Ruan v. United States
Wikipedia · Justia (with opinion) · Docket · oyez.org
Argued on Mar 1, 2022.Decided on Jun 27, 2022.
Petitioner: Xiulu Ruan.Respondent: United States of America.
Advocates: Lawrence S. Robbins (for the Petitioner in 20-1410)
Beau B. Brindley (for the Petitioner in 21-5261)
Eric J. Feigin (for the Respondent)
Facts of the case (from oyez.org)
A federal jury in Alabama convicted Xiulu Ruan and several other pain management physicians of running a medical practice constituting a racketeering enterprise in violation of several federal statutes, including provisions of the Controlled Substances Act. Ruan allegedly prescribed medicines, including Schedule II drugs (many of which are opioids), outside the standard of care for his practice. At trial, prosecutors showed that Ruan and other physicians in his practice prescribed medications for their own financial gain rather than for the benefit of their patients. Ruan and other defendants challenged their convictions, and the U.S. Court of Appeals for the Eleventh Circuit affirmed.

Question
May a physician alleged to have prescribed controlled substances outside the usual course of professional practice be convicted of unlawful distribution under 21 U.S.C. § 841(a)(1) regardless of whether he “reasonably believed” or “subjectively intended” that his prescriptions fall within that course of professional practice?

Conclusion
The crime of prescribing controlled substances outside the usual course of professional practice, in violation of 21 U.S.C. § 841, requires that the defendant “knowingly or intentionally” acted in an unauthorized manner. Justice Stephen Breyer authored the majority opinion of the Court.
In general, criminal law seeks to punish conscious wrongdoing. Thus, when a criminal statute is silent as to the mental state required, courts infer a requirement of knowledge or intent. When it is not silent, the general mental state provision applies to each term of the provision. Thus, the “knowingly or intentionally” requirement of 21 U.S.C. § 841 applies to the phrase “except as authorized.” As such, once the defendant proves their conduct was “authorized,” the prosecution must prove beyond a reasonable doubt that the defendant acted in an unauthorized manner.
Justice Samuel Alito authored an opinion concurring in the judgment, in which Justices Clarence Thomas and Amy Coney Barrett joined. Justice Alito looked to the Harrison Act, which preceded the Controlled Substances Act (CSA). Regarding the Harrison Act, the Court held that a registered physician acts “in the course of his professional practice” when the physician writes prescriptions “in good faith.” Justice Alito would thus hold that this rule applies under the CSA and vacate the judgments below and remand for further proceedings.