Content has been preserved in its original form and syntax. Modifications were made only to protect the interest of private citizens and to facilitate readability.
Xiulu Ruan, MD 66857019 E1
F.C.I. Oakdale I
P.O. Box 5000
Oakdale, LA 71463
June 21, 2018
The Saga of Holy Trinity in a Criminal Trial
To begin with, what is Holy Trinity? In his book “The History of Western Philosophy,” Mr. Bertrand Russell describes that Plotinus (AD 204-270), the founder of Neo-Platonism, defines the Holy Trinity as the One, Spirit, and Soul. fv1r. Russell also describes that Johannes Scotus (AD 810-877), a Neo-Platonist, holds that the Holy Trinity is the Father, the Son, and the Holy Ghost, Where his being is the Father, his wisdom is the Son, his life is the Holy Ghost.
According to Wikipedia, the Christian doctrine of the Holy Trinity holds that God is three consubstantial persons–the Father, the Son (Jesus Christ), and the Holy Spirit as one. God in three Divine Persons.
However, during my trial, “Holy Trinity” became a major theme of showing wrong doing of the two defendant physicians.
How and why did the term “Holy Trinity” get into the trial where both defendant physicians were charged as street drug dealers?
To fully understand the Intention of the prosecutors of this trial, we need first to understand what “Holy Trinity” meant by the government. Incidentally, as we shall see shortly, the definition of ”Holy Trinity” changed according to the need of the government; however, it is not unusual to see such occurrences according to Dr. Guy 8. Faguet, a Hematology/Oncology specialist and the author of the book “Pain Control and Drug Policy.” In his book, Or, Faguet writes:
“In conclusion, through the DEA, the U.S. government is conducting an aggressive and unjustifiable campaign against pain-treating physicians. This is achieved by a multifaceted approach. It includes redefining the terms ‘addict,’ ‘drug dealer,’ and ‘drug distributor’; criminalizing opioid prescribing patterns coupled to a disinformation campaign to convince the public that, contrary lo evidence, physicians are responsible for a ‘major prescription drug problem in the US’…” (97).
The timing of my court case was as follows: the initial Grand Jury Indictment was in April 2015; the First Superseding Indictment was in October 2015; the 2nd Superseding Indictment was in April 2016; and the trial ran from January 4th to February 23rd, 2017 .
It was only in the Second Superseding Indictment that the conspiracy to dispense and distribute hydrocodone was added as a new Count (specifically Count 4). In that Superseding Indictment, it also states: “In 2013 and 2014, Ruan ranked amongst the top purchasers of … hydrocodone… in the entire United States.” (7) (I willl address the issue of hydrocodone purchase later.)
Initially, the term “Holy Trinity” came from some prison in Houston area. At the time of the release of the Second Superseding Indictment (April 2016) there was only one article relating to “Holy Trinity” in PubMed database. That paper was written by Mathias Forrester, entitled “Ingestion of Hydrocodone. Carisoprodol, and Alprazolam ln Combination Reported to Texas Poison Center.” It was published online in April 2011 in the Journal of Addictive Diseases. In it, Mr. Forrester writes: “Hydrocodone is a prescription narcotic pain reliever…[in] Vicodin…Lorcet…Lortab…Norco. Carisoprodol is a prescription muscle relaxant known by the brand name Soma…[and Alprazolam is a prescription anti-anxiety medication know as Xanax… When taken together…this prescription drug combination, which may be referred to…’ Houston Cocktail,’ ‘Holy Trinity,’ or ‘Trio’…” (110).
As we will see shortly, this combination (Hydrocodone product, Soma/carisoprodol, and Xanax/alprazolam) was the only definition of “Holy Trinity” found in peer-reviewed literature up lo August 2016 (more than one year after my arrest in May 2015). I speculate that the prosecutors Intended to introduce the term “Holy Trinity” into the trial for the following purposes: 1) to substantiate the story that I was ”top purchaser of hydrocodone in the U.S.”; 2) to support Count4; and 3) to create an impression of impiety among defendant physicians writing addictive cocktails termed “Holy Trinity.”
After seizing our electronic medical records of PPSA patients in May 2015, the government reviewed PPSA patients In order to identify those patients who were prescribed “Holy Trinity”–those who were simultaneously prescribed hydrocodone, Xanax, and Soma. To their surprise-, they could only find a tiny fraction, based on the original definition of “Holy Trinity” defined in Forrester’s paper. As a matter of fact, at trial, the prosecutors did not show a single patient of mine that was on the combination of Hydrocodone, Xanax/alprazolam, and Soma/carisoprodol.
The prosecutors realized that in order for them to play the card of “Holy Trinity,” they would need to expand the definition of the “Holy Trinity” so that more PPSA patients could be categorically classified into receiving “Holy Trinity.” At this time, the prosecutors embarked a new endeavor–to alter the definition of “Holy Trinity” in the medical literature.
This task was assigned to Dr. Jon Eric Sprague, PhD. In June, 2016, the defense team learned that Dr. Sprague would be a government expert witness and was provided his resume. Dr. Sprague was a former Dean and Professor of Pharmacology at the Raabe College of Pharmacy, Ohio Northern University, Ada, Ohio (2006 to 2013). Dr. Sprague also worked as Director of Academic Research at the College of Pharmacy, Ferris State University, Big Rapids, Michigan (2013-2014), Dr. Sprague held the title of Director and BCI Eminent Scholar, Ohio Attorney General’s Center for the Future of the Forensic Sciences, Bowling Green State University, Ohio (2014 to time of the trial). Dr. Sprague’s resume also listed ab0ut sixty publications, a majority of which were PubMed-lndexed.
The government also informed the defense team that Dr. Sprague would be the first government witness to take the stand, and that he was going to speak to the jury about the pharmacology and toxicology of the “Holy Trinity.” From his resume, we agree that Dr. Sprague appears well published, with dozens of PubMed publications. His research qualification and his ability to publish academic papers are in sharp contrast with the other three government medical experts such as Dr. David G. Greenberg, Dr. Rahul Vohra, and Dr. Tricia Altman, as none of them had published a single paper in the PubMed database.
Interestingly, a few months after Dr. Sprague was signed on by the prosecution team in September 2016, an article entitled “The Pharmacology & Toxicology of the Holy Trinity,” authored by Joseph T. Horsfall and Jon E. Sprague, appeared online in Basic & Clinical Pharmacology & Toxicology. In this article, there was the novel statement that the government needed: “The combination of an opioid, benzodiazepine, and the skeletal muscle relaxant, carisoprodol is commonly referred by the street name of ‘Holy Trinity’ (Reference 5)” Here, as we can see, Horsfall and Sprague changed the previous “Holy Trinity” which contains hydrocodone, alprazolam, and carisoprodol to the newly defined “Holy Trinity,” which does not specify Hydrocodone or alprazolam; rather it claims a nonspecific opioid and a nonspecific benzodiazeplne. In their paper, the cited “Reference 5” is the 2011 Forrester paper that carried the original definition of “Holy Trinity,” but the Forrester paper was the only reference cited relating to the definition of the “Holy Trinity.” Thus for the first time, “Holy Trinity” has been newly defined by Horsfall and Sprague in September 2016 (close to one and half years after the initial Grand Jury Indictment in April 2015). It now has an expanded definition which includes any combination of an opioid, a benzodiazeplne, and carisoprodol.
Of further interest and despite that Dr. Sprague had published a number of papers, prior to the publication of the “Holy Trinity” paper, according to his resume, he had never published anything on opioids, or benzodiazepines, or carisoprodol. Joseph T. Horsfall, the primary author, had never published anything in PubMed prior to this. Yet, in this new “Holy Trinity” paper, Horsfall is acknowledged as having “contributed equally to this work.” I wonder how Horsfall had contributed equally and thus deserved a first author of the paper, when he had never before published anything at all?
Frankly, I was glad Dr. Sprague would be the first expert witness for the government as Dr. Sprague was indeed a researcher. I was happy that my defense attorney could use his academic research publications to educate the Jury so that the jury would have a better understanding of what It meant for a physician, pharmacist, or clinical researcher to publish in the challenging academic field. At the time of my trial, I had over 120 papers in PubMed. I worked with my defense attorney to prepare the cross examination note on Dr. Sprague and emailed my attorney my opinion on what the cross examination should include. Inexplicably, just prior to the trial, the defense team found out that Dr. Sprague would be replaced by Ms. Susannah Herkert, a DEA agent. Despite the fact that Dr. Sprague did not testify at the trial, the new definition of “Holy Trinity” was used by Ms. Susannah Herkel in her testimony. When Ms. Herkert was asked what the- “Holy Trinity” was by the prosecutor Mr. Bodnar, she answered: “The Holy Trinity cocktail is comprised of three different categories: the oploids…being hydrocodone, morphine, oxydocone, hydromorphone, oxymorphone, or fentanyl…The benzodiazeplne is the second category…the alprazolam, diazepam, clonazepam, lorazepam, midazolam…carisoprodol. ..” (1/6/17 p. 122).
Under this newly defined “Holy Trinity,” significantly more patients at PPSA could be labeled as receiving “Holy Trinity.” Despite that, still only a small fraction of PPSA patients were shown to have received “Holy Trinity,” i.e. 5.26% in all Dr. Couch’s controlled prescriptions (1/9/17 p. 392-93), and 9.85% in my controlled prescriptions (id. p. 399).
With regard to prescribing combinational medications such as an opioid, a benzodiazepine, and a muscle relaxant, Dr. Warfield, defense medical expert, a world-class pain specialist and the Lowenstein Distinguished Professor of Anesthesia at Harvard Medical School, [and incidentally who Is also the first woman at Beth Israel Hospital of Harvard Medical School to have earned an endowed professorship under whom the Pain Management Center of Beth Israel Hospital was named (2/817 p. 4661, p. 4663)], stated when questioned about such a drug combination:
“That’s absolutely within the usual course of medical practice. That’s what we do. And…it’s not just pain. You know, you have blood pressure, the doctor may give you three different -they may give you a diuretic and they may give you two blood pressure bills. I mean, you can call it a cocktail. You can call it whatever you want. But it’s combination of drugs. And, of course, when we do that, that increases the side effects if you give more than one drug, sure. But, we’re aware of that and It’s done very commonly to treat anything” (Id. p. 4706).
Also, even the government witnesses, including agent Susannah Herkert (1/6/17 P. 145) and Dr. Tricia Aultman (1/30/17 p. 3276), testified that there was nothing intrinsically wrong to prescribe such drug combinations.
Even at trial, there was no evidence shown that any patient out of thousands of PPSA patients had ever used the term “Holy Trinity.” None. Neither Dr. Couch nor I had any Idea what “Holy Trinity” was 1n a pain clinic setting or in any other capacity than its religious implication (2/14/17 p. 5749). Further, there was not a single defense witness, such as PPSA staff member, C&R pharmacy employee, patient, or defense expert witness who testified that he or she knew what “Holy Trinity” meant besides its spiritual implication. ·
Indeed, the government witness Deputy Patrick Shawn Kelley (undercover agent who posted as a chronic pain patient and saw Dr. Couch) gave us a clear answer as to why none of PPSA patients, staff members, physicians ever used the term “Holy Trinity’ in PPSA clinical practice. This is because the term “Holy Trinity” is either a lqw enforcement term (or a prison term In Houston area per Forrester’s paper). The following dialogue occurred during the cross examination of Deputy Kelley by the defense attorney Mr. Brandon Essig:
Q Okay. At any point in time did anybody at the clinic–you’re familiar with the term “Holy Trinity”?
A Yes, sir. I am.
Q All right. And you’re familiar that that’s a slang, street term?
A No, Sir, It’s not a street term. But, yes, l’m–l’m aware of it.
Q At any point in time when you were at PPSA did anybody, any of the nurses, any of the staff, and of the doctors, every pull you aside and say: Hey, if you want some real drugs, if you want the Holy Trinity, meet me out back and I’ll see it to you?
A No, sir.
Q Did anybody ever use the term “Holy Trinity” with you the entire time you ever visited there?
A That’s a law enforcement term, sir. They would not use them (1/20/17 p. 1806).
From these exchanges, Agent Kelley explicitly told us that “Holy Trinity” is a law enforcement term, i.e., a term specifically used by the prosecutors, DEA, FBI, and law enforcement agents and that staff at PPSA or C&R Pharmacy would not use It. On this basis, we can now understand why there was not a single piece of evidence presented at court that the term “Holy Trinity” was ever used at PPSA. In addition, even the government witness Gary Douthitt, a former PPSA patient of mine, arrested years later for trafficking heroin with a firearm, admitted that he had no Idea what “Holy Trinity” was (1/30/17 p. 3448).
Now, I want to discuss the issue of hydrocodone purchase and Count 4. I believe the initial charge on Count 4 was based on the erroneous assumption that I was a “top purchaser of hydrocodone” in the nation. Recall the second Superseding Indictment stating: “In 2013 and 2014, Ruan ranked among the top purchasers of…hydrocodone…in the entire United States.” But, factually this is not true.
First of all, my DEA number was used to purchase all of the scheduled drugs used by the workers compensation (WC) dispensary at PPSA (1/30/17 p. 3275). Therefore, I was not the only physician who prescribed the opioids purchased under my DEA number because all physicians at PPSA used the WC dispensary. So, the amount of hydrocodone purchased under my DEA number does not reflect the amount of hydrocodone I actually prescribed.
Moreover, during the trial, the government actually showed that my hydrocodone purchase contradicted with the Second Superseding indictment. Specifically, in Government Exhibit 40-1 Subsection (3) and 40-1 Subsection (4), I purchased 75,330 and 72,510 hydrocodone pills in 2013 and 2014, respectively (1/25/17 p. 2483).
Assuming these numbers are correct, based on the DEA Automation of Reports and Controlled Substance Ordering System (ARCOS) report (provided by the government in the discoveries), these numbers ranked #4 and #5 in the Stale of ALABAMA, in 2013 and 2014, respectively. The #1 hydrocodone purchaser out purchased me by 2-3 times (157,810 and 211,360 pills in 2013 and 2014, respectively). This comparison made it unlikely that my hydrocodone purchase “ranked among the top purchasers in the entire United States” as alleged in the Second Superseding Indictment.
Indeed, during the cross examination of the government witness Nancy Jackson, Unit Chief of ARCOS of the DEA, by my defense attorney Mr. Jason Darley, Ms. Jackson acknowledged that I was not “Top 10 purchaser” in the entire United States:
Q Okay. And I mean, were you asked if Dr. Ruan was in the top 10?
A That is–1 don’t recall the request. That was done–this started a long time ago. This was done before I arrived as ARCOS Unit Chief.
Q Do you–do you even know if he’s top 1O?
A No, I don’t.
Q Would you have the data at your disposal in your office in Washington?
A I’m sure he wasn’t in the top 10.
Q You’re sure he wasn’t?
A I’m sure he wasn’t. But–
Q But–l’m sorry. Go ahead.
A I’m sure he wasn’t in the top 10 in the U.S. But, I don’t know what–where his ranking was in the State either.
Q So you don’t even know if he’s in the top 1O of Alabama?
A No, I don’t. No, I don’t (1/25/17 p. 2514-15).
Clearly, the testimony of Ms. Nancy Jackson, the Unit Chief of ARCOS of the DEA, directly contradicted the part of the Second Superseding Indictment stating my hydrocodone purchase in 2013 and 2014 ranked among top purchasers in the nation. Further, Ms. Jackson also admitted that she could not even testify whether I personally dispensed these medications purchased under my DEA number (Id. p. 2508), which factually were for the purpose of stocking PPSA WC dispensary, used by Dr. Couch, me, and Dr. Chen.
Also, the prosecutors not only have not met their burden to prove their case in Count 4. Ms. Griffin herself appeared to be confused about Count 3 vs. Count 4, which is reflected during her statement at the concluding of the government presentation on Day 20 of the trial:
By Ms. Griffin; “For all the drugs but hydrocodone, which Is Count three [personal comment: should be Count 4], and then the fentanyl from Count four [should be Count 3), we contend we have met those as well to show a conspiracy to distribute outside the usual course of professional practice or for no legitimate medical purpose ” (2/7/17 p. 4462).
As we can see, Ms. Griffin knew she had not met her burden to prove the case, as she specifically acknowledged that the government failed with regard to the hydrocodone count. When the prosecutor Ms. Griffin could not even remember, at the end of its 3-week presentation, which Count was for what charge, how could they have met their burden to prove that we are guilty as charged beyond a reasonable doubt? Nevertheless, both Dr. Couch and I were convicted of Count 4, despite insufficient evidence, even acknowledged by the prosecutor. Thus something else rather than evidence played a major role in the jury’s minds. Could it be the prejudicial effect caused by the repetitive use of the term “Holy Trinity” by the prosecution team–the resultant impression of irreverence?
As we now know that “Holy Trinity” is, in essence, a fabricated label or frame, rather than a piece of valid physical or objective evidence, to prejudice the defendants by drawing on the jury’s religious background. Another issue shown, during the trial, concerns repeated observations that suggest pervasive witness coaching. The problem of witness coaching is not new. In his book titled “Prosecution complex,” Daniel S. Medwed, a law Professor at the University of Utah and a nationally recognized scholar in the field of wrongful convictions, writes:
“Improper witness coaching by prosecutors is one of the dirty secrets of the adversary system. a pervasive practice that subverts the search tor truth during trials. Prosecutors normally prepare-witnesses in closed-door sessions where no notes are taken. The participants in these encounters seldom disclose what happened, and cross-examination has limited utility in prompting such revelations” (82).
Indeed, observations consistent with witness coaching are replete. Here, I will only discuss a few which are related to “Holy Trinity.” The first example Is that with medical expert witnesses, Drs. Rahul Vohra and Tricia Aultman. Neither Dr. Vohra nor Dr. Aultman was board certified In Addiction Medicine. As a matter of fact, Dr. Vohra did not even know there is a board certification in Addiction Medicine.
Q Do you know that Dr. Ruan Is board certified in Addiction Medicine?
A There’s no such board.
Q There’s no board certification in Addiction Medicine.
A Not that I’m aware of) (Tr. 1/24/17 p. 2389).
Dr. Aultman is an Internist by training, working as a hospitalist. Her lack of basic pain management knowledge is evident as follows: When she was asked by the prosecutor Mr. Bodnar: “Can you explain to the jury what is a Spurling test?” Her response was: “I’m going to be honest. I’m not exactly sure” (Tr. 2/6/17 p. 4291). When she was asked by Mr. Bodnar: “What’s Gralise?” Her response was: “I believe it’s also a fentanyl” (Id. p. 4292-93). The fact is Gralise Is sustained release gabapentin, an anticonvulsant used for managing neuropathlc pain, and it is not an opioid.
Also, pain management physicians are usually familiar with the term “Pseudoaddiction” which simply means seemingly drug seeking behavior of patients due to poorly controlled pain. When this question was asked by the defense attorney Mr. Sharman, she equivocated as follows:
Q You’re familiar with the term “pseudoaddictlon,” are you not?
A I’m not entirely sure what you mean by pseudoaddiction.
Q Have you ever heard that term?
A I am not sure I have (Tr. 2/6/17 p. 4367).
On questions not normally coached, three “expert” government witnesses each gave a different answer when it came to explain how potent fentanyl is in comparison to morphine:
The DEA agent Ms. Susannah Herkert told the jury: “The fentanyl …is considered to be 50-100 times as potent as morphine” (Tr. 1/6/17 p. 115-16).
Dr. Aultman told the jury: “It is, because fentanyl itself is more than twice as strong as morphine” (Tr. 2/6/17 p. 4303).
Dr. Vohra told the jury: “It is something that’s several hundred times more powerful than morphine” (Tr. 1/23/17 p. 2200).
This observation gives us a rough idea what type of “pain specialists” Dr. Vohra and Dr. Aultman were. However, when it came to questions related to “Holy Trinity,” both Dr. Vohra and Dr. Aultman became quite knowledgeable. In contrary, neither Dr. Couch nor I knew what “Holy Trinity” was in a pain clinical setting, despite that both of us were board certified in Addiction Medicine [I received mine In December 2010. I was also the immediate President of Alabama Society of Addiction Medicine. Also, Professor Warfield, the Lowenstein Distinguished Professor at Beth Israel Hospital of Harvard Medical School and a world renowned pain specialist, did not know what “Holy Trinity” was in a clinical setting (Tr. 2/8/17 p. 4702).
The explanation to this stark difference is simple: both Dr. Vohra and Dr. Aultman were coached by the government and thus became versed with the law enforcement term of “Holy Trinity.” None of the rest of us were similarly trained by the prosecutors or law enforcement agents.
The next example, I believe, is not just simple witness coaching. The government witness involved is Mr. Doug Moore, who worked for United Healthcare. The following statement was made by the prosecutor Mr. Bodnar to Judge Granade and defense attorneys where the jury was not present.
By Mr. Bodnar: “Doug Moore, who works for United Healthcare …his testimony is going to be…sometimes after Dr. Ruan and Dr. Couch were indicated in 2015, found out from online that Dr. Ruan and Dr. Couch had been indicted, they had a program already in place in which they looked at certain doctors to see whether or not they were prescribing–or what level of Holy Trinity combinations any given doctor at United Healthcare was prescribing.
His testimony is-not asked by the DEA or FB\ or U.S. Attorney’s office, but once they learned that Dr. Ruan Dr. Couch had been Indicted, they created a report about the number of Holy Trinity combinations that Dr. Ruan and Dr. Couch have prescribed and then contacted the U.S. Attorney-well, I think they contacted the FBI and passed us this document” (Tr.1/25/17 p. 2598-99).
Here, Mr. Bodnar repeatedly clarified that United Healthcare had contacted the government, not the other way around. But, my arguments are:
We already know “Holy Trinity” Is a law enforcement term. according to Agent Deputy Kelley’s testimony, shown previously.
We know that none of PPSA physicians, staff members, patients knew what “Holy Trinity” was; how could United Healthcare, an insurance company, all of a sudden become interested in a law enforcement term or argument. and take on a role as a law enforcement agency on its own?
We have seen, from the above dialogue, that Mr. Bodnar told the jury that the United Healthcare found out that Dr. Couch and I were indicted from online report in 2015, and then United Healthcare did their own analysis as to how many PPSA patients were on ”Holy Trinity” drug combinations. Yet, none of the Indictments Including the Initial Indictment (April 2015), the first Superseding Indictment (October 2015) or the Second Superseding Indictment (April 2016) contained the term “Holy Trinity.”
The more Mr. Bodnar insisted that it was the United Healthcare that contacted the government on its own, the more I believe it was the other way around, because United Healthcare is not a law enforcement agency. That is why I believe Mr. Bodnar did more than just witness coaching in preparation of his witness Mr. Doug Moore.
The last example of witness coaching is an Interesting one. Here, we will see a shoddy coaching job by the prosecutor Ms. Griffin resulting in a poor performance of her “student,” the government witness Ms. BP. Ms. P already pled guilty to a drug count (Tr. 2/1/17 p. 3873), but her sentence was still pending on her participation of my trial as a government witness. Since the “Holy Trinity” seemed to be a big deal, although there was no evidence to show any awareness of “Holy Trinity” at PPSA in the entire trial discoveries, the prosecutors were desperate to show the jury that there was something out there incriminating the defendants and PPSA staff were aware of “Holy Trinity.” Thus, the coaching of Ms. BP was for the purpose that she would admit that she knew what “Holy Trinity” was.
Unfortunately for the “coach,” Ms. Griffin gave a wrong suggestion when she conducted her direct examination on Ms. P, and Ms. P provided a wrong answer:
Q Do you know what the Holy Trinity is?
A Yes, ma’am.
Q What is it?
A Well, I know it’s Soma, Xanax–I don’t know it for sure. I just know it’s Soma, Xanax-
Q Was it Soma and Adderall–
A Adderall, Adderall–
Q–that you were told to back off on by Dr. Couch?
A Uh-huh (Nodding head affirmatively) (Tr. 2/1/17 p. 3827).
As we can see, Ms. P could not even remember what “Holy Trinity” was [due to poor coaching or poor learning], but she pretended she knew what “Holy Trinity” was, because she had been “instructed” to do so. Unfortunately, she could not remember what the combination was–it involved an opioid (based on the expanded definition by Horsfall and Sprague), not Adderall, a stimulant. But, when given the wrong suggestion (Adderall) by Ms. Griffin, she readily took it even though she really had no clue, she was already conditioned to Ms. Griffin’s coaching.
In this trial, everything related to “Holy Trinity” was erroneously admitted to court by Judge Granade, despite repeated vehement objections by the defense attorneys. The very first objection to the introduction of evidence related to “Holy Trinity” occurred during the direct examination of the first government witness, a DEA diversion agent, Ms. Susannah Herkert, by the prosecutor Mr. Bodnar:
Q –what is some of those combinations of drugs?
A …throughout the United States we commonly see drug seekers wanting an opioid or an narcotic, a benzodiazepine, and often a codeine-based cough syrup or a muscle relaxant similar to carisoprodol.
Q And is there a term for that type of–cocktail?
A Yes, it’s considered a drug cocktail, or the Holy Trinity.
Mr. Essig: Your Honor, I’m going to object to that testimony.
THE COURT: On what ground?
Mr. Essig: There is no relevance shown to this case whatsoever.
THE COURT: Overruled (Tr. 1/6/17 p. 121).
As we can see, despite vigorous objection from the defense team, “evidence” associated with the ”Holy Trinity” was wrongly admitted by Judge Granade, when factually, nothing about “Holy Trinity” had any veritable probative value and thus should never have been admitted, based on the F. R. Evld. 401 and 402. As Deputy Kelley has admitted, “Holy Trinity” ls a law enforcement term. Defense attorney Gordon Armstrong also insisted that “Holy Trinity” was nothing but a government argument and raised his objection to Judge Granade: “We think that’s inappropriate. We think that’s extremely prejudicial, its’ argument…That’s not a medical tern and that’s not in the data. That’s argument by the government. So we would object to that” (1/9/17 p. 251).
Nevertheless, the “Holy Trinity” became a major theme in showing wrong doing of the defendants. At trial, multiple government witnesses testified in various details on the “Holy Trinity,” just to name a few: DEA diversion agent Susannah Herkert (Tr. 1/6/17 p. 121-22, p. 173-74), DEA analyst Paul Short (Tr. 1/9/17 p. 350-54), agent Patrick Shawn Kelley (Tr. 1/29/17 p. 1806-07), medical expert Dr. Rahui Vohra (Tr. 1/23/17 p. 2192-93, p. 2434), United Healthcare representative Doug Moore (Tr.1/25/17 p. 2633-34, p. 2643), medical expert Tricia Aultman (Tr. 2/6/17 p. 4253-54, p. 4272-74, p. 4278, p. 4280, p. 4283-84,p.4287-88, p.4290, p.4292, p.4295)
Taking advantage of Judge Granada’s erroneous rulings in letting everything related to “Holy Trinity” be admitted as evidence, the prosecutors were able to incriminate the defendants before the jury using questions directly related to prescribing the “Holy Trinity” as a de facto given in their line of questioning. For example, during the direct examination of the government expert Dr. Tricia Aultman by Mr. Bodnar on the care rendered by me to my patient Ms. SW, the following questions were asked and answered: ·
“So did she receive the Holy Trinity on this date?” (Id. p. 4278)
“So even after being told that she might be doctor shopping, she still received the Holy Trinity?” (Id. p. 4280) “Does she continue month after month to get the Holy Trinity?” (Id.)
“–does she still receive the Holy Trinity of carfsoprodol…” (Id. p. 4283) “In addition to the Holy Trinity, what is she receiving?” (Id. p. 4289)
“And here does it show with the Klonopln, the Soma, and the Opana that she is still receiving the Holy Trinity?” (Id. p. 4288) To this prejudicial matter, here are my comments:
The care provided to SW by me was between 2011 and 2015 (Indictment period), and the definition of “Holy Trinity” at that time was as defined in Forrester’s paper (hydrocodone, xanax, soma). Reviewing of her chart revealed that SW was never on the hydrocodone/xanax/soma combination thus her regimen could not be alleged as “Holy Trinity” in the first place.
The definition of the “Holy Trinity” was deliberately expanded in September 2016 by the government’s effort through the paper by Horsfall and Sprague, allowing her prior medication regimen be labeled as the “Holy Trinity.” Recall the last statement of the above, she was taking Klonopin, Soma, and Opana, a combination not fitting the definition of “Holy Trinity” In Forrester’s paper; yet, it met the new definition by Horsfall and Sprague In their post-indictment paper.
As we can see in the newly defined “Holy Trinity” allowed the prosecutors to question witnesses along the line of the “Holy Trinity” for earlier services provided to SW from 2011 to 2015, despite the use of term newly defined years later. Without the newly defined “Holy Trinity,” the card of “Holy Trinity” could not have been played by the prosecutors because most of PPSA patients alleged to have received the “Holy Trinity” did not receive the “Holy Trinity” according to the definition of “Holy Trinity” during that time frame.
Interestingly, as a result of the change of definition of the original “Holy Trinity” to the new definition by Horsfall and Sprague, hydrocodone prescribing by defendants was barely mentioned during the entire trial, which is the reason that the- prosecutor Ms. Griffin admitted that the government did not prove Count 4–the conspiracy for dispensing hydrocodone count. [“For all drugs but hydrocodone…we contend we have met those…”(Tr. 2/7/17 p. 4462)]
Nevertheless, both defendants were convicted of Count 4 (conspiracy to distribute hydrocodone) and most other Counts charged, despite the fact that there was insufficient evidence of actual guilt. The result of such a contradictory outcome, I believe, was planned for by the prosecutors–playing the card of “Holy Trinity” to cast a semblance of desecration of Christianity via the pervasive use of the fabricated frame of prescribing the “Holy Trinity.” This was especially powerful when the prescribing of “Holy Trinity” was heard by the jury alongside slang terms such as “ice,” “angel dust,” and “crystal” (Tr. 1/6/17 p. 172). Its prejudicial effect caused by the Image of impiety proved to be quite consequential, considering the trial was conducted in the Southern District of Alabama, the most conservative district in the nation.
I know of an old Asian saying, “If you are out to condemn someone, you can always trump up a charge.” It appears that this practice actually still applies to modern America today. The saga of “Holy Trinity” tells us how far the prosecutors could go in order to reach their ends–to get convictions. I believe it is when innocent people are purposely criminalized while the dishonest prosecutors are glorified and rewarded, that grave injustice has been served.
Xiulu Ruan, MD
