the district court in this case improperly applied the sophisticated means enhanced it to mr redmond's convictions for wire fraud and false statements to conduct that the government described to the jury in closing arguments a simple and  the district court further improperly applied the risk of stansell bodily harm or death and hanson it to conduct that the district court could only speculate caused any risk to park the evidence does not show what risk of harm if with actual or no your honor the analysis for this enhanced myth is a risk analysis and in a case like this where there was no evidence that anyone suffered actual bodily harm there has to be some sort of analysis beyond basic intuition that that the actions of the defendant here caused that risk of harm to be elevated you look at the evidence it shows that mr redmond saw patients who generally had preexisting diagnosis he was supervised by someone at the clinic who testified that he generally performed as one would expect someone out of medical school before so is it your position that someone who goes to medical school and undergoes a residency and get certified to be a physician able to prescribe medication is not more likely to be safe someone like your client who didn't go through that whole process doesn't  any risk because that training doesn't lower in any way the risk that someone would prescribe medication in a way that it was a risk of substantial injury to the patient a properly trained physician would pose a lower risk of harm than someone dangerous and they're controlled for a reason but that doesn't mean that prescribing controlled substances to people who generally have preexisting conditions for the supervision of another doctor for a limited period of time of two months rises to the level of risk spiritual bodily harm is defined in the notes is surgery it's not a discomfort and a knowledge that someone without so giving someone so much over what their weight could handle or a drug that interacted poorly with another drug that they may be taking it's your position that that could never put someone in the hospital or even potentially cause death yes absolutely it could but in this case i don't think there's evidence that anyone was over scarred there so that goes back to the question of whether you were asked looking for actual harm rather than substantial risk of harm the fact that his patients they with the exception of one testified that the diagnosis is that he made were either preexisting anything can tell you the diagnosis and that's prescribe drugs that were deemed by the doctor to be appropriate doesn't lead to the conclusion that it was necessarily at the risk of substantial bodily harm the evidence shows that the documents that mr redmond taint off the internet were surprisingly easy to obtain fake id dot com degree package dot com you know he only went to one source for the package agrees he needed it had to do much other than put on the requisite attire of the physician and bear the qualifications he didn't ever accomplish what he may have attended to what he said he was trying to do is get actual degrees on the wall he never had actual degrees posted in his office where he saw patients he shows up at a cocktail party with with a vendor exhorts a group of doctors and he's able to pull it off that may have seemed easy but and the half of the united states district court did not clearly err in increasing the defendant's offense level by two levels for the use of sophisticated means or the evidence in this case show that the defendant  created a whole host of fake documents lied his way into saikai a tree position at a medical clinic treated patients and pursue private then actual controlled substances all the while not making it past the eleventh grade and  enhanced the defendant sentence based on the use of sophisticated means the district court rightly focused on the substantial amount of fake documents that the defendant procured to perpetrate the prot it wasn't just one document it wasn't just two documents this court looks at the whole certificate driver's license social security card illinois medical and controlled substance licenses the list goes on and on to create this quarter it of a real doctor then he did all of the things that a doctor would do once he actually got inside the door its of this clinic he treated patients he had administered diagnostic tests he checked the illinois prescription monitoring program issued prescriptions this was all sophisticated clearly earn increasing the dependence of the funds level by two because the offense involved the conscious or reckless risk of death or serious bodily injury here the district court rightly noted that this defendant did not possess the proper training education or could rent credentials to serve as a psychiatrist again this was supported by the p s r that said that he did not finish high school the district court also noted correctly that the these pieces were suffering from serious psychiatric disorders and that was on display at the porty trial in this case where patients testified and then went on to say that prescribing these controlled substances created a risk of serious bodily injury or death in this was supported by a multitude of things but i want to point to one specific example and that's the real doctor in this case the name that the defendant stole dr  trial but he also wrote a letter to the district court in anticipation of sentencing the government read that letter into the record at the sentencing hearing and there dr lopez opined of the complicated process it is to  to prescribe controlled substances that a doctor must take into account that haitians other medications that they might be taking their risk profile their personal preference as whether they drink alcohol for example i maybe a point in consideration and what the doctor lopez said was it's a complex process and if it's done incorrectly it can even cause a patient's demise and that's why the district work period it in sentencing and also the court noted that the risk that the errors in psychiatric treatment could have led patients to harm themselves or others and i think that's an important consideration here that these are serious psychiatric conditions and this defendant was in no way qualified to make clinical assessments of the rest to themselves or others so for all of these reasons and all of the recent state in the government's brief the government respectfully request that you affirm the defendant sentence there was little more than what was necessary to establish the basic conviction as for sophisticated means it's a risk analysis that needs something to women the intuition that someone's prescribing drugs that are dangerous but in this case they were prescribed by someone who was under the supervision of another doctor to patients who generally had preexisting conditions and in a manner that generally showed they were not incorrect yes a real doctor might have done something differently in each individual case but as a general matter evidence shows that the patients received drugs that were not inappropriate for the diagnosis as it were generally with the exception of one case seemed to be appropriate from the start for the questions thank you