Whether the Fourth Circuit unconstitutionally applied the plain error standard to affirm a physician's conviction where jury instructions misstated the law after Ruan v. United States by failing to consider the defendant's subjective intent

In Ruan v. United States, 597 U.S. ___ (2022), this Court answered the question on whether a physician alleged to have prescribed controlled substances outside the usual course of professional practice could be convicted of unlawful distribution under 21 U.S.C. §841(a)(1) regardles s of whether he “reasonably believed” or “subjectively intended” that his prescriptions fell within that course of professional practice. This Court ruled that the crime of prescribing controlled substances outside the usual course of professional practic e, in violation of 21 U.S.C. §841(a)(1), requires that the defendant “knowingly or intentionally” acted in an unauthorized manner. The question presented for review in this Petition is whether the Fourth Circuit unconstitutionally applied the plain error standard to affirm Dr. Naum’s conviction where the court admitted and agreed that the jury instructions misstated the law after Ruan v. United States; jury instructions which failed to consider Dr. Naum’s subjective intent. The Fourth Circuit’s ruling completely disregarded the basic tenets and purpose jury instructions. Jury instructions affect juror decision making by providing gui dance on the evidence presented and play a critical role in shaping how jurors evaluate evidence. Nonetheless, the efficacy of jury instructions depends on factors such as timing, content, and jurors' psychological tendencies. In this case, where the district court precluded the admission of the very evidence to support Dr. Naum’s subjective intent, no “plain error” can exist when the district court precluded Dr, Naum from introducing the medical standard upon which he based his subjective suboxone prescribing practice. ii George P. Naum III, was convicted of violating 21 U.S.C. §841(a)(1) and 21 U.S.C. §846 for prescribing Suboxone, a drug used to treat opioid use disorder. The central issue at trial was his use of nurses to expand the availability of patient care consistent with SAMHSA regulations. At trial, the district court held that the elements of 21 U.S.C. §841(a)(1), as applied to a physician, can be interpreted in the disjunctive, allowing the Government to choose between theories that prescrip tions were issued either “beyond the bounds of professional practice” or “for other than a legitimate medical purpose.” This enabled the Government to prosecute and convict Dr. Naum solely for violating professional standards dictated by the government. To compound the error at trial, the district court barred expert testimony regarding the medical legitimacy of the prescriptions and hospital programs that operated similarly to those of the Defendant; such expert testimony would have supported Dr. Naum’s subjective intent, a prerequisite for conviction under 21 U.S.C. §841 as outlined in this Court’s Ruan opinion. The district court’s vehement exclusion of evidence supporting a legitimate medical purpose necessarily led to the prohibition of a requesting, objecting or giving jury instruction based upon Dr. Naum’s subjective intent concerning that purpose. In so doing, the District Court permitted the State to prosecute and convict a physician without proving the requisite subjective mens rea under this Court’s holding in Ruan.