United States v. Webb, 655 F.3d 1238

Webb, a Florida-licensed physician operating as Doctors on Call, was convicted on 130 counts involving wire fraud, health care fraud, and unlawful dispensing of controlled substances, plus three death- resulting counts; he received concurrent life sentences on the death-related counts and other prison terms for remaining counts.
The 131-count indictment charged conspiracy to defraud health care programs, substantive health care fraud, unlawful dispensing of controlled substances, and possession/use of another’s DEA registration number.
Trial evidence showed Webb prescribed controlled substances in high doses with minimal evaluations, ignored red flags of addiction, and continued prescribing after learning patients obtained narcotics from other sources.
Webb’s license was suspended for 30 days in 2005 for inappropriate prescribing; during suspension he allegedly issued prescriptions using another doctor’s DEA number and caused backdated or unauthorized claims.
At trial, government witnesses argued Webb’s prescribing practices caused patient deaths, while Webb contended his prescriptions were medically appropriate; the district court instructed the jury on death-related counts without Webb’s requested causation instruction.
The Eleventh Circuit affirmed, holding that the death-enhancement provisions do not require foreseeability or proximate cause, and analyzing the sufficiency of evidence and ineffective assistance claims.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether the § 841(b)(1)(C) death enhancement requires foreseeability or proximate cause.	Webb argues the statute requires proximate cause/foreseeability.	Webb contends a more stringent causation standard is required.	No; no foreseeability/proximate cause element is required.
Whether §1347(a) death enhancement requires foreseeability or proximate cause.	Ortega death must be linked by proximate cause.	District court properly applied a cause-in-fact standard.	No foreseeability/proximate cause element; district court correct.
Whether the government presented sufficient evidence to sustain the convictions and whether ineffective assistance applies.	Evidence supports conviction; motions would fail.	Evidence may be insufficient; counsel allegedly ineffective.	Evidence supports convictions; any ineffective-assistance claim would fail.

United States v. Patterson, 38 F.3d 139 (4th Cir. 1994) (death-resulting penalty applies without foreseeability)
United States v. Robinson, 167 F.3d 824 (3d Cir. 1999) (no proximate cause requirement for §841(b)(1)(C))
United States v. McIntosh, 236 F.3d 968 (8th Cir. 2001) (no foreseeability/proximate cause requirement; strict liability reading)
United States v. De La Cruz, 514 F.3d 121 (1st Cir. 2008) (death-resulting penalty requires cause-in-fact; no foreseeability needed)
United States v. Houston, 406 F.3d 1121 (9th Cir. 2005) (proximate cause not required; error harmless in that case)
United States v. Martinez, 588 F.3d 301 (6th Cir. 2009) (proximate cause appropriate for §1347; discussed causation standard)