Opinion ID: 2976069
Heading Depth: 5
Heading Rank: 1

Heading: Calculation of the Sentencing Guidelines

Text: Defendant alleges that the district court erred in calculating the applicable Guidelines range, thus rendering her sentence procedurally unreasonable. As noted above, district courts are required No. 06-5581 United States v. Moon Page 9 to “consult” the Guidelines as part of their consideration of the § 3553(a) factors. We have observed that “a district court’s misinterpretation of the Guidelines effectively means that it has not properly consulted the Guidelines.” United States v. Hazelwood, 398 F.3d 792, 801 (6th Cir. 2005). In reviewing a district court’s application of the Sentencing Guidelines, this Court will “accept the findings of fact of the district court unless they are clearly erroneous and [will] give due deference to the district court’s application of the Guidelines to the facts.” United States v. Williams, 355 F.3d 893, 897-98 (6th Cir. 2003); 18 U.S.C. § 3742(e). A factual finding is clearly erroneous “when the reviewing court on the entire evidence is left with the definite and firm conviction that a mistake has been committed.” Tran v. Gonzales, 447 F.3d 937, 943 (6th Cir. 2006). We review a district court’s legal conclusions regarding the Sentencing Guidelines de novo. United States v. Latouf, 132 F.3d 320, 331 (6th Cir. 1997). Defendant argues that the district court erred in applying a sentencing enhancement for a “large number of vulnerable victims” and “risk of death or serious bodily injury.” Additionally, Defendant alleges that the district court engaged in impermissible “double counting” in sentencing her to both 60 months for making false statements and enhancing her sentence under the Guidelines for obstruction of justice. We address each allegation in turn. 1. Large Number of Vulnerable Victims Under § 3A1.1(b)(1) of the Guidelines, a two-level enhancement is proper “[i]f the defendant knew or should have known that a victim of the offense was a vulnerable victim.” A “vulnerable victim” is defined as a person who “is a victim of the offense of conviction and any conduct for which the defendant is accountable under 1.3 (Relevant Conduct); and . . . who is unusually vulnerable due to age, physical or mental condition, or who is otherwise particularly susceptible to criminal conduct.” USSG § 3A1.1(b)(1), cmt 2. “Relevant conduct” is defined as “all acts and omissions committed, aided, abetted, counseled, commanded, induced, procured or willfully caused by the defendant . . . that occurred during the commission of the offense of conviction, in preparation for that offense, or in the course of attempting to avoid detection or responsibility for that offense.” USSG § 1B1.3. Where there are a “large” number of vulnerable victims, the enhancement may further increase by two levels. USSG § 3A1.1(b)(2). Defendant challenges the district court’s application of the large number of vulnerable victims enhancement. Before the district court, Defendant did not challenge the district court’s determination that a “large” number of vulnerable victims were affected by Defendant’s behavior nor did Defendant challenge the district court’s determination that her cancer patients were “vulnerable” within the meaning of the enhancement. Rather, Defendant alleges that the district court erred in characterizing her patients as “victims” and her administration of chemotherapy medication as “relevant criminal conduct.” Defendant argues that only those parties who were actually defrauded as a result of her offenses of conviction constitute “victims” for sentencing purposes. The government, for its part, asserts that Defendant’s patients were properly considered victims of Defendant’s conduct as a result of the partial doses of medication she administered as part of her fraudulent billing scheme. For the reasons discussed below, we find that the district court properly applied the vulnerable victims enhancement to Defendant’s “relevant criminal conduct.” As an initial matter, it appears that Defendant’s patients are squarely within the class of “vulnerable victims” contemplated by the Guidelines to serve as a basis for the enhancement. The Application Commentary suggests that “[t]he adjustment would apply, for example, in a fraud case in which the defendant marketed an ineffective cancer cure . . . .” USSG § 3A1.1(b)(1), cmt. 2. We believe that the hypothetical presented in the commentary and the factual scenario of the case at bar are analogous. In this case, the Defendant was convicted of fraud which related to the amount of medication used in treating cancer patients. While her fraudulent conduct did not stem from No. 06-5581 United States v. Moon Page 10 representations of a “cure” for cancer, Defendant did present an ineffective treatment for cancer as a central aspect of her fraud conviction. Despite the language contained in the commentary, Defendant argues that her patients were not “victims” for purposes of the vulnerable victims enhancement. Defendant correctly notes that the application of the vulnerable victims enhancement is inappropriate where the statutory scheme defining the offense of conviction does not speak to the protection of individual victims but of broad societal interests. See, e.g., United States v. Madden, 403 F.3d 347, 350 (6th Cir. 2005) (vote sellers could not be deemed victims of a defendant convicted of violating a federal vote buying statute because “[t]he vote buying statute protects ‘society at large’ from corruption of the electoral process” rather than “individuals who value money more highly than their right to vote in a given election.”); United States v. Smith, 139 F. App’x 681 (6th Cir. 2005) (unpublished) (same). However, it appears that Defendant’s argument regarding “relevant conduct” is foreclosed by our decision in United States v. Gawthrop, 310 F.3d 405 (6th Cir. 2002). In Gawthrop, we held that the vulnerable victims enhancement was properly applied based on “relevant conduct” as provided by the Guidelines, notwithstanding the fact that a societal interest or a governmental entity is the primary victim of the offense of conviction. Id. at 410-411. Although Gawthrop is a pre-Booker case, its reasoning nevertheless remains in force. Indeed, we have noted that while Booker severed the mandatory provisions of the Sentencing Guidelines, it “recognized that [t]he remainder of the [Sentencing Reform Act] functions independently.” United States v. Milan, 398 F.3d 445, 456 (6th Cir. 2005) (internal citations omitted). Thus, where provided by the Guidelines, a district court may examine relevant conduct to determine the applicable Guidelines range, even if not captured as an element of the offense of conviction. See United States v. Stone, 432 F.3d 651, 654-655 (6th Cir. 2005). In the case at bar, the district court considered evidence that Defendant provided partial doses of life-saving chemotherapy medication without notifying the patients that their doses were being so adjusted and without any medical justification. Defendant’s act of depriving her patients of the opportunity to receive the full benefit of their treatment through her failure to administer the recommended dosage of medication certainly qualifies as “harm” within the meaning of the vulnerable victims enhancement. Significantly, this “harm” occurred during the course of Defendant’s scheme to defraud a number of healthcare benefit programs. Accordingly, we see no error in the district court's application of the vulnerable victims enhancement on the basis of Defendant’s conduct with respect to her patients, despite the fact that her offenses of conviction were fraud offenses.