- Associated Press - Saturday, March 3, 2012

LOS ANGELES (AP) - The prosecutor who took the rare step of charging a doctor with murder in the prescription drug overdose deaths of three patients said Friday that the case should serve as a warning to unethical physicians who become pill pushers.

Los Angeles County District Attorney Steve Cooley said his office will continue to prosecute greedy and unethical doctors after charging Dr. Hsiu-Ying “Lisa” Tseng, 42, with second-degree murder and 21 other felony counts. If convicted of all the charges, she faces a maximum sentence of 45 years to life in prison.

“This case was beyond anything else we have ever seen,” said Cooley, who stressed that these types of cases must be carefully researched before the extreme charge of murder is filed.

Tseng made her first court appearance Friday, wearing a pink sweatshirt and looking glum. Her arraignment was postponed until March 9, when her bail, currently $3 million, also will be reviewed.

Her lawyers declined to comment after the hearing.

Tseng is one of just a few doctors nationwide to be charged with murder related to prescription drugs. Authorities have been cracking down on drug deaths, which fueled by prescription drug overdoses now surpass traffic fatalities. But the murder charges could be hard to prove because the victims played a role by seeking out and taking the drugs.

Tseng, a licensed osteopath, and her husband, also a physician, set up a storefront office in the Los Angeles suburb of Rowland Heights in 2005. Three years later, she was under investigation by the Drug Enforcement Administration and the California Medical Board for prescription irregularities reported by a pharmacy. Patient deaths were linked to her in 2009, according to authorities, but not all led to murder charges.

Tseng wrote more than 27,000 prescriptions over a three-year period starting in January 2007 _ an average of 25 a day, according to a DEA affidavit. DEA agents swept into her office in 2010 and suspended her license to write prescriptions.

She was arrested this week after voluntarily surrendering her license to the Osteopathic Medical Board of California. Her husband continues to run their clinic.

The case highlights a murky region of medicine as patients hooked on prescription drugs seek out a source for their addiction. Prosecutors have charged many doctors with dispensing prescription drugs illegally, arguing they wrote prescriptions outside the normal course of practice and for no legitimate medical purpose.

There are about 880,000 doctors nationwide who are registered to write prescriptions, and federal agents investigate somewhere between 200 and 300 suspected dirty physicians every year, said DEA spokesman Rusty Payne.

But filing a murder charge against a doctor in a case where a patient dies from an overdose is extremely rare.

In 2008, Harriston Bass was convicted of second-degree murder in Nevada for the death of Gina Micali, 38, who died after taking the pain reliever hydrocodone. Bass was sentenced to 25 years to life.

A Georgia doctor was sentenced to life in prison in October 2007 for the drug overdose death of his patient and housemate. Noel Chua was found guilty of felony murder and violating the state’s controlled substances act in the death of Jamie Carter III, who died of multi-drug intoxication. Among the prescriptions Carter received from Chua were oxycodone and methadone.

In Florida, Dr. Sergio Rodriguez faces three counts of first-degree murder in the overdose deaths of three patients. His case is still pending.

The second-degree murder charges that Tseng is facing rely on the theory of “implied malice.” Authorities said Tseng knew that her prescriptions could have a deadly result because others in her care had died before the three alleged murder victims named in the criminal complaint.

The three victims were otherwise healthy men in their 20s who came to her with complaints of pain and anxiety. Records of the Osteopathic Medical Board showed that she gave them cursory exams that didn’t meet the level of adequate medical care before issuing prescriptions for opiates and benzodiazepines.

Among the victims was Joey Rovero, a 21-year-old Arizona State University student who drove with two friends to Southern California to get prescriptions from Tseng in December 2009.

Rovero’s mother, April, said her son had prescriptions filled for 90 tablets of oxycodone, 90 tablets of the muscle relaxant Soma and 30 tablets of the anti-anxiety medication Xanax. An autopsy found the younger Rovero died from a mixture of alcohol and moderate to trace levels of the three drugs Tseng gave him.

Rovero, who founded the National Coalition Against Prescription Drug Abuse, said murder charges against Tseng are appropriate in her son’s case because Tseng was told by the coroner that some of her patients were dying from overdosing on pills she prescribed.

“From all indications, she (Tseng) was warned,” prior to the death, Rovero said. “It was like she wasn’t listening. There were all these red flags and she did nothing.”

Records showed that Rovero complained of wrist pain, but the doctor did not establish which wrist was hurting, nor did she explore the source of his complaint of anxiety.

Tseng was also charged Thursday in the 2009 deaths of Vu Nguyen, 29, of Lake Forest, and Steven Ogle, 25, of Palm Desert.

Tseng’s attorneys have declined opportunities to comment, but she has previously said she is not guilty of any wrongdoing.

“I was really strict with my patients, and I followed the guidelines,” she said in a 2010 interview with the Los Angeles Times. “If my patient decides to take a month’s supply in a day, then there’s nothing I can do about that.”

Roger Rosen, a defense attorney who represented a doctor convicted with running a pill mill and sentenced to four years in prison, said doctors sometimes begin prescribing for legitimate pain management and become victimized themselves by those seeking medication for other reasons. He said many patients lie to their doctors to get medication.

“I don’t know what doctor in their right mind would want to go into pain management these days. It’s as if you have a bull’s-eye painted on you,” Rosen said. “Delivering babies is a lot easier.”

Ron Clyburn knows what Rovero’s mother is experiencing. In April 2008, his 23-year-old son Alex died after overdosing on pills prescribed by Masoud Bamdad, a Southern California doctor who was convicted of selling prescriptions and sentenced to 25 years in prison. However, jurors couldn’t reach a verdict on four counts, including one that accused Bamdad of causing Alex Clyburn’s death.

“If it’s a case where the doctor is clearly abusing that privilege and people are dying, then they should be prosecuted,” Clyburn said. “Looking at it from a legal standpoint, to prove murder there has to be a lot of data to back that up. It would be a shame if prosecutors filed these charges just for effect, because this is such a hot issue.”

In January, federal prosecutors in Los Angeles charged a Santa Barbara doctor with illegally prescribing large amounts of painkillers to patients who didn’t need the drugs, and for accepting sexual favors as payment from some women. Despite having a dozen of his patients die of overdoses since 2006, Diaz was not charged in their deaths.

A spokesman for the U.S. attorney’s office said at the time that the direct connection between a doctor’s prescription and a patient’s death is difficult to prove.

Prescription drug abuse is so great in the U.S., some agents who once chased Mexican and Colombian drug traffickers are now investigating doctors who push pills illegally, said Payne, the DEA spokesman. But doctors are only one part of the problem.

“We go after the biggest and most egregious cases,” Payne said. “We have to hit the problem at every level.”

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