Prosecutors had accused Smithers of prescribing controlled substances, including fentanyl, hydromorphone, oxycodone, and oxymorphone, to every patient at his Martinsville, Virginia office since its opening in August 2015[2]. Many patients reportedly traveled significant distances to see Smithers, who did not accept insurance and allegedly collected over $700,000 in cash and credit card payments before his office was raided by law enforcement in March 2017[2].
In May 2019, jurors convicted Smithers on 861 counts, following instructions that the government needed to prove he acted “without a legitimate medical purpose or beyond the bounds of medical practice”[2]. However, the appeals court deemed this instruction defective in light of a 2022 U.S. Supreme Court decision that clarified the necessity of proving a defendant “knowingly or intentionally” acted in an unauthorized manner when prescribing controlled substances[2].