United States Court of Appeals for the Fifth Circuit United States Court of Appeals Fifth Circuit ____________ FILED May 6, 2024 No. 23-30191 ____________ Lyle W. Cayce Clerk United States of America,

Plaintiff—Appellee,

versus Randy J. Lamartiniere,

Defendant—Appellant. ______________________________

Appeal from the United States District Court for the Middle District of Louisiana USDC No. 3:18-CR-87-1 ______________________________ Before Davis, Smith, and Haynes, Circuit Judges. W. Eugene Davis, Circuit Judge: A jury convicted Dr. Randy Lamartiniere, an internal medicine doctor, of twenty counts of unlawful distribution of controlled substances. On appeal, Lamartiniere challenges the district court’s jury instructions and the sufficiency of the evidence supporting his convictions. Finding no reversible error, we AFFIRM. Case: 23-30191 Document: 126-1 Page: 2 Date Filed: 05/06/2024

No. 23-30191

I. A. At the time of his trial, Lamartiniere had been practicing as a licensed physician specializing in internal medicine for approximately thirty years. In 2012, he was hired as a staff physician at a clinic in Baton Rouge, Louisiana, operated by Ochsner Health. At first, Lamartiniere mainly saw general internal medicine patients, but that started to change in 2013 as he saw a growing number of chronic pain patients. By 2014, Ochsner began to develop concerns about Lamartiniere’s management of opioid and narcotic prescriptions and his inability to timely maintain his patient records. After several warnings, Ochsner terminated Lamartiniere at the end of 2014. Following his termination from Ochsner, Lamartiniere opened his own “direct primary care” practice in early 2015. At his new practice, patients paid a $300 membership fee in exchange for three months of medical care for any issue that arose during that time period. The practice accepted neither insurance nor Medicaid. Although Lamartiniere testified that he initially hoped to see mostly internal medicine patients, within a year of opening the practice, he had between 200-250 patients, eighty percent of whom were pain management patients. In early 2015, shortly after Lamartiniere opened his practice, the Drug Enforcement Administration (“DEA”) launched an investigation into his prescription practices after receiving a tip from a confidential informant. As part of the DEA’s investigation, it recruited two undercover agents to pose as chronic pain patients seeking controlled substances from Lamartiniere. Over the course of almost six months, the undercover agents, outfitted with recording devices, visited Lamartiniere’s practice a total of nine times, each time leaving with a prescription for a controlled substance. In November

2 Case: 23-30191 Document: 126-1 Page: 3 Date Filed: 05/06/2024

No. 23-30191

2015, the DEA executed a search warrant for fifty patient files from Lamartiniere’s practice. In 2021, a superseding indictment charged Lamartiniere with twenty- eight counts1 of unlawful distribution of Schedule II controlled substances in violation of 21 U.S.C. § 841(a)(1). Counts 1 through 7 of the superseding indictmen