United States v. David Lague, 971 F.3d 1032

David Lague, a physician’s assistant at a San Leandro pain clinic, was indicted on 39 counts for unlawfully prescribing Schedule II and IV controlled substances to five patients; DEA seized clinic records after a cooperating patient (SL) recorded visits and was arrested for possession with intent to distribute.
Recordings and patient charts showed Lague doubled prescriptions for cash, falsified notes (e.g., falsely reporting compliance and urine testing), and prescribed large quantities and dangerous combinations (including opioids + benzodiazepines and the "holy trinity").
The government introduced practice-wide prescription data (458 uncharged patients) from Medicare and California CURES showing Lague was an extreme outlier in opioid prescribing in 2015–2016.
The district court admitted the practice-wide data under Fed. R. Evid. 404(b) to prove intent/knowledge; Lague objected that the uncharged prescriptions were not shown to be unlawful and thus irrelevant and prejudicial.
The jury convicted Lague on the unlawful-distribution counts (acquitted on healthcare fraud); the Ninth Circuit affirmed, holding the practice-wide data admissible under Rule 404(b) and that any Rule 403 error in admitting data without preview was harmless given overwhelming patient-specific evidence.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Admissibility of practice-wide prescription data under Fed. R. Evid. 404(b)	Gov't: data probative of intent/knowledge; patterns and extreme prescribing show prescriptions were outside usual practice	Lague: uncharged prescriptions not shown unlawful; no logical nexus to charged acts; intrinsic‑evidence exception inapplicable	Admissible—uncharged, aberrational prescriptions reasonably infer intent to prescribe outside usual practice; Ninth Circuit follows Merrill approach
Applicability of intrinsic‑evidence exception to Rule 404(b)	Gov't: some data may be intrinsic or necessary for coherent narrative	Lague: evidence not inextricably intertwined with charged acts	Intrinsic exception does not apply here, but Rule 404(b) covers the practice‑wide data
Rule 403 / district court’s failure to preview underlying data & limiting instruction	Lague: court abused discretion by not previewing all data and risked undue prejudice; sought specific limiting instruction	Gov't: any error harmless; general limiting instruction given; evidence overall compelling	Even if preview omission was an abuse, error was harmless given overwhelming patient-specific evidence; general limiting instruction sufficient (no request for more specific instruction)

United States v. Merrill, 513 F.3d 1293 (11th Cir. 2008) (upholding admission of practice‑wide prescription data to prove intent under Rule 404(b))
United States v. Jones, 570 F.2d 765 (8th Cir. 1978) (reversing where quantity of uncharged prescriptions alone, without proof they were unlawful, was not probative of intent)
United States v. Curtin, 489 F.3d 935 (9th Cir. 2007) (Rule 404(b) is a rule of inclusion; intent, motive, knowledge admissible under low threshold)
United States v. Bailey, 696 F.3d 794 (9th Cir. 2012) (four‑part test for admitting other‑act evidence)
Huddleston v. United States, 485 U.S. 681 (1988) (standard for sufficiency of proof for admitting Rule 404(b) evidence)
Moore v. United States, 423 U.S. 122 (1975) (prescription lawful only if issued for a legitimate medical purpose in the usual course of professional practice)
United States v. Feingold, 454 F.3d 1001 (9th Cir. 2006) (benchmark for criminal liability under Controlled Substances Act)