Source: https://casetext.com/case/us-v-tran-trong-cuong
Timestamp: 2019-01-23 18:18:41
Document Index: 363197036

Matched Legal Cases: ['§ 841', '§ 841', '§ 841', '§ 812', '§ 841', '§ 853', '§ 841', '§ 801']

U.S. v. Tran Trong Cuong, 18 F.3d 1132 | Casetext
U.S. v. Tran Trong Cuong
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United States Court of Appeals, Fourth CircuitFeb 28, 1994
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ARGUED: Cary Steven Greenberg, Alexandria, Virginia; Edward Scott Rosenthal, Rosenthal, Rich, Grimaldi Guggenheim, Alexandria, Virginia, for appellant. Vincent L. Gambale, Assistant United States Attorney, Alexandria, Virginia, for appellee.
Appellant Tran Trong Cuong, M.D. (Tran) is a physician educated in Paris, France and admitted to practice medicine in the Commonwealth of Virginia since 1973. He is registered as a practitioner with the Drug Enforcement Administration and authorized to prescribe controlled substances listed in Schedules II, III, IV and V as set forth in 21 U.S.C. § 812. He was indicted under 21 U.S.C. § 841(a)(1) for knowingly and willfully distributing and dispensing by prescription various quantities of Schedule II through V controlled substances outside the usual course of medical practice and for other than legitimate medical purposes. The indictment contained 136 counts of unlawful distribution of the drugs and a separate count for criminal forfeiture of property allegedly used in connection with these offenses, as provided by 21 U.S.C. § 853. Following a jury trial, Tran was convicted of 127 counts, and the jury returned a special verdict supporting forfeiture of certain real estate located in Alexandria, Virginia. He was acquitted of eight counts, and one count was dismissed prior to the verdict.
Drugs are ranked in these schedules according to their potential for abuse. Schedule I substances are strictly illegal. Schedule II substances have a high abuse potential leading to severe psychological or physical dependence but are currently accepted in some medical applications and can safely be used when a patient is under medical supervision. Schedule III substances have less potential for abuse leading only to moderate or low physical dependence or high psychological dependence, and are currently accepted for use in medical treatment. Schedule IV substances are currently accepted in medical application and have a comparatively low abuse risk with a potential for only limited physical or psychological dependence. Schedule V substances have an even lower potential for risk abuse and only a limited potential for physical or psychological dependence.
Tran was sentenced to 97 months in prison, ordered to pay a special assessment of $6,350, and an order of forfeiture was entered as to the real estate. Tran now appeals. This appeal presents a number of issues: (1) sufficiency of the evidence, particularly as to the 80 counts as to which there was no testimony from the patient receiving the prescription; (2) reputation evidence presented by the government although Tran had not placed his reputation at issue nor presented any evidence tending to prove his good reputation; (3) the government's medical expert's effort to bolster his opinion with that of another physician, who did not testify; (4) the proper standard to use in determining whether a prescription violated 21 U.S.C. § 841(a)(1), and (5) various questions as to the sentence.
Not that the law invests the defendant with a presumption of good character; . . . it simply closes the whole matter of character, disposition and reputation on the prosecution's case-in-chief. . . .
But this line of inquiry firmly denied to the State is opened to the defendant because character is relevant in resolving probabilities of guilt. . . . The price a defendant must pay for attempting to prove his good name is to throw open the entire subject which the law has kept closed for his benefit and to make himself vulnerable where the law otherwise shields him. The prosecution may pursue the inquiry with contradictory witnesses to show that damaging rumors, whether or not well-grounded, were afloat — for it is not the man that he is, but the name that he has which is put in issue.
Other crimes, wrongs, or acts. Evidence of other crimes, wrongs, or acts is not admissible to prove the character of a person in order to show action in conformity therewith. It may, however, be admissible for other purposes, such as proof of motive, opportunity, intent, preparation, plan, knowledge, identity, or absence of mistake or accident. . . .
The government's position is disingenuous and lacking in merit. Witness Coats was not testifying as to other "crimes, wrongs or acts". She was testifying as to acts covered by the indictment, and the court did not admit this evidence as other acts, but as evidence of the defendant's reputation and character, the one area it could not enter unless the defendant first opened the door, which the defendant had not done. We have held that a strong and immediate curative instruction may sometimes dissipate the prejudice from the inadvertent admission of character evidence, but here the admission was not inadvertent. The evidence was admitted because "it goes to character," and since the court did not realize that it had committed error, no curative instruction was given. See United States v. Johnson, 610 F.2d 194, 196 (4th Cir. 1979), cert. denied, 446 U.S. 911, 100 S.Ct. 1840, 64 L.Ed.2d 264 (1980).
In United States v. Harris, 331 F.2d 185 (4th Cir. 1964), the defendant was convicted of concealing 150 gallons of non-tax paid whiskey. Harris operated a business known as the Ponderosa which sold canned goods, sandwiches and soft drinks. The alleged offense did not occur at the Ponderosa, but the government, over objection, was permitted to cross examine the defendant as to the reputation of the Ponderosa being "bad for liquor." The government was also permitted to present testimony, over defendant's objection, as to his reputation for violating the liquor laws. The government argued that since the defendant had testified that he had twice been convicted of dealing in non-tax paid whiskey, his reputation was a proper subject for inquiry. We rejected this argument. In reversing the conviction, we reiterated the rule that when a defendant testifies as a witness in his own behalf, his general reputation as to truth and veracity in the community may be shown, but the defendant's general character may not be attacked by the government unless evidence of his good character is first introduced by the defendant. We concluded: "It was substantial error to permit the Government to attack defendant's character by introducing testimony concerning his reputation as a `liquor law violator on a large scale.'" Id. at 188. The same reasoning applies to the present case. Tran had not placed his character or reputation in evidence and the violation of this well-established rule clearly prejudiced the defendant's right to a fair trial, and his convictions must be reversed.
Tran argues that the evidence was insufficient to convict him of any offense, and that this insufficiency was most apparent as to the 80 counts in which the patients, who had received four prescriptions each, did not testify. As to these counts, he claims that there is no proof of his criminal intent in issuing the prescriptions, nor was there proof that his actions "exceeded the bounds of `professional practice'" as required by United States v. Moore, 423 U.S. 122, 142, 96 S.Ct. 335, 345, 46 L.Ed.2d 333 (1975) (footnote omitted).
First, we must consider what proof is required in the prosecution of a physician under this statute. Section 841(a) of Title 21 of the United States Code provides, in part: "(a) . . . it shall be unlawful for any person knowingly or intentionally — (1) to . . . distribute, . . . a controlled substance. . . ." In order to secure a conviction under this section the government must prove beyond a reasonable doubt that (1) defendant knowingly or intentionally distributed the controlled substance alleged in the indictment, and (2) at the time of such distribution the defendant knew that the substance distributed was a controlled substance under the law. There is no dispute that the prescriptions written by Tran were drugs that appear on Schedules II through V of the Controlled Substances Act, 21 U.S.C. § 801 et seq., and therefore are "controlled substances" and may not be lawfully distributed other than as provided by law.
Tran is a licensed physician under the laws of Virginia, and a licensed practitioner with the Drug Enforcement Administration. As such, he is authorized to write prescriptions for controlled substances in the care and treatment of his patients. The court in Moore, supra, held, "[T]he scheme of the statute, viewed against the background of the legislative history, reveals an intent to limit a registered physician's dispensing authority to the course of his `professional practice.'" 423 U.S. at 140, 96 S.Ct. at 344. Therefore, a licensed physician who prescribes controlled substances outside the bounds of his professional medical practice is subject to prosecution and is no different than "a large-scale `pusher.'" Id. at 143, 96 S.Ct. at 345.
First, Tran contends that the court and the prosecution used a medical malpractice standard rather than a criminal standard to judge his actions. At times the court did confuse the two standards. When Dr. MacIntosh was testifying, the court advised him, "The standard is whether a reasonably prudent physician would do it." Later the court commented, "whether it is within the standard of care of a family practitioner" and "like you use in a civil case, whether in the usual course of treating a patient by the average family practitioner . . . ." These statements reflect the use of a negligence standard. A criminal prosecution requires more — that is, proof beyond a reasonable doubt that the doctor was acting outside the bounds of professional medical practice, as his authority to prescribe controlled substances was being used not for treatment of a patient, but for the purpose of assisting another in the maintenance of a drug habit or of dispensing controlled substances for other than a legitimate medical purpose, i.e. the personal profit of the physician.
For example, evidence that a doctor warns his patients to fill their prescription at different drug stores, prescribes drugs without performing any physical examinations or only very superficial ones, or ask [sic] patients about the amount or type of drugs they want, may suggest that the doctor is not acting for a legitimate medical purpose than a [sic] outside the usual course of medical practice. These examples are neither conclusive nor exhaustive. They are simply meant to give you an idea of the kind of behavior from which you may conclude that a doctor was not prescribing drugs for a legitimate medical purpose and was not acting in the usual course of medical practice.
Having decided that the jury was properly instructed as to the correct medical standard for this criminal prosecution, we turn to the evidence. Although the court told Dr. MacIntosh to use a negligence or malpractice standard, an examination of his testimony and the other evidence presented convinces us that Dr. Tran's actions in dispensing narcotics and other controlled substances violated the criminal standard and were outside the bounds of his professional medical practice. Dr. MacIntosh has practiced family medicine for 32 years and is Board certified in this discipline. He testified that he had examined 33 charts of patients listed in the indictment and prepared a written report summarizing the information on each chart. This is government exhibit 34. He also prepared an exhibit that correlated 1,800 narcotic prescriptions to specific patients and he read the grand jury testimony of a number of patients. He also reviewed the DEA undercover reports and pertinent medical literature and examined the patient waivers or releases that were in the files found in the defendant's office. He also reviewed the opinions of Dr. Stevenson as to the same patient charts.
We address this issue in part V of this opinion.
The government has convicted the appellant of 80 counts based upon the summary report of 33 patient files prepared and submitted by its medical expert and the testimony of the medical expert that the drug prescriptions contained in these files were made for other than legitimate medical purposes and beyond the bounds of medical practice. Although the witness admitted that he did not have sufficient information from some of the charts to conclude that the prescriptions were improper, these charts were included in the exhibit and also formed the basis of separate counts in the indictment, simply because they followed a pattern. This is not sufficient to convict a person of a felony, and it concerns us that, as to these 80 counts, defendant may have been found guilty of some counts by association — the association of the counts properly proved with those that were not.
In addition to the problems of hearsay and Stevenson's report being used to vouch for the opinion of MacIntosh, it is doubtful if Dr. Stevenson's report would qualify as data "of a type reasonably relied upon by experts in the particular field." The Stevenson report was prepared at the request of the prosecution and thereby is a forensic opinion or report in a criminal case. We question whether Dr. MacIntosh usually relies upon forensic medical opinions or reports in forming his opinions in his field of expertise — family medicine.