Ruan v United States Amicus Brief
in November 2021, my colleagues and I submitted an Amicus Brief to the U.S. Supreme Court to support a request to overturn the conviction of Xiulu Ruan, MD. He was convicted in a lower court of prescribing a controlled substance without a “legitimate medical purpose” and not in “the usual course of practice,” which are the requirements set by the Controlled Substances Act (CSA). Our Amici argued that Dr. Ruan’s conviction, along with other similar cases involving prescribers, are unlawful. The overarching argument we made centered on intent.
First, we argued that the government exceeded its authority by using standard care as a proxy for CSA requirements. The government made wrongful conviction more likely by removing the mens rea (or mental state) requirement for a criminal act, thus converting a law created by Congress into a strict liability statute.
Second, we maintained that the CSA mens rea requirement that the accused “knowingly or intentionally” did wrong applies not only to the intent to write or dispense the prescription but to knowing the prescription was illegal at the time it was issued.
Third and lastly, we asserted that even unprofessionally written prescriptions may be considered in light of a good faith defense if the defendant made an honest effort to comply with accepted medical practice. This issue of good faith goes to the heart of intent and consists of both a subjective and objective standard. In our view, the defense depends on analyzing whether the defendant believed the prescription was lawfully issued and whether such a belief was reasonable.
The government’s actions may be well intended. But standard of care is an administrative standard and was not intended as a means to ease the government’s path to conviction. The threat to physicians of wrongful conviction is real. The threat of disrupted medical care is also real for millions of people who use their prescriptions responsibly, whether to treat pain or another disease helped by controlled substances.