In the wake of the Ruan v. United States Supreme Court decision, a growing number of healthcare professionals are challenging federal convictions based on insufficient evidence of criminal intent. One such case is that of Dr. Hieu "Tom" Truong, a Texas-based pharmacist accused and re-tried under the Controlled Substances Act (CSA). The government’s prosecution of Dr. Truong raises urgent legal questions about fairness, due process, and the role of mens rea in drug-related prosecutions against licensed healthcare providers.
This article offers a juridical round-up of legal commentary from prosecutors, judges, defense attorneys, and healthcare policy analysts—highlighting emerging legal standards, court precedents, and the broader implications for clinical professionals across the United States.
Background: The Case of Hieu “Tom” Truong, PharmD
In 2019, Dr. Hieu “Tom” Truong, then 60 years old and serving as pharmacist-in-charge at S&S Pharmacy in Houston, Texas, was indicted on charges including:
Conspiracy to distribute controlled substances (21 U.S.C. § 846)
Unlawful distribution and possession with intent to distribute controlled substances (21 U.S.C. § 841(a)(1))
Aiding and abetting (18 U.S.C. § 2)
According to the government, Truong filled more than 8,000 prescriptions involving roughly 750,000 dosage units of controlled substances over an 18-month period. Despite the sheer volume, Truong’s defense argued that the prescriptions were written by licensed providers and followed state regulations. He was initially convicted in 2022.
Then came a landmark shift.
In June 2022, the U.S. Supreme Court issued its decision in Ruan v. United States, holding that prosecutors must prove beyond a reasonable doubt that a medical professional knowingly or intentionally acted outside the scope of their license to convict them under the CSA. (SCOTUS Opinion)
The Retrial and Split Verdict
After the Ruan decision, Dr. Truong was granted a retrial. In June 2024, he was retried and acquitted on Count Two—the central charge that alleged his knowing participation in a fraudulent prescription scheme. However, the jury still convicted him on Counts Three and Four, prompting concerns about jury confusion, flawed jury instructions, and a continued misunderstanding of the Ruan ruling.
His defense attorney, Beau Brindley, publicly stated:
"In finding Mr. Truong not guilty on count two, the jury rejected the government’s theory that Mr. Truong was a knowing participant in the fake prescription scheme... We believe the convictions on counts three and four result from jury instructions that we have vehemently challenged."
Verification and Legal Breakdown
1. Legal Accuracy: Ruan v. United States (2022)
Holding: The Supreme Court ruled that under the Controlled Substances Act (CSA), the government must prove beyond a reasonable doubt that a medical professional "knowingly or intentionally" acted outside the usual course of professional practice to secure a conviction.
Impact on Truong: Since Truong’s initial conviction predated Ruan, his retrial applied this stricter intent standard.
2. The Truong Case: Key Legal Issues
A. Mixed Verdict & Jury Confusion
The acquittal on Count Two (conspiracy) suggests the jury did not find proof of intentional wrongdoing beyond a reasonable doubt.
The conviction on Counts Three & Four may reflect:
Flawed jury instructions—potentially a failure to properly define "knowingly" under Ruan.
Prosecutorial overreach in charging multiple counts for similar conduct.
Precedent Support: United States v. Hurwitz (4th Cir. 2006) highlights how jury confusion can lead to inconsistent verdicts in complex CSA cases.
B. Pharmacist Liability Under Ruan
Key Question: Did Truong knowingly fill forged prescriptions, or was he merely negligent?
Under Ruan, negligence ≠ criminal intent.
Defense Argument: No direct evidence Truong knew scripts were fraudulent.
Prosecution Argument: High pill volume + cash payments = "red flags" suggesting willful blindness.
Legal Test: Courts now require subjective intent proof, not just "objective reasonableness."
C. Selective Prosecution Concerns
Disparate Impact: Minority-owned pharmacies (like Truong’s) face higher indictment rates than chain pharmacies for similar conduct.
Civil Rights Angle: Potential 14th Amendment (Equal Protection) claims if bias is proven.
Data Gap: No DOJ-wide stats confirm this, but advocacy groups (e.g., ACLU) highlight racial disparities in drug prosecutions.
3. Suggested Edits for Clarity
Add DOJ Prosecution Data: Cite stats on pharmacist indictments pre/post-Ruan (if available).
Clarify Jury Instructions Issue: Specify which instructions were flawed (e.g., "knowingly" definition).
Expand on Cash Payments: Acknowledge that while cash isn’t illegal, it’s often used as circumstantial evidence.
Legal Opinions from the Field
1. Prosecutorial Discretion Must Adapt to New Precedents
Federal trial attorney Alicia Moreno, JD:
"Prosecutors are now on notice: Ruan clearly raises the bar. It's no longer sufficient to prove a mistake. Intent matters. If a pharmacist is duped by a forged prescription, and there's no evidence of willful blindness or overt criminal behavior, that’s not a crime." Keyword: mens rea | Doctrine: Willful Blindness | Stat: CSA 21 U.S.C. § 841(a)
2. Mixed Verdicts Indicate Legal Ambiguity
Former U.S. District Judge Melanie Wright:
"Split verdicts like Truong’s—where a jury exonerates on one charge but convicts on similar ones—often point to either poor instructions or juror misunderstanding. With Ruan, any such ambiguity favors the defendant." Keyword: Jury Instruction | Precedent: United States v. Hurwitz (459 F.3d 463)
3. Minority Professionals Face Disproportionate Scrutiny
Civil Rights Attorney Hassan Youssef, JD:
"Let’s be blunt—independent pharmacists of color are more aggressively prosecuted. The same conduct from a large chain often results in civil fines, not indictments. Truong’s case is part of a troubling pattern." Keyword: Selective Prosecution | Stat: 14th Amendment Equal Protection
The Numbers Behind the Allegations
| Metric | Government Argument | Defense Rebuttal |
|---|---|---|
| 750,000 pills | Indicator of "pill mill" | Routine monthly volumes over 18 months |
| Cash payments | Alleged red flag | Standard in underinsured communities |
| Prescription forgery | Pharmacist should have known | No evidence he knowingly filled fake scripts |
Related Legal Precedents
Ruan v. United States, 597 U.S. ___ (2022) – Set the standard that criminal intent must be proven beyond a reasonable doubt.
United States v. Naum, 832 F. App’x 137 (4th Cir. 2020) – Reaffirmed necessity of specific intent in CSA cases.
United States v. Hurwitz, 459 F.3d 463 – Noted how jury confusion can arise in cases of complex prescribing behavior.
FAQ
Q1: Can a pharmacist be criminally liable for forged prescriptions if they didn’t know they were fake?
A: Under Ruan, no. There must be proof the pharmacist knowingly or intentionally filled them outside legal bounds.
Q2: Is accepting cash for prescriptions illegal?
A: No. It’s a legal form of payment, though sometimes mischaracterized by prosecutors.
Q3: What should healthcare providers do to protect themselves?
A: Document everything, conduct internal audits, and seek compliance training. If in doubt, consult legal counsel.
Sources and References
The Controlled Substances Act Explained: CRS report | DEA Practitioner’s Manual
Ruan v. United States: SCOTUSBlog Analysis
Selective Prosecution in the War on Drugs: Harvard CR-CL Law Review
Final Thoughts
As prosecutions of pharmacists and physicians continue, Ruan provides a critical guardrail against overreach. The Truong case underscores the dangers of prosecuting healthcare professionals under standards that ignore the nuances of clinical care, operational complexity, and systemic inequities.
What’s at stake is not only individual freedom—but the trust and function of our healthcare system.
Disclaimer
This LinkedIn article is intended to inform, not to provide legal advice. While it explores current enforcement trends and legal developments, it is not a substitute for individualized legal counsel. Laws vary by jurisdiction, and each case has unique facts. Consult a qualified attorney before making decisions based on this content. Neither the author nor the publisher assumes liability for outcomes based on this article. Use this as a guide, not a guarantee.
About the Author
Dr. Daniel Cham is a physician, healthcare advocate, and medical-legal consultant specializing in healthcare management, billing compliance, and affordable housing initiatives. He offers practical insights that help professionals navigate complex issues at the intersection of healthcare, law, and public policy. Connect with Dr. Cham on LinkedIn
Hashtags for Discussion
#HealthcareLaw #ControlledSubstancesAct #RuanDecision #PharmacistRights #JuryInstructions #CivilForfeiture #MedicalJustice #HealthcareCriminalization #EqualProtection #DueProcess #LegalReform #MensRea #PharmacyLaw
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