United States v. Sherrie Bennett , 874 F.3d 236 ( 2017 )


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  •      Case: 17-60038   Document: 00514196603        Page: 1   Date Filed: 10/16/2017
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE FIFTH CIRCUIT
    United States Court of Appeals
    Fifth Circuit
    No. 17-60038                          FILED
    October 16, 2017
    Lyle W. Cayce
    UNITED STATES OF AMERICA,                                                 Clerk
    Plaintiff - Appellee
    v.
    SHERRIE BOX BENNETT,
    Defendant - Appellant
    Appeal from the United States District Court
    for the Southern District of Mississippi
    Before HIGGINBOTHAM, SMITH, and HAYNES, Circuit Judges.
    PATRICK E. HIGGINBOTHAM, Circuit Judge:
    Sherrie Bennett was convicted of one count of conspiracy to distribute a
    controlled substance, ten counts of distributing or dispensing a controlled
    substance, and three counts of bankruptcy fraud. Ms. Bennett appeals, urging
    error by the district court and the prosecutor. Finding no reversible error, we
    affirm.
    I.
    At all times relevant here, Defendant Sherrie Box Bennett worked as a
    registered nurse at Biloxi Radiation Oncology Center (the “Clinic”) for Dr.
    Laurence Lines. Dr. Laurence Lines began to suffer from symptoms of
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    dementia, becoming increasingly reliant on Ms. Bennett. 1 Ms. Bennett helped
    him buy a home next door to her home, was a named beneficiary of Dr. Lines’
    will, and held his medical power of attorney.
    The Government presented evidence that, from at least 2010,
    prescriptions for controlled medications in Dr. Lines’ name were written for
    Ms. Bennett, her husband and co-defendant Jerry Dean Bennett, and other
    members of her family. The Clinic’s medical records did not reflect that the
    recipients were patients. At trial, the Government introduced evidence that
    Ms. Bennett effectively wrote these prescriptions using Dr. Lines’ DEA number
    and tracing a signature stamp embossed with Dr. Lines’ signature. 2
    In 2011, the Clinic filed for protection under Chapter 11, initially
    remaining a debtor-in-possession before the United States Trustee moved to
    have a Chapter 11 trustee appointed. 3 Prior to the trustee’s appointment, Ms.
    Bennett remained in control of the Clinic’s checkbook. An appointed
    accountant noticed three suspicious checks that formed the basis for the counts
    of bankruptcy fraud against Ms. Bennett: (1) Check #1372, dated 1/25/13, for
    $16,636; (2) Check #1422, dated 3/22/13, for $10,000; and (3) Check #1445,
    dated 4/3/13, for $28,000. Evidence was presented at trial that Ms. Bennett
    had written and cashed those checks and deposited similar amounts into her
    own checking account. 4 Attorney Kimberly R. Lentz was appointed as the
    1 In 2013, Dr. Steven Fineburg, who had been treating Dr. Lines since 2011,
    documented the following: “Since I have been taking care of him for probably a year and a
    half I would think his primary issues are his Alzheimer’s disease, his hypertension, and
    hyperthyroidism. In my opinion, from the evaluations and the visits, it’s been difficult for
    him to make any decisions, even about his general well-being and his health.”
    2 Ms. Bennett testified that she had only called in prescriptions at Dr. Lines’ request
    and that she had not used the signature stamp.
    3 See In re Bioloxi Radiation Oncology Center, LLC, No. 11-52727-KMS, (Bankr. S.D.
    Miss. Nov. 22, 2011).
    4 Ms. Bennett testified that the checks were to refund monies Dr. Lines had loaned to
    the Clinic and that her own cash deposits around the same time were proceeds from the sale
    of Mary Kay cosmetics and the sale of other personal assets.
    2
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    Chapter 11 Trustee, and on June 17, 2013, Lentz filed an adversary proceeding
    against Ms. Bennett, alleging gross mismanagement of the bankruptcy estate
    and fraudulent appropriation of debtor assets.
    Separately, the Mississippi Department of Human Services was
    contacted about Dr. Lines. Jamie Thompson, then supervisor of a unit “that
    deals with the investigation of abuse, neglect, and financial exploitation of
    vulnerable persons,” was dispatched to Dr. Lines’ home, where he found the
    doctor living in squalor. Thompson additionally testified that, on another
    occasion, “we went by there actually to try to interview the Bennetts in their
    home, and Mr. Bennett . . . was actually the one who said, you know, ‘We have
    nothing to say,’ and slammed the door in our face, so that was the end of our
    conversations with them. He informed us that he did have an attorney, and so
    we respected his right to counsel.”
    Ultimately, a federal grand jury returned an 11-count indictment
    against the Bennetts, and then a first superseding indictment, charging both
    of the Bennetts with one count of conspiracy to distribute and dispense a
    controlled substance as prohibited by 21 U.S.C. § 841(a)(1), all in violation of
    21 U.S.C. § 846; ten counts of knowingly and intentionally distributing and
    dispensing a controlled substance outside of professional practice in violation
    of 21 U.S.C. § 841(a)(1) and 18 U.S.C. § 2; and charging Ms. Bennett alone with
    three counts of bankruptcy fraud in violation of 18 U.S.C. § 153.
    The jury trial began on July 19, 2016 and concluded ten days later. After
    the Government rested its case-in-chief, the Bennetts moved for a judgment of
    acquittal under Rule 29 of the Federal Rules of Criminal Procedure, which the
    district court denied for Ms. Bennett and granted in part and denied in part
    for Mr. Bennett. The jury returned a verdict of guilty on all charges against
    Ms. Bennett. The court sentenced Ms. Bennett to: (1) concurrent terms of: (a)
    3
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    78 months of imprisonment for the distribution of schedule II and schedule III
    narcotics; (b) 60 months imprisonment for distribution of schedule IV
    narcotics; and (c) 60 months for bankruptcy embezzlement; (2) a three-year
    term of supervised release for each charge to run concurrently; (3) an $8,000
    fine; (4) a $1,400 special assessment; and (5) $54,636 in restitution.
    Ms. Bennett filed a post-trial Motion for Judgment of Acquittal or
    Alternatively, Motion for a New Trial, which the district court denied. Ms.
    Bennett appeals that denial, inter alia, raising the following challenges: (1)
    The court failed to give her proposed jury instructions; (2) The court failed to
    declare a mistrial following alleged prejudicial testimony; (3) The court failed
    to declare a mistrial following alleged prosecutorial misconduct; (4) The court
    erroneously allowed the prosecution to amend its indictment; and (5) the
    evidence presented was insufficient to sustain her conviction. 5
    II.
    We begin with Ms. Bennett’s claim that the district court erred when it
    rejected two of her proposed jury instructions. This Court reviews the propriety
    of jury instructions for abuse of discretion, asking “whether the charge, as a
    whole, is a correct statement of law.” 6 “Where, as here, the defense requested
    a jury instruction and the request was denied, we review the denial for abuse
    of discretion. . . . [We] afford[] ‘substantial latitude to the district court in
    describing the law to the jury.’” 7 “A district court abuses its discretion by failing
    to issue a defendant’s requested instruction if the instruction ‘(1) is
    substantively correct; (2) is not substantially covered in the charge given to the
    5 Ms. Bennett filed a motion to expedite this appeal on April 25, 2017, which this Court
    granted. Docket No. 41-42. The docket also reflects that the appeal of co-defendant Mr.
    Bennett was partially dismissed for failure to order the transcript and that he is currently in
    the process of reopening the case. Mr. Bennett is not a party to this appeal. Docket No. 69.
    6 United States v. Sanjar, 
    853 F.3d 190
    , 205 (5th Cir. 2017).
    7 United States v. Bowen, 
    818 F.3d 179
    , 188 (5th Cir. 2016) (citation omitted) (quoting
    United States v. Barnes, 
    803 F.3d 209
    , 222 (5th Cir. 2015)).
    4
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    jury; and (3) concerns an important point in the trial so that the failure to give
    it seriously impairs the defendant’s ability to present effectively a particular
    defense.’” 8
    Ms. Bennett argues that the district court erroneously rejected her
    proposed instructions, thereby enabling the Government to prosecute for
    failure to adhere to medical regulations, rather than the crimes charged. For
    instance, Ms. Bennett points to the Government’s closing argument in which
    the prosecutor argued that the evidence showed that no physical exam had
    been performed nor had a medical file been maintained; that these regulatory
    violations sufficiently constituted distribution of a controlled substance outside
    the usual course of professional practice. While this Court has held that
    regulations can be used to help clarify the law, Ms. Bennett argues, the use of
    regulations here went beyond that. 9
    Ms. Bennett claims that her proposed jury instructions would have
    explained the difference between a violation of regulations and a criminal
    violation. The first proposed instruction read:
    During the trial, you have received evidence regarding certain
    regulations, rules, and guidelines. Even though the use of a rubber
    stamp in lieu of a physician’s signature and/or the failure to keep
    a medical chart when prescribing certain controlled substances
    and/or telephonically calling in a schedule II controlled substance
    to a pharmacy may be inappropriate or a violation of the rules,
    such an act is not done in violation of the offense unless it was done
    corruptly or if it was intended at the time it is done with the
    8 United States v. Sheridan, 
    838 F.3d 671
    , 672–73 (5th Cir. 2016) (quoting United
    States v. Simkanin, 
    420 F.3d 397
    , 410 (5th Cir. 2005)); accord United States v. Lucas, 
    516 F.3d 316
    , 324 (5th Cir. 2008).
    9 Additionally, Ms. Bennett states, in a footnote, that this same reasoning applies to
    the bankruptcy conviction, but does not go beyond that conclusory assertion to explain how
    the Government attempted to prove bankruptcy fraud through failure to adhere to
    regulations. Thus, this argument, or the lack thereof, is waived due to inadequate briefing.
    See United States v. Martinez, 
    263 F.3d 436
    , 438 (5th Cir. 2001).
    5
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    specific intent to violate the elements of the crime charges as set
    forth in these jury instructions.
    Furthermore, if the defendant has a good faith belief that she/he
    was acting in accordance with the proper rules, regulations and
    guidelines, then that good faith belief is a defense to the crime
    charged.
    The second instruction, lifted directly from a pair of judiciary bribery trials
    that Ms. Bennett’s counsel had participated in, read:
    Even though giving a judge something of value may be
    inappropriate or a violation of the ethical rules, such an act is not
    done corruptly so as to constitute a bribery offense unless it is
    intended at the time it is given to affect a specific action the judge
    officially will take in a case before him, or may take in a case that
    may be brought before him.
    A gift or favor bestowed on a judge solely out of friendship, to
    promote good will, or for motive wholly unrelated to influence over
    official action does not violate the bribery statutes.
    The district court, in rejecting the first proposed instruction, held that
    acting “corruptly” was not an element of any of the charges and giving this
    instruction would have served to confuse and mislead the jury. Additionally,
    the court noted that it had already included an instruction on good faith. As to
    the second proposed instruction, the court held that there was no legal or
    evidentiary basis to give the instruction from the bribery cases—the
    instruction was plainly not relevant.
    On appeal, the Government adds that it was required to prove: (1) that
    the defendant distributed a controlled substance; (2) that she did so knowingly
    and intentionally; and (3) that she did so other than for a legitimate medical
    purpose and in the usual course of professional practice. Given those elements,
    the Government’s argument goes, the jury was entitled to take into account
    6
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    accepted medical standards in determining whether a prescription was
    distributed outside of professional practice. 10
    Assuming that Ms. Bennett preserved this issue for appeal, the district
    court did not abuse its discretion in omitting her proposed instructions. Section
    841(a) states:
    Except as authorized by this subchapter, it shall be unlawful for
    any person knowingly or intentionally—
    (1) to manufacture, distribute, or dispense, or possess with intent
    to manufacture, distribute, or dispense, a controlled substance; or
    (2) to create, distribute, or dispense, or possess with intent to
    distribute or dispense, a counterfeit substance. 11
    The statute does not require a defendant to have acted “corruptly.” Therefore,
    the first proposed instruction is not substantively correct. 12 Ms. Bennett’s
    second proposed instruction fares no better; that is, even if the instruction is a
    substantively correct statement of the law regarding bribery, it is plainly not
    relevant. 13
    The heart of Ms. Bennett’s argument, however, is that the court, in
    rejecting her proposed instructions, sanctioned a conviction based on Ms.
    Bennett’s failure to adhere to medical regulations, rather than the elements of
    10  See United States v. Norris, 
    780 F.2d 1207
    , 1209 (5th Cir. 1986) (affirming district
    court’s instruction to jury to consider “from an objective standpoint whether the drugs were
    dispensed in the usual course of professional practice”).
    11 21 U.S.C. § 841(a).
    12 Additionally, Ms. Bennett’s proposed instruction would have been partially
    duplicative as the court had already included an instruction on good faith.
    13 Ms. Bennett argues that the bribery instruction “was intended to [show how]
    another district judge drafted a limiting instruction in a similar situation.” We need not
    entertain this argument because we conclude that the Government’s reference to medical
    regulations was appropriate.
    7
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    the crimes charged. A close examination of the cases that Ms. Bennett relies
    on—United States v. Brown and United States v. Christo—proves otherwise. 14
    In Brown, we affirmed all but two counts of the convictions of
    pharmacists who engaged in a drug distribution conspiracy. 15 One pharmacist,
    like Ms. Bennett, argued that the “government worked a Due Process violation
    by transforming a violation of the regulations and guidelines of the [Texas
    Pharmacy Laws and Regulations] into a criminal offense.” 16 We disagreed,
    finding that the government “both charged and proved a violation of the
    appropriate criminal statutes, not merely the related regulations” and thus
    drew a proper contrast between the “irreproachable, commonplace use of duly
    issued regulations in clarifying the scope and contour of criminal laws [and]
    the inappropriate replacement of criminal laws with civil regulations.” 17
    By contrast, in Christo, the defendant was charged with the criminal
    misapplication of bank funds, but the government’s theory was centered upon
    violation of 21 U.S.C. § 375a, a civil regulatory banking statute that prohibited
    the extension of credit in excess of $5,000 to bank officers. 18 There, we found
    that the “government’s evidence and argument concerning violations of 21
    U.S.C. § 375a impermissibly infected the very purpose for which the trial was
    being conducted.” 19 Because we were left “question[ing] whether [appellant]
    14  United States v. Brown, 
    553 F.3d 768
    , 790–91 (5th Cir. 2008) (rejecting an argument
    that admission of the Texas Pharmacy Laws and Regulations (“TPLR”) replaced criminal law
    with regulations and guidelines and concluding that the TPLR was probative of defendant’s
    state of mind); United States v. Christo, 
    614 F.2d 486
    , 490–92 (5th Cir. 1980) (reversing and
    remanding where the jury instructions focused the jury on the intent element for a civil
    regulatory violation rather than the intent standard of the felony charged).
    15 
    Brown, 553 F.3d at 801
    .
    16 
    Id. at 790.
            17 
    Id. at 791
    & n.71.
    
    18 614 F.2d at 489
    .
    19 
    Id. at 492.
    8
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    was found guilty of willful misapplication with intent to injure and defraud the
    bank or . . . for overdrafting his checking account,” we reversed. 20
    Our case is more akin to Brown. As noted above, the Government was
    required to prove: (1) that Ms. Bennett distributed a controlled substance; (2)
    that she did so knowingly and intentionally; and (3) that she did so other than
    for a legitimate medical purpose and in the usual course of professional
    practice. 21 In United States v. Armstrong, we explained that the “third element
    is not expressly required . . . but relevant regulations provide that a controlled
    substance can be dispensed by a prescription ‘issued for a legitimate medical
    purpose by an individual practitioner acting in the usual course of his
    professional practice.’” 22 “The logical converse is that a practitioner is
    unauthorized to dispense a controlled substance if the prescription either lacks
    a legitimate purpose or is outside the usual course of professional practice.” 23
    Stated differently, “knowingly distributing prescriptions outside the course of
    professional practice is a sufficient condition to convict a defendant under the
    criminal statutes relating to controlled substances.” 24 The medical regulations
    therefore helped clarify the scope and contour of “outside the course of
    professional practice”—the very purpose for which the trial was being
    conducted—and thus did not work a due process violation against Ms.
    Bennett. 25
    20 
    Id. 21 See
    Brown, 553 F.3d at 781
    ; see also United States v. Armstrong, 
    550 F.3d 382
    , 397
    (5th Cir. 2008), overruled on other grounds by United States v. Balleza, 
    613 F.3d 432
    , 433 n.
    1 (5th Cir. 2010).
    22 
    Armstrong, 550 F.3d at 397
    .
    23 
    Id. 24 Id.
           25 See 
    Brown, 553 F.3d at 790
    –92; See also 
    Norris, 780 F.2d at 1209
    ; United States v.
    Ogle, 201 F. App’x 979, 980 (5th Cir. 2006) (“§ 1306.04 is not a civil regulation but instead an
    interpretive one that defines the circumstances subjecting practitioners to criminal
    prosecution.”).
    9
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    III.
    Next, Ms. Bennett claims that the district court erroneously denied a
    mistrial following alleged prejudicial testimony. We review such denials for
    abuse of discretion, subject to harmless error review, with the following
    principles in mind:
    If a defendant moves for a mistrial on the grounds that the jury
    heard prejudicial testimony, a new trial is required only if there is
    a significant possibility that the prejudicial evidence had a
    substantial impact upon the jury verdict, viewed in light of the
    entire record. If the evidence is so prejudicial that the jury will
    unlikely be able to erase it from their minds, then a mistrial should
    be ordered. 26
    “‘We give great weight to the trial court’s assessment of the prejudicial
    effect of the evidence, and prejudice may be rendered harmless by a curative
    instruction.’” 27 “When denying a motion for a mistrial, the district court abuses
    its discretion, giving rise to reversible error, only ‘if the evidence, when viewed
    in the context of the whole trial, is so highly prejudicial that it would have had
    a substantial impact on the jurors’ verdict.’” 28
    Ms. Bennett claims that two separate instances of prejudicial testimony
    merited a mistrial. The first instance occurred when Thompson, a supervisor
    of a unit at the Mississippi Department of Human Services, testified the
    following: “[W]e went by there actually to try to interview the Bennetts in their
    home, and Mr. Bennett . . . was actually the one who said, you know, ‘We have
    nothing to say, and slammed the door in our face, so that was the end of our
    conversations with them. He informed us that he did have an attorney, and so
    26  United States v. Zamora, 
    661 F.3d 200
    , 211 (5th Cir. 2011) (internal quotation
    marks and citations omitted).
    27 
    Lucas, 516 F.3d at 345
    (quoting United States v. Valles, 
    484 F.3d 745
    , 756 (5th Cir.
    2007)).
    28 United States v. Delgado, 
    672 F.3d 320
    , 340 (5th Cir. 2012) (quoting United States
    v. Baresh, 
    790 F.2d 392
    , 402 (5th Cir. 1986)).
    10
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    we respected his right to counsel.” Ms. Bennett argues that the sole aim of this
    testimony “was simply to tell the jury that the Bennetts are bad because they
    used their Constitutional fifth [sic] Amendment right to not make a statement,
    and are therefore guilty in the mind of the government.” The second instance
    occurred when Lentz, the bankruptcy trustee, testifying about the civil
    bankruptcy proceeding, stated that “Ms. Bennett showed up and said that she
    wanted to have a lawyer present.” Ms. Bennett again claims that the
    government offered this evidence “to make it appear that Sherrie Bennett was
    hiding behind her Constitutional Rights, to evade the truth.”
    The district court, in addressing this issue on a post-trial motion,
    reaffirmed its initial decision to deny Ms. Bennett’s ore tenus and written
    motions for a mistrial. As to Thompson’s testimony, the court noted that
    Thompson’s attempt to interview the Bennetts concerned a welfare check on
    Dr. Lines, rather than the charges brought against the Bennetts at trial. As to
    Lentz’s testimony, the court held that there is no constitutional right at stake.
    On appeal, the Government adds that the court instructed the jury to disregard
    what it had heard in both instances.
    Even assuming that the prosecutor impermissibly used Mr. Bennett’s
    pre-arrest, pre-Miranda silence, we find no error. 29 “Fifth and Sixth
    Amendment rights, like Fourth Amendment rights, are personal in nature and
    cannot be asserted vicariously.” 30 Therefore, Mr. Bennett does not speak for
    29  See United States v. Ashley, 
    664 F.3d 602
    , 604 (5th Cir. 2011) (discussing circuit
    split on whether and when pre-arrest, pre-Miranda silence can be used in the government’s
    case in chief).
    30 United States v. Fortna, 
    796 F.2d 724
    , 732 (5th Cir. 1986).
    11
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    Ms. Bennett. 31 Additionally, Ms. Bennett’s argument concerning Lentz’s
    testimony fails. Ms. Bennett’s statement that she wanted a lawyer present at
    an injunction proceeding in a civil bankruptcy case is plainly not relevant.
    Moreover, the district court promptly and unequivocally instructed the jury to
    disregard Thompson’s and Lentz’s testimony, curing any prejudicial effect. 32
    IV.
    Ms. Bennett next argues that the district court erroneously denied her
    post-trial motion on the basis of prosecutorial misconduct. “In attempting to
    establish that a prosecutor’s improper comments constitute reversible error,
    the criminal defendant bears a substantial burden. We do not lightly make the
    decision to overturn a criminal conviction on the basis of a prosecutor’s
    remarks alone.” 33 “We also presume that a jury can and will follow an
    instruction that attorneys’ statements are not evidence, ‘unless there is an
    overwhelming probability that the jury will be unable to follow the instruction
    and there is a strong probability that the effect is devastating.’” 34 “The ultimate
    31  The cases that Ms. Bennett cite do not challenge this principle. United States v.
    Okatan is out-of-circuit precedent in which the government used a defendant’s pre-arrest,
    pre-Miranda silence, an issue that we have yet to resolve and need not do so here, as
    substantive evidence of that defendant’s guilt. 
    728 F.3d 111
    , 120 (2d Cir. 2013). United States
    v. Hale presents a wholly different factual scenario than the case at bar—that a prosecutor
    may not cross-examine a defendant about his silence during a custodial police interrogation.
    
    422 U.S. 171
    , 181 (1975). And, United States Department of Labor v. Triplett is not about
    standing to object in court, but rather about third-party standing to sue in the line of Pierce
    v. Soc. of Sisters, 
    268 U.S. 510
    (1925) and Singleton v. Wulff, 
    428 U.S. 106
    (1976). 
    494 U.S. 175
    , 720 (1990).
    32 
    Lucas, 516 F.3d at 345
    (quoting 
    Valles, 484 F.3d at 756
    ).
    33 United States v. Virgen-Moreno, 
    265 F.3d 276
    , 290 (5th Cir. 2001) (citations
    omitted).
    34 United States v. Valencia, 
    600 F.3d 389
    , 410 (5th Cir. 2010) (quoting United States
    v. Morganfield, 
    501 F.3d 453
    , 468 (5th Cir. 2007)).
    12
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    question for this court is ‘whether the prosecutor’s remarks cast serious doubt
    on the correctness of the jury’s verdict.’” 35
    This already narrow standard of review is further constrained by Ms.
    Bennett’s failure to object to all but one instance of alleged prosecutorial
    misconduct. Aside from Ms. Bennett’s objection to certain remarks in the
    prosecutor’s rebuttal, which we review for abuse of discretion, Ms. Bennett
    bears the burden of demonstrating that the prosecutor’s statements constitute
    plain error. 36 That is, Ms. Bennett must show “‘(1) error, (2) that is plain, and
    (3) that affects substantial rights.” 37 “If these conditions are present, we may
    exercise our discretion to correct the error if it seriously affects the fairness,
    integrity, or public reputation of judicial proceedings.’” 38
    A.
    Ms. Bennett alleges that the first instance of prosecutorial misconduct
    occurred during the Government’s opening when the prosecutor made several
    misstatements that were not later supported by evidence. These statements
    include: (1) Ms. Bennett “put herself on as Dr. Lines power of attorney;” (2) Ms.
    Bennett “made herself beneficiary of Dr. Lines’ will;” (3) Ms. Bennett “made
    Dr. Lines purchase a house next door to her and live there, where she kept him
    in squalor to control him;” (4) Ms. Bennett had medical power of attorney over
    Dr. Lines; (5) Ms. Bennett made herself the beneficiary of two life insurance
    35 United States v. Anchondo-Sandoval, 
    910 F.2d 1234
    , 1238 (5th Cir. 1990) (quoting
    United States v. Iredia, 
    866 F.2d 114
    , 118 (5th Cir. 1989)); see also United States v. Mendoza,
    
    522 F.3d 482
    , 491 (5th Cir. 2008) (“‘Improper comments by a prosecutor may constitute
    reversible error where the defendant’s right to a fair trial is substantially affected.’”) (quoting
    United States v. Andrews, 
    22 F.3d 1328
    , 1341 (5th Cir. 1994)).
    36 United States v. Valas, 
    822 F.3d 228
    , 242–43 (5th Cir. 2016) (“We review the
    preserved issues for abuse of discretion and the unpreserved issues for plain error.”) (citations
    omitted).
    37 United States v. Valencia, 
    600 F.3d 389
    , 409 (5th Cir. 2010) (quoting United States
    v. Mares, 
    402 F.3d 511
    , 520 (5th Cir. 2005)).
    38 
    Id. (internal quotation
    marks omitted).
    13
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    policies; and (6) Ms. Bennett had Dr. Lines fire his long-time friend and
    accountant by falsely claiming that he was stealing from the Clinic. 39
    The district court determined that the prosecutor’s opening statement
    represented a roadmap of what the Government indicated would be its case-
    in-chief. More importantly, the court observed that “[e]vidence pertaining to
    the statements were introduced at trial, and the jury was free to accept or
    reject that evidence.” Accordingly, the court concluded that Ms. Bennett had
    failed to show that her substantial rights had been affected—a conclusion
    further bolstered by the multiple instructions provided to the jury that
    attorney statements are not evidence.
    Upon review of the record, we find no error. The jury heard testimony
    that Ms. Bennett was appointed Dr. Lines’ power of attorney; 40 that Ms.
    Bennett helped him buy a home next door to her 41 where he lived in a state of
    39   While Ms. Bennett employs quotation marks, she does not directly quote from the
    trial transcript.
    40 On this issue, Ms. Bennett testified as follows:
    Q. I want to make sure you’re asked about this. You had a—could you describe
    what you had with respect to the power concerning his medical issue? Just
    describe one time just to make sure they’re clear on that, what that was.
    A. Yes, sir. After he had the cardiac problem at Biloxi Regional when Dr.
    McNair sent him to the Biloxi Regional for the cardiac arrhythmia, Dr. Lines—
    at that time, Eric Dahlhauser, who lived in Nashville, Tennessee, I think held
    his power of attorney. And Dr. Lines said, you know, “I really need to change
    that where someone who is close to me, near me, if something should happen.”
    He was really specific with the cardiologist that if something should happen in
    the procedure, he did not want to be resuscitated and that was his wishes. And
    he did put me on his power of attorney.
    41Eric Dalhauser, Dr. Lines’ former accountant, testified that “[t]here was another
    home that was -- that Sherrie helped Dr. Lines buy right next to her.”
    14
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    No. 17-60038
    degradation; 42 that Ms. Bennett was a named beneficiary of his will 43 and life
    insurance policies; 44 and that Ms. Bennett assisted in the firing of Dr. Lines’
    long-time friend and accountant by alleging that he was stealing funds from
    Dr. Lines. 45 As the district court properly observed, the jury was free to accept
    or reject this testimony. Moreover, the court instructed the jury at the start of
    trial and during opening statements that attorney statements are not
    evidence, rendering any prejudice harmless. We therefore find that the court
    did not plainly err.
    B.
    Ms. Bennett alleges that the second instance of prosecutorial misconduct
    occurred when the Government proffered false discovery. This alleged
    misconduct specifically arose when the Government, during discovery,
    proffered a list of people who had received prescriptions from Dr. Lines only to
    then reveal through a witness at trial that the list included patients from a
    42 As mentioned, Thompson’s testimony concerned his visit to Dr. Lines’ home and his
    evaluation of “whether or not it appeared to be in a neglectful-type environment.”
    43 On cross-examination, after Dahlhauser testified that “my understanding is the will
    was finally changed to where maybe Sherrie was the sole beneficiary,” the jury heard the
    following:
    Q. Okay. Because Dr. Lines was able to do what he wanted to do; right? You
    told him—let me rephrase that. You told him, ‘You don't have to do that, Dr.
    Lines,’ but he knew what he wanted to do?
    A. With the guidance of Sherrie. I really think in 2000—starting somewhere—
    Dr. Lines really relied, you know, heavily on me and then on Sherrie for
    guidance and would follow most direction. So he did—I mean, you know, 2009,
    2010, you know, he was starting to struggle, and again, the reason Sherrie
    asked for the return of my interest in Cedar Lake is supposedly he didn't
    remember. So he was struggling.
    44  James Grunwald, an FBI agent, testified that the beneficiaries on two of Dr. Lines’
    life insurance policies were changed to the Bennetts on June 30, 2009.
    45 Dalhauser, Dr. Lines’ former accountant, testified that “I had heard, you know, and
    understood that Sherrie also told him that I was embezzling or stealing funds or she had to
    have—and actually I think also asked the FBI to investigate me.”
    15
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    No. 17-60038
    different physician, Dr. Laurence Line (without an “s”) who practiced in
    Hattiesburg. Ms. Bennett argues that the defense relied upon this list to
    formulate a defense strategy, namely that “Dr. Lines was a multi-board
    certified doctor, who helped many people beyond cancer patients, and he did
    not keep medical charts on many people, despite regulations.”
    The district court found that no prosecutorial misconduct occurred here
    because both parties were equally mistaken about the list. Nonetheless, the
    court considered Ms. Bennett’s argument under both Giglio v. United States 46
    and Brady v. Maryland, 47 determining that neither case was on point because
    the true evidence in this case was inculpatory rather than exculpatory. On
    appeal, the Government reiterates that the production of an inaccurate list was
    an honest mistake that neither party recognized and did not involve fabrication
    of evidence or some other overt bad act.
    Reviewing this instance of alleged prosecutorial misconduct for plain
    error or abuse of discretion is of no moment. By either metric, no error occurred
    in the district court’s rejection of this claim. 48
    C.
    Ms. Bennett alleges that the third instance of prosecutorial misconduct
    occurred during the Government’s rebuttal following defendants’ closing. Ms.
    Bennett contends that the italicized portions of the following statement during
    the prosecutor’s rebuttal were improper:
    46 Giglio v. United States, 
    405 U.S. 150
    , 154 (1972) (holding that a prosecutor’s promise
    to a witness that he would not prosecute if he cooperated was enforceable against the
    government even where the prosecutor did not have authority to make the statement).
    47 Brady v. Maryland, 
    373 U.S. 83
    , 87 (1963) (holding that a prosecutor may not
    withhold potentially exculpatory evidence from the defense).
    48 United States v. Holley, 
    463 F.2d 634
    , 638 (5th Cir. 1972) (“A criminal defendant is
    entitled to a fair trial, but not every prosecutorial ineptitude can be magnified into a colossus
    mandating a reversal.”).
    16
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    No. 17-60038
    Ladies and gentlemen, I’ve only got eight minutes, and I don’t have
    enough time to contradict all the misrepresentations about the facts
    that you’ve heard over the last two hours. I’m going to trust you
    because I—because that’s what we do in this system of justice. We
    trust your memory.
    I’m not going to go into all what Vice-president Biden would call
    malarkey that you just heard, but we also heard, and I can’t not
    address it, some of the most offensive things I have ever heard in a
    courtroom.
    Mr. Carlisle’s theory of the case is that we’re only here, the case
    was fabricated, because Kim Lentz wanted to make money. That’s
    all the reason we’re here. I charged this case. I didn’t charge it
    because Kim Lentz made some money. And then he came and said
    to you not only was the case fabricated, but these agents got on the
    stand and the prosecutor only did this because we gotta get a
    conviction, no matter what. My salary is the same whether those
    people go home or they go to jail. I am not here to convict an
    innocent person. I have never, to my knowledge, convicted an
    innocent person. And for them to suggest that, that these agents are
    getting on the stand solely in order to promote their careers and
    they’re going to do whatever it takes, is the most offensive thing I
    think I’ve ever heard in a courtroom.
    Now, let me address some of the things—not the factual matters
    that they told you incorrectly, but let me tell you some other things
    that they didn’t tell you. And it’s absolutely true that the defense
    has no burden whatsoever to put on any evidence. None. They don’t
    have to put on a witness, they don’t have to put on a document,
    and they don’t have to do anything. But nothing stops them from
    it. Nothing stops them from issuing a subpoena for the bank
    records they claim that the government hid from you. 49
    They don't have to put on anything, but they have subpoena power.
    And the reason we didn't put on any of those patient records or any
    of those patients is because they don't exist. We asked the clinic --
    and I think there’s actually a document in there where the clinic
    49Ms. Bennett objected, stating that the prosecutor is “now trying to shift the burden.”
    In response, the district judge instructed the jury that “you’ve been instructed more than
    once, and I remind you again, the defendants are under no obligation to produce any evidence
    whatsoever.”
    17
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    No. 17-60038
    responded to a subpoena where we were asking for them and they
    said, ‘We don't have them.’ 50
    ...
    Now, the last thing I want to say, because there’s an awful lot more
    in my notes and I can’t get to any amount of them, the defendants
    really loved that little chart that they showed. They both showed
    it to you. And their idea of what was reasonable doubt and what’s
    not reasonable doubt is fine, but there's an instruction, it’s
    Instruction Number Three, and the Court told you what
    reasonable doubt is. And that’s what you ought to follow, not some
    chart that—I don’t know where it came from. I guess since both of
    them used it, most defense lawyers must have it. But the actual
    instruction is written in Instruction Three. 51
    Ms. Bennett first argues that the prosecutor improperly shifted the
    burden of proof and suggested that evidence not presented at trial provides
    additional grounds for Ms. Bennett’s guilt. For example, the prosecutor
    insisted that “nothing stops [the Defendants] from issuing a subpoena for the
    bank records they claim that the government hid from you” and that “[t]hey
    50   Ms. Bennett objected to the prosecutor’s discussion of the subpoena power. The
    district judge subsequently instructed the jury that “no inference whatsoever can be drawn
    from the fact that the defendants may or may not have produced any evidence whatsoever.
    They are under no obligation to do so.”
    51 Ms. Bennett objected to the prosecutor’s comments about the chart, and the district
    judge gave a curative instruction, in the jury charge, regarding the burden of proof as a result.
    On appeal, Ms. Bennett argues that “the prosecutor intentionally misrepresented the burden
    of proof, to the jury, and specifically disputed that the burden of ‘beyond reasonable doubt,’
    is not greater than other burdens such as, ‘preponderance,’ ‘highly likely guilt,’ or ‘likely
    guilt.’” While we find the prosecutor’s comments needlessly sarcastic and dismissive, the
    prosecutor referred the jury to the Court’s instruction on reasonable doubt. Therefore, we
    find no error.
    18
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    No. 17-60038
    don't have to put on anything, but they have subpoena power.” 52 We “do not
    approve of comments reflecting on the lack of evidence presented by a
    defendant in a criminal case . . . [as] [s]uch a course of action is a parlous one
    at best, of necessity sailing close to implying that the defendant is obligated to
    produce evidence of his innocence.” 53 Similarly, we “have condemned
    suggestions that evidence not presented at trial would compel a finding of
    guilty.” 54 Because the prosecutor contravened these well-settled rules, we have
    no problem concluding that these remarks were improper.
    Ms. Bennett next argues that the prosecutor made himself a witness on
    multiple occasions. Specifically, Ms. Bennett takes issue with the first-person
    statements in the prosecutor’s rebuttal. We recognize that “closing argument
    is just that—argument—we allow prosecutors to use expressive language and
    ‘a bit of oratory and hyperbole’ in arguments.” 55 “[W]e generally place
    statements characterizing a defendant’s positions or arguments as ‘ridiculous,
    absurd, and insulting’ in this category.” 56 At the same time, it is well-
    established that a prosecutor may “‘not express his personal opinion on the
    52  After arguing that the Bennetts had subpoena power, the prosecutor continued,
    explaining: “And the reason we didn’t put on any of those patient records or any of those
    patients is because they don’t exist. We asked the clinic—and I think there’s actually a
    document in there where the clinic responded to a subpoena where we were asking for them
    and they said, ‘We don’t have them.’” Ms. Bennett argues that the prosecutor misrepresented
    the truth because the Government only asked for records of Ms. Bennett and her family, not
    records pertaining to all patients of the Clinic.
    The district court agreed that “there is no one specific item of evidence in the record .
    . . which indicates that the Government sought every medical file from Cedar Lake Oncology,”
    but concluded that the prosecutor’s statement was a reasonable inference from the evidence
    presented at trial. The district court’s curative instructions concerning the subpoena power
    and evidence supporting Ms. Bennett’s guilt mitigate the prejudicial effect, if any, from this
    particular comment.
    53 
    Anchondo-Sandoval, 910 F.2d at 1238
    (internal quotation marks omitted).
    54 United States v. Carter, 
    953 F.2d 1449
    , 1460 (5th Cir. 1992); see also 
    Bowen, 818 F.3d at 191
    .
    55 United States v. Boyd, 
    773 F.3d 637
    , 645 (5th Cir. 2014) (quoting United States v.
    Thompson, 
    482 F.3d 781
    , 786 (5th Cir. 2007)).
    56 
    Id. (quoting United
    States v. Bush, 451 F. App’x 445, 451 (5th Cir. 2011)).
    19
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    No. 17-60038
    merits of the case or the credibility of witnesses.’” 57 The prosecutor here defied
    that rule when he expressed his personal opinion on the merits of the case—
    the defenses’ summation was “the most offensive thing I have heard in a
    courtroom”—and the credibility of his witnesses—“it is the most offensive
    thing I think I’ve heard in a courtroom” “to suggest that, that these agents are
    getting on the stand solely to promote their careers and they’re going to do
    whatever it takes.” Therefore, we find such remarks improper.
    The third and final category of prosecutorial comments is the most
    disturbing. In rebuttal, the prosecutor argued, “I am not here to convict an
    innocent person. I have never, to my knowledge, convicted an innocent person.”
    In Hall v. United States, we considered a similar statement made by the
    prosecutor—“we try to prosecute only the guilty”—and explained:
    Expressions of individual opinion of guilt are dubious at best. . . .
    This statement takes guilt as a pre-determined fact. The remark
    is, at the least, an effort to lead the jury to believe that the whole
    governmental establishment had already determined appellant to
    be guilty on evidence not before them. . . . Or, arguably it may be
    construed to mean that as a pretrial administrative matter the
    defendant has been found guilty as charged else he would not have
    been prosecuted, and that the administrative level determination
    is either binding upon the jury or else highly persuasive to it.
    Appellant’s trial was held and the jury impaneled to pass on his
    guilt or innocence, and he was clothed in the presumption of
    innocence. The prosecutor may neither dispense with the
    57 
    Id. (quoting United
    States v. Alaniz, 
    726 F.3d 586
    , 616 (5th Cir. 2013) (finding
    improper prosecutor’s comments about defense’s theory as “one of the most preposterous
    things I’ve heard in my life” and “one of the dumbest things I have ever heard”); see also, e.g.,
    United States v. Smith, 
    814 F.3d 268
    , 274 (5th Cir. 2016) (“We have repeatedly admonished
    that a prosecutor ‘may not state, ‘The prosecution’s witnesses are telling the truth’ or ‘I
    believe that the prosecution’s witnesses are telling the truth.’”) (quoting United States v.
    Morris, 
    568 F.2d 396
    , 402 (5th Cir. 1978)); 
    Bowen, 818 F.3d at 191
    (finding that prosecutor’s
    closing argument constituted improper vouching when prosecutor argued that “government
    witnesses should be credited because they would be ‘called to task’ pursuant to their plea
    agreements for any dishonesty”); United States v. Ramirez-Velasquez, 
    322 F.3d 868
    , 875 (5th
    Cir. 2003) (“The [government] . . . went too far in arguing that, as a rule, federal law
    enforcement agents appear in court and tell the truth.”) (citation omitted).
    20
    Case: 17-60038       Document: 00514196603          Page: 21     Date Filed: 10/16/2017
    No. 17-60038
    presumption of innocence nor denigrate the function of the trial
    nor sit as a thirteenth juror. 58
    “This entire line of argument presume[s] that the whole government
    apparatus, and the prosecutor individually, had reached a determination of the
    defendant’s guilt before the trial.” 59 In short, such commentary is indefensible
    and holds no place in federal court. 60
    The Government agrees that several of the prosecutor’s statements, in
    particular his first-person statements, were improper, but argues that the
    rebuttal was aimed at highly-charged allegations from the defense, namely
    that the bankruptcy trustee, law enforcement officers, and prosecutors brought
    this case for personal gain. Specifically, the Government refers to the italicized
    portions of defendants’ closing:
    Even Kim Lentz, who met with [Dr. Lines], she claims that
    whenever she fired Dr. Lines and Sherrie, that they—that they left
    but she called Dr. Lines back in, in all her detailed notes, for which
    she was paid ungodly hundreds of thousands of dollars, her, her
    husband, and junior, paid all these hundreds of thousands of
    dollars that she can’t even remember how much they were paid it
    was so much, getting paid, you know, hundreds of thousands to do
    what Sherrie Bennett got no extra money to do, by the way. You
    know, Sherrie Bennett’s money never went up. She was paid—her
    salary was set all the way back in the Dahlhauser days, but when
    she had to take on this new task of bankruptcy issues, she got no
    extra pay. But even Kim Lentz did not write down a single note in
    all her detailed notes that there was something wrong with Dr.
    Lines, because that clearly would be an issue that you should
    address. That would be of concern with anybody.
    ...
    58 
    419 F.2d 582
    , 587 (5th Cir. 1969).
    59 United States v. Garza, 
    608 F.2d 659
    , 665 (5th Cir. 1979).
    60 
    Smith, 814 F.3d at 275
    (finding impermissible the “prosecutor’s remark . . . that the
    Government had no incentive to try [the defendant] unless he were in fact guilty”); 
    Garza, 608 F.3d at 664
    –65 (finding improper the prosecutor’s statements that “the Government has
    no interest whatsoever in convicting the wrong person” and that “if I ever thought that I had
    framed an innocent man and sent him to penitentiary, I would quit”).
    21
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    No. 17-60038
    [The Government] – it’s just so much, so much that’s disturbing
    about what we see about what they did.
    ...
    And also Ms. Lentz would not have been there if Sherrie Bennett
    was there. She gets appointed, she makes hundreds of thousands
    of dollars for her family and her firm, but they get zero if Sherrie
    Bennett is there and if Dr. Lines is there.
    ...
    Why are we here? I can tell you several hundred thousand reasons
    we’re here, maybe half a million reasons we’re here. We’re here
    because Kim Lentz stood to make a lot of money for her and her
    firm, over $300,000 between her and her husband. She said, ‘I
    worked on the case 18 months.’ That didn’t mean she worked every
    day, y’all. Remember, she’s going to 341 hearings, she’s having
    other hearings, she’s doing other things. That might have been a
    few hours a month. It took 18 months to close the case out, but she
    made over $300,000. That’s the reason we’re here, and that’s why
    this case is fabricated.
    ...
    All—most of the government’s witnesses have a stake in this case.
    You’ve got Agent Grunwald. This is a performance. They grade you.
    That’s how you get promoted, the more convictions you get. That’s
    how the DEA works. That’s how you go from regular agent up to
    field agent up to I don’t know all the—all the different ranks, but
    you do it by having successes.
    And then all these people have a bias. And I’m not saying it in a
    bad sense. I want FBI agents to do their job. I want DEA agents to
    do their job. I want police to do their job. I want safe streets. I don’t
    have a problem with that. And them having a bias is because they
    take it on, but they have a bias. And they’re here because either they
    believe, wrongfully, or they just sunk their teeth in it so bad that
    they’ve got to get a conviction of Jerry Bennett, no matter what it
    takes.
    Even in the wake of defenses’ summation, the prosecutor’s rebuttal was
    not permissible. To be sure, the Supreme Court has instructed that “[i]n order
    to make an appropriate assessment, the reviewing court must not only weigh
    22
    Case: 17-60038       Document: 00514196603          Page: 23     Date Filed: 10/16/2017
    No. 17-60038
    the impact of the prosecutor’s remarks, but must also take into account defense
    counsel’s opening salvo.” 61 At the same time, two wrongs do not make a right. 62
    Closing argument is “‘to assist the jury in analyzing, evaluating, and
    applying [t]he evidence.’” 63 In particular, “‘[a] prosecutor is confined in closing
    argument to discussing properly admitted evidence and any reasonable
    inferences or conclusions that can be drawn from that evidence.’” 64 “‘We have
    repeatedly chastised federal prosecutors for making improper remarks in
    closing arguments,’” such as the ones made here. 65 We repeat: federal
    prosecutors “may not suggest that evidence which was not presented at trial
    provides additional grounds for finding defendant guilty” and “may not express
    . . . personal opinion[s] on the merits of the case or the credibility of
    witnesses.” 66
    With those principles in mind, we refuse to chalk up the prosecutor’s
    outright defiance of these elementary principles of advocacy as permissible “tit-
    for-tat.” The prosecutor, by alluding to evidence not presented at trial,
    personally opining on the case and his witnesses, and denigrating the
    presumption of innocence, “roam[ed] beyond the evidence presented at trial,”
    opting for the “improper, even pernicious” route of invoking his “personal
    61  United States v. Young, 
    470 U.S. 1
    , 12 (1985).
    62  
    Id. at 11.
            63 
    Garza, 608 F.2d at 662
    (quoting 
    Morris, 568 F.2d at 401
    ).
    64 
    Bowen, 818 F.3d at 191
    (quoting United States v. Ceballos, 
    789 F.3d 607
    , 624 (5th
    Cir. 2015)).
    65 
    Id. (quoting United
    States v. Rodriguez-Lopez, 
    756 F.3d 422
    , 433–34 (5th Cir. 2014)
    (citing cases)); see also United States v. Diaz-Carreon, 
    915 F.2d 951
    , 956–57 (5th Cir. 1990)
    (“Persistent inflammatory or misleading comments must be viewed with alarm.”).
    66 
    Garza, 608 F.2d at 663
    .
    23
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    No. 17-60038
    status as the government’s attorney” to serve as a basis for the conviction of
    Ms. Bennett—a route that we have time and again denounced. 67
    Having determined that the prosecutor’s remarks were improper, we
    proceed to the second step of our analysis and determine whether the
    prosecutor’s rebuttal affected Ms. Bennett’s substantial rights. That is,
    “whether the prosecutor’s remarks cast serious doubt on the correctness of the
    jury’s verdict.” 68 To answer this inquiry, we generally look to the following
    three factors: “(1) the magnitude of the prejudicial effect of the prosecutor’s
    remark, (2) the efficacy of any cautionary instruction by the judge, and (3) the
    strength of the evidence supporting the conviction.” 69
    As to the first factor, we “look[] at the prosecutor’s remarks in the context
    of the trial in which they were made and attempt[] to elucidate their intended
    effect.” 70 Bearing that in mind, “we cannot say the prosecutor’s statements
    overshadowed what had come before” in this nearly two-week trial in which
    the jury heard almost six full days of testimony from thirty-five different
    witnesses and received over 200 exhibits that were admitted into evidence. 71
    67   See, e.g., 
    Bowen, 818 F.3d at 191
    (finding that prosecutor’s rebuttal, while
    responsive to the defendant’s closing arguments, did not draw on evidence before the jury
    and thus was improper); United States v. McCann, 
    613 F.3d 486
    , 496 (5th Cir. 2010) (“[T]he
    factual contents of the Closing Comment were limited to evidence that was in the record”
    whereas the “Rebuttal Comment was a largely emotional appeal to the jury to credit the
    arresting officers’ testimony because they were police officers.”); 
    Ramirez-Velasquez, 322 F.3d at 875
    (finding that the prosecutor “exceeded the range of response necessary to ‘right the
    scale’” when arguing that “as a rule, federal law enforcement agents appear in court and tell
    the truth”); United States v. Gallardo-Trapedo, 
    185 F.3d 307
    , 320 (5th Cir. 1999) (finding
    that government may “respond to defense attorney’s statement . . . but cannot base
    arguments on facts not in evidence or cloak . . . witness[es] in the protective mantle of the
    United States government”).
    68 United States v. Weast, 
    811 F.3d 743
    , 752 (5th Cir. 2016) (internal quotation marks
    omitted).
    69 
    Id. (internal quotation
    marks omitted).
    70 
    Gallardo-Trapero, 185 F.3d at 320
    .
    71 
    Id. (determining that
    prosecutor’s improper vouching did not taint “strident
    advocacy on both sides of this case and the numerous witnesses, pieces of evidence, and issues
    placed before the jury”).
    24
    Case: 17-60038        Document: 00514196603          Page: 25      Date Filed: 10/16/2017
    No. 17-60038
    In addition, the district court helped mitigate any prejudicial effect by
    instructing the jury on multiple occasions. Specifically, as to the prosecutor’s
    comments that improperly shifted the burden and alluded to additional
    evidence not presented at trial, the court responded to Ms. Bennett’s objections
    with prompt and unequivocal instructions: first, in response to the prosecutor’s
    comment that Ms. Bennett could have issued a subpoena for bank records, the
    court instructed the jury that “you’ve been instructed more than once, and I
    remind you again, the defendants are under no obligation to produce any
    evidence whatsoever;” and second, in response to the prosecutor’s comment
    that Ms. Bennett had subpoena power, the court again reminded the jury that
    “no inference whatsoever can be drawn from the fact that the defendants may
    or may not have produced any evidence whatsoever. They are under no
    obligation to do so.” As to the remainder of the prosecutor’s remarks, which Ms.
    Bennett did not object to, the court, at the start of trial, during opening
    statements, prior to closing arguments, and in the charge, issued generalized
    instructions that “what the attorneys say is not evidence.” “We presume that
    such instructions are followed unless there is an overwhelming probability that
    the jury will be unable to follow the instruction and there is a strong probability
    that the effect is devastating.” 72
    This brings us to the final factor of our consideration—the strength of
    the government’s case against the defendant. We find that Ms. Bennett’s
    conviction was supported with strong evidence of her guilt. As mentioned, the
    Government was required to prove that (1) the Defendants distributed or
    72 United States v. Gracia, 
    522 F.3d 597
    , 604 (5th Cir. 2008) (explaining that merely
    generic cautionary instructions may be able to “purge the taint of a prosecutor’s prejudicial
    comments”); see also 
    Gallardo-Trapero, 185 F.3d at 321
    (determining that a generalized
    instruction to the jury to base its decision solely upon the testimony and evidence presented
    helped to mitigate any prejudicial effect); United States v. Fields, 
    72 F.3d 1200
    , 1207 (5th Cir.
    1996) (explaining that we afford “considerable weight” to the district court’s “on-the-scene
    assessment of the prejudicial effect”).
    25
    Case: 17-60038    Document: 00514196603      Page: 26   Date Filed: 10/16/2017
    No. 17-60038
    dispensed a controlled substance; (2) that the Defendants acted knowingly and
    intentionally; and (3) that Defendants did so for other than a legitimate
    medical purpose and outside the usual course of professional practice. The
    Government proved those elements with the following evidence: (1) Ms.
    Bennett, in collaboration with her husband, took advantage of Dr. Lines to
    procure prescriptions for controlled substances for themselves and their family
    members; (2) Ms. Bennett, in fact, obtained prescriptions for controlled
    substances for her and her family members; (3) None of the prescriptions were
    supported by medical files in the Clinic indicating that the recipients were
    Clinic patients; and (4) Ms. Bennett effectively wrote these prescriptions using
    Dr. Lines’ DEA number and tracing a signature stamp embossed with Dr.
    Lines’ signature.
    Likewise, the bankruptcy charges were well supported. The Government
    was required to prove that Ms. Bennett had access to the bankruptcy estate
    and that she knowingly and fraudulently appropriated to her own use,
    embezzled, spent, and transferred property belonging to that estate. In proving
    those elements, the Government presented the following evidence: (1) Ms.
    Bennett had access to the Clinic’s accounts during the bankruptcy proceedings;
    and (2) Ms. Bennett had written and cashed three checks, depositing similar
    amounts in her own checking account. Lastly, the jury heard, and rejected, Ms.
    Bennett’s version of events.
    Taken together, these factors persuade us that the prosecutor’s rebuttal,
    although disturbing and unprofessional, did not compromise Ms. Bennett’s
    26
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    No. 17-60038
    substantial rights. 73 We have reversed convictions in the past for improper
    prosecutorial comments when the “most important problem facing the jury was
    its decision whether to credit the testimony of the . . . government witnesses,
    or that of the defendant[s].” 74 The case before us does not solely turn on
    credibility. Therefore, in light of the evidence in the record and the court’s
    curative instructions, we find that the court neither abused its discretion nor
    committed plain error in denying a mistrial or a new trial based on alleged
    prosecutorial misconduct.
    V.
    Ms. Bennett next claims that the district court erred when it allowed the
    prosecution to amend the indictment. This Court reviews a constructive
    amendment claim de novo. 75 “In reviewing a claim of constructive amendment,
    however, we are mindful to distinguish between a constructive amendment,
    which is reversible per se, and a variance between the indictment and proof,
    which we examine for harmless error.” 76
    We scrutinize any difference between an indictment and a jury
    instruction and will reverse only if that difference allows the
    defendant to be convicted of a separate crime from the one for
    73 See, e.g., 
    Bowen, 818 F.3d at 191
    (holding prosecutor’s improper vouching did not
    constitute reversible error because of overwhelming evidence supporting conviction); 
    Valas, 822 F.3d at 247
    (holding that prosecutor’s comment shifting the burden did not constitute
    reversible error because court gave curative jury instruction); 
    Boyd, 773 F.3d at 645
    –46
    (holding prosecutor’s improper vouching did not constitute reversible error because of strong
    evidence of guilt); 
    Gallardo-Trapero, 185 F.3d at 321
    (holding prosecutor’s improper vouching
    did not constitute reversible error because of overwhelming evidence supporting conviction);
    
    Diaz-Carreon, 915 F.2d at 957
    –58 (holding prosecutor’s comments shifting the burden,
    among others, did not constitute reversible error due to “defense counsel’s failure to preserve
    error and the district court’s able use of firm curative instructions”); 
    Anchondo-Sandoval, 910 F.2d at 1238
    (holding that prosecutor’s comments shifting the burden and opining on the
    merits of the case did not constitute reversible error in light of court’s instructions).
    74 
    Garza, 608 F.2d at 666
    (holding prosecutor’s improper vouching constituted
    reversible error when conviction turned on credibility); see also, e.g., 
    Gracia, 522 F.3d at 606
    (same); 
    Smith, 814 F.3d at 267
    –77 (same).
    75 United States v. Jara-Favela, 
    686 F.3d 289
    , 299 (5th Cir. 2012).
    76 
    Id. (citing United
    States v. Adams, 
    778 F.3d 1117
    , 1123 (5th Cir. 1985)).
    27
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    No. 17-60038
    which he was indicted. Otherwise, we review the purported
    amendment as a variance, and the defendant must show how the
    variance in the language between the jury charge and the
    indictment so severely prejudiced his defense that it requires
    reversal under harmless error review. 77
    Ms. Bennett argues that the jury instructions used the disjunctive “or”
    in each count where the conjunctive “and” had been used in the indictment,
    changing “distributing and dispensing controlled substances” to “distributing
    or dispensing controlled substances” and changing “embezzling, spending,
    and transferring property” to “embezzling, spending, or transferring
    property.” Ms. Bennett argues that notes sent from the jury during
    deliberations indicate that the jury noticed this discrepancy and that this
    discrepancy affected the verdict. Relying on Sitrone v. United States, 78 Ms.
    Bennett argues this constitutes a constructive amendment of the indictment,
    thereby violating her Fifth Amendment rights.
    The district court correctly determined that United States v. Holley and
    United States v. Haymes foreclose relief on these grounds. 79 In Holley, citing to
    Haymes, we stated that “[i]t is well-established in this Circuit that a
    disjunctive statute may be plead conjunctively and proved disjunctively.” 80 In
    Haymes, like here, the statute used “or,” the indictment used “and,” and the
    court charged the jury using “or.” 81 We rejected the argument that these
    77  
    Id. at 300
    (internal quotation marks and citations omitted).
    78  
    361 U.S. 212
    , 215–19 (1960).
    79 United States v. Holley, 
    831 F.3d 322
    , 328 (5th Cir. 2016) (“Although the indictment
    listed these different ways of violating § 841(a) using ‘and’ rather than ‘or,’ the Government
    still only had to prove that Holley conspired to violate the statute in one of these four possible
    ways.”) (citing United States v. Haymes, 
    610 F.2d 309
    , 310 (5th Cir. 1980) (per curiam) (“It is
    well-established in this Circuit that a disjunctive statute may be pleaded conjunctively and
    proved disjunctively.”).
    80 
    Holley, 831 F.3d at 328
    n.14.
    81 
    Haymes, 610 F.2d at 310
    –11.
    28
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    No. 17-60038
    differences meant the government improperly amended its indictment. That is
    the argument before us now, and we reject it once again.
    VI.
    Finally, Ms. Bennett challenges the sufficiency of the evidence presented
    against her. Where a defendant moves for acquittal in the district court, this
    Court reviews sufficiency of the evidence challenges de novo. 82 On reviewing
    the record, this Court asks “whether, considering the evidence and all
    reasonable inferences in the light most favorable to the prosecution, any
    rational trier of fact could have found the essential elements of the crime
    beyond a reasonable doubt.” 83
    Ms. Bennett first argues that the Government failed to prove the
    controlled substances charges because the Government did not meet its burden
    of showing that the drugs dispensed were “for other than a legitimate medical
    purpose and outside the usual course of professional practice.” Specifically, she
    argues that the Government did not dispute that the persons named in the
    prescriptions had medical needs for the drugs prescribed, and thus failed to
    demonstrate what she argues is a required element—that the drugs were not
    for a legitimate medical purpose. Next, Ms. Bennett disputes the bankruptcy
    charges, arguing that the bankruptcy guidelines were vague and repeating her
    trial testimony that she wrote the three checks for a legitimate purpose and
    that she attempted to conform her actions to the law. In her reply brief, she
    contends that thirty-eight highly skilled and educated people who had contact
    with Dr. Lines failed to contemporaneously document any incompetence and,
    while weighing evidence is a question for the jury, the prosecution’s case was
    not as strong as the Government makes it sound.
    82   United States v. Danhach, 
    815 F.3d 228
    , 235 (5th Cir. 2016).
    83   United States v. Vargas-Ocampo, 
    747 F.3d 299
    , 303 (5th Cir. 2014) (en banc).
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    No. 17-60038
    The district court, addressing Ms. Bennett’s arguments on a post-trial
    motion, recited the elements for each charge and concluded that a reasonable
    trier of fact could have found each element of each count of the indictment.
    Considering the record in the light most favorable to the prosecution, we
    find that the evidence presented sufficiently supports Ms. Bennett’s conviction.
    Ms. Bennett’s first argument—that the Government failed to prove that
    prescriptions were not for a legitimate medical purpose—is of no legal
    consequence. We have held that “knowingly distributing prescriptions outside
    the course of professional practice is a sufficient condition to convict a
    defendant under the criminal statutes relating to controlled substances.” 84 As
    we 
    explained supra
    , the Government presented evidence that showed that Ms.
    Bennett, in collaboration with Mr. Bennett, procured prescriptions for
    controlled substances outside the course of professional practice. Based on that
    evidence, a rational trier of fact could have found the elements of the crime
    beyond a reasonable doubt. 85
    Similarly, Ms. Bennett’s argument concerning the sufficiency of the
    evidence for the bankruptcy charges fails. The jury was not required to credit
    Ms. Bennett’s testimony and proffered evidence that she attempted to comply
    with the bankruptcy regulations and that she did not fraudulently transfer
    funds from the bankruptcy estate. Again, as we 
    explained supra
    , the
    Government presented sufficient evidence for a rational trier of fact to conclude
    that Ms. Bennett had access to the bankruptcy estate’s accounts and that she
    84  
    Armstrong, 550 F.3d at 397
    (emphasis added) (“[A] practitioner is unauthorized to
    dispense a controlled substance if the prescription either lacks a legitimate medical purpose
    or is outside the usual course of professional practice.”).
    85 
    Jara-Favela, 686 F.3d at 302
    (“We need not exclude every reasonable hypothesis of
    innocence to affirm.”).
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    fraudulently appropriated property from the estate to her personal account. As
    such, Ms. Bennett’s conviction stands. 86
    VII.
    The judgment of conviction and sentence is affirmed.
    86   United States v. Loe, 
    262 F.3d 427
    , 432 (5th Cir. 2001).
    31