(HC) Pierce v. Holifield

District Court, E.D. California·Decided January 13, 2022·No. 1:20-cv-00459·Unknown

Opinion

DOLPHUS DWAYNE PIERCE, Case No. 1:20-cv-00459-DAD-HBK Petitioner, FINDINGS AND RECOMMENDATIONS TO DENY PETITION FOR WRIT OF HABEAS v. CORPUS AND TO DECLINE TO ISSUE A CERTIFICATE OF APPEALABILITY1 FOURTEEN-DAY OBJECTION PERIOD Respondents. (Doc. No. 1) Petitioner Dolphus Dwayne Pierce, a state probationer represented by counsel, has pending a petition for writ of habeas corpus under 28 U.S.C. § 2254. (Doc. No. 1). The Petition raises two grounds for relief: (1) the trial court failed to require jury unanimity on the criminal objects of his conspiracy charge and (2) the prosecutor’s office was biased against him. (See generally id.). For the reasons set forth below, the undersigned recommends the Court deny Petitioner any relief on his petition and decline to issue a certificate of appealability. A. Procedural History Pierce initiated this case on March 31, 2020 by filing the instant petition. (Doc. No. 1). On April 15, 2020, the Court ordered Respondents to respond to the petition. (Doc. No. 6). On 1 This matter was referred to the undersigned pursuant to 28 U.S.C. § 636(b)(1)(B) and Local Rule 302 (E.D. Cal. 2019). June 10, 2020, Respondents filed an answer to the petition and lodged the pertinent state court record. (Doc. Nos. 13, 14, 15, 16). On July 6, 2020, Pierce filed a reply. (Doc. 17). On November 17, 2020, the case was reassigned to the undersigned. (Doc. No. 18). B. Facts Based Upon the Record In 2016, a Kern County jury convicted Pierce of conspiracy to commit insurance fraud. (Doc. No. 13 at 12). Pierce was sentenced to five years of probation on the condition that he serve one year in jail and was ordered to pay restitution. (Id.) The Court sets forth below the pertinent facts of the underlying offenses, as summarized by the California Court of Appeal. A presumption of correctness applies to these facts. See 28 U.S.C. § 2254(e)(1); Crittenden v. Chappell, 804 F.3d 998, 1010-11 (9th Cir. 2015). Introduction Operating under their company, P&R Med-Legal Medical Corporation (P&R), Dolphus Dwayne Pierce II, a chiropractor, and Tomas Ballesteros Rios, a physician, conspired with others to defraud various workers’ compensation insurance carriers. P&R contracted with physicians to perform cursory (if any) examinations of workers’ compensation patients at chiropractic clinics, and then dispense prepackaged medications to these patients with little or no regard for medical need. Pierce and Rios contracted with a company to prepare and submit canned medical reports and bills to workers’ compensation insurance carriers. These bills sought payment for the medications dispensed, and for services relating to the dispensing of medications—some of which were not performed, and some costlier than the services actually performed by the physician. Eventually, a search warrant was executed on businesses and homes associated with P&R. After P&R shut down, Pierce and Rios contracted with another company to rebill the insurance carriers for services initially billed by P&R, seeking to collect on existing unpaid bills for medications previously dispensed. Prosecution’s Evidence Witness Tomas Rios, M.D. Rios pled guilty to conspiracy as charged in count 1 and testified for the prosecution. In the mid 1990’s, while still a medical resident, Rios began moonlighting at a physician’s group as a disability evaluator for Social Security claimants, where he met Dr. Lonnie Powell, a chiropractor. The physicians’ group rented office space from Powell in Visalia, and Rios saw Social Security disability patients there two weekends a month. During this time, Rios familiarized himself with the operations of medical corporations having a chiropractic partner, and between 1999 and 2002, Rios and Powell formed Physicians Medical Management Group (PMMG), which managed independently contracted physicians to provide medical services as secondary treating physicians for workers’ compensation patients at various chiropractic locations throughout California. Most of the chiropractors whose workers’ compensation patients were seen by these independent contractor physicians were friends and acquaintances of Rios or Powell. The chiropractors were seeking physicians to provide medication and care for their workers’ compensation patients. As explained by Rios, in the workers’ compensation system generally, the chiropractor (as primary treating physician) can provide therapy, but many patients need some type of pain medication, which a chiropractor cannot prescribe. The chiropractor would then refer the patient to a PMMG physician (as a secondary treating physician), who would come to the chiropractic clinic, do their own evaluation and prescribe medication if appropriate. The physician generated a report and signed it, a bill was then prepared, and the report and bill were sent out by PMMG to the workers’ compensation insurance carriers. Payment was made by the carriers to PMMG. Rios knew which various current procedural terminology (CPT) codes were related to the medical services provided and determined which CPT codes would be billed by PMMG for a physician’s services. According to Rios, because the cases referred by chiropractors to the physicians involved nonsurgical muscular- skeletal injuries, the injuries were similar from patient to patient. As such, Rios “already” knew what treatment would be required for the physician to manage the patient, allowing Rios to predetermine what code was necessary to bill. Unless the physician corrected the report to indicate such services were not provided, it was billed as Rios predetermined. Rios testified that there are five levels of examinations specified in the CPT billing codes, ranging from the most basic to the most complex. The report given to the physician would have a specific, predetermined statement on the level of care expected of him, such as a comprehensive medical examination or an intermediate medical consultation. The initial consultation could take anywhere from 30 to 60 minutes and the CPT billing code for that consultation was set at the highest level of service. Follow-up consults were scheduled for less time and billed for less. Rios acknowledged that he might not have specifically articulated to the physicians hired by PMMG that the treatment level, depicted in the reports he showed them as examples, were necessarily the CPT codes that would be billed. PMMG also created a formulary of medicines purchased by PMMG that could be dispensed by the consulting physician. The formulary was a collection of medications Rios predetermined would be used in the practice, although the independent contractor physician could also write a prescription for medication they deemed more appropriate. PMMG would purchase medications to be dispensed with an expectation of later repayment by the workers’ compensation insurance carrier. Since 80 to 90 percent of the workers’ compensation patients referred to the physicians suffered back pain, it was anticipated that the physicians would utilize the formulary of medicines that were available for dispensing. Rios testified that he expected the physicians to dispense medication, because “that’s the reason why [the physician is] in the clinic in the first place.” In 2003, Rios began doing business with Pierce. By this time, Rios was not only actively engaged in PMMG, but he had also partnered with various other medical groups and clinics. Pierce had chiropractic practices in Avenal and Huron and was familiar with the PMMG business plan of placing a physician in a chiropractic clinic to serve as a secondary treating physician. Rios and Pierce met to discuss forming rural health clinics in Avenal and Huron. Pier

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