The Supreme Court’s Prescription for the United States: Implications of Ruan v. United States

07/11/2022

         Amongst the recent release of
controversial opinions, the Supreme Court issued an opinion that opioid “pill
mill” doctors cannot be convicted under the Controlled Substances Act (“CSA”) without
a finding of subjective mens rea. The CSA makes it unlawful for any
person “knowingly or intentionally…to manufacture, distribute, or dispense…a
controlled substance.” Registered doctors, however, a permitted to dispense
controlled substances via prescription, so long as the prescription is “issued
for a legitimate medical purpose…acting in the usual course of his/her
professional practice.”

        Petitioners Dr. Xiulu Ruan and Dr.
Shakeel Kahn were both individually indicted and convicted of violating 21
U.S.C. § 841, also known as the CSA. Dr. Ruan was accused of improperly issuing
more than 300,000 prescriptions for controlled substances over a four-year
period, being a top prescriber in the nation for a type of fentanyl, and linking
his prescribing practices to his own financial interests. On the
other hand, Dr. Kahn was accused of selling controlled substances in exchange for cash
without performing any physical or legitimate exam. While both physicians
appear to have violated the CSA, the Supreme Court was tasked with reviewing
the physician’s state of mind in their unlawful prescribing practices.

        The government argued heavily for
an objective mens rea standard, stating that the statute’s “knowingly or
intentionally” language contains an implicit “objectively reasonable good-faith
effort” or “object honest-effort standard.” The Court rejected this argument
and held that in order to convict a doctor for violating § 841, the government
must prove beyond a reasonable doubt that the defendant knew that they
were acting in an unauthorized manner or intended to do so. Had the Court sided
with the government, a defendant’s criminal liability would turn on the mental
state of a hypothetical “reasonable” doctor, rather than on the mental state of
the actual defendant.

        With this decision, pill mill
doctors are not off the hook, but rather, charged physicians face higher
scrutiny from jurors when brought to court. Considering the lengthy sentences
that follow a violation of the CSA, the clarification of the appropriate
standard is critical to the proper prosecution of such violations and
administration of justice. However, the objective hypothetical of a “reasonable”
person makes frequent appearances in criminal law. In cases where a defendant
is charged with involuntary manslaughter, negligent homicide, or assault, the
defendant’s criminal liability rests heavily on an objective standard that the
Supreme Court has now taken a step away from. The Supreme Court’s decision may
influence how defense attorneys argue their client’s mens rea in crimes
where reasonableness is the standard. If these newly founded arguments succeed,
the stability of criminal definitions and statutory elements may be in
jeopardy. While all nine justices considered the policy reasons behind
implementing a subjective mens rea standard, their limited focus to CSA
violations may prove disruptive to the entire criminal legal field.  

-- Faith Zellman, Law Clerk