United States v. Naeem Kohli

In the

United States Court of Appeals

For the Seventh Circuit

____________________

No. 15-3481

UNITED STATES OF AMERICA,

Plaintiff-Appellee,

v.

NAEEM MAHMOOD KOHLI,

Defendant-Appellant.

____________________

Appeal from the United States District Court for the

Southern District of Illinois.

No. 14-cr-40038 — J. Phil Gilbert, Judge.

____________________

ARGUED SEPTEMBER 9, 2016 — DECIDED FEBRUARY 1, 2017

____________________

Before POSNER, MANION, and WILLIAMS, Circuit Judges.

MANION, Circuit Judge. Dr. Naeem Kohli, an Illinois physi-

cian who specialized in pain management, was convicted on

multiple counts of prescribing narcotics without a legitimate

medical purpose in violation of § 841(a) of the Controlled Sub-

stances Act. On appeal, he argues that the district court

should have granted his motion for acquittal based on insuf-

ficient evidence. He also challenges the district court’s jury in-

structions and several of its evidentiary rulings at trial.

2 No. 15-3481

We conclude that the jury’s verdict is supported by suffi-

cient evidence and that the motion for acquittal was properly

denied. We further hold that the district court’s jury instruc-

tions provided a fair and accurate summary of the law, and

that its challenged evidentiary rulings were not an abuse of

discretion. We therefore affirm Dr. Kohli’s conviction.

I. BACKGROUND

Dr. Naeem Kohli was a board-certified neurologist with

extensive training in the treatment of chronic pain. He oper-

ated a private medical practice called the Kohli Neurology

and Sleep Center located in Effingham, Illinois. Irregularities

in the practice eventually caught the attention of federal offi-

cials, and in 2014 Dr. Kohli was indicted on three counts of

healthcare fraud, two counts of money laundering, and ten

counts of illegal dispensation of a controlled substance. Dur-

ing a fifteen-day trial, the jury learned about Dr. Kohli’s pre-

scribing practices from a variety of sources, including law en-

forcement and healthcare professionals, several expert wit-

nesses, and Dr. Kohli’s patients and their family members. Dr.

Kohli also testified in his own defense.

A. Expert Testimony of Dr. Parran

Some of the most important testimony came from the gov-

ernment’s expert witness Dr. Theodore Parran, an addiction

specialist and internal medicine physician who has previ-

ously testified for the government in similar prosecutions.

See, e.g., United States v. Chube II, 538 F.3d 693, 698 (7th Cir.

2008). Before trial, Dr. Parran reviewed Dr. Kohli’s patient files

for each of the patients who had received the allegedly unlaw-

ful prescriptions charged in the indictment. Dr. Parran did not

dispute that these patients suffered from legitimate, painful

No. 15-3481 3

medical conditions that might ordinarily warrant treatment

with narcotics. As Dr. Parran explained to the jury, however,

Dr. Kohli’s files reflect that he prescribed narcotics to these pa-

tients under circumstances that were far from ordinary.

The files showed, for example, that Dr. Kohli routinely

prescribed addictive opioids to patients who had a history of

drug addiction and who were known to be “multi-sourcing,”

or simultaneously obtaining various prescriptions for con-

trolled substances from multiple sources or providers. He

also prescribed early refills, anywhere from a day to several

weeks before the refills were due, to patients who repeatedly

claimed that their narcotics medications had run out or were

lost or stolen. These same patients often had irregular toxicol-

ogy screens in which they tested negative for the drugs that

Dr. Kohli had prescribed, but positive for other drugs (includ-

ing illegal drugs and other controlled substances) that he did

not prescribe. Dr. Kohli’s office also received phone calls from

the Veterans Administration and a certain patient’s family

members reporting that one of his patients was actively abus-

ing drugs. Despite these troubling developments, Dr. Kohli

continued to prescribe highly addictive Schedule II opioids,

such as oxycodone and hydromorphone, on a regular basis.

According to Dr. Parran, Dr. Kohli’s prescriptions under

these circumstances offered no medical benefit and were in

some cases simply “inconceivable” from a clinical standpoint.

Ultimately, based on his review of the relevant patient files,

Dr. Parran concluded that the prescriptions identified in the

indictment were inconsistent with the usual course of profes-

sional practice and had no legitimate medical purpose.

4 No. 15-3481

B. Other Evidence regarding Dr. Kohli’s Prescribing

Practices

Dr. Kohli’s patients testified that he charged $350 per office

visit to obtain a prescription for a controlled substance. Pa-

tients who did not have insurance, or who had insurance but

were visiting early to obtain an early refill, paid the entire fee

out of pocket. Dr. Kohli also traveled from his office once a

month to see additional patients at Richland Memorial Hos-

pital. The director of physician services at that hospital testi-

fied that she noticed Dr. Kohli’s prescriptions for controlled

substances were already filled out before he saw his patients

there. She also observed that Dr. Kohli would see about 30 pa-

tients in 90 minutes.

C. Cross-Examination and Impeachment of Dr. Kohli

For four days, Dr. Kohli testified about his medical prac-

tice and insisted that he prescribed narcotics in a good-faith

effort to help manage his patients’ chronic pain. At one point,

on direct examination, he also testified that no patient had

ever died under his care: “Have you ever had a patient die

under your care? No, sir.” He reiterated the point the follow-

ing day, again on direct examination. Faced with this unex-

pected claim, the government decided to investigate; it

checked with the local coroner’s office and found that a pa-

tient named Kenneth Kramer had died of an accidental over-

dose while under Dr. Kohli’s care in 2006.

In light of this new information, the government pro-

ceeded to impeach Dr. Kohli on cross-examination by ques-

tioning his earlier testimony that no patient had ever died un-

der his care. When Dr. Kohli answered as before, the govern-

No. 15-3481 5

ment asked him if he remembered his patient Kenneth Kra-

mer. Dr. Kohli replied that he did not. The district court then

stopped the government’s line of questioning and ordered it

to give opposing counsel the materials it had obtained from

the coroner’s office before the questioning could resume.

After the defense reviewed the materials overnight, the

government resumed its impeachment the next day by asking

Dr. Kohli (over the defense’s objection) if he remembered that

a patient named Kenneth Kramer had died of an accidental

overdose while under his care. Dr. Kohli responded that he

did not know about Kramer’s death until he received the ma-

terials from the government the day before. 1 The government

did not introduce the materials from the coroner’s office into

evidence, but limited its impeachment to questioning Dr.

Kohli on cross-examination and was bound by Dr. Kohli’s an-

swers by order of the district court.

D. Jury Instructions and Verdict

At the close of the evidence, Dr. Kohli moved for acquittal

on grounds that the government had failed to present suffi-

cient evidence to sustain a conviction. The district court de-

nied the motion and submitted the case to the jury. The court

instructed the jury to render a conviction only if it found, be-

yond a reasonable doubt, that Dr. Kohli intentionally pre-

scribed controlled substances outside the usual course of pro-

fessional practice and without a legitimate medical purpose:

In order for you to find the Defendant guilty of

a charge of causing the illegal dispensation of a

1 Dr. Kohli also testified, however, that the coroner’s office had con-

tacted him after Kramer’s death to confirm that Kramer was his patient.

6 No. 15-3481

Schedule II controlled substance, the Govern-

ment must prove the following elements be-

yond a reasonable doubt as to the charge that

you are considering:

1: That the Defendant knowingly caused to be

dispensed the controlled substance alleged

in the charge you are considering;

2: That the Defendant did so by intentionally

prescribing the controlled substance outside

the usual course of professional medical

practice, and not for legitimate medical pur-

pose; and

3: That the Defendant knew that the substance

was some kind of a controlled substance.

The court further instructed the jury to consider the nor-

mative standards of professional medical care when evaluat-

ing whether Dr. Kohli’s conduct deviated from the usual

course of professional practice:

In determining whether Defendant’s conduct

was outside the usual course of professional

medical practice, you should consider the testi-

mony you have heard relating to what has been

characterized during the trial as the norms of

professional practice. You should consider the

Defendant’s actions as a whole, the circum-

stances surrounding them, and the extent of se-

verity of any violations of professional norms

you find the Defendant may have committed.

Finally, the court cautioned the jury not to convict Dr.

Kohli if it found that he acted in good faith:

No. 15-3481 7

[T]he Defendant may not be convicted if he dis-

penses or causes to be dispensed controlled sub-

stances in good faith to patients in the usual

course of professional medical practice. Only

the lawful acts of a physician, however, are ex-

empted from prosecution under the law. The

Defendant may not be convicted if he merely

made an honest effort to treat his patients in

compliance with an accepted standard of prac-

tical practice. . . . Good faith in this context

means good intentions and the honest exercise

of good professional judgment as to the pa-

tient’s medical needs.

The jury ultimately convicted Dr. Kohli on seven counts of

illegally dispensing Schedule II controlled substances, in vio-

lation of 21 U.S.C. § 841(a), and acquitted him on the remain-

ing eight counts charged in the indictment. Dr. Kohli was sen-

tenced to 24 months in prison and ordered to pay a fine of

$10,000.

II. DISCUSSION

Dr. Kohli’s primary argument on appeal is that the district

court should have granted his motion for acquittal based on

insufficient evidence. He also argues that the district court

erred by permitting Dr. Parran to testify to legal conclusions

in violation of Federal Rule of Evidence 704, and by permit-

ting the government to impeach him on cross-examination re-

garding the death of his former patient Kenneth Kramer.

Lastly, he contends that the district court’s jury instructions

conflated the standards for civil and criminal liability and

thus permitted the jury to convict him based on a finding of

mere civil malpractice. We address each argument in turn.

8 No. 15-3481

A. Motion for Acquittal

Dr. Kohli asserts that he was entitled to acquittal because

the evidence did not establish that he intentionally engaged

in any unlawful conduct. We review a district court’s denial

of a motion for acquittal de novo. United States v. Vallar, 635

F.3d 271, 286 (7th Cir. 2011).

A motion for acquittal should be granted “only where ‘the

evidence is insufficient to sustain a conviction.’” United States

v. Jones, 222 F.3d 349, 351–52 (7th Cir. 2000) (quoting Fed. R.

Crim. P. 29(a)). When considering the sufficiency of the evi-

dence, “[w]e view the evidence in the light most favorable to

the government and will overturn a conviction only if the rec-

ord contains no evidence from which a reasonable juror could

have found the defendant guilty.” United States v. Longstreet,

567 F.3d 911, 918 (7th Cir. 2009); see also Jones, 222 F.3d at 352

(“[A]s long as any rational jury could have returned a guilty

verdict, the verdict must stand.”). When challenging a convic-

tion based on sufficiency of the evidence, a defendant bears a

“heavy” burden that is “‘nearly insurmountable.’” United

States v. Moses, 513 F.3d 727, 733 (7th Cir. 2008).

To convict a prescribing physician under § 841(a) of the

Controlled Substances Act, the government must prove that

the physician knowingly prescribed a controlled substance

outside the usual course of professional medical practice and

without a legitimate medical purpose. United States v.

Pellmann, 668 F.3d 918, 923 (7th Cir. 2012); Chube II, 538 F.3d at

698; 21 C.F.R. § 1306.04(a). In other words, the evidence must

show that the physician not only intentionally distributed

drugs, but that he intentionally “act[ed] as a pusher rather

than a medical professional.” See Chube II, 538 F.3d at 698; see

also United States v. Moore, 423 U.S. 122, 138–43 (1975).

No. 15-3481 9

In this case, the government presented ample evidence es-

tablishing that Dr. Kohli intentionally abandoned his role as a

medical professional and unlawfully dispensed controlled

substances with no legitimate medical purpose. Indeed, Dr.

Kohli’s own patient files (introduced through the testimony of

Dr. Parran) showed that he regularly prescribed highly addic-

tive and potentially dangerous Schedule II opioids to patients

who (1) had a known history of drug abuse; (2) repeatedly

sought early refills based on dubious claims that their medi-

cations had disappeared; (3) frequently “multi-sourced” their

prescriptions by simultaneously obtaining additional quanti-

ties of controlled substances from other providers; and (4) dis-

played alarmingly irregular toxicology results suggesting

both obvious drug abuse and possible secondary dealing.

Based on this evidence, a reasonable jury could infer that Dr.

Kohli knowingly prescribed controlled substances to patients

who were misusing the prescriptions, and thus that he delib-

erately made the prescriptions outside the ordinary scope of

professional practice and with no acceptable medical justifi-

cation.

To be sure, Dr. Kohli presented conflicting evidence, in-

cluding his own testimony, indicating that he made the chal-

lenged prescriptions in a good-faith medically appropriate ef-

fort to manage his patients’ chronic pain. But the jury was not

required to believe that evidence, and we will not supplant

the jury’s credibility findings on appeal. See United States v.

Griffin, 84 F.3d 912, 927 (7th Cir. 1996); United States v. Curry,

79 F.3d 1489, 1497 (7th Cir. 1996) (“[Q]uestions of credibility

are solely for the trier of fact.”); United States v. Nururdin, 8

F.3d 1187, 1194 (7th Cir. 1993) (“As an appellate court, we ‘will

not reweigh the evidence or judge the credibility of witnesses

when reviewing the sufficiency of the evidence.’”).

10 No. 15-3481

Dr. Kohli also argues that his case should not have gone to

a jury because, unlike in the typical “pill-mill” prosecution,

the evidence here convincingly established that the relevant

prescriptions were given exclusively to patients who suffered

from documented medical conditions associated with chronic

pain. Since the evidence also showed that these same patients

exhibited addictive behaviors, Dr. Kohli contends that the

jury must have convicted him based on an erroneous belief

that the Controlled Substances Act categorically criminalizes

prescribing narcotics to patients who happen to suffer from

addiction disorder in addition to chronic pain.

This argument misses the mark. The issue before the jury

was not simply whether Dr. Kohli prescribed narcotics to

drug addicts. That, in itself, is certainly not a violation of the

Controlled Substances Act. 2 Rather, the issue was whether he

deliberately prescribed outside the bounds of medicine and

without a genuine medical basis. As discussed above, the gov-

ernment presented substantial evidence that Dr. Kohli inten-

tionally prescribed narcotics to patients that he knew were

misusing the prescriptions rather than legitimately using

them to treat pain. A rational jury could thus conclude that

those prescriptions were essentially non-medical in nature

and served no legitimate medical purpose—regardless of

2Indeed, certain controlled narcotics are commonly used to treat nar-

cotic addiction. See Drugs.com https://www.drugs.com/suboxone.html;

https://www.drugs.com/methadone.html (last visited Feb. 1 2017). Nor

are physicians prohibited from prescribing narcotics to drug-addicted pa-

tients for the purpose of pain management, so long as the prescription is

made within the usual course of professional practice and is intended to

confer a medical benefit.

No. 15-3481 11

whether the patients were addicted to the drugs (non-ad-

dicted patients can misuse drugs too), and regardless of

whether they suffered from medical conditions that might

otherwise warrant treatment with those same drugs under

different circumstances.

To be clear, we agree with Dr. Kohli that physicians are not

automatically liable under § 841(a) whenever they prescribe

narcotics to a patient who happens to be addicted; but we add

that neither are they automatically immune from liability

whenever a patient who is obviously misusing their prescrip-

tion happens to suffer from chronic pain. The Controlled Sub-

stances Act does not give physicians carte blanche to pre-

scribe controlled drugs for a non-medical purpose simply be-

cause the immediate recipient of the prescription has an ill-

ness that the drugs could in theory alleviate if used properly.

In every case, the critical inquiry is whether the relevant pre-

scriptions were made for a valid medical purpose and within

the usual course of professional practice. Here, a jury could

reasonably conclude that they were not.

In sum, viewed in the light most favorable to the prosecu-

tion, the evidence was sufficient to enable a rational jury to

conclude beyond a reasonable doubt that Dr. Kohli intention-

ally and knowingly prescribed controlled substances outside

the usual course of professional medical practice and without

a legitimate medical purpose. The conviction is supported by

sufficient evidence, and the motion for acquittal was properly

denied.

B. Expert Testimony of Dr. Parran

Dr. Kohli next argues that the district court erred by allow-

ing Dr. Parran to testify about applicable legal standards and

12 No. 15-3481

legally dispositive issues in violation of Federal Rule of Evi-

dence 704. We review the district court’s decision to admit ex-

pert testimony for an abuse of discretion. United States v. Good-

win, 496 F.3d 636, 641 (7th Cir. 2007). Rule 704 permits experts

to testify about an “ultimate issue” in a case, Fed. R. Evid.

704(a), but prohibits them from stating an “opinion about

whether the defendant did or did not have a mental state or

condition that constitutes an element of the crime charged or

of a defense,” Fed. R. Evid. 704(b).

Dr. Parran’s expert testimony in this case falls squarely

within the parameters of Rule 704. As noted earlier, Dr. Parran

testified that he believed certain of Dr. Kohli’s prescriptions

were inconsistent with the usual course of professional prac-

tice and lacked a legitimate medical purpose. That testimony

tracks the elements necessary to sustain a conviction for ille-

gal dispensation, see 21 C.F.R. § 1306.04(a), and it therefore

embodies an opinion about ultimate or dispositive issues in

the case. Such opinions are expressly allowed, however, un-

der Rule 704(a). Likewise, consistent with Rule 704(b), Dr. Par-

ran offered no opinion about Dr. Kohli’s subjective mental

state when he wrote the prescriptions at issue, or about

whether Dr. Kohli had the requisite intent to be convicted of

the crimes charged. Dr. Parran did not rely on “‘some special

knowledge of [Dr. Kohli’s] mental processes,” but clearly and

properly based his expert opinion on a review of Dr. Kohli’s

office records in light of his own experience and training. See

United States v. Winbush, 580 F.3d 503, 512 (7th Cir. 2009).

We also reject Dr. Kohli’s argument that Dr. Parran ex-

ceeded his role as a medical expert witness by instructing the

jury on the applicable legal standard. It is true that Dr. Par-

ran’s testimony touched on the applicable standard of care

No. 15-3481 13

among medical professionals—a standard that is no doubt

closely linked to § 841(a)’s prohibition on prescribing outside

the “usual course of professional medical practice.” But testi-

mony on the standard of care is not converted into an imper-

missible jury instruction on the governing legal standard just

because the two standards overlap. If that were the case, phy-

sicians could virtually never offer meaningful expert opinions

in prosecutions under § 841(a). See Chube II, 538 F.3d at 698

(recognizing that “it is impossible sensibly to discuss the

question whether a physician was acting outside the usual

course of professional practice and without a legitimate med-

ical purpose without mentioning the usual standard of

care”). 3 Dr. Parran did not lecture the jury about the legal

meaning or application of § 841(a), but simply opined that cer-

tain of Dr. Kohli’s actions were medically unjustified and con-

trary to standard professional medical practice. That opinion

was within Dr. Parran’s area of expertise and was not inappro-

priate under Rule 704 or otherwise.

Accordingly, the district court did not abuse its discretion

in admitting Dr. Parran’s expert testimony.

C. Impeachment on Cross-Examination

Dr. Kohli also maintains that the district court erred by al-

lowing the government to impeach him about the death of his

former patient Kenneth Kramer. We review the district court’s

ruling for an abuse of discretion. See United States v. Boswell,

3 See also United States v. Feingold, 454 F.3d 1001, 1007 (9th Cir. 2006)

(“[O]nly after assessing the standards to which medical professionals gen-

erally hold themselves is it possible to evaluate whether a practitioner’s

conduct has deviated so far from the ‘usual course of professional practice’

that his actions become criminal.”).

14 No. 15-3481

772 F.3d 469, 476 (7th Cir. 2014); United States v. Owens, 145

F.3d 923, 927 (7th Cir. 1998).

It is well-settled that “when a criminal defendant elects to

testify in his own defense, he puts his credibility in issue and

exposes himself to cross-examination, including the possibil-

ity that his testimony will be impeached.” Boswell, 772 F.3d at

475; see also United States v. Taylor, 728 F.2d 864, 874 (7th Cir.

1984). As mentioned earlier, Dr. Kohli unequivocally testi-

fied—not once but twice—that no patient had ever died under

his care: “Have you ever had a patient die under your care?

No, sir. . . . I never had a problem, a patient died on me.” By

making these affirmative statements on direct examination,

Dr. Kohli put his credibility in issue and thus opened the door

for the government to impeach him on cross-examination. We

agree with the district court that the government had every

right to question the truthfulness of what Dr. Kohli himself

chose to say in his own defense in open court.

1. Collateral Evidence Rule

Dr. Kohli tries to evade this conclusion by invoking the fa-

miliar rule against impeachment by contradiction on collat-

eral matters (commonly known as the collateral evidence

rule). But that rule does not apply here for several reasons. To

begin, the collateral matter at issue––whether any patients

had ever died under Dr. Kohli’s care––was elicited by Dr.

Kohli’s counsel on direct examination, not by the government

on cross-examination. See Taylor, 728 F.2d at 873–74 (empha-

sizing that the collateral evidence rule applies only when a

witness is “impeached by contradictions as to collateral or ir-

relevant matters elicited on cross-examination”). Furthermore,

the rule is implicated only when a party presents “extrinsic

evidence” that a witness’s testimony is incorrect. United States

No. 15-3481 15

v. Senn, 129 F.3d 886, 893–94 (7th Cir. 1997). 4 As previously

stated, however, the government offered no extrinsic evi-

dence (e.g., documents from the coroner’s office or testimony

from the coroner) to impeach Dr. Kohli, but limited its im-

peachment to questioning him on cross-examination and ac-

cepted his answers without contradiction. 5 See Simmons, Inc.

v. Pinkerton’s, Inc., 762 F.2d 591, 605 (7th Cir. 1985), abrogated

on other grounds as recognized by Glickenhaus & Co. v. House-

hold Int’l, Inc., 787 F.3d 408, 425 n.12 (7th Cir. 2015) (specifying

that “the collateral evidence rule does not . . . limit the scope

of all types of impeachment by cross-examination,” but “merely

precludes extrinsic evidence of certain facts that would im-

peach by contradiction”).

2. Rule 16

Dr. Kohli also contends that the government failed to

timely disclose its impeachment materials in violation of Rule

16 of the Federal Rules of Criminal Procedure, which requires

the government to promptly disclose any documents that are

within its possession, custody, or control, and that are “mate-

rial to preparing the defense.” Fed. R. Crim. P. 16(a)(1)(E)(i),

(c); see also Fed. R. Crim. P. 16(a)(1)(B), (F). According to Dr.

4 See also Taylor v. Nat’l R.R. Passenger Corp., 920 F.2d 1372, 1375 (7th

Cir. 1990) (“[T]he collateral evidence rule limits the extent to which the

witness’ testimony about non-essential matters may be contradicted by

extrinsic proof.”).

5Although the government referenced the exhibit number of the cor-

oner’s report during cross-examination, the exhibit was not admitted into

evidence.

16 No. 15-3481

Kohli, Rule 16 required the government to turn over the in-

formation from the coroner’s office before using that infor-

mation to initiate its impeachment on cross-examination. 6

We see no reversible error. As a preliminary matter, we’re

doubtful that Rule 16 applies here because the information

from the coroner’s office bears no relation to the charges in

this case (Kramer died years before the earliest events giving

rise to the indictment) and so doesn’t appear “material to pre-

paring the defense.” Rather, the information became mate-

rial—for the limited purpose of impeaching Dr. Kohli—only

after Dr. Kohli voluntarily testified at trial that no patient had

ever died under his care. It is difficult to see how an admit-

tedly “collateral matter” that is otherwise irrelevant to the

pending charges could suddenly become “material” to the de-

fense simply because the defendant chooses to testify about it

on direct examination. See United States v. Caro, 597 F.3d 608,

621 & n.15 (4th Cir. 2010) (collecting cases) (holding that in-

formation is “material to the defense” under Rule

16(a)(1)(E)(i) only if there is “some indication that the pretrial

disclosure of the disputed evidence would have enabled the

defendant significantly to alter the quantum of proof in his

favor”).

In any event, even if the government violated Rule 16 by

failing to disclose the coroner’s report sooner than it did, any

error was harmless. The materials were not introduced into

6 Recall that the government had not yet disclosed the coroner’s report

when it initially asked Dr. Kohli if he remembered a patient named Ken-

neth Kramer. (Of course, after Dr. Kohli answered that initial question, the

government promptly disclosed the report and did not resume its inquiry

until the defense had time to review it.)

No. 15-3481 17

evidence, and the district court granted a continuance by al-

lowing the defense to review the materials overnight before

the government could continue its cross-examination the fol-

lowing day. Under Rule 16, these remedial measures were

clearly within the trial court’s discretion and effectively cured

any harm that might otherwise have resulted from the sup-

posed violation. See Fed. R. Crim. P. 16(d)(2) (stating that a

district court may remedy a Rule 16 violation by, among other

things, granting a continuance, ordering the government to

permit the inspection of the materials in its possession, or pro-

hibiting the introduction of the materials into evidence).

On the whole, the district court’s balanced approach to Dr.

Kohli’s impeachment was reasonable and not an abuse of dis-

cretion. Reversal is not warranted.

D. Jury Instructions

Dr. Kohli’s final argument is that the district court errone-

ously instructed the jury that a finding of civil malpractice

was sufficient to support a conviction. A district court has

substantial discretion in formulating the precise wording of

jury instructions “‘so long as the final result, read as a whole,

completely and correctly states the law.’” United States v. Gib-

son, 530 F.3d 606, 609 (7th Cir. 2008). Dr. Kohli’s counsel did

not object to the jury instructions he now challenges on ap-

peal, so we review the instructions for plain error. 7 United

7 The government alternatively argues that Dr. Kohli has waived the

right to appellate review by affirmatively approving the challenged in-

structions at trial. See United States v. Anifowoshe, 307 F.3d 643, 650 (7th Cir.

2002) (“Waiver of a right at the trial level precludes a party from seeking

review on appeal.”). Because we conclude that the instructions were not

plainly erroneous, we need not reach this alternative argument.

18 No. 15-3481

States v. Javell, 695 F.3d 707, 713 (7th Cir. 2012). Plain-error re-

view “is ‘particularly light-handed in the context of jury in-

structions,’ since it is unusual that any error in an instruction

to which no party objected would be so great as to affect sub-

stantial rights.” United States v. DiSantis, 565 F.3d 354, 361 (7th

Cir. 2009).

The district court’s jury instructions in this case were not

plainly erroneous. The court instructed the jury to convict Dr.

Kohli of illegally dispensing controlled substances under §

841(a) only if the jury found, beyond a reasonable doubt, that

Dr. Kohli (1) knowingly and intentionally prescribed con-

trolled substances (2) outside the usual course of professional

medical practice, and (3) for no legitimate medical purpose.

That is exactly what the statute requires to support a convic-

tion. See 21 U.S.C. § 841(a); 21 C.F.R. § 1306.04(a). The district

court thus correctly spelled out each of the elements of the of-

fense, and clearly articulated the appropriate burden of proof

governing criminal liability. The court further instructed the

jury that it should not convict Dr. Kohli if it found that he

made the relevant prescriptions in good faith.

We see no support for Dr. Kohli’s argument that the dis-

trict court somehow conflated the standards for civil and

criminal liability, or that it otherwise misled the jury into be-

lieving that it could find Dr. Kohli criminally liable for engag-

ing in mere civil malpractice. The district court’s jury instruc-

tions fairly and accurately stated the law and do not warrant

reversal.

III. CONCLUSION

For the foregoing reasons, the judgment of the district

court is AFFIRMED.