Thougths on this new legal case?

[ventana]

Murder trial sends message to doctors: 'Don't get reckless,' medical expert says
la-me-prescription-docto

Hsiu-Ying "Lisa" Tseng, a Rowland Heights doctor, is on trial, charged with second-degree murder and other counts in the prescription drug overdose deaths of three male patients. She is pictured here at her 2012 preliminary hearing. (Luis Sinco / Los Angeles Times)




By Marisa Gerber contact the reporter

Drugs and Medicines Crime Homicide Conrad Murray Arizona State University Michael Jackson

The prosecutor projected a picture of a young man on a screen next to a copy of a Xanax prescription signed by Dr. Hsiu-Ying “Lisa” Tseng.

“He overdosed and died,” Deputy Dist. Atty. John Niedermann said loudly to the jurors.

Then he put up a picture of another man and prescription, and another and another. They all overdosed, he said.

During opening statements in her case Monday, Tseng hunched forward in her chair, settling in for a landmark second-degree murder trial that’s expected to last for months. The general practitioner, who scribbled notes on a yellow notepad and tapped her foot over and over, is the first California doctor ever charged with murdering patients who overdosed merely for prescribing them medication, Niedermann said.
Legal drugs, deadly outcomes
Legal drugs, deadly outcomes

“[it’s] a big deal,” said Steve Smith, who teaches health law at California Western School of Law. The case, he said, sends a warning to California doctors: “Don’t get reckless.”

It’s an understandable message, Smith said, considering the country’s prescription drug overdose epidemic. But he and other medical and legal experts are worried that if Tseng is convicted, it will have “a chilling effect,” making good doctors reluctant to prescribe painkillers to patients, who will suffer unnecessarily.

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Doctors have long faced the threats of malpractice lawsuits and losing their medical licenses, but it’s relatively rare to hold physicians criminally accountable for patients’ deaths. A handful of doctors across the country have faced murder charges for prescribing painkillers that killed patients, including a Florida doctor currently on trial for first-degree murder. In 2011, a Los Angeles County jury convicted Dr. Conrad Murray of involuntary manslaughter — a lesser charge than Tseng’s — for giving pop legend Michael Jackson a dose of propofol, a surgical anesthetic, which killed him.

But the Tseng case seemed to bring L.A. County prosecutors to a tipping point.

Computer evidence seized from Tseng’s office, Niedermann said, shows that coroner’s or law enforcement officials had called Tseng more than a dozen times and informed her that patients of hers had died of an overdose or potential overdose. Despite those calls — and various other “red flags,” which Niedermann said included a patient overdosing in the hallway of her clinic — Tseng didn’t change her prescribing practice.
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Tseng’s receptionist will testify, Niedermann said, that she once overheard someone talking on the phone with Tseng on a day the doctor was late to work. The person told Tseng that the waiting room at her Rowland Heights office had filled up and patients were getting anxious. Niedermann said the receptionist will testify that she overhead Tseng respond: “They’re druggies, they can wait.” Addicts and former patients will also testify, Niedermann said, including a man who will say that Tseng merely glanced at his chart and asked him what he wanted.

Tseng is charged with second-degree murder for the deaths of Vu Nguyen, 28, of Lake Forest; Steven Ogle, 25, of Palm Desert; and Joey Rovero, 21, an Arizona State University student, who prosecutors say traveled more than 300 miles with friends from Tempe, Ariz., to get prescriptions from Tseng. She is also charged with several felony counts of prescribing drugs to people with no legitimate need for the medications and a count of fraudulent prescribing.
cComments

Doctors who prescribe strong opiates without reason and to supply addictions are not really doctors. They are dealers. The saddest part is that people under her "care" died. Another sad part is that legitimate needs for pain medications may be compromised. There is such a thing as...
Barbaraeg
at 8:17 AM September 05, 2015

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A 2010 Times investigation found that at least eight of her patients died of overdoses from the same type of drug she prescribed to them.

Tseng’s attorney, Tracy Green, asked jurors to think about Tseng’s patients’ decisions to take more than the prescribed dosage of pills and to mix the pills with alcohol — things out of her client’s control, Green said. The calls from officials about patients’ deaths were only five-minute conversations, Green said, saying that authorities didn’t counsel her in a way to change her practice. Tseng, 45, should never have been charged with murder, Green said, adding that her client didn’t act with malice.

“She was not street-smart,” Green said, earning a small nod from Tseng. “She just got in over her head.”

In the audience, April Rovero intertwined her fingers and closed her eyes for a moment. She said she was thinking of her son, Joey. The young man with a sweet disposition — the “friend magnet” who listened so well everyone thought he could fix their problems. Her brown-eyed boy who wore his hair in short spikes, played soccer and loved fantasy football. He died, she said, after mixing alcohol with Xanax and Oxycodone. Rovero said she remembers the detective’s voice on the phone describing Joey’s room littered with near-empty vials of his medicine. The name of the doctor on the bottles, she said, was Tseng.

“A doctor that just throws pills out there?” Rovero said. “It’s horrifying.”

Rovero, who launched the National Coalition Against Prescription Drug Abuse after her son’s death, said she hopes Tseng is convicted, sending a message to every doctor’s office across the country: “Don’t think you’re going to get away with it.”

Smith, the health law professor, said Tseng’s prosecution comes after a surge in the availability of pharmaceutical drugs over the last 25 years and a prescription drug abuse epidemic, especially among young people.

“It went from raiding the liquor cabinet when your parents were out of town,” Smith said, “to the medicine cabinet.”

[cop to pa]

Sounds like the murder conviction will stem from establishing a track record of prescribing in a manner closer to an illegal drug dealer than a practicing physician. If that's the case, there should be no concern for providers who prescribe in good conscious. If the way the article depicts her really is how she practices, she needs her license revoked and some jail time IMO. The over prescribing of opioids by some is ridiculous. The addicted user (as a whole) will not stop, so the legal supply needs to be shored up some. 

[Joelseff]

Sounds like the murder conviction will stem from establishing a track record of prescribing in a manner closer to an illegal drug dealer than a practicing physician. If that's the case, there should be no concern for providers who prescribe in good conscious. If the way the article depicts her really is how she practices, she needs her license revoked and some jail time IMO. The over prescribing of opioids by some is ridiculous. The addicted user (as a whole) will not stop, so the legal supply needs to be shored up some.

Exactly! The warning from the Health Law professor should have been "don't run a pill mill" instead of "don't get reckless."

 

Sent from my S5 Active...Like you care...

 

 

[EMSGuy1982]

Kinda makes me sick. I am just about to start my clinical rotations and I am apprehensive to prescribe pain medication for anything. This case sounds like she definitely knew what she was doing unfortunately. I previously worked in EMS for 13 years and have seen first hand that abuse like this is nothing new. Why not also go after the pharmacists that handed over the medication as well? Or against the families that witness the abuse but enable them?

 

This little fact seems to point to the real problem ..

 

"The United States makes up only 4.6 percent of the world's population, but consumes 80 percent of its opioids -- and 99 percent of the world's hydrocodone, the opiate that is in Vicodin."

 

Just yesterday a case similar to this was in the news.

 

http://www.king5.com/story/news/local/2015/09/11/doctors-license-suspended-after-several-patient-deaths/72048718/

 

Wouldn't a referral to a pain management clinic be the most appropriate?

[GetMeOuttaThisMess]

This was on national news several weeks back (ABC, and yes, I'm one of the few who actually comes home and still watches the national news broadcasts).  You're damned if you do, and damned if you don't.  Just got a Medscape email about how horrible group A strep is and then in the other corner you've got folks saying "meh" since we don't see rheumatic fever hardly ever anymore. We walk a fine line.

[Guest Paula]

I'm at the point of believing the opioids should be prescribed only for cancer pain  (or for severe pain, i.e., fractures) and strict guidelines set up for who prescribes them and under what setting.   The pain killer market is also a US pharmaceutical problem and they make loads of money.

 

Prescribers get stuck in their own inability to say no or get lazy and give up on patients and just hand over the scripts.

 

All I can say is after 11 years of practice I am continually decreasing the opioids and benzos I write and spend lots of time with patients who have been prescribed them for nebulous reasons.  Just yesterday I had a guy in for back pain who had been getting opioids and benzos and suboxone from 18 different prescribers in 11 different cities over the course of 11 months, with well over 2 dozen prescriptions in that time period.  (all for a mildly bulging disk).

 

The train stopped with me and he is now referred to a suboxone clinic / treatment facility. 

[rev ronin]

Even if you run a conscientious practice, you still run across the occasional abuser.  Discharged a patient last night (he doesn't know it yet) because I saw him on short notice for another provider, and he seemed like a well-adjusted patient, so I didn't run a PMP query until after the visit.  Shame on me for getting too busy to check every patient every time!  Our stated practice is actually "at least one query within the past year without any issues", but I go above and beyond.

[Boatswain2PA]

This doesn't worry me too much.

 

First, it's in California.  Who the hell wants to practice in the lawyer-paradises of California, New York or Florida?  I never will.

 

Second, from the sounds of this news article (which I never, ever, ever, ever, ever believe a news article) it sounds like she was wayyyyyyy out there on her prescribing habits.  This isn't a provider who got "burned" by a dishonest patient (like Paula or Rev's example), sounds like this is a provider who went down the slippery slope.

 

EMSguy:  Take care of your patients.  Always keep it in the back of your head, like a differential diagnosis, that your patient MAY be drug-seeking, but practicing medicine means operating in the grey zone.  New patient to you (like in the ED), give him a few and see him back.  If he comes back, check him out again, and give him a few more.  Once you establish a long term relationship then you will better know what to do.  If you work in the ED, then never give out more than a few days worth.

 

[ventana]

I think it is great

 

She is committing malpractice and actually injuring her patients

 

I would disagree with the thought of only giving opiates for cancer pain

 

I think the crux of this issue is you have to be able to "see" the source of the pain - the generic "my back hurts" is just a load of garbage for CHRONIC opiates

 

Just last week I had it out with a nurse who thought that a fractured hand only needed motrin!  It was a nasty break....

 

 

 

I do think that the CHRONIC opiates need to be for ONLY cancer pain or things which a specialist is involved, sorry but to many FP and IM folks just don't have a clue with the dangers of benzo's and opiates, and to a degree some of the psych folks also seem to be to liberal in my little area....

 

 

 

overall we all should be held liable if we knowingly are giving abuse-able meds to an addict for no good reason - challenges come up with addicts who have TRUE pain, ie a fracture, then you need to really think about it....

[EMEDPA]

agree with most of above. for me to give narcs the pt needs a visible source of pain(fx, burn, wound, etc) or a verifiable dx like metastatic ca, etc.

Dental pain, back pain? almost never give narcs unless they got punched in the mouth and I SEE multiple dental fxs, etc.

I had an elderly guy in the ER last week that I gave 60 peercocet to. back story: he came in for hip pain and I dx him with metastatic prostate CA.

his pcp can't see him for 2 weeks and it will be longer than that for him to see oncology. really nice guy and zero chance this was drug seeking.

[EMEDPA]

I think it is great

 

She is committing malpractice and actually injuring her patients

 

I would disagree with the thought of only giving opiates for cancer pain

 

I think the crux of this issue is you have to be able to "see" the source of the pain - the generic "my back hurts" is just a load of garbage for CHRONIC opiates

 

Just last week I had it out with a nurse who thought that a fractured hand only needed motrin!  It was a nasty break....

 

 

 

I do think that the CHRONIC opiates need to be for ONLY cancer pain or things which a specialist is involved, sorry but to many FP and IM folks just don't have a clue with the dangers of benzo's and opiates, and to a degree some of the psych folks also seem to be to liberal in my little area....

 

 

 

overall we all should be held liable if we knowingly are giving abuse-able meds to an addict for no good reason - challenges come up with addicts who have TRUE pain, ie a fracture, then you need to really think about it....

I don't think you need to think about it too hard. obvious new source of pain on xray or big burn, etc I tx addicts just line anyone else. they don't get ms contin though because of their tolerance, they get the same norco anyone else would. if they want to score heroin on the side to feed their addiction, fine, I won't help with that side of the equation.

[winterallsummer]

delete

[sas5814]

It is a slippery slope and the bad actors make it hard on the rest of us. This physician was clearly off the reservation and deserves whatever happens (assuming the "news" story is correct).  I hate hate hate pain management because of all the drug seekers and abusers. Ironically I have chronic back pain and have been taking Norco once or twice a day since my motorcycle accident several years ago. There is no easy answer beyond being concientious and careful. 

[TWR]

In 2012, a Family Practice Physician in Baldwin, NY, Dr. William Conway,  was charged with 2nd degree murder after 2 patients had died form overdoses of oxycodone.