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INTRODUCTION
The intersection of medicine and the legal system is a complex battleground where the legal system has struggled to distinguish between a physician making a difficult clinical decision and a criminal selling drugs on a street corner. The landmark Supreme Court case Ruan v. United States fundamentally altered this landscape, establishing that a physician’s “intent to treat” is a powerful legal shield rather than a mere professional courtesy.

CRIMINALIZATION OF GOOD FAITH MEDICAL MISTAKES

Are courts currently ignoring these Supreme Court protections?
According to the sources, there is significant evidence that the protections established by the Supreme Court in the Ruan decision are being ignored or bypassed by various parts of the legal system.

Evidence of Non-Compliance
- Widespread Disregard: One source explicitly states that the Ruan ruling’s “good faith” protections are being ignored by most federal district courts, the DEA, and prosecutors.
- Specific Judicial Actions: The Department of Justice (DOJ) is described as all but ignoring the defense in its prosecutions, and specific federal judges, such as Chad Kenny, are cited as having discarded the “good faith” defense despite the Supreme Court’s 9-0 ruling.
- Ideological Conflict: The sources suggest that these protections are being sidelined by an “ideological crusade” and “anti-narcotic zealotry” that prioritizes intimidation and “shady academic guesswork” over the legal standards set by the Court.

Instances Where Protections Were Applied
Despite these claims of widespread disregard, the sources do highlight cases where the Ruan standard has been successfully enforced:
- Dismissal of Indictments: In the case of United States v. James Barclay, federal prosecutors moved to dismiss the indictment because the Ruan decision made the standard of proof—“beyond a reasonable doubt” regarding subjective intent—too high for the government to meet.
- Heightened Burden of Proof: The ruling has officially made it much harder for the government to secure convictions against authorized practitioners because they must now prove the practitioner subjectively knew their actions were unauthorized, rather than just showing a deviation from professional guidelines.

Intent to Treat: Practitioners possess formal education and a legitimate “intent to treat,” which fundamentally differentiates them from dealers. Protection from Prosecution: By requiring proof of criminal intent, the decision protects doctors from being prosecuted as “drug dealers in white coats” for what may actually be good-faith medical disagreements or errors..”
INTENT TO TREAT
Distinction Between Doctors and Drug Dealers
The ruling creates a clear legal distinction between DEA-registered practitioners and street drug dealers. The “Intent to Treat”: Defining the Legal Distinction

The standard is rooted in the “intent to treat,” which creates a clear legal boundary between a DEA-registered practitioner and a street drug dealer. Formal Education: A practitioner’s professional status and therapeutic relationship with patients differentiate them from illicit traffickers. Protection of Medical Disagreements: This standard prevents the “criminalization of errors,” ensuring that doctors are not imprisoned for good-faith mistakes, minority medical opinions, or treating patients with incurable pain in ways that government protocols might discourage. Good Faith Defense: Formerly a vulnerable standard, the “Good Faith Defense” is now a robust shield that requires the government to look beyond simple data points to find evidence of actual criminal motivation
Learning Objective: Identify the legal barriers that distinguish DEA-registered practitioners from illicit drug traffickers.

The Ruan decision creates a clear legal boundary between a DEA-registered practitioner and a street dealer. This distinction is rooted in a physician’s formal education and legitimate “intent to treat,” creating a presumption of lawful activity that the government must actively overcome. This distinction provides three primary protections:
- Protection from Criminalizing Medical Disagreements: Ensures doctors are not prosecuted for good-faith mistakes or for treating patients who suffer from the lived reality of incurable pain in ways that “shady academic guesswork” might discourage.
- Differentiation Based on Formal Education: Recognizes that a practitioner’s professional status and registration fundamentally differentiate them from a dealer who has no therapeutic relationship with a “buyer.”
- Shielding Against “Prosecution by Proxy”: Prevents the government from using medical errors as a substitute (proxy) for evidence of illicit drug trafficking.
This “Intent to Treat” prevents the “criminalization of errors” by requiring the government to look beyond simple data points to find evidence of actual criminal intent. However, while these protections are now the law of the land, their application in real-world courtrooms has met with varying degrees of resistance.

Intent to Treat: Practitioners possess formal education and a legitimate “intent to treat,” which fundamentally differentiates them from dealers.
Protection from Prosecution: By requiring proof of criminal intent, the decision protects doctors from being prosecuted as “drug dealers in white coats” for what may actually be good-faith medical disagreements or errors
- Intent to Treat: Practitioners possess formal education and a legitimate “intent to treat,” which fundamentally differentiates them from dealers.
- Protection from Prosecution: By requiring proof of criminal intent, the decision protects doctors from being prosecuted as “drug dealers in white coats” for what may actually be good-faith medical disagreements or errors.
Impact on Prosecutions and Resistance
The high standard of proof required by Ruan has already impacted federal cases, leading to the dismissal of indictments where prosecutors determined they could not meet the “beyond a reasonable doubt” standard, such as in United States v. James Barclay.
However, the sources also indicate significant resistance to these protections:
- Reported Non-Compliance: One source claims the Ruan ruling is being “ignored by most federal district courts, the DEA, and prosecutors”.
- Judicial Disregard: The “good faith” defense has reportedly been discarded by certain federal judges, such as Chad Kenny, and is “all but ignored” by the Department of Justice.
- Ideological Conflict: This disregard is characterized in the sources as a “naked attempt at intimidation” and a “destructive ideological crusade” that prioritizes “anti-narcotic zealotry” over the legal mandates of the Supreme Court.

What reasons do judges give for discarding the good faith defense?
According to the motion, lead prosecutor Paul J. Koob made four categorical false representations of fact directly to the Court during a Rule 29 proceeding on April 8, 2025. The motion alleges these were not mere arguments or inferences, but were objectively refuted by the government’s own records, which do not provide direct legal justifications or written statements by judges explaining why they are rejecting the “good faith” defense.

Instead, the Dr. Neil Anand, MD, trial characterizes the actions of federal judges—such as Chad Kenny—and the Department of Justice as a deliberate bypass of the Supreme Court’s 9-0 mandate.
Good Faith vs. Criminal Intent: The “good faith” defense protects practitioners from prosecution for medical errors or disagreements. Because a doctor’s professional status and “intent to treat” fundamentally differentiate them from street drug dealers, the government is required to look beyond simple data points to find evidence of actual criminal intent

The four alleged false statements are:
“The documentation doesn’t support that there is any basis for prescribing those opioids”: The prosecution told the Court that patient files produced in discovery contained no documentation supporting a medical basis for the opioid prescriptions. The motion claims this was a “flat factual assertion” that is refuted by objective diagnostic findings within those same files, including MRI reports showing spinal stenosis and EMG reports confirming radiculopathy for the patients in question.

“The Glasgow Fabrication”: The prosecution claimed that witness Frederick Glasgow testified he watched Dr. Anand “sign and stamp a whole pad” and allowed “unlicensed folks to fill out drugs that are going out the door“. The motion asserts that Glasgow’s actual testimony only described Dr. Anand sitting at his desk “signing and stamping a book of prescriptions,” which is consistent with ordinary medical paperwork, and that Koob invented the criminal elements of the account.
Tamara Gage “continued to get the bag every month”: The prosecution stated as established fact that a patient, Tamara Gage, “continued to get the bag [of non-opioid medications] every month”. The motion argues this is a “mathematical impossibility” because the government’s own dispensing records (File 303) show nine consecutive months of zero dispensing to Gage during that period.
“Each of the patients did not want, need, or use this medication”: The prosecution asserted that every patient testified they gave notice to office staff that they did not want, need, or use the non-opioid “Goody Bag” medications. The motion contends that government records and the patients’ own testimony prove the opposite: that these patients were voluntarily filling those same non-opioid medications at retail pharmacies outside of Dr. Anand’s office.

According to the sources, the “reasons” or motivations driving this disregard for the Ruan protections include:
- Ideological Zealotry: The sources describe these actions as a “destructive ideological crusade” that prioritizes “anti-narcotic zealotry” over the legal standards set by the Court.
- Attempt at Intimidation: The disregard for these protections is characterized as a “naked attempt at intimidation” directed toward medical practitioners,.
- Reliance on “Shady” Guesswork: The sources claim that instead of following the Supreme Court’s subjective knowledge standard, some legal protocols rely on “‘shady’ academic guesswork” and medical protocols that ignore the “lived reality of incurable suffering”,.
- Dehumanization of Patients: The sources suggest that the discarding of these protections is part of a broader “corruption and dehumanization” within medical protocols that treat complex physical diseases as criminal matters,.
- Criminalization of Errors: The DEA and prosecutors are described as attempting to “criminalize good faith medical mistakes” by treating professional errors as criminal acts, effectively ignoring the requirement to prove a practitioner’s subjective intent.
- Good Faith vs. Criminal Intent: The “good faith” defense protects practitioners from being prosecuted for medical mistakes or disagreements. Because a doctor’s professional status and “intent to treat” fundamentally differentiate them from street drug dealers, the government is required to look beyond simple data points to find evidence of actual criminal intent
While the sources highlight that these protections are being “all but ignored” by the Department of Justice and “discarded” by certain federal judges, they emphasize that such actions contradict the Supreme Court’s ruling that the government must prove a defendant subjectively knew a prescription was issued without a legitimate medical purpose.
Subjective Knowledge Standard: To secure a conviction under the Controlled Substances Act (CSA), the government must prove beyond a reasonable doubt that the practitioner subjectively knew the prescription was issued without a legitimate medical purpose. Data-mined metrics, such as “pill numbers,” are objective figures that cannot independently prove a person’s internal state of mind

Legal Analysis: The Shifted Burden of Proof in CSA Prosecutions Post-Ruan
1. The Paradigm Shift: Contextualizing the Ruan v. United States Decision
The Supreme Court’s unanimous 9-0 ruling in Ruan v. United States effectively decapitates the federal government’s ability to rely on objective negligence in criminal proceedings. This decision fundamentally dismantled the Department of Justice’s (DOJ) long-standing strategy of criminalizing medical practitioners based on mere deviations from professional norms.
The “Good Faith Defense,” once a vulnerable professional standard easily discarded by “anti-narcotic zealotry,” has been transformed into a robust legal shield. It ensures that practitioners are not imprisoned for medical disagreements or errors. While the law still maintains a disjunctive standard, the Ruan decision ensures that the subjective element now dominates the “beyond a reasonable doubt” burden.
For years, federal judges such as Chad Kenny and various prosecutors ignored the “Good Faith Defense,” treating medical practice as a per se criminal enterprise if it reached a certain volume. The Ruan ruling reasserts that the practice of medicine—even when high-volume or specializing in chronic pain—cannot be categorized as criminal without specific, subjective intent.
The Core Holding: To convict a practitioner under the Controlled Substances Act (CSA), the government must prove beyond a reasonable doubt that the defendant “subjectively knew” their actions were unauthorized. Specifically, the government must prove the defendant (1) subjectively knew the prescription was issued without a legitimate medical purpose OR (2) issued a prescription that was objectively not in the usual course of professional practice.
Summary
In summary, while the Ruan decision has created insurmountable legal hurdles for a DOJ accustomed to a “destructive ideological crusade,” it has ended the era of “prosecution by proxy,” in which medical mistakes were treated as synonymous with illicit drug trafficking, and has led to the dismissal of some high-profile cases. However, the sources indicate a persistent struggle, as some federal judges and executive agencies continue to operate in ways that undermine these Supreme Court-mandated protections.
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REFERENCE:
HEARING MARCH 2022 MATTER BEFORE THE COURT
UNITED STATES VS. DR. NEIL ANAND, MD, MOTION TO PERFECT THE APPELLATE RECORD UNDER RULE 29 AND HAZEL-ATLASS GLASS CO V. HARTFORD EMPIRE CO., 322 U.S.238 (1944)

