Physician Convicted of Unlawful Prescription Seeks SCOTUS Review of ‘Bounds of Professional Practice’

A physician who was convicted for providing prescriptions to patients “beyond the bounds of professional practice” is appealing to the Supreme Court to revisit the question of whether the legitimate medical need of a patient has weight in whether a prescribing doctor has violated professional standards.

George P. Naum III filed his petition Tuesday after losing on appeal in the Fourth Circuit and being denied a rehearing en banc. The United States argued that its burden of proof was to show that the defendant prescribed a controlled substance — opioid-use disorder treatment drug Suboxone in particular — “for other than a legitimate medical purpose or not within the bounds of professional practice,” the petition explained.

Pursuant to 21 C.F.R. §1306.04, “A prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.” 

According to the petition, the court allowed the United States “to sever the standard outlined” in the above statute and instead only force the government to prove that the defendant’s prescribing conduct was not within “the bounds of professional practice.” The government was able to plead its case because Naum had authorized nurses to see his patients (after an initial intake) and refill their suboxone prescriptions.

Naum claimed that he continued to review patients’ treatments and instruct the nurses to adjust prescriptions accordingly, noting the testimony of addiction medicine and pain management physician Standiford Helm, who said he believed “it was medically appropriate to assign follow-up care to a nurse” under Substance Abuse and Mental Health Services Administration guidance.

Helm also testified that a patient having a legitimate medical need means that a prescription written for said patient would be within the bounds of professional practice, to which the prosecution argued that medical legitimacy is not relevant and the government’s burden of proof was only that the prescription was outside the scope of professional practice. The court sided with the prosecution on that question, concluding that medical legitimacy was not a necessary question to consider. Accordingly, Naum was convicted and sentenced to six months of incarceration and six months of home detention.

In his petition, Naum disputed that the standard by which the court operated in his case — that the only burden of the government was to prove that Naum was working outside professional standards and that medical necessity was irrelevant — was misguided, seeking review of previous purported appellate discrepancies concerning a similar question of how to define “bounds of professional practice” and how medical legitimacy affects that definition, if at all.

The government’s deadline to file a response is May 24.

Chapman Law Group represents Naum.