The Supreme Court of the State of Montana (“Montana Supreme Court”), in a 4-3 decision filed on September 16, 2020, overturned the negligent homicide convictions of a former Montana doctor who was charged with distributing dangerous drugs outside the course of a professional practice to eleven patients selected by the prosecutor among approximately 4,700 patients treated by the doctor. Two of those patients died from prescription drug overdoses shortly after obtaining prescriptions from the doctor.
The doctor was a general physician who has practiced in California, Washington, Idaho, and most recently, Montana. Although he was not a pain specialist, he considered himself to have a special interest in managing chronic pain. The doctor prescribed to patients narcotics like Methadone, a long-acting synthetic opioid agonist, and Dilaudid (hydromorphone hydrochloride), a short-acting opioid analgesic that modifies patients’ psychologic interpretation of and physiologic response to pain. He often administered prescriptions for opioids in conjunction with benzodiazepines like Diazepam (Valium), Lorazepam (Ativan), and Alprazolam (Xanax), used for treating anxiety, muscle spasms, and depression. Benzodiazepines are classified as Schedule IV controlled substances pursuant to the DEA. Scheduled narcotics may only be prescribed by a physician or other medical professional with a DEA license.
On October 19, 2017, Montana filed a final Amended Information accusing the doctor of two counts of Negligent Homicide, felonies, in violation of § 45-5-104, MCA, for the deaths of two of his patients; nine counts of Criminal Endangerment, felonies, in violation of § 45-5-207, MCA, for nine patients; and, eleven counts of Criminal Distribution of Dangerous Drugs, felonies, in violation of § 45-9-101, MCA.
A jury trial was held October 23 through November 20, 2017, after which the doctor was found guilty on all counts. On March 8, 2018, the doctor was sentenced to 20 years in the Montana State Prison with ten years suspended. The doctor appealed.
Montana Supreme Court Opinion
The heavily-divided Montana Supreme Court held: “We conclude that the State failed to meet its burden to prove beyond a reasonable doubt that Christensen’s prescribing of dangerous drugs was the cause-in-fact of the deaths of Philbrick and Griffin. The toxicologist determined that both deaths were “accidental overdose deaths,” caused from “mixed drug toxicity.” Further, both Griffin and Philbrick had a mixture of legal and illegal drugs in their system, not all of which were prescribed by Christensen. And no expert testimony provided that the actual cause of death was from Methadone and benzodiazepine prescriptions written by Christensen or opined as to how each victim’s combination of drugs caused their deaths … under these facts, without more, whether Christensen’s prescriptions, standing alone, caused the deaths of Philbrick and Griffin remains speculation. The State argues that Christensen’s grossly negligent conduct, in which he provided Griffin and Philbrick with dangerous prescriptions, contributed directly to their deaths “as if he handed each a loaded gun.” However, the evidence presented at trial does not indicate that Christensen’s prescribing practices caused Philbrick and Griffin to die or that Christensen’s prescriptions were the sole cause of Philbrick’s and Griffin’s deaths. Because there was no evidence that Christensen’s negligent prescribing of dangerous drugs was the cause of Philbrick’s and Griffin’s deaths, there was insufficient evidence to support Christensen’s convictions for negligent homicide.”
The Montana Supreme Court concluded: “For the reasons stated, Christensen’s convictions for eleven counts of Criminal Distribution of Dangerous Drugs, § 45-9-101, MCA, and nine counts of Criminal Endangerment, § 45-5-207, MCA, are affirmed. We reverse and vacate Christensen’s conviction for two counts of Negligent Homicide, § 45-5-104(1), MCA, because the State did not meet its burden to demonstrate that Christensen was the cause-in-fact of the deaths of Kara Philbrick and Gregg Griffin.”
Three of the Montana Supreme Court Justices wrote separately that they would have upheld the two negligent homicide convictions (“Whether Gregg’s and Kara’s deaths were caused by Christensen’s conduct was a question for the jury to decide”), and two other Justices wrote that Montana’s criminal laws were not designed to prosecute doctors under these circumstances and that Montana medical malpractice laws provide the victims with causes of action for damages (“the irrefutable fact is that the Legislature neither designed, nor intended, Montana’s current criminal endangerment and criminal distribution of dangerous drugs statutes for the prosecution of duly licensed physicians for writing ill-advised medical prescriptions to patients”); therefore, they would have overturned all of the convictions.
Source State of Montana v. Christensen, 2020 MT 237.
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