United States v. Okechukwu Dimkpa

Court of Appeals for the Fourth Circuit·Decided March 3, 2026·No. 23-6245·Published

Opinion

USCA4 Appeal: 23-6245 Doc: 62 Filed: 03/03/2026 Pg: 1 of 17

PUBLISHED

UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT

No. 23-6245

UNITED STATES OF AMERICA,

Plaintiff – Appellee,

v.

OKECHUKWU DIMKPA,

Defendant – Appellant.

Appeal from the United States District Court for the Middle District of North Carolina, at Greensboro. Catherine C. Eagles, Chief District Judge. (1:19-cr-00443-CCE-1; 1:22-cv- 00770-CCE-LPA)

Argued: September 9, 2025 Decided: March 3, 2026

Before DIAZ, Chief Judge, and WYNN and HARRIS, Circuit Judges.

Affirmed by published opinion. Judge Harris wrote the opinion, in which Chief Judge Diaz and Judge Wynn joined.

ARGUED: Blair T. Westover, THE LAW OFFICES OF BEAU B. BRINDLEY, Chicago, Illinois, for Appellant. Julie C. Niemeier, OFFICE OF THE UNITED STATES ATTORNEY, Greensboro, North Carolina, for Appellee. ON BRIEF: Beau B. Brindley, THE LAW OFFICES OF BEAU B. BRINDLEY, Chicago, Illinois, for Appellant. Randall S. Galyon, Acting United States Attorney, OFFICE OF THE UNITED STATES ATTORNEY, Greensboro, North Carolina, for Appellee. USCA4 Appeal: 23-6245 Doc: 62 Filed: 03/03/2026 Pg: 2 of 17

PAMELA HARRIS, Circuit Judge:

Dr. Okechukwu Dimkpa pled guilty to unlawfully distributing oxycodone in

violation of 21 U.S.C. § 841(a)(1). Three years later, in Ruan v. United States, 597 U.S.

450 (2022), the Supreme Court held that § 841’s scienter provision requires the

government to prove that a physician knew he was acting in an unauthorized manner when

prescribing a controlled substance, such as oxycodone. Dimkpa then filed a § 2255 motion

challenging his convictions under § 841, arguing that his guilty plea was not knowing and

voluntary because he was not informed of the mens rea requirement articulated in Ruan.

The district court denied Dimkpa’s motion, finding that Dimkpa had procedurally

defaulted his Ruan-based claim by failing to raise it during his initial criminal proceeding,

and that he had not shown cause to overcome this default. Although Ruan had yet to be

decided when Dimkpa pled guilty, the district court reasoned, the legal basis for a Ruan-

style claim was reasonably available to Dimkpa at that time. Accordingly, Dimkpa’s mens

rea argument was not sufficiently novel to constitute cause for his procedural default. We

agree and therefore affirm the judgment of the district court.

I.

A.

Defendant Okechukwu Dimkpa, a physician, was charged with six counts of

unlawfully distributing oxycodone, a Schedule II controlled substance, in violation of 21

U.S.C. § 841(a)(1). That statute makes it a federal crime, “[e]xcept as authorized,” for any

person “knowingly or intentionally” to “manufacture, distribute, or dispense” a controlled

2 USCA4 Appeal: 23-6245 Doc: 62 Filed: 03/03/2026 Pg: 3 of 17

substance. 21 U.S.C. § 841(a)(1). Registered doctors may prescribe such substances to

their patients, but pursuant to federal regulations, “a prescription is only authorized when

a doctor issues it ‘for a legitimate medical purpose . . . acting in the usual course of his

professional practice.’” Ruan, 597 U.S. at 454 (alteration in original) (quoting 21 C.F.R.

§ 1306.04(a) (2021)).

Dimkpa’s charges corresponded to six instances in which he prescribed oxycodone

to the same patient. According to the government, those prescriptions were not

“authorized” under § 841 and were instead “outside the course of usual medical practice”

and “not medically legitimate.” J.A. 44–45. Dimkpa was aware, the government alleged,

that his patient was addicted to opioids – because his patient told him so – and nevertheless

continued to prescribe oxycodone. And each of the six prescriptions in question was issued

immediately after the patient tested positive for heroin or cocaine. Five days after receiving

the last of his oxycodone prescriptions from Dimkpa, the patient died of an opioid-involved

drug overdose. 1

Dimkpa pled guilty to all six charges in September 2019. At the plea hearing, the

district court informed Dimkpa that should the case proceed to trial, the government would

be required to prove each element of the charged § 841 offense beyond a reasonable doubt.

And that would include, the district court explained, proof that Dimkpa had acted in an

unauthorized manner by prescribing oxycodone “outside the usual course of professional

practice.” J.A. 60. But consistent with then-governing Fourth Circuit precedent, the

More specifically, a medical examiner determined that the patient died of “Acute 1

Combined Drug Toxicity (oxycodone, alprazolam).” J.A. 43. 3 USCA4 Appeal: 23-6245 Doc: 62 Filed: 03/03/2026 Pg: 4 of 17

district court did not inform Dimkpa that the government would have to prove that he knew

his prescriptions were unauthorized as outside the bounds of professional practice. See

United States v. Hurwitz, 459 F.3d 463, 477–80 (4th Cir. 2006) (applying an objective

rather than subjective standard to a physician’s “good faith” defense that his prescriptions

were authorized).

Satisfied that Dimkpa’s guilty plea was knowing and voluntary, the district court

accepted it and sentenced Dimkpa to 46 months of imprisonment – the low end of the

applicable Sentencing Guidelines range – followed by three years of supervised release.

Dimkpa did not pursue a direct appeal.

B.

In June 2022, nearly three years after Dimkpa’s 2019 guilty plea, the Supreme Court

held in Ruan v. United States that a physician can be convicted under § 841 only if the

government proves that he “knowingly or intentionally acted in an unauthorized manner.”

597 U.S. at 457. Section 841, recall, makes it unlawful, “[e]xcept as authorized[,] . . . for

any person knowingly or intentionally . . . to manufacture, distribute, or dispense” a

controlled substance. 21 U.S.C. § 841(a)(1). In Ruan, the Supreme Court, citing the

“presumption of scienter,” held that § 841’s “knowingly or intentionally” mens rea applies

not only to the “manufacture, distribute, or dispense” clause, but also to the “except as

authorized” clause. 597 U.S. at 457–59. To convict a physician under § 841, in other

words, it is not enough that “a prescription was in fact not authorized”; the government

must prove beyond a reasonable doubt that “the doctor knew or intended that the

prescription was unauthorized.” Id. at 454–55 (emphasis in original).

4 USCA4 Appeal: 23-6245 Doc: 62 Filed: 03/03/2026 Pg: 5 of 17

Dimkpa, proceeding pro se, moved to vacate his § 841 convictions pursuant to 28

U.S.C. § 2255. He argued that his guilty plea was constitutionally invalid because the

district court did not inform him of the scienter requirement newly recognized in Ruan.

The government did not dispute that Dimkpa’s plea colloquy was inadequate under Ruan. 2

Instead, the government invoked the doctrine of procedural default. Dimkpa’s Ruan claim

was barred, the government argued, because it was not raised during Dimkpa’s initial

criminal proceeding or on direct appeal, and Dimkpa failed to overcome this default by

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