Scissors are safe for even small children to use (with adult supervision, of course), yet your mother always told you not to run with them or you could poke your eye out. Matches are also safe (though not for children), but your mother told you not to play with them or else you could burn the house down. Cars are very safe, but your mother (hopefully) reminded you to put on your seatbelt. All of these items have their inherent dangers, but we generally don’t think twice about using them because these risks have been drilled into our heads since childhood until using them safely becomes second nature. However, thousands of people every year still abuse them and end up paying the price.
Similarly, medical students are taught from day one how narcotics and other controlled substances can be dangerous and potentially deadly, and doctors are taught about judicious prescribing: give only the amount needed, and only for those who need them. Unfortunately some doctors just don’t get the message. Unlike the previous examples, however, in the case of prescription drug abuse it isn’t the doctor who ends up suffering. It’s their patients and their families.
Dr. Hsiu-Ying Tseng is just such a doctor, but she is now paying for her deadly mistakes. Tseng, a general practitioner in Los Angeles, was arrested and charged with second-degree murder in the death of three of her young patients who overdosed on legal medication that she prescribed for them. She did not kill them, she merely prescribed the pills that did.
One of her patients, Joey Rovero, was a 21-year-old senior at Arizona State University who drove over 300 miles with some of his fraternity brothers to see Dr. Tseng after he learned of her reputation for doling out large numbers of powerful pills. Dr. Tseng had thoroughly earned her reputation: She prescribed him hundreds of pills, including 30 mg tablets of oxycodone, as well as Xanax.
Nine days later Rovero mixed those medications with alcohol and died.
Dr. Tseng had a long history of running a so-called “pill mill.” She allegedly would perform a cursory physical examination—if at all—before prescribing highly-abused medications, often to people with no legitimate need. In all, at least eight of her patients died, all under age 30, and several more were found to be selling the medicines she prescribed them, leading to even more deaths. After an investigation by both the U.S. Drug Enforcement Administration and the California Board of Osteopathic Medicine in 2010, Dr. Tseng lost her license to prescribe controlled substances. A few years later her license to practice medicine was revoked. Her career as a doctor was over.
In an era of exploding prescription drug abuse, Tseng’s prescribing pattern was unethical at best and horrifying at worst. Over the three-year period before losing her prescribing privileges, she wrote over 27,000 prescriptions. Assuming an eight-hour workday, five days a week, 50 weeks a year, that is an average of over 35 prescriptions per day—or one every 15 minutes or so. Make no mistake—that is a lot of prescriptions by any definition.
Prescription drug abuse is a growing problem. Instead of raiding the liquor cabinet like in decades past, teenagers are raiding their parents’ medicine cabinets, looking for Vicodin, Xanax, Percocet, Valium, OxyContin, or any number of other pills. Stories of pill parties make the rounds periodically, though the validity of their popularity has been called into question. Children of doctors steal their prescription pads and write themselves whatever they please.
However, most people who abuse prescription drugs don’t steal them or buy them from a dealer. Instead, the pills are illegally given to them by friends or relatives.
Joey Rovero’s death, like the deaths of Tseng’s other patients, was senseless and completely preventable, and Dr. Tseng’s actions were not defensible in any way. But was this murder?
Murder is defined as “the unlawful premeditated killing of one human being by another.” Tseng didn’t force Rovero to come see her. He chose to search for a known pill pusher. He chose to drive over 300 miles to see her instead of someone closer because he knew she would be an easy score. He chose to take more than the prescribed number of pills specified on the bottle. He chose to mix the drugs with alcohol. That series of bad decisions was his and his alone. It was Rovero’s choices, not Tseng’s, that killed him.
Though a doctor being accused of murder is unusual, it is not unprecedented. Harold Shipman was a British doctor who was convicted of killing 15 of his elderly patients by injecting them with a lethal dose of heroin, though an investigation later confirmed that he had killed over 200. Virginia Soares de Souza allegedly killed as many as 300 of her intensive-care patients in Brazil by giving them lethal doses of sedatives and anesthetics, apparently in an effort to free up hospital beds.
But unlike in this case, these two criminals were directly responsible for their patients’ deaths. Tseng’s actions most assuredly contributed to her patients’ deaths and also the worsening prescription drug abuse problem, but she did not kill any of them. There was no intent, no premeditation. Without defending Dr. Tseng’s behavior, what she did was not murder. One cannot be held responsible for the actions of other legal adults. Many things we buy without even thinking about possible ramifications are inherently dangerous. Cars driven in an irresponsible manner without all proper safety measures can kill, but are car dealers responsible for those actions? Of course not.
On the other hand, the recent scandals involving GM’s defective ignition switch and Volkswagen’s fraudulent emissions testing show what can happen when a manufacturer knowingly sells a defective product. They are, and should be, held accountable. When a manufacturer or retailer knowingly sells a defective—and also inherently dangerous—item, and that item injures or kills the owner even while being used properly, few people would argue that the manufacturer is responsible. However, if the item being sold is in normal working order and perfectly safe when used properly, but the buyer misuses it and accidentally injures or kills himself, the store who sold cannot still be considered responsible. That is solely the fault of the person who abused it.
Tseng’s prescribing habits were deplorable, unethical, immoral, and most assuredly deserving of having her medical license stripped permanently. People who act with such callous disregard for not only patients’ health but also for an obvious growing public health crisis do not deserve to have the privilege of taking care of people.
But murder? No.