Intrinsic Evidence and Rule 404(b): Sixth Circuit’s Clarification in United States v. Sadrinia

Introduction

United States v. Jay M. Sadrinia (6th Cir. April 16, 2025) arises from a tragic overdose death following a dentist’s prescriptions of powerful narcotics. Dr. Sadrinia was tried, convicted, and sentenced for prescribing morphine and oxycodone to his patient, Cheyenne Witt, without a legitimate medical purpose, resulting in her fatal overdose. On appeal, the Sixth Circuit examined two core issues: (1) whether the evidence was sufficient to prove Sadrinia’s knowledge that his prescriptions were unauthorized, and (2) whether the district court erred in admitting misconduct testimony as “intrinsic” evidence under Federal Rule of Evidence 404(b). The court affirmed sufficiency but held that the admission of unrelated bad‐act testimony violated Rule 404(b) and required vacating the convictions and remanding for a new trial.

Summary of the Judgment

The Sixth Circuit’s opinion, authored by Judge Kethledge, reached three principal conclusions:

1. Sufficient evidence supported the conviction under 21 U.S.C. § 841(a)(1) & (b)(1)(C). Expert testimony and pharmacy‐regulation evidence permitted a rational jury to infer that prescribing 30 mg morphine tablets—twice exceeding Kentucky’s three‐day limit—fell outside the usual course of Dr. Sadrinia’s professional practice and lacked a legitimate medical purpose.
2. The district court abused its discretion by admitting testimony from three former employees—Dr. Kaitlin Everidge, Dona Ducker, and Elexis Widener—about Dr. Sadrinia’s unrelated bad acts as “intrinsic” evidence of the charged offenses. Those events occurred months before or after the charged conduct and bore no causal, temporal, or spatial connection to Ms. Witt’s treatment.
3. Because the improper 404(b) receipt of evidence was not harmless beyond a reasonable doubt—and indeed the prosecutor emphasized that character evidence in closing—the convictions and sentence were vacated, and the case remanded for a new trial. A challenge to the indictment’s conjunctive “and” pleading was rejected under the “charge in the conjunctive, prove in the disjunctive” principle.

Analysis

Precedents Cited

• Ruan v. United States (597 U.S. 450, 2022): Established that authorized prescribers can be prosecuted under § 841(a)(1) only if they knowingly prescribe outside the usual course of professional practice and without legitimate medical purpose, quoting 21 C.F.R. § 1306.04(a).
• United States v. Jenkins (593 F.3d 480, 6th Cir. 2010): Articulated the sufficiency‐of‐the‐evidence standard under Rule 29 and the harmless‐error inquiry for improper evidence.
• United States v. Sadler (24 F.4th 515, 6th Cir. 2022): Defined “intrinsic” evidence as that part of the same criminal episode or inextricably intertwined with the charged act, contrasted with “extrinsic” bad‐act evidence requiring Rule 404(b) notice.
• United States v. Hardy (228 F.3d 745, 6th Cir. 2000) and Barnes (49 F.3d 1144, 6th Cir. 1995): Limited the scope of intrinsic evidence by insisting on strict temporal, causal, or spatial connections.
• Miller (471 U.S. 130, 1985) and LaPointe (690 F.3d 434, 6th Cir. 2012): Addressed grand‐jury indictment requirements, including that an indictment’s conjunctive pleading may be proved disjunctively without constructive amendment.

Legal Reasoning

1. Sufficiency of Evidence: The core element was knowledge—did Dr. Sadrinia know the prescriptions were unauthorized? The Sixth Circuit applied the familiar Rule 29 standard, viewing all evidence in the government’s favor. Expert testimony established that 30 mg morphine is virtually never indicated in dental practice outside end‐of‐life care. Pharmacy‐regulation evidence showed the August 24 script exceeded Kentucky’s three‐day limit. The jury heard Dr. Sadrinia’s own chart note saying Ms. Witt was “healing normally.” A rational jury could infer that a 30‐year practitioner knew he was stepping outside legitimate practice.

2. Rule 404(b) and Intrinsic Evidence: Federal Rule 404(b) prohibits admission of other “crimes, wrongs, or acts” to prove character propensity. Such evidence is admissible only for proper purposes (e.g., intent or knowledge) and with “reasonable notice.” An exception exists for “intrinsic” evidence that forms part of the same criminal episode or is inextricably intertwined. The Sixth Circuit has strictly confined intrinsic evidence to acts sharing a tight temporal, causal, or spatial nexus with the charged conduct.

Here, the district court admitted three witnesses’ testimony—two about a December 2020 prescription‐pad incident and one about a December 2020 firing—as intrinsic to Dr. Sadrinia’s August 2020 treatment of Ms. Witt. The Sixth Circuit held those events too remote in time and context to be intrinsic: they were classic extrinsic bad‐act evidence requiring proper Rule 404(b) notice. The government’s late notice (12 days before trial) was held insufficient at the district‐court level, and the court’s alternative “intrinsic” rationale was an abuse of discretion.

3. Harmless‐Error Analysis: Because the improper evidence was prejudicial—highlighted in closing argument (“white trash” remark)—and because the government relied on it in the district court’s sufficiency analysis, the error was not harmless beyond a reasonable doubt. The convictions were vacated and remanded for a fresh trial with proper evidentiary constraints.

Impact on Future Cases

United States v. Sadrinia sharpens the boundary between intrinsic and extrinsic Rule 404(b) evidence. Trial courts must closely evaluate whether alleged “inextricably intertwined” acts truly share a direct nexus to the charged offense in time, causation, or setting. Remote misconduct—even by the same defendant—cannot slip in as intrinsic simply because it pertains to the same general subject matter. Practitioners should anticipate more rigorous pretrial challenges and notice requirements for bad‐act evidence, and prosecutors must craft clear justifications under Rule 404(b)(2) or risk reversal. In medical‐prescription prosecutions, this decision further underscores the importance of expert testimony on legitimate medical practice and the necessity of tying extrinsic acts directly to the charged conduct.

Complex Concepts Simplified

• Rule 404(b) “Intrinsic” vs. “Extrinsic” Evidence: Intrinsic evidence is part of the same time‐and‐place story as the crime you’re prosecuting. Extrinsic evidence is about other bad things a defendant did at different times. Only intrinsic evidence slides in automatically; extrinsic evidence needs prior notice and a proper purpose.
• “Legitimate Medical Purpose” in § 841(a)(1): An authorized prescriber can still be guilty if he knowingly writes prescriptions that aren’t supported by accepted medical standards or are outside normal professional practice.
• Rule 29 Sufficiency Review: On appeal, the court views the trial evidence in the government’s favor and asks whether any rational jury could have found guilt beyond a reasonable doubt.
• Constructive Amendment of Indictment: The Fifth Amendment requires a defendant to be tried only on charges in the grand‐jury indictment. But charging facts in the conjunctive (“and”) and proving them disjunctively (“and/or”) is permissible.

Conclusion

United States v. Sadrinia represents a significant clarifying precedent on the limits of “intrinsic” evidence under Rule 404(b). While reaffirming the sufficiency standard in § 841 prosecutions of licensed prescribers, the Sixth Circuit insisted that trial courts cannot circumvent Rule 404(b) notice requirements by labeling remote misconduct as intrinsic. The decision mandates careful gatekeeping of character and propensity evidence and reinforces defendants’ rights to fair notice. As a result, prosecutors and trial courts must rigorously distinguish between truly intertwined acts and mere bad‐act propensity evidence, ensuring that convictions rest on properly admitted, directly related proof.