Chua sentenced to life in prison on murder conviction

Judge Amanda Williams sentenced Noel Chua to life in prison after a jury returned a unanimous guilty verdict on felony murder charges in the overdose death of Jamie Carter.
Williams also sentenced Chua to five years in prison after he was found guilty of seven of 16 drug charges for violating the Georgia Controlled Substance Act.
After the sentence was read, Chua was led from the courtroom. He will be held at the Glynn County Jail until Friday when Williams will consider a request from defense attorney Donald Samuel to have Chua held at the Camden County Jail.
District Attorney Stephen Kelley asked Williams to hold Chua in Glynn County because the convicted murderer had been given preferential treatment such as being seen unsupervised outside the Camden County Jail before his trial.

Chua guilty of felony murder and seven drug charges

After nearly 11 hours of deliberations, a five woman, seven man jury found Noel Chua guilty of felony murder and seven of the 16 drug charges for violating Georgia's Controlled Substance Act.

Prior the clerk of court reading the verdict, Judge Williams told the audience she would allow no outbursts or they would be arrested.

After the verdict was read, Williams asked each juror answered individually that his or her verdict was freely and voluntarily given. Each juror answered yes to the question.

Chua sat erect and displayed no emotion as the guilty verdicts were read, but supporters of the doctor in the audience slumped as the guilty verdicts were read.

Jury still weighing evidence

Jurors have been in their chambers since before 10 a.m. weighing evidence in the trial of Noel Chua. Court officials brought a carry-out meal for jurors about 7 p.m., rather than bring them to a restaurant to eat dinner.
Conflicting evidence is a likely cause for the lengthy deliberations.
Family members for Jamie Carter said they expect jurors to return a guilty verdict on at least some of the 16 drug charges against Chua.

Chua jury still deliberating

Jurors in the murder and drug trial of Noel Chua have been deliberating more than seven hours, but have still not returned a verdict in the case.
Attorneys for both the prosecution and defense say they are unsure about why jurors have been unable to reach a unanimous verdict in the case.
Jurors have been weighing evidence and conflicting testimony from the weeklong trial. Medical experts for the prosecution argued Chua prescribed drugs to Jamie Carter for no valid medical reason and compared the defendant as a drug dealer.
Attorneys for the defense had medical experts testify Chua followed acceptable medical practices when he prescribed different prescriptions of narcotic pain killers to treat Carter's chronic pain from headaches.
It's unclear how long Judge Amanda Williams will keep jurors deliberating today. In other trials, Williams have kept jurors deliberating late into the night -- sometimes beyond 1 a.m. before adjourning court for the day.
Updates will continue until the jury returns a verdict.

Chua deliberations still ongoing

Six hours into their deliberations, a jury still has not returned a verdict against Noel Chua, a St. Marys doctor accused of prescribing drugs that led to the death of 20-year-old Jamie Carter III on Dec. 15, 2005.
Chua was charged with felony murder by prosecutors who said the drugs prescribed to Carter were for no apparent medical reason. He also faces 16 drug charges for violating the Georgia Controlled Substances Act.
Supporter for Carter's family and Chua have been in the courtroom since 9 a.m., when Judge Amanda Williams gave the jury instructions on how the law applies to each of the criminal charges, all felonies.
If convicted, Chua faces 5 years in prison on each of the individual drug charges and up to life in prison on felony murder.
Updates will continue until the jury reaches a verdict.

Chua jury still deliberating

After five hours of deliberations, jurors still have not returned a verdict in the case against Noel Chua.

The courtroom audience was asked to leave the courtroom at 2:30 p.m. to meet with Judge Amanda Williams and attorneys for the prosecution and defense. The only thing court officials would say about the private meeting is jurors had a procedural question.

It's unclear how long it will take for the jury to reach a verdict. In past trials, Williams has kept juries deliberating late into the night if they are unable to reach a unanimous verdict.

Many people who have watched the trial all week say they don't believe the jury will return a guilty verdict on all the charges against Chua. But few are predicting he will be found not guilty on all 16 drug charges.

Jury foreman selected in Chua trial

Jurors have selected a foreman in the Noel Chua trial. The evidence was sent to jury chambers about 10:30 a.m. Updates will hourly until the jury returns a verdict.

Chua jury begins deliberations

After listening to testimony since Monday, jurors began deliberations this morning in the trial of St. Marys physician Noel Chua.

Prior to sending jurors to their chambers to begin deliberations at 9:45 a.m., Judge Amanda Williams explained how the law applies in each of the 16 drug charges and the felony murder charge against Chua.

Jurors will weigh conflicting evidence and testimony in the drug overdose death of Jamie Carter III, Chua's patient and housemate.

Prosecutors claim the drugs Chua prescribed to Carter for no apparent medical reason led to the 20-year-old man's death on Dec. 15, 2005.

Defense attorneys argued Carter was suffering from chronic headaches and Chua followed medically acceptable practices when he treated his patient.

Updates of the deliberations will be posted hourly until the jury reaches a verdict at the Glynn County Courthouse in Brunswick.

Closing arguments completed

Prosecuting attorney Stephen Kelley described Chua's attempt to hide details of his treatment to Carter "a web of deceit" to mislead investigators.

Chua didn't disclose Carter's past hospitalization or the many prescriptions written to Carter when a coroner arrived the day of the overdose death.

Kelley also accused Chua of fabricating medical records to protect himself after Carter's death.

"All good plans sometimes don't work out,' he said. "He didn't chart all the drugs. Even smart people can't remember this much when it's not documented."

He urged jurors to look at the records, photographs and phone records admitted as evidence.

"There are so many unanswered questions in this case," he said. "It's part of the totality in these circumstances. You decide what that means."

He questioned why Chua never called Carter's family after his death.

"Why not cry with them and say, 'I'm so sorry,'" he said. 'Why not a card? Why not attend the funeral?"

The facts in the case "came back to haunt him," Kelley said of Chua.

"He's guilty of felony murder for prescribing methadone," he said. "Every one of you knows what to do."

Jurors are scheduled to receive their final instructions from Judge Amanda Williams when the trial resumes at 9 a.m. Saturday. Read Saturday's Times-Union for a full account of Friday's proceedings.

Prosecution asks jury for a guilty verdict

District Attorney Stephen Kelley began the prosecution's closing arguments by telling the jury to reach a verdict "that reaches the truth in this case."

"I am here to ask you to convict Noel Chua on the charges against him," Kelley said.

He said the prosecution does not have to prove its case "to a mathematical certainty."

"We only have to come in here and prove to you the elements of all these charges to a reasonable doubt," he said.

He said Chua didn't have to have intent to convict him of murder. Instead, the felony of violating the state controlled substance act by prescribing drugs to Carter for no apparent medical reason led to the murder charge after the victim's overdose death.

Prescribing methadone, oxycodone and morphine intentionally and for not legitimate medical purpose, Chua should be found guilty of felony murder, Kelley said.

"We have to show the defendant intended to prescribe for no legitimate purpose," he said.

Testimony by medical experts said the methadone was enough to kill Carter. Other drugs found in Carter's system Kelley said Chua prescribed to Carter also contributed to the overdose death.

"Under this crime, it's the whole picture," he said. "If it was being sloppy, you could go in my office right now and I'd be guilty."

He said it's time for a jury to determine all the circumstances in the case.

"Only you a jury, the conscience of the community, can tell us what that means," he said.

Kelley said medical experts said drugs prescribed to Carter were "excessive," according to testimony by medical experts during the trial.

There were no evaluations in Carter's medical records to show if they were effective, he told jurors.

He said doctors who don't chart controlled substances are in violation of the law.

He showed jurors drug containers prescribed to Carter not charted in medical records.

Kelley continued to stack pain medications prescribed to Carter on a table in front of jurors, including nasal sprays, pills and patches.

But, it's not just about the medications, he told the jury.

He said Carter's parents didn't know when Chua hospitalized Carter in November 2005 for questionable reasons.

Carter was given enough morphine for a patient recovering from "major medical surgery," during his hospitalization.

"It's off the charts," he said. "Who was going to know? It was just Dr. Chua and Jamie Carter having a good time."

Chua ignored a nurse's concerns Carter was a drug seeker when he asked for specific narcotic pain medications in the hospital.

"This visit [to the hospital] was just a fabrication," he said. "It was just pushing drugs."

Carter's death avoidable if he had followed directions, defense attorney concludes

Defense attorney Donald Samuel concluded his closing arguments by telling jurors prosecutors are blaming Chua for Carter's death, but if Carter had followed the directions on the prescriptions, "he probably would not have died."

A lawful prescription for methadone and prescriptions for other medications prescribed earlier did not cause Carter's death.

Samuel urged jurors to find Chua not guilty on every count.

Samuel said it was "quite a burden" to represent Chua since his arrest.

He urged jurors to return a verdict of not guilty on all 17 counts.

The prosecution will present their closing arguments beginning about 5 p.m.

Defense asks jury to find Chua not guilty

John Garland, one of the defense attorneys for Noel Chua, began closing arguments Friday afternoon to jurors by explaining the responsibility they face when the weigh the evidence presented during the past five days.

He told jurors they will find Chua not guilty after considering the evidence.

The prosecution, he said, must prove the charges and show Chua was not acting as a doctor trying to treat a patient.

"We're not talking about Dr. Chua being better or worse than other physicians," he said.

The drugs prescribed by Chua were "not outside the bounds" of normal medical practice.

Chua honestly exercised good medical judgment when he treated Jamie Carter III in the months before his overdose death from drugs prosecutors say were prescribed for no apparent medical reason.

"When Dr. Chua prescribed these medications, it was simply to try and treat Jamie Carter's headaches," he said.

Carter's death was not foreseeable, he said.

The entirety of the state's case against Chua "rests on circumstantial evidence," he said.

Testimony proved Chua, acting as a doctor, was trying to help a patient with medically approved treatments.

Attorney Donald Samuel continued closing arguments for the defense by saying some of the evidence was "remarkably difficult to understand."

He told jurors the verdict they will reach will be "the most important decision of your life."

Samuel told jurors the issue is not about Chua's ability to keep accurate medical records.

"It makes absolutely no difference if a doctor keeps no records or sloppy records," he told jurors. It's not a crime to keep sloppy or incomplete medical records, he told jurors.

The trial is not about a doctor's code of professional responsibility, he said.

Every prescription to Carter was signed by Chua, he said.

If Chua was a drug dealer, he didn't have to write a prescription, Samuel said. Chua could have given Carter some of the drugs investigators found in the doctor's desk drawer.

The prosecution has not proved Chua intentionally tried to murder Carter, Samuel told jurors.

Carter was prescribed "every single drug" listed in the indictment by other physicians before Chua treated the patient, he said.

There was also evidence presented during the trial that Carter got drugs from other sources while under Chua's care, he said.

It is only when a person abandons his role as a doctor that a jury can find Chua guilty of a crime, he said.

The dosages for drugs prescribed to Carter by Chua were less than the maximum dosages he could have legally recommended, Samuel said.

Medical experts testifying on behalf of the defense all said the drugs prescribed by Chua were appropriate to treat Carter's headaches, he said.

Chua had no obligation to force Carter to take drugs that weren't working, he said.

"He was trying to figure out the best way to treat pain," he said.

Chua was not indicted for keeping patients' drugs they returned in his office because it's not a crime, he told jurors. Instead, the drugs found in his office showed Chua insisted patients return unused drugs before he'd write another prescription, which Samuel said was "the prudent thing to do."

Chua had no way to know Carter had additional drugs the day he died besides methadone, Samuel said.

What the state wants jurors to believe is Chua was supposed to know what was in Carter's blood.

"He didn't know he had morphine in his blood, or oxycodone in his blood," he said.

Motion to dismiss charges denied

Prior to the start of closing arguments, defense attorney Donald Samuel asked Judge Amanda Williams to drop charges against St. Marys physician Noel Chua.

She denied the motion to drop murder and all 16 drug charges against Chua for the overdose death of Jamie Carter III in December 2005.

The discussion was held in the courtroom outside the presence of jurors.

Closing arguments set to begin

Attorneys for the prosecution and defense will begin their closing arguments Friday afternoon in the trial against Noel Chua.
Attorneys on both sides will summarize the evidence and testimony presented since the trial began Monday.
Both the defense and prosecution will be given two hours to explain their interpretation of evidence to jurors. After closing arguments, Judge Amanda Williams will charge the jurors -- an explanation of the charges against Chua and how the law applies to each of 16 drug charges and one murder charge.

Defense rests its case

Defense attorney rested his case at noon. The jury will return at 1 p.m.

Sister testifies about male visitors to Chua home

When jurors returned to the courtroom, Feliciano resumed her testimony. She said two other young men under the age of 20, besides Jamie Carter, also worked in Chua's office in the past.

Feliciano said she moved from Chua's house the summer before Carter's death in 2005. She testified two boys under 15 years old who were patients of Chua's slept in the doctor's bedroom when they stayed in his home for the weekend before he met Carter.

"You did not approve of this conduct, did you?" Johnson asked. "You told your brother young boys would get you in trouble, did you not?"

Feliciano denied she expressed concern to Chua about his relationship with male patients visiting his home.

Chua sister tesimony begins

The morning's testimony resumed with Chua's sister, Marites "Tess" Feliciano taking the witness stand. Feliciano told jurors she didn't know who bought an advertisement in a twice-weekly newspaper in Camden County soliciting donations to help pay for Chua's legal defense after his arrest.

But during questioning, Feliciano said her cell phone number was given in the ad for contact information.

Jurors were excused from the courtroom after prosecuting attorney Jackie Johnson asked Feliciano asked how she got immigrated to the United States from the Philippines. Johnson told Judge Amanda Williams that the witness would not be able to remain in the country without Chua's support.

The outcome of this trial depends on whether she stays in this country," Johnson said. "If we could get her to answer the question, we could get to the heart of the issue."

During questioning while jurors were excused from the courtroom, Feliciano said she was unable to remember details about meeting with an attorney after Carter's death, who paid for an advertisement supporting Chua and her immigration status if Chua is convicted.

Feliciano denied going online to discuss the case against her brother. She denied sending any money collected for Chua's defense fund to support another brother's political campaign to the Philippines.

Johnson questioned Feliciano about why she moved out of Chua's house.

"How many boys have stayed at the house with Noel without their parents being there?" Johnson asked. "How many of those young boys are children of Dr. Chua's patients?"

Feliciano said one boy was 15 years old, another was younger. She said the boys stayed in Chua's bedroom.

Feliciano's testimony before jurors is scheduled to resume about 11:30 a.m.

Pharmacist testifies it's uncertain where Carter got drugs found in his system

The first witness for the defense on day five of the trial of Noel Chua was Wal-Mart pharmacist Mark Mitchell.

He told jurors he filled a prescription for methadone for Jamie Carter III on Dec. 9, 2005, less than a week before his overdose death in Chua's St. Marys home.

Defense attorney Donald Samuel asked Mitchell to count the unused methadone tablets found in Chua's home after Carter's death. Six pills were missing from the original prescription of 60 tablets.

Prosecuting attorney Jackie Johnson asked Mitchell to pour the methadone tablets on a tray.

The pills were consistent with the 30-day supply he put in a bottle for Carter, but he couldn't say whether they are the same drugs found in Carter's system after his death.

When Carter brought another prescription to the store for morphine three days later, Mitchell said the only way Carter could have gotten more of the drug was from another prescription from a physician.

Mitchell said he "probably would not have filled it," when he was asked what he would have done if Carter had returned to his store, instead of going elsewhere with a prescription for more methadone three days later.

Doctor for defense maintains Chua's treatment of Carter

During cross examination, District Attorney Stephen Kelley, questioned Hueston's medical analysis of Carter's treatment by Chua.

Hueston was unable to explain why Chua had other medications, some several years old, from other patients stored in the desk drawer in his office.

"I would be uncomfortable with that," he said.

He also said he would advise doctors from bringing controlled substances home.

Even though Chua's records show Carter returned pain medication, the records don't indicate how many, if any, pills were returned. The records also don't indicate how Carter responded to the medications prescribed by Chua, he testified.

Other doctors, on three different occasions, expressed concern about Carter possibly being a drug seeker. But Hueston maintained it was still appropriate for Chua to prescribe narcotic pain medications to Carter.

"Show me in the records where this pain medication is working," Kelley asked.

Hueston said there was no record showing why many of the medications were prescribed or if it was effective to relieve Carter's headaches.

The undocumented prescriptions written by Chua to Carter would be a violation of the medical board in South Carolina, where Hueston practices medicine, he testified.

Some medications prescribed to Carter by Chua were changed so quickly, Hueston said it would be impossible to evaluate whether they were effective.

The first time Carter was hospitalized in a St. Marys hospital in November 2005, Hueston said Chua prescribed 10 milligrams of morphine several hours after he was admitted. Carter was given more morphine, demoral and valium during his two-day stay in the hospital.

"I don't see anything wrong with that at all," Hueston said.

Carter's request for Demerol to replace morphine to manage pain while he was hospitalized is typical behavior by people with a drug problem, Hueston said.

Later in his testimony, Hueston defended Chua's decision to give Carter a dose of morphine just before his release from the hospital, saying morphine is appropriate if Carter was prescribed medications after his release that take a long time to work.

Hueston said Carter was never prescribed an excessive number of medications by Chua during the three months he was the doctor's patient. He did say, however, there were other non-narcotic medications Chua never tried to treat Carter.

More witnesses for the defense are scheduled to testify Friday starting at 9 a.m. Attorneys said they expect to begin closing arguments sometime Saturday, then the jury will begin their deliberations. A complete wrap-up of Thursday's proceedings will be in Friday's Times-Union.

Doctor for defense disputes earlier medical testimony

The day's first witness for the defense, William Hueston, a medical instructor from the University of South Carolina, said he reviewed medical records from Chua's office.

He concluded Carter suffered from pain and headaches and believed the patient's complaints were legitimate.

The records from Chua and other doctors indicated Carter was in severe pain, he testified.

He speculated Carter was prescribed so many different drugs in an attempt by Chua to find a medication that worked.

There was "no evidence" other doctors were successful in treating Carter's headaches, he said.

Hueston said Chua was "fairly cautious" with the drugs he prescribed to Carter.

As treatment progressed, he said Chua prescribed longer lasting medications in an attempt to treat Carter's headaches.

The medications prescribed by Chua for Carter when he was hospitalized a month before his death were for legitimate reasons, he said.

"I think everything was appropriate for the practice of medicine," Hueston said of Chua's treatment of Carter during the hospitalization.

He disagreed with previous testimony by a medical expert for the prosecution who said it is inappropriate for a patient to receive a morphine injection prior to being discharged from a hospital.

The dosages of drugs prescribed by Chua were well within normal standards, he said.

He said Carter was not going through withdrawal from drugs because prescription pain killers were found in the home after Carter overdosed and died.

The methadone was likely prescribed in a legitimate attempt to treat Carter's headaches, he said.

"It's only used when everything else has failed," he said.

He said there is no rule about physicians taking unused drugs from patients. He said it's "common practice" for physicians to prescribe different drugs to treat an ailment. When drugs are returned, Hueston said he flushes them down a toilet while the patient watches.

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Prosecution rests case in Chua trial

Jackie Johnson, a prosecuting attorney in the case against Noel Chua, said the prosecution will not call any more witnesses and will rest its case when the trial resumes about 3:35 p.m.

Mothers describe concerns about son's relationship with Chua

Thursday afternoon's first witness, Walter Butler Jr., a Georgia Bureau of Investigation crime lab employee, testified he analyzed evidence taken from Chua's house after Carter's death.

He testified he didn't test a syringe found at the crime scene, because the liquid inside was transferred to another container by investigators. The liquid found inside was a local anesthetic, he said.

Lynette McCall testified she was a nurse at the Southeast Georgia Health System hospital in St. Marys when Carter was admitted as a patient by Chua in a week before his death. Carter had complained about severe headaches.

When Carter arrived to the hospital, he was "semi-conscious," she said.

Carter appeared to be "under the influence" of drugs," she said.

Nurses were unable to get Carter from a stretcher to a table for tests, after he was admitted to the hospital, she said.

All the medications later prescribed were listed on medical charts, she testified.

While he was hospitalized, Carter repeatedly asked for more pain medication than had been prescribed, McCall said.

Joanna Talano, a Drug Enforcement Agency employee, said doctors are required to prescribe methadone for the purposes of treating drug addiction.

But doctors don't need a special license if they prescribe methadone for pain, she said.

Steve Will, an investigator with the Composite State Board of Medical Examiners, said doctors should not treat or prescribe drugs to immediate family members. At the time of Carter's death, he was living with Chua.

Johnna Carter, the victim's step-mother, described her son's relationship with Carter from September 2005 until his death three months later.

Jamie was staying at her home nearly every night until Oct. 31, then he quit coming home every day.

She wiped tears from her face as she described her son failing to come home to celebrate his birthday in mid-November. She described her son and Chua showing up three hours late for Thanksgiving dinner.

She asked her son if he had a health problem when she saw his hands trembling at the dinner table.

I asked him, 'What is wrong with you?'"

She said her son told her he and Chua were going to New York together a few days later. It was the last day she saw her son, she testified.

She got a call from a sheriff's deputy notifying her about her son's death. Chua never talked to family members after her son's death, she testified.

She said she never received any bills or other information indicating her son had ever been one of Chua's patients.

Tammy Flannery, Carter's mother, was the next witness to testify about her son's relationship with Chua.

She described seeing her son the weekend after Thanksgiving and said he appeared "very sleepy and lethargic."

She said she questioned Chua to determine if her son had been prescribed any medications.

Chua told her not to worry about her son's health and that he had "everything under control."

On Dec. 11, Flannery said her son returned home and brought gifts he purchased while he and Chua were in New York.

She said her son had a bag of white powder he described as a crushed up pain medication. Medical experts earlier testified some drug users crush pain pills to get a faster, more intense high.

She asked him why he was so sleepy and couldn't keep his eyes open.

Chua never tried to contact her after her son's death, Flannery said.

Defense says doctor testimony only proves "sloppy" records by Chua

During cross examination by defense attorney Donald Samuel told Grubb the only thing he could tell jurors was Chua kept "sloppy" records.
But Chua was in a unique position to be familiar with Carter's ailments because they lived and worked together, Samuel said.
"You, unlike Dr.Chua, were unable to see Jamie Carter on a day to day basis," Samuel said.
Grubb said he "didn't see a rational basis" for Chua to keep prescribing pain killers to Carter to treat his headaches.
Carter had seen many doctors who had prescribed some of the same drugs as Chua, Samuel said.
The difference, Grubb said, is it appeared other doctors tried to avoid prescribing narcotic pain killers to Carter, even though some were prescribed. Carter also received narcotic pain killers when he was hospitalized in 2003, Samuel said medical records showed.
Samuel attacked Grubb's credibilty for failing to mention Carter passes a drug test given by another physican who expressed concerns about Carter possibly having a substance abuse problem. The drug test Carter passed likely told Chua his patient did not have a drug addiction problem, Samuel said.
When Chua prescribed methadone to Carter less than a week before his death on Dec. 15, 2005, there was nothing in the medical records saying he should take any other drugs prescribed earlier, Grubb said.
"There's nothing in any record saying use them all at once," Samuel said of other medications prescribed before the methadone.
Court was adjourned for lunch at 12:45 p.m. and testimony will resume at 1:45 p.m. Prosecutors are expected to rest their case against Chua this afternoon after testimony by several Carter family members.

Chua should have confronted patient about suspected drug addiction, doctor testifies

Grubb questioned the number of pain killers prescribed to Carter. The proper response to Carter's headaches, he said, would have been to confront the man about his addiction to pain killers and find a non-narcotic medication to treat the ailment.
Carter should have been admitted to a clinic for drug withdrawal, he said.
"There's ample evidence here this person was a suspected addict," Grubb said. "A physician has the obligation to confront [a patient]."

Carter likely addicted to pain medications, doctor testifies

More than an hour into his testimony, Dr. George Grubb told jurors Carter should have never been given a morphine injection by Chua, less than an hour before his discharge from a St. Marys hospital a few weeks before his death.
"It's a strategy that's going to fail," he testified.
Carter should have remained hospitalized if his pain was severe enough to warrant an injection of the drug, Grubb said.
He said Carter was possibly going through withdrawal from prescription pain killers, some of which may have increased the frequency and severity of his headaches.
He said there was nothing in the doctor's charts indicating if Carter was responding to treatment.
Grubb said patient records show Carter was prescribed medications without a visit to the doctor's office.
Patient records show Carter returned some medications, but they never identified which ones, he testified.
Chua also noted in Carter's patient record he prescribed a narcotic pain killer to be taken once a day. But the prescription instructions for the medication called for it to be taken twice a day.
He said the medications should not have been prescribed for headaches, and the medications should not have been taken on a daily basis.

Chau failed to follow code of conduct, doctor testifies

The fourth day of the trial of St. Marys physician Noel Chua began with testimony by Dr. George Grubb, an internal medicine specialist with the Southeast Georgia Health System in Brunswick.

Grubb explained the process to evaluate a patient for diagnosis and treatment, including a list of medications taken.

Grubb was asked to evaluate Jamie Carter's medical charts and explain any abnormalities for jurors.

The past history on Carter's medical charts written by Chua is abbreviated, he said, especially considering Carter's records indicated he did not want to be labeled a "drug seeker." .

The prescription log showing the drugs Chua prescribed to Carter in the months before his overdose death in the doctor's St. Marys home indicate some of the pain medications prescribed to Carter "were not a prudent thing to do."

"I think it's excessive," he said of the medications to treat Carter's headaches.

He also expressed concern about another doctor's records from another doctor who noted Carter claimed he lost a prescription for narcotic pain killers and asked for a refill. That fact should have caused concern for any doctor reading the records because if could indicate a possible drug abuse problem, he said.

Grubb said he would have been concerned Carter was a "drug seeker" if he was treating him as a patient, based on other physician's evaluations in the records and a drug test showing Carter had used cocaine.

Somebody using cocaine should not be prescribed any addictive substances, he told jurors.

Grubb said Chua's treatment of Carter violated the code of ethics for physicians.

"I would have had a dialogue [with Carter] seeking alternative treatment," he testified.

Chua's records for Carter failed to mention some of the narcotic medications prescribed or his history of headaches and his response to the prescribed medications.

Grubb said Chua failed to note in his charts that Carter had failed a test for illicit drug use, when it was noted in another doctor's records for the patient.

Former patients point to pattern of misconduct

One says he and Chua were lovers, while another testifies that prescription drugs were easy to receive.
Read more from today's Times-Union at http://jacksonville.com/tu-online/stories/101807/geo_209428201.shtml

Witness for defense defends prescriptions written by Chua

William Morton, a pharmacist and professor emeritus who teaches medical students about psychiatric drugs at the University of South Carolina, began his testimony for the defense about 4:55 p.m.

After explaining his professional background, Morton said pain medications were part of his expertise but he is not a toxicologist.

He said he has testified at least 35 times as an expert witness in trials throughout the Southeast.

But Stephen Kelley, one of the prosecuting attorneys, objected to questions about his evaluation of drugs prescribed because Morton is not a medical doctor.

After the jury was sent back to their chambers, Judge Amanda Williams said she would not allow Morton to answer questions about the drugs Chua prescribed to Carter.

"I am not going to let him talk like he is a doctor," Williams said. "He doesn't even have M.D. behind his name. I don't care what he teaches. He's not a doctor."

Defense attorney Donald Samuel said he would preface every question with a disclaimer that Morton is not a medical physician.

While the jury was out of the courtroom, Morton said he reviewed Carter's medical records and concluded drugs prescribed by Chua were "rationally prescribed" for tretment of headaches.

Morton said hydrocodone is an appropriate medication for a patient with Carter's symptoms. He listed the many pain medications prescribed by other doctors to treat Carter's headaches.

Morton said physicians contact him when they have questions about the drug and dosage to treat a patient's medical condition.

A nasal spray prescribed for pain relief was also an appropriate medication to treat Carter's problem, he said. A patch that slowly releases medication into the skin, fentanyl, was also a useful drug to treat Carter's symptoms.

"You always weigh that good effects often outweigh the bad effects," he said.

He said it's not unusual for a doctor to change a patient's medications to find a drug that effectively treats an ailment.

Morton said he reviewed the drugs found in Chua's house and some of the medications were not prescribed by Chua.

The morphine given to Carter in the hospital and the Demerol given to him shortly before his release were also appropriate, Morton testified.

Demerol is "not one of my favorite drugs" to prescribe because it's difficult for a patient to absorb.

"My experience is people do not have a good response," he said.

The oxycontin and percocet prescribed to Carter simultaneously is also acceptable medical practice by many physicians, he said.

One of the problems with the drugs is the potential for abuse, he said.

The methadone prescribed to Carter on Dec. 9, but it has less likelihood to get someone high, he said.

There aren't that many people searching for methadone for illicit purposes because the drug takes days to build in a person's system.

The levels of methadone found in Carter's system at the time of his death were at medically acceptable therapeutic levels, he said.

It did not appear Carter took excessive amounts of methadone, Morton said.

He said it was inappropriate to use other narcotic pain killers in combination with methadone, however.

Morton said other alternative therapies such as acupuncture are also acceptable ways to treat headaches. Carter was referred for the treatment the day before his death, medical records show.

During cross examination, prosecuting attorney Stephen Kelley questioned Morton about different controlled substances. Some of the drug Chua prescribed Carter such as hydrocodone, morphine, Demerol and methadone are among the most dangerous, addictive prescription drugs, he said.

Morton told jurors many of the drugs prescribed to Carter could still have been in his possession at the time of his death because some of them were prescribed to be taken as needed by the patient.

Morton said all medications prescribed to patients should be charted in a patient's medical records. At least four drugs were prescribed to Carter by Chua with no explanation in his medical records, Morton testified.

He said when he first reviewed Carter's medical records, his first response was "it looked like he was way over-prescribed."

But after a more careful analysis, he reversed his opinion.

If there was evidence that Jamie Carter was a drug abuser, Morton said he would change his opinion.

Chua should have prescribed methadone to Carter earlier because oxycontin has a higher risk of addiction, Morton said.
But Morton said Chua was "not grossly over-prescribing" medications to Carter.

Testimony is scheduled to resume 9 a.m. Thursday, with the remaining witnesses for the prosecution and additional testimony by witnesses for the defense.

Doctor testifies about Chua medical records

Dr. David Faulk, a psychiatrist from St. Simons Island, began his testimony about an earlier witness, identified by court officials as "John Doe 9."

Faulk said he treated the witness about two years ago for "medical detox." He said the patient left the program without medical advice. Faulk refused to give the patient any of the medications he requested when he left the program.

Instead, he told the patient to go to his family physician, but didn't know the patient's doctor was Chua.

Faulk also treated Carter after a friend died of a drug overdose in September 2005. A drug test of Carter showed he had opiates and cocaine in his system.

"I was treating him because he was scared," Faulk said.

Initially, Carter denied taking cocaine until doctors confronted him about the test results, he said.

Faulk prescribed a non-narcotic drug to treat Carter's headaches and another drug for "social anxiety."

During Carter's final visit on Nov. 2, 2005, about six weeks before his death, Faulk said he tested positive for opiates. Carter never showed up for any other appointments, he said.

Faulk said he would have put Carter in drug rehabilitation if he would have tested Carter and found the opiates Chua had prescribed.

Faulk said he never attempted to contact Chua to determine why he prescribed pain medication to Carter.

After Carter's death, Faulk reviewed Carter's medical records of medications prescribed by Chua. He said some of the drugs prescribed were not in Carter's medical charts.

Most doctors, Faulk said, routinely identify all prescriptions to patients to make sure they remember all the medications prescribed and ensure none of the prescriptions are duplicated.

Chua's records show one pain killer was prescribed on Nov. 15, but Carter brought the prescription to a pharmacy the day before. Other drugs were prescribed to Carter that Chua never indicated in medical records, Faulk said.

On Dec. 9, Faulk said Carter was prescribed 60 doses of methadone, which were marked in Carter's records. Chua prescribed 30 more doses two days later that were not noted in Carter's medical records, however.

He said it is unusual for medications such as Demerol and methadone not to be noted in patient records because the drugs are "closely regulated" and there is a significant risk of overdose.

"It seems it was excessive," Faulk said of medications prescribed to Carter by Chua.

Testimony by a medical expert called by the defense is scheduled to testify after jurors return from a break about 4:50 p.m. The witness testimony is expected to last about three hours, attorneys said.

Doctor testimony about incomplete medical records

Testimony resumed about 2:25 p.m., after Judge Amanda Williams settled a disagreement about the line of questioning by defense attorney Donald Samuel.

Jacksonville physician Bill Jacobs returned to the witness stand and testified medical records did not indicate whether Jamie Carter finished a prescription for Demerol.

Jacob's testimony was repeatedly interrupted by sidebars -- meetings at the judge's bench outside the earshot of jurors to clarify evidence presented during questioning by Samuel.

During a review of Carter's medical history, the initial assessment included complaints about headaches, blackouts and a prior automobile accident.

It's possible the assessment about Carter's fears about being labeled a drug seeker could inaccurately label him as an addict, Jacobs testified.

Samuel chronicled the drugs prescribed after each doctor's visit, including pills, nasal sprays and patches. The drugs were all prescribed to help Carter deal with his headaches and "other medical complaints."

Though Carter tested positive for cocaine use on Sept. 24, 2005, he never failed a subsequent test for illicit drugs, including tests after his death, Jacobs said.

Even when doctors made a mistake and their patients become addicted on pain medication, the physicians are still practicing medicine, Samuel said.

Jacobs said it is "good medicine" for doctors to destroy medications returned by patients, not store it in a desk drawer like Chua apparently did.

Based on the level of methadone in Carter's blood at the time of his death, there's no way to determine how much of the drug he took because he could have vomited after taking the medication.

But there was no evidence to indicate whether Carter vomited the day of his death, Jacobs said.

The low level of methadone didn't indicate how much he took, just that Carter hadn't taken the medication for an extended period of time, Jacobs testified.

On Dec. 9, 2005, medical records show Carter was prescribed methadone, but there is no record the patient ever visited Chua's office that day.

The records say nothing about Carter being hospitalized that day or that he was prescribed pain medication.

There was no mention about methadone, which Jacobs said should have been recorded in the medical records.

"The office record is not consistent with the hospital records," Jacobs said. "The office notes don't make any sense based on what happened that day."

But, Chua did see Carter in the hospital the day before and the day of his release,

Carter drug use described as "out of control"

After the jury returned from lunch, Bill Jacobs, a Jacksonville physician specializing in pain management and addiction, continued testimony about the drugs Carter used in the months before his overdose death.

Defense attorney Donald Samuel asked how Jacobs could have possibly known Carter would die from the drugs prescribed to him by Chua, as he described in earlier testimony Wednesday.

Jacobs described Carter's drug use as "out of control," based on his prior medical history and by the number of drugs prescribed to him by Chua and other doctors.

He said "it is usual behavior" for someone with a substance abuse problem to keep multiple prescriptions of unused drugs, even if other medications were prescribed to replace them.

"I believe it's likely the drugs came from Dr. Chua and other sources," Jacobs testified. "Addicts take anything that's available."

It's unclear where the morphine found in Carter's system came from, he told jurors. High levels of oxycodone were found in Carter's blood by medical examiners, Jacobs said.

Though Chua changed Carter's medications many times, Jacobs said he "did not see any instructions to stop taking anything."

During Jacobs' testimony, Judge Amanda Williams sent jurors to their chambers to settle a disagreement between the attorneys for the prosecution and defense about earlier testimony regarding photographs of drugs found in Chua's home.

"I want to be able to respond to show it wasn't careful testimony," Samuel said.

Williams said she will instruct the jury about the disagreement between attorneys and ask them to use their own recollection about earlier testimony.

"We can't even agree what happened," Williams said. "I'll have to say the record is unclear. Nobody in the courtroom has a record about what happened."

Jacobs said his medical opinion had nothing to do with photographs of pills and containers found in Chua's home.

Jacobs said Carter's death was not unexpected, considering his medical history. Jacobs said he believed Carter took all the medications prescribed, despite Samuels contending it would be impossible for Carter to take all the medications such as 90 methadone pills and 90 oxycodone pills in one week.

"I don't know how many he took," Jacobs said. "Addicts rarely have left over drugs."

Jacksonville physician says drugs prescribed for no apparent medical reason

William Jacobs, a Jacksonville physician specializing in addiction and pain management, testified lots of people have been treated with addictive pain medications and had problems.

Jacobs said it's acceptable to treat patients with opiates, but it's easy for anyone to develop a physical dependence to pain killers such as hydocodone, percocet and oxycontin.

"Addiction is about having your brain highjacked," he said ""It's almost as if a switch has been thrown in the brain."

When asked if it was unusual for doctors to take unused prescription drugs from patients, Jacobs said "it's illegal for doctors to take drugs from patients."

Jacobs testified he reviewed Jamie Carter's medical records and Chua noted in the initial evaluation that Carter did not want to be labeled a drug seeker.

Carter overdosed and died in Chua's home less than three months later.

Carter's medical records should have caused concern for Chua, however, because Jacobs said the records indicated Carter had been treated for "depression, anxiety and substance abuse."

Most doctors would have been concerned about Carter's medical history, he said.

Jacobs said he and most physicians have a policy of not treating his office staff or family members because it "clouds your objectivity." Carter was treated by Chua while he worked in the doctor's office and lived in his home.

Jacobs discussed the effects of methadone, one of the drugs prescribed to Carter by Chua.

He said all his patients treated with methadone are screened for other drugs that might be in their system because they could increase the effect of methadone.

Jacobs said he couldn't think of any legitimate medical reason for a patient to be prescribed the drugs given to Carter to treat his pain.

"I couldn't prescribe that number prescriptions and assess whether they were working," he said.

Jacobs said Carter was prescribed nearly every narcotic pain killer while he was treated by Chua.

The day of Carter's death, Chua brought the victim home after he complained about being lethargic.

Jacobs said Carter's death was not unexpected, considering the number of drugs prescribed during the previous month and the number of drugs later found in Chua's home.

When Carter complained about his symptoms about six hours before his death, Chua should have hospitalized his patients, Jacobs said.

Jacobs is scheduled to continue his testimony after the court resumes at 1 p.m.

Former patient said he was addicted to drug Chua prescribed; second patient said he had relationship with doctor

The first witnesses scheduled to testify on the third day of the trial against a St. Marys physician facing murder and drug charges were not identified by court officials. Prosecutors said they took the step to protect the identities of the two witnesses, but they didn't say why they couldn't be identified.

Prior to testimony by the two witnesses, Judge Amanda Williams told jurors the prosecution's intent is to "show motive, intent or source of conduct," by the defendant, Noel Chua.

The first witness, identified as "John Doe 9," testified he was a former patient of Chua's. He said he was addicted to the pain killer hydocodone prescribed by Chua and later went through drug rehabilitation for cocaine use.

During cross examination, however, defense attorney Donald Samuel showed medical records indicating only two prescriptions for hydrocodone written by Chua.

Prosecuting attorney Jackie Johnson produced records indicating the witness was prescribed hydrocodone by Chua six different times.

The witness said he was also prescribed the drug two other times by other doctors.

The witness also testified Chua offered him a job in his office and invited him to his house at Osprey Cove.

The second witness, identified as "John Doe 10," identified himself as a 19-year-old who was a former patient of Chua.

In 2004, the witness said Chua invited him to "shadow" him in his office and worked in the doctor's office for two summers. The witness said he stayed in Chua's house while working for the doctor.

The witness said he also traveled to Turkey with Chua in the summer of 2005 while he worked for the doctor. Chua paid for the trip, he said.

The relationship with Chua eventually became sexual the first summer, he testified.

But Chua refused to resume an intimate relationship with John Doe 10 the second summer he worked in the doctor's office

The bulk of the day's testimony is expected to be taken by medical experts for both the prosecution and defense.

Witnesses say Chua knew victim had drug problem

The prosecution says Chua prescribed the drugs that killed Jamie Carter. Defense says there's no proof the specific drugs that killed Carter were prescribed by Chua. Read more coverage of yesterday's testimony at http://www.jacksonville.com/tu-online/stories/101707/geo_209117398.shtml

Carter cautioned to distance himself from Chua by college instructor

The day's last witness, Jenny Harper, a biology teacher at Coastal Georgia Community College, described Carter as a very nice student, "very pleasant to be around."

Harper said she became concerned about Carter's relationship with Chua several weeks before his death..

"It just seemed peculiar he [Chua] wanted to spend so much time with Jamie," she testified.

She told Carter not to take morphine any more and not to see Dr. Chua after learning about the medications he was prescribed.

Harper said she was "shocked" when she learned of Carter's death.

Witnesses for the prosecution were expected to testify all day when the trial resumes at 9 a.m. Wednesday, including more testimony from Carter's friends and family members.

Concerns expressed about apparent drug problems

After the medical testimony ended about 2:30 p.m., the prosecution's witnesses began testimony about Carter's apparent problems with prescription drugs in the weeks before his death.

Osprey Cove security guard Sharon Palmer said she was working on Dec. 6, when two men drove Carter home in a pickup truck.

One of the passengers asked if Carter would have any problem driving into the residential community. One of the men expressed concern about Carter's well being. She asked for someone to check on Carter.

"I called Dr. Chua to advise him what happened," she testified. "I told him the young man was brought home and there was some concern about the young man taking pills. I expressed concern for his safety."

Linda Amos, a student advisor at the Coastal Georgia Community College where Carter attended classes, described a problem he had weeks before his death.

She said Carter began acting incoherent and was slurring his words at school. She told jurors she brought him to see a nurse and college officials found two syringes and two prescription bottles in his possession.

The medication in the syringes was "to make him feel better," Carter told the nurse, Amos said.

She said the drugs in the bottles were prescribed by Chua. She said Carter did not want her to call Chua about the apparent problem.

Another witness, Christa Cox,.a nurse who worked at a St. Marys hospital in November 2005 when Carter was admitted as a patient.

She said Carter was admitted for severe headaches, nausea and vomiting. During his 2-day stay, he was prescribed morphine and later requested Demerol, saying the morphine was no longer effective.

She testified she believed Carter might be addicted to pain killers and expressed her concerns to Chua.

Cox said she expressed concerns about Carter's apparent drug problem in his medical files while he was hospitalized.

Chua ordered Carter a dose of Demerol by injection at 6 p.m., 45 minutes before he was discharged from the hospital on Nov. 18, 2005, Cox said. Another nurse had given Carter an injection of Demerol at 3:30 p.m., she said.

Cox said the doctor's order was unusual because patients are typically given oral pain medication before they are discharged, she said.

Defense attorney Donald Samuel questioned Cox about Carter's assessment of pain when he specifically asked for Demerol for relief.

"You were concerned about the patient because he talked about the type of drugs he wanted," Samuel said. "Dr. Chua basically told you to mind your own business."

Questions arise about drugs found in Carter's blood

After breaking for lunch, testimony in the murder and drug trial of Noel Chua continued at 1 p.m. The crowd in the courtroom was evenly split among supporters for the defense and the prosecution.

The afternoon's first witness was a Ed Varvieri, a forensic toxicologist with NMS Labs in Pennsylvania. Vavieri testified he analyzed blood sample results from Jamie Carter III after his death in December 2005.

A blood sample tested for drugs showed Carter had three different opiates and "a variety of compounds." No illicit drugs were found in Carter's blood, he testified.

The test results indicated Carter took more than the prescribed amount of pain medication, he told jurors. In fact, the level of morphine in Carter's system was high enough to be lethal in some cases, he said.

Other drugs found in Carter's blood were within "therapeutic levels," he said.

Methadone levels were not high enough to indicate Carter had been taking the drug for a long time period.

His opinion was levels of drugs found in Carter's blood could be life-threatening.

Midway through the testimony, defense attorney Donald Samuel objected when prosecuting attorney Jackie Johnson asked what led to Carter's death.

Judge Amanda Williams ruled Varvieri was allowed testify after Johnson explained she wanted to establish Carter's cause of death for the jury.

The combined levels of drugs found in Carter's system were high enough to cause death, Varvieri told jurors.

"All the drugs were working the same way," he said. "The effects were additive. I can't think of a reason to have all four of these drugs present."

During cross examination, the toxicologist was shown prescriptions written to Carter.

He testified that a prescription for morphine prescribed to Carter on Nov. 15, would have run out before his death if Carter had taken them as directed.

"If he took them as directed, this would not be the morphine found in his blood," Samuel said.

Morphine was detected at "significant' levels above therapeutic levels, Varvieri testified.

But Samuel said Varvieri "didn't have a clue" where some of the drugs found in Carter's system came from.

"You don't know what doctor prescribed it," Samuel said.

Varvieri agreed there is no way to determine if drugs found in Carter's blood were prescribed by Chua. He said Carter could have crushed a morphine tablet and injected it, which could have caused his death.

But there is no way to determine if the morphine was injected or taken in tablet form, he testified

The methadone levels, however, indicated Carter may have taken a large and potentially dose before his death.

Drugs prescribed by other doctors found in Chua home

As testimony continued Tuesday morning, Wal-Mart pharmacist Mark Mitchell said the pain medications Chua prescribed to Carter could have been prescribed in much higher dosages.

"There was nothing fraudulent, nothing hidden," defense attorney Donald Samuel said.

Mitchell said he expressed concern about the number of pain medications Chua prescribed to Carter. But he didn't know if Carter had given any unused medications to the doctor.

Evidence shows Chua was not the only physician to prescribe pain killers to Carter.

Investigators found empty pill bottles that contained pain killers prescribed by six different doctors in Chua's home.

The jury was excused for lunch about 11:50 a.m. Testimony will resume at 1 p.m.

Prescription drugs not prescribed by Chua found by investigators

During cross examination, defense attorney Donald Samuel asked Wal-Mart pharmacist Mark Mitchell if it was unrealistic to find unused medication prescribed to Carter.

"You are speculating perhaps he didn't take it all," Samuel said of the medications found in Chua's home after Carter's death.

All the chart showing prescriptions written to Carter from Chua from Sept. 22, 2005 until his death about three months later illustrates is drugs prescribed to the victim, not actually taken, Samuel said.

No empty hydrocodone pill bottles were found in the house, but two hydrocodone pills that didn't come from prescriptions filled at the Wal-Mart pharmacy were found in a bottle that was supposed to contain methadone, Mitchell testified.

Other pain medications not prescribed to Carter by Chua were also found in incorrect containers in the house by investigators. Mitchell said the medications didn't come from his store and he didn't know who prescribed the drugs.

Testimony was expected to continue about 11:30 a.m., after a short break.

Pharmacist testifies about Chua prescriptions

Testimony in the trial of Noel Chua, a St. Marys physician facing murder and drug charges, resumed Tuesday morning at the Glynn County Courthouse in Brunswick.

The day's first witness was Wal-Mart pharmacist Mark Mitchell, who continued his testimony from Monday afternoon.

Mitchell, on Monday, testified about filling multiple prescriptions for Jamie Carter III. Prosecutors claim Carter, 20, overdosed and died from drugs prescribed by Chua in December 2005 and the drugs were prescribed for no apparent medical reason.

Mitchell told jurors on Monday he wrote a note in his records expressing concern about the number of prescriptions written to Carter over a span of less than three months.

Mitchell was shown a photograph of pill bottles found in Chua's home the day of Carter's death and told jurors he prescribed some of the drugs found in the containers.

Prosecutor Stephen Kelley made a "demonstrative" presentation to jurors during Mitchell's testimony, where the pharmacist was shown a group of photographs on a chart of medicines admitted into evidence. All the medications shown were prescribed to Carter, Mitchell told Kelley.

Medications in the photographs included antibiotics, anti-inflammatory drugs, anti-constipation medication, muscle relaxers and numerous pain medications. Mitchell testified during the 25-minute presentation.

Kelley then showed Mitchell a large calendar showing the dates prescriptions were given by Chua to Carter.

Mitchell used a red magic marker to indicate the dates each drug was prescribed to Carter. Mitchell explained the minimum time it would take for Carter to finish the medication, if taken as directed

The chart showed many of the medications for pain relief were prescribed simultaneously, Mitchell testified.

Jurors hear about flow of pills at doctor's home

Police found dozens of prescription pill bottles in Jamie Carter's room after he died of a drug overdose in the home of his doctor and housemate, witnesses testified Monday.
Read more of today's story about the first day of the trial at http://www.jacksonville.com/tu-online/stories/101607/geo_208808236.shtml

Medical testimony

Susan Utley, a medical examiner for the Georgia Bureau of Investigation, testified late Monday afternoon about her role performing the autopsy on Carter after his body was sent to the GBI crime lab two days after his death.
Utley testified Carter suffered from swelling of brain and fluid in the lungs at the time of his death.
A toxicology exam and other tests showed the cause of death "mulit-drug intoxication," she testified.
Methadone, oxycodone and morphine were found in Carter's system by medical examiners, but there were no traces of the pills found in his stomach during the autopsy, she said.
She testified she didn't know where Carter got the oxycodone and morphine that was found in his blood after his death. She was also unable to determine when Carter took the two drugs in combination with the methadone found in his system.
After Utley's testimony ended at 6 p.m., Judge Amanda Williams adjourned the court for the day. Testimony is scheduled to being 9 a.m. Tuesday.

Medical receiver and pharmacist testimony

The medical receiver managing Chua's assets after his arrest, said patient records show there were an estimated 2,000 patients treated by the doctor at the time of his arrest.
Defense attorny Donald Samuel said there is often conflicting information on the appointment sheet compared to those who actually show up for their doctor's appointments.
But the medical receiver said records did not indicate that Carter was one of Chua's employees.
Mark Mitchell, a pharmacist at the Wal-Mart store in St. Marys, explained how his store keeps records of drugs prescribed to customers by physicians.
Much of his testimony was spent explaning how his store keeps records of prescriptions filled and how pharmacists interpret prescriptions brought to his store.
Hydrocodone, one of the drugs taken by Carter, was described as an opiate related to morphine or codine. The drug is prescribed primarily for pain relief, Mitchell testified.
He also described other drugs prescribed to Carter for pain relief and to alleviate side effects for other medications he was taking.
In one instance, Chua visited the pharmacy to fill out a prescription for Carter, Mitchell testified.
On one prescription for two pain medications, Mitchell said he wrote a note expressing concern about the number of pain medications prescribed by Chua to Carter.
"Told patient too many pain medications," the note said.
"As a pharmacist, this threw up a red flag," he said of the doctor prescribing so many pain medications over a short time period.

Detective and coroner testimony

Detective Johnny Guy told defense attorney Donald Samuel there were no oxycodone bottles in Chua's house during his investigation. He was unable to say where a single pill of oxycodone came from that was found in the house.
The next witness, L.W. Bruce, the Camden County coroner, took the witness stand about 3:30 p.m. to testify about his investigation into Carter's death.
Bruce described his visit to Chua's home after authorities were called. Bruce said Chua was standing outside when he arrived and the two men later had a conversation about what happened at the house.
"He told me he [Carter] had come to work that morning in his office," Bruce said. "He was in a drowsy state."
Chua said he initially thought Carter was asleep and didn't check on him until more than 20 minutes after he got home. Bruce said he was "numerous medications" in the home when he arrived.
Bruce said Chua told him Carter was on "methadone maintenance" at the time of his death.
During his examination of Carter's body, Bruce said he found a needle puncture in the victim's right arm.
Bruce said he asked Chua to contact Carter's family after the death because it is easier for family members to get the news from a family friend or physician. But Chua refused, saying he was "not comfortable" contacting the family, Bruce testified.
During cross examination, Bruce testified Chua told him Carter was taking numerous medications for pain but was now using methadone maintenance for pain.
The night of Carter's death, Chua told Bruce his patient was on numerous medications and Carter had taken cocaine in the past.

Chua originally said medications were stolen from office

Johnny Guy, a detective with the St. Marys Police Department, continued his testimony when jurors returned to the courtroom about 2:30 p.m. after a brief break.
During cross examination, Guy said he gave a copy of the 911 call Chua made when he reported Carter's death. Chua remained outside after Guy arrived and began his investigation.
Medications were found in different parts of the house, including desk drawers, plastic bags and a closed zippered pocket of a suitcase.
Chua told investigators Carter probably stole some of the medications from his office, Guy testified.
Defense attorney Donald Samuel asked Guy why information explaining the contents of a syringe found in Carter's room was not included in his final version of an incident report, even though the contents of the syringe were mentioned in two earlier incident reports.
Defense attorney Donal Samuel showed medical records indicating Carter's medical history, including the medications prescribed by other physicians. Many of the drugs were the same ones Chua is accused of prescribing for no apparent medical purpose.
When Samuel asked Guy to give details about seized medical issues, Judge Amanda Williams sustained an objection about their contents. Williams said Guy had no first-hand knowledge about how the records were gathered and didn't have to testify.
"It's almost repititous," Williams said. "It's already in evidence. He doesn't know when the doctor received the evidence."
Williams said she would not permit heresay evidence contained in the medical records.
She said Guy was not the appropriate witness to discuss the evidence from medical records.

Carter brought 11 prescriptions to one pharmacy

Johnny Guy, a detective with the St. Marys Police Department, explained the purpose of seizing medical records from Chua's office about one month after Carter's overdose death in December 2005.

Carter's medical records were found stored in the doctor's home, Guy said.

Records show Carter brought prescriptions written to him by Chua to two different pharmacies, Guy testified. Carter brought 11 different prescriptions written to him by Chua to one pharmacy, Guy said.

Jackie Johnson, one of the prosecutors in the case, showed a printout of phone records from the day of Carter's death showing the doctor called the victim's cell phone twice the day of his death.

Phone records also show Chua used his personal cell phone to call Carter the day after his first medical examination on Sept. 23, 2005, Guy told jurors.

The calls from Chua "increased in frequency" in subsequent weeks, he said.

Chua also sent multiple text messages until the time of Carter's death, Guy testified.

Guy is expected to continue testimony during cross examination after the jury returns from a break about 2:20 p.m.

Prescription drugs found in locked desk in Chua's office

Kelly Romatz, a Georgia Bureau of Investigation medical examiner office employee, explained how a toxicology examination was performed after Carter's death.
She explained the procedure to ensure the four vials of Carter's blood were protected to ensure nobody but qualified testers could examine the samples.
The next witness, Sgt. Vicky Lauf, a detective with the St. Marys Police Department, described a visit she made to Chua's office after Carter's death. Lauf testified she found nine prescription containers in a locked desk in Chua's office. The drugs were prescribed some of Chua's patients, by both Chua and other doctors, Lauf said.
There were also "numerous medications," such as samples and other unspecified drugs found in the office by investigators, she said.

Chua testimony begins

The first witness to testify in the case, Sgt. Shannon Brock, a St. Marys Police officer, said he was among the first investigators to arrive to Chua's home after receiving a report of a dead body.

Jurors craned their necks for a better view when Brock showed them a photograph of Carter's body taken after police arrived to Chua's home..

Other photos from the scene shown included open bottles of pills, a syringe, three vials of what Brock said investigators believe was human blood and a plastic bag containing drugs.

Also, other drugs, including professional samples for doctors, were found in the house by investigators, Brock said.

After the initial investigation, Chua wrote a voluntary witness statement explaining what had happened the day of the overdose death.

Chua told investigators Carter was taking methadone for medication "and nothing else," Brock testified.

During cross examination, Brock told Donald Samuel, Chua's attorney, prescription medications, doctor's samples and empty pill bottles were found in the house.

Samuel named prescriptions for Carter from other doctors that were also found at the scene. Brock testified he was not sure how drugs prescribed to Carter by different doctors got into the house.

The jury was excused for lunch at noon. The trial will resume at 1 p.m.

Chua trial begins

Prior to the start of opening arguments for the trial of Noel Chua, Superior Court Judge Amanda Williams cautioned the audience not to make any "moan or groans" or any other reaction during testimony. Any inappropriate response will result in automatic ejection from the courtroom for the duration of the trial against Chua, who faces murder and drug charges.

After jurors entered the courtroom, she explained the process for considering evidence and deliberating for a verdict. She cautioned jurors not to discuss the case among themselves until instructed to begin deliberations.

"This case has some unusual parts to it," Williams said.

Chua, a St. Marys physician, is charged with the drug overdose death of Jamie Carter III, 20, who died in the doctor's home Dec. 15, 2005. Chua was charged with murder and 17 drug charges for prescribing drugs to Carter for no apparent medical reason.

Jackie Johnson, assistant district attorney for the Brunswick Judicial Circuit, began opening arguments by explaining details of Carter's death.

The evidence will show all the drugs found in Carter's system were from drugs prescribed from Chua.

She explained how Carter's relationship with Chua changed from a doctor/patient relationship in September 2005 to a friendship where the two men lived together less than two months later.

"From that point forward, it ceased to be a doctor/patient relationship to something more," Johnson said. "Experts will tell you this is way out of bounds for a proper doctor/patient relationship."

Johnson acknowledged Carter had a history of headaches after being struck in the head by a baseball and other doctors had prescribed drugs to treat the problem. Chua, however, prescribed excessive numbers of drugs, compared to other doctors, she said.

Five days before his death, Johnson said Chua prescribed two prescriptions for methadone.

The combined effect of the drugs led to Carter's death, she told jurors.

When police arrived to Chua's house, he told investigators Carter was taking methadone "and nothing else."

Defense attorney Donald Samuel, however, disputed Johnson's claims.

"Each and every prescription is for a legitimate medical purpose," he said. "This is not a murder case."

Carter had been suffering from headaches for 15 years that made it impossible for him to go to school or other activities.

Chua reviewed Carter's medical history prior to prescribing drugs to his patient.

"One doctor after another was unable to diagnose the problem," Samuel said.

In 2003, Carter was suffering from headaches so severe his parents had to "literally carry him into the doctor's office."

Other physicians in the Waycross area prescribed pain killers to treat the problem multiple times to treat headaches. He was also hospitalized in Brunswick and Jacksonville to treat his headaches.

"That was two years before he went to see Dr. Chua," he said. "Not one of those doctors has been indicted for writing prescriptions to Jamie Carter."

Doctors in Brunswick noted Carter would probably need "massive doses of medication" to give him relief from headaches. But there was never any mention of the drugs other doctors had prescribed.

When Carter visited Chua for the first time in September 2005, he prescribed hydrocodone, "the exact same drug he has taken over and over again for years."

Chua tried prescribing other drugs because he hasn't gotten relief from other medications, none of which worked.

"Dr. Chua was trying to figure out what it is that it's going to take [for relief from headaches]," Samuel said. "Then he puts in him the hospital and gets indicted for the drugs he gave him in the hospital."

He claimed Chua tried to find "whatever would work."

Chua later prescribed methadone for pain relief, "not to feed an addict.".

"Most experts will tell you it's very effective for pain relief," he said. "It gives you no exhilaration, no high."

Carter had the exact amount of methadone in his system at the time of this death and wasn't supposed to be taking other medications.

"He also had morphine and oxycodone in his blood," he said.

Because the two men lived together, Chua was constantly monitoring Carter's health and the level of medications prescribed.

The intent the entire time he was Chua's patient was to find relief for Carter's headaches, Samuel said.

"When you hear all the evidence in the case, I'm confident you will find a verdict of not guilty," he said.

Jury selected; trial to begin at 9 a.m.

A seven-man, five-woman jury was selected Sunday afternoon for the murder trial of St. Marys physician Noel Chua.
The trial will begin at 9 a.m. today at the Glynn County courthouse.
Jurors were sequestered minutes after they were picked Sunday will remain sequestered in Brunswick for duration of the trial the trial. Lawyers in the case said they will present all their evidence in five days.
As soon as the jury was picked, defense lawyer Donald Samuel objected saying prosecutors had struck most of the African-Americans in the pool and that the jury was not representative. Samuel said it appeared the strikes were based on race.
Assistant District Attorney Jackie Johnson went down the list of all the jurors she and District Attorney Stephen Kelley had struck, black and white. Those struck had indicated they were close friends of Sheriff Bill Smith, had friends for relatives working at the Camden County Sheriff's Office or had had some family member prosecuted by the District Attorney's Office, Johnson said.
A potential jury's grandmother had been Smith's nanny, Johnson said.
"I think maybe the state didn't have enough strikes," Superior Court Judge Amanda Williams said in answering Samuel's objection.
Williams found the prosecutor's strikes were "race neutral,'' and said, "I am absolutely satisfied with the strikes,'' she said.
Chua himself is a close friend of Smith. The sheriff has said he believes Chua is innocent and has given Chua special treatment in the Camden County jail where he has been held since his September, 2006, arrest.
Smith traveled to China with Chua in spring, 2006, to look for alternative treatments for Smith's son, Blake, who is paralyzed from an auto accident.
The trial will include a number of experts on physician's practices and medical ethics.
Williams has ordered that Camden County deputies transport Chua to the Glynn County Detention Center daily in an inmate uniform. Only after he is in custody of Glynn deputies will he be allowed to change into the personal clothing for the trial. And he must change back to an inmate uniform before being returned to the custody of Camden officers, Williams ordered.
During the trial, Williams ordered that Chua be served the same meals as other Glynn County inmates "and no other."
-- Terry Dickson and Paul Pinkham

A primer on the case

Last month we wrote a full primer on the case. Take a look at it at http://www.jacksonville.com/tu-online/stories/091607/met_199959904.shtml.

The case's timeline

Information in this case stretches back to Sept. 22, 2005 when Dr. Chua first met Jamie Carter. Take a look at the information below to get a step-by-step look at the case.

Also, did we miss any major events? Were you at any of the events? Let us know.

THE STATE OF GEORGIA VERSUS NOEL CHUA

Sept. 22, 2005: College student Jamie Carter, 19, strikes up friendship and patient relationship with St. Marys physician Noel Chua. Later, Carter starts working in Chua's office.

Oct. 31: Carter moves into Chua's Osprey Cove home.

November: Carter and Chua travel to New York together.

Dec. 15: Carter found dead of a prescription drug overdose inside Chua's home after the doctor calls 911. St. Marys police find numerous medications in the home and a hypodermic syringe on Carter's bed. Autopsy shows Carter had methadone and numerous painkillers, all prescribed by Chua, in his system.

Spring 2006: Chua travels to China with Camden County Sheriff Bill Smith to look into alternative spinal cord treatments for Smith's son, paralyzed in a car accident.

Sept. 13: Chua arrested after Camden County grand jury indicts him on charges of felony murder and 17 counts of violating the Georgia Controlled Substances Act. Judge moves Chua to the Glynn County jail because of the doctor's friendship with Sheriff Smith. Chua's assets are seized as part of a civil racketeering action.

October: Yard signs and a newspaper advertisement supporting Chua appear in Camden County. Online and prayer meeting support begins. Chua is denied bail but returned to Camden County jail. Smith says he doesn't think Chua is guilty.

Nov. 7: Georgia's Composite State Board of Medical Examiners suspends Chua's license.

January 2007: Carter's family settles malpractice lawsuit with Chua. Terms are confidential.

July 17: Smith attends rally of Chua supporters and says he supports their petition drive to get the doctor released on bail but can't lead it. A resolution asking for bail and bearing Smith's name is presented to county commissioners, who decline to get involved. Prosecutors cite Smith's support and special treatment of Chua as reason the doctor should be moved to another jail.

August: Prosecutors reach a compromise with Chua's lawyers resulting in Chua's trial being moved to Brunswick but allowing him to remain in the Camden County jail.

Oct. 9: Jury selection scheduled for Chua's murder trial.

Sources: Camden County court records, St. Marys police, Georgia's Composite State Board of Medical Examiners and Times-Union archives