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Will the doctors face consequences following the arrests in connection with the death of Matthew Perry?

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Two doctors are among the five people charged in connection with the death of “Friends” star Matthew Perry, authorities announced Thursday.

Perry, 54, was found unconscious in his pool last year and the Los Angeles County Medical Examiner's Office said his death was caused by “the acute effects of ketamine.”

While this is not unusual, experts told USA TODAY that given the large number of physicians in the U.S., it is relatively rare for doctors to be prosecuted for overdoses. Most of the cases in which charges are filed are related to the ongoing opioid crisis.

“This is an extraordinary and tragic case,” said Dr. Caleb Alexander, a professor at the Johns Hopkins Bloomberg School of Public Health.

Southern California doctors Salvador Plasencia and Mark Chavez are both accused of conspiring to distribute ketamine to Perry and intentionally fueling his addiction for personal profit, prosecutors said. Three other people are also charged: Jasveen Sangha, also known as the “Ketamine Queen” of North Hollywood; Perry's live-in assistant Kenneth Iwamasa; and Erik Fleming, who admitted to distributing the ketamine that killed Perry.

What accusations are made against the doctors?

The two doctors played a crucial role in Perry's early death and “exploited” Perry's well-known battle with drug addiction to make a profit, US Attorney Martin Estrada said at a press conference.

Plasencia, 42, is charged with one count of conspiracy to distribute ketamine, seven counts of distribution of ketamine and two counts of forgery.

Chavez, a 54-year-old doctor from San Diego, pleaded guilty to one count of conspiracy to distribute ketamine. Prosecutors allege he sold the drug to Plasencia and submitted a fake prescription in the name of another unsuspecting patient to obtain more vials of ketamine, which he could sell to Plasencia and distribute to Perry.

Prosecutors said Plasencia, a Santa Monica native, learned that Perry wanted to buy ketamine — which is most commonly used as an anesthetic and requires close monitoring — and coordinated with Chavez to obtain large quantities of the drug. Plasencia met with Perry and his assistant, Iwamasa, and taught them how to inject Perry with the drug, they said. Plasencia also injected the drug into Perry himself, including in a parked car, prosecutors said.

“I wonder how much this idiot will pay,” Plasencia said in a message to Chavez, according to the indictment.

Plasencia continued to sell Perry ketamine even after he realized his addiction was “getting out of control,” prosecutors said.

“Dr. Plascencia and Dr. Chavez violated their oath to care for their patients. Instead of 'doing no harm,' they caused harm to make more money,” said Anne Milgram, head of the Drug Enforcement Administration.

How often do doctors face charges?

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“Ketamine Queen” among the suspects in the drug death of Matthew Perry

Those charged in connection with Matthew Perry's death include a network of doctors, an alleged drug supplier and a live-in assistant.

The charges are reminiscent of the case of Dr. Conrad Murray, Michael Jackson's personal physician, who was found guilty of manslaughter after the singer died from a lethal dose of the drug propofol in 2009.

But most drug overdose charges target doctors who treated ordinary Americans, not celebrities, says Adam Gershowitz, a professor at William & Mary Law School who published a study of doctors convicted of prescribing opioids for illegal medical purposes. Still, a high-profile death can motivate prosecutors to conduct a thorough investigation.

“Generally, these are cases where the U.S. Attorney's Office has opened an investigation not because anyone famous has died, but because … they have been tasked with prosecuting doctors for the illegal drug trade and the deaths that occur,” Gershowitz said.

Overall, criminal charges against doctors are rare, and most cases involve opioid overdoses. This has led to a crackdown on doctors who overprescribe drugs. At the same time, illegally manufactured fentanyl has taken over drug sales on the street.

Since 2014, around the time illicit fentanyl hit the U.S. market and caused tens of thousands of opioid deaths each year, more than 4,200 doctors have been charged with drug-related offenses, according to an analysis of National Practitioner Data Bank data by Tony Yang, professor and associate dean for health policy and population sciences at the George Washington University School of Nursing.

In recent years, the number of doctors being prosecuted has declined, Yang told USA TODAY. The DEA took action against 479 doctors in 2016. In 2021, the number had dropped to 447 and steadily declined to 391 in 2022 and 330 in 2023.

In 2015, Southern California physician Hsiu Ying “Lisa” Tseng became the first doctor in the U.S. to be convicted of murder for prescribing drugs that led to the fatal overdoses of three patients. Other cases include Dr. Martin Tesher, who was convicted in Brooklyn in 2017 of distributing oxycodone without a legitimate medical reason, resulting in a fatal overdose. Manhattan physician Gordon Freedman was sentenced to more than 17 years in prison in 2021 for drug offenses, including distributing oxycodone and fentanyl without a medical reason to a patient who also died.

The legal challenges of prosecuting a doctor

When prosecutors decide to charge doctors with drug abuse, they must prove not only that the doctor distributed the drugs, but also that there was no legitimate medical reason for doing so. That's a high burden of proof that is difficult to prove beyond a reasonable doubt, Gershowitz says, because doctors can often claim that the prescriptions were related to the patient's symptoms. Often, a doctor's license can be suspended or revoked without facing criminal charges, he says.

Charges are usually only brought when the crimes are particularly serious, Alexander said. This could be a doctor who treats dozens of patients every day, does not take enough time to examine them properly, but still prescribes dangerous drugs, exchanges large amounts of money during a consultation or keeps sloppy medical records.

For example, Nassau County, New York, doctor George Blatti was sentenced to up to 15 years in prison earlier this year for second-degree manslaughter after killing five people by overprescribing opioids. Prosecutors said he prescribed patients vast quantities of drugs, including some he had never examined or even met. He would meet patients in his car and write them prescriptions while parked outside the hotel where he was staying or at a nearby Dunkin' Donuts.

Ketamine is a little different from the opioid cases, Alexander said. While opioids have a wide range of appropriate uses and reasons for their prescription, ketamine is used almost exclusively to administer anesthetics, he said. Its primary effect is to alter a person's state of consciousness, mood, behavior and perception.

Alexander said the charges against the doctors who allegedly administered ketamine to Perry are important.

“These cases serve two purposes: First, a well-functioning legal system requires that individuals be held accountable,” he said. “And it is also important in that it deters others from going beyond reasonable due diligence.”

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