## In the



# U n ited S ta tes Co urt o f Ap p ea ls

F o rth eS e v e n th C ir cu it

N o. 10

- 3873 U NI T ED S TATE SOF A MERI CA, P la intif f-A pp ellee, v. B ENJ AMI N M UOG HALU, D ef endant-Appellant.

A pp eal from the United S t ates Di strictC our t fo r the N o rthernDi stricto f Illino is, Eas tern Div isi on. No . 07 C R 750-02

—V irgin ia M . Ken dall, Judge

.
A RG UE D S EP TE MBE R 30, 2011

— D ECI DE D N OVE MBE R 21, 2011

Befo re E A S T E RB R OO K, Ch i e f Ju dge, a nd P OSNERa nd W I L L I A MS, C ircu it Judges . P OSNER, C ir cu i tJudg e . A j ury convi cted the defendant, M u og h alu , of a va rie ty of fed er al felon ies re lat in g t o h is so l i c i t a t i o n a n d r e c e i p to fk i c kb a c k s , a n d th e j u d g e s e ntence d him to 22 m onths i n pri son. M uogh alu had bee n i nd i cted al ong w i th J ose ph L evato, wh o had dir ecte d the pay m ent o fthe ki ckba cks by hi s firm , but Levato pl ea ded g ui l tya nd t es ti fi ed ag ains t M uo g ha l u.2 N o. 10

- 3873 M uo g ha l u was the pha r m ac y di r ec to r ofthe Pr o ve na St

. J ose ph M edi calCenteri n J ol i et, I l l i noi s, an d had c on sid er ab le, p e r h a p s d ec isiv e, in flu en c e o ve r th e h os p ital ’ s deci si ons concerni ng wh i c h drugs to sto ck. Levat o w as the l oca l busi n es s m anage r ofthe pharm aceuti cal co m pan y Ave nt i s ( no w Sa no fi, b ut w e’l l st i ckwi ththe na m e th at the c om pany bor e duri ng the per i od i n w hi ch th e e ve n ts giv in g ris e t o t h is p ro s e c u t ion oc c u rre d ). H is te rrit or y in c lu d ed St. Jos ep h . L ea rn in g t h at M u o g h a lu w as consi deri ng re pla ci ng Lovenox, a bl oo d thi nner m ade b y Ave nt i s, wi thPfi ze r ’ s bl o o d thi nnerF r ag m i n, Levato and an Aventi s s al es re p m et w ith M u ogha l u to tr y t o persuade hi m to r eta i n Lovenox. Sal es ofLoveno x to St. Josep h h osp ital am ou nt ed to al m ost $200 , 000 a year, and Leva to f ear ed that i f St

. J ose ph s w i tched to Fr ag m in so w oul d otherPro vena hospi tal s. M uog ha l u t o l d the m a tthe me e t i ngtha th e i ndeed pl anne d t o s wi tc h th e ho spi ta l t o F r ag m i n. Butl at erhe ar ra nged to m eetwith Leva to al one at a r est aurant, and at th e m ee tingo ff er ed to make the i ss ue o fr epl ac i ng L ovenox “g o aw ay” i fLevat o w oul d gi ve hi m two Rol ex w at c h es . L ev at o re fu se d bu t s a id th at M u og h alu co u ld ea r n the m o ne y t o b uy the Ro l ex es hi m se l fb y g i ving so m e spe ec he s fo r Ave nt i s. M uo g ha l u a g r ee d. But A venti s thought s o i l l o fM uoghal u’s speakin g abi l i ty that h e w as neveractual l y a ske d to gi ve any s peeches, an d s o was pa i d no th in g . Gr o wi ngi m pat i en t, he re new ed hi s threa t t o re pla ce Lov enox. Levat o w i th h is s u p er vis or ’ s co n c u rre n c e a gr ee d to p ay M u og h alu $18, 000 not to sw itc h , and m ade co m pu terentr i es re c or d in g n in e n on ex ist en t s p ee c h es giv en by M u og h aluN o. 10

- 3873 3 f o r Ave nt i s. M uo g ha l u was pa id the $ 18 , 00 0 f o r the fi cti ti ous s peeches and l ate r re cei ved another $14, 000 f r o m Av e n t i s f o r s e v e n a d d i t i o n a l fi c t i t i o u s s p e e c h e s . He h eld u p h is s id e o ft h e b ar ga in

— ne ve r a g ain di d he th r ea te n t o aba ndo n Lo ve no x. I n 200 6 a n FDA ag ent who w as i nvest i gat i ng al l ega ti ons ofm i sbr an d in g a nd ki ckba cks by pharm aceuti cal c om p an ies in te rv iew ed M u og h alu an d sh ow ed h im cop ies ofA ven tis’s record s li sting th e sp eec h e s he’d supp ose dly given f orthe com pany. M uoghal u adm i tte d he’ d gi ven no speech es yethad re cei ved and cashe d ch ec k s f r o m Av e n ti s, o st en sibl y f o r s pee ch m ak i ng, t o ta l i ng $32, 000. H e s ai d they w er e paym ents f ori nfo rm alta l ks th at h e h ad giv en to n u r s e s atth e h os p ita l d u rin g h is l unc h h o ur, b uthe ha d no do cument atio n t o b ac kup the c l ai m , such a s no tes , sl i des, o r cal endar e ntri es. A t t ri alM uoghal u w as the o nl y witness f orthe defe nse; none o fthe nurses wh o he sai d had attended tal ks by hi m te sti fi ed. H e deni ed havi ng to l d Levato that he was consi deri ng r epl aci ng Love nox, o r havi ng as ked Levat o f orRol exes or o th er b ribes. H i s guil t i s s o pla i n that w e m ight stop here; non e o f th e all eged tri al err ors coul d have a ff ecte d t h e re sul t o fthe tr i al, as sum i ng, as cour ts do w hen as sessi ng tr i aler ro r, thatthe j ury w as re as on ab l e (n o on e c an p re d ict w h at an u n re as on ab le j ur y woul d do )

. Butwe’ l l t r udg e o n. Muo g h a l u a sk s u s t o r e v e r s e h i s c o n v i c t i o n o n t wo gr ounds, the fi rs t be i ng tha t the go ver nm ent withheld Bradym ate ri al, se e Brady v . M aryl and, 373 U

. S. 83 (1963); U ni t ed Sta t e s v. Gr ay, 648 F.3d 562 , 566 (7th C ir. 2011),4 N o. 10

- 3873

w hich i s to say tha t it su p p r e s s e d m aterial ex cu lpato ry e v i d e n c e th a ti tkn e w i th a d , s p e c i fi c a l l y me mo r a nd a p rep ared by the De p artm en t o f H e alth an d H um an Servi ces sum m ar i zi ng the r esul ts ofan invest i gat i on o f su spe ct ed m i sc o nduc t byAve nt i s, i nc l udi ngpay m en t ofki ckba cks

— th at is, br ibes to em plo yee s o fcusto m er s. The mem o r an da fi ng er ed M uo g ha l u a nd Le va to
. The U .S. A tt or n ey ’s o ffice th at w as p ro se c u tin g M u og h alu di sc o ve r ed the mem o r an da afte r the t r i ale nde d b ut b efo re M u og h alu w as se n te n c ed , an d im m ed iat ely tu r ne d the m o ve r t o hi s l awy er . S o the r e w as no wi th

h old in g of e x c u lp a t o r y m at er ial u n les s t h e H H S in ve st igat or s s houl d be co nsi dered par t of t h e pr ose cutor i al tea m i n thi s c as e. Kyles v . W hit ley, 51 4 U.S

. 41 9, 43 7- 38 (19 95 ); U ni t e d Sta te s v. Gr ay, sup ra , 648 F.3d at56 6; U nited St a tes v. Bhut ani, 175 F.3d 572 , 577 (7th C ir. 1999); U ni t e d S t at e s v. Wood, 57 F

. 3d 73 3, 73 7 ( 9th Ci r . 1995 ). But w e’ l l as sum e they s houl d be. The dis tr i c t j u d ge rej ecte d the Bradyc l ai m o n the g r o un d th a tMu o g h a l u ’ s l a wy e r h a d kn o wnab o u tt he H H S i nvest i gati on, knew that i ts tar get s i ncl ud ed not onl y hi s cl i ent but al so the gov er nm ent’s p rinci pal w i tness ( besi d es the FDA ag ent)

— Levato

— an d co u ld ha ve r eque st ed th e i nv es ti g atory r ec o r ds i fhe tho ug ht they m i ght underm i ne Levat o’ s cr edibi l i ty. That’ s a s o u n d g r o u n d f o r th e r ej e c t i o n o fth e c l a i m. Furth er m ore, the ri ght c re ate d by the Bradydeci si on appli es onl y t o evi dence favor abl e t o the defense. The docum ents i n q u est i on would be unl i kel y t o ha v e s t re ng the ne d, a nd mi g htwe l l h a v e we a k e ne d, M uoghal u’s defense i n the m i nd s o fj uror s.N o. 10

- 3873 5 The Foo d a nd Drug A dm i ni str ati on h ad approv ed Lo v e no x ( e no xa pa r i n s o di um) a s a b l o o d thinn e r to be u s e d f o rth e p r e v e n t i o n a n d t r e a t me n to fd e e p v e i n th r o mbo s i s ( b l o o d c l o t s i n v e i n s th a t a r e d e e p i n s i de th e bo dy) , a nd f o r the t r ea tmento fc er ta i n c o m pl i ca ti o ns of angina p ect o r is a nd of he art attac ks. Ph ysicians are author i zed to pre scr ibe a drug f ora non- ap p ro ved use, 21 U .S.C . § 39 6; B uc k m a n C o . v . P la intif fs’ Leg a l C o m m ittee, 531 U

. S. 341, 350 ( 2001 )

— th e dec i si o n t o do s o b eing deem ed to be w i thi n th eir pro f ess i onalco m petence

—but the dr ug’ s m anu factur eri s f orbi dd en to pro m ote that u se , d ire c tly o r ind ire c tly . 21 C .F.R . § 20 2.1 (e)(6 ); Ir onworke rs Lo ca l U ni on 68 v. As t r aZen e ca Pha rm a ce ut i ca l s , LP , 634 F. 3d 1352 , 13 56 n. 5 ( 11th Cir

. 20 11) . A q u i ta m sui t a gai nst Aventi s a l l ege d that t h e c om pany had vi o l at ed th e l aw bypr o m o ting

— som eti m es w i th f atal conse que n c es

— Lovenox f ornon- approve d uses, f or exam ple f ortr eat i ng hea rtpati ents w i th atr i alfibri l l ati on, f oruse i n car diaccatheter i zat ion o n pati ents w i th unstabl e a ngin a, and fo r pati ents und er going m echani cal he art

- val ve re pla cem ent. A llthis M uo gh alu’s law yer knew ; w ha t he d idn ’t know w as th at the invest i gat i on bythe Dep ar tm ent o f H ea l th a nd Hum anS er vi ce s ha d c o nfi r m ed th e dea th s a nd de s c r ib e d the m a s “ l i nk e d” t o no n- a pp r o v e d us es of Lovenox. M uoghal u w ante d t o argue thatthes e fi nd i ngs by the invest i gat or s m ade Levat o f ear t h at h e would be pr o se c u t e d f o r h o mi c i d e a n d s o g a v e h i m a s t r o n gi n ce nti ve to coo p er at e with the pros ecuti on byte sti fyi ng tha t M uoghal u had rec ei ved ki ckba cks ; t hus the evi dence potenti al l y had i m peachm ent v al ue.6 N o. 10

- 3873 Butdi d i t ha ve mor e i m pea ch m en t va l ue tha n the unconfi rm ed al l ega ti ons of pati ent deaths? Pro babl y no t, bec au se th ere is no in d ication th at L evat o knew m ore th an th e al l eg at i o ns . And a ny way, kno wi ngabo utthe HHS i nv e s t i g a t i o n M uo g ha l u’ s l a wy e r c o ul d ha ve re quested the r esul ts. Even i fthe c o nfi r mat i o n o fp a t i e ntde a ths wo ul d h a ve had an i ncre m entali m peachm ent valu e i n the cro ssex am ination of Lev ato, M uo g h a lu ’s l aw yer sure ly d idn ’t wantt o c o nne ct hi s cl i en t to a dr ug“ l i nk ed” t o pa ti en t deaths. But it w ou l d have be en i m possibl e t o connect Lev a t o b utn o tMuo g ha l u, wh o h a d b e e n pa i d $ 3 2 , 000 not to ya n k L o v en ox from St. J osep h h osp ital. A j ury to ld a b ou t t h e p at ien t d ea th s m igh t t h in k M u og h alu and Levato l i ttle betterthan a pai r ofm urdere rs . That mi g h t n o t b e a l e g i t i ma t e i n f e r e n c e ; f o r a l l we k n o w, M uoghal u w as unaw ar e that Love nox w as bei ng p resc ribed i napp ro pri ate l y, thatA venti s had be en acc used of en co ur ag i ngs uchpr es cr i pti o ns , a nd tha t dea th s had res ult ed

— the invest i gation by the Dep ar tm ent o f H eal tha nd Hum anS er vi ce s di d no t i den ti fy a ny de aths at St

. J ose ph. A nd an i nvest i gat i ve fi nd i ng car ri es l ess w ei gh t tha n a j ud i c i a l de t e r mi na t i o n a ft e r t r i a l o r an age ncy’ s dete rm i nation afteran a dvers ar i aladj ud i catio n . M u og h alu ’s la w ye r c ou ld h av e t rie d t o e x p lain all thi s to the j ury, but hi s e xplanat i on pro babl y would not h av e e ra se d th e in fer en c e t h at L e v at o a n d M u og h alu ha d b ee n e nda ng er i nghuman l i f e f o r fi na nc i alg ain. A s cases i n thi s and o ther cour ts have note d, see , e.g., P a yn e v. Tenn e s see, 501 U .S. 80 8, 81 9 (1 99 1); U nited Sta tesN o. 10

- 3873 7

v. Al varado- Tizoc, N o. 10 -1 6 1 3 , 2 01 1 W L 39 04 08 3, at *2 ( 7t h C ir. Sep t. 7, 20 11 ); M ilner v . Ap fel , 14 8 F

. 3d 812, 81 5 (7 th C ir. 19 98 ); U ni t e d S t at e s v. M ar t inez , 1 6 F

. 3d 202, 20 5-0 6 (7 th C ir. 19 94 ); U nited Sta tes v. Tha m , 118 F. 3d 1501 , 1 5 0 7 ( 1 1 th C ir. 19 97 ); U nite d State s v. Sm it h , 27F. 3d 649, 652-53 (D

. C

. Cir. 1994), o u r m oral cod e includ es a form ofst ri ct l i abi l i ty

— w hat ph i l oso phers cal l “m or alluck. ” S ee T h om as N ag el, “M or al L u c k ,” in N ag el, M or t al Q ue s t i ons 24 ( 1979 ) ; Bernar d W i l l i am s, “M or alLuck, ” i n W i l l i am s, M or al Lu ck: Phi l os ophi ca l Pape rs 19 73- 198020 (19 81 ); W ill i am s, “M or al Lu ck: A Pos tscr i pt, ” i n hi s bo ok M a k ing Sense of H um ani ty an d Othe rPhi l os ophi ca l Pape rs 19 82- 1993 24 1 ( 19 9 5 )

. T h e c o n c e p th a s i n fi l t r a t e d th e l a w. I ft wo dri ver s a re equal l y c ar el ess , and one dri verhas an acci dent i n w hic h another perso n i s k i l l ed and the o ther dri verhas no a cci dent, the fi rs t g ets ch ar ge d w i th hom i ci de an d t h e seco nd ge ts a t i cket( m aybe )

. Yet they’ d m ade i denti calchoi ces and perf or m ed i denti cal acts , and the diff er ence i n conse quences was a m att er pure l y o fchance

— b u t co nsequences eve n w hen f o r t ui t o us h a v e a n e ff e c to n o ure v a l ua t i o n o fthe g o o dness orbadness ofan a ct. Thi s eff ec t i s e m bedded i n the c r i m i na l c o de an d s en t e nc i ngg ui de l i ne s . S e e , e . g . , 1 8 U. S

. C. § 1 1 1 1 ( a ) ; U. S. S. G. §§ 5K2.1 , 5K2. 2, 5K2. 3, 5K2. 5; Kevi n Col e, “Kil l i ngs du ri ng Cri m e: Toward a D isc ri m i nati ng Theor y o fS tr i ct Liab i l i ty , ” 2 8 Am

. Cr i m . L. Re v. 73 , 74 (1 99 0). D es p ite all the e xplai ni ng away that M uoghal u or h i s l aw yer m i ght ha ve a tt em pted had the j ury been appri sed o f pat i en t dea th s f r om non - appr o ve d us es o fLo ve no x, the j ur y woul d ha ve be en l i k el y to i nfer th at f o r purely p ecu-8 N o. 10

- 3873

n i a r y g a i n Mu o g h a l u h a d r e fu s e d t o r e p l a c e a d r u gi mpli cate d i n pati ent deaths as a re sul t o fm i sco n d u ct byLo ve no x’ s m anufa ctur er ; tha t he ha d r i sk ed pat i en t live s, th ou gh p ro b ab ly u n w itt in gly ; an d th at w h ile m aybe no one had died atM uoghal u’s hos pit althe possibil ity ofa p atient ’s dea th cou ld n ot be ex clud ed

. So m o r all uckf av o r ed M uo g ha l u i n o ne s en se : there was no pr oof th at h e h ad ca u se d an y d ea th s. B u t ith u rth im i n another sense : h e m ay have contr ibuted to cr eat i ng a ri sk of de a th. A r i s k o f de a th i s no t a de a th, b ut i t i s a c on se q u en c e t h at w eig h s in p eo p le’s th in kin g e ve n if it w as cre ate d unintenti onal l y. H ad M uoghal u’s l aw yer to l d the ju dge a nd j ur y abo utthe r i sktha t hi s cl i en t ha d e nda ng er ed l i ve s, M uo g ha l u wou l d no w be a r g ui ng f ora new tr i alo n the gr ound ofi neff ecti ve ass i sta nce of c ou n se l. A risk of p atient d eath s w ou ld m ake j ud ge an d j ury th i n k w or se of L ev at o a s w ell, bu t t h e jur y m igh t w ell ha ve f o und him the mor e sy m pathe ti c o fthe t wo de f en dan ts
. He g o t o ffwi thpr o ba tion, m aybe b ec au se the g o ve r nm en t an d the j ud ge be l i ev ed th athe was the vi c ti m o fexto rt i on

— whi chi fs o made M uo g ha l u the extor ti oni st. A gai nst a l l thi s i t ca n b e a rgued that t o a “ re aso nabl e” j ur y t h e p atient de ath s cou ld be relevan t only to Lev ato’s c re dibi l i ty

— th ey co u ld n ot be rele va n t t o t h e t ru th fu lness ofM uogha lu’s deni alo fexto rt i on a nd cl ai m to ha ve g i ve n the t al ks f o r whi chhe was pa i d. But ev i den ce c ano fc o ur se b e i r r el ev an t y etpr ej udi ci al, a nd a c om p et en t la w ye r st riv es to ex c l u d e s u c h ev id en c e if h is c lien t w ou ld be th e v ict im o ft h e p rej u d ice . E ve n ifN o. 10

- 3873 9 th e e vid en c e o f p at ien t d ea th s w as lega lly re lev an t o n ly to L evat o’s cred ibi li ty, its p resen tation to t h e ju ry woul d ha ve b een prej udi ci alt o M uo g ha l u b y a ss o ci at i ng hi m with pat i ent deaths fro m i l l ega l pro m oti on o f L ov en ox . I t is d ou b tfu l th at its p rej u d icia l e f f e c t w ou ld ha ve bee n offset by its e ff ect in u nd erm ining L evat o’s te sti m o ny, a nd i fthe e ff ec ts wer e o ff se tt i ng, the ev i den ce woul d no t h av e be en Bradym at er ial. In deci ding w hetherevidence i s Bradym ate ri al

— that i s, w hether i f known to and use d b y the defe nse i t w ou ld ha v e i nc r e a s e d the c ha nc e s o fa n a c qu i t t al

— th e cour t has to d et er m i ne the l i kel y neti m pact o fthe evi dence, with re al i sti c awarene ss ofprej ud i ce a s wel l as pro bati venes s. I n any eve nt, as we sai d ear l i er, a dist i nct r eas on a gai nst inferri ng a viol ation of Bradyi s tha t th e g o ve r nm en t had al re ady ar m ed M uoghal u w i th al l the i nfo rm ati on th at h is l aw yer cou ld h ave u sed to i m p each Le vato’s tes ti m ony. T h e s ec on d g r o u n d of ap p ea l is th at th e jud ge sh ou ld ha v e a ll ow ed the law yer m ore l eew ay at trialto exp lore the inter vi ew o fhi s cl i ent b y the FD A ag ent. The l aw yer w anted to be al l owed to ask the age nt on cr oss - exam i nat io n w h e th er M uo gh alu ha d asked f or the p resen ce of a l aw y e r d u r i n gth e i n t e r v i e w. We d o n ’ tu n d e r s t an d the r el evance o fthe questi on, and so we thi nk t h e j ud ge w as ri ght t o f orb id it

. M uoghal u w as not und erar re st w hen he was i nter vi ew ed, and so he c oul d h av e r efused to be inter vi ew ed had the a ge nt r efused to i nter vi ew him i n th e pres en ce of a l aw yer. M uoghal u ’s lawyer al so w anted hi s cl i ent t o be p erm itted to testify t o w h a t he h ad said d uring the inter-10 N o. 10

- 3873 vi ew . The ag ent t est i fied to hi s o w n ver si on o fwh at ha d b ee n s ai d, a nd tha t ve r si o n i nc l ude d f at ala dm i ss i o ns byM uo g ha l u. M uo g ha l u c o ul d, wi th o utvi o l at i ngthe hear sayr ule , have te sti fi ed to wh at ha d been s ai d at the intervie w ( w hi ch had not been re cor ded ) ; but w hen the j ud ge rej ecte d the r equest ofM uoghal u’s l aw yer that hi s cl i ent b e per m i tt ed t o testi fy t o w hat had be en sai d, the l aw yerm ade no off ero fpro of

— no i nd i cati on ofwh at he tho ught such quest i oni ng wo u l d produce tha t wo ul d b e mat e r i a l

. By f a i l i ng t o mak e a n o ff e r o f proo f, he for f ei ted a chal l enge to the j ud ge’ s r uling. F e d

. R . E vid . 103 (a)( 2); U nite d State s v. B artl et t, 56 7 F

. 3d 901, 910 (7th C ir. 2009). Anyway the ch all en g e ha s no mer i t. Rul e 10 6 o fthe F ede r alRul es o fE vi den ce pr o vi des tha t “whe n a wri ting orr ecorded sta tem ent o r part ther eofi s i ntro du ced by a party, an a dvers e par ty m ay re quir e the i ntro du cti on at that ti m e o fany othe r part orany othe r w ri ti ng o r r ec o r ded st atem en t whi cho ug htin f ai r ne ss t o b e co nsi der ed co nt empor an eo us l y wi thi t” ; a nd underthe nam e “ rul e o f c om ple tenes s, ” the pri nci ple o fRule 10 6 h as be en ex te n d ed to n on re c or d ed s t a te m en ts
. U nited Sta te s v. P ri ce, 516 F.3d 597, 604-05 (7th C ir. 2008); U ni ted Sta t e s v. Li, 55 F. 3d 325, 329-30 (7th Cir. 19 95 ); U ni t e d S t at e s v. Range, 94 F. 3d 614, 62 1 ( 11th Ci r . 1 99 6)

. How r ul es pr o l i f er at e i n Am er i ca n l aw! One do es n’ t ne ed a r ul e o f“ co m pl et en es s” t o a l l o w a de f en dan t to te s t i fy, i n th e c a s e o fa n u n r e c o r d e d i n t e r r o g a t i o n, th atthe i nt er r o g at o r ’ s ve r si o n o fwhat th e de f en dan t sa i d i s f al se , o r was t ak eno uto fc o nt ex t; a nd i n the l at te r i ns ta nc e th e defen dan t ca n te st i fy to the cont ex tN o. 10

- 3873 11 ( “sur ro und i ng ci rcum stan c es” )

. But M uoghal u’s co unsel h a s n e ve r in d ica te d w h at h is c lien t w ou ld h av e s aid h a d h e b e e n p e r mi t t e d t o t e s t i fy ab o u tth e i n t e r v i e w. A FFI RMED
.

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