Morphine doctor's murder trial begins

APBnews.com

June 8, 2000

FARMINGTON, Utah -- On Dec. 29, 1995, a 91-year-old woman died the day after she was admitted to a geriatric psychiatric unit at a Utah hospital. By mid-January 1996, three more women and one man were dead.

The five patients in the Davis Hospital and Medical Center in Layton had a lot in common. All were elderly, the youngest 72, and confused, with mental problems that made them difficult or impossible to care for in nursing homes. But investigators say they were in good physical condition considering their age, and their doctors, nurses and families expected them to leave the unit within weeks after being stabilized on psychotropic medication.

And all were being treated by Dr. Robert Weitzel, a psychiatrist who had been working for Horizon Mental Health Management, operator of the Davis unit, for three months. Weitzel ordered morphine injections for all five.

Weitzel is now under indictment for the murder of Ellen Anderson, 91; Judith Larsen, 93; Mary Crane, 72; Lydia Smith, 90; and Ennis Alldredge, 82. The trial began this week with jury selections, and opening statements are set for Friday. The case is expected to last about six weeks.

'Somebody should have realized'

Prosecutors in Utah argue that Weitzel intended to kill, that he knowingly prescribed morphine in lethal amounts to patients who were not in pain and suffered no physical problems except the normal infirmities of old age.

"Somebody should have realized something was wrong," said Betsy Bowman, the deputy attorney general for Utah's Division of Occupational and Professional Licensing. "People were being carried out of there in body bags."

Weitzel's lawyer, Peter Stirba, argues that the doctor is on trial for legitimate "medical judgments."

"I believe that the evidence will show that they were appropriate and consistent with standards of care in terms of the treatment of those patients at the hospital," Stirba added.

'Pointing a gun'

In an ordinary murder trial, jurors would likely be dealing with testimony from eyewitnesses or partners in crime, from scientific experts and police officers who investigated the crime scene. At Weitzel's trial, the disputes involve the purpose of the unit where the five patients died and the appropriateness of the kinds and dosages of drugs given to them.

If the jury finds that Weitzel committed a crime, he could be convicted of intentional murder or of a lesser charge such as criminally negligent homicide.

At a preliminary hearing, one of the prosecutors addressed the difficulty of the case. Melvin Wilson said that in a typical shooting the case is much clearer.

"However, you have the administration of a drug that is so dangerous and so insidious that in the course of its administration, if it's not handled appropriately and properly, it creates the same grave risk of death as an individual pointing a gun at somebody's head," Wilson said.

Prescribing by telephone?

Prosecutors are also likely to present evidence that Weitzel gave orders for large doses of morphine and powerful psychotropic drugs over the telephone without monitoring the patients and that he often failed to respond to pages from the hospital.

Jurors must decide whether Weitzel's conduct went beyond ordinary negligence or incompetence.

Weitzel's medical career was unraveling while he was working at Davis. He had moved to Utah from California in 1993 after becoming sexually involved with a patient.

Around the time he was hired by Horizon in September 1995, the Utah Division of Occupational and Professional Licensing received an anonymous complaint that Weitzel was abusing Demerol and morphine that he obtained by writing prescriptions for his patients. Late that year, a state investigation got under way.

In April 1996, a similar anonymous tip to the federal Drug Enforcement Administration (DEA) sparked a federal investigation.

Arrested

Homicide Detective Joe Morrison of the Layton Police Department headed the investigation into the deaths at the Horizon unit. He said some witnesses reported seeing Weitzel apparently drunk while he was at the hospital.

But Weitzel continued to practice medicine until September 1999 when he was charged with killing the patients at Davis and two days later indicted on federal drug charges. He was arrested in Bay City, Texas, as he stepped off his private plane. He is now free on bail.

Weitzel was hired in February 1998 as director of another geriatric psychiatric clinic at Matagorda County Hospital in Texas. The unit was subcontracted to Cornerstone Behavioral Health Services Inc.

Another death

A patient at Matagorda, Laura Ware, 86, died under his care under similar circumstances to the five patients in Utah. Police are investigating her death.

For terminally ill patients, suppressing pain might be more important than providing a few more hours or days of life, and many doctors would prescribe high dosages of morphine and similar drugs, even at the risk of death. Weitzel's lawyer believes that is what his client was doing.

"Morphine injections were provided as comfort measures to people who were being provided end-of-life care," Stirba said.

Trotting out the door

But prosecutors in Utah argue that Weitzel had no reason to prescribe morphine for the five patients who died in Utah. Morrison and other investigators say that no one with a life-threatening illness was supposed to be admitted to the unit.

A nurse who did not want her name used said she and her colleagues were not "palliative care nurses."

"We were there to see people get well psychologically and trot out the door, not to go out in a body bag," she added.

Some nurses told investigators or APBnews.com that Weitzel threatened and browbeat anyone who questioned his orders.

Robert Johnson, a DEA investigator in Utah, said that Weitzel may very well avoid conviction, at least on the murder charges.

"All he's got to do is convince one juror that he was providing merciful care," Johnson said.

Dr. Robert Weitzel

APBnews.com

June 8, 2000

FARMINGTON, Utah -- A few weeks ago, a reporter called the Texas State Board of Medical Examiners' hot line for information on a psychiatrist, Dr. Robert Weitzel.

A representative, who identified himself as Jason, said that the only infraction on Weitzel's record had been cleared in January 1999 with payment of a $3,500 penalty and a reprimand. Pressed for more details, Jason said the infraction was an "action due to dishonorable conduct, likely to deceive or defraud the public."

The hot line is intended to give the public up-to-date information on the history and medical standing of all physicians in the state.

What it did not reveal is that Weitzel was facing charges in Utah that he had killed five elderly patients suffering from psychiatric problems by injecting them with lethal doses of morphine. Opening statements in his trial will begin Friday.

And that's only one of the things the Texas hot line didn't know. Police in Texas are investigating a sixth death. Weitzel surrendered his license to practice medicine in California rather than fight charges of becoming sexually involved with a patient. He is also under federal indictment on 22 charges of fraudulently obtaining Demerol and morphine, allegedly for his personal use. In addition, the Utah Division of Occupational and Professional Licensing (DOPL) has filed charges against Weitzel, accusing him of prescribing injectable morphine and Demerol to patients in his private practice without proper medical screening and without trying less powerful medications first.

A spokeswoman for the Board of Medical Examiners was reluctant to admit any problems with the hot line's reporting of information regarding physicians practicing in the state. Jill Wiggins, the public information director for the medical board, said that employees in the call center are limited to giving information available to them by computer and that members of the public can request a copy of the full order.

A frustrated investigator

Robert Johnson, the lead investigator on the Weitzel case for the Drug Enforcement Administration (DEA), finds the limits on public information "frustrating," especially when a doctor is suspected of being a drug user.

"A lot of times you're in the middle of an investigation and you pretty much know that a doctor is abusing -- or have pretty good evidence to show that he is -- and you feel like going up into an operating room where some of these guys are and telling the patient who's being wheeled in there: 'You don't want this guy working on you today, he's abusing something,'" Johnson said. "But you can't do that until it goes through the court system and it's proven, otherwise you'll end up being sued."

At present, Weitzel can still legally practice medicine in Texas.

In the past decade, Weitzel has practiced in three states, showing an apparent pattern of moving on before investigators caught up with him.

An affair with a patient

According to records of the Medical Board of California, Weitzel was a psychiatric resident employed by the University of California at San Diego's Giford Mental Health Center in 1990 when he began treating a 32-year-old woman who came in complaining of depression and marital problems and had attempted suicide. The patient, identified in records as Nancy M., remained in psychotherapy with Weitzel for two years, and Weitzel prescribed anti-anxiety and antidepressant medication.

On June 22, 1992, Weitzel reported in medical records that Nancy M.'s divorce was complete, that she chose to terminate treatment and that he was changing the location of his practice. Medical board records also indicate that around June 22, 1992, Weitzel began an intimate sexual relationship with Nancy M. Weitzel applied for and was issued his Utah medical license in 1992 and moved there in 1993. His relationship with Nancy M. lasted until 1994, and in the interim, Nancy M. became pregnant and had an abortion.

The board began an investigation. Board spokeswoman Candis Cohen said information on what prompted the probe or when it began is confidential. Weitzel surrendered his California license in 1997 rather than contest charges that he had "methodically manipulated [a] patient and her treatment in order to use her as an object to gratify his own emotional and sexual needs."

APBnews.com obtained a copy of Weitzel's Texas reprimand order and discovered the two states have markedly different versions of the California affair. The Texas paperwork indicates the patient initiated the relationship after therapy ended, and that Weitzel's only infraction was not allowing sufficient time to elapse before he began seeing her. Neither agency could explain the discrepancy.

A complaint of drug use

In September 1995 he was hired by Horizon Mental Health Management Inc. to direct the psychiatric geriatric unit in Davis Hospital and Medical Center in Layton.

Johnson said DOPL got an anonymous complaint that Weitzel was obtaining Demerol and morphine under his patient's names for his personal use. This complaint came in around September or October 1995, Johnson said -- approximately three months before five patients on Weitzel's ward died within a 15-day period.

Dr. Charles Walton, head of DOPL's Utah Recovery Assistance Program, admitted that the agency did not handle the case well.

"It took two months to act on a complaint that someone is using drugs -- that's too long," Walton said. "And I think DOPL has to stand up and accept some responsibility for that."

Federal authorities get involved

Johnson said the DOPL didn't share its complaint with the DEA. The DEA got the same complaint about six months later, in April 1996. The complainant informed investigators about Weitzel's sexual involvement in California with Nancy M., that he abused drugs in California and that he was continuing to abuse drugs in Utah, among other allegations.

A law enforcement source also told APBnews.com of allegations that Weitzel injected drugs with his brother, who later died of an overdose.

Homicide Detective Joe Morrison of the Layton Police Department, the lead investigator into the deaths at Davis Hospital, said he also heard a number of allegations that Weitzel was drunk on the hospital floor at Davis hospital, confirming a charge a nurse who worked with Weitzel made to APBnews.com.

A red flag?

While Weitzel was working at Davis, he was also treating patients at an office near Pioneer Valley Hospital, south of Salt Lake City. Johnson said Weitzel was obtaining Demerol and morphine for his own personal use from August 1995 through June 1996 by ordering greater amounts than he administered to patients.

In some cases, Weitzel would go to pharmacies himself to pick up drugs in the patients' names, something that should have raised a red flag with pharmacists, Johnson said.

In late April 1999, DOPL filed charges against Weitzel, accusing him of substandard care in the treatment of nine patients who came to see him complaining of headaches. (According to the DEA, Weitzel might have been falsely documenting the headache complaints to create an opportunity to prescribe and obtain Demerol or morphine or both for himself.)

According to DOPL legal documents, "No indication was found in the charts of all but one of those patients that [Weitzel] prescribed any oral headache medication before prescribing injectable morphine or Demerol, as is standard medical practice. ... [Weitzel] prescribed morphine injections on five different occasions with no indication that patient ever underwent neurological evaluation."

Most of the patients were allowed to drive themselves home immediately after receiving an injection of morphine or Demerol.

"If you've got a patient who's got some type of psychological issues -- depression, anxiety, suicidal tendencies -- why would you give a patient a drug as powerful as morphine to inject under self-will at home, under no supervision," Johnson said.

An inch-high stack of papers

Davis discontinued its contract with Horizon in 1996 and took over the operation of the geriatric psychiatric unit. While the hospital did its own internal investigation of the deaths on the unit, Morrison was unable to get details and was allowed only to look at the file without making copies.

"It was a stack of papers about an inch thick -- for six deaths," Morrison said.

Weitzel lost his Utah license in 1999 when he refused to undergo a mental status exam ordered by DOPL to determine whether he had "a malignant personality disorder which could cause any possible immediate and significant dangers of threats to the public health, safety, or welfare." But in February 1998, he moved on again, this time to Texas.

A move to Texas

Weitzel was hired as director of another geriatric psychiatric clinic at the Matagorda County Hospital in Texas despite his California license surrender and the investigations in Utah. The unit was subcontracted to Cornerstone Behavioral Health Services Inc.

When he began working for Cornerstone, he had no DEA registration. The hospital allowed him to use their number to prescribe medication and apparently never checked with the agency in either California or Utah. According to Jerry Ellis, an investigator with the DEA in Houston, Weitzel applied for an agency license in Texas.

"We knew we were going to do everything we could to keep him from getting registered down here," Ellis said.

Ellis said that if Weitzel's employers had called, he would have warned them about the doctor's alleged drug problems.

Remaining on the job

He continued to work at Matagorda even after he was reprimanded in October 1998 for lying on his Texas medical license renewal form. He continued to work after he was charged by Utah's DOPL with failing to keep required records regarding disposition of controlled substances; prescribing controlled substances in excess of necessary amounts; and demonstrating incompetence or negligence in the practice of medicine. He continued to work after 86-year old Laura Ware died under his care in circumstances similar to those of his patients in Utah.

Wick Baker, a spokesman for Matagorda Hospital, said that Weitzel did a "great job."

On Sept. 20, 1999, Weitzel's past finally caught up with him. He was arrested by authorities in Texas on a warrant issued in Utah and charged with five counts of murder. Two days later, federal prosecutors in Utah unsealed an indictment charging him with 22 counts of obtaining controlled substances by deception.

Weitzel has denied all the charges and has not yet been convicted of criminal conduct. He refused written and telephone requests for interviews from APBnews.com.

Medical judgments?

Weitzel's lawyer, Peter Stirba, responded only to questions about the homicide charges before hanging up on a reporter. Stirba argues that Weitzel is on trial for legitimate medical judgments about treatment.

Eight years after he began his involvement with Nancy M. and almost five years after the deaths at Davis hospital and the beginning of the first drug investigation, Weitzel is now on trial for murder. The judge has ruled that nothing about Weitzel's past misconduct may be introduced during the trial because it may prejudice the jury.

Weitzel's trial on murder charges in Utah is expected to keep him occupied for the next six weeks. If he is convicted, he could face years in prison.

Dr. Robert Weitzel

APBnews.com

June 8, 2000

LAYTON, Utah -- The histories of three of Dr. Robert Weitzel's alleged victims show the kind of issues a Utah jury must wrestle with in deciding whether he is guilty of murder.

The three victims, along with two more women who died at the geriatric psychiatric unit at Davis Hospital and Medical Center between December 1995 and January 1996, were elderly and frail, severely demented or depressed and suffering from a variety of physical problems. All were given a variety of powerful drugs for anxiety, depression or psychosis, as well as morphine, in the hours and days before they died.

Prosecutors allege that Weitzel ordered these medications without monitoring their effects on his patients and issued amounts of morphine that he knew or should have known could be lethal. They also say that the patients were not suffering from physical pain or life-threatening physical problems before they came onto Weitzel's ward.

In most cases, the families at first believed their relatives had received compassionate treatment, even though it ended in death. Some have now filed malpractice suits against Weitzel and the hospital.

The first to die

Ellen Anderson, 91, a widow for 28 years, died the day after she was admitted to the unit. Her medical records describe her as a former elementary school teacher and a Mormon who did not drink or smoke. She had been diagnosed with dementia four years earlier and was unable to make herself understood. She also had suffered a recent hip fracture and had a history of hypertension, angina and osteoporosis.

She was transferred to the Horizon unit after three weeks at Pioneer Care Center. Her records there describe her as "severely anxious, calling out for her children."

Her Horizon treatment plan estimated that she could return to the nursing home after two to three weeks and suggested the use of several drugs to control anxiety and depression, as well as morphine sulfate for pain control.

The night she was admitted at 11:30 p.m., nursing notes indicate she was given an injection of morphine.

A 'needy' patient

Records described her as "very needy of staff attention," screaming when she was alone.

At 1 a.m. a nurse noted that her breathing was "very erratic."

Weitzel was paged at least twice, according to the notes, once at around 1 a.m. and again at 3:15 a.m. when Anderson was described as "thrashing arms" and "moaning and screaming."

At 3:30 a.m., Weitzel returned the page and ordered another shot of morphine.

In the morning Anderson was dead.

Jaye Poelman, Anderson's son-in-law, said the care center never gave the family any indication that she was in severe pain. Family members said that at the nursing home Anderson was calm when her sister or daughter was with her but when she woke up alone she would scream, but the screams were out of anxiety rather than pain.

A daughter's last visit

Ennis Alldredge, 82, was transferred to Horizon after five months in the Sunshine Terrace Nursing Home. His oldest daughter, Danice Mikesell, said her father became violent and "took out five aides."

Alldredge was given two types of anti-psychotics, a sedative and morphine. He died six days after admission.

Mikesell visited her father the day before his death and found him strapped to his bed. She said a nurse warned her she would get hit or kicked if she removed the restraints. But instead her father squeezed her hand and cried, although he was unable to speak.

As Mikesell sat with her father, a nurse gave him a shot, saying it was for pain. At the time, she believed her father was getting good care.

"When I went down there that morning, I felt really good that I knew he knew who I was and that he squeezed my hand," Mikesell said. "You know that makes you feel good that you're a comfort to them even at that time. ... They told us he had a stroke and that was what we figured for 4 years."

A place to die

Judith Larsen, 93, had been a patient at a nursing home, Holladay Care Center, before she was transferred to Horizon. Larsen had suffered a series of strokes and often shouted, disturbing other residents at Holladay.

Her son Merlin Larsen testified at a preliminary hearing that the nursing home recommended Horizon as a place that would "improve the behavior of some people and make them more peaceful and easier to live with."

Three weeks after his mother's admission, Merlin Larsen said, the nursing staff told him that his mother would have to be moved to another facility. Holladay wouldn't take her back.

"Dr. Weitzel said it was his opinion that she would not live very long," Merlin Larsen said. "And he said -- I thought very kindly -- he recommended that we not move her. He said, 'We won't require you to move her. We'll just keep her comfortable until she dies.'"

Harold Larsen, another son, said that when he visited his mother she was often asleep or unresponsive, that she went from knowing who he was to being almost comatose.

"We thought she was getting good care. ... Her vital signs were good, but we noticed a continuous deterioration of her condition in less than a month," Larsen said. He said that his mother never complained of pain.

Intent to kill?

Eventually, Judith Larsen was given 5-milligram shots of morphine every four hours around the clock. On Jan. 3, 1996, the day she died, she was given an additional 25-milligram shot.

Melvin Wilson, the county attorney, testified in the preliminary hearing that according to the state's pain expert, this shot was lethal.

"It shows intent, I would submit to this court, to cause death," Wilson said.

"There is no medically acceptable reason to order this kind of dose, particularly when there is no indication that the patient is in pain."

Dr. Robert Allan Weitzel

September 25, 1999

Allen Weitzel

January 10, 2001

A Salt Lake City psychiatrist convicted of killing five of his elderly patients with excessive doses of morphine was granted a new trial. Second District Judge Thomas L. Kay ruled that prosecutors should have disclosed pre-trial statements from a pain-management expert that could have aided the case of Dr. Robert Allen Weitzel. Kay ruled that prosecutors had a legal and ethical duty to disclose the testimony of Dr. Perry Fine to defense attorneys, and their failure to do so warranted a new trial.

Mercy­-or murder?

Jan 11, 2002

By Mark Crane

Medicaleconomics.modermedicine.com

A troubled physician faces criminal charges in the deaths of five patients. The state says it was homicide; the doctor says it was compassionate care.

Some 4,400 physicians in Utah received a letter early last year with the ominous warning that they, too, could be charged with murder for prescribing pain medication to the terminally ill. The letter's author, a board-certified psychiatrist with a long history of trouble, claims he was unjustly prosecuted because he'd provided "moderate amounts" of morphine to hopeless elderly patients in deep pain.

His view of the case wasn't news to Utah physicians who'd followed his torturous legal woes over the previous few years. What was unprecedented was that Robert Allen Weitzel, 45, set up a Web page, www.weitzelcharts.com , with extensive hospital and nursing home records of his patients, including psychiatric histories, comments by family members, and medication charts.

"I had some qualms about putting the charts on the Web because of confidentiality concerns," says Weitzel. "But they're part of the public record of my trial, and they clear me. No doctor who reads them could conclude that I'd committed a crime."

But a jury could. Weitzel was convicted in 2000 of two counts of manslaughter and three counts of negligent homicide in the deaths of five patients at Davis Hospital and Medical Center's geriatric-psychiatric unit. All the deaths occurred within a 16-day period from December 1995 to January 1996.

Weitzel was sentenced to up to 15 years in prison, and he served six months before the conviction was overturned. A judge found that prosecutors improperly withheld information about an expert witness who'd told them that Weitzel's care, however "bumbling," was no crime. The judge concluded that Weitzel might not have been convicted if the jury had heard this evidence, and he ordered a new trial.

Prosecutors, patients' families, and many Utah medical leaders are disturbed to see the patients' charts on the Web. "It's not illegal because they are public, but to release such private information to the world like that is unethical and wrong," says Elizabeth Bowman, a state assistant attorney general.

Even more galling to prosecutors is how Weitzel has portrayed himself as a victim of authorities seeking to punish doctors for providing palliative or end-of-life care. Instead, they argue that Weitzel systematically weakened patients with psychotropic drugs, misled their families into agreeing to withhold care, and then finished off the patients with morphine overdoses.

The Utah Medical Association takes no position on Weitzel's guilt or innocence, but has distanced itself from him, and reassured physicians that there is no "witch hunt" to punish them for prescribing appropriate pain medication. Other medical and advocacy groups have protested his prosecution.

Weitzel argues the UMA has "stabbed me in the back," but he understands the lack of support: "I'm not exactly the poster boy for Utah medicine. I've had some problems in my past, and that makes me a convenient target. Prosecutors use my history as a smoke screen because they don't want anyone to focus on the facts of the case."

Saying that Weitzel has had some problems is putting it mildly. He's pleaded guilty to federal charges that he prescribed morphine and Demerol to patients, but administered only half the prescribed doses. Prosecutors say he kept the remaining drugs for his own use. His medical license has been suspended in three states. Utah officials contend that Weitzel has engaged in inappropriate sexual behavior with patients, stalked former girlfriends, intimidated nurses, assaulted people, and lied on licensing applications to cover up his past.

An investigation at a headache clinic leads authorities to five deaths

Weitzel was working at the Salt Lake Headache Clinic when Utah and federal Drug Enforcement Administration officials began investigating his prescribing patterns in 1996. They noticed that what he'd prescribed and what was actually administered to patients didn't match up. "For example, he'd prescribe 30 mg of morphine but administer only 12 mg," says Bowman. "No record was kept of how excess medications were disposed of." There were other problems with overprescribing and inadequate monitoring of patients, she adds.

In 1999, investigators also began looking into five suspicious deaths at the 10-bed gero-psychiatric unit at the Davis hospital, where he served as assistant medical director. A nurse there told investigators about the deaths that had occurred in the winter of 1995-96. Weitzel alleges that the nurse had a grudge against him and was repeating innuendo and rumor.

Prosecutors pulled the patients' charts and showed them to medical experts. They interviewed the patients' families and asked a court for permission to exhume the bodies. While the postmortems were inconclusive to prove morphine overdoses, prosecutors were nevertheless suspicious.

Other events were coming to a head around the same time. Utah officials learned that Weitzel had voluntarily surrendered his medical license in California because of allegations of sexual misconduct with an ex-patient. Weitzel never notified Utah officials of the suspension. They were also investigating charges by a female patient that he had fondled her breasts. Weitzel angrily denies this.

"The licensing board ordered that he be examined at the Menninger Clinic in Kansas to rule out malignant personality disorder," says Bowman. "When he refused, we immediately suspended his license to protect the public."

Prosecutors in Davis County filed first-degree murder charges against Weitzel in the five deaths, while federal prosecutors indicted him on 22 drug fraud charges.

Was he relieving pain or killing patients?

The five patients Weitzel was accused of killing would present a tough challenge to any physician. Their average age was 86. All were admitted to the unit with severe dementia and agitation, including assaultive behavior directed at other patients and staff at the nursing homes they were transferred from. They all had extensive comorbidities and were legally incompetent. Their families were in charge of medical decisions.

But were they terminally ill and in dire pain requiring extensive morphine injections? That issue became a battle between medical experts for both sides.

According to trial testimony, Weitzel had tried to control the patients' aggressive symptoms with sedating antipsychotics, mood stabilizers, and anxiolytics, and had intended for them to return to their nursing homes in a couple of weeks. But after admission, four of the patients developed other acute medical problems, including a GI bleed, evidence of stroke, renal failure, and sepsis, Weitzel testified.

"I told the patients' families how bad things were and gave them this option: The patient could be transferred to our ICU where we'd do everything we could, or we could withdraw all but comfort care and let nature take its course," says Weitzel.

The families signed directives withdrawing all interventions and urged Weitzel to keep the patients free from pain, he testified. All previous medications were stopped, and Weitzel ordered regular intramuscular doses of morphine.

The fifth patient, a 91-year-old woman with cardiac disease and numerous other conditions, was also admitted because "she'd been screaming almost constantly whenever anyone touched her," says Weitzel. But she seemed to be in relatively better shape than the other patients.

Prosecutors say Weitzel never saw this patient but told nurses by phone to administer morphine. In less than a day, the patient was dead. Weitzel, who claims he did see her, says the woman suffered an MI, and the morphine had nothing to do with her death.

His attorney argued that these patients' conditions deteriorated rapidly once they were in the hospital, which isn't uncommon for sick elderly people. "The state wants to pick apart with perfect 20/20 hindsight all that medical care and call it first-degree murder," he told the jury.

Weitzel never administered any morphine himself, but left instructions for nurses. Some testified for him, and some testified that he had intimidated them into going along with his treatment plans.

Prosecutors charge it is inconceivable that all five patients died of different acute events during such a short time period. Overdoses of morphine were the common denominator, they told the jury. They endorsed the comments of one patient's daughter who said, "Five victims in just over two weeks in a unit of only 10 patients that had only one death in the previous two years screams of wrongdoing."

Prosecutors say that Weitzel falsely told family members their loved ones were terminally ill, and encouraged them to withdraw needed care. His motive? Money and convenience, say prosecutors. Weitzel received fees for psychiatric evaluations, so he wanted to "get someone else into that bed so he'd get paid more," a prosecutor said. "He didn't like these people. They were old and of no more use to society."

The state's experts argued that Weitzel had over-sedated the patients and then ordered overdoses of morphine. They said the patients were medically stable when they were admitted to the hospital.

Defense experts took the opposite view. They testified that all the patients were terminally ill and in great pain, and that Weitzel met the standard of care. One called the prosecution "one of the most egregious abuses of government power I have ever witnessed."

Following a six-week trial, a jury deliberated for just a few hours before reaching its verdict. They were unanimous that Weitzel hadn't committed first-degree murder, but they convicted him of two counts of felony manslaughter and three counts of negligent homicide, a misdemeanor.

A new trial is ordered, and the legal battles rage on

Weitzel had been in prison for six months when his attorney learned about the potential expert witness who believed the psychiatrist was innocent. Before the trial, prosecutors had asked Perry Fine, an end-of-life care specialist at the University of Utah School of Medicine, for his opinion on the case. While highly critical of Weitzel's care, as he was of care rendered by most physicians in end-of-life situations, Fine thought the patients were terminally ill and in pain, and that Weitzel's actions didn't constitute a crime.

Prosecutors felt they weren't required to turn over this information, but trial judge Thomas L. Kay ordered a new trial.

Since then, the legal wrangling and public relations offensives have been filled with more twists and turns than a soap opera. Weitzel has uploaded thousands of pages of trial transcripts and newspaper articles on to his Web page. He peppers these transcripts with comments like "ludicrous!" after portions of testimony he disagrees with, and provides a chatty running commentary on each day's developments.

Weitzel openly taunts the prosecutors. "I'm going to the mat with them," he vows. He's filed complaints against four prosecutors with the Utah State Bar.

Meanwhile, Weitzel agreed to a plea bargain on the federal drug charges. He told his Web readers that he did so only to focus his energies on the homicide retrial. He admits to record-keeping mistakes, but denies that he uses drugs. He also denies the sexual misconduct allegations, saying they were filed by spiteful ex-girlfriends.

Prosecutors requested that Judge Thomas Kay be removed from the case because of allegations that he's biased and has made intemperate remarks to the victims' families. They claim they weren't allowed to enter evidence that nurses had complained about Weitzel and that other physicians had warned him about over-sedating patients.

In a highly unusual motion, two families also demand that Kay be removed, arguing that victims as well as defendants are entitled to a fair trial. Kay has denied allegations of bias.

An appeals court judge disqualified Kay last November, saying that his apparent anger at prosecutors, "even though justified, does reasonably call into question his impartiality." The appeals judge denounced prosecutors for inappropriate and unethical conduct that bordered on prosecutorial misconduct. He accused them of engaging in a witch hunt against Kay by attempting to try the case in the press. Prosecutors "created an atmosphere of bias and prejudice, and then blamed Judge Kay for the poisoned atmosphere," he said.

Groups such as Compassion in Dying Foundation and Association of American Physicians and Surgeons have filed briefs in favor of Weitzel, arguing that prosecuting physicians for providing adequate pain medication is unjust.

Prosecutors and Utah Medical Association leaders answer back that Weitzel's case hasn't had any chilling effect. "There is no evidence of a state-sanctioned witch hunt against physicians who legitimately use narcotics to treat pain," says UMA past president Val B. Johnson.

Prosecutors decided against seeking first-degree murder charges against Weitzel for the retrial, which isn't expected for several months. But he'll face counts of manslaughter and negligent homicide.

Despite his troubled record, Weitzel is confident that he will prevail and ultimately regain his medical license. "I've done some very stupid things. But prosecutors have smeared me with irrelevant allegations. If what I did in this case is murder, then half of all doctors in America are probably guilty also."

Prosecutors insist that physicians who follow established guidelines have nothing to fear, and this trial is only about Weitzel, not palliative care. "It's our obligation to pursue justice in this case," says Elizabeth Bowman.

Dr. Robert Allen Weitzel