United States v. Saad Sakkal, M.D.
20-3880
| 6th Cir. | Feb 24, 2022Background
- Saad Sakkal, an Ohio-licensed physician with a DEA registration, practiced at Lindenwald Medical Association (Feb 2015–Dec 2016) and was investigated by the DEA after pharmacist complaints and an Ohio Medical Board referral.
- A federal grand jury indicted Sakkal on 39 counts: 30 counts of illegal distribution (21 U.S.C. § 841(a)(1)), 2 counts of distribution resulting in death (21 U.S.C. § 841(b)(1)(C)), and 7 counts of using another’s registration (21 U.S.C. § 843(a)(2)).
- Government evidence showed risky prescribing practices: therapeutic duplication, dangerous drug combinations, high dosages, failure to review OARRS reports and drug screens, and ignoring pharmacy warnings.
- Patient Ashley Adkins filled prescriptions from Sakkal the day she died; autopsy listed benzodiazepine and oxycodone toxicity with drug levels outside therapeutic ranges; toxicology found no fentanyl, cocaine, or marijuana.
- The jury convicted Sakkal on multiple illegal-distribution counts, the Adkins death count, and several registration-counts; post-trial, Sakkal moved for a new trial alleging ineffective assistance of trial counsel; after an evidentiary hearing the district court denied relief, and Sakkal appealed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Pretrial detention/bail (18 U.S.C. §3142) | District court improperly denied reasonable bail and violated Sixth and Eighth Amendments | Conviction and credit for pretrial detention moots pretrial-detention and constitutional claims | Moot — claims rendered moot by conviction and credit for time served |
| Sufficiency of evidence for death count (Adkins) | Government did not prove Sakkal’s prescriptions were the but‑for cause of Adkins’s death; had she taken meds as directed she would not have died | Evidence showed Adkins filled prescriptions, ingested large amount, and died of benzodiazepine+oxycodone toxicity; but‑for causation satisfied | Evidence sufficient for jury to find the prescribed controlled substances were a but‑for cause of death; conviction affirmed |
| Ineffective assistance — plea bargaining (Strickland/Lafler) | Trial counsel’s late recommendation and prior assurances were deficient and prejudicial during plea negotiations | Counsel advised defendant to seriously consider the plea, explained time‑served and sentencing consequences; district court credited counsel’s testimony | No deficient performance found; counsel’s advice was competent and not clearly erroneous |
| Ineffective assistance — decision not to call expert (Strickland) | Counsel’s strategy to forgo an expert (and not call Sakkal) was unreasonable and prejudiced defense | Counsel consulted two experts who discouraged a battle‑of‑experts; tactical choice to avoid testifying due to credibility concerns was reasonable | No deficient performance shown; appellate review defers to reasonable trial strategy |
Key Cases Cited
- Burrage v. United States, 571 U.S. 204 (2014) (but‑for causation required for death/injury enhancement under §841(b)(1)(C))
- United States v. Volkman, 797 F.3d 377 (6th Cir. 2015) (applies Burrage standard to physician prescription cases)
- United States v. Jeffries, 958 F.3d 517 (6th Cir. 2020) (interpreting death‑result enhancement language in §841(b)(1)(C))
- Strickland v. Washington, 466 U.S. 668 (1984) (two‑prong test for ineffective assistance of counsel)
- Lafler v. Cooper, 566 U.S. 156 (2012) (right to effective counsel extends to plea bargaining)
- Murphy v. Hunt, 455 U.S. 478 (1982) (constitutional claims can become moot after conviction)
- United States v. Williams, 998 F.3d 716 (6th Cir. 2021) (reviewing sufficiency of evidence by construing facts in the light most favorable to the government)