Santa Rosa doctor pleads not guilty to murder charges connected to four patient deaths

Santa Rosa neurosurgeon and pain specialist Dr. Thomas McNeese Keller pleaded not guilty Tuesday in Sonoma County Superior Court to second-degree murder charges for allegedly causing the deaths of four patients by overprescribing pain medications, choosing to engage in a legal battle against state prosecutors that could land him in prison for life.

In a case that puts the scourge of opioid abuse front and center, Keller, 72, faces not only the murder charges, but a single felony count of elder abuse and four counts of issuing prescriptions without legitimate medical purposes in connection with four other patients. Prosecutors alleged the doctor's illicit activity occurred between 2013 and 2018, according to a criminal complaint filed Aug. 8.

Keller was arrested last week and booked into Sonoma County Jail on the state charges, which came almost a year after he was indicted by a federal grand jury and accused of health care fraud and illegally distributing opioids.

A county judge Tuesday set bail for Keller at $12 million, which his defense attorney John Cox said will force his client to remain behind bars pending further court proceedings. The doctor will return to court for a two- or three-day preliminary hearing on Sept. 3 to determine if there is enough evidence for a judge to order him to stand trial.

Cox said he doesn't think the charges will stand, given evidence that one patient connected to a murder charge assaulted her mother to get access to a locked safe where her opioids were kept and that no cause of death had been determined in the case of another patient, for instance.

“It's easy to paint a bad picture of the guy,” Cox said of his client in an interview, “and it's much more difficult to get into the details and look at the actual facts.”

Deputy Attorney General Thomas Brennan argued for the high bail amount - in fact, he initially favored no bail. Brennan said Keller possessed a “depraved heart” that made him a public safety risk and was a “de facto flight risk” on account of facing 70 years to life in prison if convicted on all counts.

But Cox said that Keller not only had a pending federal case, he had been presented with the state's criminal complaint five months earlier and yet had remained in Santa Rosa awaiting arrest.

He also said that Keller had suspended his medical practice last fall and surrendered his license to prescribe medications.

“He may not be a likable person,” Cox told the court, but he was still entitled to reasonable bail.

The arguments provided such provocative discussion about Keller's character that even the dozen or more inmates in the courtroom on their own matters clearly were riveted.

They also provided a preview of the potential trial ahead, with Brennan citing passages in the doctor's personal journal that he said revealed the “implied malice” necessary to prove second-degree murder, as well as a reflection of what he called Keller's “complete, utter contempt for humanity.”

The prosecutor accused Keller of running his medical practice with such wanton recklessness that pharmacies, health care insurers and other physicians repeatedly warned him about overprescribing medications.

But Keller, he said, simply ignored their letters, stuffing them in patient files later seized by investigators who, among other evidence, also recovered the doctor's journal.

Keller, a former U.S. Army, Air Force and Veterans Administration neurosurgeon, revealed in the journal that the military and neurosurgery “f---ed his career,” that he had “rejected America” as a child and found himself in his recent years “sitting here as a legal drug dealer on Farmers Lane,” according to Brennan.

The prosecutor cited at length from Keller's journal about a young woman in his care when she overdosed on oxycodone in July 2017, shortly after an earlier suicide attempt that had prompted Keller to cut ties and instruct her to go to see a psychiatrist.

But Keller agreed to take her back after a pleading letter from the patient's mother, who stated, “You're her only friend,” Brennan said.

Keller prescribed her more oxycodone, medication Cox said was stored in a safe until the woman beat up her mother to gain access. She was found dead the next day.

“Knew she had to go,” Keller wrote about the patient, Brennan said.

“Not only was the suicide foreseeable, he expected it,” Brennan said.

Brennan also described an undercover California Department of Justice agent who presented himself at Keller's office last year with what Brennan described in court as “crystal clear signs” of someone abusing opioids and who was still prescribed multiple medications.

Cox said his client's area of specialization invites second-guessing because it is so fraught with complications, particularly given the risks of addiction and the difficulties of treating unrelenting chronic pain. But that doesn't mean his client committed murder, Keller's attorney said.

“Instead, what this is, is the government trying to show us that they're doing something on a politically hot topic, against an individual doctor who they believe a jury won't like because of what's contained in his personal diary,” Cox said.

You can reach Staff Writer Mary Callahan at 707-521-5249 or mary.callahan@pressdemocrat.com. On Twitter @MaryCallahanB.