People v. Xuhui Li

• Decision Date: 30 November 2017
• Docket Number: Ind. 5170/11,4678,4679
• Citation: 67 N.Y.S.3d 1,155 A.D.3d 571
• Parties: The PEOPLE of the State of New York, Respondent, v. Stan XUHUI LI, Defendant–Appellant.
• Court: New York Supreme Court — Appellate Division

155 A.D.3d 571

67 N.Y.S.3d 1

The PEOPLE of the State of New York, Respondent,

v.Stan XUHUI LI, Defendant–Appellant.

4678

4679

Ind. 5170/11

Supreme Court, Appellate Division, First Department, New York.

ENTERED: NOVEMBER 30, 2017

Belair & Evans LLP, New York (Raymond W. Belair of counsel), for appellant.

Cyrus R. Vance, Jr., District Attorney, New York (Vincent Rivellese of counsel), for respondent.

Manzanet–Daniels, J.P., Mazzarelli, Webber, Oing, JJ.

Judgment, Supreme Court, New York County (Michael R. Sonberg, J.), rendered December 19, 2014, convicting defendant, after a jury trial, of 2 counts of manslaughter in the second degree, 3 counts of reckless endangerment in the first degree, 3 counts of reckless endangerment in the second degree, 170 counts of criminal sale of a prescription, 1 count of scheme to defraud in the first degree, 2 counts of grand larceny in the third degree, 9 counts of falsifying business records in the first degree, and 8 counts of offering a false instrument for filing in the first degree, and sentencing him to an aggregate term of 10 to 20 years, unanimously affirmed.

Defendant was a physician specializing in pain management. In 2004, he opened a pain management clinic in Queens. According to the People, the clinic was nothing more than a "pill mill" catering to people who were hopelessly addicted to pain medicine, primarily opioids. The People's evidence showed that, despite having been trained in the wide variety of methods for identifying legitimate pain and treating it, defendant engaged in only the most cursory attempts to confirm patients' complaints, such as asking them where they had pain, and occasionally palpating a purportedly sore area or testing the range of motion of a limb. He rarely ordered diagnostic scans. Moreover, defendant, despite the plethora of options for treating pain, regularly prescribed opioids as a first resort, and not a last resort, which would have been the prudent course given the highly addictive nature of those drugs.

Further demonstrating the fact that defendant's clinic was not focused on the legitimate practice of pain medicine, but rather profiting from the opioid addiction epidemic, is that appointments were not necessary and all payments were required to be made in cash. A typical visit would cost $100, but patients who came back earlier than a month later for their next month's prescriptions, who obtained prescriptions from other doctors or who needed more than three prescriptions or prescriptions for more than 60 mg per day of opioid were charged an additional $50. Patients usually handed the money to defendant, who placed the money directly into his pocket. Defendant often prescribed whatever medication patients requested. On occasion, he would issue a prescription without seeing the patient at all, and if he hesitated in writing a particular prescription, he could be persuaded if he was offered more money. From 2008 through October 2011, defendant wrote over 21,000 prescriptions for controlled substances, at an increasing pace, with more than half for substances containing the opioid oxycodone, and more than a quarter for alprazolam (Xanax ). As explained by the People's expert, NYU Director of Pain Medicine Christopher Gharibo, Xanax, when taken with opioids, can depress respiration, making the combination particularly dangerous.

Indeed, defendant's prescription practices led to tragedy. Two of defendant's patients, Joseph Haeg and Nicholas Rappold, died within days of their last visits to defendant's clinic. Toxicological evidence revealed that Haeg's body contained over 20 times what would be considered a therapeutic amount of oxycodone—a fatal dose—and a moderately high therapeutic amount of Xanax. Although Rappold was not found to have fatal levels of either oxycodone or Xanax in his system when he died, his death was determined to have been caused by the drugs' having worked synergistically to depress his respiration. In connection with the deaths, defendant was charged with second degree manslaughter. He was also charged with first-degree reckless endangerment with respect to three other patients, and second-degree reckless endangerment with respect to four more patients. For all 19 patients at issue defendant was charged with criminal sale of prescriptions; an aggregate 180 counts of this charge were leveled. Finally, although not at issue on this appeal, defendant was charged with one count of first-degree scheme to defraud, two counts of third-degree grand larceny from Medicare and Blue Cross/Blue Shield; 11 counts of first-degree falsifying business records submitted to the Centers for Medicare and Medicaid Services; and 16 counts of first-degree offering a false document for filing with the New York State Department of Health's Office of

Professional Medical Conduct. He was convicted after a jury trial of all charges, save for one second-degree reckless endangerment count, 10 criminal sale counts, and 2 falsifying records counts.

Defendant argues that the manslaughter convictions should be reversed because, as a matter of law, the sale of a controlled substance can never support a homicide charge in the absence of express legislative authorization. He bases this position on a Second Department decision, People v. Pinckney, 38 A.D.2d 217, 328 N.Y.S.2d 550 (2d Dept. 1972)affd 32 N.Y.2d 749, 344 N.Y.S.2d 643, 297 N.E.2d 523 (1973). In Pinckney, the defendant sold heroin, and provided the means to inject it, to the victim, who died ( 38 A.D.2d at 218, 328 N.Y.S.2d 550 ). He was charged with, inter alia, manslaughter in the second degree and criminally negligent homicide ( id. ). Contrasting the sale of heroin with the sale of wood alcohol, which is known to be inherently deadly, the Court held that the defendant could not be held criminally responsible for the death, because

"[a]lthough it is a matter of common knowledge that the use of heroin can result in death, it is also a known fact that an injection of heroin into the body does not generally cause death. The homicide cases involving a sale or use of an illegal drug or instrument for the purpose of causing an abortion were prosecutions ... pursuant to express statutory provisions. There are no provisions contained in the present Penal Law which set forth that the illegal sale of a dangerous drug which results in death to the user thereof constitutes manslaughter or criminally negligent homicide" ( id. at 219, 328 N.Y.S.2d 550 [citations omitted] ).

Defendant contends that there is no legal distinction between himself and the drug dealer in Pinckney, since, he claims, opioids are not even as dangerous as heroin and, in any event, he merely provided the pills, and was not present when Haeg and Rappold ingested them. He argues that, since the Penal Law, in the sections criminalizing sales of controlled substances, is silent on the consequences if a sale results in the buyer's death, his prosecution for manslaughter is without any legal basis.

We disagree. Nothing in Pinckney suggests that one who provides a controlled substance, whether it be heroin by a street dealer, or opioids by a medical doctor, can never be indicted on a manslaughter charge. Indeed, in People v. Cruciani, 36 N.Y.2d 304, 367 N.Y.S.2d 758, 327 N.E.2d 803 (1975), the Court of Appeals affirmed the second degree manslaughter conviction of the defendant, who injected the victim with heroin, because he knew she was already in a highly intoxicated state. The Cruciani Court distinguished Pinckney, because in the latter case there was not

"any proof,

as here, of awareness of the ongoing effect of drugs in the victim's body at the time any self-inflicted injection might have been made, or, beyond the general knowledge of the injuriousness of drug-taking, of a real threat to life. The remoteness of that fatal injection from the fact of sale diffused intent and scienter by possibly unknown or intervening events beyond Pinckney's control" ( 36 N.Y.2d at 305–306, 367 N.Y.S.2d 758, 327 N.E.2d 803 ).

At bottom, all that was needed for the manslaughter charge to be sustained was for the People to satisfy its elements. That is, that defendant was "aware of and consciously disregard[ed] a substantial and unjustifiable risk that [death] [would] occur ... The risk [being] of such nature and degree that disregard thereof constitute[d] a gross deviation from the standard of conduct that a reasonable person would observe in the situation" ( Penal Law § 15.05 [3] ; People v. Lora, 85 A.D.3d 487, 491, 925 N.Y.S.2d 38 [1st Dept. 2011], appeal dismissed 18 N.Y.3d 829, 938 N.Y.S.2d 833, 962 N.E.2d 254 [2011] ).

The question then becomes whether the People presented sufficient evidence to establish that defendant consciously disregarded the risk that Haeg and Rappold would die as a result of his prescribing practices. Trial evidence is legally sufficient to support a conviction if, viewed in the light most favorable to the People, it could lead a rational jury to find the defendant guilty beyond a reasonable doubt (see People v. Danielson, 9 N.Y.3d 342, 349, 849 N.Y.S.2d 480, 880 N.E.2d 1 [2007] ). A jury's verdict is supported by sufficient evidence if the evidence presented supports "any valid line of reasoning and permissible inferences which could lead a rational person to the conclusion reached by the jury" ( People v. Bleakley, 69 N.Y.2d 490, 495, 515 N.Y.S.2d 761, 508 N.E.2d 672 [1987] ).

Defendant attacks the proof of his responsibility for Rappold's death because there was no evidence that the oxycodone that...