A California doctor who sits in court accused of murder listened to an expert witness Tuesday describe how three young men came to her for drugs and wound up dead after she failed to provide adequate care and diagnosis before issuing prescriptions.
Dr. Hsui-Ying "Lisa" Tseng, one of only a handful of doctors to face murder charges involving prescription drugs, sat with her head down as Dr. William Strauser denounced her care of the men as inadequate and puzzling.
Strauser, a San Diego pain management specialist, said he could not figure out from Tseng's records what she had in mind as treatment goals with the men and how she would follow up.
He said each man had only one visit with Tseng and never saw her again.
"Dr. Tseng committed an extreme departure from the standard of care in not monitoring the patient," he said. "I did not find any aspects of informed consent or warnings of the risks of taking sedatives."
The testimony came at a preliminary hearing for Tseng to determine if she should stand trial. She has pleaded not guilty to 27 felony counts, including three counts of second-degree murder, and could be sentenced to 45 years to life in prison if convicted.
In each death, he said, the patient came to Tseng's Rowland Heights office complaining of pain and anxiety. For some, she prescribed opiates and sedatives.
But in the case of Joey Rovero, she dramatically reduced doses of heavy duty drugs he said he was already taking. As the mother of Rovero watched from the courtroom audience, Strauser said the 21-year-old University of Arizona student told Tseng he was already taking huge doses of Oxycontin, Xanax and Soma.
Strauser said a high dose of Oxycontin, a powerful opioid, might be about 140 milligrams. But Rovero was taking between 480 and 640 milligrams a day, and doses of Xanax and Soma for anxiety also were high, he said.
Strauser said Tseng's records did not delineate Rovero's illness other than to say he had back and wrist pain associated with numbness in his hand. She did not specify which hand.
Her recommended treatment, Strauser said, was a dramatic decrease in all the medication doses.
"What she did with the medications was quite remarkable," he said, telling how she reduced the Oxycontin to 90 milligrams.
"That's an extreme reduction in an opioid and would have precipitated withdrawal," he said.
The Xanax, a benzodiazepine sedative, was reduced from 8 milligrams to 2 milligrams a day, Strauser said.
"She would have placed him at risk for benzo withdrawal," he said, "and put him at risk for seizures."
The witness said Tseng `also reduced the Soma by 50 percent and there was no indication that she ever tried to reach Rovero's previous doctor to find out why he had been taking such high doses of medication.
Prosecutors were presenting evidence in the 2009 deaths of Rovero, Vu Nguyen and Steven Ogle and in uncharged cases involving three other men who died in 2007 and 2008.
Prosecutors are trying to use the uncharged cases as evidence to show Tseng knew young men were dying.
Authorities allege she wrote more than 27,000 prescriptions over a three-year period. She has been in custody since March and is being held on $3 million bail.