Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-3_14-cr-00306/USCOURTS-almd-3_14-cr-00306-4/pdf.json

Parties Involved:
John W. Mitchell
Defendant
USA
Plaintiff

Document Text:

THE UNITED STATES DISTRICT COURT 

FOR THE MIDDLE DISTRICT OF ALABAMA 

NORTHERN DIVISION 

UNITED STATES OF AMERICA, ) 

 ) 

v. ) CASE NO. 3:14-cr-306-MHT-WC 

 ) 

JOHN W. MITCHELL ) 

 

RECOMMENDATION OF THE MAGISTRATE JUDGE 

 Before the court is Defendant’s Motion to Strike Surplusage (Doc. 55), the 

Government’s Response (Doc. 65), and Defendant’s Reply (Doc. 66). For the reasons 

that follow, the undersigned RECOMMENDS that the motion be DENIED. 

Defendant moves the court to strike as surplusage paragraphs 24, 25, and 26 of the 

Indictment pursuant to Rule 7(d) of the Federal Rules of Criminal Procedure. Def.’s 

Mot. (Doc. 55) at 1. Rule 7(d) provides, “[u]pon the defendant’s motion, the court may 

strike surplusage from the indictment or information.” “A motion to strike surplusage 

from an indictment should not be granted unless it is clear that the allegations are not 

relevant to the charge and are inflammatory and prejudicial. This is a most exacting 

standard.” United States v. Awan, 966 F.2d 1415, 1426 (11th Cir. 1992). 

Defendant challenges paragraphs 24 and 25 of the Indictment as surplusage 

because he believes the language is prejudicial and potentially confusing to the jury. 

Def.’s Mot. (Doc. 55) at 1-3. Those paragraphs state as follows: 

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24. An additional imaging procedure, called intravascular ultrasound 

(or “IVUS”), can be performed together with cardiac catheterization to 

obtain detailed images of the walls of the blood vessels. IVUS was 

available at East Alabama Medical Center where MITCHELL practiced but 

he did not regularly utilize IVUS. 

25. Fractional Flow Reserve (or “FFR”) is another procedure that 

can be performed together with cardiac catheterization to measure blood 

pressure and flow through a specific part of the coronary artery and thereby 

assist in determining whether to perform angioplasty or coronary stenting 

for intermediate blockages. FFR assists a cardiologist in determining 

whether a stenosis visible on an angiogram is significantly restricting blood 

flow in the artery. FFR was available to MITCHELL but he did not 

regularly utilize FFR. 

Ind. (Doc. 1) at ¶¶ 24, 25. Defendant asserts that these paragraphs “infer” that he 

“is somehow not treating his patients in accordance with medical standards 

because he does not utilize the referenced procedures[.]” Def.’s Mot. (Doc. 55) at 

2. He maintains that “those procedures are not yet commonly used by 

cardiologists and certainly not indicative of any lower standard of care, much less 

relevant to guilt of a criminal offense.” Id. at 3. 

 In response, the Government asserts that the paragraphs do not in any way 

allege, or require as an inference, that Defendant’s failure to utilize the identified 

procedures contravenes medical standards or procedures. Gov’t’s Resp. (Doc. 65) 

at 3-4. The Government explains that it plans to rely on an additional medical 

procedure utilized by one of its experts, quantitative coronary analysis, to prove its 

case. Furthermore, the Government asserts, because it cannot know how 

Defendant will defend his case, “it cannot be said at this juncture that reciting the 

other types of diagnostic procedures Mitchell chose not to use in any way will 

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prejudice his ability to put on a defense or create any inflammatory impression 

with the jury.” Id. at 4. 

 In order for the targeted language to be considered surplusage worthy of 

being stricken pursuant to the “most exacting standard” discussed above, 

Defendant has to show irrelevance and that the language is prejudicial or 

inflammatory. The undersigned finds that Defendant has failed to show that 

paragraphs 24 and 25 are irrelevant and prejudicial or inflammatory. Defendant is 

accused of entering false statements and entries into medical records relating to the 

insertion of medically unnecessary coronary stents in patients. Def.’s Mot. (Doc. 

55) at 2. Defendant attempts to argue prejudice by inferring that paragraphs 24 

and 25 indicate that he did not follow standard medical procedures by failing to 

use the intravascular ultrasonic test or the fractional flow reserve. However, the 

paragraphs merely state that such procedures were available but were not used. 

Defendant will have the opportunity at trial to present evidence about why such 

tests may not have been appropriate in any given circumstance, as well as why any 

alternative procedure he did use may have been consonant with accepted medical 

standards or the peculiarities of any given patient. Thus, the paragraphs in the 

indictment listing available procedures not used by the Defendant are not 

prejudicial or inflammatory. 

 Additionally, Defendant has failed to show that the paragraphs describing 

these two procedures are irrelevant to the crimes alleged in the indictment. 

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Evidence is considered relevant when it has “any tendency to make the existence 

of any fact that is of consequence to the determination of the action more probable 

or less probable than it would be without the evidence.” Fed. R. Evid. 401. 

Depending on the evidence adduced at trial, it is at least conceivable that the 

availability of two other procedures to aid the judgment of whether a coronary 

stent should be placed may be relevant to an accusation of healthcare fraud 

involving falsifying records related to performing unnecessary coronary stents. As 

such, it is not “clear” that paragraphs 24 and 25 are irrelevant as required by 

Awan.

1

 

 The undersigned Magistrate Judge concludes that Defendant has failed to 

show that paragraphs 24 and 25 of the Indictment should be stricken as surplusage 

and that, therefore, the Motion to Strike Surplusage relating to these two 

paragraphs should be denied without prejudice at this time. 

 Defendant also challenges paragraph 26 of the Indictment as surplusage 

because, he asserts, it may confuse the jury. Def.’s Resp. (Doc. 66) at 4. 

Paragraph 26 provides as follows: 

 

1

 In this context, the undersigned here notes the language in Awan concluding that, in certain 

circumstances, “it is proper to reserve ruling on a motion to strike surplusage until the trial court has 

heard evidence that will establish the relevance of the allegedly surplus language[.]” 966 F.2d at 1426. 

Indeed, it places the court in a difficult position to judge the relevance of language in the indictment 

where the court is mostly not privy to the evidence which will be offered at trial and, depending on the 

evidence adduced at trial, it is not inconceivable that the language could be relevant. As such, the District 

Judge may consider, as in Awan, reserving ruling on the motion until after the close of evidence and 

“carefully prevent[ing] the jury from being prejudiced by the challenged allegations by providing the jury 

with only a summary of the indictment that [does] not include [specific] references” to matters Defendant 

has challenged at this stage as irrelevant and unduly prejudicial. See id.

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26. Medicare, Medicaid and private insurers would not pay for a coronary 

stent that was not “medically necessary” for the patient. It was generally accepted 

among cardiologists that a coronary stent was not “medically necessary” absent a 

diagnosis of at least a 70 percent (70%) lesion or 70% stenosis in the artery and 

symptoms of blockage. 

Ind. (Doc. 1) at 8. Defendant contends paragraph 26 “misleads the jury with a higher 

standard than the medical profession and/or the law requires and thereby prejudices the 

Defendant.” Def.’s Resp. (Doc. 66) at 4. He asserts that paragraph 26 “suggests a ‘bright 

line’ test that a physician must see a 70% blockage in order for a stent procedure to be 

medically necessary.” Def.’s Mot. (Doc. 55) at 3. However, Defendant maintains, no 

such “bright line” test exists and, indeed, the Government’s own experts do not support 

the “bright line” rule he perceives in ¶ 26. Moreover, he asserts, numerous factors other 

than the percentage of blockage inform the judgment whether such a procedure is 

medically necessary. Id. at 3. 

The Government asserts that paragraph 26 accurately recounts that the “prevailing 

guideline for placement of a stent is the 70% level” cited in the paragraph, as reflected in 

grand jury testimony by several cardiologists which has been provided to Defendant. 

Gov’t’s Resp. (Doc. 65) at 4-6. Further, the Government argues that in every count of the 

indictment the blockage assessed by Defendant was 70 percent or greater and that, 

therefore, Defendant’s contentions regarding supposedly inconsistent opinions by the 

Government’s experts are irrelevant. Id. at 7-8. 

Paragraph 26 does not state that a diagnosis of 70 percent or greater for a lesion or 

stenosis is the only time a stent would be medically necessary. Instead it states that “it 

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was generally accepted among cardiologists” that absent a 70 percent diagnosis a stent 

would be unnecessary. Ind. (Doc. 1) at 8 (emphasis supplied). As such, Defendant’s 

argument that the paragraph states a bright line rule and a higher medical standard that 

could confuse the jury is unpersuasive. Paragraph 26 merely alleges what is the 

“generally accepted” standard about what constitutes medical necessity in this domain. 

In asserting that something is “generally accepted,” the language plainly recognizes that 

specific circumstances may warrant a different judgment about medical necessity. In any 

event, to the extent it is relevant, Defendant is free to rebut any assertion about what is 

“generally accepted” with evidence at trial. But it cannot be said, at this stage, that it is 

so likely the jury will be misled to conclude that a coronary stent could be performed 

only with a blockage of 70 percent or greater based only on the language of paragraph 26 

such that the “most exacting standard” applicable to Defendant’s motion has been 

satisfied. 

The undersigned Magistrate Judge finds that Defendant has failed to show 

that paragraph 26 should be stricken as surplusage and that, therefore, Defendant’s 

motion to strike paragraph 26 should be denied. 

 For the reasons stated above, it is the RECOMMENDATION of the Magistrate 

Judge that Defendants’ Motion to Strike Surplusage (Doc. 55) be DENIED. 

 It is further

ORDERED that the parties are DIRECTED to file any objections to the said 

Recommendation on or before May 18, 2015. Any objections filed must specifically 

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identify the findings in the Magistrate Judge’s Recommendation to which the party is 

objecting. Frivolous, conclusive, or general objections will not be considered by the 

District Court. The parties are advised that this Recommendation is not a final order of 

the court and, therefore, it is not appealable. 

Failure to file written objections to the proposed findings and recommendations in 

the Magistrate Judge’s report shall bar the party from a de novo determination by the 

District Court of issues covered in the report and shall bar the party from attacking on 

appeal factual findings in the report accepted or adopted by the District Court except 

upon grounds of plain error or manifest injustice. Nettles v. Wainwright, 677 F.2d 404 

(5th Cir. 1982); see Stein v. Reynolds Securities, Inc., 667 F.2d 33 (11th Cir. 1982); see 

also Bonner v. City of Prichard, 661 F.2d 1206 (11th Cir. 1981) (en banc) (adopting as 

binding precedent all of the decisions of the former Fifth Circuit handed down prior to 

the close of business on September 30, 1981). 

Done this 4th day of May, 2015. 

 /s/ Wallace Capel, Jr. 

 WALLACE CAPEL, JR. 

 UNITED STATES MAGISTRATE JUDGE 

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