Supreme Court's 9-0 Ruan ruling is a win for TRT clinics

xqfq

Active Member
Ruling itself:

https://www.supremecourt.gov/opinions/21pdf/20-1410_1an2.pdf

Cato Institute (libertarian think tank) summary: Supreme Court Sets Higher Bar for Prosecuting Doctors Who Prescribe Opioids for Pain

It seems like this decision is a win for HRT clinics and all doctors who prescribe controlled substances. In order to prosecute doctors, the Federal government must now prove their prescribing was actually unauthorized, rather than rely on a more hand-wavey "unreasonable" standard.

My reading (not a lawyer, etc!) -

So doctors who prescribe a lot of e.g. testosterone to all of their patients are no longer at risk of prosecution merely for the act of prescribing a lot of testosterone.

If the government wishes to prosecute a doctor for prescribing testosterone, they must prove beyond a reasonable doubt that the doctor knowingly and willingly prescribed testosterone in an unauthorized manner. The government must produce beyond-a-reasonable-doubt evidence of an unauthorized prescription, not merely rely on whether or not an "ordinary doctor" would consider such prescription as reasonable, or whether the doctor's general conduct (e.g. prescribing a lot in general, only prescribing testosterone, etc) is "reasonable."

The summary opinion above is readable - well worth a quick read if interested.
 
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From an attorney:

"This would only affect criminal prosecutions and not board cases."
Nelson: This is correct. It all has to deal with the burden of proof. Criminal cases are beyond a reasonable doubt. Most State boards have a standard of clear and convincing evidence (this varies by state). The easiest burden of proof to meet is in a negligence or medical malpractice case which is by a preponderance of the evidence (more likely than not, they were negligent). Yes, I’m an attorney as well. :)
 

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Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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