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Kansas Doctor Convicted of Murder in End-Of-Life Cases; Reversal On Appeal

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OCTOBER 19/26, 1998 VOLUME 6, NUMBER 16/17

Terminally ill patients often experience considerable, intractable pain from their illness. Adequate management of that pain, usually by painkilling medications, is a continuing concern of individual physicians and the entire medical community. In sufficiently large doses, painkilling medication often suppresses the respiratory system and may actually accelerate the patient’s death. This creates a common situation; the physician may be eager to reduce or eliminate pain, but reluctant to prescribe a dose which might lead to the patient’s early death.

Most advocates insist that the physicians’ concern about painkiller overdoses is misguided. They note that there are few cases in which physicians experienced any difficulty from licensing agencies, hospital peer review committees or anyone else for overprescribing pain medications, particularly when treating the terminally ill.

Dr. Stan Naramore’s case may give doctors new cause for alarm. The Kansas physician recently scored a significant victory in his state’s Court of Appeals, but only after a six-year personal nightmare.

Dr. Naramore was charged with murder and attempted murder in two unrelated cases arising out of his medical practice in 1992. In one, he was accused of trying to administer a deadly dose of morphine. In the other, he was accused of withdrawing life-sustaining treatment from a patient who might have been successfully resuscitated.

Mrs. Ruth Leach, a 78-year-old patient of Dr. Naramore’s, had been treated for cancer for several years. In 1992, her condition had deteriorated to the point that her death was anticipated within a short time, and her family gathered at the St. Francis, Kansas, hospital knowing that she would not live much longer.

Mrs. Leach’s son Jim, who happened to be a paramedic, told Dr. Naramore that he believed his mother needed a higher dose of painkilling medication. Dr. Naramore met with the family, warned them that increasing the painkillers could actually hasten Mrs. Leach’s death, and discussed the choices available for her care.

After that meeting, Dr. Naramore and the family returned to Mrs. Leach’s bedside, where he administered two separate painkilling shots. Dr. Naramore asked the family to join hands, he recited Robert Frost’s poem “Into The Woods,” and then he prepared a syringe with a dose of morphine. At this point Mrs. Leach’s son became convinced that Dr. Naramore was attempting to end his mother’s life. The two men met in the hallway outside her room, where Jim Leach told Dr. Naramore “I’d rather my mother lay there and suffer for ten more days than you do anything to speed up her death.” Dr. Naramore decided he did not want to continue with Mrs. Leach’s care, and arranged for her transfer to another hospital. She received additional morphine at the new hospital, and died a few days later.

In the second case, Dr. Naramore treated Chris Willt, an 81-year-old diabetic with a pacemaker and a history of heart disease. Mr. Willt had refused to continue his heart medication, and several days later arrived at the hospital after having been found slumped over at a local convenience store, with an irregular heart beat, and difficulty breathing. Mr. Willt was unable to speak.

After three hours of emergency medical work, Dr. Naramore decided that continued treatment of Mr. Willt was futile. He consulted another local physician, who confirmed his opinion. The mechanical ventilator was turned off, and Mr. Willt died eight minutes later.

Two years after the two deaths, Dr. Naramore was indicted for murder of Chris Willt and attempted murder of Ruth Leach. After a jury trial in rural St. Francis, Kansas, he was convicted on both counts. He appealed to the Kansas Court of Appeals, which overturned his convictions in July of this year.

In its opinion, the Kansas court discussed the fine line between adequate pain management and euthanasia, and the difficulties faced by medical practitioners on a daily basis. Several medical groups had filed briefs with the court, and the judges clearly understood the meaning of “palliative care” as used by the medical professionals. In this case, wrote the Judges, “there is nothing close to a medical consensus that Dr. Naramore’s actions were homicidal. In fact, there was extremely strong testimony to the contrary.”

At trial, Dr. Naramore had produced testimony of six physicians who had reviewed the records of the two deceased patients; one of those had been present during Dr. Naramore’s treatment of patient Chris Willt. The state had relied on the testimony of three other physicians.

With regard to Ruth Leach (the terminal cancer patient for whom Dr. Naramore had prescribed, but not administered, a final dose of morphine), the state’s expert witnesses testified that her respiration had been so slowed that the administration of another morphine injection would have led to her death. Dr. Naramore’s experts disagreed, saying that pain control was an appropriate choice for Ms. Leach, and that the morphine dose was a fraction of what Dr. Naramore would have used if his intention had been to end her life.

In the second case, that of Chris Willt, the experts hired by the state again testified that Dr. Naramore must have had the intention of ending the patient’s life. They testified that he removed a mechanical ventilator from Mr. Willt after having treated him with a paralyzing drug; although they agreed that the drug administration had been appropriate treatment, they questioned Dr. Naramore’s decision to withdraw the life-sustaining machinery before the drug’s effects had worn off.

Again, physicians called by the defendant disagreed. They noted that Mr. Willt had been aggressively treated for three hours, and that Dr. Naramore consulted another physician before deciding that continued treatment would be futile. That doctor, and all Dr. Naramore’s expert witnesses, agreed that Mr. Willt was already dead when the ventilator was disconnected.

The court was faced with two choices. Either the conviction could be reversed outright, and Dr. Naramore found not guilty, or the case could be returned to St. Francis for another trial. By a two-to-one vote, the three appellate court judges chose to dismiss the charges altogether. In their opinion, the judges noted that “there is a reason why there has yet to be in Anglo-American law an affirmed conviction of a physician for homicide arising out of medical treatment based on such highly controverted expert evidence as here.” State v. Naramore, July 24, 1998.

Although Dr. Naramore was ultimately acquitted, his trial, conviction and appeal exacted a heavy price. His license to practice medicine was suspended and he was put through the agony of the trial itself. Although his license has now been restored, the damage to his career and his ability to practice medicine must surely be incalculable. His case should give pause to any practicing medical professional.

9 Responses

  1. I just saw this case on notorious. It was an absolute travesty that he was convicted in the first place. Patty Weick, who was one of the jurors, obviously had an IQ south of average and shouldn’t be judging a dog show. This case, along with many others clearly indicates a need for an through examination of the justice system where emotion often dominates rational thinking. In addition, as the pharmacist and family friend who gave her life savings to help defend Dr. Naramore correctly pointed out, the jurors were not the peers of the Doctor. They knew nothing of medicine and the demands of an emergency room doctor. By the way, the pharmacist is the kind of friend that all of us would like to have. Hats off to her.

  2. I saw this case on Notorious today. It really ran home to me that in a small townI there can be so little diversity of view point, that ignorance prevails. The interviews with the jurors were really telling. They gave more weight to the testimony of a local Emergency Medical Technician with who knows what sort of training than licensed physicians with years of education, training and experience. It was also clear that Dr. Naramore was disliked by the locals. I suspect he used polysyllabic words. These good folks in St. Francis would be happier with a shaman.

  3. Our family would have been standing in line for Dr Naramore when he opened his new practice. What a shame that the jurors had no clue of the information they were suppose to be deciding. My heart goes out to the GOOD doctor and best wishes for finding new clients that will appreciate his efforts.

  4. Reading the comments of David, Robert, Debbie they need to do a followup on this case. Dr. Naramore was given his license to pracitice Medicine again and setup his office in southern Ohio where he once again was found guilty of over priscribing pain killers to people in southern Ohio and Kentucky which resulted several deaths in that area. He once again lost his license to practice Medicine. The small town of Saint Francis keeps getting black balled for this Doctors fate, when it was the State of Kansas that pushed this to point of no return. I really think that people need to visit this small community and find out how nice the people really are here.

  5. This wonderful, compassionate doctor was WRONGFULLY tried & WRONGFULLY convicted! He should have been paid at least a million dollars by the state of Kansas!

  6. Hey Buster, would you provide a URL where we can read about Dr. Naramore’s Ohio transgressions. I tried googling it to no avail. Without that piece of additional info, it’s clear that this man was railroaded by a bunch of simpletons.

  7. Don D. This Stan Naramore and the one in the story you have are two different people. You really need to watch and make sure you are getting the stories straight. There will always be other Doctors with similar names!!

  8. Having recently undergone open-heart surgery I am appalled how patients who need pain killers are denied because Dr.s are being intimidated to the point of fearing for their right to practice. Apparently the ‘witch hunt’ is so bad a lot Dr.s are allowing legitimate patients to suffer unnecessarily. Ten years ago I was given a script for Percocet after hernia operation. Needed them, used them, no problem. The heart operation much more intrusive and painful I was allowed one tenth of the strength I was given before. Ridiculous!! The fact that I had to endure INCREDIBLE pain because the nation has an opiate problem is unacceptable to me. Next time if I can I will procure what I need ahead of time and THAT is on the profession!!!!!

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Robert Fleming is a Fellow of both the American College of Trust and Estate Counsel and the National Academy of Elder Law Attorneys. He has been certified as a Specialist in Estate and Trust Law by the State Bar of Arizona‘s Board of Legal Specialization, and he is also a Certified Elder Law Attorney by the National Elder Law Foundation. Robert has a long history of involvement in local, state and national organizations. He is most proud of his instrumental involvement in the Special Needs Alliance, the premier national organization for lawyers dealing with special needs trusts and planning.

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