, regarding the due process claim, the court rejected Dr. Fletcher's argument that reliance on disbarred attorney Eric Deters violated his rights. The court explained that the Due Process Clause constrains state action, not private citizens. Because Deters acted as a private individual and Dr. Fletcher concealed this relationship from the court, there was no connection to state action. Additionally, by waiving his right to counsel, Dr. Fletcher relinquished protections against ineffective assistance of counsel.
The decision affirms the conviction and sentence of Dr. Fletcher, ending his appeal. It clarifies that doctors who prescribe high volumes of opioids while ignoring obvious signs of diversion or lack of medical purpose can be found to have the requisite knowledge for criminal liability. The ruling also establishes that experienced pro se defendants may validly waive their right to counsel a second time without a fresh colloquy if the record shows they understand the risks. Finally, it reinforces that secret reliance on unlicensed advisors does not trigger due process protections unless the court was aware of the arrangement.
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