Former patient and undercover agent testify in Santa Rosa doctor’s murder trial

A patient of the Santa Rosa pain specialist on trial testified Thursday that she first met him in the role of caretaker for her husband, who was awaiting spinal surgery for a disabling neck condition.

But a month into that treatment, Dr. Thomas Keller offered to prescribe narcotics for the wife, Jennifer Silver, even though she had no real complaint at first beyond occasional soreness from daily workouts at the gym, according to her testimony in Sonoma County Superior Court.

Silver described a bewildering ramp up in the potency and number of drugs she was prescribed by Keller, leading quickly to an acute, debilitating addiction that lasted over four years of visits with the doctor.

Then in late 2015, he suddenly, inexplicably told her “to get the f--k out” when she came in to renew her prescriptions one day, she testified. It was “devastating.”

Her testimony came in the fourth week of a trial in which Keller stands accused of causing the death of four patients who died of drug overdoses while under his care between 2013 and 2018. The patients, all Sonoma County residents include Tripo Nelson, Ashlee McDonald, Dean Rielli and Jerri Lee Badenhop-Bionda.

The California Attorney General’s Office, in a first-of-its-kind case for the state agency, has charged Keller with four counts of second-degree murder, charges that could earn him 60 years to life in prison.

The doctor has shuttered his Farmers Lane office and surrendered his medical license. He has been held in the county jail since his arrest last August. His bail is set at $12 million.

In a separate jury trial scheduled for June in federal court, Keller faces three charges of prescribing drugs outside the scope of practice and two charges of Medicare fraud.

Silver said at times she was taking 29 pills a day, most of them from the so-called “holy trinity” - a high-risk cocktail of Oxycodone, Xanax, an anti-anxiety drug, and Soma, a muscle relaxer. After Keller abruptly canceled her treatment she was forced to detox on her own, cold turkey, without help, she said.

“It was like dying,” she said, describing weeks of vomiting, dry heaves and other unpleasant symptoms.

She is one of four victims identified in the criminal complaint whom prosecutors said Keller prescribed drugs to without any legitimate medical reason.

Another of the victims, an undercover agent who posed as a drug-seeking patient, testified Thursday that Keller told him he shouldn’t be taking opioids, but the doctor prescribed them anyway.

The undercover agent, California Department of Justice Special Agent Ross Martin, told of laying the trap that would help support bringing charges against Keller. It required first that he start a doctor-patient relationship he discovered would be weird in the extreme.

He had partial proof in a video-recording taken with a hidden camera during a 2018 visit in which Keller appeared both giddy and agitated, telling jokes to any patient within earshot and grousing in crude language about the impact of increased alarm over the nation’s opioid epidemic.

He had in his office several copies of a newspaper story about the risks of using narcotics to treat chronic pain. At one point during Martin’s visit Keller handed him the article to read, Martin said.

But then he agreed to prescribe 120 doses of a controlled drug called Tramadol to Martin, with four refills - snatching a pocket knife from a counter to cut the prescription slip off the pad.

“I’ve never seen a doctor so volatile,” Martin said. “As you can see, I stayed composed, but inside I was reeling. … When you’re in law enforcement, there’s no rhyme or reason to why they’re behaving the way they are, and now they have a knife, you never know what’s going to ?happen next.”

Silver described one appointment in which Keller was laughing about the overdose death of a patient - like “she was stupid, it was funny, ha ha,” Silver testified, describing Keller’s tone.

He had good days and bad days, and on good days, the mood was “there’s no pain on Farmers Lane, and here, have some candy,” she said.

His defense attorney, John Cox, has conceded his client is brusque and perhaps unlikable, but he challenged both witnesses Thursday with written medical records that appeared to contradict their accounts of receiving drugs without reporting any pain.

Each time she saw Keller, Silver had to fill out a form on which she was asked to circle a number identifying the intensity of her pain on a scale of one to 10 - usually around seven - while also shading in areas of a human figure showing where she experienced discomfort.

She had been in a car accident and had carpal tunnel surgery in the first year of her treatment with Keller, both of which prompted him to increase her medications, though she hadn’t recalled or completely understood it, according to medical records offered in court and her testimony. She also described a much earlier injury to her hip that was in the records.

Cox and Martin wrangled over whether a fictitious referral from a Southern California doctor might have given Keller legitimate reason to prescribe pain medications.

Cox suggested it might have been justified for Keller to assume that since Martin was ostensibly seeking the expertise of a pain specialist, that he in fact was suffering from pain and needed prescription drugs to help relieve what ailed him. His fictitious chart documented recurring ankle and back pain, and other records reported concerns about unemployment.

Cox also displayed a letter that Martin may not have received, because he was not using a real address, in which Keller told him he no longer would treat him and was referring him to another doctor.

In an interview after court, Cox said other patient witnesses have testified to lying about their pain in order to obtain more drugs, including one who went so far as to tell Keller he needed more pills because someone had broken into his car and taken his. The man then admitted in court that he filed a false police report to bolster his claim.

“There’s no understanding that if you go to your doctor and you lie to your doctor and your doctor believes you, your doctor could now be convicted of murder or other felonies because he actually prescribes you medicine that he believes is actually helping you based on what you tell him and what he’s observing,” Cox said.

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