Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca11-14-11765/USCOURTS-ca11-14-11765-0/pdf.json

Parties Involved:
Cynthia Cadet
Appellant
Joseph Castronuovo
Appellant
United States of America
Appellee

Document Text:

[DO NOT PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT

________________________

No. 14-11765

________________________

D.C. Docket No. 9:10-cr-80149-KAM-30

UNITED STATES OF AMERICA,

 Plaintiff-Appellee,

versus

JOSPEH CASTRONUOVO, M.D.,

CYNTHIA CADET, M.D.,

 Defendants-Appellants.

________________________

Appeals from the United States District Court

for the Southern District of Florida

_______________________

(May 17, 2016)

Before WILLIAM PRYOR and FAY, Circuit Judges, and ROBRENO,

* District 

Judge.

 

* Honorable Eduardo C. Robreno, United States District Judge for the Eastern District of 

Pennsylvania, sitting by designation.

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ROBRENO, District Judge: 

Defendants Joseph Castronuovo and Cynthia Cadet (“Defendants”) appeal 

their judgments of conviction under 18 U.S.C. § 1957 for conspiracy to engage in 

monetary transactions affecting interstate commerce in criminally derived property 

exceeding $10,000, also known as conspiracy to commit money laundering. After 

reviewing the record and hearing oral argument, we affirm the judgement of 

conviction for both Defendants.

I. BACKGROUND

Defendants were indicted by a federal grand jury in the Southern District of 

Florida and charged alongside thirty other individuals for their roles in an illegal 

“pill mill” operation involving two pain management clinics owned by Christopher 

George: American Pain and Executive Pain. The clinics’ operations depended on 

doctors, like Defendants, who were licensed to prescribe and dispense narcotics.

George paid the doctors a portion of their salary by check and the rest by cash.

Before receiving their weekly paychecks, the doctors would sign forms that stated 

“I did not see anything illegal happen or do anything illegal at the office.”

Defendant Cadet began working at American Pain, formerly called South 

Florida Pain, after responding to a Craigslist ad for employment. During her 

interview, George told Cadet that “we prescribe medication here for people that 

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allege to be in pain, and that’s all we do.” He told her that she would earn $75 per 

patient and $1,000 per week for the use of her dispensing license.

Once employed, Cadet saw as many as 100 patients per day. On one 

particular day, surveillance videos and patient records indicated that Cadet spent an 

average of 4 minutes and 40 seconds with each patient, and prescribed a total of 

15,860 Oxycodone pills at 30 mg each; 5,790 Oxycodone pills at 15 mg each; and 

3,600 Xanax pills at 2 mg each. One patient testified at trial that Cadet prescribed 

pills to him after merely checking his blood pressure and reviewing his 

prescriptions from George’s other clinic. Cadet also signed drug-supplier forms

that falsely underestimated how many patients were seen daily, how many received 

prescriptions for controlled substances, and how many were from other states. 

The Internal Revenue Service (“IRS”) determined that Cadet received a total 

of $1,217,125 in compensation during her tenure. And Drug Enforcement Agency 

(“DEA”) records showed that 878,600 Oxycodone pills were dispensed under 

Cadet’s license between 2008 and 2010.

Defendant Castronuovo also responded to one of George’s employment ads 

for a position at Executive Pain. During the interview, George stated that 

Castronuovo would be paid $75 per patient to prescribe pain medication and 

shared sample charts displaying patients’ Oxycodone and Xanax prescriptions. 

George described the clinics’ “business model” during the interview and testified 

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that he “wouldn’t have hired [Castronuovo]” if Castronuovo had not agreed to the 

clinics’ prescription practices. 

A statistical sample of Castronuovo’s patient files showed that Castronuovo

engaged in a “pattern” of prescribing Oxycodone, Xanax, and sometimes Soma.

Like Cadet, Castronuovo signed documents falsely stating the number of patients 

from out of state and the number of patients receiving controlled substances. 

Because Castronuovo worked only part time, George paid him up to $200 per day 

for use of his dispensing license. But Castronuovo also received $75 for each 

patient he saw. Moreover, seized surveillance footage corroborated that he

received $3,200 for seeing 40 patients on one particular day and $4,025 for seeing 

51 patients on another day. The IRS determined that Castronuovo received a total 

of $164,025 during his tenure. And DEA records showed that 328,600 Oxycodone 

pills were dispensed under Castronuovo’s license between 2008 and 2010.

On March 3, 2010, government agents executed search warrants at both 

clinics and recovered surveillance videos from American Pain’s security cameras. 

Agents also seized all patient files and patient logs, which listed how many patients 

each doctor saw and dictated each doctor’s pay. 

On January 18, 2011, before he was charged with any crimes, Castronuovo 

and his attorney met with prosecutors and DEA agents to describe his prescription 

practices and compensation from the clinic. Castronuovo stated that he received

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$75 per patient, with a minimum daily total of $1,500. He explained that George 

paid him in cash during his first five months of employment and then by check. 

The original indictment charged George, the clinics’ owner, with unlawful

possession of a firearm and ammunition, in violation of 18 U.S.C. §§ 922(g)(1) and 

924(a)(2). Then, the first superseding indictment charged thirty-two clinic staff

members and doctors, including Cadet and Castronuovo. Therein, Cadet was 

charged as part of a racketeering conspiracy, in violation of 18 U.S.C. § 1961(1)

and (5); money laundering conspiracy, in violation of 18 U.S.C. § 1956(h); and an 

Oxycodone trafficking conspiracy, in violation of 21 U.S.C. § 841(a)(1). Both 

Cadet and Castronuovo were charged with mail/wire fraud, in violation of 18 

U.S.C. §§ 1341 and 1343. 

After a majority of the codefendants pled guilty, Cadet and Castronuovo

were charged in a second superseding indictment with conspiracy to traffic in 

Oxycodone, in violation of 21 U.S.C. §§ 846, 841(a)(1), and 859(a), and

conspiracy to engage in money laundering, in violation of 18 U.S.C. §§ 1956(h)

and 1957. In addition, Cadet was charged individually with two counts of 

Oxycodone and Alprazolam distribution resulting in deaths, in violation of 21 

U.S.C. § 841(a)(1) and (b)(1)(C); five counts of Oxycodone distribution resulting 

in deaths, in violation of 21 U.S.C. § 841(a)(1) and (b)(1)(C); and one count of 

conspiracy to distribute anabolic steroids, in violation of 21 U.S.C. §§ 841(a)(1) 

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and 829(e). Castronuovo was charged individually with one count of Oxycodone 

distribution, in violation of 21 U.S.C. §§ 846, 841(a)(1) and 859(a), and two counts 

of Oxycodone distribution resulting in deaths, in violation of 21 U.S.C. § 841(a)(1)

and (b)(1)(C). 

Defendants pled not guilty and proceeded to trial. After the district court 

denied Castronuovo’s motion to sever his trial from Cadet’s, Defendants were tried 

together and agreed that objections made by one were joined by the other unless 

otherwise stated. 

After a 31-day trial and four days of deliberations, the jury reported that they 

had reached a verdict and submitted the verdict forms. When the district court 

examined the returned verdict forms, it noted that “[t]he forms are not completely 

filled out” and instructed the jury to return to the deliberation room to “fill out 

either guilty or not guilty on all of the counts.” The district court explained that 

“[y]ou can’t leave it blank . . . We need to know what your decision is on each of 

those counts where you’ve left it blank.” The court told the jury to send a note if 

they did not understand the instructions, and no party objected to these directions.

Shortly thereafter, the jury sent a note reporting that it was “deadlocked” on 

certain counts. After all parties agreed, the district court gave a modified Allen

instruction based on the Eleventh Circuit Pattern Jury Instructions. Approximately 

2 to 2 1⁄2 hours later, the jury returned a guilty verdict against Defendants on the 

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money laundering conspiracy count. Defendants were acquitted on all other 

charges. 

The district court entered judgment against both Defendants after denying 

their post-trial motions. It sentenced Castronuovo to 18 months’ imprisonment and 

two years’ supervised release. It sentenced Cadet to 78 months’ imprisonment and 

two years’ supervised release. Defendants now appeal.

II. STANDARDS OF REVIEW

Numerous standards of review govern the issues on appeal. “We review the 

sufficiency of evidence to support a conviction de novo.” United States v. Taylor, 

480 F.3d 1025, 1026 (11th Cir. 2007). As to a cumulative error argument, we 

review de novo the cumulative impact of the alleged errors at trial. United States v. 

Dohan, 508 F.3d 989, 993 (11th Cir. 2007). We also review a claim of 

prosecutorial misconduct de novo “because it is a mixed question of law and fact.”

United States v. Duran, 596 F.3d 1283, 1299 (11th Cir. 2010).

“We review a district court’s denial of a motion to dismiss an indictment for 

abuse of discretion but, in determining whether the court abused its discretion, we 

resolve issues of law de novo.” United States v. Cavallo, 790 F.3d 1202, 1219 

(11th Cir. 2015). We also review de novo the issue whether jury instructions 

constructively amended the indictment, United States v. Gutierrez, 745 F.3d 463, 

473 (11th Cir. 2014), but when a defendant raises this argument for the first time 

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on appeal, we review it for plain error, United States v. Madden, 733 F.3d 1314, 

1322 (11th Cir. 2013). 

“The grant or denial of a motion to suppress evidence is reviewed in this 

Court as a mixed question of law and fact. We assess the district court’s findings of 

fact under the clearly erroneous standard and review the application of the law to 

the facts de novo.” United States v. Perkins, 348 F.3d 965, 969 (11th Cir. 2003) 

(citation omitted).

We review for abuse of discretion a district court’s ruling on a severance 

motion, its limitation on the scope of cross-examination, its decision to give an 

Allen charge, and its refusal to give a requested jury instruction. See United States 

v. Maxwell, 579 F.3d 1282, 1295 (11th Cir. 2009) (limitation of crossexamination); United States v. Westry, 524 F.3d 1198, 1216 (11th Cir. 2008) (jury 

instruction); United States v. Woodard, 531 F.3d 1352, 1364 (11th Cir. 2008) 

(Allen charge); United States v. Kennard, 472 F.3d 851, 859 (11th Cir. 2006)

(severance motion). But where a defendant does not request specific instructions 

and fails to object at trial to the district court’s failure to include specific 

instructions, we review for plain error only. United States v. Pena, 684 F.3d 1137, 

1151 (11th Cir. 2012).

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III. DISCUSSION

Defendants1 raise a number of issues on appeal: (1) whether there was 

sufficient evidence to convict Defendants for money laundering conspiracy; 

(2) whether the district court erred in denying Castronuovo’s motion to dismiss the 

Second Superseding Indictment; (3) whether the district court erred in dismissing 

Castronuovo’s motion to suppress his pre-indictment statements; (4) whether the 

district court erred in denying Castronuovo’s motion to sever; and (5) whether the 

district court coerced the jury by effectively delivering two Allen charges. 

Also, Cadet raises the issue (6) whether she should be granted a new trial 

based on the cumulative prejudicial effect of: (a) the district court’s constructive 

amendment of the indictment; (b) the prosecutor’s argument based on “guilt by 

association”; (c) the district court’s limitation on the scope of cross-examination; 

and (d) the district court’s failure to give a good faith instruction for the money 

laundering conspiracy charge. Each issue is discussed in turn.

A. Sufficiency of the Evidence as to the Money Laundering Convictions

Title 18 U.S.C. § 1956(h) makes it unlawful to conspire to violate any 

provision of §§ 1956 or 1957. In turn, § 1957 makes it unlawful to engage in 

monetary transactions in property derived from “specified unlawful activity.” 18 

 1 Castronuovo moved to adopt three of Cadet’s arguments on appeal, and we granted the 

motion. Those adopted arguments are designated by footnote in this opinion.

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U.S.C. § 1957. Together, these provisions make it unlawful to engage in a money 

laundering conspiracy.

Here, the jury convicted Defendants of conspiring to violate § 1957 by 

agreeing “to knowingly engage and attempt to engage in monetary transactions . . ., 

in criminally derived property of a value greater than $10,000.” The “specified 

unlawful activity” was “the distribution, dispensing and possession with intent to 

distribute and dispense[] oxycodone, a Schedule II narcotic controlled substance, 

outside the scope of professional practice and not for a legitimate medical 

purpose.” 

To establish the existence of a money laundering conspiracy, the 

government was required to prove beyond a reasonable doubt “(1) an agreement 

between two or more persons to commit a money-laundering offense; and 

(2) knowing and voluntary participation in that agreement by the defendant.”

United States v. Moran, 778 F.3d 942, 962 (11th Cir. 2015) (quoting United States 

v. Broughton, 689 F.3d 1260, 1280 (11th Cir. 2012)). No evidence of willfulness 

or specific intent is required, Dohan, 508 F.3d at 994, and conviction does not 

require proof of an overt act in furtherance of the conspiracy. Whitfield v. United 

States, 543 U.S. 209, 214 (2005).

Defendants argue that the government did not present sufficient evidence for 

the jury to find beyond a reasonable doubt that they conspired to commit money 

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laundering. The question for our review is “whether, after viewing the evidence in 

the light most favorable to the prosecution, any rational trier of fact could have 

found the essential elements of the crime beyond a reasonable doubt.” Musacchio 

v. United States, 136 S. Ct. 709, 715 (2016) (quoting Jackson v. Virginia, 443 U.S. 

307, 319 (1979)). “That limited review does not intrude on the jury’s role ‘to 

resolve conflicts in the testimony, to weigh the evidence, and to draw reasonable 

inferences from basic facts to ultimate facts.’” Id. (quoting Jackson, 443 U.S. at 

319).

1. An agreement between two or more persons to 

 commit the money laundering offense

To satisfy the first element of money laundering conspiracy, no evidence of 

a “formal agreement” is required; instead, the government may “demonstrate by 

circumstantial evidence a meeting of the minds to commit an unlawful act.” United 

States v. Arias-Izquierdo, 449 F.3d 1168, 1182 (11th Cir. 2006). “Proof that the 

accused committed an act which furthered the purpose of the conspiracy is an 

example of the type of circumstantial evidence the government may introduce to 

prove the existence of agreement.” Id. The government need not prove that a 

conspiracy participant knew all details of the conspiracy or participated in its every 

aspect. United States v. Arbane, 446 F.3d 1223, 1229 (11th Cir. 2006) (citing 

United States v. Fernandez, 797 F.2d 943, 948–49 (11th Cir. 1986)). Rather, the

government need only prove that the defendant knew “the essential nature of the 

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conspiracy.” Moran, 778 F.3d at 960 (quoting United States v. Vernon, 723 F.3d 

1234, 1273 (11th Cir. 2013)).

Here, viewing the evidence in the light most favorable to the government, a 

rational jury could have found, beyond a reasonable doubt, an agreement between 

two or more persons to commit a money laundering offense. First, the evidence 

showed that Defendants knew the conspiracy’s essential nature: to obtain payment 

of funds received through the illegal sale of Oxycodone at the clinics. During 

Cadet’s interview, George told her that “we prescribe medication here for people 

that allege to be in pain, and that’s all we do.” He told her that she would earn $75 

per patient and $1,000 per week for the use of her dispensing license. Similarly, 

during Castronuovo’s interview, George told him that he would be paid $75 per 

patient and showed him sample charts displaying “the types of medication that 

were prescribed there.” George described the clinics’ “business model” during the 

interview and testified that he “wouldn’t have hired [Castronuovo]” if he had not 

agreed to the clinics’ prescription practices. In addition to the $75 fee per patient, 

George paid him up to $200 per day to use his dispensing license. 

While there is no direct evidence that Defendants separately agreed to 

deposit their paychecks into their personal bank accounts, direct evidence is rarely 

available to prove a conspiracy’s existence. United States v. Pineiro, 389 F.3d 

1359, 1369 (11th Cir. 2004). Here, George paid Defendants, in part, with checks

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drawn from a bank account at Bank of America. Defendants then accepted the 

checks made payable to them with knowledge that the checks’ funds were derived 

from the clinics’ operations. Defendants also endorsed and negotiated the checks

through a financial institution in an amount exceeding $10,000. Based on this 

evidence and common knowledge that checks must be negotiated to transfer 

possession of their funds, a rational juror could conclude that Defendants accepted 

the checks with the intent to deposit them into their personal bank accounts. See

United States v. Gainey, 111 F.3d 834, 836 (11th Cir. 1997) (explaining that “the 

law permits jurors to ‘apply their common knowledge, observations and 

experiences in the affairs of life’” when “evaluating the facts of a case” (quoting 

United States v. Cruz-Valdez, 773 F.2d 1541, 1546 (11th Cir. 1985) (en banc))). 

Thus, the evidence was sufficient for a rational juror to conclude that Defendants 

agreed to engage in monetary transactions in criminally derived property valued

greater than $10,000 by accepting their paychecks with knowledge that the funds 

were derived from the clinics’ unlawful activity.

Defendants2 argue that a conviction for money laundering conspiracy on 

these facts renders § 1956(h) “impermissibly broad” because “[w]ithout insisting 

upon proof of a separate agreement, virtually any conspiracy involving the 

exchange of funds would automatically be punishable as money laundering.” The

 2 Castronuovo adopts this argument made by Cadet. 

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Court need not consider this argument further. As discussed above, there was 

sufficient evidence for a rational jury to conclude beyond a reasonable doubt that 

Defendants separately agreed to engage in financial transactions upon accepting 

profits from the clinics’ operations.3

Castronuovo also contends that the evidence was insufficient because it 

showed multiple conspiracies rather than a single conspiracy. According to 

Castronuovo, the evidence reflected the kind of “rimless wheel” or “hub-andspoke” conspiracy described in Kotteakos v. United States, 328 U.S. 750, 755 

(1946), and United States v. Chandler, 388 F.3d 796, 807 (11th Cir. 2004). The 

courts in Kotteakos and Chandler reversed convictions because the types of 

conspiracies proven at trial constituted material variances from the indictments in 

those cases, and Castronuovo contends that the same result should be reached here.

“A variance occurs when the facts proved at trial deviate from the facts 

contained in the indictment but the essential elements of the offense are the same.” 

United States v. Keller, 916 F.2d 628, 634 (11th Cir. 1990). A variance is 

reversible error only when “the facts established at trial materially diverge from the 

 3 Defendants additionally cite the rule of lenity to support this argument, but the rule of 

lenity is inapplicable, because there is not a “grievous ambiguity or uncertainty” in § 1956(h). 

United States v. Maupin, 520 F.3d 1304, 1307 (11th Cir. 2008) (quoting Muscarello v. United 

States, 524 U.S. 125, 138 (1998)).

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facts in the indictment and the defendant suffers substantial prejudice as a result.” 

United States v. Weissman, 899 F.2d 1111, 1114 (11th Cir. 1990).

A variance is material “if the government proves multiple conspiracies 

under an indictment alleging only a single conspiracy.” United States v. Castro, 89 

F.3d 1443, 1450 (11th Cir. 1996) (citing Kotteakos, 328 U.S. 750). On review, we 

look at the evidence in the light most favorable to the government and ask whether 

a reasonable trier of fact could have determined beyond a reasonable doubt that a 

single conspiracy existed. United States v. Seher, 562 F.3d 1344, 1366 (11th Cir. 

2009). We will not disturb the jury’s finding of a single conspiracy if it is 

supported by substantial evidence. Id. To determine whether the jury could have 

found a single conspiracy, we consider (1) whether a common goal existed; (2) the 

nature of the underlying scheme; and (3) the overlap of participants. United States 

v. Edouard, 485 F.3d 1324, 1347 (11th Cir. 2007). 

Here, viewing the evidence in the light most favorable to the government, a 

rational juror could have found beyond a reasonable doubt that there was a single, 

overarching conspiracy. Defendants shared a common goal—to obtain payment 

from the clinics’ illegal operations—and each Defendant acted in concert to further 

this goal. The clinics’ continued operation relied on Defendants’ and other doctors’

willingness to prescribe Oxycodone in mass quantities. The nature of the clinics’

scheme relied on using those same doctors’ dispensing licenses to obtain the pills 

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that the clinics sold. Moreover, evidence that Defendants sold pills to the same 

patients and George instructed Castronuovo to shadow Cadet as training indicates a 

direct overlap in participants. Because this evidence was sufficient for a reasonable

jury to find that a single conspiracy existed, there was no material variance. 

2. Knowledge and Intent

As to the second element of money laundering conspiracy, a rational jury

could have found beyond a reasonable doubt that Defendants agreed to commit a 

money laundering offense “with the requisite knowledge and intent.” United States 

v. Magluta, 418 F.3d 1166, 1174 (11th Cir. 2005). Specifically, the evidence 

showed that Defendants knew “that the property involved . . . represent[ed] the 

proceeds of some form of unlawful activity.” 18 U.S.C. § 1956(a)(1); see also

United States v. Martinelli, 454 F.3d 1300, 1312 n.8 (11th Cir. 2006).

Other clinic doctors and personnel discussed the clinics’ adverse media 

coverage with Cadet and in her presence. And Castronuovo testified that he

continued to work at the clinic despite knowing that its operations were illegal, 

referring to the clinics’ patients as “junkies” and “pillbillies.” Viewing this 

evidence in the light most favorable to the government, a rational juror could 

conclude that Defendants knew that they were being paid for their roles in the 

clinics’ unlawful distribution of narcotics.

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Defendants’ acquittal on the underlying drug conspiracy charge does not 

affect the sufficiency of the evidence as to this second element. “It is by now 

abundantly clear that in a money laundering case (or in a money laundering 

conspiracy case), the defendant need not actually commit the alleged specified 

unlawful activity.” Id. at 1312. Moreover, “inconsistent jury verdicts are not 

necessarily a cause for reversal of a conviction.” United States v. LozanoHernandez, 89 F.3d 785, 789 (11th Cir. 1996). Indeed, we have maintained that 

conviction on only one of two related counts may be upheld where “[d]ifferent 

elements comprise the two offenses.” Id. (citing United States v. Powell, 469 U.S. 

57, 65–67 (1984)). 

Here, different elements comprise the drug trafficking conspiracy and 

money laundering conspiracy offenses. Compare 21 U.S.C. §§ 841(a)(1), 846, 

859(a), with id. §§ 1956(h), 1957. And as the district court noted, even though the 

jury ultimately determined that Defendants did not personally distribute narcotics 

unlawfully, there was evidence for the jury to nevertheless find “that the other 

medical doctors were engaging in such unlawful conduct, that the money they 

received for working at the clinics was proceeds from that illegal activity, and that 

they agreed to conspire with the others to launder those illegal proceeds.”

Cadet argues that she did not know that her prescriptions were for an 

illegitimate medical purpose. She avers that her income was derived on a perUSCA11 Case: 14-11765 Date Filed: 05/17/2016 Page: 17 of 43
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patient basis; she did not have ownership interest in the clinics; and she did not 

receive money directly from narcotics sold at other clinics. But § 1957 specifically 

states that “[i]n a prosecution for an offense under this section, the Government is 

not required to prove that the defendant knew that the offense from which the 

criminally derived property was derived was specified unlawful activity.” 18 

U.S.C. § 1957(c). Plus, Cadet’s conviction was not for substantive promotional 

money laundering, so the government was not required to prove that she personally 

reinvested the illegal proceedings into the clinics’ criminal activities. Compare 18 

U.S.C. § 1956 (a)(1)(A)(i) (promotional money laundering), with id. § 1957(a) 

(monetary transactions derived from specified unlawful activity). And despite 

receiving some payments directly from patients, who she saw only by virtue of her 

position at the clinic, Cadet also received $1,000 per week for use of her 

dispensing license. Because there was sufficient evidence for a rational jury to find

both elements of money laundering conspiracy beyond a reasonable doubt, we will 

uphold Defendants’ convictions.

B. Motion to Dismiss Second Superseding Indictment for Grand Jury Abuse

Castronuovo next argues that the district court erred in denying his motion to 

dismiss the second superseding indictment for grand jury abuse. He specifically 

alleges prosecutorial vindictiveness and prosecutorial misconduct. But dismissing 

an indictment is an “extreme sanction which should be infrequently utilized.” 

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United States v. O’Keefe, 825 F.2d 314, 318 (11th Cir. 1987). And the district 

court determined that such an extreme sanction was not warranted here.

1. Second superseding indictment as retaliation

First, Castronuovo contends that the prosecutor vindictively used the second 

superseding indictment to retaliate against Castronuovo for exercising his

procedural rights—namely, his right to plead not guilty and his right to move for 

severance.

Dismissal of an indictment for prosecutorial vindictiveness is based on the 

principle that a defendant “may not be punished for exercising a protected statutory 

or constitutional right.” United States v. Goodwin, 457 U.S. 368, 372 (1982). A 

rebuttable presumption of vindictiveness arises where the government takes 

unilateral action, such as obtaining a superseding indictment alleging additional or 

more serious charges, in a context that indicates a reasonable likelihood of 

vindictiveness as a response to the defendant’s exercise of his rights. Id. at 372–77. 

Where the facts do not give rise to a presumption, the defendant may show actual 

vindictiveness by proving that the government acted solely to penalize him. Id. at 

380–81 & n.12.

No grounds for a presumption of vindictiveness exist here. After 

Castronuovo decided to plead not guilty to the mail/wire fraud count in the first 

superseding indictment, the government continued its investigation into patient 

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deaths. It then sought the second superseding indictment, which was proper. See

United States v. Cole, 755 F.2d 748, 757–58 (11th Cir. 1985) (explaining that 

additional, warranted charges may be brought against a defendant who declines to 

negotiate a lesser guilty plea). 

Castronuovo also fails to show actual vindictiveness because he has not 

proven that the government filed the second superseding indictment solely to 

penalize him. Castronuovo argues that once he expressed his intent to move for a 

severance, the government took six months to return the second superseding

indictment when it initially stated that it would be returned in less than a month.

But Castronuovo fails to show that the longer timeline was intentional or

prejudicially affected his rights. Because Castronuovo has not shown that the 

government delayed solely to penalize him, the district court did not err in refusing 

to dismiss the second superseding indictment.

2. Prosecutorial misconduct

Second, Castronuovo contends that the prosecutor’s improper questions and 

inflammatory comments during the grand jury process prejudiced his rights. “‘A 

prosecutor is . . . forbidden to make improper suggestions, insinuations and 

assertions calculated to mislead the jury’ and may not appeal to the jury’s passion 

or prejudice.” United States v. Rodriguez, 765 F.2d 1546, 1560 (11th Cir. 1985) 

(quoting United States v. Phillips, 664 F.2d 971, 1030 (5th Cir. Unit B 1981)). 

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“When the alleged prosecutorial misconduct occurs in the context of a grand jury 

proceeding, we dismiss the indictment only when the misconduct ‘substantially 

influenced the grand jury’s decision to indict’ or when there is ‘grave doubt that 

the decision to indict was free from the substantial influence of such violations.’” 

United States v. Cavallo, 790 F.3d 1202, 1219 (11th Cir. 2015) (quoting Bank of 

Nova Scotia v. United States, 487 U.S. 250, 256 (1988)). 

Here, Castronuovo identifies a number of troubling comments made by the 

prosecutor during the grand jury proceedings. For example, one juror asked about 

the two patient deaths. The juror asked if the deceased underwent MRI exams, 

stating that “the person could have given [Castronuovo] that information and 

typically, a physical exam without any cardio–.” But the prosecutor cut off the 

juror’s question. The prosecutor said, “If this was a real doctor. Again, the 

evidence has reflected that these were pill mill doctors that were there to spend the 

least amount of time possible.” The prosecutor further stated that the other doctors, 

who had admitted to drug dealing activity, would testify at trial “that they were 

drug dealers and they did the same thing these two did.” 

The prosecutor also asked one grand jury witness, Dr. Baden, whether he 

would “want to know if Dr. Castronuovo was a criminal or not” as a forensic 

pathologist expert that worked on the case. Dr. Baden answered that “I’m here to 

talk about how somebody died, not if he’s a criminal” and later stated that “unlike 

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television, the medical examiner is not an investigator.” But the prosecutor did not 

stop there. Instead, he asked the following: “Are you aware, sir, that this very 

grand jury indicted 32 people for running illegal pill mills, 28 of whom have pled 

guilty, are in prison right now, and also previously filed charges against Dr. 

Castronuovo?” Dr. Baden responded by saying he was “[v]aguely aware of it,” but 

that “[a]ll I’m dealing with are two deaths.”

The prosecutor then asked Dr. Wright, another expert witness, if he had 

“ever been in Broward County Hospital to see the babies born addicted to 

Oxycodone?” The prosecutor stated that “in 2009, nearly 1,000 babies who were 

born in Florida hospitals were treated for drug withdrawal syndrome” and 

concluded that “[i]t’s fairly obvious that Dr. Castronuovo illegally prescribed these 

drugs. He was, in fact, just a drug dealer.”

This conduct, when viewed in its totality, was more flagrant than a “few 

unwitting and inadvertent gestures by the prosecutor.” United States v. Pabian, 704 

F.2d 1533, 1540 (11th Cir. 1983). But Castronuovo has not “established that the 

violation[s] substantially influenced the grand jury’s decision to indict” and the 

record does not establish “‘grave doubt’ that the decision to indict was free from 

the substantial influence of such violations.” Bank of Nova Scotia, 487 U.S. at 

256–57 (quoting United States v. Mechanik, 475 U.S. 66, 78 (1986) (O’Connor, J., 

concurring)). The strength of the evidence on the drug and money laundering 

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conspiracies was significant. For example, the grand jurors were informed that the 

investigation required examination of patient files, wiretapped conversations, 

surveillance recordings, and autopsy reports. The jurors were also presented with 

statistics from a dispensing tracking system as to how many units of Oxycodone 

were ordered and/or received under Defendants’ dispensing licenses. And an FBI 

special agent testified that Cadet earned in excess of one million dollars, paid in 

cash and by check, from her prescribing activities, while Castronuovo earned over 

$100,000. 

Moreover, the petit jury, which did not hear the prosecutor’s remarks, found 

Castronuovo guilty for conspiracy to commit money laundering. See United States 

v. Flanders, 752 F.3d 1317, 1333 (11th Cir. 2014) (“Thus, the petit jury’s guilty 

verdicts demonstrate that there was probable cause to charge Defendants with the 

offenses for which they were convicted, and any alleged misconduct before the 

grand jury was harmless.”). Therefore, because Castronuovo has not identified any 

prejudiced he suffered as a result of the prosecutor’s conduct, the district court did 

not err in denying his motion to dismiss the indictment.

C. Motion to Suppress 

Castronuovo next argues that the district court erred in denying his motion to 

suppress his pre-indictment interview statements. Castronuovo avers that the 

district court should have granted his motion to suppress for two reasons: (1) his 

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statements were inadmissible as part of a plea agreement, and (2) his statements 

were procured as a result of his attorney’s ineffective assistance.

First, Castronuovo argues that his statements were made as part of a plea 

agreement. Federal Rule of Criminal Procedure 11(f) provides that “[t]he 

admissibility or inadmissibility of a plea, a plea discussion, and any related 

statement is governed by Federal Rule of Evidence 410.” Fed. R. Crim. P. 11(f).

Federal Rule of Evidence 410, in turn, provides that a court cannot admit against a 

defendant “a statement made during plea discussions with an attorney for the 

prosecuting authority if the discussions did not result in a guilty plea or they 

resulted in a later-withdrawn guilty plea.” Fed. R. Evid. 410 (a)(4).

“To determine whether a discussion should be characterized as a plea 

negotiation, the trial court must determine, first, whether the accused exhibited an 

actual subjective expectation to negotiate a plea at the time of the discussion, and, 

second, whether the accused’s expectation was reasonable given the totality of the 

objective circumstances.” United States v. Merrill, 685 F.3d 1002, 1013 (11th Cir. 

2012) (citing United States v. Robertson, 582 F.2d 1356, 1366 (5th Cir. 1978)).

The denial of a motion to suppress presents a mixed question of fact and 

law. United States v. Delancy, 502 F.3d 1297, 1304 (11th Cir. 2007). We review 

the findings of fact for clear error and the interpretation and application of law de 

novo. Id. “[W]e may affirm the denial of a motion to suppress on any ground 

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supported by the record.” United States v. Caraballo, 595 F.3d 1214, 1222 (11th 

Cir. 2010).

Here, the district court found that even if Castronuovo had a subjective 

expectation to negotiate a plea at the meetings with government agents, his 

expectation was objectively unreasonable. Before ruling on Castronuovo’s motion 

to suppress, the district court held a hearing with Castronuovo, his former attorney, 

and the agents who were present during the discussions. After hearing testimony, 

the court determined that an expectation of plea negotiations was objectively 

unreasonable where no charges against Castronuovo were pending and no 

discussions of potential charges or immunity occurred before or during the 

meetings. The government was still gathering evidence and interviewing witnesses 

as part of an ongoing investigation when the discussions occurred. These factual 

findings were not clearly erroneous, and the court properly concluded that even if 

Castronuovo expected to negotiate a plea during the meetings, the expectation was 

not objectively reasonable. See, e.g., Merrill, 685 F.3d at 1013 (“There were no 

pending charges against [the defendant] when the discussion occurred, and the 

general discussions of leniency did not transform [the defendant]’s meeting with 

the prosecutor and federal agents into plea negotiations.”). Therefore, the 

discussions should not have been characterized as a plea negotiation, and the 

district court properly denied Defendant’s motion to suppress.

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Second, Castronuovo argues that the district court erred in denying his 

motion to suppress because his attorney at the time, Michelle Suskauer, Esquire,

was ineffective for failing to secure limited use immunity before the interview. We

have held that “[e]xcept in the rare instance when the record is sufficiently 

developed, we will not address claims for ineffective assistance of counsel on 

direct appeal.” United States v. Merrill, 513 F.3d 1293, 1308 (11th Cir. 2008)

(alterations in original) (quoting United States v. Verbitskaya, 406 F.3d 1324, 1337 

(11th Cir. 2005)). Instead, “[t]he better-reasoned approach is to permit ineffectiveassistance claims to be brought in the first instance in a timely motion in the 

district court under [28 U.S.C.] § 2255,” “even if the record contains some 

indication of deficiencies in counsel’s performance.” Massaro v. United States, 538 

U.S. 500, 504 (2003). Here, although the district court held an evidentiary hearing 

in connection with Castronuovo’s motion to suppress, the basis for Ms. Suskauer’s 

recommendation that Castronuovo participate in the meetings and the actions taken 

by Ms. Suskauer to investigate the case against Castronuovo up to that point are 

not sufficiently developed. Thus, Castronuovo’s ineffective assistance claim would 

be more appropriately addressed in a motion under 28 U.S.C. § 2255.

D. Prejudicial Joinder

Castronuovo next argues that the district court erred in denying his motion 

for relief from prejudicial joinder because he was irreparably prejudiced by the 

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jury hearing evidence against both Defendants in the same trial. But Castronuovo 

cannot demonstrate that the district court abused its discretion.

Generally, defendants who are indicted together are tried together unless the 

defendant seeking severance can show that a joint trial would prejudice his 

substantial rights and that “severance is the only proper remedy for that prejudice.” 

United States v. Lopez, 649 F.3d 1222, 1234 (11th Cir. 2011); see Fed. R. Crim. P. 

14(a) (stating that “the court may order separate trials of counts, sever the 

defendants’ trials, or provide any other relief that justice requires” where the 

joinder of offenses or defendants “appears to prejudice a defendant or the 

government”). And we have expressed our “reluctan[ce] to reverse a district 

court’s denial of severance, particularly in conspiracy cases.” United States v. 

Knowles, 66 F.3d 1146, 1158 (11th Cir. 1995). 

In deciding a severance motion, a district court must balance the right of the 

defendant to a fair trial against the public’s interest in efficient and economic 

administration of justice. United States v. Alvarez, 755 F.2d 830, 857 (11th Cir. 

1985). Severance is granted only when the defendant can demonstrate that a joint 

trial will result in “specific and compelling prejudice” to his defense, id. (quoting 

United States v. Zielie, 734 F.2d 1447, 1464 (11th Cir. 1984)), resulting in 

“fundamental unfairness.” Knowles, 66 F.3d at 1159.

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There are four instances of prejudicial joinder that will generally require 

severance: where (1) “the [d]efendants rely on mutually antagonistic defenses”; 

(2) “one [d]efendant would exculpate the moving [d]efendant in a separate trial, 

but will not testify in a joint setting”; (3) “inculpatory evidence will be admitted 

against one [d]efendant that is not admissible against the other”; and (4) “a 

cumulative and prejudicial ‘spill over’ effect may prevent the jury from sifting 

through the evidence to make an individualized determination as to each 

[d]efendant.” United States v. Chavez, 584 F.3d 1354, 1360–61 (11th Cir. 2009). 

Demonstrating one of these four instances is a “heavy burden.” Kennard, 472 F.3d 

at 858–59.

Here, Defendants were jointly indicted for the same conspiracy based on 

their acts at sister clinics. Defendants did not rely on mutually antagonistic 

defenses, and neither Defendant contends that he or she would have testified 

against the other in the event of separate trials. There is no indication that the 

government intended to use inculpatory evidence that was admissible against 

Cadet but not admissible against Castronuovo. And Castronuovo did not identify 

any cumulative or prejudicial spillover effect that would have prevented the jury 

from sifting through the evidence to make an individualized determination as to 

each Defendant. 

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Moreover, the district court instructed the jury to consider the case of each 

defendant separately and individually. See Kennard, 472 F.3d at 859 (explaining 

that “the potential ‘spillover effect’ of evidence of a co-defendant’s guilt” is 

generally “mitigate[d]” by “a court’s cautionary instructions”). Thus, because a 

joint trial did not prejudice Castronuovo, the district court did not abuse its 

discretion in denying his severance motion.

E. Allen Charge

Castronuovo’s final argument on appeal is that the district court improperly 

coerced the jury by effectively delivering two modified Allen charges. “An ‘Allen

charge’ is a trial court’s admonition to a deadlocked jury, instructing it to make 

further attempts to reach a verdict.” United States v. Polar, 369 F.3d 1248, 1254 

(11th Cir. 2004). A district court abuses its discretion by giving an Allen charge 

only if it was “inherently coercive.” Woodard, 531 F.3d at 1364. To determine 

whether the charge was inherently coercive, we consider the language used and the 

totality of the circumstances surrounding the charge, including whether the district 

court polled the jury before giving the charge and the amount of time that elapsed 

between the charge and the verdict’s return. Id.

There was no sign of coercion here. The district court had not polled the 

jurors before issuing the Allen charge, and the 2 to 2 1⁄2 hours that elapsed between 

the charge and the returned verdict does not suggest coercion. See United States v. 

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Chigbo, 38 F.3d 543, 546 (11th Cir. 1994) (concluding after the jury returned a 

verdict within fifteen minutes of delivery of the charge that “[t]he speed with 

which the jury returned its verdict after receiving the modified Allen charge does 

not change our decision”); see also United States v. Jones, 518 F. App’x 741, 743 

(11th Cir. 2013) (nonprecedential) (Allen charge not coercive where jury returned 

a verdict roughly thirty minutes later); United States v. Miller, 451 F. App’x 896, 

898 (11th Cir. 2012) (nonprecedential) (Allen charge not coercive where jury 

returned a verdict about eight minutes later). Moreover, the district court’s charge 

was based on language from the Eleventh Circuit Pattern Jury Instruction for 

deadlocked juries, which we have held to be non-coercive. United States v. 

Trujillo, 146 F.3d 838, 846–47 (11th Cir. 1998).

Castronuovo nevertheless argues that the circumstances surrounding the 

charge were unduly coercive because the district court’s directions to completely 

fill out the verdict form constituted the “first,” constructive Allen charge, followed 

by a “second,” official Allen charge when the jury reported that it was deadlocked.

But this argument holds no water. 

In giving an Allen charge, the district court instructs a deadlocked jury to 

undertake further efforts to reach a verdict. Polar, 369 F.3d at 1254. Here, the jury 

had not indicated that it was deadlocked when the court instructed the jury to fill 

out the blank portions of the verdict sheet. Rather, the jury sent a note indicating 

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they had reached a verdict before it submitted the incomplete verdict forms. Thus, 

the district court’s subsequent instruction to fill out the form completely was not a 

“constructive” Allen charge. Instead, the district court gave a single modified Allen

charge after the jury stated that it was deadlocked, which was proper. Because no 

facts indicate that the Allen charge was inherently coercive, the district court did 

not abuse its discretion by issuing it.

F. Cumulative Prejudicial Effect

Cadet further argues that she should be granted a new trial based on the 

cumulative error doctrine. Although Cadet suggests that any one of the alleged 

errors is sufficient to warrant a new trial, Cadet argues that their combined effect 

rendered her trial fundamentally unfair.

Under the cumulative error doctrine, the “cumulative prejudicial effect of 

many errors may be greater than the sum of the prejudice caused by each 

individual error” in a manner that denies a defendant of a fair trial. United States v. 

Baker, 432 F.3d 1189, 1223 (11th Cir. 2005), abrogated on other grounds by Davis 

v. Washington, 547 U.S. 813, 821 (2006). “We address claims of cumulative error 

by first considering the validity of each claim individually, and then examining any 

errors that we find in the aggregate and in light of the trial as a whole to determine 

whether the appellant was afforded a fundamentally fair trial.” Morris v. Sec’y, 

Dep’t of Corr., 677 F.3d 1117, 1132 (11th Cir. 2012). We will reverse a conviction

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only if the defendant can show that the aggregate of nonreversible errors affected 

his substantial rights. United States v. Capers, 708 F.3d 1286, 1299 (11th Cir. 

2013).

1. Constructive amendment of the indictment

Cadet4 first contends that the district court constructively amended the 

indictment by giving a jury instruction that altered the specified unlawful activity 

underlying the money laundering conspiracy count. A constructive amendment 

occurs when “the prosecutor’s actions or the court’s instructions, ‘viewed in 

context,’ resulted in the expansion of an indictment either literally or in effect.” 

United States v. Behety, 32 F.3d 503, 508–09 (11th Cir. 1994) (quoting United 

States v. Andrews, 850 F.2d 1557, 1559 (11th Cir. 1988) (en banc)). The “essential 

elements of an indictment are impermissibly broadened when an indictment 

includes language describing the statutory crime and additional language 

narrowing the charged crime to a subset of the statutory crime, but the jury 

instruction omits the narrowing language.” United States v. Moore, 525 F.3d 1033, 

1045 (11th Cir. 2008) (citing United States v. Narog, 372 F.3d 1243, 1248 (11th 

Cir. 2004)). 

The statutory offense for a § 1957(a) money laundering conspiracy requires 

that a defendant “knowingly engage[] or attempt[] to engage in a monetary 

 4 Castronuovo adopts this argument. 

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transaction in criminally derived property of a value greater than $10,000” that “is 

derived from specified unlawful activity.” 18 U.S.C. § 1957(a). The second 

superseding indictment included language narrowing the charged crime by stating 

that “the specified unlawful activity is the distribution, dispensing and possession 

with intent to distribute and dispense[] oxycodone, a Schedule II narcotic 

controlled substance” that was “outside the scope of professional practice and not 

for a legitimate medical purpose.”

But the jury instructions did not include the indictment’s narrowing 

language. The instructions did not specify that the distribution must be “outside the 

scope of professional practice and not for a legitimate purpose” and that the 

controlled substance must be “Oxycodone.” They stated only that the criminal 

source of the proceeds must be the “felonious” distribution of a “controlled 

substance.” By omitting the narrowing language, the instruction constructively 

amended the indictment. Narog, 372 F.3d at 1248.

A jury instruction that constructively amends an indictment constitutes 

reversible error per se if the defendant objected to the jury instruction before the 

jury retired to deliberate. Madden, 733 F.3d at 1321 n.5. Cadet argues that she 

preserved the issue in a post-trial motion to vacate her conviction wherein she 

stated that the district court “deliberate[ly]” omitted the language “due to Defense 

counsels’ specific requests to mirror the definition from the Indictment.” But Cadet 

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did not object to the instruction before the jury retired to deliberate, so the 

constructive amendment is not reversible error per se.

Instead, we review the district court’s instruction for plain error. Gutierrez, 

745 F.3d at 471; Madden, 733 F.3d at 1321 n.5. Reversal is warranted only if the 

constructive amendment (1) was plain, (2) affected Defendants’ substantial rights, 

and (3) seriously affected the fairness, integrity, and public reputation of judicial 

proceedings. United States v. Romano, 314 F.3d 1279, 1281–82 (11th Cir. 2002).

Here, even though the jury instruction constructively amended the 

indictment, the constructive amendment did not affect Defendants’ substantial

rights because the indictment’s substance remained intact. See Moore, 525 F.3d at

1046. The district court instructed the jury that Defendants were charged in Count 

1 with a conspiracy to “to distribute, dispense or possess with intent to distribute or 

dispense Oxycodone without authorization by law” and that “Section 841(a)(1) 

makes it a crime for anyone to knowingly distribute, dispense or possess with the 

intent to distribute or dispense Oxycodone.” Only Counts 3 and 4, relating to the 

drug-related patient deaths, mentioned another controlled substance (i.e., 

Alprazolam, which is also known as Xanax). Evidence at trial focused on 

Oxycodone as well. See United States v. Cromartie, 267 F.3d 1293, 1296–97 (11th 

Cir. 2001) (failure to submit required element to jury was not reversible plain error 

because the jury “necessarily” relied on “[t]he only evidence” at issue establishing 

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the requisite element). And while the district court’s instructions referred to 

Oxycodone on eight separate occasions, Alprazolam was mentioned just once. 

The district court also instructed the jury that for Counts 3 through 11 the 

government must prove beyond a reasonable doubt that “[t]he Defendant 

distributed or dispensed, or possessed with intent to distribute or dispense, not for a 

legitimate medical purpose or outside the usual course of professional practice, the 

controlled substance as charged.” The court even reminded the jurors that “[a]gain, 

Defendants are charged with knowingly and willfully prescribing controlled 

substances to his or her patients outside the usual course of professional medical 

practice.” Moreover, based on the evidence presented at trial and because 

Defendants were physicians with dispensing licenses, the only way that the 

“buying, selling, and otherwise dealing in a controlled substance” at the clinics

could have been “felonious” for the purposes of Defendants’ conviction was if

those actions were taken “outside the scope of professional practice and not for a 

legitimate purpose.”

So although the instructions for Count 13 did not specify the controlled 

substance or restate how the distribution was “felonious,” no rational jury would 

have convicted Defendants for money laundering conspiracy without considering

the proceeds to be derived from Oxycodone that was dispensed “outside the scope 

of professional practice.” Thus, in light of the instructions as a whole and the 

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evidence shown at trial, Defendants’ substantial rights were not affected by the 

instruction, and a new trial is not warranted.

2. Guilt by association

As to the second error alleged in her cumulative error argument, Cadet5

contends that the prosecutor’s theory of guilt by association prejudiced her rights. 

During opening statements, the prosecutor repeatedly referred to the “criminal 

doctors” as a collective. The prosecutor stated that the jury would know Cadet’s 

guilt when other doctors “come in in their prison jumpsuit[s]” and tell the jury 

“what they did.” And the prosecutor referred to the witnesses’ “prison jumpsuits” 

on at least two other occasions. He further stated that these witnesses would “say 

they saw the same patients as Defendant Cadet and Defendant Castronuovo, and 

when they wrote those prescriptions, those criminal doctors, they were criminals, 

they were drug dealers, they did it without a medical purpose and it was outside the 

scope of their practice.” The prosecutor concluded that these were “the same 

prescriptions written by Cadet and Castronuovo.” Defendants generally objected to

these statements. 

Also, during closing argument, the prosecutor continually referred to the 

other doctors appearing “in handcuffs and leg irons.” The prosecutor posed the 

following hypothetical to the jury: “So how can Dr. Cadet reasonably distinguish 

 5 Castronuovo adopts this argument. 

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herself and her practices from those of Drs. Aruta, Boshers, and Dreszer?” The 

prosecutor suggested that “the answer is she can’t.” Defendants did not object to 

the prosecutor’s closing argument. 

We review a claim of prosecutorial misconduct de novo. United States v. 

House, 684 F.3d 1173, 1197 (11th Cir. 2012). But where the defendant does not 

object to the propriety of the prosecutor’s statement, we review for plain error 

only. Flanders, 752 F.3d at 1332–33. Under plain error review, “the defendant 

must show that (1) an error occurred; (2) the error was plain; (3) it affected his 

substantial rights; and (4) it seriously affected the fairness of the judicial 

proceedings.” Id.

Here, under either standard, the prosecutor’s comments do not warrant a new 

trial. It is well understood that “[o]ne person’s guilty plea or conviction may not be 

used as substantive evidence of the guilt of another.” United States v. King, 505 

F.2d 602, 607 (5th Cir. 1974).6 But the prosecutor may comment on the evidence 

presented to the jury when describing the close association between 

co-conspirators. See United States v. Castro, 89 F.3d 1443, 1457 (11th Cir. 1996)

(describing the appellants’ guilt-by-association argument as “meritless” because 

“the prosecutor properly commented on the evidence presented to the jury when he 

 6 In Bonner v. City of Prichard, 661 F.2d 1206, 1209 (11th Cir. 1981) (en banc), this court 

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

October 1, 1981.

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described the close association that appellants shared with others involved in the 

kickback scheme prior to and during their criminal activities”); United States v. 

Tisdale, 817 F.2d 1552, 1555 (11th Cir. 1987) (explaining that no error occurs 

when the evidence supports a prosecutor’s comments). And the prosecutor may 

“blunt the impact of ‘expected attacks on witnesses’ credibility’” by “disclos[ing] 

guilty pleas of Government witnesses.” United States v. DeLoach, 34 F.3d 1001, 

1004 (11th Cir. 1994) (quoting United States v. Countryman, 758 F.2d 574, 577 

(11th Cir. 1985)). There was no reversible error when the prosecutor commented

on witnesses appearing in their “prison jumpsuits,” a fact observable by the jurors 

themselves. See, e.g., United States v. Adams, 1 F.3d 1566, 1584 (11th Cir. 1993).

Moreover, the district court’s curative instructions mitigated the impact of 

the prosecutor’s comments. The district court told the jury to consider the 

testimony of pleading witnesses “with more caution” and stated that those 

witnesses may “hope to gain more favorable treatment.” The district court also 

explained that “the fact that a witness has pleaded guilty to an offense isn’t 

evidence of the guilt of any other person,” and it reminded the jury that “anything 

the lawyers say is not evidence.” These cautionary instructions “sufficiently cure 

any potential for prejudice to the defendant on trial.” United States v. Carrazana, 

921 F.2d 1557, 1568 (11th Cir. 1991). As such, the prosecutor’s comments do not 

warrant a new trial.

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3. Cross-examination

Cadet next challenges the district court’s limitation on cross-examination of 

Chris George about his tattoo of a Nazi symbol, a picture in which he saluted a 

Nazi flag, and his use of the “N word.” Cadet argues that the district court abused 

its discretion in limiting cross-examination pursuant to Federal Rule of Evidence 

403 and that this limitation violated Cadet’s Confrontation Clause rights under the 

Sixth Amendment.

First, under Rule 403, the district court may exclude otherwise relevant 

evidence if “its probative value is substantially outweighed by the danger of unfair 

prejudice.” Fed. R. Evid. 403. When reviewing a district court’s Rule 403 

evidentiary ruling, “we look at the evidence in a light most favorable to its 

admission, maximizing its probative value and minimizing its undue prejudicial 

impact.” United States v. Brown, 441 F.3d 1330, 1362 (11th Cir. 2006).

Here, the district court determined that the evidence had minimal probative 

value as to bias because the record indicated that George had a good relationship 

with Cadet, untainted by racial bias. The minimal probative value was substantially 

outweighed by the unfair prejudice that would result from its use. Cadet, therefore,

has not shown that the district court abused its discretion.

Moreover, Cadet has not shown that the district court’s decision impeded her 

ability to otherwise effectively cross-examine George. Cadet extensively crossUSCA11 Case: 14-11765 Date Filed: 05/17/2016 Page: 39 of 43
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examined George about the ways in which he surreptitiously operated the clinics

and kept Cadet shielded from certain aspects of the clinics’ scheme. Cadet also 

asked George about his plea agreement with the government, which required him 

to testify if called upon. There was ample evidence upon which Cadet could and 

did argue that George’s testimony was unreliable and upon which the jury could 

evaluate George’s credibility.

Second, the limitation on cross-examination did not violate Cadet’s Sixth 

Amendment rights. A defendant “is entitled only to an opportunity for effective 

cross-examination, not cross-examination that is effective in whatever way, and to 

whatever extent, the defendant might wish.” Maxwell, 579 F.3d at 1296 (quoting 

United States v. Baptista-Rodriguez, 17 F.3d 1354, 1366 (11th Cir. 1994)). District 

courts “retain wide latitude” to reasonably limit “cross-examination based on 

concerns about, among other things, harassment, prejudice, confusion of the issues, 

the witness’ safety, or interrogation that is repetitive or only marginally relevant.”

Delaware v. Van Arsdall, 475 U.S. 673, 679 (1986). “The test for the 

Confrontation Clause is whether a reasonable jury would have received a 

significantly different impression of a witness’ credibility had counsel pursued the 

proposed line of cross-examination.” United States v. Garcia, 13 F.3d 1464, 1469

(11th Cir. 1994). 

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Under these circumstances, we cannot say that a reasonable jury would have 

received a significantly different impression of George’s credibility had the district

court allowed the proposed line of questioning. Although the importance of crossexamining George was heightened because he spearheaded the clinics’ operations, 

Defendants’ counsel had ample opportunity to raise doubts about George’s 

credibility and did so. Permitting cross-examination about his tattoo, photo, and 

racial slurs would not have provided a significantly different impression of his 

credibility. Thus, the Confrontation Clause was satisfied, and the district court did 

not abuse its discretion in limiting cross-examination. 

4. Good faith defense

Finally, Cadet argues that the district court erroneously instructed the jury 

that a good faith defense applies to the substantive drug conspiracy count, but not 

the money laundering conspiracy count. Yet Cadet requested a good faith 

instruction only for the drug conspiracy count. And she did not otherwise object to 

the instruction’s absence during the charge conference. Thus, we review for plain 

error the district court’s failure to give the good faith instruction as to the money 

laundering conspiracy count. Pena, 684 F.3d at 1151. 

“Under the plain error standard, an appellant must show that: (1) an error 

occurred; (2) the error was plain; (3) it affected his substantial rights; and (4) it 

seriously affected the fairness of the judicial proceedings.” Id. The defendant 

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“bears the burden of persuasion” as to the third prong and “must show that the 

claimed error affected his substantial rights, which almost always requires that the 

error must have affected the outcome of the district court proceedings.” Id.

(quoting United States v. Pantle, 637 F.3d 1172, 1177 (11th Cir. 2011) (per 

curiam)). Where the instructions “adequately informed the jury’s good faith 

analysis,” there is “no reversible error leaving a substantial, ineradicable doubt as 

to whether the court’s instructions properly guided the jury’s deliberations.” 

Dohan, 508 F.3d at 993.

Here, the district court instructed the jury that it must find, inter alia, that 

(1) Defendants “knew the transaction involved property or funds that were the 

proceeds of some criminal activity”; (2) “the individual Defendant knew that the 

property involved in the monetary transaction was obtained or derived from 

committing some crime”; and (3) “the individual Defendant knew about the plan’s 

unlawful purpose and willfully joined in it.” These instructions required the jury to 

rule out the possibility that Cadet actually harbored a good faith belief in the 

legitimacy of the clinics’ business before it could have found that she knew that the 

money represented criminally derived proceeds. Thus, because the charges as a 

whole adequately informed the jury’s good faith analysis, the district court did not 

commit reversible error.

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Consequently, Cadet has not presented any individually reversible error, so 

no cumulative prejudicial effect warrants a new trial. 

IV. CONCLUSION

We AFFIRM Defendants’ judgments of conviction.

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