United States v. Garrison

David James Garrison (defendant) was a licensed physician’s assistant at the Lake Medical Group clinic (the clinic). The clinic operated as a pill mill, recruiting patients who lived in homeless shelters and rescue missions and using the recruited patients’ Medicare or Medi-Cal cards to generate fraudulent prescriptions for OxyContin, an opioid pain reliever. The recruited patients did not keep the OxyContin. Instead, clinic employees obtained the drugs from the recruited patients or from pharmacists who were involved in the conspiracy. Clinic employees then sold the drugs illegally. Over a two-year period, the clinic generated 13,207 OxyContin prescriptions, nearly all of which were for the maximum dose. Garrison wrote OxyContin prescriptions on prescription pads that had been pre-signed by other medical professionals, and he pre-signed his own prescription pads so that others at the clinic could write OxyContin prescriptions. Investigators found OxyContin prescriptions in Garrison’s handwriting in the files of recruited patients, but the patients testified that they had never been examined at the clinic. A coworker testified that Garrison routinely prescribed OxyContin to patients who did not need the drug. Despite asserting that he was unaware of the conspiracy and that he did not knowingly participate in it, Garrison was convicted of conspiracy to distribute controlled substances for no legitimate medical purpose. Garrison appealed his conviction to the United States Court of Appeals for the Ninth Circuit, arguing that there was insufficient evidence to prove that he was aware of the conspiracy or that he knowingly participated in the conspiracy.