First, the Court found no abuse of discretion in the denial of a motion to sever. Although two of the counts pertained only to one of the two defendants, the other defendant had not met her burden to show believe that the jury could not make an individualized determination, and any prejudice was avoided by a limiting instruction.
Second, the Court found no plain error in connection with an isolated statement by the government expert extrapolating from his review of a sample of the defendant's medical files. The Court found no prejudice by that one stray comment, as it came during his three days of testimony where he otherwise focused entirely on the files he did review.
Third, the Court found that the defendants had impliedly consented to a mistrial in the first prosecution, and therefore there was no double jeopardy violation in allowing the second trial to proceed.
Fourth, the Court found no reversible prosecutorial misconduct on three points. First, the prosecutor did not improperly comment on facts not in evidence. Second, even if the prosecutor improperly inserted an uncharged theory of conviction during closing, there was no prejudice because there was a curative instruction and there was sufficient evidence of guilt. And, third, the prosecutor's comment that a victim who died had a "butt-load" of drugs in his body was not unfairly prejudicial because, although graphic, the statement was consistent with the evidence.
Fifth, the Court found no abuse of discretion in declining to instruct the jury that it is ethical for a physician to relieve a patient's pain regardless of the victim's history of addiction. The Court found that this was not a correct statement of the law, and it was a partisan argumentative instruction about facts that the defendant hope the jury would find.
Sixth, the Court found sufficient evidence to support the convictions. As for the distribution charges, the Court found the evidence sufficient to show that the drugs ingested were prescribed by the defendant and that they were the but-for cause of the victims' deaths. The Court explained that, under the Supreme Court's decision in Burrage, the schedule II drugs needed to be only one but-for cause of death. The Court rejected the defendant's argument that it needed to be the sole but-for cause, and it was therefore irrelevant if the schedule IV drugs also played a necessary role in the deaths.
Finally, the Court vacated one of the defendant's 20-year mandatory minimum sentence under 841(b)(1)(C), because the jury's special verdict did not sufficiently reflect that it had found that the schedule II drugs were the but-for cause of the victims' deaths. Rather, the verdict was consistent with a finding that the schedule II and schedule IV drugs caused their deaths together in the aggregate. Absent that jury finding, the court erred in imposing the mandatory minimum under Alleyne and Burrage.