MOBILE, Ala. (WALA) – An Alabama doctor serving a 21-year prison sentence will get a rare shot at reversing his conviction at the U.S. Supreme Court.

A federal jury in Mobile after a seven-week trial convicted Dr. Xiulu Ruan, 58, in 2017 of writing illegal prescriptions, and a judge imposed punishment. The Atlanta-based 11th U.S. Circuit Court of Appeals upheld the conviction last year. For the vast majority of criminal convictions, that’s the end of the road.

But the U.S. Supreme Court recently agreed to the hear Ruan’s appeal, along with a case from Wyoming with similar issues.

“It is quite a rarity for a case, any case, to get accepted for review by the Supreme Court,” said Mobile lawyer Dennis Knizley, who represented Ruan during his trial. “You think about that, ‘Well, I’ll take my case to the Supreme Court.’ Well, it just doesn’t work that way. I mean, it is just a well less than 1 percent of the cases are ever heard by the United States Supreme Court.”

The Supreme Court grants about 80 of the 7,000 to 8,000 requests it receives each term.

“From the cases I’ve tried at the trial level, this would be the first case in my experience – and there’s been many of them – that ever went to the United States Supreme Court,” he said.

The justices will examine two issues. The first is whether prosecutors must prove both that a doctor has written prescriptions outside of the normal course of practice and that the prescriptions were not medically necessary. The 11th Circuit has held that prosecutors must prove one or the other. But other appeals courts have said they must prove both elements.

The other issue is whether doctors can raise a “good faith” defense that they believed the prescriptions they wrote were medically necessary.

In the wake of an overdose epidemic that has claimed hundreds of thousands of lives, federal prosecutors in Mobile and across the country have cracked down on doctors who write prescriptions for addicts.

Should the Supreme Court rule in favor of Ruan, though, it could make it harder for prosecutors to win cases.

“If the decision is that the ‘good faith’ exception is going to be broadened, that will certainly provide more of a defense mechanism,” Knizley said. “But I think the initial one, whether it’s outside the normal course of medical practice and in the conjunctive – not for medical necessity – would certainly change the prosecution of these cases dramatically and make it more difficult for the government to get convictions.”

Knizley noted that prosecutors, for instance, abandoned their contention that another of his clients – Dr. Chykeetra “Che Che” Maltbia – that prescriptions she wrote were not medically necessary. It did not impact the ultimate outcome, however, because prosecutors still were able to convince a jury that the prescriptions were outside the normal course of medical practice. Maltbia is due to be sentenced next week, but Knizley said she would have a strong appeal issue of the high court sides is Ruan and requires prosecutors to prove both elements.

“So in that case, if they were to adopt the theory that both of these prongs had to be proven in the conjunctive, Maltbia’s case would be immediately reversed,” he said.

The federal government urged the court not to take the Ruan case.

“The court of appeals correctly rejected that contention, and its decision neither contravenes any precedent of this Court nor meaningfully conflicts with any decision of another court of appeals,” a government filing states.

A group of health law and policy professors weighed in on the side of Ruan, urging the court to take the case. Kelly Dineen, a Creighton University law professor representing the group, told FOX10 News that prosecutors have criminalized what amounts to mistakes about doctors.

“Our opinion is that you ought to be able to have to prove more than you would have to simply get a malpractice verdict in order to convict somebody criminally,” she said.

Dineen said the case is ripe for the Supreme Court because appeals courts have used different legal standards for what the government must prove and what defenses are available to accused doctors.

Dineen said there are other ways to address careless or negligent behavior by doctors, including malpractice lawsuits and punishments by medical licensing boards.

“Our position is that the most, the harshest, penalties … ought to be reserved for those that really are engaged in knowingly criminal conduct,” she said.

Ruan operated a pain management clinic in Mobile when the FBI began investigating him along with co-defendant Dr. John Patrick Couch and accused them oof operating a massive “pill mill.” Although Couch has not appealed, he would benefit if the Supreme Court reversed the conviction and ordered a new trial.

Today, Ruan remains incarcerated at the Federal Correctional Institution in Oakdale, Louisiana, with a projected release date in 2035. Knizley said he has not talked to him since the high court agreed to take the case but has spoken with the doctor’s relatives.

“And, of course, they’re ecstatic that it’s going to be reviewed,” he said.

The Supreme Court will hear oral arguments next year, with a decision expected in the summer.

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