United States v. Lamartiniere

100 F.4th 625

UNITED STATES of America, Plaintiff—Appellee, v. Randy J. LAMARTINIERE, Defendant—Appellant.

No. 23-30191

United States Court of Appeals, Fifth Circuit

FILED May 6, 2024

Appeal from the United States District Court for the Middle District of Louisiana USDC No. 3:18-CR-87-1, Brian Anthony Jackson, U.S. District Judge

Harley Ferguson, Mary Patricia Jones, Assistant U.S. Attorney, Alan A. Stevens, Assistant U.S. Attorney, U.S. Attorney's Office, Baton Rouge, LA, for Plaintiff-Appellee.

Beau B. Brindley, Law Offices of Beau B. Brindley, Chicago, IL, for Defendant-Appellant.

Before Davis, Smith, and Haynes, Circuit Judges.

W. Eugene Davis, Circuit Judge:

A jury convicted Dr. Randy Lamartiniere, an internal medicine doctor, of twenty counts of unlawful distribution of controlled substances. On appeal, Lamartiniere challenges the district court's jury instructions and the sufficiency of the evidence supporting his convictions. Finding no reversible error, we AFFIRM.

I.

A.

At the time of his trial, Lamartiniere had been practicing as a licensed physician specializing in internal medicine for approximately thirty years. In 2012, he was hired as a staff physician at a clinic in Baton Rouge, Louisiana, operated by Ochsner Health. At first, Lamartiniere mainly saw general internal medicine patients, but that started to change in 2013 as he saw a growing number of chronic pain patients. By 2014, Ochsner began to develop concerns about Lamartiniere's management of opioid and narcotic prescriptions and his inability to timely maintain his patient records. After several warnings, Ochsner terminated Lamartiniere at the end of 2014.

Following his termination from Ochsner, Lamartiniere opened his own "direct primary care" practice in early 2015. At his new practice, patients paid a $300 membership fee in exchange for three months of medical care for any issue that arose during that time period. The practice accepted neither insurance nor Medicaid. Although Lamartiniere testified that he initially hoped to see mostly internal medicine patients, within a year of opening the practice, he had between 200-250 patients, eighty percent of whom were pain management patients.

In early 2015, shortly after Lamartiniere opened his practice, the Drug Enforcement Administration ("DEA") launched an investigation into his prescription practices after receiving a tip from a confidential informant. As part of the DEA's investigation, it recruited two undercover agents to pose as chronic pain patients seeking controlled substances from Lamartiniere. Over the course of almost six months, the undercover agents, outfitted with recording devices, visited Lamartiniere's practice a total of nine times, each time leaving with a prescription for a controlled substance. In November 2015, the DEA executed a search warrant for fifty patient files from Lamartiniere's practice.

In 2021, a superseding indictment charged Lamartiniere with twenty-eight counts¹ of unlawful distribution of Schedule II controlled substances in violation of 21 U.S.C. § 841(a)(1). Counts 1 through 7 of the superseding indictment charged him with prescribing controlled substances to seven patients on January 5, 2016, after the Louisiana State Board of Medical Examiners (the "Medical Board") suspended his state license to prescribe controlled substances. The remaining counts charged Lamartiniere with unlawfully prescribing controlled substances to the two undercover agents, Matthew Dixon and Craig Crawford, and four former patients, Charles Henson, Brian Boudreaux, Jeremy Doiron, and Fredrick Aughey.

B.

At trial,² the Government called nine witnesses, including Lamartiniere's former patients, the undercover agents, and expert witnesses. Additionally, the Government played for the jury recordings of the undercover agents' appointments with Lamartiniere. Lamartiniere testified in his own defense and presented testimony from his former legal counsel. Below is a sampling of that testimony.

Both undercover agents testified about their visits with Lamartiniere between April and September 2015. Detective Dixon testified that at his first appointment, he told Lamartiniere that he had pain in his right leg from an old sports injury. After Lamartiniere conducted "some sort of examination or manipulation" of Dixon's back, he diagnosed Dixon with a "disorder of [the] lower extremity."

In a recording of the visit, the jury heard Dixon tell Lamartiniere that a friend of his would "hook" him up with a "Lortab³ or something like that" if his leg bothered him. Lamartiniere responded that getting medication without a prescription was illegal. However, he said he could prescribe some pain medication for Dixon, despite acknowledging that "Aleve, Tylenol of course will work fairly well too" and are "[a] little bit more legal." After Dixon said Aleve and Tylenol were ineffective, Lamartiniere wrote him a prescription for thirty 7.5-milligram Norco⁴ pills, which he estimated would last Dixon "a couple of months, at least."

At Dixon's second appointment, he told Lamartiniere that his left leg (instead of his right leg as initially reported) was the source of his pain. Although it was only ten days after his initial appointment, Lamartiniere wrote Dixon a prescription for ninety 7.5-milligram Norco pills. Dixon then requested a prescription for Adderall, telling Lamartiniere that he took some of his co-worker's "addies"⁵ and it helped him stay awake. Lamartiniere explained to Dixon that taking Adderall for that purpose was illegal and that using Adderall to stay awake was a non-indication for adult attention deficit disorder ("ADD"). However, after Dixon said a prior doctor had prescribed him ADD medication and that he had trouble focusing on various tasks, Lamartiniere eventually agreed to prescribe Dixon 20-milligrams of Adderall.

During his next appointment, Dixon identified his right leg as the source of his pain and asked Lamartiniere for "something better" than Norcos to "make [him] feel better." Lamartiniere agreed to switch him to Percocet⁶ and wrote him a prescription for ninety tablets of 10-milligram Percocet. During this appointment, Lamartiniere did not conduct a physical exam or order any medical tests before switching Dixon to a stronger medication.

During Dixon's final appointment, Lamartiniere raised concerns that there was no indication in Louisiana's prescription monitoring program ("PMP")⁷ that Dixon had picked up his prior prescriptions. Dixon had previously said that he filled his prescriptions in Texas. Lamartiniere requested that going forward Dixon fill his prescriptions in Louisiana so he could track them on the PMP. He explained that in order to prescribe controlled substances, he was required to have documentation that Dixon was filling his prescriptions. Without such documentation, Lamartiniere acknowledged that he was "kind of losing track of things" and needed "to do a better job of recording" Dixon's prescriptions.

When Lamartiniere informed Dixon that he was going to drug test him, Dixon responded that he had not taken his prescribed medications in several weeks because he ran out early. Lamartiniere told Dixon this created a problem because in order to ensure prescriptions were not diverted, he needed to either drug test him or monitor his prescription refills and that he was "doing neither of those" in Dixon's case. He further told Dixon that "[u]nfortunately they treat doctors like they're supposed to be detectives these days. They can take licenses [away] for not doing that kind of stuff." Although Lamartiniere emphasized that he needed Dixon's pharmacy records going forward, he still agreed to provide Dixon with his prescriptions for Adderall and Percocet.

The jury also heard testimony from Crawford, the second undercover officer, who saw Lamartiniere four times between July and September 2015. At his first visit, Crawford informed Lamartiniere that he had a weightlifting injury from ten to fifteen years ago that made his leg feel "funny." Crawford said he did not have a prescription for pain medication, but he had gotten "a couple of roxies"⁸ from his friend that made him "feel good." Lamartiniere asked Crawford whether he had any history of drug abuse, and Crawford said, "No. Like I said [I] take a couple of . . . ." Lamartiniere interrupted Crawford, finishing his sentence, "[b]ut nothing on a really regular basis, not large amounts or nothing . . . ," to which Crawford responded, "No."

After Lamartiniere examined Crawford for a few minutes, he diagnosed Crawford with a nerve issue and a bulging disc. For Crawford's pain, Lamartiniere suggested a Schedule IV narcotic, but Crawford insisted he wanted "roxies." Lamartiniere informed Crawford that his symptoms "are really not something . . . [that] any doctor should prescribe a . . . major narcotic [for,] at least up front." Nevertheless, Crawford left his first appointment with a prescription from Lamartiniere for forty-five 5-milligram Norco tablets.

At his next appointment, Crawford asked for a stronger prescription. Lamartiniere again suggested less addictive medications as an alternative, but ultimately agreed to write Crawford a prescription for seventy-five tablets of 7.5-milligrams of Percocet. Lamartiniere warned Crawford that the "problem is all these pain medicines are addictive" and that people "develop a tolerance to them," which is especially concerning "for someone that's not really in a lot of pain as you said."

Crawford testified that at some point during his second appointment, Lamartiniere's demeanor changed when he informed Crawford that Louisiana's PMP showed no record of Crawford's filling his last prescription. Crawford told Lamartiniere he filled his prescription in Mississippi, to which Lamartiniere said he would only give Crawford one more prescription unless he came back with records confirming he had filled his prescription. Lamartiniere told Crawford it was important to fill his...