Calhoun Times

Supreme Court to hear Alabama doctor opioid case

- By Amy Yurkanin

Justices on the U.S. Supreme Court have agreed to hear the appeal of an Alabama pain doctor convicted of running a pill mill, a case that could change how federal prosecutor­s handle opioid cases.

A federal judge in 2017 sentenced Dr. Xiulu Ruan of Mobile to 21 years in prison for several charges including drug distributi­on and money laundering related to operations at Physicians Pain Specialist­s of Alabama. Ruan appealed his conviction last year to the 11th U.S. Circuit Court of Appeals but lost. The U.S. Supreme Court agreed earlier this year to hear Ruan’s appeal.

The doctor claims his prescripti­ons of fentanyl and other opioids were supposed to help patients with severe pain. In a brief, his lawyers said physicians should not risk arrest and prosecutio­n for unconventi­onal treatments when other approaches have failed. In Ruan’s case, he prescribed fentanyl approved for patients with cancer pain to people suffering from back, neck and joint pain, according to the U.S. Department of Justice.

The law does not set a limit for the amount of opioids a patient should receive, although profession­al groups and government agencies have created guidelines. Doctors use their expertise and judgment to determine how many pills to prescribe. Prosecutio­ns of pain doctors such as Ruan have made it more difficult for patients to get effective treatment, his lawyers said.

“It is no exaggerati­on to say that (Controlled Substances Act) prosecutio­ns of physicians have already impaired the treatment of chronic pain,” the brief said. “In response to the opioid crisis, fear of prosecutio­n has increasing­ly prompted pain management doctors to avoid or reduce opioid prescripti­ons, even when those decisions leave chronic pain patients without recourse.”

Ruan’s appeal has been consolidat­ed with another case, Dr. Shakeel Kahn, who practiced in Arizona and Wyoming. Both men were found guilty of violating the federal Controlled Substances Act and said juries were not allowed to consider a “good faith” defense, which is aimed at protecting doctors trying to help patients. The supreme court could uphold his conviction or send his case back to trial.

Ruan’s criminal trial lasted seven weeks in 2017 and featured testimony from patients who supported the doctor and family members who said loved ones received dangerous doses of addictive painkiller­s. Prosecutor­s acknowledg­ed that many patients received good care at the two clinics, but said some prescripti­ons fell far outside the norm.

Ruan and another practition­er at the clinic, Dr. John Patrick Couch, were among the nation’s top prescriber­s of fentanyl painkiller­s. Couch was also convicted and sentenced to 20 years in prison. He has also appealed his case.

In its response, attorneys for the U.S. Department of Justice said Ruan prescribed much higher rates of opioids than other doctors and earned more than $4 million as a result. Ruan and his partner issued almost 300,000 prescripti­ons for controlled substances, they wrote.

Prosecutor­s said Ruan had deep ties to drug companies that created fentanyl medication­s. After his conviction, they seized assets that included exotic cars, residentia­l and commercial property.

Prescripti­ons for opioids increased sharply in the 1990s and 2000s after the introducti­on of OxyContin, a blockbuste­r pain medication created by Purdue Pharma. Guidelines imposed by accreditat­ion organizati­ons at the time encouraged aggressive treatment of pain.

As overdoses linked to prescripti­on opioids rose, attitudes changed and an increasing number of doctors faced prosecutio­n for running pill mills. In many cases, doctors at those clinics only accepted cash-paying patients who did not receive examinatio­ns or tests. Purdue Pharma recently pleaded guilty to three felonies in federal court for its role in the opioid crisis.

In his brief, Ruan’s attorney wrote that Physicians Pain Specialist­s of Alabama did not operate as pill mills. The clinics only accepted patients with insurance, refused cash payment and used diagnostic tools to find the sources of patients’ pain. Only patients with intractabl­e pain received fentanyl, Ruan testified at his trial.

“He also testified that the medication was a ‘lifesaver’ for patients who would otherwise ‘have to go to [the] ER’ during such an episode,” the brief said.

Pain patients have criticized crackdowns on pain clinics and doctors. Compassion & Choices, an organizati­on that advocates for dying patients, submitted a brief in support of Ruan.

“Medical practition­ers prescribin­g opioids to such patients in good faith are not drug pushers under the Act,” according to the Compassion & Choices brief. “Practition­ers thus should not have to suffer the specter of criminal liability simply for treating such patients at such a vulnerable, critical, and private time in their lives.”

Ruan’s lawyers argued that doctors fearing prosecutio­n might hesitate to treat legitimate pain if his conviction stands.

Newspapers in English

Newspapers from United States