Opinion ID: 2832657
Heading Depth: 2
Heading Rank: 4

Heading: Sufficiency of evidence – conspiracy

Text: Caroni argues that the evidence was legally insufficient to support his conviction for conspiring with his co-defendants to run an illegitimate practice. 7 Under 21 CFR § 1306.04(a), “a prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.” The indictment alleges that DiLeo, Pastorek, and Caroni conspired to unlawfully distribute Schedule II, III, and IV controlled substances through prescription practices done outside the usual course of medical practice and for other than legitimate medical 7 Both Pastorek and DiLeo adopt this argument. 21 Case: 13-10661 Date Filed: 09/01/2015 Page: 22 of 47 purpose. Caroni asserts that the Government’s theory was that the clinics were pill mills but yet the clinics had employed nine doctors and only two were indicted. Caroni asserts that the Government alleged, and had to prove, an entirely corrupt practice. He also argues that the files reviewed by the experts were not statistically representative of the whole practice. We review questions about the sufficiency of the evidence de novo, “viewing the evidence in the light most favorable to the government, with all reasonable inferences and credibility choices made in the government’s favor.” United States v. Sosa, 777 F.3d 1279, 1289 (11th Cir. 2015) (internal quotations omitted and alterations adopted). Further, “we will affirm a conviction where ‘a reasonable jury could find the defendant’s guilt beyond a reasonable doubt.’” Id. (quoting United States v. Utter, 97 F.3d 509, 512 (11th Cir. 1996)). Caroni cites no cases that require the Government to show that the entire practice was illegitimate. This would be an unreasonable burden and allow a completely illegal clinic to evade prosecution by having a few legitimate patients. Rather, the Government needed to prove that there was very substantial illegal activity occurring at the clinic, thus removing any reasonable doubt that unlawful prescriptions were being issued by mistake or through negligence. 8 Thus, the 8 The district court expressly instructed the jury that “negligence, mistake or carelessness is not a sufficient finding of knowledge.” 22 Case: 13-10661 Date Filed: 09/01/2015 Page: 23 of 47 selection of the files for the experts to review did not need to precisely reflect the composition of the clinic’s patient population; rather, it had to demonstrate that the illegal behavior was substantial and it did just that. In United States v. Joseph, 709 F.3d 1082 (11th Cir. 2013), we upheld a jury’s finding of an illegitimate practice. There, we pointed to the defendant’s prescription of large quantities of controlled substances, the large number of those prescriptions, failure to do physical examinations, prescriptions to patients knowing they were giving them to others, and no relationship between the drug prescribed and the treatment of the condition alleged. The evidence in this case was similar to that in Joseph. As set forth in the immediately preceding Part C. of this opinion, there was ample evidence to support the jury’s verdict. And while there was some evidence that the Defendants became more careful about doctor shopping and misuse of prescriptions in the last year of the clinic, a reasonable jury could have concluded this was a response to the shutting down of other pain management clinics by the DEA and an effort to evade detection. 23 Case: 13-10661 Date Filed: 09/01/2015 Page: 24 of 47