## Facts

- Richard Arthur Evans, a Houston physician, operated a high-volume pain-management practice that prosecutors characterized as a pill mill.
- Over roughly seven years, Evans wrote about 11,000 oxycodone prescriptions and generated substantial income from the practice.
- Witnesses in the same building observed heavy daily crowds, frequent out-of-state (especially Louisiana) patients, and cars arriving with multiple occupants.
- Trial evidence showed Evans routinely pre-signed blank prescription forms that staff later completed.
- Patient files introduced at trial for certain charged distributions contained minimal documentation, including absent or scant medical histories and little to no physical-exam notes.
- Evidence indicated Evans commonly prescribed opioid drug combinations associated with abuse and diversion.
- A jury convicted Evans of unlawful distribution of controlled substances (21 U.S.C. § 841) and related offenses including money laundering, mail fraud, and conspiracy.

## Issues

1. Whether the evidence was sufficient to support specific controlled-substance distribution counts tied to particular patients.
2. Whether alleged indictment defects warranted reversal, including under plain-error review where objections were not preserved.
3. Whether challenged evidentiary rulings required reversal.
4. Whether admission of certain testimonial statements violated the Sixth Amendment Confrontation Clause, and if so whether any error was harmless beyond a reasonable doubt.

## Decision

- The Fifth Circuit affirmed Evans’s convictions and sentence.
- The court held the evidence was sufficient for the challenged § 841 distribution counts, including patient-specific files plus clinic-wide prescribing patterns supporting illegitimate prescribing.
- The court rejected the indictment challenges, finding no plain error and no prejudice to substantial rights.
- The court found no reversible evidentiary error, concluding either proper admission or harmlessness in light of the record.
- The court assumed without deciding that a Confrontation Clause violation occurred, but held any constitutional error was harmless beyond a reasonable doubt.

## Legal Principles

- A physician may be convicted under 21 U.S.C. § 841 when prescriptions are issued outside the usual course of professional practice and not for a legitimate medical purpose, even if prescriptions appear facially valid.
- A jury may infer illegitimate prescribing from circumstantial evidence of practice-wide patterns (e.g., extraordinary volume, out-of-state patient flow, minimal examinations/documentation, pre-signed prescriptions, and abuse-associated drug combinations), together with patient-specific proof for charged counts.
- Unpreserved challenges to an indictment are reviewed for plain error; reversal requires an error that is clear and that affects substantial rights, including a showing of prejudice in the ability to prepare a defense.
- Confrontation Clause violations are subject to harmless-error review; a conviction may be affirmed if the government shows beyond a reasonable doubt that the error did not contribute to the verdict in light of independent evidence of guilt.

## Conclusion

The Fifth Circuit affirmed Evans’s pill-mill-related convictions, holding that patient-specific records combined with strong pattern evidence supported the controlled-substance distributions, indictment objections failed under plain-error review, and any assumed Confrontation Clause violation was harmless given overwhelming independent proof.


United States v. Evans, 892 F.3d 692 (5th Cir. 2018)