Mobile doctors John Patrick Couch and Xiulu Ruan were each sentenced to at least 20 years in prison in 2017, but in a pending appeal of their landmark convictions, the incarcerated pain management specialists are arguing their trial in U.S. District Court wasn’t fair from the beginning.
Attorneys representing the pair made oral arguments in front of the 11th Circuit Court of Appeals in Montgomery last month in hopes of seeing those federal convictions overturned. Ruan and Couch owned Physicians Pain Specialists of Alabama (PPSA), which prosecutors accused of being a sophisticated pill mill that made its proprietors wealthy at the expense of some patients’ health and others’ lives.
A seven-week trial was enough to convince a jury of their guilt, but Jay Sewell, who is representing Couch on appeal, has argued there was much about his client’s medical practice those jurors weren’t allowed to hear — including testimony from a number of patients who received quality care there.
“The government can’t have it both ways,” Sewell argued to the panel of judges. “They accuse these doctors of operating a criminal enterprise. They introduce prescription records of all of the doctors’ 8,000 patients, but then turn around and claim that the only relevant and admissible evidence in this case is related to a select few patient witnesses they identified.”
At least part of Sewell’s complaint is that the trial court in Mobile didn’t allow the defense attorneys to call more of the doctors’ “good” patients to testify. That is, in part, because some of the patients who did take the stand offered material testimony to specific allegations laid out in the indictment.
Despite that, Sewell said prosecutors didn’t mind introducing prescription records for all of PPSA’s 8,000-plus patients in order to show the sheer volume of medications being prescribed. However, by limiting testimony to only those witnesses who could corroborate the government’s allegations, Sewell suggested the trial court in Mobile allowed prosecutors to essentially “craft our witness list.”
At least some of the panel seemed to dismiss that idea and pointed out prosecutors told jurors in closing arguments “a majority of the patients” at PPSA had “legitimate pain needs.” Sewell also pointed to statements prosecutors made criticizing the defense for not calling more patients to testify when they were, in fact, prohibited from doing so. One judge questioned why that wasn’t objected to at the time.
Regardless of who objected to what and when, Sonja Ralston, an appellate attorney for the Department of Justice, argued Ruan and Couch’s appeal was flawed to criticize the government seeking to limit testimony to only those patients who were relevant the charges the doctors were on trial for in 2017.
“They want to say the government created the witness list by making this list of patients, and the government always crafts the witness list when it makes a charging decision,” Ralston said. “Just because somebody robbed five banks, they don’t get it come in and say, ‘well, I passed three other banks on the way here today and I didn’t rob those.’ That’s not relevant.”
There were a number of other points outlined in the arguments made by both Ruan’s and Couch’s attorneys, though it is unclear when the 11th Circuit could reach a decision on the appeal. It is certain to be a case local federal prosecutors are keeping an eye on because of the importance of those 2017 convictions.
Ruan and Couch’s case marked the first time in U.S. history that any medical professional had been convicted at trial under the Racketeer Influenced and Corrupt Organizations (RICO) Act.
It also led to recognition for Assistant U.S. Attorneys Deborah Griffin and Christopher Bodnar, who prosecuted the case. They and their team received an Executive Office for U.S. Attorneys Director’s Award for that work earlier this year — a designation only 10 Department of Justice cases receive annually.
In the meantime, U.S. Attorney Richard Moore’s office is continuing to be to be proactive and aggressive in its efforts to combat the opioid crisis. As Lagniappe reported in July, the office has prosecuted about 50 cases related to opioid abuse, theft and distribution since 2017.
The office has also worked with other agencies like the Drug Enforcement Administration to revoke or suspend physicians’ and pharmacists’ licenses to prescribe and distribute controlled drugs. In other instances, the office has not shied away from bringing charges against doctors, either.
In fact, Moore’s office recently unsealed an indictment against Chykeetra Maltbia, a physician based in Mobile, who is accused of five counts of conspiracy to distribute Oxycodone with no medical purpose. Those appear to be for specific instances of improperly distributing the Schedule II controlled substance.
If convicted, Maltbia could face up to 20 years in prison for each count, though that would be uncharacteristically high given previous cases brought against local doctors. In the indictment, prosecutors are also attempting to bring forfeiture proceedings to seize $13,200 in U.S. currency.
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