"We believe a 20-years sentence in this case is essentially a death sentence for Dr. MacKay," Stirba told the judge.
MacKay intends to appeal his conviction, the attorney said. His defense team filed a motion to keep the doctor out of prison pending the appeal, arguing he is not a flight risk or a danger to the community.
Benson ordered MacKay to report to a yet-to-be determined federal penitentiary Feb. 1, but will likely hear arguments on the motion before then.
"This case is not going to be over for quite a while," said Michael Hansen, one of MacKay's defense lawyers.
Rep. Rob Bishop R-Utah, and Utah Senate Assistant Majority Whip Peter Knudson, R-Brigham City, were among 244 people who wrote to the court vouching for MacKay's character.
The letters praise MacKay's community, professional and church work. He served in the military, served as an LDS Church bishop, raised money for cancer research and volunteered on the Box Elder County Search and Rescue scuba team.
MacKay was Brigham City's only orthopedic surgeon for many years. He changed his practice to pain management when poor health prevented him from doing surgery.
Prosecutors acknowledged the letters show MacKay did much good but demonstrate little or no firsthand knowledge of his medical practice or inappropriate relationship with one of his female patients that came out in court.
"In short, the defendant was leading a double life with his crimes largely hidden from his present supporters," Kennedy wrote. "Charitable deeds in the community cannot negate the effect of the serious offenses committed by the defendant."
MacKay's practice amounted to asking patients what drugs they wanted and writing prescriptions for them, prosecutors said. No amount of letters from friends, congressmen or state senators can change that, Kennedy said.
The doctor wrote 20,612 prescriptions for hydrocodone products from January 2005 to October 2009, totaling more than 1.9 million pills. He had the highest volume of prescriptions for hydrocodone in the state five years in a row.
MacKay said his conviction will have a chilling effect on other doctors who want to help patients manage chronic pain. "That is not only a tragedy, it is unconscionable."
U.S. Attorney David Barlow said he believes the overwhelming majority of Utah doctors conduct their practices according to the law.
"And that wasn't the case here," Barlow said.
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