United States Court of Appeals For the Seventh Circuit ____________________ No. 20‐2783 UNITED STATES OF AMERICA, Plaintiff‐Appellee, v. WILLIAM MIKAITIS, Defendant‐Appellant. ____________________

Appeal from the United States District Court for the Northern District of Illinois, Eastern Division. No. 16 CR 361 — Virginia M. Kendall, Judge. ____________________

ARGUED NOVEMBER 10, 2021 — DECIDED APRIL 29, 2022 ____________________

Before MANION, ROVNER, and WOOD, Circuit Judges. MANION, Circuit Judge. William Mikaitis stood trial on drug charges. The government argued he was a no‐show doc‐ tor at a weight‐loss clinic who participated in illegally distrib‐ uting drugs. But he denied knowing about illegal activity. The district judge issued a deliberate‐avoidance instruction. The jury convicted. The judge sentenced Mikaitis to 30 months. He appeals, arguing that the evidence did not support the in‐ struction. But we affirm. 2 No. 20‐2783

I. Facts Michael Jennings ran Results Weight Loss Clinic in Lom‐ bard, Illinois. He was not a doctor or other medical profes‐ sional. He worked with a doctor to keep Results open, but that doctor lost his license. So Jennings needed another doctor. Someone connected Jennings to Mikaitis, a doctor licensed in Illinois with several decades of experience. They met around October 2012. Mikaitis was working full‐time for a hospital in Lockport, Illinois. Jennings offered to pay Mikaitis cash to se‐ cure a Drug Enforcement Agency registration number for the clinic and to review patient charts. Mikaitis agreed. So he ob‐ tained a DEA number and authorized Jennings to use it and Mikaitis’s credit card to order phentermine and other diet medications in bulk to distribute to patients. These diet pills are controlled substances. Over the next two years, Jennings ordered over 530,000 pills for over $84,000 using Mikaitis’s credit card and DEA number. Jennings reimbursed Mikaitis for these costs. The bulk drug shipments Jennings ordered were initially delivered to Mikaitis’s Lockport office. But Mikaitis allowed Jennings to take the drugs from Lockport to Results. And Mi‐ kaitis changed the delivery address so future shipments went directly to Results. Jennings saw many patients at Results. Mikaitis appeared weekly to get $1,750 cash and review four to eight charts. He always entered the clinic through a side door, went “right to Mr. Jennings’ office” to review the files set aside for him, and “didn’t look anywhere in the clinic,” according to Mikaitis’s testimony. He decided whether to allow drugs based on those charts. But Results also gave drugs—in person and by mail— to many patients whose charts he never reviewed. He testified No. 20‐2783 3 he knew Jennings lacked a medical license. Mikaitis testified he never saw any signs the clinic shipped out drugs. But a nurse practitioner who worked at the clinic testified she no‐ ticed almost immediately that Jennings was unlawfully dis‐ tributing drugs. She quit two days after starting. In all, Jennings paid Mikaitis about $98,000 cash, in addi‐ tion to reimbursement for over $85,000 in drug costs. Mikaitis deposited most of his weekly cash into a bank account he shared with his mistress, which funded their affair. II. Charges and Trial A grand jury indicted Mikaitis on 17 counts. Count 1 charged Mikaitis and Jennings with conspiracy “to knowingly and intentionally” distribute benzphenter‐ mine, phendimetrazine, and phentermine. Counts 2–8 charged them with “knowingly and intentionally” distrib‐ uting controlled substances “outside of the u