FALSEHOOD OF “THE HOLY TRINITY,” AND THE GOVERNMENT’S PROSECUTORIAL SMCS FABRICATIONS: RUAN vs. UNITED STATES

excerpts from

NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., NORMAN J CLEMENT RPH., DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC.T. SPIRIT OF REV. IN THE SPIRIT OF WALTER R. CLEMENT BS., MS, MBA. HARVEY JENKINS MD, PH.D., C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., WALTER F. WRENN III., MD., JULIE KILLINGWORTH, LESLY POMPY MD., CHRISTOPHER RUSSO, MD., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS

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*SMCS: SUBJECT MATTER COCK SUCKERS: A GOVERNMENT EXPERT USED IN DOJ-DEA HEALTHCARE INDICTMENTS WHO WILL DO AND SAY ANYTHING FOR A DOLLAR …

“THE HOLY TRINITY“

For this reason, such questions are extremely prejudicial because they were Introduced Into the court under the guise of “common sense language” but subsequently were used equivocally to mean crime element or legal conclusion to substitute the jury’s judgment.

Such calculated misconduct by the prosecutors and their government expert witnesses, together with Judge Granade partial condoning and indulgence violated Rt.lie 704(a) and Rule 611(c) as well as my due process rights.

Government’s Creation of the Straw Man –Our Prescribing “Holy Trinity” and Imputing It to Our “Outside the Usual Course of Professional Practice”

Using “Holy Trinity” to Prejudice against the Defendants, the Government Introduced It to Represent An Addictive Cocktail

It is well recognized that the Christian Dogma of Holy Trinity, namely the Father, the Son, and the Holy Ghost, is a sacred unity that is worshipped by nearly all Christians. In my trial, the prosecutors intended it to mean an addictive cocktail of controlled substances.

At the time of my arrest in May, 2015t there was only one reference in the PubMed database (the most authoritative scientific database), namely the article by Matthias Forrester entitled “Ingestion of Hydrocodone, Carisoprodol, and Alprazolam in combinations reported to Texas Poison Center,” published in April, 2011, in the Journal of Addictive Disease.

In this paper, the combination of Hydrocodone, Carisoprodol, and Alprazolam was defined as “Holy Trinity,’ or “Houston Cocktail,” or “Trio.” This definition was cited in cases such as United States v. Geralt, 682 Fed. Appx. 394; 2017 U.S. App. LEXIS 4326 (6th Cir. 2017); United States v. Shelton, 369 F. Supp. 3d 824; 2019 U.S. Dist. LEXIS 28191 (2019); and United States v. lfediba, 2019 U.S. Dist. LEXIS 202017 (2019).

The Government Hired Dr. Sprague to Expand the Definition of “Holy Trinity” in Literature for Our Prosecution

In the Summer of 2016, one year after our arrest, the prosecutors Informed the defense that they would use Dr. Jon E. Sprague as their expert witness, who would testify on the danger of “Holy Trinity.” Dr. Sprague was associated with the Ohio Attorney General’s Center for Future of the Forensic Sciences.

In September 2016, about 16 months after our arrest, an article entitled “The Pharmacology and Toxicology of the “Holy Trinity,” by Joseph Horsfall and Jon E. Sprague, appeared online in a journal called “Basic & Clinical Pharmacology.” [Prior to this, Dr. Sprague had published a few dozen articles, but none involving any opioid, benzodiazepine, or carisoprodol. Horsfall had never published anything under PubMed.]

The definition of “Holy Trinity” in the Horsfall and Sprague paper was expanded; it included any opioid (not just hydrocodone), any benzodiazepine (not just alprazolam), and carisoprodol. The only paper they cited to support the definition of their newly expanded definition was the Forrester paper.

“HOLY TRINITY ,” IS A DANGEROUS LAW ENFORCEMENT SLANG USED TO MISIDENTIFY PAIN AND ANXIETY TREATMENT

Therefore, for the first time, a new but expanded definition of “Holy Trinity” appeared in medical literature. This new definition was introduced into our trial by DEA Diversion Investigator Susannah Herkert {Tr. 1/6/17, p. 122).

Under this new definition, more PPSA patients could be labeled as “Holy Trinity” recipients. (This was the purpose of the Sprague’s publication.) Nevertheless, even under the expanded “Holy Trinity,” only a very small fraction of PPSA patients received “Holy Trinity,” for example, about 5.2% of Dr. Couch’s patients received such combination prescriptions (Tr. 1/7/17, p. 392-93).

None from PPSA Side Knew What “Holy Trinity” Meant and Government Witnesses Testified It Was A Slang or Law Enforcement Term

There was no evidence that any PPSA patient or staff member ever used the term “Holy Trinity.” I testified that I had never heard of “Holy Trinity” in a pain clinic. Professor Warfield, a world-class pain expert under whom ‘the Pain Management Center at Beth Israel Hospital of Harvard Medical School was named (Tr. 2/8/17, p. 4661), testified that she had no idea what it meant other than its spiritual meaning (Tr. 2/8/17, p. 4702).

Even cooperating government witness, Gary Douthitt, a former patient of mine, who was later unrelatedly charged with a felony for heroin trafficking, said he had no Idea what “Holy Trinity” meant (Tr. 1/30/17, p. 3448).

Several government witnesses testified that “Holy Trinity” was a slang term, or rather a law enforcement term, for example, Dr. Aultman acknowledged that il was a slang term (Tr. 2/6/17, p. 4370). DEA Agent Paul Short admitted that “Holy Trinity” was a slang word (Tr. 1/9/17, p. 390). Deputy Shawn Kelley told the jury that “Holy Trinity” was a “law enforcement term and they (PPSA staff and patients) would not use it.” (Tr. 1/20/17, p. 1806). Even Mr. Bodnar incidentally acknowledged that DEA Agent Paul Short’s working at DEA to be Short’s basis for being familiar with the term “Holy Trinity” in Paul Short’s direct examination by Mr. Bodnar (Tr. 1/9/17/, p. 350)

(“Q: Based .on your experience working at DEA, are you familiar with a name for that drug combination?
A: It’s often referred to as ‘Holy Trinity’.”
Nothing Medically Wrong with “Holy Trinity” and Its Admission Was Repeatedly Objected to by the Defense
There is 11othing wrong medically to use such combinational drug therapy. Professor Warfield testified: “That Is absolutely within the usual course of professional practice…you can call it a cocktail…it’s done very commonly to treat anything,” (Tr. 2/8/17, p. 4706) Even government witnesses Dr. Aultman and DEA Diversion Investigator Herkert testified that there was nothing intrinsically wrong in prescribing such a drug combination (Tr. 1/30/17, p. 3276; Tr. 1/6/17, p. 145).
The defense counsel vehemently objected to its admission first during Herkert’s direct examination by Bodnar:
Q And is there a term for that type of — cocktail?
A Yes, it’s considered a drug cocktail, or the Holy Trinity.
Mr. Essig: Your Honor, I am going to object to that testimony.
The Court: On what ground?
Mr. Essig: There’s no relevance shown to this case whatsoever.

“HOLY TRINITY,” PHRASE EXTREMELY PREJUDICIAL

The Court: Overruled (Tr. 1/6/17, p. 121)
Another timely objection was raised during the sidebar discussion, where my counsel Mr. Gordon Armstrong repeatedly argued that “Holy Trinity” was a government argument:
“If you look at it…that’s purely argument…We think that’s inappropriate. We think that’s extremely prejudicial, it’s argument. It’s not in the data as cocktail. That’s government’s assertion…That’s not a medical term and that’s not in the data. That’s argument by the government. So we would object to that.” (Tr. 1/9/17, p. 251)
Counsel’s argument is not evidence. [Showan v. Pressdee, 922 F.3d 1211; 2019 U.S. App. LEXIS 12754 (11th Cir. 2019); United States v. Ganji, 880 F.3d 760; 2018 U.S. App. LEXIS 2279 (5th Cir. 2018)]. In fact, in Judge Granade’s preliminary jury instruction, she actually gave an admonition that “the statements, the arguments, and the questions by the lawyers are not evidence.” (Tr. 1/5/17, p. 8) Yet, Judge Granade contradicted herself when she improperly admitted “Holy Trinity” as evidence over the defense counsel’s correctly raised objections.
Massive “Holy Trinity” Related Testimonies Were Admitted over Defendant’s Objections
Judge Granade, in blatant partiality, overruled the above correctly raised objections. Massive testimonies related to “Holy Trinity” poured into trial court. The following government witnesses testified on “Holy Trinity”: DEA Diversion Investigator Susannah Herkert (Tr. 1.6/17, p. 121-22, Id., p. 173-74); DEA Analyst Paul Short (Tr. 1/9/17, p. 350-54); Deputy Patrick Shawn Kelley (Tr. 1/29/17, p. 1806-07); medical expert witness Rahul Vohra (Tr. 1/23/17, p. 2192-93, Tr. 1/24/17, p. 2434); United Healthcare representative Doug Moore (Tr. 1/25/17, p. 2633-34, Id., p. 2643); former PPSA nurse practitioner Bridgette Parker (Tr. 2/1/17, p. 3827); and medical expert witness Dr. Tricia Aultman (Tr. 2/6/17, p. 4253-54, Id., p. 4272-75, Id., p. 4278, Id., 4280, Id.. p. 4283-84, ld., p. 4287-88, Id., p. 4290, Id., p. 4292, Id., p. 4295).
The following examples are taken from Or. Aultman’s direct examination by Bodnar. This examination took place on Day 19 of the trial, with Dr. Aultman being government witness No. 56. The first three questions were related to Or. Couch’s patient Ms. Brenda Ward and the last question was related to my patient Ms. Sandra Wimberly.
Q So did she receive the Holy Trinity on this date?
A Yes, sir. (Tr. 2/6/17, p. 4278)
Q Even after being told she might be doctor shopping, she still received the Holy Trinity?
A Right.
Q Is that within the usual course of practice?
A No, sir. (Id., 4280)
Q Does she again continues month after month to get the Holy Trinity?
A Yes, sir. (Id.)
Q And here does it show with the Klonopin, the Soma, and the Opana that she is still receiving the Holy Trinity?
A Yes, sir. (Id., p. 4288)
First, none of the prescriptions described above met the true definition of “Holy Trinity” based on the original paper by Forrester, because none of the above was the hydrocodone, alprazolam, and carisoprodol combination. Under the new, expanded definition, however, Mr. Bodnar was able to put the label “Holy Trinity” on these prescriptions.
Second, Dr. Aultman concluded that the alleged prescribing “Holy Trinity” was “outside the usual course of professional practice,” namely the crime element itself in 21 C.F.R 1306.04. In other words, Dr. Aultman drew a legal conclusion for the jury to substitute’s the jury’s own, in violation of Rule 704(a).
Third, the introduction of “Holy Trinity” and “outside the usual course of professional practice” were done with the improper use of leading questions. This is actually a good example to show how rampant the prosecutorial leading questions were used, as a result of Judge Granade’s erroneous rulings on such questions. The testimony of “Holy Trinity” as well as the improper uses of leading questions started with DEA Diversion Agent Susannah Herkert, government witness No. 1, and were continuing during the examination of Dr. Aultman, government witness No. 56. This gives an idea how pervasive the prosecutors’ uses of leading questions were and how hard the prosecutors pushed along the line of “Holy Trinity.”
Trial Court Violated Multiple Federal Court Rules by Improperly Admitting “Holy Trinity” Related Testimony

Judge Granade violated Rule 104(b), Rule 401, 402, and 403. Rule 104(b) dictates that the relevancy of an item of evidence depends upon the existence of a particular preliminary fact. Thus when a spoken statement is relied upon to prove a notice to X, it is without probative value unless X heard it. (Federal Court Rules, 2019) The admission of “Holy Trinity” related evidence violated Rule 104(b), as none of the PPSA physicians, staff members, even patients knew what “Holy Trinity” meant In a clinical setting, because it was a “slang term,” or a “law enforcement term,” or a government argument, and thus it does not have ahy probative value namely it is devoid of any relevance, just as what was objected to by defense counsel (Tr. 1/6/17, p. 121) (“There is no relevance shown to this case whatsoever.”) Because of the Irrelevance, its admission violated Rule 401 and 402, both of which require the admitted evidence to be relevant.
It also violated Rule 403 due to its unduly prejudicial effects: the Holy Trinity is strictly a Christian doctrine, and when this term was used by the government, to mean an addictive cocktail being “illegally” prescribed to PPSA patients, at a criminal trial in a Federal Court of Southern District of Alabama, one of the most conservative regions In the nation, the overall prejudicial impact cannot be fully assessed.

Further, its admission by the improper use of leading questions in direct examinations violated Rule 611(c), and the admission of crime-element containing language, i.e. “outside the usual course of professional practice” by Dr. Aultman also violated Rule 704 (a), which prohibits admission of expert testimony that draws a legal conclusion for the jury.
Mischaracterization of Trial Evidence Respecting “Holy Trinity” by the Appellate Court and Egregious Government Misconduct Violated My Due Process Rights
Judge Coogler mischaracterized the trial evidence respecting the “Holy Trinity.” In his 137-page Opinion, he mentioned “Holy Trinity’1 twice — once at the beginning in the Trial Evidence section, the other at the end in the Restitution Calculation section. In the former, he wrote:
“The combination of these three types of drugs – which the government referred to as the “Holy Trinity” at trial — is popular among substance abusers because of its euphoric effect, yet It is highly addictive and can increase the chances of user’s death.” (Ruan, 2020 U.S. App. LEXIS 32102, at 8-9)
Judge Coogler downplayed what the prosecution had done in presenting “Holy Trinity” related testimonies to the jury. In our case, “Holy Trinity” was essentially a straw man deliberately created by the government for our prosecution. Using their inflammatory rhetoric, the prosecutors effectively demolished their straw man before the jury, as though it had “proven” their case that we practiced “outside the usual course of professional practice.”

The government went so far as to hire Dr. Sprague to alter and expand the definition of “Holy Trinity” In medical literature (16 months after our arre.st) to aid the prosecution. Judge Granade, over the defendants’ vigorous objections, improperly admitted massive testimonies of “Holy Trinity,” and allowed the government’s unqualified medical experts, e.g., Dr. Aultman, to give expert testimony insinuating our alleged prescribing of “Holy Trinity” to be “outside the usual course of professional practice.” Judge Coogler’s mischaracterization of trial evidence dissembled what really had happened at court and was at odds with what the jury had seen and heard at trial. “Holy Trinity” related testimonies were admitted as major and substantial evidence of our alleged acting “outside the usual course of professional practice,” completely unlike what Judge Coogler lightly referenced to in his Opinion.
Again the insidious and deceiving nature of the Moore language, “outside the usual course of professional practice” is evident when considering its use in association with “Holy Trinity” in my case. As a result of the lack of statutory definition of “outside of the usual course of professional practice,” anything could be painted to be “outside the usual course of practice.”

In other words, this criminal liability standard from Moore could be easily manipulated and exploited by the government. All the prosecutors ever needed was to pay some government “experts” to say whatever was necessary. The district court kept a blind eye, allowing “outside the usual course of professional practice” to be used equivocally in court. As a result, I was deprived of my due process rights and my criminal proceedings were fundamentally unfair. I respectfully make this plea to the Court to review these Issues and to reverse my convictions.
Trial Court Egregiously Abdicated Its Gatekeeping Role in Admitting Expert Testimony of “Outside the Usual Course of Professional Practice, Justifying Plain Error Review by the Court Pursuant to Rule 24.1(a)
Rule 24.1(a) of the Supreme Court of the United States states: “At Its option, however, the Court may consider a plain error not among the questions presented but evident from the record and otherwise within its jurisdiction to decide.”

In Silber v. United States (1962), 370 U.S. 717, 8 L. Ed. 2d 798, 82 S. Ct. 1287, the Supreme Court held, “While ordinarily we do not take note error not called to the attention of the Court of Appeals not properly raised here, that rule is not without exception. The Court has power to notice a ‘plain error” though it was not assigned. (Citation omitted.) “In exceptional circumstances, appellate courts may notice errors if the errors are obvious, or if they otherwise seriously affected the fairness, integrity or public reputation of judicial proceedings.” (Citation omitted.)

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