USA v. Dextradeur

OCR transcription for search; preserved printed pages are authoritative

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IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLORADO
Judge Charlotte N. Sweeney
Civil Action No. 23-cr-00387-CNS
UNITED STATES OF AMERICA,
Plaintiff,
V.

TODD C. DEXTRADEUR,

Defendant.

ORDER

Before the Court is the government’s motion in limine to exclude evidence of
Defendant’s “good care” of certain patients. ECF No. 94. Defendant responded in
opposition. ECF No. 102. For the reasons below, the Court GRANTS in part and DENIES
in part the government's motion.

I. LEGAL STANDARDS

A. Motions in Limine

Motions in limine are intended to aid the trial process by enabling the Court “to rule
in advance of trial on the relevance of certain forecasted evidence, as to issues that are
definitely set for trial, without lengthy argument at, or interruption of, the trial.” United
States v. Cline, 188 F. Supp. 2d 1287, 1291 (D. Kan. 2002) (quoting Palmieri v. Defaria,

88 F.3d 136, 141 (2d Cir. 1996)). In many cases, however, it is more appropriate to defer

AUTHENTICATED
U.S. GOVERNMENT
INFORMATION
GPO

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such rulings until trial, allowing the Court to assess the issue based on the evidence
presented. Koch v. Koch Indus., Inc., 2 F. Supp. 2d 1385, 1387–88 (D. Kan. 1998).
The moving party carries the “burden of demonstrating that the evidence is
inadmissible on any relevant ground.” Pinon Sun Condo. Ass’n, Inc. v. Atain Specialty
Ins. Co., No. 17-cv-01595-CMA-NRN, 2020 WL 1452166, at *3 (D. Colo. Mar. 25, 2020)
(quoting First Sav. Bank, F.S.B. v. U.S. Bancorp, 117 F. Supp. 2d 1078, 1082 (D. Kan.
2000)). Granting or denying a motion in limine, however, does not preclude the Court
from later admitting or excluding certain evidence at trial because a “court may alter its
limine ruling based on developments at trial or on its sound judicial discretion.” Id. (quoting
First Sav. Bank, 117 F. Supp. 2d at 1082). A ruling in limine does not “relieve a party from
the responsibility of making objections, raising motions to strike, or making formal offers
of proof during the course of trial.” Thweatt v. Ontko, 814 F.2d 1466, 1470 (10th Cir. 1987)
(citation and quotation omitted). “The admission or exclusion of evidence lies within the
sound discretion of the trial court . . . .” Robinson v. Missouri Pac. R.R. Co., 16 F.3d 1083,
1086 (10th Cir. 1994).
B. 	Federal Rule of Evidence 404(b)
Rule 404(b) provides that “[e]vidence of any other crime, wrong, or act is not
admissible to prove a person’s character in order to show that on a particular occasion
the person acted in accordance with the character.” Fed. R. Evid. 404(b)(1). There are
two notable exceptions to Rule 404(b)(1).
First, Rule 404(b) only applies to evidence that is extrinsic to the crime charged—
the rule “does not cover evidence that is considered ‘intrinsic.’” United States v. Kupfer,
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797 F.3d 1233, 1238 (10th Cir. 2015) (quoting United States v. Irving, 665 F.3d 1184,
1212 (10th Cir. 2011)). Evidence is intrinsic when it (a) is “inextricably intertwined with the
charged conduct,” (b) occurs “within the same time frame as the activity in the conspiracy
being charged,” (c) is “a necessary preliminary to the charged conspiracy,” (d) provided
“direct proof of the defendant’s involvement with the charged crimes,” (e) is “entirely
germane background information, . . . directly connected to the factual circumstances of
the crime,” or (f) is “necessary to provide the jury with background and context of the
nature of the defendant’s relationship to his accomplice.” Id. (citations and quotations
omitted).
Second, extrinsic “evidence may be admissible for another purpose, such as
proving motive, opportunity, intent, preparation, plan, knowledge, identity, absence of
mistake, or lack of accident.” Fed. R. Evid. 404(b)(2). To properly admit Rule 404(b)(2)
evidence, the Court considers whether (1) the evidence is offered for a proper purpose
under Rule 404(b); (2) the evidence is relevant under Rule 401; (3) the evidence’s
probative value is not substantially outweighed by the potential for unfair prejudice; and
(4) upon request, the court offers the jury a limiting instruction pursuant to Rule 105.
United States v. Henthorn, 864 F.3d 1241, 1248 (10th Cir. 2017).
“Admissibility of evidence under Rule 404(b) ‘involves a case-specific inquiry that
is within the district court’s broad discretion.’” United States v. Henthorn, 864 F.3d 1241,
1248 (10th Cir. 2017) (quoting United States v. Mares, 441 F.3d 1152, 1157 (10th Cir.
2006)).
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II. 	ANALYSIS
The government seeks to exclude evidence (A) that Defendant issued authorized
prescriptions to other patients and otherwise provided “good care” to certain patients, and
(B) that the DEA renewed Defendant’s registration in June 2020. ECF No. 94 at 2–3. The
Court addresses each in turn.
A. 	Good-Care Evidence
The government alleges that Defendant knowingly issued specific prescriptions
without authorization. ECF No. 68 (Superseding Indictment). The government thus
argues that evidence that Defendant issued authorized prescriptions to other patients or
otherwise provided them with good care is irrelevant to the charges. ECF No. 94 at 2. The
Court agrees.
Several circuit courts have upheld the exclusion of similar evidence. The Seventh
Circuit has observed that “[e]vidence that a defendant acted lawfully on other occasions
is generally inadmissible to prove he acted lawfully on the occasion alleged in the
indictment.” United States v. Reese, 666 F.3d 1007, 1020 (7th Cir. 2012). The Sixth
Circuit has held that, “for the same reason that prior bad acts may not be used to show a
predisposition to commit crimes, prior good acts generally may not be used to show a
predisposition not to commit crimes.” United States v. Daneshvar, 925 F.3d 766, 779 (6th
Cir. 2019). And the Eleventh Circuit has held that Rule 404(a)(1) excludes the use of
“good-care evidence as inadmissible character evidence.” United States v. Ifediba, 46
F.4th 1225, 1238 (11th Cir. 2022) (upholding the district court’s exclusion of a physician’s
“good-care evidence showing that he provided legitimate medical treatment to some
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patients”); id. (“[T]he government never alleged that Ifediba[, a physician,] unlawfully
treated every patient who walked through CCMC’s doors; indeed, it conceded that his
treatment of some patients was legitimate. Thus, it was no defense that Ifediba lawfully
treated some patients.” (emphasis added)); see also United States v. Evers, No. 3:19-
CR-250, 2022 WL 16748601, at *2 (M.D. Pa. Nov. 7, 2022) (deferring ruling but agreeing
with principle that “[e]vidence related to the care Defendant provided to his patients
outside the conduct charged, i.e., care provided to patients other than the three
individuals identified in the Superseding Indictment, is generally irrelevant based on the
relevancy principles of Federal Rules of Evidence 401 and 402”).
Although the government does not cite any Tenth Circuit caselaw, the Court finds
the above authority persuasive. What’s more, Defendant offered no authority beyond the
general principle that “Dr. Dextradeur has a qualified constitutional right to present a
complete defense.” ECF No. 102 at 3. That unexceptional principle does not sway the
Court. See Ifediba, 46 F.4th at 1238 (rejecting the defendant’s argument that “exclusion
violated his constitutional right to present a complete defense to the charge of unlawful
distribution of controlled substances”).
The Court also questions how Defendant’s patients could testify about Defendant’s
subjective belief, as Defendant contends. ECF No. 102 at 3–4. Such testimony would be
inherently speculative and likely inadmissible on other grounds (e.g., hearsay).
Accordingly, the Court grants the government’s motion on this issue. Defendant
may revisit the issue at the close of the government’s case. See Pinon Sun Condo. Ass’n,
2020 WL 1452166, at *3.
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B. 	The DEA’s Renewal of Defendant’s Registration
In June 2020, DEA Investigator Cody Lyon investigated whether it should renew
Defendant’s DEA registration to prescribe controlled substances. ECF No. 102 at 4.
According to Investigator Lyon, at that time of his investigation, he was aware of the 2018
Colorado Medical Board Stipulation and discussed the specifics of it with Defendant
before approving the renewal of Defendant’s DEA registration. Id. The government
argues that the same logic governing the good-care evidence applies to the DEA renewal
of Defendant’s registration in June 2020. On this issue, the Court disagrees with the
government.
The parties recently entered the following stipulation concerning the Colorado
Medical Board act:
(1) 	On December 18, 2018, Dr. Dextradeur entered into a Stipulation with
the Colorado Medical Board, in which he admitted the following in
connection with medical care unrelated to the patients involved in this
case:
(a) 	That he provided treatment for chronic pain patients from
2011 to 2017.
(b) 	That he exhibited poor risk assessment of patients who were
moderate to high risk of substance abuse; he did not clearly
delineate that he identified patients as opioid dependent and
he demonstrated a poor understanding of the management
of opioid dependency; he subsequently provided high opioid
management that could be dangerous.
(c) 	That he prescribed doses of opioid medications higher than
recommended; combined opioids, benzodiazepines, and
suboxone 	without 	coordinating 	with 	a 	psychiatrist; 	and
prescribed suboxone without induction with initial use. He
prescribed 	one 	patient 	a 	benzodiazepine 	after 	he
discovered 	that 	the 	patient 	was 	taking 	the 	medication
illegally.
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(d) 	That he failed to document regular physical examinations
after 	initial 	evaluations. 	Subsequent 	follow-up 	rarely
included physical examinations. As a result, there was a lack
of correlation between escalating doses of opioids in certain
cases with patients’ pain complaints. He also disregarded
inconsistent urine drug screens in at least two patients.
(2) 	The Medical Board issued a letter of admonition and placed Dr.
Dextradeur on probation for five years, and continued his medical
license subject to the condition that he complete an educational
program 	and 	documentation 	seminar 	through 	the 	Center 	for
Personalized 	Education 	for 	Physicians 	and 	a 	prescribing 	course
through Vanderbilt University.
ECF No. 98 (Joint Proposed Stipulation).
Because the joint stipulation will be admitted as evidence at trial, and because
some of the prescriptions charged in this case occurred after Defendant submitted his
renewal application (May 11, 2020), the Court finds that evidence concerning the DEA’s
June 2020 renewal is relevant and admissible. Like the Court’s good-care evidence ruling,
the government may renew its objection if appropriate during trial. See Pinon Sun Condo.
Ass’n, 2020 WL 1452166, at *3.
III. 	CONCLUSION
For the reasons above, the government’s motion in limine, ECF No. 94, is
GRANTED in part and DENIED in part.
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DATED this 24th day of February 2025.

BY THE COURT:

Charlotte NSweéney
United States Vistrict J e