Doctor Prosecution Under the CSA

While most drug crimes and cases bring to mind local drug dealers, drug rings and sometimes cartels, there is another side to these cases: doctors and other healthcare practitioners.

The federal government, under the “Controlled Substance Act” (CSA) – can prosecutie healthcare providers: doctors, physician assistants, registered nurses, pharmacists, and others who can access any medication that are considered a controlled substance.

This law and similar state laws exist to target and prosecute “pill mills”, or healthcare providers who abuse their privilege of practice to only sell controlled substance for a profit. The federal government has been more inclined to pursue these cases over the years due to the opioid epidemic, but as with many things, they can get carried away. This law has resulted in many cases where the government charges legitimate doctors who are actually trying to help their patient, or at the very least acting in good faith and not just giving prescriptions for profit.

If you’re a healthcare provider who is facing an investigation or charges for a CSA-related crime, you should contact our lawyers immediately. We have the experience needed for these complex cases to build an effective defense.

How are Healthcare Providers Prosecuted under the CSA?

The CSA governs the distribution of “controlled substances”, which includes illegal street drugs as well as some prescription medication. The kinds of prescription medication that are listed as controlled substances typically have a great risk of addiction as well as psychological or physiological harm from taking long-term or in excessive quantities. Examples of these medications include opiate or opioid pain relievers, depressants, and stimulants such as oxycodone, hydrocodone, fentanyl, adderall, and xanax. While these drugs can all be manufactured, distributed and sold legally, they are done so under heavy regulation. Healthcare providers who prescribe these substances outside the bounds of CSA’s regulations can be subject to federal investigation and possibly prosecution.

So what is considered outside the bounds of the CSA for practitioners licensed to dispense these substances? The CSA itself does not directly state, but the Department of Justice (DOJ) has guidelines for prescriptions which include the statements that:

Prescriptions must be made for a “legitimate medical purpose”.
Medical professional must be acting in his or her “usual course of professional practice.”

If these two requirements are not met, the medical professional may be subject to prosecution under the CSA, but what to they even mean? Neither of these terms are defined in the CSA statute, but exist in the DOJ’s guidelines instead, but still remain quite vague.

The Meaning of "Legitimate Medical Purpose"

Generally, a “legitimate medical purpose” means that the primary purpose of the prescription is therapeutic. Essentially, the medicine should be prescribed to treat a condition or its symptoms, and not given out for recreational use or illegal redistribution.

Unfortunately, demonstrating a legitimate medical purpose is not as straight-forward as showing the prescribed patients had an illness or symptom that the prescriptions helps alleviate. We have defended cases where doctors were being prosecuted for prescribing opioid pain killers to patients who did have chronic pain issues, but the doctors allegedly did not follow strict protocols for testing the patients. Another common example is when doctors prescribe higher than recommended levels of pain medication, which could be for chronic pain patients who have developed a high tolerance to the medicine.

The Meaning of "Usual Course of Professional Practice"

The “usual course of professional practice” means that the healthcare provider must be acting within the scope of their official duties. This covers a few general things, such as:

Prescribing medication that you are authorized to prescribe.
Prescribing during operating hours.
Prescribing from either within the facility (e.g. hospital, clinic) you’re employed, or if working remotely or in telehealth, using the respective service that authorizes remote prescriptions.

The three points above still have many caveats, such as when remote prescriptions can be problematic, and real world cases are even more complex. This is why it is essential to hire an experienced attorney if you are facing an investigation or charges under the CSA, because the specific facts and context need to be analyzed thoroughly.

Common Factors that Result in Charges

The process of investigating healthcare practitioners for prosecution under the CSA is usually a long one. It often starts with a local investigation under the state’s laws, but eventually gets picked up by the federal government if the case is big enough to require those resources. The investigation can involve local testimonies, wired informants trying to get prescriptions, medical expert testimonies and evidence obtained through warrant or subpoena.

Much of the evidence they find will be circumstantial, but some of the factors they look for include:

Patients appearing to show signs of substance abuse, such as being intoxicated, or otherwise not in need of drugs for supposed therapeutic reasons.
Patients coming in groups and all receiving the same or similar prescriptions.
Patients receiving prescriptions after failing drug screenings.
Patients requesting and receiving specific drugs or combination of drugs.
Patients traveling long distances to see the physician.

There are often entirely reasonably explanations for the above and many other factors. For example, perceptions of people being “drug seekers” or not being adequately disabled to need certain drugs are often dubious and subject to a great deal of prejudice. This can both distort the witness testimonies, as well as be a reason why patients travel long distances because their local practitioners are discriminatory. Another example is that a healthcare provider may treat known drug abusers because they want to help monitor them closely rather than allow them to get the same drugs off the street without caution or counsel.

If you’re facing these charges and believe you have good reasons behind any of the accusations, you should still hire an experienced attorney. Creating a defense that is persuasive without being incriminating requires a great deal of knowledge of related cases and experience dealing with drug prosecutors.

Penalties for CSA Violations by a Medical Professional

Federal criminal sentencing for CSA violations are primarily driven by the quantities and types of drugs involved, though the judge may consider other things like criminal history.

Other factors that can seriously impact sentencing are whether the case involved serious bodily injury or death due to overdoses. In these cases, the stakes are much higher, and defending these charges involves a great deal of expert involvement.

The penalties themselves generally include steep fines and a prison term. The sentence can be as high as 20 years for drug distribution, and possibly higher if other factors are involved, and fines can potentially be in the millions.

Defending Healthcare Providers Charged Under the CSA

These cases are among the most challenging to defend, namely because the recent attention that has been given to the role of prescriptions in drug abuse and addiction. This is also combined with longstanding prejudices and ignorance surrounding how disability and chronic pain works, which has made it all the more harder for people with pain-related illnesses to seek proper care.

This means that defending against a CSA prosecution requires thorough research, experience and skill. Below are some elements that a strong defense should have:

An understanding and ability to present what the healthcare provider was and was not aware of.
Conveying to the jury what the applicable laws are for a criminal case against medical professionals, dispelling any confusion or conflation with other crimes and medical malpractice.
Thorough review of medical and prescription records, in consultation with another medical expert.
Having a medical expert review and rebuke inaccurate and prejudiced impressions created by witnesses or the prosecution.

Our lawyers have successfully represented medical professional clients at state and federal levels and know how to carefully structure a defense based on the facts of the case. Most importantly, we are exceptionally skilled at taking these cases to trial, as we know the tactics used in drug prosecution that often push the defendant into a plea-bargaining position before a trial begins. If you would like to learn more about how we an help, or request a consultation with us, then leave us a message or call us today.