According to prosecutors, in 2018, George Blatti set up a makeshift office in an old Radio Shack store and later prescribed pain medications from his car in parking lots without examinations to many who appeared to be struggling with opioid and/or other drug addictions. He was charged with the murders of five patients whose deaths were opioid-related, marking the first time that a doctor in New York has been charged with second-degree murder, under the legal theory that “depraved indifference” to human life led to their deaths. Here is a summary of an interview with Dr. MedLaw from a recent PW Podcast episode:

According to Dr. MedLaw, while malpractice and criminal charges both involve negligence, how it applies is very different between civil and criminal settings. Medical malpractice is an act or an omission by the doctor that results in care that falls below a required standard. The actor or mission is negligent because it represents a failure of due care. However, it occurs in a setting in which the goal is to help the patient. With criminally negligent homicide, there is no specific intent to kill, but someone acts with such recklessness and utter disregard for the risk of someone else that their recklessness can underpin a homicide charge.

The charges against Blatti were based on him not caring what happened to the people he was supplying with prescriptions. He was giving out prescriptions for high doses of opioids, to anyone who asked, without even the pretense of them being genuine patients. And he was not just ignoring obvious signs of their addiction, but actual pleas from family members to stop. He’s being charged with depraved indifference murder, which is based on criminal negligence.

In New York, this applies when a person recklessly engages in conduct that creates a grave risk of death to another person and thereby causes the death of that person. He knew that they would abuse these potentially fatal drugs, but he still continued to give out the means to get them in large quantities.

How the conduct is dealt with is completely different between malpractice and criminal negligence, explains Dr. MedLaw. The prosecution for medical negligence is to bring a private lawsuit, and the penalty is to compensate the patient. Criminal negligence is a harm committed against society, the prosecution for it is a trial conducted by the government in the name of the people of the state, and the penalty for that is imprisonment.

A malpractice case could become a criminal matter if it’s revealed that what had occurred was an utter disregard for the welfare of the patient. Alleged malpractice stays a civil matter, but changing a medical record is a separate criminal activity, but it doesn’t create criminal negligence. The negligent act stays one of medical malpractice, which is a civil matter.

Malpractice and criminal negligence really run on two separate tracks, and this is why criminal charges against doctors are rare, concludes Dr. MedLaw. They are not malpractice cases that get out of control but intrinsically criminal events that take place in a medical setting.