FI L ED U.S. COURT OF A P P E A LS E LE V EN T H C IR C U IT J ANUARY 17, 2008 THOMAS K. KAH

N CL ERK

Honora ble J . Owen F orre ster, Senior United States District Judge for the N orthern * District of Ge org ia, sitting by designation. [ PUBLISH] IN THE UN ITED STATES COURT OF APPEALS FO R T HE EL EV EN THCIRC UI T

____ ____ ____ ____ ____ ____ N o. 06- 1407 6

____ ____ ____ ____ ____ ____ D. C. Docket N o. 05-000 23-CR-5-001-MCR UNITED STAT ES OF AMERIC A, Pl ai nt iff -Ap pe ll ee, ve rs us THOMAS G. MERRILL, Defen da nt -Ap pe ll an t.

____ ____ ____ ____ ____ ____ Appeal f rom the United State s District Court for the Northern District of Florida

____ ____ ____ ____ ____ ____ _ (J an ua ry17, 200 8) Be fo re E DMO ND SO N, Chief Judge, H UL L, Circuit Judge, and FO RRE ST ER , * District Judge.18 U. S.C. § 1 34 7 s tate s: 1 Whoever knowing ly

and willfully

executes, or attempts to ex ecute , a sche me or artifice -- (1) to def raud a ny health ca re be nefit program; or (2) to obtain, by

means of f

alse or f raudule nt pretense s, repr esentations, or promises, any

of the money

or prope rty

owned by , or under

the custody

or control of, a

ny health ca re be nefit program, in connec tion with the delivery of or pa y ment for he alth car e bene fits, items, or service s, shall be fined unde r this titl e or imprisoned not more than 10 year s, or both. I f the violation results in serious bodily injury (as de fined in sec tion 1365 of this ti tle), such pe rson shall be fine d under this title or imprisoned not more than 20 year s, or both; and if the violation results in death, suc h person sha ll be fined under this title, or imprisoned for a ny term of year s or for life , or both. 2 FO RRE ST ER , D istrict Judg e: I. BACKG ROUND Fr om 199 4 un til 200 4, D r. T hom as Me rr ill ( “ Me rr ill ”) , an os te opath licensed to practice m edicine in Florida and registered under the Controlled Subs ta nc es Act, 2 1 U.S.C. § § 8 01 , et se q. , operated a clinic in Apalac hicola, Fl or ida . O n Augus t 2, 200 5, the G ove rnm ent f ile d a100 -c ount

ind ic tm ent a ga ins t Me rr ill . T he ind ic tm ent c harg ed Me rr ill w ithvari ous co unt s of w ir e fr au d ( Co unt s 1-18), health care f

raud (Counts 19-24 ), and illegally prescribing narcotics 1 outsi de the course of professional practice under the Controlled Subs tance A ct (Counts 25 -100). N ine of the counts in the indictm ent alleged that death resulted fr om e ith er the he al th c ar e fr au d or

the use of

the narc oti cs pr es cr ibe d outsi de the co ur se of pr of es sio na l pr ac tic e (C ount s 20 -2 4, 39, 65, 69, and 7 8) . O n January 30, 2006 , Me rr ill w as c onvi ct ed of 98 o f the 100 c ount s. H e w as se nte nc ed on3

July 10, 2006, to serve various concurrent sentences of five, ten, and twenty y ears on n ine ty -tw o of

tho se c ount s. H e w as a lso se nte nc ed to lif e im pr iso nm ent onsix of the c ount s to r

un c onc ur

re ntl y w iththe oth er

se nte nc es . H e ap pe al s hi s co nvi ct ion s. W e af

fi rm Me rr ill ’ s c onvi ct ion s. At tria l, the G overnm ent presented the expert testim ony of D r. Theodore Parr an , aboard -c er

tif ie d inte rn al m ed ic ine phy sic ian w ithsub -s pe ci al ty tr ai nin g in ad dic tio n m ed ic ine . D r. P ar ran, who w as qua lif

ie d a s an e xpe rt

in the are as of pa in m an ag em ent, a ddi ct ionm ed ic ine , and p re sc ri bin g c ontro lle d su bst an ce s, te st ifi edba se d o n h is rev ie w of e ig ht y pa ti en t fi le s. T his te sti m ony

and the doc um entary

e vid en ce de m onstrate d th at Me rr ill wro te m ult ipl e pr es cr ipt ion s f

or similar co ntr oll ed

sub stanc es f

or the sam e patie nt dur ing the sam e vis it; that he wro te pr es cr ipt ion s f or patie nts on whom

he pe rf orm ed no o r ve ry

m ini m al phy sic al e xam inatio n; that he f ai le d to obt ai n ol d or prior m edical re cords on his patients; that he failed to log all prescr iptio ns written fo r his patie nts in the ir

c hart s; that he f

ai le d to r un t es ts, inc lud ing tox ic olo gy screens, rec omm end phy sical therapy , or order consultation s with a specialist; that he wro te pr es cr ipt ion s f

or patie nts whose be havio r an d phy sic al appe ar an ce sho uld have r ai se d su spi ci on that the y w er e ad dic te d to c ontro lle d su bst an ce s; that he wro te pr es cr ipt ion s f

or his e m plo y ee s; that he wro te pr es cr ipt ion s f or at l ea st o ne4

patie nt who h e ha d he ar d w as se lli ng the pr es cr ibe d dr ugs; that he wro te pr es cr ipt ion s f

or at l ea st tw o patie nts who h ad a lte re d pr es cr ipt ion s; that he wro te prescriptions for at least one patient who had overdosed on controlled sub stances dur ing his c ar e; that the tr en d inhis pr es cr ibi ng w as to inc re as e a patie nt’ s do sa ge and num ber of pills with eac h prescription even on occasions where the files indicated that the patient h ad “ no new com plaints”; th at he fr equently ref illed prescriptions early

without any

subsequ ent docum entation in the charts; and that he ign or ed

w ar nin gs o f poss ibl e ad dic tio n f ro m ins ur an ce c om

panie s, pharm ac ie s, an d e ve n pr ev iou s do ct or s. D r. P ar ran te sti fi ed

that the se pr ac tic es are ir re gul ar , dange ro us, and are not the le git im at e pr ac tic e of m ed ic ine . D r. P ar

ran r ep eate dly

state d th at

pr es cr ipt ion s wr itten to particular patients appear to be outsid e the usual course of m edical pr ac tic e an d f

or oth er than le git im at e m ed ic al pur pose ( e. g. , R 15- 222 at

69, 78, 83, 88, 103 , 110 , 113 , 123 , 125 , 132 , 136 , 139 , 144 , 151 , 146 , 156 , 160 , 163 , 165 , 168-69 , and 17 2). At tim es during hi s testim ony , D r. Par ran char acter ized Me rr ill ’ s pr es cr ipt ion -wri tin g be havio r as “unbe lie vable , ” as “ aninv itatio n to di sa st er,” as “ il l-a dv is ed ,” as “ in ap pr op ria te ,” “ in co nc ei vabl e,” “bi zarr e,”

“ as ton ish ing , ” an d “ inc re dib le ” (R 15- 222 at

84, 103 , 109 , 118 , 126 , 156 , 163 , and 1 6 7 ) . M e rr i l l d i dn o to b

je c tt o th e a dmi s s i o no f

an y o f th i s t e s t i mo n y.5

Me rr ill w as c harg ed

w ithhe al thc ar e fr au d and w ithe ith er f ra udul ent a ct s or unl aw fu lly

dis pe nsi ng c ontro lle d su bst an ce s r es ult ing in the de ath of Br idg ette Persinger, Le slie Dy er, De anna Hay es, K enneth Noles, and Katherian S eay . In ea chc as e the m ed ic al e xam ine r who p er fo rm ed the auto psy

on e ac h vi ct im determ ined the cause of death to be drug overdos e of a controlled substance which Merr ill had recently

prescribed (R

12-219 at 14 0, 208, 260, 279 and R 13-220 at 113). Me rr ill c ont en ds that the dis tr ic t c ourt e rr ed in sixw ay s. Me rr ill c ont en ds that the re w as ins uf

fi ci ent e vid en ce at tri al to supp ort c onvi ct ionon the c ount s in the ind ic tm ent c harg ing him w ithpr ovi din g c ontro lle d su bst an ce s to patie nts which re sulted in their deaths. M errill also asserts that the trial c ourt adm itted an av al an ch e of

pr ej udi ci al and i rr el ev ant e vid en ce in the f orm of pr es cr ipt ion s of Merril l’s p at ie nt s wh o wer e n otth e subjec t o f an y co un t i n t he in di ct m en t. He cl ai m s he w as pr ej udi ce d by the tr ia l c ourt’ s de ci sio n to m ove the tr ia l f ro m Panam a Ci ty

to Pe nsa co la , whic h he c ont en ds w as an in co nve nie nt f or um . N ex t, Me rr ill ave rs that the tr ia l c ourt wro ngl y ins tr uc te d th e j ur

y a s to int ent and im perm issib ly

shifted the burden of proof to th e D efendant. Merr ill argues that A ssi stant Unit ed

S tate s A tto rn ey

K unzc om m itt ed pr ose cutor ia l m isc ondu ct in m isrepresenting evidence to the court and th e j ury . Merr ill claim s that he was6

denied effec tive assistance of counsel. Finally , Me rrill asserts that the trial c ourt wr ongl y dism issed an Afr ican-A m erican juror im m ediately after the j ury had been ch ar ge d. F or

a ll of the se r ea sons , Me rr ill r eque sts thi s c ourt r ev er se his c onvi ct ion an d r em an d th e m atte r fo r a ne wtr ia l. II. D ISCU SSION A. Suf

ficienc y of the Evidenc e Innin e co unt s, Me rr ill w as c harg ed w ithc om

m itt ing a ct s th at

r es ult ed in the de aths o f fi ve patie nts : B ri dge tte P er sin ge r, L es lie D y er , D eannaH ay es , K enne th N ole s, and K athe ri anS eay . Me rr ill c la im s th e G ove rnm ent pr es ente d in suf fi ci ent ev ide nc e at

tr ia l t o pr ove his a ct ion s r es ult ed in the se de aths. S pe ci fi ca lly , Me rr ill claim s that each of the patients who died wa s usin g illicit drug s, alc ohol , and oth er pr es cr ipt iondr

ugs. Me rr ill f

urthe r co nte nds that the re w as no e vid en ce at tri al by whic h it c oul d be de te rmine d th at any one of the de ce as ed

patie nts did

a ct ua lly in ge stth e dru gs pre sc rib edby Merri ll . T he de te rminatio n of

whe the r the r ec or d c ont ai ns s uf fi ci ent e vid en ce to supp ort a ju ry ’s ver di ctis a qu es ti on of l aw whi ch we rev ie w de novo. U nited Sta tes v . B

yrd , 403 F . 3d 1 278, 128 8 ( 11th C ir . 200 5) ( ci tin g United States v. H arr is, 20 F . 3d 4 45, 452 ( 11th C ir . 199 4) ). I n th is t as k, “ w e vie wthe e vid en ce in the lightm ost favorable to the gov ernm ent,” draw ing “ all rea sonable inferences7

an d c red ib il it y

ch oi ces ” in th e Gov ern m en t’s fa vo r. Id . A s M er ri ll state s inhis br ie fi ng, “ [i ] t i s no t ne ce ssary that the e vid en ce e xc lud e ev er y r ea sona ble hy pothe sis of

inn oc en ce or

be whol ly

inc onsi ste nt w ithe ve ry

c onc lus ione xc ep t that of guilt, provid ed that a re asonable trier of f act could find that the evidence established g uilt bey ond a reasonable doub t.” H arr is , 20 F . 3d at 45 2 ( ci tatio n om itt ed ). “ Ac onvi ct ionm ust be uph el d un le ss the j ur

y c oul d no t have f

ound the defendant guilt y

under any

rea sonable cons truction of the evidence.” B yrd , 403 F. 3d at 12 88 ( quot ing U

nited Sta tes v . Ch astain , 198 F.3d 1338 , 1351 (11th Cir. 1999 )). W ith regard to Merr ill’ s first contention that each of these patients who died ha d othe r subs tanc es , suc h a s a lc ohol , il lic it dr ugs, or pr es cr ipt ionm ed ic ine , not pr es cr ibe d by

Me rr ill in the ir

sy ste m s at the ti m e the y

die d, the G ove rnm ent put on the w itn es s st an d th e m ed ic al e xam ine r who p er fo rm ed the auto psy

on e ac h of th e s e p a t i e n t s . I ne a c hc a s e th e me d i c a l e x ami n e r t e s t i f i e dth a tdr

u g s o f th e s ame ty pe a s pr es cr ibe d by

Me rr ill w er e the c au se of de ath. In sof ar a s M er ri ll is c ont en din g th at

the G ove rnm ent f

ai le d to sho wthat hi s patie nts ’ de aths w er e ca

use d by the dr ugs he pr es cr ibe d a s op pose d to dr ugs prescribed by

other doctors or obtainedon the street, w e find that there w as suf fi ci ent e vid en ce f

or ar ea sona

ble tr ie r of

f ac t t o f ind gui lt be y ond a re as ona

ble8

doub t. W ith in tw o- an d- a- ha lf w ee ks o f the ir

de aths, Me rr ill pr es cr ibe d f or e ac h of these patients the exact ty pe of drug the m edical exam iner found to have caused the ir de aths. I n thre e ca se s, the re w er e ev enpil l bo ttl es or pr es cr ipt ionm ed ic ine spe ci fi ca lly

pr es cr ibe d by

Me rr ill in the im

m ed iate vic ini ty

of the de ce as ed . Whil e the G ove rnm ent di d no t e xc lud e ev er y r ea sona ble hy pothe sis of

inn oc en ce , by showing th at Merr ill was the only source of the patients’ m edications, a j ury under a r ea s o n ab l e c o n s tru ct i o no f t h e e v i d en ce , c o u l dh av e f o un dth atMe rr i l l ’s pr es cr ipt ion s w er e the a ct ion s whic h le d to the se patie nts ’ de aths. B. Evidenc e of Ot her Pr escript ions Merr ill contend s that the dist rict court abused its discretion when it allowed the G ove rnm ent t o intr oduc e ev ide nc e of m or e than 33 , 000 pr es cr ipt ion s f or co ntr oll ed

sub stanc es that M er

ri ll wro te be tw ee n January 200 1 and M ay

200 4 and a ch ar t sum m ar iz ing the se pr es cr ipt ion s be ca use suc h e vid en ce w as ir

re le vant and pr ejud ic ia l. During the course of its investigatio n, the G overnm ent subp oenaed pharm acy rec ords of all the prescriptions written betwe en January 2001 and May 2004 whic h c ont ai ne d M er ri ll’ s D E Ar eg istratio n num be r. Apharm ac ist

m ust use his uni que D E Ar eg istratio n num be r to p re sc ri be c ontro lle d su bst an ce s. O ne hund red thirteen pharm acies re spon ded to the Governm ent’ s request and producedControlled substances a re a subset of drug s that car

ry a risk of a

buse or misuse. As 2 Professor D oeringexplained duringMerrill’s trial, there a re f ive levels, or sc hedules, of controlled substanc es. Schedule Idrug s, such as he roin, are drug s with no medical bene fit, and they have the highe st level of abuse or misuse. Schedule I Idrug s have a rec ognized medical benef it, but they

“re quire the highest degree of scr utiny and super

vision in t erms of making sur e they don’t end up in the wr onghands.” Sche dule I I I -V drug s have f ewe r controls than Sche dule I or I Idrug s, and the major dif fer ence amongthe three schedule s is the degreeof punishment for not handling the m properly . (R 13-220, at 13-17) . Hydrocodone is the active ingredie nt in pain relieve rs such a s Vicodin and L ortab. (R 3 13-220, at 16). Diazepam, or V alium, and alprazolam, or Xanax, are be nzodiaz epines whic h are often 4 used to reduc e anxiety

or help pe ople sleep. ( R 13-220, at 21-22). Oxy codone is a

power ful pain-r elievingmedicine de rived fr om opiates like morphine. 5 Oxy codone c omes in immediate rele ase f orms such as Per codan, Per coce t, and Tylox , which rele ase a high dosa g e of oxycodone immediate ly and provide short-term pa in relief, a nd continuous relea se for

ms such as Oxy Contin, which relea se a lowe r dosag e of oxycodone continuously

over a twelve- hour period in order to provide long te rm pain re lief. (R 13-220, at 19-20). 9 m or e th an33 ,00 0 p res cri pt io ns id en ti fie d wi th Merr il l’s DEA reg is tra ti on nu m be r. T he G ove rnm ent i ntr oduc ed the se pr es cr ipt ion s, 99. 4% of whic h w er e ac tua lly

f or co ntr oll ed

sub stanc es . O f the c ontro lle d su bst an ce pr es cr ipt ion s, 81% w er e fo r 2 four particular drugs: hy drocodon e (Sc hedule II) ( 12,405 prescription s), 3 dia ze pam ( 5, 907) ( Sc he dul e IV ), oxy co done ( 4, 464) ( Sc he dul e II ), and

4 5 alprazolam

(4,326) (S chedule IV ). T he Governm ent, through an intellig ence an al y st w iththe N at ion al D ru g I nte lli ge nc e Ce nte r, a lso c om pil ed and i ntr oduc ed

a de ta ile d sum

m ar y of thi s m at er ia l. T he sum

m ar y c ont ai ne d f

ive ta bs whic h ( 1) d e t a i l e de a c hp a t i e n t ’s n ame, p r e s c r i p t i o nnu mb e r , wr i t e d a t e , f i l l d a t e , qu an t i ty,The full name s of the two patients have bee n remove d out of respe ct for the ir privac y 6 and that of the ir fa mil ie s. For example, Merrill presc ribed B P seven controlled substanc es on Mar ch 22, 2002. 7 For example, Merrill presc ribed two be nzodiaz ephines, Xa nax, or alprazolam, and 8 Dalmane , or flurazepam, to BP on April 23, 2002. (R 13-220, at 33). Professor D oeringtestified as to how pre scriptions are normally filled. “Ge nera lly , an 9 ins ur anc e c omp any

wi ll o nly pa y fo r a month’ s w or

th o f m e dic atio n. So ty

pic a lly a thr e e -t ime sa-da y medication would be issued f or 120 of [the] dosage units.” (R 13-220, at 32). H ere , for example, Merrill presc ribed B B thirty diazepam on J anuar

y 12, 2004, and six ty

diazepam on J anuar y 13, 2004. BB also filled a Me rrill presc ription for 75 hydrocodone /apap on Ma rch 10, 2003, and filled one for 75 more a mer e thre e day s later. 10 drug nam e, strength, total m illigram s, and pharm acy ; (2) ca lculated the total num be r of pil ls and p re sc ri pti ons fo r ea chpatie nt f or e ac h dr ug; ( 3) dis play ed

the total num ber of pills prescribed of ea ch drug; (4) calculated what percentage e ach dr ug r ep re se nte d inthe tot al num be r of c ontro lle d su

bst an ce s pr es cr ibe d; and ( 5) displ ay ed the total m illigram s prescribed for e ach of the five m ost prescribed drugs. An excerpt of the tab one data f or two patients is attached to this op inion as E xhi bit 1 a s an e xam

ple of the ty pe of datathi s sum

m ar y il lus tr at es . T his e xc er

pt 6 re ve al s th at

Me rr ill pr es cr ibe d th e sam e patie nt m ult ipl e co ntr oll ed

sub stanc es in a giv envis it; that M er

ri ll pr es cr ibe d m

ult ipl e dr ugs fr om the sam e dr

ug c at eg or

y to 7 a giv enpatie nt d

ur ing agiv envis it; that M er ri ll re -a uth or iz ed pr es cr ipt ion s f

or 8 the sam e controlled subs tance w ithin less than a m onth of eac h other; and that 9F or e xamp le , M e rrill pr e sc ri be d B P tw o- mil ligra m st re ngth X anax, wh ic h is the highe st 10 strength of that particula

r medication. (R 13-220, at 3). Mer rill also prescribed Dalmane , or flurazepam, at the higher stre ng th of 30 milli grams, and instruc ted B P to take not one but two at bedtime. (

Id. at 33). 11 Me rr ill f re que ntl y pr es cr ibe d hi gh d ose s. T he dis tr ic t c ourt a dm itt ed both th e 10 indiv idual prescription s and the summ ary over defense c ouns el’ s objection that no t al l o f th e d oc um en ts were re la te d t o t he co un ts of t he in di ct m en t. W e re view the district court’ s evidentiary rulings o n the indi vidu al pr es cri pt io ns an d t he su m m ary fo r cl ear abu se of d is cret io n. United States v. Bake r , 432 F. 3d 11 89, 1202 (11t h Cir. 2005 ). “ An abuse of discretion arises when the dis tr ic t c ourt' s de ci sio n r es ts u pon a cl earl y

e rr one ous fi ndi ng o f fa ct , an e rr ant conclusio n of law, or an im proper application of law to fa ct.” Id . T he district court has broad discretion to determ ine the relevance and adm issib ility of any given pi ece o f ev id en ce. U

nited Sta tes v . Sm ith , 45 9 F .3d12 76 , 12 95 (11 th Cir . 20 06 ). E vid en ce is adm iss ibl e if r el ev ant and o nly

r el ev ant i f it ha s “ any

te nde nc y to m ak e the e xis te nc e of

any f ac t that i s of

c onse que nc e to the de te rminatio n of the action m ore probable or less probable than it would be withoutthe evidence.” Fe d. R. E vid . 401 , 402 . T he dis tr ic t c ourt a lso ha s th e dis cr et ionto ex cl ude re le vant e vid en ce if

the c ourt f

ind s th at the pr obativ e va lue of

the e vid en ce “ is subs tanti al ly

outw ei ghe d by

the dange r of

unf ai r pr ej udi ce , c onf

usi on o f the issues, or m isleading th e j ury , or by considerations of undue delay , w aste of tim e,12

or ne ed le ss p re se ntatio n of

c um ulativ e ev ide nc e. ” F ed . R. E vid . 403 . “ But R ule 403 is an e xtr ao rd inary

r em edy whic h sh oul d be use d on ly spari ngl y

sin ce it pe rmits the tr ia l c ourt t o e xc lud e co nc ed ed ly pr obativ e ev ide nc e. I n c ri m ina l tri al s re le vant e vid en ce is inh er ently pr ej udi ci al . [ T hus, t] he r ule pe rmits e xc lus iononl y when unfair pr ej udice subs tantially outweighs probativ e value.” United States v. B etanc ourt , 734 F . 2d 7 50, 757 ( 11th C ir . 198 4) ( co ntr oll ed sub stanc e ca se ch ar gin g phy sic ians) . T he re fo re , whe n r ev ie w ing the dis tr ic t c ourt’ s de ci sio n to ex cl ude agiv enpie ce of

e vid en ce , “ w e loo k at the e vid en ce in a lig ht m ost favor ab le to its a dm iss ion , m ax im iz ing it s pr obativ e va lue and mini m iz ing it s undu e prej udicial im

pact.” United States v. B rown , 441 F . 3d 1 330, 136 2 ( 11th Ci r. 200 6) . Unde r thi s e xtr em el y de fe re nti al standard , w e w ill loo k to the ev ide nc e as awhol e an d de te rmine whe the r the spe ci fi c ev ide nc e que sti one d by Merr ill was adm issib le under Rules 401-403 in ligh t of all the evidence that w as ul ti m at el y

be fo re the co urt. L ooki ng at the c ha lle nge d e vid en ce in thi s li ght , w e have de te rmine d th at it w as r el ev ant and that i ts p ro bativ e va lue w as not outw ei ghe d by

it s po te nti al f

or pr ej udi ce . T he G ove rnm ent i ndi ct ed Me rr ill f or de vis ing asc he m e to d ef ra ud Medicaid and other insurance providers. (R 1-3, at 6). As part of the schem e, Merr ill was alleged to have “prescrib[ed] excessive and inappropriate quanti ties13

an d c om bin at ion s of

c ontro lle d su

bst an ce s to patie nts out sid e the usu al c our se of professional practice. ” (

Id . at 7) . T he G ove rnm ent a lso ind ic te d M er ri ll on num er ous co unt s of

dis pe nsi ng c ontro lle d su bst an ce s invio latio n of

the Co ntr oll ed

S ubst an ce s A ct , 21 U . S. C. § 84 1. In order to law fully

possess or dispense a controlled substance a doc tor m ust f ulf ill tw o r equir em ents. H e m ust be law fu lly

li ce nse d to pr ac tic e m ed ic ine and h e m ust be r eg ist er ed

by the D ru g E nf

or ce m ent A dm ini str at ion . D oc tor s th at are r eg ist er ed

are the n auth or iz ed

to poss ess, distribute or dispens e controlled subs tances. How ever, they m ay do so on ly

in the usual cou rse of profe ssion al practice and for a legitim ate m edical purpose. B etanc ourt , 743 F . 2d at 75 7. A t tri al , Me rr ill c la im ed that he ha d no t vi olate d th e Controlled Subs tances A ct because all his controlled sub stance prescr iptio ns were m ad e in go odfai th an d fo r le gi ti m at e m ed ic al pu rp os es . The individual prescription s and summ ary we re r elevant to prove that Me rr ill pr es cr ibe d “ ex ce ssi ve and i na ppr opr iate quanti tie s and c om bin at ion s of co ntr oll ed

sub stanc es ” an d th at

in doi ng s o he a ct ed

“ out sid e the usu al c our se of pr of es sio na l pr ac tic e. ” F ir st, the G ove rnm ent c oul d on ly pr ove “ ex ce ssi ve and ina ppr opr iate quanti tie s and c om bin at ion s” by

pr es entin g e vid en ce on the quanti tie s and c om

bin at ion s th em se lve s and the n c om pari ng those quanti tie s and co m bin at ion s to ar el ev ant no rm to showthat the y

w er e ex ce ssi ve and ina ppr opr iate . T he sum

m ar y w as thu s r el ev ant t o e sta bli sh the quanti tie s and14

co m bin at ion s th at

Me rr ill w as pr es cr ibi ng, and i f the sum m ar y it se lf w as r el ev ant, the indiv idual prescription s underly ing it were likewise re levant. T he indiv idual pr es cr ipt ion s and the sum m ar y are ide nti ca l datase ts arr ay ed in tw o di ff

er ent fas hi on s. Th e su m

m ary is m erel y

a tabu la r fo rm

of t he in di vi du al pre sc rip ti on s. T he G ove rnm ent r el ie d onthe te sti m ony of P ro fe sso r D oe ri ng and D r. P ar ran to pr ovi de the r el ev ant no rm . T he ir te sti m ony

r ev ea le d th at

the she er vol um e of ab usa ble dr ugs co nta ine d inthe sum m ar y r ai se d an in fe re nc e of

e xc es siv en es s and im pr opr ie ty . H av ing r ev ie w ed the sum m ar y , P ro fe sso r D oe ri ng t es tif ie d: [A ] s I r ea d thro ugh tho se pr of ile s, I tho ught , oh, goo dne ss, thi s is not right, there is som ething wrong here. And what I saw , a s I re viewed th es e p ro fi l es , wa s a p at t erno f o v er p re s cr i b i n g . An dal th o u g hI’m not te sti fy ing ne ce ssari ly

about the appr opr iate ne ss o f ea chone in a giv enpatie nt, I tho ught , w ow , the re is som ethin g no t r igh t a bout thi s who le pa ck et . (R 13- 220, at 51 ). D r. P ar

ran te sti fi ed : [A ] pr es cr ipt ion[ patte rn ] li ke thi s w ith81 p er ce nt o f the pr es cr ipt ion s ove r a fo ur -y ear pe ri od o f tim e be ing c ontro lle d dr ugs of one of the se thr ee – f our gr oups is som ethin g th at I w oul d be e xc ee din gly co nc er ne d a bout , e ve n if

ape rs on w as an on co log ist w orkin g on ly

in a hospice, I’ d be exceedingly concerned about. T o decide whether an ind ivi dua l pr es cr ipt ionw as f or le git im at e m ed ic al pur

pose or w ith in the c our se of

usu al m ed ic al pr ac tic e re qui re s lo oki ng at the c hart of that i ndi vid

ua l patie nt. (R 1 5- 22 2, at17 3) .15

Second, the f

requency and doses of the prescription s in the summ ary raised an inference of excessiveness and im propriety . The sum

m ary revea led that patie nts w er e co m ing in fo r vis its le ss than tw o w ee ks a part to re ce ive m ax im

um dose pr es cr ipt ion s of

the sam e dr

ug. T he e xpe rt

pharm ac ist

te sti fi ed : Wh e nI f i r s tl o o k e datth e s e . . . I w a s h o rr i f i e d . I h a dt o s h ak e my he ad and c le ar m y e y es to m ak e sur e I w as r ea din g it c or re ct ly , that i n fa ct , the y w er e al l i ssu ed

to the sam e patie nt o n th e sam e day in quantit ies that for m ost of the m eds are the m axim um doses or sup er m ax im um dos es . And I tho ught

no, y ou’ ve got

to be kid din g m e, not fo r on e p at ie nt , no t fo r th e sa m e p at ie nt . (R 13- 220, at 36 -3 8) . T hir d, the num be r of dr ugs be ing pr es cr ibe d to e ac h patie nt and the com

binatio n of drugs bein g prescribed to each patient raised an inference of ina ppr opr iate and e xc es siv e co nduc t. T he sum m ar y r ev ea le d th at

som e of the patie nts w er e pr es cr ibe d up to se ve n or e igh t dr ugs on the sam e day . T he pharm acist testified, “ Anytim e y ou get – it’s a reality that anytim e y ou get m ore than aboutthree or f

our drugs o n the sam e patient, that y ou’r e in serious troubl e – serious jeopardy

of having sid e ef

fects and unexpected outcom es.” (R 13-220 , at 46) . T he sum

m ar y a lso r ev ea le d th at

Me rr ill pr es cr ibe d m

ult ipl e dr ugs fr om the sam e dr ug c at eg or

y to the sam e patie nt at the sam e tim e, f or e xam ple , pr es cr ibi ng tw o be nz odi az ep ine s. T he se pr es cr ipt ionc om bin at ion s are a lm ost

pe r se out sid e the sc ope of

usu al m ed ic al pr ac tic e. “ T he re is no l eg iti m at e m ed ic al pur pose f or the com binin g prescribing of valium [a benzodiazephine] and xanax [aF e d. R. E vid . 4 04 (b ) s tate s, “ Ev ide nc e of oth e r c ri me s, wr on g s, or

a c ts i s n ot a dmi ssi ble 11 t o p r o v e th e c h ar a c t e r

o f a p e r s o ni no r d e r

t o s h o wa c t i o ni nc o n f

o r m i ty th e r e w i th . Itm ay, ho we ve r, be a dmi ssi ble fo r o the r p ur po se s, su c h a s p ro of

of mot ive , o pp or

tun ity , inte nt, prepa ration, plan, knowle dg e, identity , or abse nce of mistake or ac cident . . . .” 16 be nz odi az ep hin e] , e ac h of the m tw o or thr ee ti m es aday

in the sam e patie nt at the sam e tim e. T here j ust isn ’ t. T hey are very sim ilar drugs, and prescr ibing them bo th to ge th er m ak es no cli ni cal sen se .” (R 1 5- 22 2, at54 ). Me rr ill arg ue s th at

e ve n if thi s e vid en ce is re le vant, it sho uld be ina dm iss ibl e as e vid en ce of unc harg ed

c ri m ina l a ct ivi tie s or

“ba d a ct s” und er

F ed . R. E vid . 404 (b ). A s di sc uss ed above , e vid en ce of

the quanti ty

and c om bin at ion 11 of pr es cr ipt ion s M er

ri ll wro te dur ing the r el ev ant pe ri od i s di re ct ly r el at ed to the iss ue of whe the r Me rr ill c om

m itt ed he al th c ar e fr au d by

“pr es cr ib[ ing ] e xc es siv e an d in ap pr opr iate quanti tie s and c om bin at ion s of

c ontro lle d su

bst an ce s to patie nts outsi de the usual course of professional practice” and whether Mer rill wa s relieved of liability

under the Controlled Subs tances A ct because he a cted in the “ usual co ur se of pr of es sio na l pr ac tic e. ” Aj ur

y m ay c onsi de r pr es cr ipt iondatase ts outsi de those specifically charged in the indictm ent to determ ine whether a phy sician has exceeded “ the legitim ate bounds of m edical practice ” and “ as evidence of a plan, design, or schem e. ” Se e U nited Sta tes v . H

arr iso n , 651 F . 2d 353, 355 ( 5thCi r. Jul y

20, 198 1) . T hus, thi s e vid en ce w as out sid e the sc ope of Ru le 404 (b ). T o th e ex te nt that i t c anbe arg ue d th at ea ch pr es cr ipt ionis17

unc harg ed

m isc ondu ct , e ac h is a dm iss ibl e unde r Ru le 404 (b ) to s howe vid en ce of a plan. T hus, the dis tr ic t c ourt di d no t a buse it s di sc re tio n ina dmitt ing e ith er the su m m ary orth e in di vi du al pre sc rip ti on s u nd erl y in g i t. C . Tr an sf

erof t he C ase f

ro m P an am a C it y t o P en sac ola Me rr ill arg ue s th at

the tr ia l c ourt a

buse d it s di sc re tio n whe n it “ vio late d” Rule 18 of the Federa l Rules of Criminal Procedure by m ovin g the trial m ore than 100 m ile s aw ay

f ro m P an am a Ci ty

to Pe nsa co laove r de fe nse obj ec tio ns. Me rr ill argues that the transfer

wa s solely

for the convenience of the tria l court and had nothin g to do w iththe c onve nie nc e of D ef en dant, his w itn es se s, or

the pr om pt adm inistration of j ustice. Me rrill stresses that Rule 18 is m andatory and provid es for the convenience of the defe ndant and it s witnesses, but not for the convenience of the c ourt. Me rr ill li ke ns this c as e to United States v. F ernandez , 480 F . 2d 7 26 (2 d C ir . 197 3) ( cr iti ci zi ng m ovi ng the tr ia l 26 m ile s whe re the onl y pe rs on co nve nie nc ed

w as the j udge ). H e state s th at the tr an sf

er w as m ad e de spi te re pe at ed de fe nse c ouns el obj ec tio ns, a lte rn at ive s inand aro und Panam a Ci ty , and requests that the m ove be to Tallahassee. H e ar gues that the transfer w as devastating to trial preparation, denied him a fa ir venire, and presented a severe fi nanc ia l burd enon the de fe nse to the poi nt that he w as de cl ar ed ind ige nt and the18

court had to grant him

Crim inal Just ice A ct funds. Mer rill seeks to have this cou rt va cat e th e co nv ic ti on an d re m an d fo r a n ew tr ia l i n P an am a Ci ty. Adis tr ic t c ourt ha s di sc re tio n to f ix the pla ce of

atr ia l i n any

div isi on w ith in the dis tr ic t, and w e re vie wthe dis tr ic t c ourt’ s de ci sio n on ly f or abuse of di sc ret io n. U

nited Sta tes v . P ep e , 747 F . 2d 6 32, 648 ( 11th C ir . 198 4) ; United Sta tes v . B etanc ourt , 734 F. 2d 75 0, 756 (11th Cir. 1984). T he S ixth A m en dm ent t o th e U nit ed S tate s C onst itutio n gu ar ante es aspe edy an d p ub li c tr ia l i n t he st at e an d d is tri ctwher ei n t he cri m e was co m m it te d. B etanc ourt , 734 F . 2d at 75 6 ( ci tin g U nited Sta tes v . A nde rso n , 328 U . S. 699 , 704 , 70 5 (1 94 6) ). The d is tri ctm ean s t he jud ic ia l d is tri ctof t he Uni te d S ta te s C ou rts . Id. (c iti ng U

nited Sta tes v . J

am es , 528 F.2d 999, 1021 (5th Cir. 1976 )). Fe d. R. Cr im . P . 18 s tate s: U nle ss a statut e or the se r ule s pe rmit oth er

w ise , the gov er

nm ent m ust pr os ecu te anoff

en se in a di st ric t wh ere t he off en se was c omm it te d. The c ourt m

ust set the place of trial w ithin the district with due regard fo r the c onve nie nc e of

the de fe ndant and the w itn es se s, and the prom pt adm inistration of j ustice. Ru le 18 a llo w s ac ourt t o c onsi de r “ the pr om pt a dm ini str at ionof

j ust ic e” in fixing th e place of

trial, and “ m atters of sec urity clear ly fall w ithin that consideration.” U

nited Sta tes v . A

fflerbac h, 75 4 F .2d86 6, 8 69 (10 th Cir . 19 85 ). Ina ddi tio n,19

the prom pt adm inistration of j ustice includes m ore than the case at bar; the phr as e inc lud es the state of the c ourt’ s do ck et

ge ne ra lly . T he co urt m ust ba lanc e not

onl y the e ff ec t the loc at ionof

the tr ia l w ill have upo n th e de fe ndants and the ir w itn es se s, but

it m ust w ei gh the im pa ct the tr ia l l oc at ionw ill have on the ti m el y dis posi tio n of

the ins tant c as e an d othe r ca se s. In reCh es son, 89 7 F .2d15 6, 1 59 (5t h C ir. 1 99 0) (pe r curia m). In this case, the district court consid ered Me rrill’ s interest in the trial rem ai ni ng in Pan am a Ci ty butfou ndth atin te res t o ut weig he d b y sp ace c on cern s. Sp ec if ic al ly , the c ourt no te d th at the re w as onl y

one c ourtr oom

in the P an am a Ci ty federa l courthous e capable of handlin g Merrill’ s long trial. T his courtroom wa s not ava ila ble a s it ha d be ena ssi gne d to ane w ly -a ppoi nte d j udge . T he c ourt a lso found th at the j uvenile justice courthouse in Panam a City , suggested by Merr ill as ana lte rn at e loc at ionf

or the tr ia l, w as not

avia ble opt iondue to se curi ty c onc er ns as soc iate d w ithaf

ed er al c ri m ina l tri al . Having found that th e m atter c ouldnot rem ain in Panam a City , the c ourt co nsi de re d th e tr an sf

er of the c as e ei the r to T al laha sse e, f av or ed by the de fe nse , or to P en sa co la , f

av or ed by the G ove rnm ent. I n do ing so, the tr ia l j udge e xpl ic itl y co ns id eredall of t he fact or s u nd er Fe de ral Ru le of C riminal Pro cedur e 1 8. Sp ec if ic al ly , in ad dr es sin g th e co nve nie nc e of the D ef en dant and h is co unse l, the c ourt no te d th at the tr av el ti m e be tw ee n P an am a Ci ty and P en sa co lais onlyone m inute lon ger than the tim e betwe en Panam a City and Ta llahassee. It20

fo und that ho te l sp ac e, of fi ce ava ila

bil ity , and j ur

y div er sity w er e equa l i n bo th lo cat io ns . In addressing the conv enience of the w itnesses, the trial court indicated that th e majo ri ty o f d ef

en s e w i tn es s es we re fr o m Pa n ama C i ty, an dth e G o v ern m en t ’s w itn es se s w er e fr om

vari ous pla ce s aro und the c ountry . T he c ourt f ound that a ir tr av el w as m or e co nve nie nt t o P en sa co lathan to T al laha sse e, that i t w oul d im pose no a ddi tio na l burd ento have the de fe nse w itn es se s tr av el f ro m P an am a Ci ty

to Pensacola rather than to Tallahassee, and that m ost witnesses would have to travel on ly one ti m e. Finally , in addressing the prom pt adm inistration of j ustice, the trial court fo und that a

tr ia l i n P an am a Ci ty

w oul d r equir e shuttin g do wn th e Pe nsa co la doc ke t f or thr ee w ee ks, a ff

ec tin g othe r lit igants be ca use Jud ge Ro dge rs is the onl y ac tiv e j udge in the P en sa co laD ivi sio n. S he state d th at if the tr ia l w er e he ld i n Pe nsa co la , she c oul d handl e m any gr an d j ur y and o the r em er ge nc y

m atte rs dur ing the tr ia l but c oul d no t do so w er e she in T al laha sse e. T he c ourt st at ed that havin g co nsi de re d a ll thr ee f

ac tor s, the la st o f the se r equir ed the c as e to b e tr ie d in Pen sa co la . W e fi nd that the tr ia l c ourt di d no t a buse it s di sc re tio n inm ovi ng this c as e fr om P an am a Ci ty

to Pe nsa co la , F lor ida . A s no te d by the c ourt, the f

ac ili tie s in21

Panam a Ci ty

w er e ei the r not

ava ila ble f or use or la ck ed ne ce ssary

se curi ty m easures. In deciding to transfer the ca se to Pensacola rather than Ta llahassee, the tr ia l c ourt c ar ef

ull y c onsi de re d a ll of

the f ac tor s e num er at ed

in Fe de ra l R

ule of Cr im ina l P ro ce dur e 18. T he c ourt f ound that ne ith er

the c onve nie nc e of

the D ef en dant n or

the c onve nie nc e of

the w itn es s gr eatly

f av or ed e ith er loc at ion . M o re o v er , th e c o urtfo un dth atth e p ro m p tad m i n i s tra t i o no f ju s t i ce i nth e c o urt ’s do ck etm an da te d atra ns fer t o P en sa co la . D . Ju ryIn st ru ct ion s Merril l co nt en ds th atth e tr ia l co urt, i n c ha rg in g t he jury, erre d i n t wo ways. Fi rs t, he c ont en ds that the tr ia l c ourt m isunde rs too d what the G ove rnm ent ha d to pr ove und er

the Co ntr oll ed

S ubst an ce s A ct , se ct ion841 . Me rr ill arg ue s th at the co urt di d no t pr ope rl y

ins tr uc t the j ur

y by f ai lin g to state that the G ove rnm ent m ust prove that Merrill knew and intend ed to act outside th e course of profe ssion al m ed ic al pr ac tic e. S ec ond, Me rr ill c la im s th at in the ins tr

uc tio ns, the use of

“ D ef en dant a sse rt s” and “ D ef

en dant m ai nta ins ” im

pr ope rl y shi ft ed the bur de n to the defense. W e re view a trial court’ s rej ection of a proposed jury instruction for an ab us e o f di sc ret io n. U

nited Sta tes v . G arc ia , 405 F. 3d 12 60, 1273 (11t h Cir. 2005 ) (per

curiam). “ The district court has broad discretion in form ulating j ury22

instructio ns as long as those instructio ns are a correc t statem ent of the law .” Id. “ T he dis tr ic t c ourt’ s r ef

usa l t o in co rp or at e a re que ste d j ur y ins tr uc tio n w ill be reverse d onlyif the proffe red instruction was substant ially corre ct, the requested ins tr uc tio n w as not

a ddr es se d inc harg es a ct ua lly giv en , and f

ai lur e to g ive the ins tr uc tio n se ri ousl y

im pa ir ed the de fe ndant’ s a

bil ity to pr es ent an e ff

ec tiv e defense. ” Id

. (citation om itted). H ow ev er , in U

nited Sta tes v . W

rig ht , 39 2 F .3d12 69 (11 th Cir . 20 04 ), we st at ed , “ [i]n o rd er t o p res erv e anob jecti on to jury in st ru ct io ns forap pe ll at e rev ie w, a party m ust obj ec t be fo re the j ur

y r et ir ed , statin g di sti nc tly the spe ci fi c gr ound s for the obj ection.” Id

. at 1277 (citation o m itted). W here a party fails to objec t before the j ury

retire s, w e re view the assignm ent of err or under the “plain error” st an da rdof r ev ie w. Id

. A s M er ri ll’ s c ouns el did

not obj ec t t o th e co urt’ s in str uc tio n, our

r ev ie wis fo r pla in e rr or

( R 1 9- 226 at

159 -6 0, 300 ). W e fi nd that the c ourt di d no t c om m it pla in e rr or

by not ins tr uc tin g th e j ur

y that the G ove rnm ent m

ust pr ove that M er

ri ll kn ew an d i nt en de d t o a ctou ts id e th e co ur se of p ro fes si on al m ed ic al pra ct ic e. Merr ill propo sed the following charge:

“ Le gitim ate m edical purpose,” “boun ds of m edicine,” and “ usual co ur se of m ed ic al c ar e” m ean th ose m ed ic al pr oc ed ur es and pr es cr ipt ion s pr ovi de d by adoc tor to cure dis ea se or

r el ie ve suf

fe ri ng23

of apatie nt, so l ong as tho se m ed ic al pr oc ed ur es or pr es cr ipt ion s pr ovi de d are don e by

the phy sic ian ingoo d f

ai th.

“N ot f or ale git im at e m ed ic al pur

pose ” or “ out sid e the bounds of m edicine” m eans when a phy sician prescribes to, or provides tr eatm ent f

or apatie nt n ot t o tr eat a

m ed ic al c ondi tio n of

the patie nt, but f or som e oth er

pur pose , suc h a s f

or f inanc ia l ga in. R 3 -9 4, at 2. T he c ourt i ssu ed the f oll ow ing ins tr

uc tio n: A c ontrolled s ubstance is prescribed by a phy sician in the usu al co ur se of pr of es sio na l [ pr ac tic e] and, the re fo re , law fu lly , if the subs tance is prescr ibed by him in goo d faith as part of his m edical treatm ent for the patient in accordance with the standards of m edical pr act ic e g en eral ly recog ni zedan d a ccep te d i n t he Uni te d S ta te s. T he de fe ndant i n th is c as e m ai nta ins at a ll tim es he a ct ed in good faith and in accordance w ith the stand ard of m edical practice ge ne ra lly r ec ogni ze d and a cc ep te d inthe Unit ed S tate s intr eatin g hi s patie nts . (R 19-226 at 292). W e have a lr ea dy

ind ic at ed that a goo d f ai th i nstru ct ionf

oc usi ng o n th e phy sician’ s subjective intent, like the one proposed byMerr ill, “ fails to introdu ce any obj ec tiv e standard

by whic h aphy sic ian’ s pr es cr ibi ng b eh av ior c anbe j udged.” Uni te d Sta tes v. Will ia ms , 445 F. 3d 13 02, 1309 (11t h Cir. 2006 ), abrogated

on o the r ground

s, U nited Sta tes v . L ew is , No . 0 6 -1 1 8 7 6 , 2 0 0 7 WL 20 33 82 3 (1 1t h C ir. J ul y

17 , 20 07 ) (en ba nc ). The a ppropriate focus is noton the sub j ective intent of the doctor, but rather it re sts upo n whe the r the phy sic ian pr es cr ibe s m ed ic ine “ in a cc or danc e w itha24

standard of m edical practice generally rec ogni zed and acc epted in the United States. ” Id. (quot ing U

nited Sta tes v . M

oore , 423 U. S. 122, 139 (197 5)). In W il li ams , w e af

firm ed a trial c ourt’ s instructio n like the one giv en here which focuses on whether the doctor acte d in accordance w ith a generally -acc epted standard of m edical practice . Ther efore, we find that the dist rict court neither com m itted plain error nor abused its dis cretion in not gi ving Merr ill’ s propos ed jury ins tru ct io n. T he se co nd i ssu e ra ise d by Me rr ill w ithr eg ar d to the j ur y ins tr uc tio n is whether the district court im properly shifted the burden to De fendant with regar d to the goo d faith defense. W e find such argum ent without m erit. H ere, the district co urt i nc lud ed

in its ins tr

uc tio ns: “ T he de fe ndant i n th is c as e m ai nta ins at a ll tim es he acte d in go od faith and in accordance w ith stand ard of m edical practice generally rec ogni zed and acc epted in the United States in treating his patients.” (R 19-226 at 292-93 ). Merr ill argues that this in struction (byusing “ De fendant m aintains”) shifted the bur de n to him

to showthat he a ct ed

in good f ai th, and that i t w as the Gov ern m en t’s b ur de n t o s ho w th atth e dru gs were n otpre sc rib edin go odfai th . H ow ev er , the c ourt’ s ne xt i nstru ct ionsho w s th at it did not shi ft the bur de n:

“ T hus, am ed ic al doc tor

ha s vi olate d S ec tio n 84 1 when the government has pro ved25

be yo nd a re ason able doub t that the doc tor ’ s a ct ion s w er e not f or le git im at e m edical purposes in th e usual course of professional m edical practice or w ere be y ond the bounds of

pr of es sio na l m ed ic al pr ac tic e. ” ( R 1 9- 226 at 293 ) (e m pha sis a dde d) . A s su ch , w e fi nd that the c ourt’ s langua ge did not im pe rm is si bl y

sh iftth e b ur de n t o t he Defen da ntan d d idno t co ns ti tu te pl ai n e rro r. E. Pr osecutorial Miscond uct O rd inari ly , thi s c ourt r ev ie w s c la im s of pr ose cutor ia l m isc ondu ct de novo be cau se itis a m ix edqu es ti on of l aw an d fa ct . U nited Sta tes v . Eck

hard t , 466 F . 3d 938, 947 ( 11th C ir . 200 6) . H ow ev er , w ithr es pe ct to a pr ose cutor ’ s st at em ents m ad e dur in g c lo si ng wher e th e d efen da ntdi d n otrai se th is ob jecti on at t ria l, we re vie wonl y

f or pla in e rr or

“ that i s so obv iou s th at

f ai lur e to c or

re ct it w oul d j eopardize the fa irness and integrityof the trial. ” United States v. B ailey, 123 F . 3d 1381 , 1400 (11th Cir. 1997).

“ To establish prosecutorial m iscondu ct, (1) the re m arks m ust be im proper, an d ( 2) the r em ar

ks m ust pr ej udi ci al ly

a ff ec t the sub stanti al r igh ts o f the defendant.” Eck

hard t , 4 6 6 F . 3 dat9 4 7 ( qu o t a t i o nan dc i t a t i o no mi t t e d ) . “A de fe ndant’ s su

bst antia l r igh ts are pr ej udi ci al ly a ff ec te d whe n ar ea sona

ble pr oba bil ity ari se s th at , but

f or the r em ar

ks, the out co m e of

the tr ia l w oul d have26

been differe nt.” Id. T hus, whe re the re is “ suf fi ci ent i nde pe nde nt e vid en ce of guilt , any err or is harm less.” Id

. Me rr ill r eque sts ane wtr ia l c ont en din g th at the pr ose cutor

e nga ge d in m isc ondu ct

in the c hange of

the pla ce of

tr ia l, by giv ing j ur

y ins tr uc tio ns o n inte nt, and in proffering the adm issio n of res gesta e ev i d en ce i nth e f o rm of al l Me rr i l l ’s p re s cr i p t i o n s . We h av e a d dre s s edab o v e t h e p ro p ri et y o f t h e d i s tri ctco urt ’s rulings with re spect to these issu es, and therefore, they cannot form

the basis of a prosecutorial m iscondu ct claim . The only other miscondu ct claim

Merr ill raises w ithany spe ci fi ci ty

is his a lle gatio n th at

the pr ose cutor

m isl ed the c ourt and the j ur y w ithr eg ar d to the m ed ic al e xam ine r te sti m ony c onc er nin g patie nt K enne th Nol es . A t tri al , D r. S ie be rt , the m ed ic al e xam ine r who p er fo rm ed the auto psy

on K enne th N ole s, te sti fi ed

that F entany l t oxi ci ty

c oul d on ly

have oc curr ed

by injec tion andthat he found no evidence of inj ected drugs on the decedent and saw no i nj ec tio n si te . H e qua lif ie d th is a sse rt ionby

statin g th at

it w as pos sib le that he could no t see an inj ection site due to a sm all needle or that the inj ection was in an uncomm on area. When Merrill m oved for acquittal with regar d to Mr. N oles because there wa s no eviden ce of tr ack m arks on his arm s, A ssistantUnited State s Attorney Kunz advised the court that, a s he rem em bered the testim ony , D r. Siebert27

did say that he ha d ob se rv ed

tr ac k m ar

ks o n K enne th N ole s. L at er , in his c los ing , Mr . K unzr ep eate d th is a sse rt ionin his sum m at ionto the j ur

y . Mr . K unza lso asserted to the j ury

that “ of course” Me rrill sawthese track m arks during ph y sical ex aminatio ns. W e rev ie w de novo th e a l l eg edp ro s ec u t o ri al m i s co n du cto f t h e p ro s ec u t o r’s state m ents m ad e to the c ourt at the m oti on- fo r- ac qui tta l st ag e. Appl y ing the tw oste p te st r ai se d in Eck

hard t , w e fi nd that M r. K

unz ’ s st at em ents t o th e co urt duri ng th e co ll oquy onMerr il l’s m ot io n fo r a jud gm en t o f acqui tt al were i m pr op er. N one the le ss, the se state m ents d id n ot p re j udi ce Me rr ill a s th e co urt e xpr es sly s t at edth atth e e v i d en ce o f t ra ckm ark s wa s i rr el ev an tt o i t s d en i al o f M erri l l ’s m otion for a j udgm ent of acquittal on coun ts relating to Mr. N oles. Further, as stated above, there wa s sufficient independen t evidence of guilt with regard to Mr. Noles’ death, specif

ically his wife’ s testim ony

that both she and Mr. Noles w ere inj ec tin g F entany l pr es cr ibe d by Me rr ill the nig ht o f his de ath, so that any e rr or on the part of Mr. Kunz w as harm less. ( R 12-219 at 310 -14). Be ca use Me rr ill did

not obj ec t t o M r. K

unz ’ s st at em ents t o th e j ur y dur ing cl osi ng, w e re vie wMe rr ill ’ s c la im of pr ose cutor ia l m isc ondu ct he re f or pla in er ro r. I n li ght

of the tr ia l c ourt’ s c autio nary ins tr uc tio ns t o th e j ur

y and the ab undanc e of

oth er ind ep en de nt e vid en ce c onc er nin g M r. N ole s’ de ath, w e fi nd28

that the pr ose cutor ’ s m iss tate m ents d ur ing c los ing w ithr eg ar d to the tr ac k m ar ks were n otpl ai n e rro r so ob vi ou s t ha t t he co urt’s fa il ur e to co rrec t i t, sua spon te , j eo pard iz ed

the f ai rn es s and i nte gr ity

of the tr ia l. F. Ineff

ective A ssistance of C ounsel Ne xt, Mer

rill contends th at he w as denied effe ctive assistance of counsel at tr ia l f or se ve ra l r ea sons . W e have he ld that “ [e ] xc ep t i n th e rare ins tanc e whe n th e re co rd is suf fi ci ently de ve lop ed , w e w ill not

a ddr es s c la im s f

or ine ff ec tiv e assistance of counsel on d irect a ppeal.” United States v. V erbitskaya , 406 F . 3d 1324 , 133 7 ( 11th C ir . 200 5) ( ci tin g United States v. T yndale, 209 F . 3d 1 292, 129 4 (1 1thCi r. 200 0) ). I nst ea d, “ [a ] n in ef fe ct ive a ssi stanc e of

c ouns el c la im

is pr ope rl y raised in a collatera l attack on the convictio n und er 28 U .S .C. § 2255 .” United Sta tes v . B utler

, 41 F.3d 1435, 1437 n.1 (11th Cir. 1995 ). W e conclude the record be lowis not

suf fi ci ently de ve lop ed

to ev al uate Me rr ill ’ s in ef fe ct ive a ssi stanc e of counsel claim

at this tim e. T hus, the claim would be m ore appropriately addressed in a se ct ion225 5 m oti on. G. D ism iss al o f Ju ro r Fi na lly , Me rr ill obj ec ts t o th e co urt’ s in adve rt ent r ep la ce m ent of aj ur or w ith ana lte rn at e. Me rr ill c la im s th at thi s r ep la ce m ent vi olate d F ed er al Ru le of Crim inal Procedure 24(c) (3). W e evaluate such a c laim under the de novoAlthough Me rrill’s brief contends that the dismissed juror wa s Afric an-America n and 12 the alter nate juror was white w ith less education and a “per ceive d bias and lea

ning f or the prosec ution on the petit jury ,” the c itation to the recor d provided by Merrill provides no inf or matio n a s to the ra c e of

e ith e r j ur or

no r a ny e vid e nc e at a ll o f a

ny pe rc e ive d b ia s. 29 st an da rdof r ev ie w. United States. v. Bre wer , 199 F. 3d 12 83, 1286 (11t h Cir. 2000 ). T he tr ia l c ourt r ep la ce d aj ur or and s ent an a lte rn at e out f or de lib er at ion s with the other j ury

m em bers because the court mistakenlybelieved the form er w as ana lte rn at e. T he j ur

y w ent t o de lib er at e. S oon the re af te r, the c ourt di sc ove re d th e er ro r an d di sc uss ed

the e rr or w ithc ouns el f

or both part ie s. D ur ing thi s c oll oquy de fe nse c ouns el ind ic at ed ade sir e to h av e the or igi na l j ur or r ei nst at ed

whil e the G ove rnm ent di d no t; ne ith er party m entio ne d th e ra ce of

e ith er j ur or . F ind ing no prej udice to Merrill, the court decided not to reinstate the m istakenly -dism issed j ur or . Me rr ill nowc la im s th at the r ep la ce d j ur or

w as A fr ic an -Am er ic an , and the alternate seated in her place w as Caucasian. For this rea son Merrill contends th at 12 he is entit le d to ane wtr ia l. Federa l Rule of Cr im inal Procedure 24(c) provides th at “ [t] he court m ay im pane l up to 6 a lte rn at e j ur or s to r ep la ce any j ur or s who are una

ble to pe rf

orm or who are disqu alified fr om performing th eir duties. . . . Alter nate j urors replace juro rs in th e sa m e se qu en ce i n wh ic h t he alt ern at es were s el ect ed .”30

W e fi nd that whe n th e dis tr ic t c ourt r ep la ce d aj ur or w ithan a lte rn at e fo r no re as on, it e rr ed and v iol at ed

Ru le 24( c) . T he r ea l qu es tio n be fo re the c ourt i s whe the r thi s e rr one ous re pla ce m ent c onst itute s r ev er sib le e rr or or m er el y harmle ss error . W e have “ explicitlyrej ected a r ule of per se r eversal f

or Rule 24(c) violatio ns.” Brew er , 199 F . 3d at 12 86 ( ci tin g U nited Sta tes v . A ce ve do , 141 F . 3d 1421 , 142 3 ( 11th C ir . 199 8) ). “ In ste ad , r ev er sa l i s r equir ed onl y if the re is a re as ona ble pos sib ili ty

that the dis tr ic t c ourt’ s vi olatio n of Ru le 24( c) a ct

ua lly prej udiced the defendant bytainting the j ury ’ s final verdict.” Id. at 128 6- 87 (c iti ng United States v. R egister , 182 F . 3d 8 20, 842 ( 11th C ir . 199 9) ; United States v. Be ndek, 146 F.3d 1326 , 1328 (11th Cir. 1998) (per c uriam)). In Brew er , the dis tr ic t c ourt r an dom ly se le ct ed tw o of f ourte enj ur or s to be re m o v edas al t ern at es i m m ed i at el y p ri o r t o th e ju ro rs re t i ri n g t o d el i b er at e. We found th at this random

m ethod of desig nating which jurors w ouldbe alternate s vi ol at edth e “ ex pl ic itco m m an d” of Rul e 2 4( c). Brew er , 199 F . 3d at 12 86. T he plaintiff contended th at he w as prej udiced “because one of the j urors who w as designated as an alternate w as black, the district court’ s m ethod di luted black represe ntation on the jury .” Id. at 1287. W e found that this “unsupported assertion, w ithou t any

ref erence to the racial m akeup of the j ury panel that31

co nvi ct ed the de fe ndants , f

al ls f ar sho rt of the r equir ed

sho w ing of

ar ea sona

ble poss ibilitythat the district court’ s violatio n of Rule 24(c) ac tua llypr ej udi ce d th e defendants by

aff ecting the jury ’ s final verdict.” Id. (em phasis in original). H er e, Me rr ill m ak es asimilarl y uns uppo rt ed

a sse rt ion . H e cl ai m s th at he w as de nie d af

ai r cr oss se ct ionof

the c om m uni ty by the j udge ’ s in adve rt ent re pla ce m ent of

aj ur or w ithan a lte rn at e. L ike the de fe ndants in Brew er , how ever, Me rr ill ha s m ad e no r ef

er en ce to the r ac ia l m ak eu p of the j ur y pane l. F or

thi s re as on w e fi nd, a s w e did in Brew er , that Me rrill’ s unsubstantiated allegatio n does not sh ow “ a re asonable pos sibili ty that the district court’ s violatio n of Rule 24(c) ac tua llyprej udiced the [defendant] by aff ecting the jury ’ s final verdict.” III. C ONC LUS ION A s st at ed above , w e fi nd that 1) the re w as suf fi ci ent e vid en ce at tri al to supp ort counts in the indictm ent charging Merrill w ith provi ding controlled subs tanc es to patie nts whic h r es ult ed in the ir de aths; 2) the tr ia l c ourt’ s a dm iss ion of e vid en ce in the f

orm of pr es cr ipt ion s of

Me rr ill ’ s patie nts who w er e not the subject of any

count in th e indictm ent was not an abuse of discretion; 3) the trial co urt di d no t a

buse it s di sc re tio n inm ovi ng this c as e fr om P an am a Ci ty

to Pe nsa co la , F lor ida ; 4) the tr ia l c ourt di d no t wro ngl y ins tr uc t the j ur

y ; 5) A ssi stant U nit ed S tate s A tto rn ey

K unzdid not c om m it pr ose cutor ia l m isc ondu ct so32

pr ej udi ci al a s to w ar

rant a ne wtr ia l; 6) the r ec or d be lowis not suf fi ci ently de ve lop ed

to ev al uate Me rr ill ’ s in ef fe ct ive a ssi stanc e of

c ouns el c la im ; and 7 ) Merr ill has notshown prej udice resulting from the replace m ent of a j uror with an al te rn at e. For all of these r easons, w e AFFIRM the dis tr ic t c ourt.33

EXH I BI T 1 E x am p l e o f T ab 1 o f the S u m m ary for T w o P atien ts Pat i ent Rx # W ri t e Dat e Fi l l Dat e Qt y C/NC Drug Nam e Stre ng t h TotalMG Pharm acy BP 692413 6/ 21/ 02 6/ 21/ 02 60 NC Doxepi n 150 9000 Lani er Pharm acy BP 692415 6/ 21/ 02 6/ 21/ 02 100 C A l pra zol am 2 200 Lani er Pharm acy BP 692416 6/ 21/ 02 6/ 21/ 02 60 NC Flura zepam 30 900 Lani er Pharm acy BP 692417 6/ 21/ 02 6/ 21/ 02 60 C Phent er m i ne 30 1800 Lani er Pharm acy BP 692419 6/ 21/ 02 6/ 21/ 02 120 C Oxy cont i n 40 4800 Lani er Pharm acy BP 692421 6/ 21/ 02 6/ 21/ 02 100 C Car i sopr odol 350 35000 Lani er Pharm acy BP 692422 6/ 21/ 02 6/ 21/ 02 100 C H y droc odone/ A pap 10/ 500 1000 Lani er Pharm acy

BP 689549 5/ 23/ 02 5/ 23/ 02 8 NC Proza c 90 720 Lani er Pharm acy BP 689550 5/ 23/ 02 5/ 23/ 02 100 C Car i sopr odol 350 35000 Lani er Pharm acy BP 689552 5/ 23/ 02 5/ 23/ 02 100 C H y droc odone/ A pap 10/ 500 1000 Lani er Pharm acy

BP 689554 5/ 23/ 02 5/ 23/ 02 100 C A l pra zol am 2 200 Lani er Pharm acy BP 689556 5/ 23/ 02 60 C Flura zepam 30 1800 Lani er Pharm acy BP 689557 5/ 23/ 02 5/ 23/ 02 30 C Mel f i at 105 3150 Lani er Pharm acy BP 689558 5/ 23/ 02 5/ 23/ 02 120 C Oxy cont i n 40 4800 Lani er Pharm acy BP 5/ 23/ 02 5/ 23/ 02 30 NC Prev aci d 30 900 Lani er Pharm acy BP 3142566 4/ 23/ 02 100 C H y droc odone/ A pap 10/ 500 1000 Eck er d Drug s 3198

BP 686632 4/ 23/ 02 4/ 23/ 02 60 C Oxy cont i n 80 4800 Lani er Pharm acy BP 686633 4/ 23/ 02 4/ 23/ 02 60 NC Doxepi n 150 9000 Lani er Pharm acy BP 686634 4/ 23/ 02 4/ 23/ 02 100 C A l pra zol am 2 200 Lani er Pharm acy BP 686636 4/ 23/ 02 4/ 23/ 02 60 NC Flura zepam 30 900 Lani er Pharm acy BP 686637 4/ 23/ 02 4/ 23/ 02 30 C Mel f i at 105 3150 Lani er Pharm acy BP 683588 3/ 22/ 02 3/ 22/ 02 473 C Tussi onex Pennk i net i c S usp Mpi 10 4730 Lani er Pharm acy

BP 683590 3/ 22/ 02 3/ 22/ 02 100 C Oxy cont i n 40 4000 Lani er Pharm acy BP 683593 3/ 22/ 02 3/ 22/ 02 100 C Car i sopr odol 350 35000 Lani er Pharm acy BP 683594 3/ 22/ 02 3/ 22/ 02 100 C H y droc odone/ A pap 10/ 500 1000 Lani er Pharm acy

BP 683596 3/ 22/ 02 3/ 22/ 02 100 C A l pra zol am 2 200 Lani er Pharm acy BP 683597 3/ 22/ 02 60 C Flura zepam 30 1800 Lani er Pharm acy BP 683598 3/ 22/ 02 3/ 22/ 02 60 C Phent er m i ne 30 1800 Lani er Pharm acy BP 3811551 2/ 15/ 02 2/ 16/ 02 100 C H y droc odone/ A pap 10/ 500 1000 Eck er d Drug s 2632

BP 3811552 2/ 15/ 02 2/ 16/ 02 473 C Tussi onex 10 4730 Eck er d Drug s 2632 BP 6811549 2/ 15/ 02 2/ 16/ 02 120 C Car i sopr odol 350 42000 Eck er d Drug s 2632 BP 680161 2/ 15/ 02 2/ 15/ 02 120 C Oxy cont i n 40 4800 Lani er Pharm acy34 BP 680167 2/ 15/ 02 2/ 15/ 02 105 C A l pra zol am 2 210 Lani er Pharm acy BP 680168 2/ 15/ 02 2/ 15/ 02 70 C Tri azol am 25 1750 Lani er Pharm acy BP 2805707 1/ 18/ 02 1/ 21/ 02 60 C Oxy cont i n 40 2400 Eck er d Drug s 2632 BP 3805706 1/ 18/ 02 1/ 21/ 02 480 C Tussi onex 10 4800 Eck er d Drug s 2632 BP 3805711 1/ 21/ 02 1/ 21/ 02 100 C H y droc odone/ A pap 10/ 500 1000 Eck er d Drug s 2632

BP 6805710 1/ 18/ 02 1/ 21/ 02 100 C Car i sopr odol 350 35000 Eck er d Drug s 2632 BP 671997 11/ 20/ 01 60 C Oxy cont i n 40 2400 Lani er Pharm acy BP 672003 11/ 20/ 01 100 C H y droc odone/ A pap 10/ 500 1000 Lani er Pharm acy

BP 672005 11/ 20/ 01 240 C Tussi onex Pennk i net i c S usp Mpi 10 2400 Lani er Pharm acy

BP 664277 8/ 24/ 01 60 C Oxy cont i n 40 2400 Lani er Pharm acy BP 664281 8/ 24/ 01 240 C Tussi onex Pennk i net i c S usp Mpi 10 2400 Lani er Pharm acy

BP 664282 8/ 24/ 01 96 C H y droc odone/ A pap 10/ 500 960 Lani er Pharm acy

BP 661184 7/ 27/ 01 473 C Tussi onex Pennk i net i c S usp Mpi 10 4730 Lani er Pharm acy

BP 661182 7/ 20/ 01 100 C H y droc odone/ A pap 10/ 500 1000 Lani er Pharm acy

BP 661186 7/ 20/ 01 60 C Oxy cont i n 40 2400 Lani er Pharm acy Pat i ent Rx # W ri t e Dat e Fi l l Dat e Qt y C/NC Drug Nam e Stre ng t h TotalMG Pharm acy BB 3951424 5/ 13/ 04 150 C H y droc odone/ A pap 10/ 500 1500 Eck er d Drug s 2632

BB 3948990 4/ 20/ 04 60 C H y droc odone/ A pap 10/ 500 600 Eck er d Drug s 2632

B B 5 0 3 1 9 6 4 /1 2 /0 4 4 /1 2 /0 4 1 2 0 C D ia ze p am 1 0 1 2 0 0 Sp rin gfield C ity Dru gs B B 5 0 2 8 1 3 4 /5 /0 4 4 /5 /0 4 1 5 0 C Hy d ro co d o n e/ Ap ap 1 0 /6 5 0 1 5 0 0 Sp rin gfield C ity Dru gs

BB 2225579 3/ 8/ 04 3/ 15/ 04 10 C Dura g esi c ( Mcg) 100 1000 Eck er d Drug s 3619

BB 854786 3/ 8/ 04 3/ 8/ 04 120 C Di azepam 10 1200 Lani er Pharm acy BB 854787 3/ 8/ 04 3/ 8/ 04 150 C H y droc odone/ A pap 10/ 650 1500 Lani er Pharm acy

BB 851847 2/ 10/ 04 2/ 10/ 04 150 C H y droc odone/ A pap 10/ 650 1500 Lani er Pharm acy

BB 851849 2/ 10/ 04 2/ 10/ 04 120 C Di azepam 10 1200 Lani er Pharm acy BB 4527552 1/ 22/ 04 1/ 22/ 04 37 C H y droc odone/ A pap 10/ 650 370 W al - Mart 1032

BB 4527553 1/ 22/ 04 1/ 22/ 04 30 C Di azepam 10 300 W al - Mart 103235 BB 3936046 1/ 12/ 04 1/ 17/ 04 38 C H y droc odone/ A pap 10/ 650 380 Eck er d Drug s 2632

BB 4936047 1/ 12/ 04 1/ 17/ 04 30 C Di azepam 10 300 Eck er d Drug s 2632 BB 424303 1/ 13/ 04 1/ 13/ 04 60 C Di azepam 10 600 Medici ne S hoppe BB Not Li st ed 1/ 13/ 04 75 C H y droc odone/ A pap 10/ 650 750 Medici ne S hoppe

BB 3214699 12/ 11/ 03 12/ 22/ 03 75 C H y droc odone/ A pap 10/ 650 750 Eck er d Drug s 3619

BB 4214700 12/ 11/ 03 12/ 22/ 03 60 C Di azepam 10 600 Eck er d Drug s 3619 BB 4451516 12/ 11/ 03 12/ 12/ 03 75 C H y droc odone/ A pap 10/ 650 750 KMAR T 3355

BB 4451517 12/ 11/ 03 12/ 12/ 03 60 C Di azepam 10 600 KMAR T 3355 BB 841812 11/ 10/ 03 11/ 10/ 03 150 C H y droc odone/ A pap 10/ 500 1500 Lani er Pharm acy

BB 841813 11/ 10/ 03 11/ 10/ 03 120 C Di azepam 10 1200 Lani er Pharm acy BB 838679 10/ 10/ 03 10/ 10/ 03 5 C Dura g esi c ( Mcg) 50 250 Lani er Pharm acy

BB 838685 10/ 10/ 03 10/ 10/ 03 150 C H y droc odone/ A pap 10/ 500 1500 Lani er Pharm acy

BB 838687 10/ 10/ 03 10/ 10/ 03 120 C Di azepam 10 1200 Lani er Pharm acy BB 4827607 9/ 9/ 03 150 C H y droc odone/ A pap 10 1500 Campbel l Ci t yEck er d Drug

BB 4827608 9/ 9/ 03 120 C Di azepam 10 1200 Campbel l Ci t yEck er d Drug

BB 4824857 8/ 8/ 03 150 C H y droc odone/ A pap 10 1500 Campbel l Ci t yEck er d Drug

BB 4824858 8/ 8/ 03 120 C Di azepam 10 1200 Campbel l Ci t yEck er d Drug

BB 4822419 7/ 9/ 03 150 C H y droc odone/ A pap 10 1500 Campbel l Ci t yEck er d Drug

BB 4822420 7/ 9/ 03 120 C Di azepam 10 1200 Campbel l Ci t yEck er d Drug

BB 4820209 6/ 12/ 03 120 C Di azepam 10 1200 Campbel l Ci t yEck er d Drug

BB 4820210 6/ 12/ 03 150 C H y droc odone/ A pap 10 1500 Campbel l Ci t yEck er d Drug

BB 4817814 5/ 13/ 03 150 C H y droc odone/ A pap 10 1500 Campbel l Ci t yEck er d Drug

BB 4817815 5/ 13/ 03 120 C Di azepam 10 1200 Campbel l Ci t yEck er d Drug36 BB 4814882 4/ 10/ 03 150 C H y droc odone/ A pap 10 1500 Campbel l Ci t yEck er d Drug

BB 4814883 4/ 10/ 03 120 C Di azepam 10 1200 Campbel l Ci t yEck er d Drug

BB 4519378 3/ 18/ 03 60 C Di azepam 10 600 W al - Mart 1032 BB 4519377 3/ 10/ 03 3/ 13/ 03 75 C H y droc odone/ A pap 10/ 500 750 W al - Mart 1032

BB 4519377 3/ 13/ 03 0 C H y droc odone/ A pap 10/ 500 0 W al - Mart 1032

BB 4519377 3/ 10/ 03 75 C H y droc odone/ A pap 10/ 500 750 W al - Mart 1032

BB 4519378 3/ 10/ 03 3/ 10/ 03 60 C Di azepam 10 600 W al - Mart 1032 BB 4519196 3/ 4/ 03 3/ 4/ 03 35 C H y droc odone/ A pap 10/ 500 350 W al - Mart 1032

BB 4519197 3/ 4/ 03 3/ 4/ 03 21 C Di azepam 10 210 W al - Mart 1032 BB 4808478 1/ 31/ 03 150 C H y droc odone/ A pap 10 1500 Campbel l Ci t yEck er d Drug

BB 4808479 1/ 31/ 03 100 C Di azepam 10 1000 Campbel l Ci t yEck er d Drug

BB 4518221 1/ 24/ 03 1/ 24/ 03 35 C H y droc odone/ A pap 10/ 500 350 W al - Mart 1032

BB 4518222 1/ 24/ 03 1/ 24/ 03 21 C Di azepam 10 210 W al - Mart 1032 BB 4517432 12/ 20/ 02 12/ 20/ 02 75 C H y droc odone/ A pap 10/ 500 750 W al - Mart 1032

BB 4517434 12/ 20/ 02 12/ 20/ 02 50 C Di azepam 10 500 W al - Mart 1032 BB 4804651 12/ 17/ 02 75 C H y droc odone/ A pap 10 750 Campbel l Ci t yEck er d Drug

BB 4804652 12/ 17/ 02 50 C Di azepam 10 500 Campbel l Ci t yEck er d Drug

BB 4478989 10/ 10/ 02 10/ 10/ 02 75 C H y droc odone/ A pap 10/ 500 750 W al - Mart 1207

BB 4478990 10/ 10/ 02 10/ 10/ 02 50 C Di azepam 10 500 W al - Mart 1207 BB 4798474 10/ 2/ 02 50 C Di azepam 10 500 Campbel l Ci t yEck er d Drug

BB 4798475 10/ 2/ 02 75 C H y droc odone/ A pap 10 750 Campbel l Ci t yEck er d Drug

BB 4842773 9/ 27/ 02 40 C Cl onazepam 1 40 Eck er d Drug s 2632 BB 4444463 9/ 19/ 02 9/ 19/ 02 150 C H y droc odone/ A pap 10/ 500 1500 KMAR T 3355

BB 4842773 9/ 18/ 02 10 C Cl onazepam 1 10 Eck er d Drug s 263237 BB 697757 9/ 13/ 02 150 C H y droc odone/ A pap 10/ 500 1500 Lani er Pharm acy

BB 4478282 9/ 9/ 02 9/ 9/ 02 50 C Di azepam 10 500 W al - Mart 1207 BB 697756 8/ 19/ 02 8/ 19/ 02 50 C Di azepam 10 500 Lani er Pharm acy BB 697757 8/ 19/ 02 8/ 19/ 02 150 C H y droc odone/ A pap 10/ 650 1500 Lani er Pharm acy

BB 697757 8/ 19/ 02 150 C H y droc odone/ A pap 10/ 500 1500 Lani er Pharm acy

BB 4842773 8/ 13/ 02 30 C Cl onazepam 1 30 Eck er d Drug s 2632 BB 4842773 8/ 6/ 02 30 C Cl onazepam 1 30 Eck er d Drug s 2632 BB 4842773 8/ 1/ 02 30 C Cl onazepam 1 30 Eck er d Drug s 2632 B B 4 8 4 2 7 7 3 7 /1 7 /0 2 7 /1 7 /0 2 1 0 0 C Ca ris o p ro d o l 3 5 0 3 5 0 0 0 Ec ker d D ru gs BB 694643 7/ 17/ 02 7/ 17/ 02 150 C H y droc odone/ A pap 10/ 500 1500 Lani er Pharm acy

BB 694643 7/ 17/ 02 150 C H y droc odone/ A pap 10/ 500 1500 Lani er Pharm acy

BB 691950 6/ 17/ 02 6/ 17/ 02 100 C Di azepam 10 1000 Lani er Pharm acy BB 691951 6/ 17/ 02 6/ 17/ 02 150 C H y droc odone/ A pap 10/ 500 1500 Lani er Pharm acy

BB 691951 6/ 17/ 02 150 C H y droc odone/ A pap 10/ 500 1500 Lani er Pharm acy

BB 689039 5/ 17/ 02 5/ 17/ 02 100 C Di azepam 10 1000 Lani er Pharm acy BB 689042 5/ 17/ 02 5/ 17/ 02 150 C H y droc odone/ A pap 10/ 500 1500 Lani er Pharm acy

BB 393436 5/ 11/ 02 60 C Di azepam 10 600 W al g re ens 4847 BB 685758 4/ 15/ 02 4/ 15/ 02 30 C A m bi en 10 300 Lani er Pharm acy BB 685758 4/ 15/ 02 4/ 15/ 02 100 C Di azepam 10 1000 Lani er Pharm acy BB 685761 4/ 15/ 02 4/ 15/ 02 150 C H y droc odone/ A pap 10/ 650 1500 Lani er Pharm acy

BB 4510723 3/ 14/ 02 3/ 14/ 02 100 C Di azepam 10 1000 W al - Mart 1032 BB 4510724 3/ 14/ 02 3/ 14/ 02 30 C A m bi en 10 300 W al - Mart 1032 BB 4510725 3/ 14/ 02 3/ 14/ 02 120 C H y droc odone/ A pap 10/ 650 1200 W al - Mart 1032

BB 401619 3/ 13/ 02 3/ 13/ 02 10 C H y droc odone/ A pap 10/ 500 100 W al g re ens 4847

BB 393436 2/ 5/ 02 40 C Di azepam 10 400 W al g re ens 4847 BB 393075 2/ 4/ 02 60 C Endoce t 10/ 650 600 W al g re ens 4847

Unl ess ot her wi se i ndi cat ed al l drug desc ri pt i ons wer e dr awn f romt he P h y sic ian s' D esk R eference ( T h om son 61 st ed . 20 07 ) an d the li st of co n tr olle d sub st ances un der t he C ontr ol l ed Su bst ances A ct , 21 U . S.C. § 801, foun d at 21 CF R § 813.38 A lp ra z o la m : a b e n z o d i a z e p i n e d e s i g n e d t o t re a t a n x i e t y; s c h e d u le IV H yd ro c o d o n e / A p a p : o p i a t e , s c h e d u le II A m b i e n : a h yp n o t i c u s e d t o t re a t s le e p le s s n e s s ; s c h e d u le IV M e lfi a t : a n u n c o m m o n s t i m u la n t o r d i e t m e d i c a t i o n (R 1 3 -2 2 0 , a t 3 3 ); s c h e d u le III C a ri s o p ro d o l: a n o n -c o n t ro lle d m u s c le re la x a n t ; (R 1 3 -2 2 0 , a t 3 5 ) O x yc o n t i n : a c o n t ro lle d re le a s e fo rm o f t h e o p i a d o x yc o d o n e ; s c h e d u le II

C lo n a z e p a m : a b e n z o d i a z e p i n e d e s i g n e d t o t re a t a n x i e t y; s c h e d u le IV P h e n t e rm i n e : a w e i g h t lo s e d ru g ; s c h e d u le IV D i az epa m : a be nzodi az epi ne de r i v at i v e of t en r ef er r ed t o as v al i um ; sc hedul e I V Pre v ac i d: a non- cont r ol l ed medi ca t i on t o i nhi bi t gas t r i c a ci d se cr et i on

D o x ep in : n o n - co n troll ed an ti- d ep ressa n t P roz ac: no n - co n troll ed an ti- d ep ressa n t; (R 1 3 - 2 2 0 , at 34 ) D u ra g e s i c (M c g ): m e c h a n i s m t o d e liv e r f e n t a n yl, a n o p i a t e , t h ro u g h t h e s k i n ; s c h e d u le II T ri a z o la m : s c h e d u le IV E n d o c e t : a n o x yc o d o n e i n t e n d e d t o t re a t p a i n ; s c h e d u le II T u s s i o n e x : h yd ro c o d o n e u s e d t o t re a t u p p e r r e s p i ra t o ry s ym p t o m s ; s c h e d u le III

F lu ra z e p a m : b e n z o d i a z e p i n e u s e d t o t re a t i n s o m n i a ; s c h e d u le IV