United States v. Naeem Kohli
847 F.3d 483
| 7th Cir. | 2017Background
- Dr. Naeem Kohli, an Illinois pain-management physician, was indicted on multiple charges including ten counts of illegal dispensation of controlled substances under 21 U.S.C. § 841(a); after trial he was convicted on seven counts and sentenced to 24 months and a $10,000 fine.
- Government presented extensive evidence (patient records, experts, patient testimony) showing Kohli routinely prescribed Schedule II opioids to patients with histories of addiction, multi-sourcing, early refill requests, and inconsistent tox screens.
- Government expert Dr. Theodore Parran reviewed Kohli’s files and testified that many prescriptions were inconsistent with the usual course of professional practice and lacked legitimate medical purpose; Parran did not opine on Kohli’s subjective intent.
- Kohli testified in his defense, asserting good-faith medical treatment; on direct he twice stated no patient had died under his care, which opened the door to impeachment when the government questioned him about a prior patient’s overdose death.
- The district court instructed the jury that conviction requires proof beyond a reasonable doubt that Kohli knowingly prescribed controlled substances outside the usual course of professional practice and without a legitimate medical purpose; jury convicted on seven counts and acquitted on eight.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Sufficiency of evidence to convict under § 841(a) | Evidence showed Kohli knowingly prescribed outside usual practice and for no legitimate purpose; review should uphold conviction | Kohli argued evidence was insufficient — prescriptions were for patients with documented chronic pain and he acted in good faith | Affirmed: viewed in gov’t favor, evidence was sufficient for a rational jury to find Kohli acted outside professional practice and without legitimate medical purpose |
| Expert testimony (Rule 704) | Dr. Parran’s opinion on whether prescriptions fell outside usual practice was admissible as an opinion on an ultimate issue | Kohli argued Parran improperly gave legal conclusions and invaded jury’s role | Affirmed: Rule 704 permits expert opinion on ultimate issues; Parran did not opine on Kohli’s mental state and stayed within medical expertise |
| Impeachment about a former patient’s death | Gov’t properly impeached Kohli after he testified no patient had died under his care; impeachment limited to questioning and materials provided | Kohli argued collateral-evidence rule, Rule 16 disclosure violation, and unfair surprise | Affirmed: impeachment was permissible because Kohli opened the door; no extrinsic evidence was used; any disclosure issue was harmless given continuance and limited use |
| Jury instructions conflating civil malpractice and criminal liability | Government contended instructions correctly stated § 841(a) elements and required criminal mens rea and lack of legitimate medical purpose | Kohli argued instructions allowed conviction for mere civil malpractice | Affirmed: instructions correctly stated elements and burden of proof and cautioned about good-faith medical practice; no plain error |
Key Cases Cited
- United States v. Chube II, 538 F.3d 693 (7th Cir. 2008) (discusses when prescribing conduct constitutes acting as a "pusher" rather than a physician)
- United States v. Moore, 423 U.S. 122 (U.S. 1975) (physician dispensing unlawful narcotics case; intent and professional practice analysis)
- United States v. Pellmann, 668 F.3d 918 (7th Cir. 2012) (elements required to convict a physician under § 841(a))
- United States v. Winbush, 580 F.3d 503 (7th Cir. 2009) (expert testimony limits regarding mental state and reliance on records)
- United States v. Boswell, 772 F.3d 469 (7th Cir. 2014) (defendant credibility and scope of impeachment when testifying)