Murder by Prescription: Is It the Doctor's Fault When a Patient Overdoses?

This article originally appeared on VICE US

They set out west from the Sonoran Desert in the dead of night. The college guys, armed with cash, crammed into a car after a party and drove six hours until morning, when they reached a strip mall doctor's office in a suburb of Los Angeles.

It was two weeks before Christmas in 2009, and April Rovero noticed her 21-year-old son Joey had withdrawn €430 in cash from his bank account. He had told her about his impromptu trip to LA, and she decided to wait until he came home for winter break to ask about the money. But the Arizona State University senior never came home.

He died of a lethal combination of alcohol, Oxycodone, and Xanax on December 18, 2009—a day before he was supposed to fly to his parents' house in Northern California, and nine days after he drove with friends to visit Dr. Hsiu-Ying "Lisa" Tseng, the Rowland Heights, California physician who prescribed him the painkillers.

"Parents send their kids off to school like we did," April Rovero said. "We sent him off and look at what we got: a dead child. The environment and the culture there absolutely contributed to what happened to him."

Joey Rovero's use of prescription painkillers was not unique to his fraternity party scene, nor was he the only one of Tseng's patients who died that year. There was also Vu Nguyen and Steven Ogle, both Southern California men who were in their 20s when they fatally overdosed on painkillers prescribed by Tseng, a general practitioner.

Tseng has pleaded not guilty to second-degree murder charges related to the three deaths—an exceptional case that went to trial in Los Angeles County at the end of August and could drag on through mid-October. She is the first physician in the state—and one of few in the country—to be charged with murder simply for writing prescriptions.

The case comes four years into a nationwide epidemic of prescription overdose deaths. Prescription opioid-related deaths rose more than 300 percent between 1999 and 2011, and have since outpaced car accidents as the leading cause of injury death, according to data from the Centers for Disease and Control. The numbers have prompted an aggressive response by the Obama administration, which earlier this year proposed investing $133 (€120) million toward opioid overdose prevention efforts ranging from data collection to treatment programs.

As federal and state officials look for ways to fight the opioid scourge, Tseng's trial has become a flashpoint in the national push to better regulate pharmaceuticals and reduce overdose deaths. And it represents a major shift in the way government is prosecuting drug cases.

"The national policy is turning away from just the users and starting to look at the doctors," said Tracey Helton, a San Francisco-based addiction counselor and former heroin user who was featured in the 1999 HBO documentary Black Tar Heroin: The Dark End of the Street. A cult figure in some drug circles, Helton traces her opioid addiction back to the Vicodin she was prescribed after getting her wisdom teeth pulled as a teenager.

"I'm sure it's an effort between all of these agencies to try to get this doctor as a test case—because it's a really, really good one," said Helton, who is now a 45-year-old mother of three. "The money to be made here, I mean, she must've made hundreds of thousands of dollars a month. She had to have."

Tseng, who has spent three years in jail awaiting trial, was arrested in 2012 after undercover federal agents paid several visits to Tseng's practice and found it alarmingly simple to obtain a prescription after just a fleeting consultation. According to the Drug Enforcement Administration (DEA), Tseng wrote an average of 25 prescriptions a day—a total of more than 27,000 between 2007 and 2010. A 2010 Los Angeles Times investigation linked those prescriptions to the drug overdose deaths of at least eight people, including Rovero, Nguyen, and Ogle. In addition to second-degree murder, Tseng has also been charged with 21 felony counts related to writing prescriptions for people who didn't legitimately need the drugs.

Her trial follows a similar case in Florida, where a doctor was charged tried for first-degree murder in the prescription drug overdose death of 24-year-old Joseph Bartolucci. The doctor, Gerald Klein, was acquitted of the murder charge by a Palm Beach County court on September 16, but is expected to be sentenced to prison for illegally selling Xanax to another patient.

The millionaire owner of the pain clinic where Klein worked did not get off so easy. Jeffrey George, who operated several Florida pain clinics with his twin brother Chris, pleaded guilty in 2011 to second-degree murder in Bartolucci's death, and is now serving a 15.5-year sentence under a plea deal. Chris George is also in prison, following the FBI's 2010 raid on the brothers' clinics, the largest of Florida's notorious "pill mills" at the time. An FBI investigation following the crackdown found that 53 patients of the Georges' clinics had died of overdoses.

Other high-profile cases involving similar charges have resulted in even more lax sentences. In 2013, Conrad Murray, the Los Angeles doctor convicted of involuntary manslaughter in the 2009 overdose death of Michael Jackson, was released after serving two years of his four-year jail sentence. And earlier this year, psychiatrist Khristine Eroshevich escaped jail time in a case related to the 2007 overdose death of Anna Nicole Smith. Instead, a Los Angeles County judge reduced the conviction to a misdemeanor, slapping Eroshevich with a €90 fine and a year of probation.

Whether it's a celebrity coping with fame or a college student facing finals, nearly two million Americans either depend on or abuse opioids, according to the American Society of Addiction Medicine. Helton said she sympathizes with addicts who see doctor-prescribed painkillers as a safer, cleaner way to get high. "Heroin has all this stigma attached to it. You usually have to go to a shady part of town and deal with a bunch of fucking assholes," she said. "There's so many prescriptions out there, and if there's no stigma really attached to taking an opioid, people seek those out."

Outside of her job at a health clinic, Helton serves as an advocate for addicts, moderating a Reddit community of drug users who frequently seek advice and education. With Tseng's case, she says the challenge of holding someone accountable for an overdose is particularly complex. "It's like, 'I have a drug problem. Can you help me be safer in some way?'" she explained. "But on the other hand, it's like, why are we making it so readily available?"

But Dr. Nathan Kuemmerle, a psychiatrist based in San Diego, says the legal consequences of Tseng's case could do more harm than good. "I think that she deserves to get some kind of punishment, but I think that the idea of murder charges is horrendous," he said. "We can't start charging people with first-degree murder or whatever murder it is when it's an overdose that happens ten miles away."

Kuemmerle insists that Tseng's patients "were goal-oriented. It's not like they didn't know that opiates were addictive, so to completely mitigate any of their responsibility is ridiculous."

Kuemmerle is himself a recovering methamphetamine addict, better known among DEA agents as "Fame Monster." The National Geographic show Drugs Inc. nicknamed him Doc Hollywood for his reputation as a willing prescriber. In 2010, Kuemmerle was arrested after a federal probe not unlike the one launched by undercover agents in Tseng's office around the same time. Like Tseng, Kuemmerle was accused of running a "pill mill" trafficking large numbers of pharmaceutical drugs to make a buck. But unlike Tseng, he was not charged in connection with the death of any of his patients.

Kuemmerle maintains that OxyContin prescriptions comprised less than 1 percent of his practice, which is why he believes he isn't in jail today. Instead, he mostly prescribed Adderall. When one of his patients began peddling the tiny orange pills on Craiglist in 2009, the feds traced the supply back to Kuemmerle, who was described in court records as California's most prolific prescriber of Adderall. In 2009, according to the criminal complaint, Kuemmerle wrote more prescriptions for the stimulant than any other doctor in the state.

He pleaded guilty to felony drug dealing charges related to prescribing Adderall. Despite its prevalence—about a third of college students use Adderall recreationally, according to one recent study—the ADHD medication is classified as a Schedule II drug, alongside methamphetamine, cocaine, and yes, OxyContin. According to the US Attorney's office in California, undercover agents who visited Kuemmerle at his clinic were prescribed Adderall or Xanax in exchange for cash—one officer received prescriptions for both drugs for €135 in one appointment that lasted less than ten minutes.

And yet Kuemmerle had his license reinstated by the Medical Board of California in 2013. He's now a practicing psychiatrist at a physician's group in San Diego. But since his arrest, life hasn't been easy for the recovering addict. In fact, he says the past five years have been something of a nightmare.

"They tried to make it out in the media like, 'Oh yeah, they just let him go and he's writing scrips again," Kuemmerle told me, cackling wildly at the thought. "Heck no. Heck no!" he exclaimed, detailing the terms of his continued probation: supervision by a board-certified psychiatrist, a series of medical ethics courses, and drug tests conducted randomly up to six times a month at his own expense, which he said sometimes comes out to €625 a month. Not to mention, he added, there was the "absolutely brutal" five-day exam he had to retake to get his license back after a federally-mandated six-month stint in a "cockroach-infested" rehab where he claims the conditions were worse than prison.

Even for doctors who are following all the rules and prescribing medications within a reasonable limit, there's a general misunderstanding about the dangers of prescription painkillers within the industry at large, said Helton. While she's been clean for 17 years, she said the high volume of painkillers she was prescribed after having a miscarriage could have put her at risk for relapse or even death—even though her history as an intravenous drug user was well documented in her medical charts.

"The doctor's just trained to alleviate your suffering. So there has to be a lot of re-educating on a lot of different fronts," she said, adding that she encourages patients to question their doctors when given prescriptions.

"First of all, we have to recognize when people are legitimately in pain and need help, but then we also have to [ask] if opiates are necessarily the best course of action for this person, and how is the system set up to do that," Helton continued. "I don't know what the answer is. The government thinks maybe prescription drug monitoring is the answer, but then patients have pain because the doctor doesn't want to take the risk of being flagged."

Helton is referring to prescription drug monitoring programs—state-run databases that are designed to track the distribution of prescription drugs by individual doctors and pharmacies, and also to identify patients who could be filling medications from multiple doctors. As of this year, every state except Missouri has instated these programs, which collect data from pharmacies and report it to health care and law enforcement agencies if and when something is flagged as suspicious.

But the program isn't always well funded or effectively operated from state to state. After a federal budget cut in 2013, for example, the funding for California's drug monitoring program was slashed to almost nothing, according State Attorney General Kamala Harris. In its 2016 budget proposal, the White House requested that a third of federal funding for combating opioid abuse go toward funding state-run programs.

Despite White House efforts, "the parents are really the ones who are driving a lot of these changes," according to Helton, who says she sometimes fields 50 messages a day from people who are either seeking treatment for opioid addiction or know someone who died of it. "There's a whole generation of kids that are dying from overdoses. And the parents are like, 'I never knew.'"

That rings true for April Rovero, who had no idea about her son's prescription drug use until it was too late. Six months after his death, Rovero founded the National Coalition Against Prescription Drug Abuse, a nonprofit drug awareness group that aims to inform parents and policymakers about the dangers of pills—especially those prescribed by doctors.

Having retired from her 30-year career in telecommunications, Rovero now dedicates most of her time on the front lines of the war against prescription drugs. In 2013, with the help of a 100-member local task force she formed in San Ramon, California, Rovero successfully pushed for a law designating March as prescription drug abuse awareness month in California. The month is packed with rallies, advocacy events, and lobbying campaigns in the state capital, including pushing for stricter implementation of California's drug-monitoring program, pain management training for doctors, and for more oversight over insurance-approved rehab programs.

When she first started her outreach five years ago, Rovero said, the toughest part of the job was getting people to understand the gravity of the issue. "There's a phenomenon that really causes people to think these drugs aren't serious, that they can't have the devastating impact that they have," she say. Now, there's been a shift. "It's getting harder and harder to talk to people who don't have a personal impact story to tell [about drug addiction]—there are more and more people being impacted and that includes the leaders of our country."

Grief can be a powerful motivator for Rovero and her army of dozens of parents who have lost children to prescription drugs. Next month, she said, she'll be joining the third-annual FedUp! rally to push for federal action to combat opioid addiction at the National Mall in Washington, DC. But for now, she's spending her days in a downtown Los Angeles courtroom, hanging onto every word in the prosecution's case against Tseng, the woman who prescribed her son painkillers.

No matter the verdict, there's no prescription to relieve Rovero's own pain. "You learn how to cope with the death of a child but you don't get over it," she says. "You will never get over it."

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