A Santa Rosa doctor was held over for trial in Sonoma County Superior Court Friday afternoon for the second-degree murders of four patients by allegedly prescribing dangerously high levels of addictive opioids to them in 2016 and 2017.
Dr. Thomas Keller, 72, also was held over for trial for elder abuse of a fifth patient who later died, and for issuing prescriptions without legitimate medical purpose to four other patients between 2013 and 2018. One of those four patients was an undercover agent with the California Department of Justice. The remaining eight patients are or were Sonoma County residents.
The holding order by Judge Chris Honigsberg came after a four-day preliminary hearing. Keller remains in the Sonoma County Jail under $12 million bail. He faces 60 years to life in prison on the second-degree murder charges alone.
Deputy Attorney General Thomas Brennan submitted as evidence nine binders containing thousands of pages of documents that included the medical files of the alleged victims.
In his closing statement to the court Friday, Brennan said evil was Keller's motive for prescribing lethal doses of opioids to the patients. Brennan said Keller "blatantly ignored warning letters from pharmacies and insurance companies that told him to gradually decrease the doses of his prescriptions.
"Evil permeates its way into every count of second-degree murder," Brennan said.
Brennan's evidence included a personal journal Keller kept in which he made profane and disparaging comments about his patients, calling some of them "high-level addicts."
The evidence also included nine binders, one for each patient, containing thousands of pages of medical records on the potency and frequency of dosages, prescriptions and autopsy and toxicology reports.
The final prosecution witness, Dr. Timothy Munzing, a pain management specialist and family medicine physician with Kaiser Permanente in Southern California in Southern California, testified Keller's prescriptions were often a dangerous combination of Soma, a muscle relaxant, benzodiazepines and increasing doses of opioids. Instead of reducing the amount of the drugs, Keller escalated them, Munzing said.
There was no medical justification or medical purpose for the elevated levels of the drugs, Munzing said.
The complaint alleges Keller over-prescribed and consistently and drastically increased opioid prescriptions of pain medications including Vicodin, oxycodone, OxyContin, Percoset and morphine at levels well outside accepted medical practice.
Keller's attorney John Cox said Keller's actions may have been outside standard practices, but the prosecution did not prove Keller intended to kill the patients or acted with implied malice.
Honigsberg ruled Keller acted with malice and intentionally committed each of the second-degree murders, and that Munzing was a credible and compelling witness.
Keller is scheduled to re-enter pleas to the nine charges on Sept. 20.