Opinion ID: 1354921
Heading Depth: 2
Heading Rank: 2

Heading: Elements of Felonious Deliveries by Prescriptions of Practitioners

Text: The federal counterpart to W.Va.Code, 60A-4-401(a) [1983], quoted in the third paragraph of the immediately preceding subsection of this opinion, is 21 U.S.C. § 841(a) (1988). The relevant part of this federal statute provides: Except as authorized by this subchapter, it shall be unlawful for any person knowingly or intentionally[¶] (1) to ... distribute ... a controlled substance[.] The Supreme Court of the United States, in the leading case of United States v. Moore, 423 U.S. 122, 96 S.Ct. 335, 46 L.Ed.2d 333 (1975), held unanimously that registered physicians or other registered practitioners may be prosecuted under this statute providing the severest penalties when their activities knowingly or intentionally fall outside the usual course of professional practice[,] id. at 124, 96 S.Ct. at 337, 46 L.Ed.2d at 337, referring to the statutory definition of practitioner. The court so held regardless of whether the practitioners may also be prosecuted under another section, 21 U.S.C. § 842 (1988), for the less serious offenses of noncompliance with the technical, administrative requirements concerning controlled substances. Id. at 138, 96 S.Ct. at 343, 46 L.Ed.2d at 345. [11] Accordingly, the Supreme Court of the United States in Moore rejected the proposition that there were two mutually exclusive systems of sanctions, a relatively toothless system for registered practitioners and a more serious system for all other persons. In fact, a registered practitioner who complies with the easily fulfilled formal requirements of prescription writing, etc., contained in the registration sections of the statute could, under the mutually exclusive systems approach, escape even misdemeanor liability. Therefore, under that approach, a doctor would not even have to pretend to act as a doctor. He [or she] could stand on a street corner and sell prescriptions to passersby and yet he [or she] would be immune from ... prosecution. United States v. Rosenberg, 515 F.2d 190, 194 (9th Cir.), cert. denied, 423 U.S. 1031, 96 S.Ct. 562, 46 L.Ed.2d 404 (1975). See also State v. Carr, 95 N.M. 755, 761, 626 P.2d 292, 298 (Ct.App.), cert. denied, 95 N.M. 669, 625 P.2d 1186, and cert. denied, 454 U.S. 853, 102 S.Ct. 298, 70 L.Ed.2d 145 (1981). Moore [12] referred to federal (Drug Enforcement Administration) regulations on prescriptions for controlled substances, specifically, the regulation now set forth in 21 C.F.R. § 1306.04(a) (1990), which is virtually identical to the West Virginia board of pharmacy's regulation on prescriptions for controlled substances, set forth in 1 W.Va.Code of State Rules § 15-2-9.5(a) (1982). The latter significantly provides: (a) A prescription for a controlled substance to be effective must be issued for a legitimate purpose by an individual practitioner acting in the usual course of his [or her] professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is not a prescription within the meaning and intent of section three hundred eight, article three of the Act and the person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalt ies provided for violations of the provisions of law relating to controlled substances. (emphasis added) See also W.Va.Code, 30-4-11 [1986], quoted above at the end of subsection II(A) of this opinion (dentist may prescribe drugs as may be necessary to proper treatment). [13] The statutory language of W.Va. Code, 60A-1-101(v) [1983] for valid prescriptions, specifically, those issued in the course of professional practice or research, and the language of the regulation, specifically, those prescriptions issued for a legitimate purpose, have the same meaning and are used interchangeably. United States v. Kirk, 584 F.2d 773, 784 (6th Cir.), cert. denied, 439 U.S. 1048, 99 S.Ct. 726, 58 L.Ed.2d 708 (1978); United States v. Plesons, 560 F.2d 890, 897 n. 6 (8th Cir.), cert. denied, 434 U.S. 966, 98 S.Ct. 506, 54 L.Ed.2d 452 (1977); United States v. Rosenberg, 515 F.2d 190, 196-97 (9th Cir.) (a practitioner can act in the course of professional practice or research only by acting for a legitimate purpose), cert. denied, 423 U.S. 1031, 96 S.Ct. 562, 46 L.Ed.2d 404 (1975). After Moore established that registered practitioners are only qualifiedly exempt from prosecution under the generally applicable provisions of the controlled substances felony statute, many of the United States Courts of Appeals delineated the elements of the offense of a felonious distribution of a controlled substance by a registered physician or other registered practitioner who issued a purported prescription for such a substance requiring a valid prescription. For example, the court in United States v. Varma, 691 F.2d 460, 462 (10th Cir.1982), outlined these elements: (1) the defendant distributed (constructively delivered) a controlled substance by the issuance of the purported prescription; (2) the defendant issued the purported prescription for the controlled substance without a legitimate medical or other authorized purpose (language of regulation) and, therefore, outside the usual course of professional practice or research (language of statutory definition of practitioner); and (3) the defendant acted intentionally or knowingly. See also United States v. Hayes, 794 F.2d 1348, 1351-52 (9th Cir.1986), cert. denied, 479 U.S. 1086, 107 S.Ct. 1289, 94 L.Ed.2d 146 (1987); United States v. Betancourt, 734 F.2d 750, 756-57 & n. 7 (11th Cir.), cert. denied sub nom. Gerwitz v. United States, 469 U.S. 1021, 105 S.Ct. 440, 83 L.Ed.2d 365 (1984), and cert. denied sub nom. Sando v. United States, 469 U.S. 1076, 105 S.Ct. 574, 83 L.Ed.2d 514 (1984); United States v. Rogers, 609 F.2d 834, 839 (5th Cir.1980); United States v. Kirk, 584 F.2d 773, 784 (6th Cir.), cert. denied, 439 U.S. 1048, 99 S.Ct. 726, 58 L.Ed.2d 708 (1978); United States v. Roya, 574 F.2d 386, 390-91 (7th Cir.), cert. denied, 439 U.S. 857, 99 S.Ct. 172, 58 L.Ed.2d 165 (1978); United States v. Plesons, 560 F.2d 890, 896 (8th Cir.), cert. denied, 434 U.S. 966, 98 S.Ct. 506, 54 L.Ed.2d 452 (1977). [14] See generally annotation, Federal Criminal Liability of Licensed Physician for Unlawfully Prescribing or Dispensing Controlled Substance or Drug in Violation of the Controlled Substances Act (21 USCS §§ 801 et seq.), 33 A.L.R.Fed. 220 (1977 & Supp. 1990). Several state courts have delineated essentially these same elements for the corresponding offense under their respective versions of the UCSA or very similar state controlled substances legislation. See, e.g., Cilento v. State, 377 So.2d 663, 666 (Fla. 1979); State v. Vinson, 298 So.2d 505, 506-07 (Fla.Dist.Ct.App.1974), aff'd on another point after remand, 345 So.2d 711 (Fla. 1977); State v. Adams, 64 Haw. 568, 571-72, 645 P.2d 308, 311 (1982); People v. Chua, 156 Ill.App.3d 187, 194, 108 Ill.Dec. 837, 841-42, 509 N.E.2d 533, 537-38 (1987); State v. Vakas, 242 Kan. 103, 104-07, 744 P.2d 812, 813-15 (1987); State v. Moody, 393 So.2d 1212, 1214-15 (La.1981); State v. Fearing, 30 Md.App. 134, 137-38, 351 A.2d 896, 899-900 (1976); Commonwealth v. Comins, 371 Mass. 222, 232, 356 N.E.2d 241, 247-48 (1976), cert. denied, 430 U.S. 946, 97 S.Ct. 1582, 51 L.Ed.2d 793 (1977); People v. Alford, 405 Mich. 570, 582-89, 275 N.W.2d 484, 487-91 (1979); State v. Kane, 586 S.W.2d 812, 814-15 (Mo.Ct.App.1979); State v. Vaccaro, 142 N.J.Super. 167, 172-74, 361 A.2d 47, 50-51 (App.Div.) (rejecting as patently frivolous defendant's arguments that (1) statute was unconstitutionally vague and that (2) criminal culpability does not attach where criminal penalties are set forth in one statutory section and limited exemption of registered practitioner is in another statutory section), cert. denied, 71 N.J. 518, 366 A.2d 674 (1976); State v. Carr, 95 N.M. 755, 758-63, 626 P.2d 292, 295-300 (Ct.App.) (statute not unconstitutionally vague), cert. denied, 95 N.M. 669, 625 P.2d 1186, and cert. denied, 454 U.S. 853, 102 S.Ct. 298, 70 L.Ed.2d 145 (1981); State v. Sway, 15 Ohio St.3d 112, 115-16, 472 N.E.2d 1065, 1067-69 (1984) (and syllabus by court). Cf. State v. Mann, 119 R.I. 720, 721-24, 382 A.2d 1319, 1320-21 (1978) (physicians or other practitioners, as any person, may be convicted, under a provision identical to W.Va.Code, 60A-4-401(c) [1983], of knowingly or intentionally... possess[ing] a controlled substance unless the substance was obtained directly from[,] or pursuant to, a valid prescription or order of a practitioner while acting in the course of his [or her] professional practice, or except as otherwise authorized by this chapter [or act].; physicians or other practitioners are exempt from penalties of UCSA only when they are registered and acting within scope of their registration). Accord, Dover v. State, 664 P.2d 536, 537-40 (Wyo.1983). See also Commonwealth v. West, 261 Pa. Super. 246, 249-50, 396 A.2d 380, 382 (1978) (controlled substances statute proscribing obtaining possession of controlled substance by misrepresentation, fraud, forgery, deception or subterfuge applied to registered practitioners, as well as to lay persons). [15] With respect to the requisite mens rea of acting intentionally or knowingly outside the usual course of professional practice or research, more than negligence is required. Although the registered practitioner's failure to comply with accepted medical, dental or other applicable standards of practice is a part of this element of the crime, mere malpractice in the prescribing of controlled substances is not a felony. Rather, it must be shown that the registered practitioner's malpractice was intentional, that is, his or her state of mind was such that he or she was not intending to treat the patient's underlying condition, but, instead, was intending merely to satisfy the desire of the patient for the controlled substance. Commonwealth v. Comins, 371 Mass. 222, 232, 356 N.E.2d 241, 247 (1976), cert. denied, 430 U.S. 946, 97 S.Ct. 1582, 51 L.Ed.2d 793 (1977); State v. Sway, 15 Ohio St.3d 112, 116, 472 N.E.2d 1065, 1069 (1984). In accordance with the great majority of the courts, this Court holds that under W.Va.Code, 60A-4-401(a), as amended, which is part of West Virginia's Uniform Controlled Substances Act, the elements of the offense of a felonious constructive delivery of a controlled substance by a purported prescription issued by a registered physician, dentist or other registered practitioner are as follows: (1) the defendant constructively delivered a controlled substance requiring a valid prescription by the issuance of a purported prescription on behalf of a purported patient who received the controlled substance from a pharmacist who filled such prescription; and (2) the defendant issued such prescription intentionally or knowingly outside the usual course of professional practice or research, thereby not engaging in the authorized activities of a practitioner, as defined in W.Va.Code, 60A-1-101(v), as amended; in other words, such prescription was issued intentionally or knowingly without a legitimate medical, dental or other authorized purpose.