United States v. Felix Brizuela, Jr., 962 F.3d 784

Dr. Felix Brizuela, an osteopathic neurologist in West Virginia, was investigated by the DEA for opioid-prescribing practices and indicted on 21 counts alleging unlawful distribution of controlled substances tied to 21 prescriptions written for five patients.
The government called two of those five charged patients at trial and also presented testimony from four additional patients whose treatment was not part of any indictment count.
Government witnesses included former staffers, the state osteopathic board director, and an expert who opined the charged prescriptions were outside professional practice; defense presented a conflicting pain-medicine expert and Brizuela testified.
The district court admitted the four uncharged-patient testimonies after a Rule 404(b) notice, treating them as admissible under this Court’s Kennedy “complete the story” doctrine.
Jury convicted Brizuela on 15 distribution counts, acquitted on 6 distribution counts and all kickback counts; he was sentenced and appealed. The Fourth Circuit held admission of the uncharged-patient testimony was error and, because the government failed to carry its burden to show harmlessness, reversed and remanded for a new trial.

Issue	Brizuela (Appellant) Arg.	Government Arg.	Held
Admissibility under Kennedy “complete the story” doctrine	Testimony of uncharged patients was extrinsic, propensity evidence, and not necessary to complete the story of the specific prescriptions charged.	Testimony showed a consistent practice of failing to follow medical norms and thus completed the picture of the charged offenses.	Court: Abuse of discretion. The uncharged-patient testimony was not necessary to complete the story of the specific §841 prescription offenses and was extrinsic.
Admissibility under Fed. R. Evid. 404(b)(2) to show absence of mistake/accident	Not relevant: Brizuela did not assert mistake/accident; evidence was prejudicial character evidence.	Evidence showed absence of mistake or accident and rebutted good-faith defense.	Court: Government failed its burden under Hall test; the evidence was not admissible to prove absence of mistake/accident.
Harmless-error analysis	Erroneous admission was prejudicial and required a new trial.	(Government did not argue harmless error on appeal.)	Court: Because the government did not show the error was harmless and the record was close, convictions vacated and case remanded for a new trial.

United States v. Kennedy, 32 F.3d 876 (4th Cir. 1994) (articulates the “complete the story” doctrine for intrinsic other-acts evidence)
United States v. McBride, 676 F.3d 385 (4th Cir. 2012) (uncharged acts that do not complete the charged crime are extrinsic and barred by Rule 404(b))
United States v. Alerre, 430 F.3d 681 (4th Cir. 2005) (explains use of evidence of consistent departures from medical norms in prosecutions of physicians, in a conspiracy context)
United States v. Hurwitz, 459 F.3d 463 (4th Cir. 2006) (physician prosecuted under §841 must be shown to have acted outside professional practice)
United States v. Hall, 858 F.3d 254 (4th Cir. 2017) (sets four-prong test the government must satisfy to admit other-acts evidence under Rule 404(b))
Tran Trong Cuong v. United States, 18 F.3d 1132 (4th Cir. 1994) (discusses prescription-specific nature of §841 prosecution and limits on other-acts evidence)