BY ELIZABETH CHIARELLO

Illustration by Izhar Cohen

She murdered her patients. At least, that’s what the prosecutors said. All it took to get powerful opioids from California internist Lisa Tseng was a brief conversation. No X-rays. No lab tests. No medical exam. Video surveillance shows an undercover officer posing as a patient who asks Dr. Tseng for methadone (an opioid) and Xanax (an anti-anxiety medication), drugs that can form a deadly cocktail when combined. He tells her that he is in recovery and takes the drugs at night with alcohol to “take the edge off.” He makes clear that he is not in pain and does not plan to use the medications to treat a medical condition. Tseng writes the prescription—after the agent hands over $75 cash.1

Did she know what she was doing was wrong? Tseng received desperate calls from patients’ families and friends concerned that their loved ones were hooked on the meds she prescribed.2 She did not stop. Coroners and law enforcement agents called Dr. Tseng each time a patient died—14 in total.3 She did not stop. Perhaps she thought the financial perks outweighed the risks. Dr. Tseng’s reckless prescribing raked in $3,000 a day and exceeded $5 million in three years.

Dr. Tseng’s prescribing spree ended in 2015, when a jury convicted her on three counts of second-degree murder.4 In 2016, Superior Court Judge George G. Lomeli imposed a prison sentence of 30 years to life in prison. The trial lasted eight weeks. It included 77 witnesses and 250 pieces of evidence. Families of overdose victims praised the judge’s decision and concluded that “justice has been served.”5

Dr. Tseng was the first California physician ever convicted of murder for overprescribing opioids, and one of the first in the United States. Her case was a turning point for law enforcement because it created a playbook for subsequent prosecutions and because it sent a clear signal to physicians across the nation: you could be next. “The message this case sends is you can’t hide behind a white lab coat and commit crimes,” declared Deputy District Attorney John Niedermann. “A lab coat and stethoscope are no shield.” Medical experts warned that Tseng’s case could scare physicians away from prescribing opioids and leave chronic pain patients to suffer without care.6

Law enforcement is responsible for making sure that doctors only prescribe opioids legally, which is no easy task. However, some physicians make it easy when they engage in behavior that is explicitly and undeniably criminal. These are the cases that make headlines. Opioids are illegal by default. Federal law gives doctors a special exemption to prescribe them for legitimate medical purposes, particularly pain. But how can a physician be legitimate if he has a parking lot filled with out-of-state license plates and a line of patients snaking around the building as if they are waiting to buy concert tickets? If he asks the patient to state his blood pressure while a brand-new blood pressure cuff hangs on the wall, unused? If he can’t tell the difference between a dog X-ray and a human one?