United States v. Azmat
805 F.3d 1018
| 11th Cir. | 2015Background
- Dr. Najam Azmat worked ~19 days (Feb–Mar 2011) as a physician at East Health Center, a cash-based “pill mill” in Garden City, Georgia; he was the clinic’s initial doctor and was paid daily in cash.
- The government investigated after a physician reported suspect practices; agents seized patient files showing mostly out-of-state patients and heavy oxycodone prescribing.
- A grand jury indicted Azmat for conspiracy to dispense controlled substances, 49 counts of unlawful dispensation (oxycodone, hydrocodone, alprazolam), and conspiracy to launder monetary instruments.
- At a five-day jury trial Azmat was convicted on 51 counts; the district court sentenced him to 133 months’ imprisonment (concurrent sentences).
- Key factual findings supporting conviction: brief/cursory exams, pre-signed opioid agreements, high-volume oxycodone prescriptions, cash payments, marketing to out-of-state/drug-seeking patients, and expert testimony that prescriptions were not for legitimate medical purposes.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether writing prescriptions constitutes "dispensing" under 21 U.S.C. § 841(a)(1) | Govt: prescribing is a constructive delivery and thus "dispensing." | Azmat: prescribing is not a completed "delivery" and thus at most "distribution;" §802(10) presupposes a lawful order. | Court: prescribing is "dispensing" (constructive transfer); prior circuit precedent controls and statutory text supports it. |
| Sufficiency of evidence for unlawful dispensation and conspiracy to dispense | Govt: record (patient files, witnesses, experts, clinic practices) permits inference prescriptions were outside course of professional practice and Azmat knowingly joined scheme. | Azmat: exams and some reductions show legitimate treatment; government failed to prove illegitimacy beyond reasonable doubt. | Court: evidence overwhelming; reasonable juror could find prescriptions illegitimate and Azmat knowingly joined conspiracy. |
| Admissibility of government expert (Daubert/Rule 702) | Govt: Dr. Kennedy relied on recognized state/federal guidelines, medical literature, and clinical experience; methodology reliable and helpful. | Azmat: Kennedy failed to identify objective standards or peer-reviewed bases; testimony was ipse dixit and unreliable. | Court: district court did not abuse discretion; Kennedy relied on accepted authorities and methodology was reliable; any error harmless. |
| Prosecutorial misconduct (nationality comment; "wise guys" remark) | Azmat: prosecutor injected improper, inflammatory references (Pakistan, "wise guys from South Florida") prejudicing jury. | Govt: questioning relevant to witness familiarity and credibility; remarks based on record and permissible argument. | Court: no reversible misconduct; questions and remarks were within scope or harmless given overwhelming evidence. |
| Sentencing challenges (drug quantity, disparity, Sixth Amendment) | Azmat: court erred in attributing drug quantities, sentenced more harshly than codefendants, and punished him for going to trial. | Govt: quantities supported by prescription records; codefendants not similarly situated; court varied downward and did not punish exercise of trial rights. | Court: drug-quantity finding not clearly erroneous; no unwarranted disparity; no Sixth Amendment violation. |
Key Cases Cited
- United States v. Leigh, 487 F.2d 206 (5th Cir. 1973) (holding that prescribing or administering by a physician constitutes "dispensing" under the CSA)
- United States v. Joseph, 709 F.3d 1082 (11th Cir. 2013) (upholding convictions where prescriptions constituted unlawful dispensation)
- United States v. Ignasiak, 667 F.3d 1217 (11th Cir. 2012) (sufficiency of evidence for unlawful dispensing by prescription)
- United States v. Thompson, 624 F.2d 740 (5th Cir. 1980) (doctor indictable for unlawful dispensation when prescribing outside usual course of practice)
- United States v. Roya, 574 F.2d 386 (7th Cir. 1978) (prescription as constructive transfer supporting "dispense")
- United States v. Tighe, 551 F.2d 18 (3d Cir. 1977) (prescription issued outside usual practice completes dispensing offense)
- Stansell v. Revolutionary Armed Forces of Colombia, 704 F.3d 910 (11th Cir. 2013) (statutory interpretation principle: "include" is illustrative)
- Barber v. Thomas, 560 U.S. 474 (2010) (statutory term-consistency presumption: same term used uniformly through statute)
- Daubert v. Merrell Dow Pharmaceuticals, 509 U.S. 579 (1993) (expert-admissibility reliability gatekeeping under Rule 702)
- Whitfield v. United States, 543 U.S. 209 (2005) (§1956(h) conspiracy does not require proof of overt act)
- Gall v. United States, 552 U.S. 38 (2007) (abuse-of-discretion standard for review of sentence reasonableness)