In a decision issued on September 26, the Montana Supreme Court reversed and vacated the two homicide convictions of former Florence Dr. Chris Christensen. However, his conviction for 11 counts of distribution of dangerous drugs was affirmed, as was his conviction on nine counts of criminal endangerment.
Christensen was convicted on all these counts and charges following a jury trial that lasted from October of 2017 to November of 2017 and sentenced to 20 years in state prison with 10 years suspended. That sentencing was stayed pending the outcome of this appeal.
The majority court, in its ruling, found that enough evidence was presented at trial to convict Christensen of the offenses of distribution of dangerous drugs and criminal endangerment “beyond a reasonable doubt.” But they did not find enough evidence “beyond a reasonable doubt” for a jury to convict him of homicide.
The Court opined that issue of whether Christensen may be prosecuted and convicted under the statute on the distribution charges “rests on whether (1) ‘prescribing’ dangerous drugs constitutes ‘selling, bartering, exchanging, or giving away,’ and (2) he was operating outside the course of a professional practice at the time he prescribed these controlled substances.”
The State alleged that Christensen was acting outside the course of a professional practice with regard to the 11 named patients because he eschewed the use of appropriate documentation, assessments, tests, follow-ups, referrals, and provided dangerous drugs in obscene quantities such that Christensen was not acting like a physician at all but instead was acting as a “drug pusher.”
But the Court, after reviewing the facts “in the light most favorable to the prosecution,” concluded there was overwhelming evidence for a reasonable jury to find that Christensen used his prescription writing authority as a pretext to act as a drug dealer, supporting drug tolerance or feeding addictions for all 11 patients, and that he purposely or knowingly acted outside the course of a professional practice and for no legitimate medical purpose when prescribing dangerous drugs to these patients.
“Accordingly, we affirm Christensen’s convictions for eleven counts of Criminal Distribution of Dangerous Drugs,” wrote the Court.
The court noted that a person commits the offense of criminal endangerment when he “knowingly engages in conduct that creates a substantial risk of death or serious bodily injury to another.”
The court wrote, “And the issue is not, as Christensen contends, whether the statute fails to put any reasonable person on notice that the act of prescribing scheduled drugs in any medical practice constitutes a felony under the statute. Rather, the issue is whether Christensen could have reasonably understood that the statute prohibited his conduct—overprescribing and disregarding essential tests, follow-ups, and safeguards along with prescribing massive amounts of dangerous prescription drugs to patients with histories of drug abuse and addiction.”
“Common sense dictates that a licensed medical doctor who has practiced for 30 years and possesses a DEA license to administer scheduled narcotics would have known the inherent risks of prescribing opioids, benzodiazepines, and numerous other Schedule II and Schedule IV controlled substances in shocking quantities and often at the same time. He demonstrated that he knew he was way out of the realm of professional medical practice by telling patients to use a Corvallis pharmacy, as other pharmacists refused to fill his prescriptions. Despite these warnings, Christensen’s conduct in Montana reflected a similar pattern of behavior as he previously exhibited in Idaho, using his practice as a cover to administer dangerous drugs, disregarding or ignoring past medical records, ignoring appropriate tests or efforts to appropriately diagnose patients’ underlying cause of pain,” wrote the Court.
“It is undisputed that the drugs Christensen administered to the nine patients were inherently dangerous and subject to abuse. And, in enforcing the statute, police, prosecutors, and juries must adhere to the legal requirement that a physician may only be prosecuted if he or she knowingly disregards risks of abuse and nonetheless prescribes such drugs in such a manner and quantity that the risk of death or bodily injury to patients is ‘substantial’.”
The Court concluded that the law “was not unconstitutionally vague as applied to Christensen’s incredibly dangerous and unconscionable conduct.”
They found the District Court did not err in denying Christensen’s motion to dismiss the criminal endangerment charges.
“Given ample testimony regarding Christensen’s prescribing practices, viewing the evidence in the light most favorable to the prosecution, we conclude there was sufficient evidence from which a rational jury could find that Christensen was aware of a high probability that providing opioids, benzodiazepines, and other drugs to the nine named patients created a substantial risk of death or serious bodily injury,” wrote the Court.
In the matter of the homicide charges, however, the Court decided that the state did not 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 Kara Philbrick and Gregg Griffin and that the jury lacked the evidence it needed to judge without a reasonable doubt that Christensen was responsible for the deaths.
“Where a crime is based on some form of negligence,” wrote the Court, “the State must also demonstrate that the defendant’s conduct was both the ‘cause-in-fact’ of the victim’s death and that the victim was ‘foreseeably endangered’ in a manner and to a degree of harm which was foreseeable. Conduct is a cause- in-fact of an event if the event would not have occurred but for that conduct; conversely, the defendant’s conduct is not a cause-in-fact of the event if the event would have occurred without it.”
“Clearly, the risk created by Christensen’s conduct under the circumstances—providing large quantities of prescription drugs with no proper review of Philbrick’s and Griffin’s medical files, with specific knowledge that Philbrick and Griffin had a history of addiction—was foreseeable,” argues the court, “Therefore, whether Christensen is liable for negligent homicide rests on whether he was the cause-in-fact of Philbrick’s and Griffin’s deaths.”
The Court concludes that the cause-in-fact of the deaths was not proven beyond a reasonable doubt to be Christensen’s prescribing of dangerous drugs.
“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,” states the Court.
“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 Court concluded.