The prosecution did not have to prove patient’s death was foreseeable to physician for unlawfully dispensing controlled substance drugs to patient

The defendant in U.S. v. Webb was physician charged with unlawfully distributing numerous controlled substances such as oxycodone and fentanyl. Three of his patients died as a result of their over use and he was charged with enhanced provisions of the controlled substances law and enhanced provision of the healthcare fraud statute. He was charged with dispensing oxycoten, fentanyl, and alprazolan with death resulting from these three pain killers. Charges for a crime such as this have been filed in the past against other doctors in Miami and South Florida. This will probably continue in the future if there are fatalities resulting from the abuse of pain medicine. Webb raised three arguments on his appeal.

• The judge’s instruction to the jury was error,
• The evidence was not sufficient to sustain a conviction, and
• He received ineffective assistance of counsel from his lawyer in violation of the Constitution.

The evidence showed that Webb who advertised under the name “Doctors on Call” At trial witnesses testified that juries would prescribe to patients he would see for less than 15 minutes and those patients would often head straight to the pharmacy. The government called a doctor as an expert witness in drug and alcohol dependency who concluded that Webb consistently violated the Florida Board of Medicines standards for physicians who prescribe controlled substances for the treatment of pain. The expert also opined that Webb’s prescribing practices were dangerous for the patient and inconsistent with the usual course of medical practice. Other evidence showed that Webb continued to prescribe medicine even after the state Board of Medicine has suspended his license. Three of Webb’s patients died from acute oxycodone intoxication or overdose of oxycontin. Webb called his own medical expert who concluded that Webb was writing the appropriate prescriptions for his patients’ conditions and that his prescribing practices were within the professional bounds of medical practice.

Webb challenged the instruction given to the jury at the close of the case. Webb was charged under the enhanced penalty provision of the controlled substance laws, 21 U.S.C. 841(b)(1)(C) and imposes a 20 year sentence. Webb argued that because he was being subjected to the enhanced penalty the jury should be instructed to find the government must prove that the patient’s death was foreseeable to Webb or that his conduct was the proximate cause of their death. After reviewing decisions from five other circuits, the appellate court found that the statute imposing the enhanced penalty where a death or bodily injury results does not require the government to prove foreseeability. It also concluded that the government does not have to prove the defendant’s act was the proximate cause of the death.

Webb was also charged with committing healthcare fraud and with a death resulting from the fraud. Webb argued also that the foreseeability and proximate cause were required for a conviction under this enhanced healthcare fraud statute. As it decided for the enhanced drug statute, the healthcare fraud statute did not include foreseeability or proximate cause language in the statute. The court noted that where Congress included the language in other statutes where that was the intent.

The court also considered Webb’s claim that his trial counsel was performance was ineffective because he failed to make a motion for judgment of acquittal at the close of the evidence. To succeed, Webb was required to show:
1. that his counsel’s performance was deficient, and
2. the deficient performance prejudiced the defense.
Given the overwhelming evidence, the government presented sufficient evidence to sustain all of Webb’s convictions.