September 9, 2016
from the United States District Court for the Southern
District of Illinois. No. 14-cr-40038 - J. Phil Gilbert,
Posner, Manion, and Williams, Circuit Judges.
Manion, Circuit Judge.
Naeem Kohli, an Illinois physician who specialized in pain
management, was convicted on multiple counts of prescribing
narcotics without a legitimate medical purpose in violation
of § 841(a) of the Controlled Substances Act. On appeal,
he argues that the district court should have granted his
motion for acquittal based on insufficient evidence. He also
challenges the district court's jury instructions and
several of its evidentiary rulings at trial.
conclude that the jury's verdict is supported by
sufficient evidence and that the motion for acquittal was
properly denied. We further hold that the district
court's jury instructions provided a fair and accurate
summary of the law, and that its challenged evidentiary
rulings were not an abuse of discretion. We therefore affirm
Dr. Kohli's conviction.
Naeem Kohli was a board-certified neurologist with extensive
training in the treatment of chronic pain. He operated a
private medical practice called the Kohli Neurology and Sleep
Center located in Effingham, Illinois. Irregularities in the
practice eventually caught the attention of federal
officials, and in 2014 Dr. Kohli was indicted on three counts
of healthcare fraud, two counts of money laundering, and ten
counts of illegal dispensation of a controlled substance.
During a fifteen-day trial, the jury learned about Dr.
Kohli's prescribing practices from a variety of sources,
including law enforcement and healthcare professionals,
several expert witnesses, and Dr. Kohli's patients and
their family members. Dr. Kohli also testified in his own
Expert Testimony of Dr. Parran
the most important testimony came from the government's
expert witness Dr. Theodore Parran, an addiction specialist
and internal medicine physician who has previously testified
for the government in similar prosecutions. See, e.g.,
United States v. Chube II, 538 F.3d 693, 698 (7th
Cir. 2008). Before trial, Dr. Parran reviewed Dr. Kohli's
patient files for each of the patients who had received the
allegedly unlawful prescriptions charged in the indictment.
Dr. Parran did not dispute that these patients suffered from
legitimate, painful medical conditions that might ordinarily
warrant treatment with narcotics. As Dr. Parran explained to
the jury, however, Dr. Kohli's files reflect that he
prescribed narcotics to these patients under circumstances
that were far from ordinary.
files showed, for example, that Dr. Kohli routinely
prescribed addictive opioids to patients who had a history of
drug addiction and who were known to be "multi-sourcing,
" or simultaneously obtaining various prescriptions for
controlled substances from multiple sources or providers. He
also prescribed early refills, anywhere from a day to several
weeks before the refills were due, to patients who repeatedly
claimed that their narcotics medications had run out or were
lost or stolen. These same patients often had irregular
toxicology screens in which they tested negative for the
drugs that Dr. Kohli had prescribed, but positive for other
drugs (including illegal drugs and other controlled
substances) that he did not prescribe. Dr. Kohli's office
also received phone calls from the Veterans Administration
and a certain patient's family members reporting that one
of his patients was actively abusing drugs. Despite these
troubling developments, Dr. Kohli continued to prescribe
highly addictive Schedule II opioids, such as oxycodone and
hydromorphone, on a regular basis.
to Dr. Parran, Dr. Kohli's prescriptions under these
circumstances offered no medical benefit and were in some
cases simply "inconceivable" from a clinical
standpoint. Ultimately, based on his review of the relevant
patient files, Dr. Parran concluded that the prescriptions
identified in the indictment were inconsistent with the usual
course of professional practice and had no legitimate medical
Other Evidence regarding Dr. Kohli's Prescribing
Kohli's patients testified that he charged $350 per
office visit to obtain a prescription for a controlled
substance. Patients who did not have insurance, or who had
insurance but were visiting early to obtain an early refill,
paid the entire fee out of pocket. Dr. Kohli also traveled
from his office once a month to see additional patients at
Richland Memorial Hospital. The director of physician
services at that hospital testified that she noticed Dr.
Kohli's prescriptions for controlled substances were
already filled out before he saw his patients there. She also
observed that Dr. Kohli would see about 30 patients in 90
Cross-Examination and Impeachment of Dr.
four days, Dr. Kohli testified about his medical practice and
insisted that he prescribed narcotics in a good-faith effort
to help manage his patients' chronic pain. At one point,
on direct examination, he also testified that no patient had
ever died under his care: "Have you ever had a patient
die under your care? No, sir." He reiterated the point
the following day, again on direct examination. Faced with
this unexpected claim, the government decided to investigate;
it checked with the local coroner's office and found that
a patient named Kenneth Kramer had died of an accidental
overdose while under Dr. Kohli's care in 2006.
light of this new information, the government proceeded to
impeach Dr. Kohli on cross-examination by questioning his
earlier testimony that no patient had ever died under his
care. When Dr. Kohli answered as before, the govern- merit
asked him if he remembered his patient Kenneth Kramer. Dr.
Kohli replied that he did not. The district court then
stopped the government's line of questioning and ordered
it to give opposing counsel the materials it had obtained
from the coroner's office before the questioning could
the defense reviewed the materials overnight, the government
resumed its impeachment the next day by asking Dr. Kohli
(over the defense's objection) if he remembered that a
patient named Kenneth Kramer had died of an accidental
overdose while under his care. Dr. Kohli responded that he
did not know about Kramer's death until he received the
materials from the government the day before. The government
did not introduce the materials from the coroner's office
into evidence, but limited its impeachment to questioning Dr.
Kohli on cross-examination and was bound by Dr. Kohli's
answers by order of the district court.
Jury Instructions and Verdict
close of the evidence, Dr. Kohli moved for acquittal on
grounds that the government had failed to present sufficient
evidence to sustain a conviction. The district court denied
the motion and submitted the case to the jury The court
instructed the jury to render a conviction only if it found,
beyond a reasonable doubt, that Dr. Kohli intentionally
prescribed controlled substances outside the usual course of
professional practice and without a legitimate medical
In order for you to find the Defendant guilty of a charge of
causing the illegal dispensation of a Schedule II controlled
substance, the Government must prove the following elements
beyond a reasonable ...