Sarah Harris was a bright 25-year-old aspiring anesthesiologist who first met oral surgeon Dr. James Ryan as a patient when she had her wisdom teeth removed in 2020. Ryan hired her as a surgical assistant; by 2021 she was his live-in girlfriend. Neighbors and family later described a glamorous outward life that hid growing dependence and decline.
By late 2021 Sarah was thin, slurring her words and reportedly using powerful sedatives. Her mother, Tina, and sister, Rachel, found needles, saline bags, vials of drugs and other paraphernalia in Ryan’s home. Tina confronted Ryan, who at first said he was “hydrating” Sarah. Days later he reportedly admitted giving her drugs to keep her from getting them elsewhere. Sarah’s family pressed her to move home; she briefly did, then returned to Ryan.
On Jan. 26, 2022, Ryan called 911 and told police he’d been doing CPR on Sarah and believed she’d overdosed. Paramedics found her unresponsive; she later died. Authorities listed her manner of death as undetermined; Ryan was not arrested at the scene. He told police Sarah used propofol he had from his office and had injected herself at times.
Rachel did not accept that explanation. She cracked into her sister’s laptop and iCloud and found pages of texts between Sarah and Ryan. The messages referenced sedatives and powerful anesthetics — diazepam, ketamine, propofol — and included exchanges in which Ryan offered injections and, on one occasion, wrote that he had given Sarah ketamine while she was sleeping. Rachel photographed the drugs she found in the home and delivered hundreds of pages of notes, photos and texts to Montgomery County police.
A local detective experienced in pharmaceutical investigations, Ian Iacoviello, reviewed the materials and urged prosecutors to take the case seriously. He said the texts showed Ryan supplying or administering fast-acting surgical anesthetics over months and that the paraphernalia at the house — saline bags, labeled vials and professional-grade syringes — made the scene look like a makeshift operating environment, not a typical street drug overdose. Sarah’s autopsy later detected propofol, ketamine and diazepam in her system; experts informed prosecutors that the combination can suppress breathing.
Prosecutors charged Ryan with second-degree depraved heart murder, alleging he acted with reckless disregard for human life by providing and administering drugs he knew could be deadly. They also charged him with involuntary manslaughter and drug distribution counts. Depraved heart murder does not require proof of an intention to kill; it requires showing conduct so reckless it showed a gross indifference to life.
At trial, prosecutors portrayed Ryan as a controlling, older man who fed Sarah a dangerous drug habit and sometimes administered sedatives in the couple’s home without proper medical safeguards. They presented the text messages in which Ryan described giving Sarah a drug in “six seconds” and telling her he had injected ketamine while she slept. They called a medical examiner who explained how the drug cocktail produced profound sedation and respiratory depression, and social workers who testified about power imbalances in abusive relationships and how drugs can be used to control partners.
Ryan’s defense acknowledged his role in Sarah’s access to drugs but argued he did not intend to kill her. Defense lawyers emphasized Sarah’s history of mood disorders, prior substance use and a voicemail in which she said she had “lost my will to live.” They suggested investigators mishandled evidence, noting police had not secured the scene as a crime scene the morning Sarah was found and had not tested syringes for Ryan’s DNA. The defense also argued that Sarah sometimes used drugs before she met Ryan and that she could have self-administered.
Detective Iacoviello told jurors he believed the texts read like “watching a murder in slow motion” and that Sarah could not have prepared syringes, placed vials in her purse and then lain down without someone else administering the lethal combination. Prosecutors argued Ryan had the knowledge and training to understand the dangers of propofol and ketamine, and that providing them to Sarah without monitoring amounted to depraved heart conduct.
After a nearly two-week trial, jurors deliberated less than three hours. On Aug. 25, 2023 they found Ryan guilty of second-degree depraved heart murder, involuntary manslaughter and drug-related offenses. The verdict brought relief to Sarah’s family, who had long distrusted Ryan’s account. At sentencing the court imposed a 40-year term for the murder conviction, plus additional time on other counts, totaling 45 years — effectively a life sentence.
Ryan maintained in court that he did not administer the fatal dose and said he felt remorse for not preventing Sarah’s access to drugs. Friends and some supporters submitted letters attesting to his character, but prosecutors and the judge emphasized the gravity of giving powerful anesthetics outside a clinical setting and the risk posed to patients and partners.
The case prompted calls from some prosecutors for clearer laws to convict those who supply specialized sedatives linked to overdose deaths, arguing that depraved heart murder is a difficult charge in many overdose cases. Investigators said the case was unusual because of the medical nature of the drugs, the evidence preserved in texts and the detailed photo record Rachel compiled from Sarah’s home — the materials that persuaded Iacoviello and prosecutors to pursue murder charges.
For the Harris family — Tina and daughters Rachel and Sarah — the verdict was a rare measure of accountability. They described Sarah as energetic, academically gifted and kind, and said they hoped her story would raise awareness about the misuse of medically regulated sedatives and power imbalances that can hide abuse. Detectives who worked the case said they remained troubled by it, and advocates pointed to the need for both legal tools and medical safeguards to prevent similar tragedies.