The fate of Dr. Chris Christensen is in the jury’s hands.
The prosecution and defense presented closing arguments to a courtroom filled with Christensen’s family and supporters, Ravalli county attorney and law enforcement staff, and television cameras. He is charged with negligent homicide and over-prescribing dangerous drugs.
The arguments were presented in styles as different as the attorneys’ positions on the case.
Ravalli County Attorney Bill Fulbright went first, methodically laying out the legal standards he believed were proved — that Christensen knowingly, with conscious disregard for the risks he put 11 patients through, over-prescribed high amounts of opiates to them and in dangerous combinations. Fulbright said Christensen’s actions were a gross deviation from the standard of conduct for a medical professional, and led to the deaths of two of his patients.
“Every doctor you heard from in here, except Dr. Christensen, seems to be doing it right. They are taking care of patients, taking care of them using moderated, measured, deliberative approaches,” Fulbright said. “They’re dealing with long-term problems that need long-term solutions. They aren’t relying on opioids from the start.
“You can’t come here and say it’s someone else’s fault, or I thought I was doing what’s best. This is criminal. People died.”
Defense attorney Josh Van de Wetering countered that the entire trial is a “smear job” against Christensen by the state, equating him with drug dealers instead of treating him as a caring professional who prescribed drugs to ease people’s suffering. He said the state’s case shows that Christensen is only human, and when you operate in the real world, situations aren’t always black and white.
“The state has blinders on, and they’re not paying attention to the facts,” Van de Wetering said. “If you heard nothing else in this trial, you heard it ain’t easy. These cases are complex. They are difficult.”
He added that Fulbright himself noted that various patients reported they weren’t feeling any pain because they were on opiates.
“Yes! Yes! That’s the point,” Van de Wetering exclaimed, throwing up his hands. “Opioids help the pain. There is a risk of addiction. Yes, that’s like a lot of medications and procedures — there is risk.”
He noted that doctors prescribe opioids to chronic pain patients all the time, fully knowing the risks, and wondered aloud why those doctors aren’t on trial. Van de Wetering added if people don’t take any prescription in the manner in which they’re told to take them, the risks increase.
“In the real world, you make that risk/benefit assessment with the patient if you’re the doctor, and you do the best you can. When you do the best you can, you’re not a criminal,” Van de Wetering said.
Fulbright said other doctors didn’t have the number of complaints they had about Christensen in Ravalli, Missoula and Mineral counties, and pharmacies aren’t balking at filling other doctors’ prescriptions as they did with Christensen. Those numerous complaints prompted the creation of a drug task force that narrowed in on Christensen and led to his 2014 arrest.
Van de Wetering also called the nine former patients “liars and criminals” who all had something to benefit from by testifying for the prosecution, and some with an ax to grind after Christensen cut them off or lowered their doses. He noted that out of the thousands of patients seen by Christensen, charges only were brought for the 11 patients.
“Why does the state need to do a smear job? It’s because they don’t really have a case,” he said.
Fulbright also argued that even if the patients lied to Christensen, he had a responsibility to determine the truth before dispensing powerful drugs.
“Patients didn’t say they went to him because he was compassionate, but because they could get what they wanted,” Fulbright said. “Compassion means sometimes you have to say no…
“He wasn’t practicing medicine, but was just handing out opiates. Tell him it’s not compassion," he urged jurors. "It’s criminal.”
Fulbright noted that Christensen opened his Florence clinic “armed” with a Drug Enforcement Agency license that allowed him to prescribe opiates, but that didn’t mean Christensen was qualified to handle the complex patients he treated for chronic and sometimes intractable pain.
“He knew the risk he was dealing with because in this case it was not just someone who is trained; he has been told, told directly and put on notice that if you do that, your patients will die,” Fulbright said, noting that five of Christensen’s former patients died from overdoses using his prescribed medications in Idaho in the 1990s. “And here in Montana, he did it anyway.”
He pointed out experts said the patient records Christensen kept were minimal at best, and that he didn’t perform any type of meaningful physical exams before handing out prescriptions.
“The defendant gave lip service to fundamental things that are necessary to the practice of medicine before you can prescribe opiates,” Fulbright said. “It didn’t matter if you had mental health issues, neuropathic pain, addiction in your past or present — they left with opiates the first time and every time … and the dosage was always high from the start.”
Fulbright added that Christensen lost privileges at hospitals in Wyoming and Idaho, in part due to his record-keeping. But Van de Wetering argued that poor record-keeping isn’t a criminal offense.
“If he didn’t write it down, that doesn’t mean he didn’t do an assessment,” Van de Wetering said.
He urged the jury to look at all of the medical records included in at least four large binders used as evidence in the case, and noted that every time witnesses talked about the Christensen’s patients, they referred to those records.
Other doctors, including some who testified for the prosecution, prescribed similar — if not the same — mixes of opiates and tranquilizers to their patients, and that it was the mixing of those drugs with other substances that led to the death of Greg Griffin and Kara Philbrick-Lenker.
“In fact, in the real world, people testified that those things get prescribed together all the time,” Van de Wetering said. “But no one else seems to be a criminal, however, for having done it.”
Christensen is on trial for two counts of negligent homicide, nine counts of criminal endangerment, and 11 counts of criminal distribution of dangerous drugs. All of the counts are felonies, with the negligent homicide felony carrying a sentence of up to 20 years in prison. The criminal endangerment counts each are punishable by a sentence of up to 10 years; and the distribution of dangerous drugs counts each call for up to 25 years in prison. All 22 counts each include fines up to $50,000.
Van de Wetering closed by telling the jurors that they needed to consider Christensen as innocent until proven guilty, and that a conviction is final. He compared it to having a loved one on life support, and trying to decide whether to pull the plug.
“Something other doctors do, and one thing he’s not doing, is ignoring the patients in pain. He didn’t pull the plug on the patients like other doctors. Maybe that’s his fault,” Van de Wetering said. “Maybe he needs to learn how to say no to patients who need his help. Maybe. But maybe not.”