EXPERT: SUICIDE, NATURAL CAUSES POSSIBILITIES IN LUYAO DEATHS FORT PIERCE -- Prosecutors say a suspended Port St. Lucie doctor's excessive prescriptions led to the accidental overdose deaths of six of her patients, but an expert medical examiner who testified in her defense said Friday he could not rule out natural causes in two of the deaths or the possibility of suicide in some of the others. Dr. Ronald Wright did not perform any of the autopsies in the patient deaths for which Asuncion Luyao is charged with manslaughter, but he reviewed the autopsy reports and other files at the request of Luyao's attorney. The former chief medical examiner for Broward County was one of two expert witnesses expected to testify on Luyao's behalf after prosecutors rested their case Friday morning. Prosecutors are trying to convince a jury that Luyao aimed to keep patients addicted to powerful painkillers in order to continue to collect an $80 office fee required for monthly refills. Those prescription practices, they say, caused the six deaths. But her attorney, Joel Hirschhorn, said Friday he doesn't believe the state proved its case, and he attempted to plant reasonable doubt in the jury's mind about linking the deaths to Luyao. He says she was a caring physician who did not act with a reckless disregard for her patients' safety. Wright testified that he believes patient Robert Gustaf, 40, of Jensen Beach died from pneumonia and that Julia Hartsfield, 52, of Fort Pierce, died from heart disease. The Treasure Coast Medical Examiner's Office determined Hartsfield's official cause of death was a drug overdose and Gustaf died from an combination of an overdose and pneumonia. "Just because Mr. Gustaf had pneumonia doesn't mean the methadone didn't kill him," Assistant State Attorney Erin Kirkwood said of the drug Luyao had prescribed. Wright said patient Bradley Towse, 23, of Palm Beach Gardens, probably died of an overdose. But, Wright said, because the medical examiner who conducted his autopsy only tested blood taken from him at a hospital before his death, it's impossible to know exactly what drug he really overdosed on. Towse had taken methadone, which Luyao had prescribed for him the day before he died, but Hirschhorn has argued that he was released from the hospital, and no one knows if he took other drugs before he died. Wright also said Towse would have had a much better chance of survival if he had not been released from the hospital. Towse's mother testified earlier in the trial that her son did not take any other drugs in the hours after he was released from the hospital and before his death. Wright said in at least two cases, Tina Smith, 27, of Sebastian and Janice Byers, 41, of Vero Beach he could not rule out the possibility of suicide. The doctors who performed their autopsies had testified earlier they did not see any tell-tale signs of a suicide. Hirschhorn argued that patient Rona Kay, 35, of Broward County, had a history of taking gamma hydroxybutrate, or GHB, and it's impossible to know if she had taken it the day she died because it clears out of the body so quickly. "While drugs may have been a factor, I suggest it wasn't drugs Luyao prescribed, and even if it was, they were prescribed in good faith," Hirschhorn said. Kirkwood said Friday she's confident "the links have all been established" between Luyao's prescriptions and the six deaths. The defense will continue to present its case on Monday, and the jury is expected to begin deliberations on Tuesday.
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