Source: https://supreme.justia.com/cases/federal/us/423/122/case.html
Timestamp: 2017-01-20 18:14:35
Document Index: 29742669

Matched Legal Cases: ['§ 822', '§ 822', '§ 841', '§ 842', '§ 841', '§ 841', '§ 842', '§ 841', '§ 841', '§ 841', '§ 841', '§ 822', '§ 842', '§ 841', '§ 842', '§ 843', '§ 842', '§ 842', '§ 841', '§ 501', '§ 501', '§ 841', '§ 503', '§ 842', '§ 829', '§ 842', '§ 843', '§ 829', '§ 829', '§ 842', '§ 843', '§ 823', '§ 812', '§ 823', '§ 827', '§ 827', '§ 828']

United States v. Moore (full text) :: 423 U.S. 122 (1975) :: Justia U.S. Supreme Court Center Log In
U.S. Supreme CourtUnited States v. Moore, 423 U.S. 122 (1975)United States v. MooreNo. 74-759Argued October 7, 1975Decided December 9, 1975423 U.S. 122CERTIORARI TO THE UNITED STATES COURT OF APPEALS
"(1) to manufacture, distribute, or dispense, or Page 423 U. S. 125 possess with intent to manufacture, distribute, or dispense, a controlled substance. . . ."
Maintenance is the more controversial method of treatment. During the period covered by the indictment, registration under § 822, in itself, did not entitle a physician to conduct a maintenance program. In addition to a § 822 registration, the physician who wished to conduct such a program was required to Page 423 U. S. 126 obtain authorization from the Food and Drug Administration for investigation of a new drug. Dr. Moore's authorization by the FDA was revoked in the summer of 1971, and he does not claim that he was conducting an authorized maintenance program. Instead, his defense at trial was that he had devised a new method of detoxification based on the work of a British practitioner. He testified that he prescribed large quantities of methadone to achieve a "blockade" condition, in which the addict was so saturated with methadone that heroin would have no effect, and to instill a strong psychological desire for detoxification. The Government's position is that the evidence established that Dr. Moore's conduct was inconsistent with all accepted methods of treating addicts, that, in fact, he operated as a "pusher."
When a patient entered the office, he was given only the most perfunctory examination. Typically this included a request to see the patient's needle marks (which in more than one instance were simulated) and an unsupervised urinalysis (the results of which were regularly ignored). A prescription was then written for the amount requested by the patient. On return visits -- for Page 423 U. S. 127 which appointments were never scheduled -- no physical examination was performed and the patient again received a prescription for whatever quantity he requested. Accurate records were not kept, and in some cases the quantity prescribed was not recorded. There was no supervision of the administration of the drug. Dr. Moore's instructions consisted entirely of a label on the drugs reading: "Take as directed for detoxification." Some patients used the tablets to get "high"; others sold them or gave them to friends or relatives. Several patients testified that their use of methadone increased dramatically while they were under respondent's care. [Footnote 3]
The Court of Appeals, with one judge dissenting, assumed that respondent acted wrongfully but held that he could not be prosecuted under § 841. [Footnote 4] 164 U.S.App.D.C. Page 423 U. S. 128 319, 505 F.2d 426 (1974). The court found that Congress intended to subject registered physicians to prosecution only under §§ 842 and 843, [Footnote 5] which prescribe Page 423 U. S. 129 less severe penalties than § 841. [Footnote 6] The court reasoned:
". . . Congress intended to deal with registrants primarily Page 423 U. S. 130 through a system of administrative controls, relying on modest penalty provisions to enforce those controls, and reserving the severe penalties provided for in § 841 for those seeking to avoid regulation entirely by not registering."
It said, further, that §§ 842 and 843 were enacted to enforce that scheme, while § 841 was reserved for prosecution of those outside the "legitimate distribution chain." Persons registered under the Act were "authorized by [the] subchapter" within the meaning of § 841, and thus were thought to be immunized against prosecution under that section. [Footnote 7] Page 423 U. S. 131
This is a qualified authorization of certain activities, not a blanket authorization of all acts by certain persons. This limitation is emphasized by the subsection's heading "Authorized activities," which parallels the headings of §§ 841-843 "Unlawful acts." We think the statutory language cannot fairly be read to support the view that all activities of registered physicians Page 423 U. S. 132 are exempted from the reach of § 841 simply because of their status.
Section 822(b) was added to the original bill at a late date [Footnote 9] to "make it clear that persons registered under Page 423 U. S. 133 this title are authorized to deal in or handle controlled substances." H.R.Rep. No. 91-1444, p. 38. It is unlikely that Congress would seek, in this oblique way, to carve out a major new exemption, not found in the Harrison Act, for physicians and other registrants. Rather, § 822(b) was added merely to ensure that persons engaged in lawful activities could not be prosecuted.
The operative language of those sections provides no real support for the proposition that Congress intended to establish two mutually exclusive systems. It is true that the term "registrants" is used in §§ 842 and 843, and not in § 841. But this is of limited significance. All three sections provide that "[i]t shall be unlawful for any person . . . [to commit the proscribed acts]." Two of the eight subsections of § 842(a), one of the five subsections of § 843(a), and § 842(b) further qualify "any person" with "who is a registrant." The other subsections of § § 842 and 843 are not so limited. In context, "registrant" is merely a limiting term, indicating that the only "persons" who are subject to these subsections are "registrants." [Footnote 10] There is no indication that "persons" Page 423 U. S. 134 means "nonregistrants" when introducing the other subsections.
The legislative history indicates that Congress was concerned with the nature of the drug transaction, rather than with the status of the defendant. The penalties now embodied in §§ 841-843 originated in §§ 501-503 of the Controlled Dangerous Substances Act of 1969. The Report of the Senate Judiciary Committee on that bill described § 501 (the counterpart of § 841) as applying to "traffickers." S.Rep. No. 91-613, p. 8 Page 423 U. S. 135 (1969). Section 502 provided "[a]dditional penalties . . . for those involved in the legitimate drug trade," and "[f]urther penalties . . . for registrants" were specified in § 503. S.Rep. No. 91-613, p. 9. The House Committee Report on the bill that was to become the CSA explains:
Recognizing this concern, the Court of Appeals suggested that Dr. Moore could be prosecuted under § 842(a)(1) Page 423 U. S. 136 for having violated the provisions of § 829 with respect to the issuing of prescriptions. [Footnote 12] Whether Dr. Moore could have been so prosecuted is not before the Page 423 U. S. 137 Court. [Footnote 13] We note, however, that the penalties for such a violation could hardly have been deemed by Congress to be an appropriate sanction for drug trafficking by a registered physician. Indeed, the penalty for conviction under § 842 would be significantly lighter than, for example, that applicable to a registrant convicted under § 843 for using a suspended registration number. [Footnote 14] Moreover, a physician who wished to traffic in drugs without threat of criminal prosecution could, if violation of § 829 were the sole basis for prosecution, simply dispense drugs directly, without the formality of issuing a prescription. Direct dispensing is exempt from § 829, and thus is not reached by any subsection of § 842 or Page 423 U. S. 138 § 843 so long as the technical requirements are complied with.
"beyond a reasonable doubt that a physician, who knowingly or intentionally, did dispense or distribute Page 423 U. S. 139 [methadone] by prescription, did so other than in good faith for detoxification in the usual course of a professional practice and in accordance with a standard of medical practice generally recognized and accepted in the United States."
38 Stat. 786. As noted above, Congress intended the CSA to strengthen, rather than to weaken, the prior drug laws. There is no indication that Congress intended to eliminate the existing limitation on the exemption given to doctors. [Footnote 16] The difficulty Page 423 U. S. 140 arises because the CSA, unlike the Harrison Act, does not spell out this limitation in unambiguous terms.
Registration of physicians and other practitioners [Footnote 17] is mandatory if the applicant is authorized to dispense drugs or conduct research under the law of the State in which he practices. [Footnote 18] § 823(f). In the case of a physician, Page 423 U. S. 141 this scheme contemplates that he is authorized by the State to practice medicine and to dispense drugs in connection with his professional practice. [Footnote 19] The federal registration, which follows automatically, extends no further. It authorizes transactions within "the legitimate distribution chain," and makes all others illegal. H.R.Rep. No. 91-1444, p. 3. Implicit in the registration of a physician is the understanding that he is authorized only to act "as a physician."
Other provisions throughout the Act reflect the intent Page 423 U. S. 142 of Congress to confine authorized medical practice within accepted limits. Section 812(b)(2) includes in its definition of Schedule II drugs a requirement that "[t]he drug [have] a currently accepted medical use with severe restrictions." Registration under the CSA to dispense or to conduct research with Schedule I drugs, which are defined as having "no currently accepted medical use in treatment in the United States," § 812(b)(1)(B), does not follow automatically from state registration as it does with respect to drugs in Schedules II through V, all of which have some accepted medical use. § 823(f). The record and reporting requirements of § 827 are made inapplicable with respect to narcotic drugs in Schedules II through V when they are prescribed or administered "by a practitioner in the lawful course of his professional practice." § 827(c)(1)(A). Section 828(a) prohibits the distribution of Schedule I and II drugs unless pursuant to specified order forms; § 828(e) makes it unlawful for "any person" to obtain drugs with these order forms
The evidence presented at trial was sufficient for the jury to find that respondent's conduct exceeded the bounds of "professional practice." [Footnote 20] As detailed above, he gave inadequate physical examinations or none at all. Page 423 U. S. 143 He ignored the results of the tests he did make. He did not give methadone at the clinic, and took no precautions against its misuse and diversion. He did not regulate the dosage at all, prescribing as much and as frequently as the patient demanded. He did not charge for medical services rendered, but graduated his fee according to the number of tablets desired. In practical effect, he acted as a large-scale "pusher" -- not as a physician.
"* * * *" "The practicing physician has . . . been confused as to when he may prescribe narcotic drugs for an Page 423 U. S. 144 addict. Out of a fear of prosecution, many physicians refuse to use narcotics in the treatment of addicts except occasionally in a withdrawal regimen lasting no longer than a few weeks. In most instances, they shun addicts as patients. [Footnote 21]"
In the case of methadone treatment, the limits of approved practice are particularly clear. As Dr. Moore admitted at trial, [Footnote 22] he was authorized only to dispense methadone for detoxification purposes. His authorization by the FDA to engage in a methadone maintenance program had been revoked. Nor was respondent unfamiliar with the procedures for conducting a legitimate detoxification program. Charges arising Page 423 U. S. 145 out of his 1969 treatment program, which involved a combination of "long-term" and "short-term" detoxification, were dropped after he testified before a grand jury and agreed to abide by certain medical procedures in future methadone programs. These included obtaining a medical history of each patient, conducting a reasonably thorough physical examination, abiding by the results of urine tests, recording times and amounts of dosages, and either administering the methadone in his office or prescribing no more than a daily dosage. [Footnote 23] At trial, respondent admitted that he had failed to follow these procedures. [Footnote 24]
"The canon in favor of strict construction [of criminal statutes] is not an inexorable command to override common sense and evident statutory purpose. . . . Nor does it demand that a statute be given the 'narrowest meaning;' it is satisfied if the words are given their fair meaning in accord with the manifest intent of the lawmakers. "Page 423 U. S. 146