Commw. v. Pike, 110499, SJC-07950
| Citation | 718 N.E.2d 855,430 Mass. 317 |
| Decision Date | 04 November 1999 |
| Docket Number | No. SJC-07950,SJC-07950 |
| Parties | (Mass. 1999) COMMONWEALTH v. ALBERT D. PIKE |
| Court | United States State Supreme Judicial Court of Massachusetts |
Worcester County
Controlled Substances. Doctor, Controlled substances. Witness, Expert. Evidence, Expert
opinion, Admissions and confessions, Relevancy and materiality, Intent, Medical record.
Indictments found and returned in the Superior Court Department on December 5, 1995, and
August 5, 1996, respectively.
The cases were tried before James F. McHugh, III, J.
The Supreme Judicial Court granted an application for direct appellate review.
George C. Deptula for the defendant.
LaDonna J. Hatton, Assistant Attorney General (Peter Clark, Assistant Attorney General, with
her) for the Commonwealth.
and additional charges of filing false Medicaid claims, G. L. c. 118E, § 40. The defendant
argues that the Commonwealth failed to present sufficient evidence to convict him of any of the
charges. We reject the argument. We also reject the defendant's contentions that the trial judge
erred in admitting evidence, that the prosecutor's closing argument contained remarks that were
improper and prejudicial, and that he should be resentenced. Accordingly, we affirm the
defendant's convictions.
guilty. In essence, the Commonwealth's theory of the case was that the defendant was engaged in
a drug diversion scheme whereby he unlawfully prescribed to his patients controlled substances
(drugs) with a high street resale value. These patients would then either sell these drugs for
illegal narcotics or take the prescription drugs to enhance their "high" of other illicit drugs. In
either event, according to the Commonwealth, the defendant's illegitimate prescription practices
ensured that his patients would return for additional visits (and drugs), thereby maintaining or
increasing the defendant's billing to Medicaid. In support of this theory, the Commonwealth
presented the following evidence in its case-in-chief.1
The defendant, who was an approved Medicaid provider, worked as a psychiatrist at Mental
Health Resources (MHR) in Leominster. Under his arrangement with MHR, the defendant
received seventy per cent of the accounts receivables that he generated, and the remainder was
applied toward MHR's office overhead and expenses. The defendant later became unhappy with
this arrangement and tried to renegotiate his share to eighty per cent because he felt he was
entitled to more money.
A portion of the defendant's practice was devoted to treating Medicaid patients who suffered
from drug or alcohol dependency, as well as various psychiatric problems. The Commonwealth
introduced the defendant's own handwritten office notes regarding his treatment of ten Medicaid
patients that served as the basis of the indictments on which he was convicted.2 According to
the defendant's notes, most of these patients sought his assistance in overcoming their addictions
to heroin or other substances. As "treatment" for the addictions, the defendant virtually always
prescribed drugs such as methadone, Valium, clonidine, klonopin, or some combination thereof.
Most of these substances were addictive and had a high resale value on the street. The defendant
usually prescribed these drugs on a patient's very first office visit based solely on the information
the patient presented without any objective verification of the patient's claims.
The Commonwealth presented well-credentialed expert medical witnesses who practiced in the
fields of psychiatry, addiction treatment, and the psychopharmacology of addiction. These
experts testified that the extremely high dosage levels and the frequency with which the
defendant gave prescriptions to patients served no legitimate medical purpose. They also testified
that the defendant's prescription practices were not designed actually to treat the patients'
underlying problems, but, rather, further to exacerbate their problems by giving them addictive
substances that enabled their habits. For instance, the defendant gave patients prescriptions that
were supposed to last for a certain time period, but then refilled those prescriptions before that
time had expired if the patients came in before their next scheduled visit. Patient M, to whom the
defendant prescribed six different medications on the first visit, overdosed on these medications
and went into a "stupor." Patient M's father told the defendant that he suspected his son (Patient
M) was getting prescriptions from other doctors. Nevertheless, the defendant's response to this
information was to increase Patient M's dosage of klonopin, the most habit-forming of the drugs
prescribed to Patient M. The Commonwealth's experts testified (with a basis in the evidence to
support their testimony) that the defendant's treatment of patients was well below an acceptable
standard of care, so far "beyond the pale" to be "out of the ballpark," and "medically unwarranted
and dangerous."
The defendant also prescribed methadone to his patients who claimed to be in "chronic pain"
without performing any physical examination or tests to confirm these self-reports. Some of
these methadone prescriptions were in such high doses, relative to the patients' symptoms that the
defendant was allegedly treating, that they served no legitimate medical purpose and were
completely inconsistent with the manner in which drugs should be used in a legitimate treatment
program. The defendant was also quick to give new prescriptions to his patients who claimed
their prescriptions were lost or stolen, even though some of these patients had a history of being
untruthful with the defendant.3
On another occasion, Patient H came into the defendant's office requesting a prescription for
methadone. The defendant initially declined to give this prescription, but later did so when the
patient returned to the office and assured the defendant that he found a pharmacy in Worcester
that would fill a three-day supply of methadone. The defendant gave the patient the prescription
despite noting that "this [was] unlikely in view of current law." The defendant also continued to
prescribe drugs to Patient H even after that patient reported to the defendant that he had given
some of his prescribed Valium to his father.
that the defendant stated that he was "the local drug pusher."
We evaluate the adequacy of the Commonwealth's evidence under well-defined standards. We
have recited the evidence in the light most favorable to the Commonwealth, as we must, and now
inquire whether this evidence was sufficient to satisfy any rational trier of fact of the essential
elements of the crimes beyond a reasonable doubt. See Commonwealth v. Woodward, 427 Mass.
659, 682 (1998); Commonwealth v. Cordle, 412 Mass. 172, 175 (1992). "The relevant question
is whether the evidence would permit a jury to find guilt, not whether the evidence requires such
a finding." Commonwealth v. Brown, 401 Mass. 745, 747 (1988). Moreover, "[a] conviction may
be properly based entirely on circumstantial evidence so long as that evidence establishes the
defendant's guilt beyond a reasonable doubt." Commonwealth v. Martino, 412 Mass. 267, 272
(1992). Where the evidence is largely circumstantial, "it is not essential that the inferences drawn
should be the only necessary inferences . . . . It is enough that [the inferences] be reasonable and
possible." Id., quoting Commonwealth v. Merrick, 255 Mass. 510, 514 (1926). If conflicting
inferences are possible from the evidence, "it is for the jury to determine where the truth lies."
Commonwealth v. Wilborne, 382 Mass. 241, 245 (1981), quoting Commonwealth v. Amazeen,
§§ 19, 32A, and 32B. A defendant's intent is "not susceptible of proof by direct
evidence, so resort is frequently made to proof by inference from all the facts and circumstances
developed at trial." Commonwealth v. Lombard, 419 Mass. 585, 589 (1995), quoting
Commonwealth v. Casale, 381 Mass. 167, 173 (1980). The question whether the defendant acted
in bad faith is a question of fact for the jury. See Commonwealth v. Miller, 361 Mass....
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