United States v. Tamral Guzman, 571 F. App'x 356

Background

Guzman operated Maryville Pain Management, LLC (MPM) in Maryville, TN from 2008–2010 with over $2.1 million in receipts and no medical license or DEA authority.
She recruited nurse practitioners and doctors via Craigslist and faxes, and issued prescriptions on pre-signed forms without meaningful examinations.
MPM attracted widespread, problematic traffic and witnessed drug deals and cash-only transactions, and nearby providers reported patient crowding and disruptive activity.
In September 2009 Guzman began establishing a dispensing pharmacy at MPM, using another physician’s DEA number to order controlled substances; after staff resignations, MPM operated without medical practitioners for about two weeks.
In December 2010 a grand jury charged Guzman with 57 counts (drug conspiracy, possession with intent, money laundering, and structuring); trial occurred Sept. 2012, she absconded during trial, and the jury convicted her.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether referring to MPM as a pill mill/pain clinic was admissible.	Guzman argues those terms are prejudicial and amount to improper vouching.	Guzman contends the terms carry a pejorative connotation and should be barred.	No abuse of discretion; terms are probative and not unduly prejudicial under Rule 403.
Whether the indictment sufficiently charged offenses and whether any multiplicity violates Double Jeopardy.	Guzman contends many counts fail to state federal offenses and some are multiplicitous.	Government asserts indictment travels to the charged conspiracies and distributions.	Indictment sufficient; no plain-error in multiplicity or sufficiency under plain-error standard.
Whether the evidence was sufficient to sustain Counts One (conspiracy) and Two (possession with intent).	Guzman claims insufficient proof of agreement/knowledge and intent.	Evidence shows Guzman directed pre-signed forms and conspiring to distribute.	Evidence supports both Counts One and Two beyond a reasonable doubt.
Whether Guzman was deprived of Brady material and entitled to a new trial.	Guzman claims suppressed exculpatory DEA Graham documents and CTR data.	No Brady violation; information available to Guzman; untimely motion.	No Brady violation; district court did not err in denying new trial/judgment of acquittal.
Whether constructive amendments or prejudicial variance affected Counts One and Two.	Guzman asserts constructive amendment/variance to indictment.	No preserved error; plain-error standard insufficient.	No plain-error with constructive amendment or variance.

Key Cases Cited

United States v. Woods, 297 F.3d 596 (6th Cir. 2002) (evidentiary rulings reviewed for abuse of discretion in limine)
United States v. Whittington, 455 F.3d 736 (6th Cir. 2006) (Rule 403 prejudice balancing in admissibility)
United States v. Baker, 458 F.3d 513 (6th Cir. 2006) (admissibility of terms in context of trial)
United States v. Johnson, 440 F.3d 832 (6th Cir. 2006) (assessment of relevance vs. prejudice in evidentiary rulings)
United States v. Blackwell, 459 F.3d 739 (6th Cir. 2006) (abuse of discretion standard for evidentiary rulings; relevance and prejudice)
United States v. Sadler, 750 F.3d 585 (6th Cir. 2014) (use of common terminology to describe illicit acts; Rule 403 consideration)
United States v. Volkman, 736 F.3d 1013 (6th Cir. 2013) (conceding term usage and probative value balancing)
United States v. Leal, 75 F.3d 219 (6th Cir. 1996) (lay testimony and common usage of terms; Rule 701 boundaries)
United States v. Abboud, 438 F.3d 554 (6th Cir. 2006) (waiver vs. non-waiver on indictment challenges; rights preserved)
United States v. Wallace, 597 F.3d 794 (6th Cir. 2010) (issues surrounding multiplicitous counts and sentencing implications)