United States v. George Naum, III

CourtCourt of Appeals for the Fourth Circuit
DecidedOctober 13, 2020
Docket20-4133
StatusUnpublished

This text of United States v. George Naum, III (United States v. George Naum, III) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fourth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States v. George Naum, III, (4th Cir. 2020).

Opinion

UNPUBLISHED

UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT

No. 20-4133

UNITED STATES OF AMERICA,

Plaintiff - Appellee,

v.

GEORGE P. NAUM, III,

Defendant - Appellant.

Appeal from the United States District Court for the Northern District of West Virginia, at Clarksburg. Irene M. Keeley, Senior District Judge. (1:18-cr-00001-IMK-MJA-2)

Submitted: September 10, 2020 Decided: October 13, 2020

Before MOTZ, HARRIS, and QUATTLEBAUM, Circuit Judges.

Affirmed by unpublished per curiam opinion.

Elgine H. McArdle, MCARDLE LAW OFFICES, Wheeling, West Virginia, for Appellant. William J. Powell, United States Attorney, Wheeling, West Virginia, Sarah E. Wagner, Assistant United States Attorney, OFFICE OF THE UNITED STATES ATTORNEY, Clarksburg, West Virginia, for Appellee.

Unpublished opinions are not binding precedent in this circuit. PER CURIAM:

George P. Naum, III, appeals from his convictions and sentence following his jury

trial. Naum was convicted of conspiracy to distribute suboxone outside the bounds of

professional medical practice between 2008 and 2016, in violation of 21 U.S.C. § 841(a)(1)

and 21 U.S.C. § 846, and four counts of aiding and abetting the distribution of suboxone

outside the bounds of professional medical practice in violation of 21 U.S.C. § 841(a) and

18 U.S.C. § 2. The district court sentenced Naum to six months incarceration followed by

six months of home detention. In addition, the district court imposed a forfeiture order of

$77,063.00. After careful consideration of Naum’s numerous claims on appeal, we affirm.

I.

These charges arose from Naum’s involvement in a Weirton, West Virginia

suboxone clinic known as Advance Healthcare (“Advance”), which was owned and

operated by Sharon Jackson and co-defendant Eric Drake, and which also employed

co-defendant Dr. Felix Brizuela. The evidence at trial viewed in the light most favorable

to the Government was as follows.

Advance was a suboxone clinic that offered its patients office-based addiction

treatment. Jackson, a registered nurse, and Drake, an individual with no medical training,

ran the day-to-day operations of Advance. Advance employed Naum and Brizuela, who

were both authorized to prescribe suboxone to treat drug addiction. Naum and Brizuela

were scheduled to be at Advance just one evening each a week, and when they were not

present, Jackson used their authority pursuant to their “DEA numbers” to issue

prescriptions for suboxone to Advance’s patients.

2 Naum and Brizuela allowed Jackson nearly unfettered use of their DEA numbers,

delegated most of the patient care to Jackson, and frequently missed all or part of their

once-a-week assigned shifts at Advance. In fact, during a two-month period in 2016,

footage from a pole camera placed by investigators outside the clinic revealed that Naum

was present at Advance only 13.9% of the time that it was open to patients and prescriptions

for suboxone were being issued from it. Jackson testified that she could not have treated

patients without the doctors’ DEA numbers.

When they were present in the office, the doctors reviewed and signed off on patient

charts and saw new patients. New patients were given drug screens, filled out paperwork,

met with Jackson, and met with a physician if one were present. If a physician met with

the patient, he told Jackson what beginning dose of suboxone to start the patient on, and

she communicated the prescription to the pharmacy. If no physician was present at the

initial visit, Jackson diagnosed the patient with an opioid use disorder, decided on a daily

dose of suboxone, and called in the prescription using one of the doctors’ DEA numbers

Jackson and Drake both testified that they had verbal agreements with Naum and

Brizuela permitting Jackson to issue prescriptions under their DEA numbers to new

patients who had not seen a physician, so long as she did not prescribe more than 16

milligrams per day. If she conducted the entire initial visit, Jackson scheduled the patient

to come back to see one of the physicians. As a policy, Naum and Brizuela generally only

saw patients on the initial visit or one visit early on in their treatment. Follow-up visits

were generally only with Jackson.

3 In addition to making dosing decisions for new patients who had not been seen by

a physician, Jackson had blanket permission from Naum and Brizuela to wean or decrease

patients’ doses. Naum often wrote instructions in each patient’s medical chart to either

maintain or decrease a patient’s dose, but Jackson had Naum’s permission to disregard

those written instructions based on the conversations she was having with patients. Naum

never confronted Jackson about overriding his written instructions by prescribing different

doses to his patients.

The Government’s expert, Dr. Patrick Marshalek, testified about medical standards

to which physicians who prescribe controlled substances to treat addiction must adhere.

He testified that many of those standards were promulgated by the Substance Abuse and

Mental Health Services Administration (SAMHSA). Marshalek testified that physicians

must maintain an ongoing relationship with patients to whom they prescribe controlled

substances that extends beyond the initial examination and diagnosis. There is a time after

which a doctor-patient relationship expires and must be renewed by another face-to-face

visit in order to continue issuing prescriptions for controlled substances. Marshalek

testified that the rules of the West Virginia Board of Osteopathic Medicine (WVBOM) 1

require physicians to make an in-person examination of patients to whom they are

prescribing controlled substances no less than once every six months for the duration of

their treatment. See W. Va. C.S.R. § 24-1-18.2.a.5.

1 The WVBOM oversees the licensing of osteopathic physicians like Naum and Brizuela in West Virginia.

4 The WVBOM also prohibits physicians from delegating responsibilities to others

who are not qualified to carry them out. See W. Va. C.S.R. § 24-1-18.1.aa. Marshalek

testified that physicians who prescribe controlled substances to patients may not delegate

their prescriptive authority to others who do not themselves have such authority.

Physicians may not delegate the decision as to dose or medication to a nurse, and they may

not authorize nurses to override their instructions as to dosages or medication. Physicians

must also evaluate patients’ continued need for medication in an ongoing manner. The

prohibition against delegating the responsibility to prescribe suboxone to non-authorized

individuals, including nurses, is expressly explained in the SAMHSA Guidelines.

Marshalek also testified that it is the physician, and not a nurse, who must diagnose a

patient with an opioid use disorder. Marshalek reviewed the charts of the patients who

received the prescriptions charged in the indictment and opined that each prescription was

issued outside the bounds of medicine.

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