US: Meaning of “Good Faith” Efforts under Controlled Substances Act Determined by U.S. Supreme Court

U.S. Supreme Court Ruling – “Good Faith”

As reported by LAPPA (August 2022)

Xiulu Ruan v. United States, U.S. Supreme Court, Case No. 20-1410 (opinion filed June 27, 2022); Shakeel Kahn v. United States, U.S. Supreme Court, Case No. 21-5261 (opinion filed June 27, 2022). For previous updates on these consolidated cases, please refer to the December 2021, February 2022, and April 2022 issues of the LAPPA Case Law Monitor, available here. In a unanimous decision, the U.S. Supreme Court resolved the federal court of appeals split over what constitutes “good faith” efforts by doctors to meet
their legal obligations under the federal Controlled Substances Act (CSA) when dispensing controlled substances. Ruan and Kahn, two doctors separately convicted of operating “pill mills” in violation of the CSA in Alabama and Wyoming, respectively, asserted that the lower courts wrongly neglected to consider whether each made good faith efforts to abide by the standards of medical practice. At the time the Supreme Court accepted review, several U.S. Courts of Appeal had reached differing conclusions over the meaning of “good faith” in this context. To overcome a good faith defense, the Second, Fourth, and Sixth Circuits found that the government must prove that a physician did not “reasonably believe” the prescriptions fell within professional norms. The First, Seventh, and Ninth Circuits held that a showing that the physician “subjectively intended” to exceed professional norms is required. The Eleventh Circuit concluded that a defendant’s good faith belief “is irrelevant” to the question. The Supreme Court accepted the doctors’ contentions, holding that prosecutors must prove beyond a reasonable doubt that a defendant “knowingly or intentionally acted in an unauthorized manner.” Accordingly, doctors cannot be found criminally liable solely because the prescriptions fall outside accepted medical standards; it must be proven that doctors intentionally violated those standards. The Supreme Court vacated the decisions and remanded the cases back to the respective U.S. Courts of Appeal.


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