Murder trial ordered against Santa Rosa pain doctor accused of overprescribing opioids

A Sonoma County judge Friday ruled there was sufficient evidence to try a Santa Rosa doctor who specializes in pain management on charges of second-degree murder in the deaths of four of his patients, clearing the way for a unique murder trial of a physician accused of over-prescribing dangerous combinations of drugs, including opioids.

Judge Chris Honigsberg said state prosecutors had provided enough documentation that Thomas Keller prescribed what the judge called “astronomical levels” of opioids in combination with anxiety medications and muscle relaxants, disregarding patients’ other health conditions and ignoring letters from pharmacies and health insurance providers warning of the risks to those in his care.

“The defendant knew his actions were dangerous to human life,” Honigsberg said.

Keller, 72, is accused of second-degree murder in the deaths of Sonoma County residents Tripo Nelson, Ashlee McDonald, Dean Rielli and Jerri Lee Badenhop-?Bionda, The four charges together carry a potential prison term of 60 years to life.

Honigsberg also ruled there was enough evidence to try Keller on additional charges, including criminally and recklessly doling out medications to another four patients and a single count of elder abuse of a 60-year-old woman who died from respiratory and other health issues in combination with harmful levels of prescription drugs.

The trial marks the first time California Attorney General Xavier Becerra has sought murder charges against a doctor for deaths related to opioid medications. Keller, who suspended his medical practice last fall and was arrested in August, remains in the Sonoma County Jail, with bail set at $12 million. He was indicted by a federal grand jury last year on charges of health care fraud and illegally distributing opioids.

A former Army neurosurgeon, Keller has operated a medical practice on Farmers Lane since about 2008, focusing on pain management since around 2011, according to court testimony.

The judge made his decision after listening to four days of testimony from drug diversion investigators with state and federal agencies, Sonoma County sheriff’s coroner detectives and the husband of one of Keller’s patients who died. He also heard from a Southern California doctor with pain management expertise who reviewed the medical records for all nine patients involved in the criminal complaint, including autopsy and toxicology reports for those who died.

Agents read from Keller’s private journal, in which he repeatedly referred to himself as a “legal drug dealer” and to his patients as “a collection of druggies.” Writing about a patient who killed herself, Keller said “psycho b---- girl ... killed herself,” according to court testimony.

Keller’s attorney John Cox argued the investigation was biased from the start. He said three of the patients who died killed themselves and the fourth death was deemed an accident. The patient records, he said, tell a different story than the one put forward by prosecutors that Keller’s actions caused his patients deaths.

“In fact, I would argue the opposite. These were very ill people treated over a long period of time,” Cox said.

Deputy Attorney General Tommy Brennan argued Keller treated his patients as “less than human,” routinely increasing dosages and combinations of medications to risky and life-threatening levels.

“That’s evil, judge,” Brennan said. “The motive of Defendant Keller is evil.”

The judge found credible the state’s evidence. He noted that Keller appeared to be helping patients avoid scrutiny at the pharmacy when filling dangerous combinations of medications by giving patients both written and faxed prescriptions on the same day.

Keller routinely prescribed what’s known as the “Holy Trinity” of drugs - a cocktail of opioids, anxiety medications and muscle relaxants that can lead to substance abuse and is now widely viewed as risky, according to investigators’ testimony and medical records presented during the hearing. Investigators said the mix of drugs can combine to create a more euphoric experience and is commonly abused.

Keller had prescribed “extremely risky dosages” of opioids and these other types of drugs to Badenhop-Bionda, who had a documented history of addiction in her past, according to her medical records and Keller’s notes presented during the preliminary hearing.

Timothy Munzing, an opioid expert who works with Kaiser Permanente in Southern California and serves as an expert case reviewer for the Medical Board of California, testified that Keller’s records for all nine patients showed he rarely followed recognized standards of care, such as blood pressure measurements and requiring urine tests to detect whether a patient is following protocol.

Munzing said there was “no medical justification” for the amounts and dosages of medications Keller was prescribing to several of his patients, including the “cascade of opiates” he prescribed to a woman who had attempted to kill herself in the past and, while under Keller’s care, committed suicide.

“Here’s a patient who is very fragile and should be monitored closely and not given something to make them worse,” he said.

Prosecutors said Keller demonstrated unprofessional and sometimes outrageous behavior toward his patients, at times cursing at and mocking them. Working undercover, California Department of Justice Special Agent Ross Martin became a patient of Keller seeking pain medications, and he described a visit with Keller as “one of the weirdest experiences.”

Keller came into the lobby with a bucket of candy and made odd statements, including “I hope you’re not gay ... nobody’s perfect,” Martin said. He also joked about another patient’s rectal pain, according to Martin.

In the exam room, Martin claimed to be a heavy drinker, prompting Keller to reply: “Candy is dandy but liquor is quicker.”

State investigators read portions of Keller’s private journal, seized from his home, in which he wrote about his patients in vulgar terms.

Keller laughed at one point when an investigator read a portion of the journal in which he lamented not getting sex. Otherwise, he remained quiet throughout the proceedings, seated at the defense table and wearing blue jail clothes and glasses.

Honigsberg said he gave less consideration to the contents of the journal than other evidence, but that it “at best” showed Keller had “general nonchalance” toward his patients “and at worst reckless disregard for health and disregard for human life.”

When the preliminary hearing began Tuesday morning, Keller asked the judge to refer to him as “Dr. Keller” instead of “Mr. Keller.”

Honigsberg refused and began to explain his reason.

“I’m a physician,” Keller interrupted.

Honigsberg declined again. “I call everyone in your seat Mr. or Ms.,” he said to the defendant.

You can reach Staff Writer Julie Johnson at 707-521-5220 or julie.johnson@pressdemocrat.com. On Twitter @jjpressdem.