Government Waffles in Supreme Court Pain Management Case – Ruan v. United States
Insights from White Collar Criminal Defense Attorneys Trusted Nationwide
I’ve been waiting about 10 years to see how the government attones for the circuit split in physician opiate prescribing cases – and today’s the day.
I have written extensively on the important pending Supreme Court case, Ruan v. United States. If you haven’t read the previous articles and gained an understanding of the issues before the court, stop and read this and this.
Now that you’ve got some background on the complex but important issues before the court, let's discuss the Government’s brief which was filed today and can be accessed here.
Remember, the critical impasse between the two sides is that the Government believes that a physician’s “subjective” good faith is irrelevant in determining whether he can be convicted of unlawfully prescribing a drug to a patient. The Defendant’s position, and the position of a large number of amicus briefs, is that a physician’s subjective belief that she was prescribing in the furtherance of medical practice is an important determination for the court. If the government wins, physicians could be convicted if they fall outside “objectively” established guidelines for prescribing. If the defense wins, physicians can avail themselves of the defense that even though conduct falls outside of objective guidelines – they were engaged in the good faith treatment of a patient.
As you can see, a decision in either direction has drastic consequences for pain patients and physicians.
Let’s get to the Government’s brief to understand how they thread the needle of the existing Supreme Court precedent, United States v. Moore, and its attempt to hold physician’s to an objective standard. And this sentence from the brief sums it up pretty succinctly:
“The government may rebut such a claim by a DEA registered physician by proving beyond a reasonable doubt that he did not even make an objectively reasonable attempt to ascertain and act within the bounds of professional medicine.”
Ruan v. United States Government’s Brief
We can see the government waffle slightly, refusing to take the bright line approach that deviation from an “accepted standard of practice” amounts to criminal conduct. Instead, the Government argues that a physician must show that he attempted to engage in an objectively reasonable practice – but does not go so far as to require that they actually do so.
We’re reading the tea leaves here but it appears the government knows that it's not on solid footing if it chooses to hold physicians strictly to an “objective standard of care”. Perhaps it knows that there isn’t really one in existence like the-ahem- hotly contested 2016 CDC Guidelines. Perhaps it knows that the current composition of the court is unlikely to expand federal authority into dictating and regulating the appropriate practice of medicine. Perhaps it knows – deep down it its bureaucratic little belly – that the government is not properly poised to make medical judgments impacting the rights of millions of patients – but lets not get ahead of ourselves here.
Instead of taking on the responsibility of convincing nine justices that an “objective” standard of care is relevant here – the Government expertly slithers around this argument by couching its argument in the “effort” shown by a physician to attempt to engage in the practice of medicine. Well done. Now it can state that Dr. Ruan and Khan are guilty because they made no effort to comply with general standards of practice. A very effective alamo position that might gain some points with the court.
In support of its theory that some “objective” standard of medicine applies, the government cites to the old hand authoritative text of…you guessed it.. Webster’s dictionary. The government argues that the term “usual professional practice” refers to customary conduct. They further escape the federalism argument by stating that customary conduct is established by medical boards and the states. The comity here is apparent: One physician’s subjective view of what constitutes medicine is not relevant but a group of physicians subjective views of what constitutes medicine is considered “objective” and creates a standard.
The Government concludes by stating that neither petitioners nor Amici (interested parties who filed a brief in support of petitioners) have failed to show any doctors who have been convicted of “good faith conduct”. In the small pages of ContraFed, let me take a stab at that:
Dr. Roger Anderson, convicted upon the testimony of the notorious Timothy King (a paid government expert) who believes that patients who have “mental health co-morbidities” should be denied opiates. His case is pending before the 6th Circuit. Dr. Joel Smithers, convicted on the basis of similar expert testimony derived from the now defunct CDC Guidelines. Dr. George Naum, whose case is pending before the Supreme Court was convicted when the court utterly refused to allow him to present evidence that he was conforming to the legitimate practice of medicine. The list goes on. Hundreds of doctors around the country were convicted based on Government arguments of the application of an “objective” standard of practice that exceeds even the objective standard that the government advocates for in its brief.
We shall see, I’ll be there on March 1, 2022 and will be sure to update you on the oral arguments.
Ronald Chapman II is the founder of Chapman, Dowling & Mallek and a top-rated Michigan federal criminal defense attorney who represents clients in federal courts nationwide. His practice is focused on defending individuals and organizations in complex federal prosecutions, including white-collar criminal matters and healthcare fraud investigations.
Throughout his career, Mr. Chapman has helped clients avoid more than $550 million in potential penalties, primarily in cases involving physicians, healthcare providers, executives, and professionals facing federal charges. He is widely recognized for his work as a Michigan healthcare fraud defense attorney, as well as for his results in white collar criminal defense in Michigan, where cases often involve parallel civil, regulatory, and criminal exposure.
Apr-8-2026
Hospice fraud is a serious enforcement priority for Medicare, and federal regulators are under pressure...
Apr-2-2026
In federal court, some of the most important battles happen after trial—on appeal—where the focus...
Jan-9-2026
Memphis, Tennessee – The verdict returned this week in United States v. Sanjeev Kumar closed...
Dec-31-2025
Dr. Lonnie Joseph Parker, a Texarkana physician, was recently convicted in federal court of unlawfully...
Serving Clients Nationwide.
Chapman, Dowling & Mallek is headquartered in Detroit, Michigan and represents clients in federal investigations and criminal matters across the United States. Our attorneys handle complex federal cases nationwide while maintaining offices in Michigan and other states.
456 E. Milwaukee, Detroit, MI 48202
4 Comments
Awesome that you’ve come this far. Looking forward to how this unfolds and how it will affect the future of doctors treating pain in our country.
🙏🏻🙏🏻🙏🏻
Prayers all around for all these Dr's involved in this nonsense. Dr's being punished for an oath they took for the career they chose.
Drunk drivers get time served for 9th, 10th, 11th, 12th offenses! In WI of course! 93,000 alcohol related deaths in 2019, (USA) where's the outrage?? No one is going after manufacturer s, distributors, liquor stores or bars! Hell, even Walgreens has 1000 bottles of booze for sale on any given day!
It's never been RX opiates, it's FENTANYL POISONING, illicit fentanyl!! Even DEA admitted this! 7 yrs too late, but still admitted.
I absolutely agree these attacks on innocent Doctors by DEA/ DOJ AND GOVERMENT bureaucrats based on all personal opinions and profiling it's a witchunt against those doctors just trying to treat their pts ethically , compassionately and effectively with the only thing that allows many of us with intractable / chronic pain tolerable relief and a quality of life . As well as those suffering acute pain ost surgeries or accidents / trauma . These idiots need to suffer through the pain we do and walk a dam mile in our shoes . Aldo that's why these ANTI OPIOID ZEALOT IDIOTS LIKE THE DEA / DOJ ( ATTORNEY GENERAL'S ) , CDC , PROP ( Andrew Kolodny, Anna Lempke, Dr Balentyne and Dr Chao ) passed the guidelines and the gov legislators made them laws in many states so the dam medical boards and DEA /DOJ could go after Dr based on this objective principle based on their personal opinions on opioid prescribing and junk science and fake statistics and studies 🙄 that they Gould use these guidelines to go after opioid manufactures and doctors who they say prescribed out of the scope of objective guidelines ( above 90 mmed or over prescribed based on guidelines and their personal opinions) that's why now their Making the revised guidelines even worse now over 50mmed instead of knowing the harm these guidelines have caused abd the increase in forced tapering and abrupt removal of millions of legitimate patients from their effective meds causing much pain a d suffering , suicide and deaths in pain community has tripled and many forced took seek relief unfortunately on the streets where Nancy gave accidentally overdosed due to illegally manufactured illicit fentanyl ( carafentanyl ) laced street drugs counterfeit pills laced with illicit fentanyl ( carafentanyl) all for sake of scaring doctors that if prescribing opioids k is we will prosecute you abd take your livelihoods and put you in jail if you treat pts using opioids above the cdc guidelines or put of the objective principles what a group of anti opioid doctors feel is out of normal practice for treating pain again based on personal opinions , objective principles and cdc guidelines . I guarantee that's why these idiots don't want them removed , redone or the mme take out of the guidelines nie their trying to use the junk science and lower the mme to really go after doctors or stop doctors from prescribing opioids altogether prohibition will never work . Addiction will never be gone and street drug deaths will only continue to skyrocket and more will die harm reduction saves lives not prohibition . The doctors are treating pts pain which these idiots are all obviously clueless abd have no knowledge in treatment of debilitating pain or pain in general . Need to all get out of the doctors offices and medical care altogether until they actually educate themselves correctly abd let them suffer like we do pr will even more if government wins this . We all need to send our letters to the courts describing our illnessess our stories and how this will affect us abd how we are affected right now . The pain suffering and dying those with chronic illnesses we didn't ask for or cause . Causing Debilitating intractable / chronic pain . Again we didn't ask for or cause . But I guarantee 💯 % this is why those guidelines are so crucial too the DEA/ DOJ ( ATTORNEY GENERAL'S ) GOV PROSECUTERS , PROP AND ANTI OPIOID ZEALOT GROUPS CASES AGAINST ALL THOSE THEIR TRYING TO BLAME FOR "THE FAKE " "opioid crisis " when it's actually a overdose crisis , illicit illegally manufactured fentanyl ( carafentanyl) laced street drug abd counterfeit street pills crisis ( substance abuse wiyh mental health issues/ illness crisis ( like bipolar disorder / severe ptsd anxiety disorders with severe depression from being molested / abused or sexually assaulted / domestic assault ) all without effective or affordable mental health treatment so the self medicate and fuel to hereditary cause gene for addiction becone addicts without predisposed gene / hereditary cause gene for addiction won't get addicted also addiction has nothing tok due with dependence or withdrawal ( which withdrawal has nothing too do with addiction anyway it is a side rffect of the drug once become dependent happens with many types of meds antidepressants , anticonvulsants , hormones , blood pressure meds ect even over the counter stuff like krantum ect but again having withdrawal after abruptly stopping a dependent med doesn't mean addiction it is a side effect t only of med Luke n/ v , diarrhea ect is to most meds . I pray this group of people are truly listening to the dependent lawyers and the letters send by many wuyh debilitating intractable chronic pain , ama the law firm representing the doctors ect. These cases represents a doctors freedom and their freedom to prescribed based on their educated knowledgeable decision and our agreement yo take despite any risks because theses mrds unfortunately are our only choice to have a quality of life with tolerable pain or not be bedridden existing not living or committing suicides or turning to streets and actually accidentally overdosing or dying medically due to untreated or under treated horrific intractable / chronic debilitating pain . This is fir Dr freedom period make those who think they can work without a medical license like the DEA / DOJ PROP ANTI OPIOID ZEALOT GROUPS OUR GOVERMENT / LEGISLATORS ECT!!!!