People v. Tseng

Facts

D was a licensed physician practicing internal medicine and osteopathy. D joined Advance Care AAA Medical Clinic (the clinic) in Rowland Heights, a general medical practice operated by her husband. The patients were from the local Hispanic and Asian communities, the wait time for each patient was 15 to 30 minutes, and 90 percent of the patients paid for treatment through their insurance. The next year, the practice and the clientele of the clinic had changed. Most of D's patients were now White males in their 20's and 30's who came from outside Los Angeles County seeking pain and anxiety management medications. By 2010, the clinic had developed a reputation as a place where patients could easily obtain prescriptions for controlled substances, including opioids, sedatives, muscle relaxants, and drugs used to treat drug addiction. fees had doubled, and nearly all patients paid in cash. The clinic's income increased from $600 a day in cash to $2,000 to $3,000 per day. According to one visitor, the clinic looked “like a parole office” with “drug dealing.” The wait time for D's patients also increased to about six hours with 20 to 30 patients inside the waiting room or outside the clinic at any one time. Some patients appeared to be under the influence of drugs or suffering from drug withdrawals, and one patient overdosed in the waiting room. D spent about 10 to 15 minutes with new patients and five minutes with them on return visits. She would see two or three unrelated patients in the same examination room at the same time. D undertook no medical examination of her patients; patients for whom she would prescribe pain medications who often expressed nonspecific complaints about anxiety and pain from old injuries. D did not obtain an adequate medical history or prior medical records before prescribing medications. D did not do drug testing or review California's Controlled Substance Utilization Review and Evaluation System (CURES) database.to determine whether patients had current or prior prescriptions for controlled substances from other doctors. D routinely wrote prescriptions for opioids (such as oxycodone, oxymorphone, fentanyl, and hydrocodone), sedatives (such as promethazine and benzodiazepine), muscle relaxants (such as carisoprodol, which is sold under the brand name Soma), and amphetamines, as well as controlled substances used to treat drug and opioid addictions (such as methadone and buprenorphine/naloxone). D allowed patients to pick up prescriptions for other patients who were not at the clinic. D prescribed a patient's relative, who had never been Ds patient, a controlled substance. D acknowledged that some patients, who presented symptoms suggesting opioid and drug addiction and withdrawal, were merely seeking drugs. Pharmacists began to refuse to fill prescriptions written by D. D then referred her patients to “mom and pop” pharmacies, which continued to fill her prescriptions. Investigators from the coroner's office began calling to discuss the deaths of several of her patients and to apprise her that the patients had died of suspected drug overdoses shortly after obtaining prescriptions from her. In 2012, D was arrested and charged with three counts of second-degree murder and other charges. At trial, the prosecution presented evidence that from September 2007 to December 2009, nine of D's patients-ranging from 21 to 34 years of age-died shortly after filling the prescriptions D wrote them for controlled substances. The prosecution also presented evidence that Dg did not obtain information from Nguyen to corroborate his complaints of pain and anxiety or complete an adequate physical examination to determine whether a legitimate medical reason existed to prescribe the controlled substances. Although Nguyen reported to D that he was taking “high doses of opioids” prescribed by other doctors, D did not contact Nguyen's other doctors. D did not obtain medical records relating to Nguyen's prior treatment or a complete medical and mental health history of Nguyen. The prosecution's medical expert testified that D's treatment of Nguyen represented an extreme departure from the standard of medical care. The prosecution presented expert medical testimony that D's method of treatment of Ogle represented an extreme departure from the standard of care in various ways, including that D was not a licensed addiction specialist and did not have the training to monitor Ogle's use of methadone. The prosecution also presented evidence that the prescriptions D wrote for Rovero likely increased his potential for overdose and death because D failed to verify the doses of the drugs he had been previously prescribed. The prosecution also presented evidence of six uncharged deaths of D's patients from prescription drug overdoses between late 2007 and 2009. D described all six as drug-seeking and yet she wrote them all prescriptions. The deaths all occurred within days after D wrote them prescriptions for high doses of opioids, sedatives, or other drugs. A jury found D guilty of three counts of second-degree murder among other crimes. D appealed. 

Issues

Rule of Law

Holding and Decision

Legal Analysis

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