## Facts

- David James Garrison was a licensed physician’s assistant at Lake Medical Group, a California clinic that operated as a pill mill.
- The clinic recruited “patients” from homeless shelters and rescue missions and used their Medicare or Medi-Cal cards to obtain prescriptions for OxyContin, an opioid pain reliever.
- The recruited patients generally did not keep the OxyContin; clinic employees obtained the drugs from the patients or from pharmacists involved in the scheme and then sold the drugs illegally.
- Over about two years, the clinic generated 13,207 OxyContin prescriptions, nearly all for the maximum dose.
- Garrison wrote OxyContin prescriptions on prescription pads that had been pre-signed by other medical professionals.
- Garrison also pre-signed his own prescription pads so others at the clinic could write OxyContin prescriptions.
- Investigators found OxyContin prescriptions in Garrison’s handwriting in the files of recruited patients, and those patients testified they were never examined at the clinic.
- A coworker testified that Garrison routinely prescribed OxyContin to patients who did not need it.
- A jury convicted Garrison of conspiracy to distribute controlled substances in violation of 21 U.S.C. § 846, based on proof that he intentionally prescribed OxyContin for no legitimate medical purpose as part of the clinic’s unlawful distribution scheme.
- On appeal, Garrison argued (1) the evidence was insufficient to show he knew of the conspiracy and knowingly participated, and (2) the government failed to timely disclose emails relating to government witness Cho’s potential cooperation benefits, requiring dismissal, acquittal, or a mistrial.

## Issues

1. Whether the evidence, viewed in the light most favorable to the government, was sufficient to permit a rational jury to find beyond a reasonable doubt that Garrison knowingly and intentionally joined a conspiracy to distribute controlled substances in violation of 21 U.S.C. § 846.
2. Whether the government’s late disclosure of emails concerning witness Cho’s possible deal or cooperation benefits constituted a Brady violation requiring dismissal of the indictment, a judgment of acquittal, or a mistrial.

## Decision

- The Ninth Circuit affirmed Garrison’s conviction.
- The court held the evidence was sufficient for a rational jury to find that Garrison knew the clinic’s essential unlawful purpose and intentionally participated by issuing OxyContin prescriptions without a legitimate medical purpose in furtherance of the scheme.
- Assuming the Cho-related emails were favorable impeachment evidence that should have been disclosed under Brady, the court held the nondisclosure was not material because the information was cumulative of other impeachment evidence and there was no reasonable probability of a different verdict.

## Legal Principles

- Sufficiency of the evidence is reviewed by viewing the trial evidence in the light most favorable to the prosecution and asking whether any rational trier of fact could find the elements of the offense beyond a reasonable doubt.
- A drug-distribution conspiracy under 21 U.S.C. § 846 requires proof that a conspiracy existed and that the defendant knew of the conspiracy’s essential objectives and knowingly and intentionally joined it; direct evidence is not required, and the agreement and participation may be shown through circumstantial evidence.
- In controlled-substance prescribing cases, evidence such as high-volume or high-dose prescribing, prescriptions linked to sham or absent examinations, and practices that facilitate mass issuance of prescriptions can support an inference that prescriptions were issued for no legitimate medical purpose and as part of unlawful distribution.
- Under Brady, the government must disclose evidence favorable to the accused that is material to guilt or punishment, including impeachment evidence.
- A Brady violation warrants relief only if the suppressed evidence is material, meaning there is a reasonable probability that earlier disclosure would have changed the outcome; evidence that is cumulative of other available impeachment material generally is not material.

## Conclusion

The Ninth Circuit affirmed Garrison’s § 846 conspiracy conviction arising from a clinic’s pill-mill operation, holding that the prescribing practices tied to Garrison—pre-signed pads, prescriptions in his handwriting for recruited patients who were not examined, and testimony that he issued OxyContin to patients without need—allowed a rational jury to find he knowingly joined the unlawful distribution scheme, and that any Brady error concerning late-disclosed emails about witness Cho’s potential deal did not warrant reversal because the information was not material to the verdict.


United States v. Garrison, 2018 WL 1938523, 888 F.3d 1057 (2018)