United States v. Tamral Guzman

571 F. App'x 356
CourtCourt of Appeals for the Sixth Circuit
DecidedJuly 2, 2014
Docket13-6051
StatusUnpublished
Cited by10 cases

This text of 571 F. App'x 356 (United States v. Tamral Guzman) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth 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. Tamral Guzman, 571 F. App'x 356 (6th Cir. 2014).

Opinion

*357 GRIFFIN, Circuit Judge.

Defendant Tamral Guzman appeals multiple convictions arising from her operation of an illicit pain management clinic from which thousands of dosage units of controlled substances were illegally prescribed to individuals, most of whom paid cash for their visits. Because we find no merit in Guzman’s claims of error, we affirm.

I.

From October 2008 until her arrest in December 2010, Guzman owned and operated Maryville Pain Management, LLC (“MPM”), in Maryville, Tennessee. While in business, MPM generated more than $2.1 million in receipts. Guzman, a high-school dropout with a GED, had no formal medical training, no license to practice medicine, and no DEA license to issue prescriptions. Before opening MPM, she served as the manager of several restaurants and spent approximately two years working at pain clinics in Broward County, Florida.

MPM was originally located on East Broadway Street in Maryville. The business grew rapidly, publicized by word-of-mouth and paper flyers. Because Guzman lacked medical training and could not legally prescribe drugs, she recruited and hired a succession of nurse practitioners and doctors by placing advertisements on Craigslist and sending faxes to medical practices. From its start, MPM bore all of the hallmarks of an illegal operation, quickly attracting the attention of surrounding businesses because of the customer traffic it generated and the drug deals that were witnessed in MPM’s parking lot.

When MPM eventually moved into a medical office park on Parliament Drive in order to accommodate the increasing number of customers, its clientele began causing problems for the neighboring medical professionals. A pediatric dentist testified that people lingered in vehicles in the shared parking lot and that some of the “folks that were in the cars out there were [not] in a fully conscious state.” Another witness testified to seeing — and conducting — drug deals in the MPM parking lot, noting that some people waited in their ears for other customers whose appointments they had sponsored. An oral surgeon in an adjacent office characterized the atmosphere as an unruly “tailgate party,” with belligerent and unkempt individuals loitering and demanding to use nearby bathroom facilities when those at MPM were occupied. The surgeon reported seeing vehicles from “pretty much every county in Tennessee ... [and] from Florida, Georgia, North and South Carolina, from Kentucky.” The situation eventually deteriorated to the point that the dentist and oral surgeon deemed it necessary to lock their office doors during business hours; they testified that they also lost patients and patient referrals because of the dubious activities at MPM. Law enforcement received numerous complaints, and one police officer testified that pill use “skyrocketed” in Blount County and the number of thefts increased.

The day-to-day internal' operations of MPM likewise indicated that something was amiss. Witnesses testified that MPM’s waiting room was very crowded, with some customers even sitting on the floor. MPM originally required cash payments from its customers, but later accepted credit cards. At no point did MPM ever accept or process health insurance. Although Guzman had no medical training or license, she did not hesitate to see customers and issue prescriptions on forms that had been signed in advance by MPM’s nurses and doctors. The staff testified that they did not conduct meaningful examinations; rather, the emphasis was on *358 speed — one long-time MPM employee testified that, on average, 150 to 170 customers were seen and received prescriptions at MPM each day. Bank employees testified that Guzman regularly deposited thousands of dollars in cash at a local bank.

After MPM opened, local pharmacists noticed an increase in the number of Schedule II narcotics they were dispensing. Groups of people often entered the pharmacies together, “as if a bus just pulled up out front,” and they carried prescriptions for the same medication or combinations of medications. Those individuals never presented insurance and always paid cash for the prescriptions. The pharmacists realized that it was not uncommon for MPM customers to pay up to $1,500 cash at once for prescriptions. According to the pharmacists, the MPM customers were generally between the ages of 25 and 40, with no visible indications of pain or other infirmities. Oddly, the MPM customers would request particular forms of drugs, such as tablets imprinted with particular markings, thereby suggesting attempts to obtain medications that would be easier to abuse or redistribute.

In September 2009, Guzman initiated the process of establishing a pharmacy at MPM. Using the DEA license number of a physician who was then employed at MPM, Guzman ordered more than $24,000 worth of controlled substances from Dispensing Solutions, Inc. When MPM’s physician and nurse practitioner both resigned in October 2009, Guzman, undeterred, operated MPM without any medical practitioner for approximately two weeks, using pre-signed prescription forms. The nurse practitioner who was hired as a replacement by Guzman immediately became concerned that he had joined an illegitimate pain management clinic, and, at the end of October 2009, he began meeting with the DEA regarding his concerns.

As a result, in December 2010, a federal grand jury returned a sealed indictment against Guzman. One week later, law enforcement agents arrested Guzman and executed a search warrant at MPM, seizing currency, customer files, and other documentary evidence. Ultimately, Guzman was charged in a Third Superseding Indictment with fifty-seven counts: conspiring to distribute and possess with intent to distribute oxycodone, hydrocodone, al-prazolam, diazepam, and zolpidem, in violation of 21 U.S.C. §§ 846, 841(a)(1), (b)(1)(C), and (b)(2) (Count One); possession with intent to distribute the above-mentioned drugs in violation of 21 U.S.C. §§ 841(a)(1), (b)(1)(C), and (b)(2) (Count Two); six counts of money laundering in violation of 18 U.S.C. §§ 1956(a)(l)(A)(i) and (a)(l)(B)(ii) (Counts Three through Eight); and forty-nine counts of structuring financial transactions in violation of 31 U.S.C. §§ 5324(a)(3) and (d)(2) (Counts Nine through Fifty-Seven). 1

Over the course of its operations, MPM’s gross receipts exceeded $2,164,611. In reviewing the prescription records in sixty files, Internal Revenue Service Special Agent Meredith Louden determined that 97.5 percent of the prescribed drugs were Schedule II narcotics, predominantly oxycodone, and 1.62 percent were Schedule III medications. In conjunction with Guzman’s sentencing, Louden reviewed the accounting system of MPM for the period from August 11, 2009, through December 14, 2010. During this 320-day period, 11,-333 customers were seen. Based upon prescription records maintained by the State of Tennessee and using the conser *359

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Bluebook (online)
571 F. App'x 356, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-v-tamral-guzman-ca6-2014.