Courts will now weigh physician intent in “pill mill” prosecutions and more under the Controlled Substances Act.
What is Pill Mill?
A pill mill is an illegal facility that resembles a regular pain clinic, but regularly prescribes painkillers (narcotics) without sufficient medical history, physical examination, diagnosis, medical monitoring, or documentation. Clients of these facilities usually receive prescriptions only against cash. Pill mills contribute to the opioid epidemic in the United States and are the subject of a number of legislative initiatives at the state level.
Business Model and Characteristics
In pill mills, doctors or staff supervised by them prescribe opioids for non-existent or exaggerated pain. The primary purpose behind this prescribing practice is not to relieve pain or cure it, but to make high profits. This makes pill mills a criminal enterprise.
Characteristics of such facilities include that they are often owned by non-medical personnel and only cash is accepted (no credit cards or insurance payments). Medical records, findings, or X-rays are not required; no medical examinations are performed or are merely pro forma; alternatives to treatment with tablets are not discussed; strong painkillers are prescribed; and prescriptions can only be redeemed at certain pharmacies. Additionally, long queues are visible in front of the facilities, parking spaces in front of or near the facility are heavily frequented, and security personnel or doormen are used.
According to investigating authorities and scientists, such facilities come in different shapes and sizes, but for them it is important to give the impression that they are independent pain treatment centres. To avoid prosecution, pill mills’ managers tend to run their facilities like pop-up stores. Clients of pill mills are addicted to pills or trade their pills.
Understanding Mens Rea
Mens rea is a legal phrase used to describe the mental state a person must be in while committing a crime for it to be intentional. It can refer to a general intent to break the law or a specific, premeditated plan to commit a particular offense. To convict an accused person of a wrong doing, a criminal prosecutor must show beyond any reasonable doubt that the suspect actively and knowingly participated in a crime that harmed another person or their property.
Every crime tried in court has two factors: the actus reus, the actual criminal act, and mens rea, the intent to commit that act. Prosecutors must prove that both of these conditions existed to win a conviction.
Applying Mentes Reae
If a statute specifies a mental state or a particular offense, courts will usually apply the requisite mental state to each element of the crime. Moreover, even if a statute refrains from mentioning a mental state, courts will usually require that the government still prove that the defendant possessed a guilty state of mind during the commission of the crime. For example, the Supreme Court of the United States instructed that federal criminal statutes without a requisite mental state “should be read to include ‘only that mens rea which is necessary to separate “wrongful from innocent conduct.'”
Mental states are usually organized hierarchically by the offender’s state of blameworthiness. Generally, the blameworthiness of an actor’s mental state corresponds to the seriousness of the crime. Higher levels of blameworthiness typically correlate with more severe liability, and harsher sentencing.
Historically, states categorized mental states into crimes which required “general intent” and “specific intent.” However, due to the confusion that ensued over how to describe “intent,” most states now either use the Model Penal Code‘s (MPC) four-tiered classification, or the malice distinction.
The MPC and Mens Rea
Most states use the MPC’s classification for various mentes reae. The MPC organizes and defines culpable states of mind into four hierarchical categories:
- acting purposely – the defendant had an underlying conscious object to act
- acting knowingly – the defendant is practically certain that the conduct will cause a particular result
- acting recklessly – The defendant consciously disregarded a substantial and unjustified risk
- acting negligently – The defendant was not aware of the risk, but should have been aware of the risk
Thus, a crime committed purposefully would carry a more severe punishment than if the offender acted knowingly, recklessly, or negligently. The MPC greatly impacted the criminal codes of a number of states and continues to be influential in furthering discourse on mens rea.
Get To Know Ruan v. United States Case
|Docket No.||Op. Below||Argument||Opinion||Vote||Author||Term|
|20-1410||11th Cir.||Mar 1, 2022||Jun 27, 2022||9-0||Breyer||OT 2021|
Holding: For the crime of prescribing controlled substances outside the usual course of professional practice in violation of 21 U.S.C. § 841, the mens rea “knowingly or intentionally” applies to the statute’s “except as authorized” clause.
Judgment: Vacated and remanded, 9-0, in an opinion by Justice Breyer on June 27, 2022. Justice Alito filed an opinion concurring in the judgment, in which Justice Thomas joined and in which Justice Barrett joined as to Parts I-A, I-B, and II.
|Date||Proceedings and Orders (key to color coding)|
|Apr 05 2021||Petition for a writ of certiorari filed. (Response due May 7, 2021)|
|Apr 27 2021||Motion to extend the time to file a response from May 7, 2021 to June 7, 2021, submitted to The Clerk.|
|Apr 28 2021||Motion to extend the time to file a response is granted and the time is extended to and including June 7, 2021.|
|May 07 2021||Brief amici curiae of Professors of Health Law and Policy filed.|
|May 27 2021||Motion to extend the time to file a response from June 7, 2021 to July 7, 2021, submitted to The Clerk.|
|May 28 2021||Motion to extend the time to file a response is granted and the time is further extended to and including July 7, 2021.|
|Jul 07 2021||Brief of respondent United States of America in opposition filed. VIDED.|
|Jul 20 2021||Reply of petitioner Xiulu Ruan filed. (Distributed)|
|Jul 21 2021||DISTRIBUTED for Conference of 9/27/2021.|
|Oct 04 2021||DISTRIBUTED for Conference of 10/8/2021.|
|Oct 12 2021||DISTRIBUTED for Conference of 10/15/2021.|
|Oct 25 2021||DISTRIBUTED for Conference of 10/29/2021.|
|Nov 01 2021||DISTRIBUTED for Conference of 11/5/2021.|
|Nov 05 2021||Petition GRANTED. The petition for a writ of certiorari in No. 21-5261 is granted. The cases are consolidated, and a total of one hour is allotted for oral argument.|
|Nov 05 2021||Because the Court has consolidated these cases for briefing and oral argument, future filings and activity in the cases will now be reflected on the docket of No. 20-1410. Subsequent filings in these cases must therefore be submitted through the electronic filing system in No. 20-1410. Each document submitted in connection with one or more of these cases must include on its cover the case number and caption for each case in which the filing is intended to be submitted. Where a filing is submitted in fewer than all of the cases, the docket entry will reflect the case number(s) in which the filing is submitted; a document filed in all of the consolidated cases will be noted as “VIDED.”|
|Dec 08 2021||Blanket Consent filed by Petitioner, Xiulu Ruan|
|Dec 17 2021||ARGUMENT SET FOR Tuesday, March 1, 2022. VIDED.|
|Dec 17 2021||Brief amicus curiae of Pacific Legal Foundation filed (in 20-1410).|
|Dec 20 2021||Brief of petitioner Xiulu Ruan filed (in 20-1410).|
|Dec 20 2021||Joint appendix filed (in 20-1410). (Statement of costs filed)|
|Dec 20 2021||Joint appendix filed (in 21-5261). (Statement of costs filed)|
|Dec 20 2021||Brief of petitioner Shakeel Kahn filed (in 21-5261).|
|Dec 21 2021||Record requested from the U.S.C.A. 11th Circuit.|
|Dec 21 2021||Brief amicus curiae of Compassion & Choices filed. VIDED.|
|Dec 22 2021||The record from the U.S.C.A 11th Circuit is electronic and located on Pacer|
|Dec 23 2021||Brief amici curiae of Professors of Health Law and Policy filed (in 20-1410).|
|Dec 27 2021||Amicus brief of Physicians Against Abuse not accepted for filing. (Corrected version submitted – February 15, 2022).|
|Dec 27 2021||Brief amicus curiae of Physicians Against Abuse filed (in 20-1410) (1/15/2022). (Distributed)|
|Dec 27 2021||Brief amicus curiae of Due Process Institute filed (in 20-1410).|
|Dec 27 2021||Brief amicus curiae of Cato Institute filed (in 20-1410).|
|Dec 27 2021||Brief amici curiae of Association of American Physicians and Surgeons and Jeffrey A. Singer, M.D. filed (in 20-1410).|
|Dec 27 2021||Brief amicus curiae of National Pain Advocacy Center filed. VIDED.|
|Dec 27 2021||Brief amicus curiae of National Association of Chain Drug Stores in support of neither party filed. VIDED.|
|Dec 27 2021||Brief amicus curiae of Chamber of Commerce of the United States of America in support of neither party filed. VIDED.|
|Dec 27 2021||Brief amicus curiae of National Association of Criminal Defense Lawyers filed. VIDED.|
|Dec 27 2021||Brief amicus curiae of Anmol Singh Kamra filed. VIDED.|
|Dec 27 2021||Brief amici curiae of Stephen J. Ziegler, et al. filed (in 20-1410).|
|Jan 18 2022||CIRCULATED|
|Jan 19 2022||Brief of respondent United States filed. VIDED. (Distributed)|
|Jan 24 2022||Motion for divided argument filed by petitioners. VIDED.|
|Feb 17 2022||Reply of petitioner Shakeel Kahn filed (in 21-5261). (Distributed)|
|Feb 18 2022||Motion for divided argument filed by petitioners GRANTED, and the time is divided as follows: 15 minutes for petitioner in in No. 20-1410 and 15 minutes for petitioner in No. 21-5261. VIDED.|
|Feb 18 2022||Reply of petitioner Xiulu Ruan filed (in 20-1410). (Distributed)|
|Mar 01 2022||Argued. For petitioner in 20-1410: Lawrence S. Robbins, Washington, D. C. For petitioner in 21-5261: Beau B. Brindley, Chicago, Ill. For respondent: Eric J. Feigin, Deputy Solicitor General, Department of Justice, Washington, D. C. VIDED.|
|Jun 27 2022||Judgment VACATED and case REMANDED. Breyer, J. delivered the opinion of the Court, in which Roberts, C. J., and Sotomayor, Kagan, Gorsuch, and Kavanaugh, JJ., joined. Alito, J., filed an opinion concurring in the judgment, in which Thomas, J., joined, and in which Barrett, J., joined as to Parts I–A, I–B, and II. VIDED.|
|Jul 29 2022||JUDGMENT ISSUED|
Read more on Get To Know Ruan v. United States Case.
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