In United States v. McIver, the Fourth Circuit ventured into the world of pain management. Dr. Ronald A. McIver, a pain management physician, was convicted for various counts of unlawful distribution of a controlled substance, unlawful distribution of a controlled substance resulting in death, and conspiracy to unlawfully distribute a controlled substance. Formerly he operated a medical clinic in Greenwood, South Carolina that specialized in treating chronic pain. During its investigation, the DEA discovered that Dr. McIver had prescribed massive quantities of oxycodone, Dilaudid, OxyContin, methadone, and morphine to his patients. Many of his patients included admitted drug addicts who traveled significant distances to see him, appeared without referrals, paid in cash, and sought specific drugs which were prescribed for them based on little or no physical examination.
On appeal, Dr. McIver raised several issues. The main issue argued was that the district court erred in telling the jury to consider the extent to which "any violation of professional norms you find to have been committed by the defendant interfered with his treatment of his patients and contributed to an over prescription and/or excessive dispensation of controlled substances."
Reading the charge as a whole, the Fourth Circuit rejected Dr. McIver's argument. The government had to prove that Dr. McIver used "his authority to prescribe controlled substances . . . not for treatment of a patient, but for the purpose of assisting another in the maintenance of a drug habit or" some other illegitimate purposes, such as his own "personal profit." The government further had to prove that the physician acted outside the scope of professional practice. Considering the proof requirements on the government, the Fourth Circuit approved the professional norms language and affirmed the conviction.