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L.A. County prosecutor has played a key role in crackdown on 'pill mill' doctors

L.A. County prosecutor has played a key role in crackdown on 'pill mill' doctors
L.A. County Deputy Dist. Atty. John Niedermann speaks to the jury during closing arguments in the trial of Dr. Hsiu-Ying "Lisa" Tseng in 2015. (Anne Cusack / Los Angeles Times)

The battle against "pill mill" doctors in Los Angeles County began with four boxes gathering dust in a prosecutors' building downtown.

The cardboard containers were stuffed with incriminating documents about a doctor so prolific at dispensing drugs that only the entire staff of Johns Hopkins Hospital had written more prescriptions for painkillers in a single month.

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But the boxes went largely ignored, shuttling from unit to unit within the district attorney's office before finally landing in front of veteran narcotics prosecutor John Niedermann. When he cracked open the boxes and began reading through thousands of pages of reports, he realized that the deadline for filing charges against Dr. Carlos Estiandan was just weeks away.

"Oh my God," Niedermann thought. "We can't just drop this."

The prosecutor filed charges and won his first conviction against a doctor accused of overprescribing, launching what has become a campaign garnering national attention. In the years that followed, Niedermann has spearheaded a district attorney's crackdown against reckless drug prescribers that has won praise from law enforcement, elicited fears among some doctors and turned the tall lawyer with a disarming laugh into a hero of sorts to families of overdose victims.

Since Estiandan's 2010 conviction, Niedermann has helped prosecute another dozen doctors for overprescribing. In a landmark victory in February, a Rowland Heights doctor was sentenced to 30 years to life in prison for the second-degree murder of three patients who overdosed on pills she prescribed.

Mark Nomady, a recently retired agent with the federal Drug Enforcement Administration who played a key role in doctor prosecutions in Southern California, said Niedermann's work has helped establish the district attorney's office as one of the country's leading prosecutorial agencies on the issue. He described Niedermann as a fearless prosecutor willing to take on tough cases.

With Niedermann, if there's a chance, he'll take it -- 100%. He definitely is aggressive.... L.A. is way ahead of the curve.


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"With Niedermann, if there's a chance, he'll take it — 100%," Nomady said. "He definitely is aggressive.... L.A. is way ahead of the curve."

The district attorney's efforts come amid an opioid overdose epidemic ravaging the nation. Last month, the U.S. Centers for Disease Control and Prevention urged the medical community to stop prescribing addictive painkillers for common ailments, calling the problem "doctor-driven."

Still, some in the medical world say that Niedermann's tough approach isn't the answer and warn that aggressive prosecutions have started to create a dire situation for pain patients who desperately need relief.

Peter Osinoff, who represents doctors at medical board disciplinary hearings, says he's already noticed a "chilling effect" since the Los Angeles murder conviction. Many physicians he represents have stopped prescribing powerful painkillers altogether, fearful of criminal charges, he said.

"Think of the people who need that pain medication," Osinoff said. "Criminal prosecution has had a bad effect — very bad."

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The opioid epidemic hadn't started when Niedermann, now 46, graduated from law school at Pepperdine in 1994.

Before long, the Central Coast native joined the D.A.'s office and began working misdemeanor cases in Inglewood. He landed his first murder trial in 2008 the case of a woman stomped to death on skid row. After the jury deadlocked, Niedermann tried the case a second time and won. He said he can still hear the sound of the victim's family sobbing after the man was convicted.

"Finally," he said. "This girl's family had some peace."

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Niedermann — who knew by age 7 that he wanted to be a lawyer — shows up to court most mornings carrying a big Starbucks mocha and a stack of binders. He has an easy laugh and often responds to texts with an emoji of a thumbs-up sign or a smiley face wearing sunglasses. He has an unassuming air in the courtroom and the mannerisms of a veteran. (During one trial, he occasionally coughed and left his hand over his lips, as if to keep anyone from overhearing as he whispered to a fellow prosecutor.)

In 2009, the head of the major narcotics unit, Joseph Esposito, picked Niedermann to join the unit.

Niedermann is the type of lawyer, Esposito said, who endears himself to jurors but also keeps a competitive edge. Esposito assigned him to look into the Estiandan case.

"He will peel back the onion until there's nothing left," said Esposito, now an assistant district attorney.

A jury convicted Estiandan of 13 counts of unlawfully prescribing a controlled substance and he was sentenced in 2010 to five years in prison.

Niedermann had planned to return to wiretap and drug cartel cases, but began to realize the scope of the prescription abuse problem.

Estiandan "wasn't just this novel case I tripped upon in my office," he said. "It was a national cry for change."

Since then, Niedermann has worked to at least some degree on all of the office's doctor cases, including one against two of Anna Nicole Smith's doctors and her boyfriend. He knew prosecuting the high-profile trial following the actress-model's 2007 death from an overdose of prescription drugs would be a challenge.

"I was like, 'You're doomed,'" Niedermann said, laughing as he recalled getting the assignment. "I didn't ask for this."

The case turned into something of a black eye for the D.A.'s office. Dr. Sandeep Kapoor was acquitted outright. And after years of appeals, all the felony charges against Smith's psychiatrist and the model's boyfriend were either dropped or reduced to misdemeanors.

Still, Niedermann said, the publicity helped communicate a necessary message to law enforcement: Come to us with doctor cases and we'll prosecute.

He began fielding more phone calls from investigators across the state. They had stumbled across his name in news articles online, they often said, asking the same question: "What kind of evidence do you need to put a case together?"

Niedermann told the callers he needed really strong evidence — simple, shocking details that would make jurors say, "Holy cow, there is no way."

In the Estiandan case, the "holy cow" detail was the Johns Hopkins comparison. In the case of Dr. Hsiu-Ying "Lisa" Tseng, the Rowland Heights doctor convicted of murder, it was the overall number of patients who overdosed: 13. And in a case Niedermann is currently working on, a doctor is accused of using a chest X-ray of a dog to justify writing a patient a prescription.

Niedermann attributes his sizable caseload to aggressive local and federal authorities, who he says have taken the issue seriously and come to him with thoroughly investigated cases. Local federal prosecutors have also aggressively pursued doctors.

After a verdict in the Tseng case, which he prosecuted with Deputy Dist. Atty. Grace Rai, the D.A.'s office sent out a press release hailing it as the first time in the country that a doctor had been convicted of murder for overprescribing drugs to patients. (A Georgia doctor was convicted in 2007 of felony murder for prescribing drugs not for a legitimate use, but in that case, the patient lived with the doctor and the prosecution argued that they had had an inappropriate relationship for a doctor and patient.).)

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The Tseng case will probably define Niedermann's career.

During the trial, the prosecutor's face reddened as he told jurors about one of the victims, Joey Rovero, a patient who died after mixing alcohol with Xanax and oxycodone he had obtained from Tseng.

He argued that she repeatedly shirked responsibility for her patient's overdoses, instead blaming drug companies, other doctors, her patients' families. He asked jurors to think of it as a "wheel of blame."

Whenever Niedermann sat down, his pant legs inched up a bit, revealing a pair of socks with wheels on them. They were a gift from a DEA agent on the case who wanted to honor Niedermann's "wheel of blame" argument.

At Tseng's sentencing in February, a judge rebuked her as "very irresponsible." Tseng addressed the audience filled mainly with victims' family members, apologizing and vowing to spend her life praying for them.

In the hallway after the hearing, Rovero's mother, April, thanked Niedermann.

Rovero, who founded the National Coalition Against Prescription Drug Abuse after her son's death, credits Niedermann with pushing the national discussion. She believes the Tseng conviction has put doctors on notice and will embolden prosecutors across the country to seek murder charges.

Now, Rovero said, when she stumbles upon a news article about a doctor charged with overprescription, not murder, she sends a link to Niedermann along with a note of encouragement.

"Maybe you need to give them some pointers," she tells him, "on how they should really do this case."

Twitter: @marisagerber

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