Jury Instructions in Doctor Drug Dealing Case Didn’t Violate Ruan

US v. Ball: Ball was a doctor who, for seventeen years “practiced medicine from her home” and was charged with 20 counts of distribution of controlled substances and one count of conspiracy. At trial, the parties submitted a joint instruction that the Government was required to prove Ball “knew she was acting outside the ‘course of her professional practice.’” The district court removed “her” from the instruction, concluding that “the use of the possessive pronoun could get the jury hung up on this issue of idiosyncratic practice.” Ball was convicted on every count, save one of the distribution charges.

On appeal, the Fourth Circuit affirmed Ball’s convictions. Ball argued that the district court’s alteration of the jury instructions violated the Supreme Court’s decision in Ruan because “so long as she was acting in the usual course of her own professional practice – one that doled out generous quantities of opioids – she could not be found guilty.” The court disagreed, holding that “Ruan did not make the authorization wholly subjective and that the Government “must prove that the physician knew the prescription fell outside those objective bounds of medical practice or that he intended that result.” The instructions given “tracked the correct standard” and they were “not a model of clarity.”