Ruan v. United States

Decision Date27 June 2022
Docket Numbers. 20-1410,21-5261
Citation142 S.Ct. 2370,213 L.Ed.2d 706
Parties Xiulu RUAN, Petitioner v. UNITED STATES Shakeel Kahn, Petitioner v. United States
CourtU.S. Supreme Court

Lawrence S. Robbins, for petitioner in No. 20–1410.

Beau B. Brindley, Chicago, IL, for petitioner in No. 21–5261.

General Eric J. Feigin, Deputy Solicitor, for respondent.

Lawrence S. Robbins, Counsel of Record, William J. Trunk, Jeffrey C. Thalhofer, Carolyn M. Forstein, Leslie C. Esbrook, Robbins, Russell, Englert, Orseck & Untereiner LLP, Washington, DC, for Petitioner in No. 20–1410.

Elizabeth B. Prelogar, Solicitor General, Counsel of Record, Kenneth A. Polite, Jr., Assistant Attorney General, Eric J. Feigin, Deputy Solicitor General, Nicole Frazer Reaves, Assistant to the Solicitor General, Joshua K. Handell, David M. Lieberman, Attorneys, Department of Justice, Washington, DC, for Respondent.

Beau B. Brindley, Counsel of Record, Blair T. Westover, Law Offices of Beau B. Brindley, Chicago, IL, for Petitioner in No. 21-5261.

Justice BREYER delivered the opinion of the Court.

A provision of the Controlled Substances Act, codified at 21 U.S.C. § 841, makes it a federal crime, "[e]xcept as authorized [,] ... for any person knowingly or intentionally ... to manufacture, distribute, or dispense ... a controlled substance," such as opioids. 84 Stat. 1260, 21 U.S.C. § 841(a) (emphasis added). Registered doctors may prescribe these substances to their patients. But, as provided by regulation, a prescription is only authorized when a doctor issues it "for a legitimate medical purpose ... acting in the usual course of his professional practice." 21 C.F.R. § 1306.04(a) (2021).

In each of these two consolidated cases, a doctor was convicted under § 841 for dispensing controlled substances not "as authorized." The question before us concerns the state of mind that the Government must prove to convict these doctors of violating the statute. We hold that the statute's "knowingly or intentionally" mens rea applies to authorization. After a defendant produces evidence that he or she was authorized to dispense controlled substances, the Government must prove beyond a reasonable doubt that the defendant knew that he or she was acting in an unauthorized manner, or intended to do so.

I

The question we face concerns § 841 ’s exception from the general prohibition on dispensing controlled substances contained in the phrase "[e]xcept as authorized." In particular, the question concerns the defendant's state of mind. To prove that a doctor's dispensation of drugs via prescription falls within the statute's prohibition and outside the authorization exception, is it sufficient for the Government to prove that a prescription was in fact not authorized, or must the Government prove that the doctor knew or intended that the prescription was unauthorized?

Petitioners Xiulu Ruan and Shakeel Kahn are both doctors who actively practiced medicine. They both possessed licenses permitting them to prescribe controlled substances. The Government separately charged them with unlawfully dispensing and distributing drugs in violation of § 841. Each proceeded to a jury trial, and each was convicted of the charges.

At their separate trials, Ruan and Kahn argued that their dispensation of drugs was lawful because the drugs were dispensed pursuant to valid prescriptions. As noted above, a regulation provides that, "to be effective," a prescription "must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice." 21 C.F.R. § 1306.04(a). We assume, as did the courts below and the parties here, that a prescription is "authorized" and therefore lawful if it satisfies this standard. At Ruan's and Kahn's trials, the Government argued that the doctors’ prescriptions failed to comply with this standard. The doctors argued that their prescriptions did comply, and that, even if not, the doctors did not knowingly deviate or intentionally deviate from the standard.

Ruan, for example, asked for a jury instruction that would have required the Government to prove that he subjectively knew that his prescriptions fell outside the scope of his prescribing authority. The District Court, however, rejected this request. The court instead set forth a more objective standard, instructing the jury that a doctor acts lawfully when he prescribes "in good faith as part of his medical treatment of a patient in accordance with the standard of medical practice generally recognized and accepted in the United States." App. to Pet. for Cert. in No. 20–410, p. 139a. The court further instructed the jury that a doctor violates § 841 when "the doctor's actions were either not for a legitimate medical purpose or were outside the usual course of professional medical practice." Ibid. The jury convicted Ruan, and the trial court sentenced him to over 20 years in prison and ordered him to pay millions of dollars in restitution and forfeiture.

The Eleventh Circuit affirmed Ruan's convictions. See 966 F.3d 1101, 1120, 1166–1167 (C.A.11 2020). The appeals court held that a doctor's "subjectiv[e] belie[f] that he is meeting a patient's medical needs by prescribing a controlled substance" is not a "complete defense" to a § 841 prosecution. Id. , at 1167. Rather, the court said, " [w]hether a defendant acts in the usual course of his professional practice must be evaluated based on an objective standard, not a subjective standard.’ " Id. , at 1166 (quoting United States v. Joseph , 709 F.3d 1082, 1097 (C.A.11 2013) ; emphasis added; alteration in original).

Kahn's trial contained similar disagreements over the proper mens rea instructions. Ultimately, the District Court instructed the jury that it should not convict if it found that Kahn acted in "good faith," defined as "an attempt to act in accordance with what a reasonable physician should believe to be proper medical practice." App. 486. The court added that to find "good faith," the jury must conclude that Kahn "acted in an honest effort to prescribe for patients’ medical conditions in accordance with generally recognized and accepted standards of practice." Ibid. The court also told the jury that "good faith" was a "complete defense" because it "would be inconsistent with knowingly and intentionally distributing and/or dispensing controlled substances outside the usual course of professional practice and without a legitimate medical purpose." Ibid. The jury convicted Kahn of the § 841 charges, and he was sentenced to 25 years in prison.

The Tenth Circuit affirmed Kahn's convictions. See 989 F.3d 806, 812, 824–826 (C.A.10 2021). In doing so, the court held that to convict under § 841, the Government must prove that a doctor "either: (1) subjectively knew a prescription was issued not for a legitimate medical purpose; or (2) issued a prescription that was objectively not in the usual course of professional practice." Id. , at 825.

Both Ruan and Kahn filed petitions for certiorari. We granted the petitions and consolidated the cases to consider what mens rea applies to § 841 ’s authorization exception.

II

As we have said, § 841 makes it unlawful, "[e]xcept as authorized[,] ... for any person knowingly or intentionally ... to manufacture, distribute, or dispense ... a controlled substance." We now hold that § 841 ’s "knowingly or intentionally" mens rea applies to the "except as authorized" clause. This means that once a defendant meets the burden of producing evidence that his or her conduct was "authorized," the Government must prove beyond a reasonable doubt that the defendant knowingly or intentionally acted in an unauthorized manner. Our conclusion rests upon several considerations.

A

First, as a general matter, our criminal law seeks to punish the " ‘vicious will.’ " Morissette v. United States , 342 U.S. 246, 251, 72 S.Ct. 240, 96 L.Ed. 288 (1952) ; see also id., at 250, n. 4, 72 S.Ct. 240 (quoting F. Sayre, Cases on Criminal Law, p. xxxvi (R. Pound ed. 1927)). With few exceptions, " ‘wrongdoing must be conscious to be criminal.’ " Elonis v. United States , 575 U.S. 723, 734, 135 S.Ct. 2001, 192 L.Ed.2d 1 (2015) (quoting Morissette , 342 U.S. at 252, 72 S.Ct. 240 ). Indeed, we have said that consciousness of wrongdoing is a principle "as universal and persistent in mature systems of [criminal] law as belief in freedom of the human will and a consequent ability and duty of the normal individual to choose between good and evil." Id. , at 250, 72 S.Ct. 240.

Consequently, when we interpret criminal statutes, we normally "start from a longstanding presumption, traceable to the common law, that Congress intends to require a defendant to possess a culpable mental state." Rehaif v . United States , 588 U. S. ––––, ––––, 139 S.Ct. 2191, 2195, 204 L.Ed.2d 594 (2019). We have referred to this culpable mental state as "scienter," which means the degree of knowledge necessary to make a person criminally responsible for his or her acts. See ibid. ; Black's Law Dictionary 1613 (11th ed. 2019); Morissette , 342 U.S. at 250–252, 72 S.Ct. 240.

Applying the presumption of scienter, we have read into criminal statutes that are "silent on the required mental state"—meaning statutes that contain no mens rea provision whatsoever—" ‘that mens rea which is necessary to separate wrongful conduct from "otherwise innocent conduct." ’ " Elonis , 575 U.S. at 736, 135 S.Ct. 2001 (quoting Carter v. United States , 530 U.S. 255, 269, 120 S.Ct. 2159, 147 L.Ed.2d 203 (2000) ; emphasis added). Unsurprisingly, given the meaning of scienter, the mens rea we have read into such statutes is often that of knowledge or intent. See, e.g., Staples v. United States , 511 U.S. 600, 619, 114 S.Ct. 1793, 128 L.Ed.2d 608 (1994) ; United States v. United States Gypsum Co. , 438 U.S. 422, 444–446, 98 S.Ct. 2864, 57 L.Ed.2d 854 (1978).

And when a statute is not silent as to mens rea but instead "includes a general scienter...

To continue reading

Request your trial
33 cases
  • United States v. Little
    • United States
    • U.S. Court of Appeals — Fifth Circuit
    • November 3, 2023
    ...legitimate purpose or is outside the usual course of professional practice."29[] After Dr. Hirjee's trial, the Supreme Court decided Ruan v. United States,[30] holding "[a]fter a defendant produces evidence that he or she was authorized to dispense controlled substances, the Government must......
  • United States v. Freeman
    • United States
    • U.S. District Court — District of New Hampshire
    • August 22, 2023
    ...States, 575 U.S. 723, 736 (2015)). Specifically, “the mens rea [courts] have read into such statutes is often that of knowledge or intent.” Id. (citing cases). Applying this principle Freeman cannot be convicted of money laundering unless he knowingly conducted a prohibited financial transa......
  • Sibounheuang v. United States
    • United States
    • U.S. District Court — Western District of North Carolina
    • July 24, 2023
    ...filed a Motion to Dismiss arguing that Petitioner waived and procedurally defaulted the right to contest his conviction and, in any event, his Ruan claim lacks merit; and that Petitioner's claim of ineffective assistance of counsel lacks merit. [Doc. 9]. The Court informed Petitioner of his......
  • Sibounheung v. United States
    • United States
    • U.S. District Court — Western District of North Carolina
    • July 24, 2023
    ...filed a Motion to Dismiss arguing that Petitioner waived and procedurally defaulted the right to contest his conviction and, in any event, his Ruan claim lacks merit; and that Petitioner's claim of ineffective assistance of counsel lacks merit. [Doc. 9]. The Court informed Petitioner of his......
  • Request a trial to view additional results
5 books & journal articles
  • Alienating criminal procedure
    • United States
    • Georgetown Immigration Law Journal No. 37-2, January 2023
    • January 1, 2023
    ...337. United States v. Armstrong, 517 U.S. 456 (1996). 338. See Kelly v. United States, 140 S. Ct. 1565 (2020); Ruan v. United States, 142 S. Ct. 2370 (2022). 339. Far from the border, in the districts encompassing Washington D.C., Boston, New York City, Chicago, Los Angeles, and San Francis......
  • Criminal Law
    • United States
    • Mercer University School of Law Mercer Law Reviews No. 74-4, June 2023
    • Invalid date
    ...at 1192.19. Id. at 1192-93.20. 46 F.4th 1225 (11th Cir. 2022).21. Id. at 1230-31.22. Id. at 1238; but see Xiulu Ruan v. United States, 142 S. Ct. 2370 (2022) to consider whether this evidence is now admissible given the new standard requiring the government to disprove good faith. 23. Ifedi......
  • The Appellate Corner
    • United States
    • Alabama State Bar Alabama Lawyer No. 83-5, September 2022
    • Invalid date
    ...but instead prohibits successive prosecutions for the same offense. Distribution of Controlled Substance Ruan v. United States, 142 S. Ct. 2370 (2022) Once a defendant meets the burden of producing evidence that his conduct was "authorized" by federal law, the government prosecuting him und......
  • Us Court of Appeals for the Tenth Circuit
    • United States
    • Colorado Bar Association Colorado Lawyer No. 52-3, April 2023
    • Invalid date
    ..."knowingly or intentionally" mens rea requirement applies to the "except as authorized" clause of the statute. Ruan v. United States, 142 S.Ct. 2370 (2022). The Court vacated the Tenth Circuit's judgment and remanded the case for further proceedings, instructing the Tenth Circuit to address......
  • Request a trial to view additional results

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT