When cause of death is opioid overdose is it murder or malpractice?


Is a doctor guilty of malpractice or murder or is the patient responsible for his or her actions when there is a death by overdose? This is the question that a jury in Los Angeles will have to decide as they are presented the facts in the case of Dr. Lisa Tseng.

The prosecution’s version is that Dr. Tseng handed out opioids like candy without any regard for standard of care. Over the years at least 12 of her patients died from overdoses. She is now standing trial for three deaths…

So opioids are a big deal. I was once a far more liberal opioid scribe than I am now. Fifteen years ago we were all “under treating” pain and so we prescribed more and more opioids. That is what our professional societies told us. I saw almost no one get better or lead a more productive life. I also heard of more lost prescriptions than I can count. Pain scores rarely budged, but doses gradually escalated.

I don’t understand why doctors expect miracles from opioids and discount the stabilization of pain levels (scores).  All treatments tried by a patient up to this point have not been able to provide enough relief, so opioid therapy is chosen. And when pain levels are stabilized, that’s not considered a success? Keeping a person off disability is not considered a success? Allowing patients to keep caring for themselves and remain independent is not a success? Keeping a chronic pain patient from committing suicide is not a success?

I would never keep someone on a beta blocker if it wasn’t controlling their hypertension, so why would I keep someone in an opioid if it wasn’t lowering their pain score? If 240 Norco and 60 OxyContin a month isn’t helping your pain dramatically then you have opioid resistant pain…

Asking for opioids to “control” pain is, like I said, asking for miracles. Some patients will be helped “dramatically” with opioids, but some not. Some patients can’t tolerate opioids and some have a metabolism that decreases the effectiveness of opioids. Saying that a patient’s pain must be helped dramatically at a certain dosage sounds like this doctor treats patients like robots on a conveyor belt.

About ten years ago I decided that chronic opioids were not for my practice. The percentage of people in my 15+ year career in chronic pain who have truly benefited from them, meaning a significant reduction in pain scores with a corresponding improvement in functionality, is very small…

Expecting patients disabled by pain to increase their functionality just because they take opioids is a fairly narrow view of pain syndromes. I wonder, do you treat any cancer patients, Dr. Gunter? Anyone with trigeminal neuralgia? Tell me, doctor, do your chronic pain patients achieve “a significant reduction in pain scores with a corresponding improvement in functionality” with any other treatment you prescribe?

Oh wait, it looks like Dr. Gunter prescribes yoga:

The Feldenkrais Method® is a form of somatic education that uses gentle movement and directed attention to improve movement and enhance human functioning. Through this Method, you can increase your ease and range of motion, improve your flexibility and coordination, and rediscover your innate capacity for graceful, efficient movement. These improvements will often generalize to enhance functioning in other aspects of your life. The Feldenkrais Method is based on principles of physics, biomechanics and an empirical understanding of learning and human development. By expanding the self-image through movement sequences that bring attention to the parts of the self that are out of awareness, the Method enables you to include more of yourself in your functioning movements. Students become more aware of their habitual neuromuscular patterns and rigidities and expand options for new ways of moving. By increasing sensitivity the Feldenkrais Method assists you to live your life more fully, efficiently and comfortably.

Is this description from their website supposed to be easily understandable?  Dude, it’s yoga, no need to make it sound so fancy. And I don’t need to pay a doctor to tell me to try yoga. While yoga and stretching exercises can be part of a home treatment program, rarely do they help enough to be the only treatment being used. In fact, without something to decrease the pain, either before or after (and sometimes both), I can’t perform all of my daily stretching exercises. If Dr. Gunter was my doctor, I guess I’d be SOL.  (Free the weed.)

Speaking of freeing the weed, there’s no mention of cannabis in this doctor’s post. For anyone who alleges to treat pain, without offering access to cannabis (or opioids, in this case), you’re really worth nothing to me.

There is no scenario where I can see giving a 21 year man from out of state an opioid prescription of any kind unless he was in the emergency room with a traumatic injury. It doesn’t sound as if Dr. Tseng was anyone’s family doctor or internist trying to keep people afloat. Whether she started out with good intentions and was the most gullible person on the planet or this was truly a pill mill will be pretty easy to tell from a record review…

I love how doctors stand up for each other, don’t you?  Even if Dr. Tseng is guilty of being gullible — or if she’s simply guilty of trying to help treat the pain reported by her patients — she’s not a criminal. She’s not a murderer. And even if she was running a pill mill, do you think 100% of her patients were drug addicts and none of them were chronic pain patients? I wonder what happened to all her abandoned patients…

Are alcohol, car, or gun salespeople (dealers) responsible for those who abuse their products? If someone gets drunk, robs a bank with a gun, uses a getaway car, and then drives over a cliff like Thelma and Louise, who’s responsible? The person who sold him the alcohol, gun, or car? Or now that he’s dead, since he’s an alcoholic and a bank robber, who cares?

Under comments:

The DEA keeps a list of criminal prosecutions of doctors who lost their DEA registration as a result: http://www.deadiversion.usdoj.gov/crim_admin_actions/doctors_criminal_cases.pdf

There are at least two prior instances of physicians getting convicted of murder for improper subscribing. Dr. Harrison Bass of Las Vegas was convicted of second degree murder in 2008 for a death related to running what sounds like a mobile pill mill. Dr. Noel Chua of Georgia was convicted of felony murder in 2007 for illegitimately prescribing “multiple controlled substances” to the victim.

Additionally, Dr. James Bischoff of Montana pled guilty to charges including negligent homicide in 2006 and Dr. Jesse Henry of New Mexico pled guilty in 2004 to charges including seven counts of involuntary manslaughter related to at least three deaths linked to over-prescribing of multiple opioids.



During opening statements in her case Monday, Tseng hunched forward in her chair, settling in for a landmark second-degree murder trial that’s expected to last for months. The general practitioner, who scribbled notes on a yellow notepad and tapped her foot over and over, is the first California doctor ever charged with murdering patients who overdosed merely for prescribing them medication, Niedermann said…


Your Daily Dose of Hypocrisy


Former sheriff wants in on medical marijuana

Darren White, whose law enforcement credentials include stints as cabinet secretary for the Department of Public Safety, Bernalillo County Sheriff and public safety director for the City of Albuquerque, is one of eight names serving as a board of director with Purlife, which filed an application with the state to open a medical marijuana nonprofit…

White’s previous public statements and actions against marijuana reform have been extensive—in 1999 he resigned as Department of Public Safety cabinet secretary after Republican Governor Gary Johnson announced that he was in favor of legalizing marijuana. As recently as 2007, when medical marijuana became legal in New Mexico, White was vehemently opposed to it…

White is an ally of Gov. Susana Martinez and frequently writes Twitter posts blasting anything critical of her administration. He appeared in a 2010 Martinez campaign ad as a sheriff.

Martinez ran that year opposed to the state’s medical marijuana program. Last year, she later voiced disapproval of decriminalizing marijuana possession. Earlier this year, Martinez vetoed a bill that would have allowed hemp cultivation for research purposes…

Closed Formularies


The recent success of the closed pharmacy formulary in the Texas workers’ comp system has caught the attention of practitioners in other states. A new report from the Workers Compensation Research Institute concludes that, all things being equal, other states could see similar results. Texas was the first multi-payor state to adopt a formulary that requires pre-authorization for certain medications deemed as investigational, experimental, and those with “N” drug status under the Official Disability Guidelines, including many opioids…

Ex-Wife Lies to Unum, Results in Denied Disability


Arlington, VA: Kevin was diagnosed with multiple sclerosis in 1998, one year after he took out an Unum, or Unum Provident policy. After a messy divorce, Kevin says his ex-wife told Unum that he had MS in the 1980s, which meant he had a preexisting condition and would be denied Unum long-term disability benefits…

“They saw that I suffered from migraines before I took out the policy and said they would never have underwritten my policy had they known…

Unum is demanding that Kevin pay back $300,000, which amounts to the long-term benefits he received until Unum stopped paying him in 2006…

Texas: Med Board lets DEA sneak peeks at patient records


The Drug Enforcement Administration has been sifting through hundreds of supposedly private medical files, looking for Texas doctors and patients to prosecute without the use of warrants.
Instead, the agents are tricking doctors and nurses into thinking they’re with the Texas Medical Board. When that doesn’t work, they’re sending doctors subpoenas demanding medical records without court approval. The DEA can’t even count how many times it has resorted to the practice nationwide. A spokesman estimated it was in the thousands…

In Texas, the DEA’s criminal investigators do an end run around the Constitution’s warrant requirements by getting the Texas Medical Board to order doctors to open their records…

The problem is this: The medical board has authority to issue “administrative subpoenas,” as they’re called, because it’s in the business of administering the medical industry. The DEA isn’t. It’s in the business of criminal investigations, which can be hindered by the Fourth Amendment.

The entire apparatus of administrative law is something of a shadow government grafted onto a constitutional system back in the New Deal era, and this shadow government has few safeguards. Rather than checks and balances, the regulatory state is characterized by agencies that handle all the investigation, prosecution, adjudication and appeals in-house, with little interference from other bodies…

Salmonella Outbreak Prompts Widespread Cucumber Recall


The recalled cucumbers, grown in Mexico and distributed by Andrew & Williamson Fresh Produce, have sickened 285 people in 27 states, including a woman in California who died from the illness, according to the California Department of Public Health.

Andrew & Williamson Fresh Produce, a San Diego-based company, initiated the recall of its “Limited Edition” brand of pole grown cucumbers. “The labeling on these cases indicates the product was grown and packed by Rancho Don Juanito in Mexico. These cucumbers were distributed between August 1 – September 3, 2015,” the California Department of Public Health said.

The New York Times reports the cucumbers were shipped to 22 states, including New Jersey. Eighteen of those states have reported infections. New Jersey health officials have not reported infections, the New York Times reported.

Other states that received the recalled cucumbers include: Alaska, Arizona, Arkansas, California, Colorado, Idaho, Illinois, Kansas, Louisiana, Minnesota, Montana, Nevada, New Mexico, Oklahoma, Oregon, South Carolina, Texas and Utah, Florida, Kentucky and Mississippi.

Health officials in California say it is unlikely that cucumbers in retail grocery stores will have any identifying brand information. “CDPH recommends that consumers check with their grocer to determine if the cucumbers they purchased are impacted by this warning,” California health officials said.

Domestically produced cucumbers are not involved in this outbreak, according to health officials.

The Bug Times

Brought to you by Flybynight Loans


There’s a roadblock on I-90 that won’t be cleared until it rains.



Earl and Merle are still fighting about gay marriage.



The latest quote from the Executive Suite: “I wish people would stop fighting and start spending.”



The Mayor has suffered from a headache for the past month.

0DSC09592 (2)

He’s tried to ignore it.

0DSC09583 (3)

He’s tried yoga.

0DSC09591 (2)

Now he’s lifting the ban on painkillers so his doctor can treat him.

The Bug Times is a product of Corporations and Boredom. Nevertheless, we appreciate our readers. 🙂