People v. Tseng

California Court of Appeal, 5th District
30 Cal. App. 5th 117, 241 Cal.Rptr.3d 194 (2018)

ELI5:

Rule of Law:

A physician may be convicted of second-degree murder on a theory of implied malice when they prescribe dangerous controlled substances with conscious disregard for the life-threatening risk to their patients, particularly when they have actual knowledge of prior patient deaths resulting from similar prescriptions.

Facts:

Beginning around 2008, Dr. Hsiu Ying Lisa Tseng's medical practice shifted to primarily treating young men seeking pain and anxiety medications, with most patients paying in cash.
Tseng conducted little to no physical examination of her patients, spent only 5-15 minutes with them, failed to obtain adequate medical histories, and did not check the state's prescription drug database (CURES).
She routinely prescribed large quantities of dangerous and addictive controlled substances, including opioids like OxyContin and Opana, sedatives like Xanax, and muscle relaxants like Soma.
Starting in 2008, large pharmacies began refusing to fill Tseng's prescriptions due to a lack of legitimate medical purpose, prompting her to refer patients to smaller pharmacies.
From 2008 onward, coroner's investigators repeatedly contacted Tseng to inform her that multiple patients, including Matthew Stavron and Ryan Latham, had died from overdoses of the drugs she had just prescribed.
Despite knowledge of these deaths, Tseng continued her prescribing practices and told her receptionist that the patients were 'druggies.'
In 2009, patients Vu Nguyen, Steven Ogle, and Joseph Rovero all died from acute drug intoxication days after Tseng prescribed them dangerous combinations of controlled substances.
Before treating her final murder victim, Joseph Rovero, Tseng was aware that at least eight of her patients had died from prescription drug overdoses.

Procedural Posture:

The State of California charged Dr. Hsiu Ying Lisa Tseng in a state trial court with three counts of second-degree murder and multiple counts of unlawfully prescribing controlled substances.
Following a six-week trial, a jury found Tseng guilty of three counts of second-degree murder, 19 counts of unlawful prescribing, and one count of fraud.
The trial court sentenced Tseng to a term of 30 years to life in state prison.
Tseng (appellant) filed an appeal of the judgment to the California Court of Appeal, arguing that the evidence was insufficient to support the murder convictions.

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Issue:

Does substantial evidence support a physician's convictions for second-degree murder on a theory of implied malice when the physician repeatedly prescribed dangerous combinations of controlled substances to patients she knew were abusing them, despite being directly notified by authorities of multiple other patient overdose deaths?

Opinions:

Majority - Rothschild, P. J.

Yes. Substantial evidence supports the convictions for second-degree murder because the prosecution established implied malice by showing the physician subjectively appreciated and consciously disregarded the life-threatening risk of her prescribing practices. Implied malice requires more than gross negligence; it requires proof that the defendant knew their conduct was dangerous and acted with a conscious disregard for human life. The evidence demonstrated Tseng's subjective awareness of the risk through several key facts: 1) As a physician, she possessed expert knowledge of the lethal danger of the drugs she prescribed. 2) She was directly and repeatedly notified by coroner's investigators about numerous patient overdose deaths linked to her prescriptions. 3) Despite this knowledge, she continued her prescribing practices unchanged, indicating a conscious disregard for the lives of her patients. 4) Her actions, such as directing patients to different pharmacies after major chains raised concerns and altering patient records, further demonstrated her awareness that her conduct was illegitimate and dangerous. The court also held that the victims' own actions, such as taking other unprescribed drugs, were not unforeseeable superseding causes that would absolve Tseng of liability, as her prescriptions were a substantial cause of their deaths.

Analysis:

This case is significant for affirming that a physician's prescribing conduct can meet the high standard for implied malice second-degree murder, moving beyond mere medical malpractice or involuntary manslaughter. The decision establishes that direct notification of prior patient deaths can serve as powerful evidence of a doctor's subjective awareness and conscious disregard of life-threatening risks. It sends a strong deterrent message to practitioners operating 'pill mills,' clarifying that they can be held criminally liable for murder if they continue dangerous prescribing patterns after being put on notice of fatal consequences. The ruling also reinforces that a victim's contributory actions, if foreseeable, do not break the chain of legal causation for a defendant who creates the deadly situation.

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