Opinion ID: 391067
Heading Depth: 1
Heading Rank: 1

Heading: sufficiency of the evidence

Text: 4 Dr. Guerrero was convicted on twelve counts of dispensing controlled substances outside the usual course of professional medical practice for legitimate medical purposes. See 21 U.S.C. § 841(a)(1); 21 CFR § 1306.04(a). 1 These twelve counts involved prescriptions written by Dr. Guerrero for Robert D. Burger, an undercover narcotics officer with the Houston Police Department. 5 Dr. Guerrero strenuously contends on this appeal that the evidence presented at trial was insufficient to sustain his conviction. To convict Dr. Guerrero, it was incumbent upon the government to prove that he dispensed controlled substances for other than legitimate medical purposes in the usual course of professional practice, and that he did so knowingly and intentionally. United States v. Rogers, 609 F.2d 834, 839 (5th Cir. 1980). 6 Guerrero moved for a judgment of acquittal at the close of the government's case and renewed that motion at the conclusion of all the evidence. Thus, in reviewing the sufficiency of the evidence, we must determine whether, viewing the evidence in the light most favorable to the government, a reasonable jury could conclude that the evidence is inconsistent with any hypothesis of the accused's innocence. United States v. Suarez, 608 F.2d 584, 586 (5th Cir. 1979). See also United States v. Robbins, 629 F.2d 1105, 1105 (5th Cir. 1980) (on rehearing). As noted by this court in Suarez, (t)he test is not whether the trial judge or the appellate judge concludes that the evidence fails to exclude every reasonable hypothesis of innocence, but rather whether the jury might reasonably so conclude. United States v. Suarez, supra, 608 F.2d at 586. 7 The government's case against Dr. Guerrero is founded upon his dispensation of twelve prescriptions to an undercover governmental agent, Burger, during his six appointments with the doctor over a period of eight months. 2 Burger was ostensibly an overweight long-haul truckdriver in need of medication to stay awake. Dr. Guerrero's defense is that, based on this testimony alone and that of the government's medical expert, the prescriptions were issued in the normal course of medical practice for appropriate medical reasons. 8 As the district court noted, except for Count Eleven (where, Burger testified, the physician at his request prescribed fifteen tablets of Quaalude for the use of Burger's girlfriend), the government's case is very weak. The government's expert medical witness admitted that the prescriptions for Burger were consistent with those issued in the course of normal medical practice for a patient with Burger's complaints and ostensible medical needs. 9 Ultimately, however, the district court concluded that a jury issue was presented because of certain testimony by Burger as to exchanges between him and the doctor, by reason of which the jury might have concluded that the doctor knew Burger was not obtaining the prescriptions for normal medical purposes. Although (as was the trial court) we are concerned with the weakness of the government's evidence of unlawful dispensation, in the last analysis we agree with the district court's conclusion that a jury issue is presented: reasonably-minded jurors might conclude that the course of conduct proved permits the inference that the defendant doctor prescribed drugs for Burger's use or disposition on the six occasions in question, knowing that Burger desired to acquire them for some other purpose than for treatment of his medical complaints. 10 We have attached a detailed summary judgment of the evidence as an appendix to this opinion. Before we summarize the evidence that we find raised a jury question as to whether Dr. Guerrero's prescriptions to Burger were issued in the normal course of a medical practice, we do note that more than half of the evidence in the record concerns extrinsic acts or conduct of peripheral, at best, relevance to the issue of Dr. Guerrero's knowingly unlawful prescription of drugs for other than legitimate medical purposes on the six occasions charged by the indictment, some of which prejudicial extrinsic evidence was erroneously admitted (see parts II and III infra). 11 In United States v. Rosen, 582 F.2d 1032, 1035-36 (5th Cir. 1978), this court listed nine factors that prior decisions had recognized under their particular facts were indicative of a doctor's dispensation of drugs for an illegitimate purpose and not in the usual course of a medical practice: (1) Inordinately large quantities of controlled substances are prescribed; (2) large numbers of prescriptions are issued; (3) no physical examinations are given; (4) patients are warned to fill their prescriptions at different pharmacies; (5) prescriptions are issued to patients known by the physician to be delivering the drugs to others; (6) prescriptions are issued at intervals inconsistent with legitimate medical treatment; (7) the physician uses street slang rather than medical terminology in referring to the drugs prescribed; (8) there is no logical relationship between the drugs prescribed and the condition to be treated; (9) the physician issues more than one prescription on occasions in order to spread them out. 3 12 With regard to the twelve prescriptions issued to Burger, only factors (5) and (7) are minimally present, although on at least one occasion extrinsic to the indictment a variation of factor (9) is available: 13 While the drug prescriptions issued by Dr. Guerrero to Burger were consistent with normal medical practice on the basis of Burger's complaints, the doctor's responses (which the jury could have accepted as jocularly intended, but did not) to Burger's insinuations that he was obtaining the drugs for nonmedical purposes could have been accepted by a reasonable juror as indicative of the doctor's knowledge that Burger was using or disposing of the drugs for nonmedical purposes; and on at least one occasion (Count Eleven) the doctor wrote out a prescription for fifteen tablets of Quaalude to be used by Burger's girlfriend. The government's medical expert (on drug prescriptions in the normal course of a medical practice) concluded, solely on the basis of these verbal exchanges described to him (and not on the basis of the prescriptions themselves), that the drugs were probably not issued in the normal course of medical practice or that he would not think so i. e., he could not say that the prescriptions themselves under the circumstances could be considered outside the normal course of a medical practice; but the conversational asides in conjunction with the prescriptions became the basis for his belief of a nonlegitimate medical purpose for issuance. Finally, Lorraine Smith, the defendant's former secretary-receptionist, testified that on at least one occasion (not related to the present indictments), Dr. Guerrero had instructed her to make up four false files for nonexistent patients, in which were recorded four prescriptions actually given to a single patient in exchange for a stereo. 14 Our review of the evidence persuades us that a reasonable jury, believing the testimony of Robert Burger, Dr. Barr, and Lorraine Smith, could conclude that the evidence presented at trial was inconsistent with any hypothesis of Dr. Guerrero's innocence. Thus, although we agree with the district court that the evidence is but marginally sufficient, we can find no fault with that court's determination that the jury was entitled to weigh the credibility of Burger and to determine whether, in light of the testimony of Burger, Barr, and Smith, the government had proved Guerrero's guilt beyond a reasonable doubt. We therefore find no error in the trial court's denial of Guerrero's motion for a judgment of acquittal. 15