Opinion ID: 6330205
Heading Depth: 5
Heading Rank: 3

Heading: For the Purpose of Illegal Distribution

Text: To prove the last element, the government was required to show that each defendant “was significantly motivated to maintain [or use] the premises for drug-related purposes.” United States v. Serrano-Ramirez, 811 F. App’x 327, 339 (6th Cir. 2020); see also Russell, 595 F.3d at 642 (finding that a defendant maintains or uses a place “for the purpose of” distributing drugs if the “drug distribution was a significant or important reason”). There must also be sufficient evidence that the controlled substances were distributed illegally, or “without a legitimate medical purpose.” United States v. Chaney, 921 F.3d 572, 591 (6th Cir. 2019). Sufficient evidence supports this element as to each defendant. When Hofstetter opened her own clinic with Tipton at Lovell Road, she instructed her staff to solicit patients that had been discharged from other pain clinics for signs of drug abuse, such as displaying “track marks” or testing positive for illegal drugs. (Trial Tr., R. 906, PageID 76749.) Hofstetter used this strategy to build much of the initial patient base at Lovell Road. The government also submitted evidence that Hofstetter prioritized profit over patient care: she limited appointments to 15 minutes, she instructed staff members with no medical training to fill out patient charts, and she generally focused on getting “the patients . . . in there and paying their fee.” (Trial Tr., R. 906, PageID 76794.) Sufficient evidence also supports the jury’s finding that Clemons, Newman, and Womack used the clinics for the purpose of distributing opioids unlawfully. In addition to the number of opioid prescriptions that they issued (in the same proportions, described above), Dr. John Everett Nos. 20-6245/6426/6427/6428 United States v. Hofstetter, et al. Page 19 Blake—an anesthesiologist and pain management physician—testified that high-dose opioids accounted for the vast majority of treatment offered at the clinics, and that none of the opioid prescriptions he reviewed in about 90 patient files were written for a legitimate medical purpose. Another expert witness testified that none of the files he reviewed contained the necessary elements of a medical chart, noting that medical histories and results from physicals, diagnoses, and treatment plans all fell below the standard of care. See infra part II.D.ii. And former patients testified that they visited the clinics to obtain opioids to feed their addictions or to resell. Moreover, former staff member Stephanie Puckett testified that she and another staff member participated in one of the pharmaceutical kickback schemes, where they received a payout each time they prescribed a specific pain cream. Because Puckett and the other staff member could not write prescriptions themselves, they asked Clemons, Newman,4 and Womack to participate in the scheme and, according to Puckett, all three women agreed. Womack even allegedly signed a blank prescription for the pain cream, so that Puckett could copy it and place them in the file of every Womack patient with insurance. Clemons, Newman, and Womack highlight that some of the clinics’ former patients testified that they did experience chronic pain and needed medication to control it. But this argument does not change our analysis because: [W]e look at a provider’s reason for issuing the prescription when determining whether it was issued for a legitimate medical purpose, rather than the patient’s underlying conditions . . . a [provider] prescribing opioid painkillers to anyone walking through the door is not saved if a person happens to have an underlying condition that could justify the prescription. Chaney, 921 F. 3d at 590–91 (collecting similar cases). Clemons, Newman, and Womack also emphasize that some witnesses testified that the defendants acted professionally and ethically with respect to prescriptions. And Dr. Blake testified that reasonable minds could differ as to the standard of care offered by the providers, in 4Newman disputes that the trial record supports an inference of her involvement in this scheme. Specifically, she highlights Puckett’s recross-examination testimony as demonstrating that Newman was not involved. Newman’s argument, however, distorts the scope of the recross-examination, and a reasonable jury could have viewed Puckett’s testimony as implicating Newman. Nos. 20-6245/6426/6427/6428 United States v. Hofstetter, et al. Page 20 part because the Tennessee guidelines at the time did not limit the amount of medication that could be prescribed to a patient. In essence, with these challenges, Clemons, Newman, and Womack ask us to weigh some testimonies over others and to assess witness credibility, which we may not do when considering the sufficiency of the evidence on appeal. Emmons, 8 F.4th at 478. There was sufficient evidence for a reasonable jury to conclude that the evidence proved each element of this offense, and we affirm the defendants’ convictions.