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Murder trial begins for Santa Rosa doctor accused of overprescribing opioids

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After years watching her mother’s addiction grow, Sonoma County resident Jaidene James confronted the doctor writing her mother’s prescriptions for the strong opiate oxycodone, she testified in court Wednesday.

In an exam room beside her mother, Andrea Flocchini, James told Santa Rosa pain doctor Thomas Keller she feared the drugs were making her mother lethargic and clumsy, sometimes causing her to suddenly fall unconscious, she said from the witness stand in Sonoma County Superior Court. James said she repeatedly found her mother unresponsive on the floor in their home, sometimes forcing her to revive her with CPR and call 911.

“I explained she was abusing the pills, hurting herself and couldn’t stop,” James, 28, said.

On the first day of trial in an unusual case of a doctor accused of killing four patients by overprescribing opioids, state prosecutors said Keller continued prescribing strong pain medication to Flocchini for at least another year after that exam room encounter. Flocchini died after overdosing on the medication on July 18, 2014 — two days after she received 120 pills of oxycodone prescribed by him, according to court testimony.

“This case is about betrayal,” Deputy Attorney General Meghan Anderson said during opening statements to the jury. “The evidence will show the defendant betrayed his patients time and again by turning them into drug addicts.”

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

Keller is not charged in the death of Flocchini. But prosecutors said her death should have been a warning for Keller and put him “on notice” that he was putting his patients’ lives in danger.

He is also charged with elder abuse and recklessly prescribing medications in connection with five additional patients he treated at his medical practice on Farmers Lane, which he opened in 2008. Keller shifted his focus to pain management starting in 2011.

Keller’s lawyer asked jurors to be cautious about blaming a doctor for the complicated health conditions and history of drug abuse among some of his patients. Defense attorney John Cox asked the jurors to listen to evidence showing that while Keller may have been unhappy and rude, he treated a group of patients living with chronic pain at a time when medical providers had been trained to eradicate patient pain and drug companies were peddling opioids as safe.

“I don’t expect you to like Dr. Keller, you might hate him — I don’t care,” Cox said. “Hatred is not evidence of a crime.”

Against a backdrop of an entrenched opioid epidemic, the case is one of a handful across the country where prosecutors have brought murder charges against doctors or pharmacists seeking to hold the providers responsible for patients’ addictions and deaths. A Los Angeles doctor is serving 30 years to life in state prison after a jury in 2015 convicted her of three counts of second-degree murder for opioid-related deaths, as well as 20  other crimes.

Keller’s trial is the first led by California Attorney General Xavier Becerra following an investigation led by a division of the California Department of Justice Bureau of Medi-Cal Fraud and Elder Abuse.

A former Army neurosurgeon, Keller has a checkered medical career. He was found to have engaged in sexual misconduct with several patients in 1989 in a case that led to a six-month jail term and stripped him of his license. His license to practice medicine was reinstated in 1994.

In 2017 Keller began cutting ties with patients after learning his pain practice was under investigation by the California medical board, and he suspended his practice in the fall of 2018 after learning he was under investigation by federal authorities for health care fraud and illegally distributing opioids. He was indicted by a federal grand jury later that year in case that is still pending.

He was arrested in August on suspicion of second-degree murder and remains in Sonoma County Jail. A judge set bail at $12 million.

In court Wednesday, Cox told jurors prosecutors were mischaracterizing Keller, whom he acknowledged has abrasive, unlikable characteristics.

Key to the state’s case is Keller’s personal journal, a spiral-bound diary in which he wrote about his patients, often using crass, profane and derogatory language, which prosecutors said showed he acted with careless indifference for his patients’ lives.

Keller referred to his medical office as “this goofy legal drug-dealing pain practice” and appeared to celebrate his patients’ deaths, according to portions of the journal presented in court.

But his attorney accused prosecutors of exposing Keller’s private thoughts he scribbled in a notebook to shake off the frustrations of each day — notes that prove only that he was miserable and not that he set out to harm any of his patients.

Cox told jurors that three of Keller’s patients — Nelson, Rielli and Badenhop-Bionda — died of accidental overdoses, according to coroner reports. Badenhop-Bionda had been receiving medication from a methadone clinic and not telling Keller, according to Cox. McDonald killed herself by ingesting too much of a prescription headache medication, he said.

Cox said Keller had a good relationship with McDonald, 23, who gave Keller some of her artwork, paintings he hung on his office walls. Her mother — who has said she believes Keller is innocent of the charges — is expected to testify in his defense.

“He was trying to take care of her,” Cox said.

The trial is expected to take two months. Prosecutors said they will bring former patients to testify about how Keller fed — or created — their addictions to pain medication, often by prescribing a dangerous combination of drugs known to be highly addictive.

“Family members begged the defendant to reduce their dosages, and he ignored them,” said Anderson, the prosecuting attorney. “He ignored multiple red flags of addiction.”

The trial resumes Thursday.

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

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