Opinion ID: 64036
Heading Depth: 1
Heading Rank: 4

Heading: dr cullins's sentencing

Text: Dr. Cullins challenges the reasonableness of her sixty-month sentence, arguing that the trial court erred in calculating an initial Sentencing Guidelines range of forty-one to fifty-one months because it improperly included legitimate prescriptions and drugs dispensed by the clinics before she began working there. Dr. Cullins further argues that her sentence is unreasonable because it is disproportionate to her culpability, particularly in light of Armstrong's seventy-month sentence. [35] The Government responds that Dr. Cullins did not object to the factual findings in the Presentence Investigation Report (PSR), which was adopted by the district court. The Government asserts that the base offense level calculated by the district court was correct and that a mere difference of sentences among co-defendants does not constitute an abuse of discretion. 1. Standard of Review The review of sentencing decisions is limited to determining whether they are reasonable. Gall v. United States, ___ U.S. ___, 128 S.Ct. 586, 594, 169 L.Ed.2d 445 (2007). That process of review is a bifurcated one. Id. We first examine whether the district court committed any significant procedural error, such as: (1) failing to calculate (or improperly calculating) the applicable Guidelines range; (2) treating the Guidelines as mandatory; (3) failing to consider the 18 U.S.C. § 3553(a) factors; [36] (4) determining a sentence based on clearly erroneous facts; or (5) failing to adequately explain the chosen sentence, including an explanation for any deviation from the Guidelines range. Id. at 597. Analyzing for procedural error, the reviewing court examines the district court's interpretation or application of the Sentencing Guidelines de novo, and its factual findings for clear error. United States v. Cisneros-Gutierrez, 517 F.3d 751, 764 (5th Cir.2008). There is no clear error if the district court's finding is plausible in light of the record as a whole. Id. (quoting United States v. Juarez-Duarte, 513 F.3d 204, 208 (5th Cir.2008)). Next, assuming the district court's decision is procedurally sound, we consider the substantive reasonableness of the sentence. Gall, 128 S.Ct. at 597. While a sentence within a properly-calculated Guidelines range enjoys a presumption of reasonableness in this Circuit, Cisneros-Gutierrez, 517 F.3d at 766, a sentence that includes an upward or downward departure as allowed by the Guidelines is reviewed for an abuse of discretion. See Gall, 128 S.Ct. at 597 (holding that absent a presumption of reasonableness, abuse of discretion is the standard for reviewing sentences, whether Guideline or non-Guideline, for substantive reasonableness). That the Court of Appeals might reasonably have concluded that a different sentence was appropriate is an insufficient justification for reversal of the district court, because the sentencing judge is in a superior position to evaluate the § 3553(a) factors, given that [t]he judge sees and hears the evidence, makes credibility determinations, has full knowledge of the facts and gains insights not conveyed by the record. Gall, 128 S.Ct. at 597 (internal quotations omitted). 2. Analysis A district court should begin all sentencing proceedings by correctly calculating the applicable Guidelines range. Gall, 128 S.Ct. at 596. At the sentencing hearing, the district court adopted the factual findings of the Pre-Sentencing Report (the PSR). Dr. Cullins stated that she had no objections to those findings. The PSR stated that the usual prescription given to the clinics' patients generally included three medications in the following dosage units for a fourteen day period: 90 Lorcet; [37] 30 Xanax; [38] and 90 Soma. [39] The PSR also stated that: (1) on most occasions, each doctor at the clinics often saw more than eighty patients per day; (2) for certain doctors, that number of patients increased to hundreds per day; and (3) at times the doctors, on average, saw one patient every 3.3 minutes. The PSR specifically noted that Dr. Cullins was known as the in and out lady because she wrote prescriptions so fast. [40] The PSR calculated Dr. Cullins's base offense level as 20, pursuant to United States Sentencing Guidelines § 2D1.1(a) and (c)(10), based on her responsibility in dispensing more than 40,000 dosage units of a Schedule III substance. To find that Dr. Cullins, or her co-conspirators, illegally prescribed 40,000 dosage units requires finding 445 or more patient visits accompanied by illegal Hydrocodone dispensations of typical dosage. At the rate that Dr. Cullins and the other physicians wrote these prescriptions, it would take only six days for one doctor at the clinic, seeing approximately 80 patients per day, to dispense that amount of Hydrocodone. The evidence shows that Dr. Cullins wrote 302 such prescriptions in four hours of work at one clinic on April 9, 2005. In light of the fact that Dr. Cullins worked at the clinic for over two years, was found guilty of a conspiracy to dispense controlled substances, the district court's finding that at least 40,000 illegally dispensed doses of a Schedule III drug were attributable to Dr. Cullins was plausible and did not constitute clear error. [41] See United States v. Carbajal, 290 F.3d 277, 287 (5th Cir.2002) (applying the general rule that information in a PSR is presumed reliable and may be adopted by the district court without further inquiry if the defendant fails to demonstrate by rebuttal evidence that the information is untrue or unreliable). We conclude that the district court committed no procedural error in determining Dr. Cullins's sentence. The Guidelines sentence range was correctly calculated, [42] and a review of the sentencing hearing transcript clearly shows that the district court did not treat the Guidelines as mandatory, and that it considered the § 3553(a) factors, gave an individualized assessment, and adequately explained the chosen sentence, including an explanation for imposing an upward departure from the Guidelines range. We now turn to Dr. Cullins's argument that her sentence was nonetheless substantively unreasonable, particularly in comparison to the sentence meted out to Armstrong. Cullins argues, based on the proportionality principle of 18 U.S.C. § 3553(a)(6), that she should have been given a shorter sentence because Armstrong was more culpable and received a sentence only ten months longer. Reviewing the reasonableness of the sentence imposed by the district court, an upward departure from the initial calculation of a Guidelines range, we do not find it to be abuse of discretion. See Smith, 440 F.3d at 707. At the sentencing hearing, the court noted the substantial number of letters received on Dr. Cullins's behalf and heard defense counsel describe Dr. Cullins's years of service as a doctor and lay minister. Acknowledging these mitigation arguments, the district court discussed Dr. Cullins's position of trust as a doctor and the special role that doctors have in society, tending to people when they are vulnerable, and starting with the command to do no harm. Finding that Dr. Cullins's conduct in her two years at the clinic violated this command and trust, the district court concluded that her patients and society had a right to expect better. The district court agreed with the Government that the trial testimony and facts of the case revealed substantial harm to individual victims and the public's faith in the healthcare delivery system. After this careful considered Cullins's conduct and the relevant § 3553(a) factors, the district court imposed a sentence of sixty months, an upward departure from the Guidelines range but within the statutory range. Nonetheless, Cullins argues that her sixty-month sentence is excessive in relation to Armstrong's seventy-month sentence, and therefore that the district court failed to consider the need to avoid unwarranted sentencing disparities. See § 3553(a)(6). Dr. Cullins is correct that identifying a case in which a similarly-situated defendant received a lesser sentence is one way that a defendant can establish the existence an unwarranted disparity. See Smith, 440 F.3d at 709. However, we are not persuaded that the comparison of the co-defendants' sentences in this case shows an abuse of discretion. Armstrong, the acknowledged mastermind, did receive a longer sentence that Dr. Cullins. Dr. Cullins contends that her conduct was less egregious than Armstrong's and warrants a greater sentencing differential than the ten-month difference in length between Armstrong's sentence and her own. The district court correctly noted that Armstrong is a non-registrant and could not have carried out the enterprise without doctors like Dr. Cullins who worked at the clinics and wrote all of the prescriptions. Dr. Cullins has not demonstrated that, considering this significant difference in situation between the defendants, the sentence imposed is disproportionate to her culpability such that the district court abused its discretion. See Cisneros-Gutierrez, 517 F.3d at 767 (rejecting argument that defendant's sentence was unreasonable because his brother, more deeply involved in the conspiracy, received a sentence ten years shorter, noting: Defendant also fails to consider that his microcosmic approach to sentencing disparities, while relevant, would create its own set of disparities with other similarly situated defendants.).