Opioid prescriptions at center of closing arguments in trial of Santa Rosa pain doctor accused of murder

Four patients treated by a Santa Rosa pain doctor on trial for their murders had suffered from an extraordinary list of health problems compounded by anxiety, depression, suicide attempts and substance abuse.

They had lifelong back pain, diabetes, Lupus autoimmune disease, chronic obstructive pulmonary disease and injuries from car crashes.

All four Sonoma County residents - Tripo Nelson, Dean Rielli, Jerri Lee Badenhop-Bionda and Ashlee McDonald - died in 2016 or 2017 from drug overdoses while under the care of Dr. Thomas Keller. McDonald’s death was listed as a suicide on her death certificate, while the others were ruled accidental.

On Wednesday, a Sonoma County jury began the task of deciding whether Keller, 73, is guilty of second-degree murder for their deaths given his role prescribing powerful medications, including opiates, and what prosecutors argued was a track record of recklessly ramping up dosages without care for his most troubled patients.

“Is he being a compassionate doctor? Is he in good faith treating pain?” Deputy Attorney General Thomas Brennan said in his closing arguments, which concluded Wednesday. “Or is he feeding addiction?”

Keller is also charged with elder abuse for his treatment of former patient Susan Ross, who died at age 67 in 2015, plus four counts of recklessly prescribing medications to Jennifer Silver and Alyssa Rieden of Santa Rosa, Steven Delacour of Forestville, and an undercover agent posing as a patient. Silver, Rieden and Delacour testified in court against him.

He faces 60 years to life in prison if convicted on all counts.

The trial began late January and over the ensuing weeks broadened into an indictment of the nation’s opioid epidemic, the pharmaceutical industry’s profit-driven motives, the ?federal government’s ineptitude to halt the crisis and one disgruntled doctor’s role amid the maelstrom. The jury began deliberations Wednesday afternoon and will continue Thursday morning.

Keller’s lawyer John Cox argued the government launched a witch hunt against him during a major shift in the medical establishment’s guidance on opioid prescribing because Keller treated patients with complicated problems and recorded his ugliest thoughts about them in a journal.

The state’s case is one of a handful across the country involving doctors accused of murdering patients through their opioid prescribing practices, and the second case of its kind in California.

In his closing statement, Cox asked jurors to consider the national impact of their decision, saying their verdict could “indeed change the world” and have a “huge impact on the medical community.”

“Doctors used to get sued for not prescribing opioids,” Cox claimed. “Now they’re being charged with murder.”

State prosecutors drew direct links between the medications Keller doled out to his patients in risky combinations and evidence he ignored obvious warning signs, including suicide attempts and drug-seeking behavior. They said Keller’s journal provided a window into the cruel mindset at play when Keller was giving out heavy doses of narcotics, tranquilizers and muscle relaxers.

Keller referred to himself as “a legal drug dealer” about a dozen times, according to portions of the journal read during the trial. He wrote that McDonald was “very strange and knew she had to go.”

Jurors must decide if Keller acted with conscious disregard for human life and with a mindset that he knew the risks and disregarded them.

Cox argued to jurors that standard is impossible to meet if each patient’s case, including their histories of mental illness and substance abuse, is closely examined. Cox dissected the toxicology and pharmacy records for each patient named in the criminal complaint, and suggested the documents don’t show the neglect prosecutors tried to portray. He questioned testimony from the forensic pathologist who conducted the autopsies and determined drugs prescribed by Keller were substantial factors in their overdose deaths.

But in addition to prescriptions, the toxicology reports for some of those who died included other substances like alcohol. Cox suggested Nelson’s death also should have been ruled a suicide because he had become depressed over his father’s recent suicide, and Cox questioned whether the morphine in his system came from heroin and not prescription drugs.

“They have not connected the dots on this case,” Cox said.

The trial included testimony from more than two dozen witnesses, including competing medical experts testifying for both sides who reached contrasting conclusions about whether Keller’s prescriptions were within reasonable medical practice. Some patients testified in his defense.

Several former patients of Keller took the stand and described in stark and emotional terms their battles with addiction, including the role they claimed Keller played in launching or enabling their substance use problems. Brennan and his prosecution team argued Keller provided starkly different treatment for patients with financial means and self-confidence compared to his most vulnerable, complex patients.

“What was he doing with severely depressed people? Loading them up,” Brennan said.