Murder charges cleared after patient death

Six months after Richard Teh, MD, an internist in Las Vegas, NV, was handcuffed and taken to jail from his office as patients, staff, and partners looked on, murder charges against him were dropped, according to a statement from the Association of American Physicians and Surgeons (AAPS), which has been monitoring the case.

The charges were dismissed with prejudice, which means they can never be reinstated. A patient did die, but there was never any evidence that she had been murdered, much less that the doctor had done it, his defense attorneys argued. The criminal complaint alleged that the doctor did "willfully, unlawfully, feloniously, ... and with malice aforethought, kill [the patient], ... by making available ... controlled substances..."

Teh was treating the patient for chronic pain. One medical examiner ruled that the death was due to "multiple drug intoxication," as well as an enlarged heart and kidney failure, which "could be" caused by drug intoxication, court records show. Bottles of prescription medications were found in the patient's home by her estranged husband and his off-duty detective friend, who took them to the coroner's office.

Drug levels in the patient, however, were low, far below toxic levels, and she had walked into the emergency department fully alert, explains AAPS Executive Director Jane M. Orient, MD. Hospital records showed a very low white count, compatible with overwhelming infection, she says.

"The killer was actually a bacterium called Pseudomonas, which grew out of the patient's blood," Orient says. "This infection, which can be extremely difficult to treat, caused pneumonia, adult respiratory distress syndrome, and multiple organ failure."

Numerous patients and physician colleagues expressed support for Teh — as well as concerns that chronic pain patients will have still more difficulty obtaining medicine they need because of heavy-handed law enforcement. "The Teh case is by no means unprecedented," Orient says. "Many physicians have been prosecuted and even gone to prison for years for the crime of trying to relieve pain."

The Teh case initially was brought to the attention of the state Drug Enforcement Agency task force by the patient's estranged husband and his friend, then to the prosecutor after settlement of a malpractice suit brought by the husband, Orient says. As frequently happens, she says, the physician's malpractice carrier had advised him to settle to avoid the costs of defense. This can be misconstrued as an admission of wrongdoing, where none occurred, Orient notes.

"Clark County prosecutors did the right thing in dismissing this case," Orient says. "But all too often, prosecutors want a conviction at all costs."