Probes of doctor in opioid fatalities
Officials had scrutinized physician over pain drugs
A Santa Rosa physician facing murder charges in the deaths of five patients who suffered opioid overdoses was already under investigation by the state medical board for allegedly overprescribing strong pain drugs to five patients, including one man who was being prescribed 360 pills a month by the time he left the doctor’s care.
Dr. Thomas McNeese Keller, a primarycare physician with a specialty in neurosurgery, still has a California medical license, though it is under review while the state medical board continues its investigation. The state attorney general’s office arrested Keller on Monday and charged him with four counts of seconddegree murder and one count of elder abuse. He is currently in jail and awaiting a bail hearing next Tuesday.
Keller’s medical license was revoked once before, in 1990, after he was convicted of battery
on three patients in Shasta County. According to medical board records, he had been accused of sexual abuse and misconduct involving eight patients. His license was reinstated in 1994.
Nearly 50,000 people die of opioid overdoses in the United States each year, and in the midst of the epidemic, those prescribing the drugs have come under intense scrutiny. But even as state medical boards have pursued cases against doctors for overprescribing dangerous narcotics, it’s unusual for murder charges to be filed.
Keller is the first to be charged with murder by the California attorney general. In one of the first such cases in the United States, a Southern California doctor was convicted in 2015 for overprescribing drugs to three patients who overdosed.
His attorney has said that Keller was not at fault for the overdose deaths of patients in his care, and that the doctor is being unfairly targeted by politicians and prosecutors who want to appear as though they’re taking aggressive measures to fight the opioid crisis.
California Attorney General Xavier Becerra, though, said that the state has a responsibility to protect communities from doctors who are overprescribing drugs that are known to be dangerous. “When we see evidence of a crime and patient harm, we must act,” he said in a statement.
Though the criminal cases may be outliers, they are representative of a climate of discipline and intimidation directed at physicians, said many pain specialists on Thursday. And while they could not comment on the details of the Keller case, they said that punishing doctors in most cases will not improve patient care, and may in fact harm patients who suffer from pain and possibly addiction and need treatment.
“No physician is going to want to prescribe when they can go to jail for murder,” said Dr. Robert Brody, director of the pain services and clinics at San Francisco General Hospital. He added that patients who have been taking opioids for many years are most likely to suffer when doctors are afraid to prescribe the drugs.
Brody and other pain specialists said that most doctors now know to closely monitor patients’ opioid prescriptions and to make careful plans to help people taper off their medications if they’re already used to high dosages.
“It’s always tragic when a professional peer is accused of murder. I wouldn’t want to make any judgments on this individual case without reviewing the specific details,” said Dr. Anna Lembke, chief of the Stanford Addiction Medicine Clinic. “Having said that, doctors need to be held accountable.”
Many doctors, especially primary care physicians who don’t necessarily specialize in treating pain, are shying away from patients who have a history of opioid use, Lembke said. One recent study of primary care clinics in Michigan found that 40 percent of them were refusing to take new patients who were using opioids.
Those patients often are challenging cases that take more time and care — if doctors also fear they may be criminally responsible if patients die from an overdose, they may just turn them away, said Peter Osinoff, a Los Angeles attorney who represents doctors who go before the state medical board. He was an attorney for the Southern California doctor who was convicted of murder.
“Many doctors have gotten out of that area entirely, and most are reluctant to prescribe more than a few pills to tide someone over,” Osinoff said. “It is a dangerous, slippery slope to start criminalizing deaths from medical care.”
He added that it’s appropriate for medical boards to investigate doctors who are suspected of overprescribing and to take appropriate action, including revoking licenses. “The medical boards have been very proactive in this area. We should let them do their jobs,” he said.
Neither the state medical board nor the state attorney general’s office would comment on details about the ongoing investigations into Keller, including whether officials from the agencies were working together. Keller also was indicted on federal charges last year relating to health care fraud and distributing drugs outside the scope of practice.
Keller, 72, faces up to 60 years to life in prison on the seconddegree murder charges and 45 years in the federal case.
The criminal charges against Keller were filed in California Superior Court in Sonoma County on Aug. 8. The victims are identified only by initials. In addition to the four murder charges and one elderabuse charge, Keller is accused of prescribing drugs without a legitimate medical purpose to four people.
The state medical board accusations against Keller were filed in December. The cases date back to 2011, and include multiple allegations of patients prescribed narcotics that they didn’t ask for or appear to need; of patients given a much higher dosage than is typically advisable; and of Keller’s not assessing patients’ risk of overdose or whether they’re prone to addiction before prescribing the drugs.
One patient, a 62yearold Vietnam War veteran with osteoarthritis in his shoulder and spine, was prescribed two narcotics plus a drug to treat nerve pain and a sleeping pill on his first visit, according to the medical board complaint. Keller kept prescribing those drugs and others even when the patient complained of side effects.
The patient was being prescribed 360 pills a month when he left Keller’s care and began treatment at the Veterans Administration. A nurse practitioner there immediately expressed concern at the high dosage of drugs he was on and began tapering him off.
Another patient in the medical board complaint was a 35yearold woman who was kept on high doses of opioids despite informing Keller that she was pregnant and that her obstetrician had recommended she be moved to a lowdosage treatment plan. Erin Allday is a San Francisco Chronicle staff writer. Email: eallday@sfchronicle.com Twitter: @erinallday