In 2004, a physician specializing in pain management, opened a clinic. The prosecution asserted that the clinic was nothing more than a "pill mill" catering to people who were hopelessly addicted to pain medicine, primarily opioids. The evidence showed that defendant engaged in only the most cursory examinations and rarely ordered diagnostic scans. Notwithstanding the options for treating pain, the doctor regularly prescribed opioids as a first resort. Appointments were not necessary and all payments were required to be made in cash. From 2008 through October 2011, defendant wrote over 21,000 prescriptions for controlled substances, at an increasing pace, with more than half for substances containing the opioid oxycodone, and more than a quarter for alprazolam (Xanax).

The jury convicted the physician of manslaughter and reckless endangerment. He was sentenced to a term of 10 to 20 years. Despite the doctor's arguments that he could not be criminally responsible for the death of his patients, his conviction was affirmed. People v. XuHui Li, 155 App. Div, 3d 571 (N.Y. App. Div. Nov. 30, 2017).

On appeal, the doctor argued that the manslaughter convictions should be reversed because, as a matter of law, the sale of a controlled substance can never support a homicide charge in the absence of express legislative authorization. The Appellate Division rejected this argument: "all that was needed for the manslaughter charge to be sustained was ... to satisfy its elements..., that defendant was "aware of and consciously disregard[ed] a substantial and unjustifiable risk that [death] [would] occur ... The risk [being] of such nature and degree that disregard thereof constitute[d] a gross deviation from the standard of conduct that a reasonable person would observe in the situation" The Jury's verdict was upheld.