Opinion ID: 3063680
Heading Depth: 2
Heading Rank: 1

Heading: National standard of care

Text: A doctor may not be convicted under the CSA for issuing prescriptions to patients unless the doctor failed to act in good faith and for a legitimate medical purpose. United States v. Merrill, 513 F.3d 1293, 1301-02 (11th Cir. 2008). Johnston acknowledges this standard, but argues that the district court erred by instructing the jury that it should apply a national standard of care in determining 9 whether Johnston failed to act in furtherance of a legitimate medical purpose. Specifically, Johnston takes issue with the district court’s instruction that, “a physician’s mere subjective personal belief that she is meeting a person’s medical needs by prescribing a controlled substance is not sufficient to show good faith if the physician acts outside the accepted standard of medical practice in the United States” (emphasis added). Johnston argues that under Gonzales v. Oregon, 546 U.S. 243 (2006), state medical standards should be used to determine whether a doctor acted in conformance with accepted medical standards for the purposes of the CSA. Johnston argues that by failing to instruct the jury that Florida’s standard of care governs, the district court committed reversible error. Moreover, Johnston argues that this error is jurisdictional and therefore should be review de novo. Where a party properly objects to the jury instructions, we review the legal correctness of a district court’s jury instruction de novo and issues of phrasing for abuse of discretion. United States v. Prather, 205 F.3d 1265, 1270 (11th Cir. 2000). Ordinarily, if the complaining party fails to object, we review for plain error. United States v. Schlei, 122 F.3d 944, 973 (11th Cir. 1997). A party waives the ability to contest the propriety of the instructions, however, if the party invites the error by requesting the substance of the instructions that she later seeks to challenge on appeal. United States v. Stone, 139 F.3d 822, 838 (11th Cir. 1998). 10 “Where invited error exists, it precludes a court from invoking the plain error rule and reversing.” United States v. Silvestri, 309 F.3d 1311, 1327 (11th Cir. 2005) (citation omitted). In this case, not only did Johnston fail to object to the district court’s imposition of a national standard of care, but she invited the alleged error by requesting that the court charge the jury that in order to convict they must find that she “acted outside the course/scope of professional practice, not in accordance with a standard of medical practice generally recognized and acted in the United States” (emphasis added). Furthermore, Johnston’s proposed jury instructions included charging the jury on the section of the Florida Administrative Code that addresses the state’s standards for the use of controlled substances for the treatment of pain, but Johnston affirmatively withdrew this instruction at the charge conference.8 We are also unpersuaded by Johnston’s argument that the alleged error in the jury instructions is jurisdictional. “A jurisdictional defect is one that ‘strip[s] the court of its power to act and ma[kes] its judgment void.’” McCoy v. United States, 266 F.3d 1245, 1249 (11th Cir. 2001) (citation omitted). An indictment suffers from a jurisdictional defect when it charges no crime at all, i.e. a non- 8 At trial, Johnston’s attorney also questioned Romano about his opinion as to whether Johnston’s treatment “was consistent with accepted professional standards of care in the United States.” 11 offense. United States v. Peter, 310 F.3d 709, 714-15 (11th Cir. 2002) No such situation exists here because the district court had jurisdiction pursuant to a valid indictment charging Johnston with crimes under the CSA. Because the alleged error is not jurisdictional, we conclude that invited error doctrine precludes review of the jury instruction that applied a national standard of care.