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.
"[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.
See the most-read stories this hour >>
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.
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.
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."
For more news from the Los Angeles County criminal courts, follow @marisagerber