Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

United States v. Hofstetter

United States District Court, E.D. Tennessee

October 11, 2019

UNITED STATES OF AMERICA, Plaintiff,
v.
SYLVIA HOFSTETTER, CYNTHIA CLEMONS, COURTNEY NEWMAN, and HOLLI WOMACK, Defendants.

          MEMORANDUM OPINION AND ORDER

          THOMAS A. VARLAN UNITED STATES DISTRICT JUDGE

         This criminal case is before the Court on two motions in limine [Docs. 587, 588] filed by defendants Hofstetter, Clemons, and Newman seeking to exclude evidence of uncharged patient deaths. The government responded in opposition [Doc. 625]. Also before the Court is the government's Motion in Limine to Permit Evidence Concerning the Vehicular Deaths of Clinic Patients [Doc. 577]. Defendants responded in opposition [Doc. 615].

         The Court addressed the status of these motions with the parties at the final pretrial conference in this case, held on September 25, 2019. At this conference, the Court, after hearing argument on these motions, stated that it would take the motions under advisement and requested that the parties file supplemental briefing on this issue [Doc. 641]. The government filed a post-hearing brief [Doc. 646], as did defendants [Doc. 648]. The government then filed a supplement to its post-hearing brief [Doc. 650] and with leave of the Court, a sealed attachment thereto [Doc. 652].

         Having reviewed the parties' pleadings and supplemental briefs and considered the arguments made at the final pretrial conference, the Court will GRANT defendants Hofstetter, Clemons, and Newman's motion to exclude evidence of uncharged deaths of Hollywood clinic patients [Doc. 588], DENY as moot the corresponding motion, in the alternative, to continue trial [Doc. 588], DENY in part the government's motion [Doc. 577] to permit the introduction of evidence of the vehicular deaths of S.S. and K.T., and DEFER ruling on the admissibility of evidence of other uncharged deaths of patients of the Tennessee clinics [Doc. 587].

         I. Background

         This case arises out of the operation of pain management clinics by the Urgent Care & Surgery Center Enterprise (“UCSC”) in Hollywood, Florida and East Tennessee [Doc. 320, ¶¶ 8-11]. The Fourth Superseding Indictment alleges that the clinics operated by UCSC enterprise were in fact “pill mills” where medical providers wrote unreasonable and medically unnecessary prescriptions for opioids and other narcotics [Id.].

         The indictment alleges that from about May 2011 to about March 2015, defendant Sylvia Hofstetter administered and managed two (2) of the three (3) clinics allegedly operated by UCSC in East Tennessee, the Comprehensive Healthcare Systems (“CHCS”) clinics, and owned, administered, and managed East Knoxville Healthcare Services (“EKHCS”), the third clinic allegedly operated by UCSC in East Tennessee [Id. ¶ 20].[1] Before moving to Tennessee, defendant Hofstetter was allegedly employed at UCSC's Hollywood clinic until around December 2011 [Id. ¶¶ 54.4, 54.21-23]. Defendants Courtney Newman and Cynthia Clemons[2] were, according to the indictment, employed as nurse practitioners at CHCS and EKHCS [Id. ¶¶ 23-24]. While practicing at these clinics, defendants Newman and Clemons allegedly prescribed opioids and other narcotics outside the scope of professional practice and without a legitimate medical purpose [Id]. According to defendants, defendants Newman and Clemons did not treat patients or otherwise work at the Hollywood clinic [Doc. 588 ¶ 7].

         The indictment charges defendant Hofstetter with a RICO conspiracy (Count One) [Id. ¶¶ 28-58], conspiracies to illegally distribute and dispense controlled substances (Counts Two and Four) [Id. ¶¶ 59-69, 72-80], money laundering conspiracies (Counts Three and Five) [Id. ¶¶ 70-71, 81-82], money laundering (Counts Six through Ten)[3] [Id. ¶¶ 83-86], maintaining drug-involved premises (Counts Eleven through Thirteen) [Id. ¶¶ 87-92], and illegally distributing and dispensing controlled substances (Counts Fourteen through Nineteen) [Id. ¶¶ 93-127]. The indictment charges defendants Newman and Clemons with conspiracies to illegally distribute and dispense controlled substances (Counts Two and Four) [Id. ¶¶ 59-69, 72-80], maintaining drug-involved premises (Counts Eleven and Thirteen) [Id. ¶¶ 87-92], and illegally distributing and dispensing controlled substances (Counts Fourteen and Seventeen as to defendant Newman; Counts Fifteen, Sixteen, Eighteen, and Nineteen as to defendant Clemons) [Id. ¶¶ 93-127].

         Defendants are also charged with sentencing enhancements based upon the death or serious bodily injury, allegedly resulting from the use of controlled substances, of clinic patients (“charged deaths”). Defendant Hofstetter faces sentencing enhancements for Counts One, Two, Four, and Fourteen through Nineteen; defendant Newman faces sentencing enhancements for Counts Two, Four, Fourteen, and Seventeen; and defendant Clemons faces sentencing enhancements for Counts Two, Four, Fifteen, Sixteen, Eighteen, and Nineteen.[4]

         Before the Court are defendants Hofstetter, Clemons, and Newman's motion to exclude all evidence related to any deaths not charged in the indictment [Doc. 587] and motion to exclude evidence related to the deaths of approximately 152[5] patients of the Hollywood clinic or, in the alternative, to continue trial to permit defense experts to review the death certificates of said patients [Doc. 588]. Also before the Court is the government's motion to introduce evidence concerning the vehicular deaths of two (2) clinic patients [Doc. 577]. The Court has taken these motions under advisement and now rules or defers ruling.

         II. Analysis

         The Court will first address the admissibility of evidence of uncharged deaths of Hollywood clinic patients [Doc. 588] and will then turn to the admissibility of evidence of other uncharged deaths, namely deaths of patients of the Tennessee clinics [Doc. 586].

         A. Evidence of Uncharged Deaths of Patients of the Hollywood Clinic

         Defendants Hofstetter, Clemons, and Newman move the Court to exclude evidence related to 152 uncharged deaths of patients of the Hollywood clinic patients under Rules 402 and 403 of the Federal Rules of Evidence [Doc. 588].

         The government opposes the motion [Docs. 625, 646]. In the government's post-hearing brief, it clarifies that the 152 deaths of Hollywood clinic patients that are the subject of defendants' motion in limine include all deceased Hollywood clinic patients, many of which the government does not intend to offer at trial. The governments states that it intends only potentially to introduce evidence of uncharged deaths of the thirty-three (33) patients of the Hollywood clinic “who died within weeks of receiving opioid prescriptions” [Doc. 650; see also Doc. 652] and will most likely limit testimony about the uncharged deaths of Hollywood clinic patients to the ten (10) deaths “that occurred within 31 days of receiving opioid prescriptions from the Hollywood clinic” [Doc. 650 p. 2].

         The Court addresses the admissibility of evidence of uncharged deaths of Hollywood clinic patients under Rules 402 and 403 in turn.

         1. Relevance

         Defendants argue that evidence of uncharged deaths of Hollywood clinic patients is not probative of any issue in this case and is therefore irrelevant under Rule 401 of the Federal Rules of Evidence. In support, defendants argue that evidence of these deaths do not relate to any death charged in the indictment and note that none of the provider defendants were ever employed at the Hollywood clinic [Doc. 588 ¶¶ 2-4, Doc. 648 p. 2- 3]. The government disagrees, arguing that this evidence is relevant to the status of the Hollywood clinic as a pill mill [Docs. 625 p. 2, 646 p. 2], to certain investigative decisions [Doc. 625 p. 2], and the defendants' knowledge or deliberate ignorance of the fact that patients were misusing prescriptions [Docs. 625 p. 3, 646 p. 4-5].

         Rule 402 of the Federal Rules of Evidence states that relevant evidence is generally admissible, whereas irrelevant evidence is inadmissible. Fed.R.Evid. 402. Rule 401 provides a two-prong test for determining whether evidence is relevant: “Evidence is relevant if (a) it has any tendency to make a fact more or less probable than it would be without the evidence; and (b) the fact is of consequence in determining the action.” Fed.R.Evid. 401. The relevance threshold established by Rule 401 is very low. United States v. Lang, 717 Fed.Appx. 523, 539 (6th Cir. 2006) (citing Dortch v. Fowler, 588 F.3d 396, 401 (6th Cir. 2009)).

         As to the first prong of Rule 401's relevance test, the Court finds that evidence of uncharged deaths of Hollywood clinic patients has some tendency to make more probable the fact that Hollywood clinic patients were misusing prescriptions and that the Hollywood clinic was operating as a pill mill. The Court further finds that evidence of uncharged deaths of Hollywood clinic patients occurring during defendant Hofstetter's administration of that clinic would make it more probable that she had knowledge or was deliberately ignorant[6] of the fact that Hollywood clinic patients were misusing prescriptions. See United States v. Bourlier, 518 Fed.Appx. 848, 855 (11th Cir. 2013) (affirming the district court's finding that evidence of uncharged patient deaths was relevant to show defendant's knowledge that patients he treated were misusing prescriptions); cf. Lang, 717 Fed.Appx. at 538 (holding that evidence of a patient's overdose death was admissible on cross examination to impeach a witness, a nurse at an alleged pill mill, who testified that her patients were “legitimate pain patients”).

         As to the second prong, patient misuse of prescriptions, defendant Hofstetter's knowledge or deliberate ignorance thereof, and the Hollywood clinics' status as a pill mill is of consequence in determining the action because those facts constitute circumstantial evidence of elements of charges Defendant Hofstetter faces, namely the RICO conspiracy charge (Count One). The elements of this charge are set forth in 18 U.S.C. § 1962, which provides that it is unlawful for any person employed by an enterprise, the activities of which affect interstate commerce, to conspire to participate in the conduct of such enterprise's affairs through a pattern of racketeering activity. 18 U.S.C. §§ 1962(c)-(d). The indictment alleges that the racketeering activity in this case includes, among other offenses, drug trafficking offenses in violation of the Controlled Substances Act, 21 U.S.C. §§ 841 and 846, namely distributing controlled substances outside the scope of professional practice and not for a legitimate medical purpose [Doc. 320 ¶ 53]. See 18 U.S.C. § 1961 (defining “racketeering activity” as used in section 1962 to include offenses such as those alleged in the indictment). The indictment also alleges as an overt act in furtherance of the RICO conspiracy a practice of overprescribing patients at the Hollywood clinic, which is supported by specific instances of providers at the clinic overprescribing opioids and other narcotics to patients and undercover agents ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.