United States v. Jack Kelly Joseph, 709 F.3d 1082

Green operated a Perry, Georgia medical clinic accused of prescribing controlled substances outside the usual course of practice and without legitimate medical purpose; Mack assisted as a physician’s assistant and Joseph was a pharmacist.
Indictment charged Green, Mack, and Joseph with multiple counts under 21 U.S.C. § 841(a)(1) and conspiracy under § 846, including arranging prescriptions for Schedule II–IV drugs and distributing them to drug abusers.
Evidence at trial included patient-volume and clinic-structure anomalies, undercover drug-buying corroborating patient danger signals, and expert testimony that prescriptions often lacked legitimate medical basis or proper examinations.
Key contested evidence included Green’s pre-signing of prescriptions and Mack’s delivery of those prescriptions to patients during a week in September 2002; Green and Mack admitted the practice violated some regulations.
The district court instructed the jury on a good-faith defense and allowed testimony about 300 known drug offenders among Green’s patients; a warrant for Green’s home was challenged but sustained as supported by probable cause.
Green was convicted on multiple counts; Mack and Joseph were convicted or acquitted on various counts; Green received a 30-year sentence, Mack received 41 months, and Joseph 84 months.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Jury instruction and Gonzales compliance	Gonzales not controlling; instruction properly used an accepted US standard.	Instruction read as a national standard contrary to Gonzales.	No reversible plain error; instruction acceptable
Good-faith defense instruction	Good faith proper defense reflected in charging and evidence.	Proposed subjective good-faith standard misstates law.	District court's instruction adequate; not plain error
Conspiracy instructions and good-faith reference	Conspiracy charges correctly tied to substantive good-faith defense.	Conspiracy lacked equal good-faith guidance for all defendants.	No reversible error; charges read together adequately
Distributing vs dispensing distinction	Proper understanding allows dispensing/distribution to be prosecuted if unlawful.	Error conflates lawful dispensing with unlawful distribution.	Not error; Moore permits both avenues for prosecution
Sufficiency of evidence and standard of practice	Evidence showed outside usual practice and lack of legitimate medical purpose.	Expert proof of standard of practice was insufficient.	Sufficient evidence; standard proven via lay and expert testimony

Gonzales v. Oregon, 546 U.S. 243 (U.S. 2006) (Supreme Court on national standards in medical practice context)
Moore, 423 U.S. 122 (U.S. 1975) (Conviction upheld where standard of medical practice recognized nationally)
Tobin, 676 F.3d 1264 (11th Cir. 2012) (Discusses standard-of-practice instruction and Gonzales relation)
Merrill, 513 F.3d 1293 (11th Cir. 2008) (Affirmed instruction measuring practice against generally recognized standard)
Williams, 445 F.3d 1302 (11th Cir. 2006) (Judicially approved standard-of-practice instruction)
Ignasiak, 667 F.3d 1217 (11th Cir. 2012) (Governs sufficiency review and standard for 841(a)(1) conviction)
Gates, 462 U.S. 213 (1983) (Totality-of-the-circumstances probable cause standard for warrants)