Web only rx16 len-tues_330_1_kougasian-sakacs_2niedermann

Investigating and Prosecuting
Homicide by a Prescribing Doctor
Presenters:
•Peter Kougasian, JD, Counsel to the Special Narcotics
Prosecutor, City of New York
•Ryan Sakacs, JD, Chief, Prescription Drug Investigation Unit,
Office of the Special Narcotics Prosecutor, City of New York
•John Niedermann, JD, Deputy District Attorney, Los Angeles
County District Attorney’s Office
Law Enforcement Track
Moderator: Jackie L. Steele, Jr., JD, Commonwealth Attorney,
Kentucky 27th Judicial Circuit, and Vice Chairman, Operation
UNITE Board of Directors

Disclosures
Peter Kougasian, JD; John Niedermann, JD; Ryan
Sakacs, JD; and Jackie L. Steele, Jr., JD, have disclosed
no relevant, real, or apparent personal or
professional financial relationships with proprietary
entities that produce healthcare goods and services.

Disclosures
• All planners/managers hereby state that they or
their spouse/life partner do not have any
financial relationships or relationships to
products or devices with any commercial interest
related to the content of this activity of any
amount during the past 12 months.
• The following planners/managers have the
following to disclose:
– John J. Dreyzehner, MD, MPH, FACOEM – Ownership
interest: Starfish Health (spouse)
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center

Learning Objectives
1. Describe two criminal cases that resulted in
convictions against prescribing doctors in the
deaths of their patients.
2. Identify challenges and solutions to
investigating homicide by a prescribing
doctor.
3. Explain how to prepare for and prosecute a
criminal trial against a prescribing doctor.

Investigating and Prosecuting Homicide by aInvestigating and Prosecuting Homicide by a
Prescribing PhysicianPrescribing Physician
Part One: New YorkPart One: New York
ADA Ryan Sakacs & ADA Peter Kougasian
Office of the Special Narcotics Prosecutor
for the City of New York

Disclosure statement
• Assistant District Attorneys Ryan Sakacs and Peter Kougasian have disclosed no relevant, real or
apparent personal or professional financial relationships with proprietary entities that produce health
care goods or services.

Learning objectives
• Describe two criminal cases that resulted in
convictions against prescribing doctors in the
deaths of their patients.
• Identify challenges and solutions to
investigating homicide by a prescribing
doctor.
• Explain how to prepare for and prosecute a
criminal trial against a prescribing doctor.

“Doctor is prescribing medication to people who don’t need it”
- Complaint Received by the NYPD on October 19, 2010

First Investigative Step: Analyzing the Prescription Data

*Decrease in prescriptions after April
2011 reflect incomplete May 2011 data
How Did Prescription Activity Change Over Time?

When Were The Prescriptions Written ?

How Many Prescriptions Were Being Written Per Day?

Who Received These Prescriptions?

*Based on
prescription records
from January 1, 2009 -
June 18, 2011.
Distance Between Reported Patient Residences & Pain Management Clinic

Dr. Stan Xuhui Li
• DOB: 02/10/54
• Born in China, Naturalized Citizen
• Attended Medical Schools in China and the US
• Licensed to Practice Medicine in NY since
1999
• Licensed by the DEA to Prescribe Controlled
Substances
• Full time Anesthesiologist at Robert Wood
Johnson University Hospital in Hamilton, NJ
• Board Certified in Anesthesiology
• Board Certified in Pain Medicine
• Prescriptions issued in New York State,
from a location in Flushing, Queens

Surveillance: Outside the Doctor’s Preferred Pharmacy
April 30, 2011

• Was the OSNP the proper agency to take action?
– DEA
– OPMC
• Could we charge a physician for writing
prescriptions within the context of a medical
practice?
• Would the case be based on undercover buys or
past prescriptions?
• Could we hold the doctor accountable for the
deaths or endangerment of any of his patients?
Considering Criminal Charges

June 19, 2011: Medford Killings

o Over 15,000 Prescription Records Analyzed
o Extensive Surveillance Conducted
o Two Confidential Informants Utilized
o Over 100 Witnesses Interviewed
o Multiple Bank Accounts Identified & Reviewed
o Three Search Warrants Executed
o Sixteen Fatal Overdoses Identified from 2009 to 2011
o 1,200 Patient Charts Reviewed
o Dozens of Patient Chart Submitted for Expert Medical Review
o Hundreds of Medicare and Private Insurance Claims Audited
o 76 Witnesses Called Before a 6-Month Special Grand Jury
Investigative Steps

Identifying
Witnesses and
Decedents

“I have been in recent contact
with Jimmy’s primary
doctor…He has no
knowledge of your
prescriptions…”
“I am puzzled why you have
never contacted Jimmy’s primary
care physician when prescribing
such serious pills and
medications that could
ultimately lead to death when
misused or mixed with other
medications that Jimmy has been
taking.”
“This type of negligence and
abuse by your office will be
made known to the proper
authorities…”
Letter to Doctor from
Patient’s Concerned
Father
September 4, 2009

Prescribing Practices That Jeopardized
Health & Public Safety
• Prescribing multiple forms of opioids to the same
patient on the same day
(i.e. Percocet, OxyContin, Hydrocodone and Fentanyl)
• Frequently increasing dosage and quantity of pills
prescribed
• Prescribing dangerous combinations of drugs
• Excessive, long-term opioid prescribing
• Patients steered to preferred pharmacy
• Patients reporting conditions such as carpal tunnel
and ovarian cysts to obtain Oxycodone
• Countless patients with prior convictions for
narcotics-related crimes or DWI

Focusing on the Doctor’s Criminal Conduct
• Fees tied to quantities and dosages of Schedule II
substances
• Disregarding clear evidence of addiction, abuse,
morbidity and mortality
• Patients forced to pay cash for visits and procedures
in addition to fees billed to Medicare and private
insurance
• False claims to gov’t and private health insurance
• Altered patient files

Key issues:
Foreseeability: What was the likelihood that the prescription
would lead to tragedy?
Good faith: Was the doctor genuinely trying to treat illness, or
simply selling a prescription?
Causation: Is it clear beyond a reasonable doubt that drugs
prescribed by the doctor, as opposed to illicit drugs or drugs
prescribed by other physicians, was a direct cause of death?
Physician Liability for Patient Overdose

07/13/09
Dr. Li: 90 Oxycodone pills (30mg)
08/03/10
Substance Abuse Clinic: Suboxone
08/08/10
Dr. Li: 60 Alprazolam tablets (2 mg)
08/11/10
08/14/10
Dr. Li: 120 Percocet pills (10/325 mg)
08/18/10
08/24/10
09/11/10
09/14/10
Nicholas Rappold found dead
Nicholas Rappold
January 6, 1989 – September 14, 2010
9/13/10:OXY PILLS PURCHASED ON STREET

Li’s Prescriptions
Were a Proximate
Cause of Death

• Manslaughter in the Second Degree (2 counts)
• Reckless Endangerment in the First Degree (3 counts)
• Reckless Endangerment in the Second Degree (4 counts)
• Criminal Sale of a Prescription for a Controlled Substance (180
counts)
• Scheme to Defraud in the First Degree (1 count)
• Grand Larceny in the Third Degree (2 counts)
• Offering a False Instrument for Filing in the First Degree (8
counts)
• Falsification of Business Records in the First Degree (16 counts,
reduced to 11 following motion practice)
Charges

The subjective mental element
• Penal Law Section 220.65 (Criminal Sale of a
Prescription for a Controlled Substance):
– “…a person sells a prescription for a controlled
substance unlawfully when he does so other than
in good faith in the course of his professional
practice.” (emphasis added)

Manslaughter in the Second Degree
• “A person is guilty of manslaughter in the second
degree when…he recklessly causes the death of
another person.” (NY Penal Law Section
125.15[1])
• “A person acts recklessly…when he is aware of
and consciously disregards a substantial and
unjustifiable risk that such result will occur…The
risk must be of such a nature and degree that
disregard thereof constitutes a gross deviation
from the standard of conduct that a reasonable
person would observe…” (emphasis added)

Evidentiary issues –
Motions in limine
• How much context would Court allow into
evidence?
– Statistics regarding
• Numbers of patients seen in one day
• Numbers of prescriptions written in one day
• Distances traveled by patients
– Financial data
• Cash deposits to bank accounts in New Jersey
– Surveillance of crowds waiting for doctor to arrive
– Descriptions of conditions in waiting room

Sheer number of patients seen per day
strongly suggested a “pill mill”

Surveillance recorded patients loitering
Outside of Doctor’s Office - June 25, 2011

Theme of Defense
Defendant was a conscientious doctor who
brought board-certified pain management to
an underserved neighborhood

Theme of defense: Defendant was a conscientious
doctor who provided high quality care
• Defense expert: board certified in
anesthesiology and pain management and a
founding member of the New York Pain
Society.
• Testified with respect to every charged
prescription that it was consistent with
effective and conscientious medical practice.

Countering the theme of the defense
• People’s expert: Board certified in
anesthesiology and pain management,
Associate Professor of Anesthesiology,
Medical Director of Pain Management.
• Testified that patient records lacked a “work-
up,” and often lacked any imaging or records
from or referral letters from other doctors.
• No demonstration that defendant was
actually practicing medicine.

Countering defense theme
(“Defendant provided high-quality
medical care…”)
(Patient had recently had gastric bypass and
large weight loss)

Countering defense theme, cont’d.
• Doctor added fictitious vital signs to records
before submitting to OPMC

Countering defense theme, cont’d.
Fictitious vital signs:

“Narcotic agreements” were window-
dressing

Defense arguments at trial
• Patients lied to the doctor (e.g. claimed to be
in serious pain) and doctor believed them
• Doctor often began patients with dosages
lower than they reported on intake, and
sometimes suggested tapering schedules
• Patients took drugs other than as directed
and were multi-sourcing
• Other doctors prescribed in equal or greater
doses to these patients

Meeting the Defenses
“The patients lied…”
Counterargument: While patients did indeed
lie to the defendant, it is clear that the
defendant knew they were lying, or was at
least profoundly indifferent.

Alterations refute defense that doctor
was deceived by patients

Alterations refute defense that doctor
was deceived by the patient

Meeting the defenses
“The patients were multi-sourcing…”
The evidence demonstrated that defendant
was aware of the multi-sourcing, and yet
continued to prescribe.

Defendant prescribed in the face of
outrageous muti-sourcing

“The doctor used tapering schedules”

Counterargument: the Doctor routinely
ignored his own tapering schedules

Tapering schedules were ignored
March 1, 2008 intake form: Excerpt from medical record, 2009:

“the doctor often began the patients with dosages
lower than what they had been receiving before they
came to see him”

Defense: “but often the doctor began by
lowering the dosage…”
Counterargument: where there is no physical
examination, only a cursory patient
interview, and no attempt to diagnose the
genesis of the pain, there is no practice of
medicine, even if the prescription is for
slightly lower dosages than the patient
claimed to be receiving.

Verdict
• Defendant convicted on 198 out of 211
counts:
– 2 counts of Manslaughter in the Second Degree
– 3 counts of Reckless Endangerment in the First
Degree
– 3 counts of Reckless Endangerment in the Second
Degree
– 170 counts of Criminal Sale of a Prescription for a
Controlled Substance

Verdict, cont’d…
– 1 count of Scheme to Defraud in the First Degree
– 2 counts of Grand Larceny in the Third Degree
– 9 counts of Falsifying Business Records in the First
Degree
– 8 counts of Offering a False Document for Filing

Newsday, July 19, 2014
• “Substance abuse experts praised the
verdicts. ‘I hope this sends a message to
other physicians,’ said Dr. Jeffrey Reynolds of
the Family and Children’s Association in
Mineola. ‘…Long Island is wrestling with a
profound prescription drug crisis, which is
fueled in large part by a small number of
overprescribing doctors.’”

PROSECUTING A DOCTORPROSECUTING A DOCTOR
FOR MURDERFOR MURDER

SEPTEMBER 2007 TO MAY 2010 (LESS THAN 3 YEARS)SEPTEMBER 2007 TO MAY 2010 (LESS THAN 3 YEARS)
PC 187
PC 187
PC 187
PC 187
PC 187
PC 187

FELONY MURDER
+The unlawful killing of a human being,
+Whether intentional, unintentional, or
accidental,
+Which occurs during the commission
or attempted commission of felony,
+When the perpetrator had the specific
intent to commit that specified felony
= MURDER

FELONY MURDER
+The unlawful killing of a human being,
+Whether intentional, unintentional, or
accidental,
+Which occurs during the commission
or attempted commission of felony,
+When the perpetrator had the specific
intent to commit that specified felony
= MURDER
CALIFORNIACALIFORNIA
OVER-PRESCRIBING STATUTESOVER-PRESCRIBING STATUTES

EXPRESSMALICE
IMPLIEDMALICE
IINTENDTOKILLSOMEONE
IINTENDTODOSOMETHING
THATIKNOW
CANKILLSOMEONE
ANDIDON’TCARE
MURDERMURDER MURDERMURDER
-------------------------
-------------------------

SECOND DEGREE MURDER
DANGEROUS TO LIFE
1. The killing resulted from an intentional act,
2. The natural consequences of the act are
dangerous to human life, and
3. The act was deliberately performed with
knowledge of the danger to, and with conscious
disregard for, human life.
• When the killing is the direct result of such an act, it is notWhen the killing is the direct result of such an act, it is not
necessary to prove that the defendant intended that thenecessary to prove that the defendant intended that the
act would result in the death of a human being.act would result in the death of a human being.

DR. WALTER STRAUSERDR. WALTER STRAUSER
THE STANDARD OF CARETHE STANDARD OF CARE
“THE LEVEL OF SKILL, KNOWLEDGE AND
CARE IN DIAGNOSING AND TREATING
THAT A REASONABLY PRUDENT
PHYSICIAN WOULD EXERCISE IN SIMILAR
CIRCUMSTANCES.”
THE SAME STANDARD OF CARE APPLIES TO ALL
PHYSICIANS
AN EXTREME DEPARTURE FROM THE STANDARD OF
CARE:
GROSS NEGLIGENCE AND LACK OF SCANT CARE

THE UNDERCOVER OPERATIONS
SPECIAL AGENT STEPHANIE MORELANDSPECIAL AGENT STEPHANIE MORELAND APRIL 25, 2008APRIL 25, 2008
• TOLD DEFENDANT SHE NEEDED SOMETHING FOR CRAMPS
AND A HEADACHE
• TOLD THE DEFENDANT SHE WAS COMING FROM OCEANSIDE
• NO PHYSICAL EXAM WAS GIVEN
• DEFENDANT SAID SHE WOULD PRESCRIBE VICODIN TO TAKE
THE EDGES OFF

CONDITIONS INSIDE THE CLINIC
DR. TU’S OFFICE
DR. TSENG’S OFFICE

GLORIA RODRIGUEZGLORIA RODRIGUEZ
DEMOGRAPHIC OF PATIENTS CHANGED
OVER TIME:
•YOUNG KIDS 18 TO 25
•WHITE
•NOT FROM THE AREA
• A LOT CAME FROM ORANGE OR
RIVERSIDE COUNTIES
•TATTOOS
•SOMETIMES WERE ANXIOUS OR
AGITATED
WAIT TIME CHANGE FROM AN HOUR TO TWO OR
THREE HOURS
RECEPTIONISTRECEPTIONIST

GLORIA RODRIGUEZGLORIA RODRIGUEZ
CASH INCREASED FROMCASH INCREASED FROM
$500-$600 PER DAY$500-$600 PER DAY
TO $2,000 SOMETIMESTO $2,000 SOMETIMES
$3,000 PER DAY$3,000 PER DAY
““They’re druggies, theyThey’re druggies, they
can wait.”can wait.”
PER ADVANCED CAREPER ADVANCED CARE
AAA TAX RETURNSAAA TAX RETURNS
2007-20102007-2010
+ $5,000,000+ $5,000,000

SOME PATIENTS HAD BLANK
RECORDS IN 2010 THEN HAD
COMPLETED RECORDS IN 2012STEVEN OGLESTEVEN OGLE
2010 2012

SOME PATIENTS HAD NO TREATMENT
RECORDS AT ALL

CREATING A CAPTIVE AUDIENCECREATING A CAPTIVE AUDIENCE
MICHAEL COOK: WITHDRAWAL IS HELL. THE BODY GETS WEAKER
AND THE TOLERANCE GROWS. IT’S AN EQUATION FOR DISASTER.
JUSTIN SMITH: WOULD WAIT 2-3 HOURS EACH TIME BECAUSE HE
NEEDED TO GET HIS MEDICATION. WHEN YOU ARE ADDICTED, YOU
DON’T REALLY CARE WHAT YOU TAKE OR WHAT YOU DO. IF IT
MAKES YOU NORMAL OR HIGH, THEN IT WORKS. AND THERE IS A
RISK OF DYING ALMOST EVERY DAY.
LANA RAU: FELT LIKE SHE WAS GOING THROUGH WITHDRAWALS
EVERY MORNING AND NEEDED THE MEDICATION JUST TO FEEL
NORMAL.
ALEXANDER HUY: HE WOULD WAIT UP TO 6 HOURS JUST TO GET
HIS PRESCRIPTION.

20072007 20082008
20092009
20102010
STAVRONSTAVRON
DEATHDEATH
LATHAMLATHAM
DEATHDEATH
COOKCOOK
OVERDOSEOVERDOSE
KENNEYKENNEY
DEATHDEATH
NGUYENNGUYEN
DEATHDEATH
OGLEOGLE
DEATHDEATH
KATSNELSONKATSNELSON
DEATHDEATH
CHAMBERSCHAMBERS
DEATHDEATH
GOMEZGOMEZ
DEATHDEATH
HUGGARDHUGGARD
DEATHDEATHROVEROROVERO
DEATHDEATHBENDERBENDER
DEATHDEATHMATAMATA
DEATHDEATH
TIMELINETIMELINE APPRECIATIONAPPRECIATION
OF THE RISKOF THE RISK

DR. EZEKIEL FINKDR. EZEKIEL FINK
IMPACT OF NOTIFICATION OF AIMPACT OF NOTIFICATION OF A
PATIENT DEATH ON THE PRACTICEPATIENT DEATH ON THE PRACTICE
OF MEDICINEOF MEDICINE
““I THINK THAT A PATIENT DYING IN ONE’SI THINK THAT A PATIENT DYING IN ONE’S
CARE WOULD HAVE A PROFOUNDCARE WOULD HAVE A PROFOUND
IMPACT AND WOULD MAKE ME GO BACKIMPACT AND WOULD MAKE ME GO BACK
AND TRY TO FIGURE OUT IF THERE WASAND TRY TO FIGURE OUT IF THERE WAS
SOMETHING THAT COULD HAVE BEENSOMETHING THAT COULD HAVE BEEN
DONE DIFFERENT TO PREVENT THATDONE DIFFERENT TO PREVENT THAT
DEATH.”DEATH.”
““DIDN’T CREATE AN ISSUE IN THE OFFICE. WASDIDN’T CREATE AN ISSUE IN THE OFFICE. WAS
AN ORDINARY CALL, MOSTLY FYI.”AN ORDINARY CALL, MOSTLY FYI.”
Dr. Gene Tu

MATTHEW STAVRONMATTHEW STAVRON
BRUCE STAVRON:
•DRUG USE BEGAN AT 15 YEARS OLD
•WAS UNDER THE INFLUENCE 30-40% OF
THE TIME
•COULDN’T SEND HIM TO REHAB
BECAUSE IT HE DIDN’T HAVE THE
RESOURCES
•PRIOR TO HIS DEATH, MATTHEW WAS
IN THE BEST HEALTH BRUCE HAD SEEN
HIM

EXTREME DEPARTUREEXTREME DEPARTURE
FROM THE STANDARD OF CAREFROM THE STANDARD OF CARE
IN EVALUATING PRIOR TOIN EVALUATING PRIOR TO
PRESCRIBING CONTROLLEDPRESCRIBING CONTROLLED
SUBSTANCESSUBSTANCES STRAUSERSTRAUSER
2 DAYS
2 DAYS
SEPTEMBER 16, 2007SEPTEMBER 16, 2007

VICTORIA REICHARTVICTORIA REICHART::
She had concerns of drug seeking.She had concerns of drug seeking.
Said Stavron had an injury but did not knowSaid Stavron had an injury but did not know
the source of the injury.the source of the injury.
DECEASED
DECEASED

DECEASED
DECEASED
ANDERSONANDERSON
CAUSE OF DEATH: OXYCODONE WAS TOXICCAUSE OF DEATH: OXYCODONE WAS TOXIC

RYAN LATHAMRYAN LATHAM
MARK LATHAM:
•HIS SON BEGAN TO USE VICODIN
AFTER HE BROKE HIS JAW IN JANUARY
2007
•HIS PERSONALITY CHANGED AND HE
WAS LETHARGIC AND LISTLESS
•LIFE TOOK AN UPSWING AND HE WENT
BACK TO COLLEGE
•PRIOR TO HIS DEATH, HE’D BEEN IN A
FIGHT DEFENDING HIS FRIEND

6 DAYS
6 DAYS
MARCH 25, 2008MARCH 25, 2008

KELLY RALPHKELLY RALPH::
Had back pain with unknown source but appearedHad back pain with unknown source but appeared
to be a sports injury.to be a sports injury.
Thought 5 hydrocodone per day was safe.Thought 5 hydrocodone per day was safe.
DECEASED
DECEASED

DECEASED
DECEASED
ANDERSONANDERSON
CAUSE OF DEATH: HYDROCODONE WAS A TOXIC LEVELCAUSE OF DEATH: HYDROCODONE WAS A TOXIC LEVEL

MICHAEL COOKMICHAEL COOK
It never took long in the exam room and no
physical exam was done. Started adding
prescriptions to what I wanted. Overdosed 3
times in 2 days, the last time
in the restroom at AAA.

MICHAEL COOKMICHAEL COOK
Went to clinic on April 25, 2008.
Patient’s screen was positive
for opiates. Doctor said he’d taken
6 Opana yesterday.
MATTHEW BRIONESMATTHEW BRIONES

NAYTHAN KENNEYNAYTHAN KENNEY
ERIN WHITNEY:
•DOCTOR’S RECEPTION AREA LOOKED
LIKE A PAROLE OFFICE
• PEOPLE IN THERE HAD LOTS OF
TATTOOS
• DRUG DEALING AND PEOPLE
EXCHANGING NUMBERS
• 2 TO 3 PEOPLE IN EACH EXAM ROOM
•SHE RECEIVED PRESCRIPTIONS FROM THE
DEFENDANT WITH NO EXAM, NO X-RAYS

4 DAYS
4 DAYS
SEPTEMBER 16, 2008SEPTEMBER 16, 2008

STRAUSERSTRAUSER
No medical record except date of
visit, blood pressure and pulse or no
examination of the patient while
giving controlled substances is an
Extreme Departure from the standard
of care. It falls outside the scope of
practice.

DECEASED
DECEASED
ANDERSONANDERSON
CAUSE OF DEATH: OXYCODONECAUSE OF DEATH: OXYCODONE
AND METHADONEAND METHADONE
BOTH AT TOXIC LEVELSBOTH AT TOXIC LEVELS
OXYCODONE IN THE “HIGHER ECHELON” OF TOXICOXYCODONE IN THE “HIGHER ECHELON” OF TOXIC

VU NGUYENVU NGUYEN
VIET NGUYEN:
•DID NOT KNOW OF ANY MEDICAL
CONDITIONS AS TO WHY HIS BROTHER
WOULD BE ON PAIN KILLERS
NISHA ANAYA:
•VU WAS NOT IN VISIBLE PAIN—HE WAS
YOUNG AND HE WORKED HARD
SAMANTHA NGUYEN:
•KNEW OF NO MEDICAL OR
PSYCHOLOGICAL REASONS FOR HIM TO
GET PRESCRIPTIONS

VU NGUYENVU NGUYEN
FEBRUARY 7, 2009FEBRUARY 7, 2009

VU NGUYENVU NGUYEN
DECEASED
DECEASED
21 DAYS
21 DAYS

DECEASED
DECEASED
VU NGUYENVU NGUYEN
STRAUSERSTRAUSER
REFILLED HIS MEDICATION EARLY
CHANGE HIS NORCO TO OPANA WHICH IS
3 TIMES STRONGER
PRESCRIBED HIM TWO SHORT ACTING
OPIOIDS AT THE SAME TIME. THAT DOESN’T
MAKE PHARMACOLOGICAL OR CLINICAL
SENSE.
NOTICE TO THE DEFENDANT THAT HER PATIENTSNOTICE TO THE DEFENDANT THAT HER PATIENTS
ARE ABUSING THEIR MEDICATIONARE ABUSING THEIR MEDICATION

DECEASED
DECEASED
VU NGUYENVU NGUYEN
ANDERSONANDERSON
CAUSE OF DEATH: OXYMORPHONE, WITHCAUSE OF DEATH: OXYMORPHONE, WITH
METHADONEMETHADONE
AND ALPRAZOLAM AS CONTRIBUTORSAND ALPRAZOLAM AS CONTRIBUTORS

DECEASED
DECEASED
VU NGUYENVU NGUYEN
ERICA ARELLANO:
He was always seeking more medications and stronger
dosages. Never prescribed methadone but thought that
he was drug seeking with other physicians.

STEVEN OGLESTEVEN OGLE
ELISSA OGLE:
•LIVED WITH HER BROTHER-IN-LAW IN PALM SPRINGS.
DROVE 1 HOUR AND 10 MINUTES ONE WAY TO SEE
THE DEFENDANT
•CONFRONTED STEVEN ABOUT HIS DRUG USE WHEN
HE APPEARED UNDER THE INFLUENCE
•HE SAID HE WAS GOING TO CONTINUE TO USE IT
BECAUSE IT WAS PRESCRIBED BY HIS DOCTOR
•ON THE LAST VISIT TO AAA, SAW SOMEONE LEAVE
THE RESTROOOM AND THERE WAS SMOKE AND A
DISCARDED SYRINGE IN THE TRASH

APRIL 7, 2009APRIL 7, 2009

2 DAYS
2 DAYS DECEASED
DECEASED

DECEASED
DECEASED
FINKFINK
THE AMOUNT OF MEDICATION OGLE
CLAIMED TO BE TAKING WAS
OUTRAGEOUS.
WITH A PATIENT LIKE THIS, YOU HAVE TO MAKE SURE YOU ARE IN
THE RIGHT PLACE BECAUSE IT’S GOING TO BE THE LAST
APPOINTMENT THEY EVER HAVE WITH YOU IF YOU DON’T TREAT IT
WITH THE RIGHT SERIOUSNESS.

DECEASED
DECEASED
ANDERSONANDERSON
CAUSE OF DEATH: METHADONE WAS A TOXIC LEVELCAUSE OF DEATH: METHADONE WAS A TOXIC LEVEL

JOSEPH ROVEROJOSEPH ROVERO
JOSEPH ROVERO JR.:
•DID NOT KNOW OF ANY NEED FOR HIS SON TO TAKE
PRESCRIPTIONS FOR ANY PHYSICAL OR
PSYCHOLOGICAL NEED.
•SPOKE TO JOEY IN DECEMBER ON HIS WAY HOME
AND HE SAID HE WAS DOING SOME GUY A FAVOR.
ONLY TIME HE HEARD JOEY SLURRING HIS WORDS.
DAVID LOVE:
•WORKS FOR THE MARICOPA COUNTY MEDICAL
EXAMINER’S OFFICE.
•CONTACTED THE DEFENDANT FOR JOEY’S MEDICAL
RECORDS AND SHE INITIALLY REFUSED TO SEND HIM
MEDICAL RECORDS BECAUSE SHE HAD ONLY
TREATED HIM ONCE AND DIDN’T HAVE MANY
RECORDS.

THE ARIZONA CONNECTIONTHE ARIZONA CONNECTION
361 MILES

DECEMBER 9, 2009DECEMBER 9, 2009

DECEASED
DECEASED
DECEMBER 18, 2009DECEMBER 18, 2009
9 DAYS
9 DAYS

ANDERSONANDERSON
CAUSE OF DEATH: OXYCODONE IN A LEVEL FORCAUSE OF DEATH: OXYCODONE IN A LEVEL FOR
A NAÏVE USER THAT WOULD BE LETHAL IFA NAÏVE USER THAT WOULD BE LETHAL IF
COMBINED WITH ALCOHOL (.10 -- .13)COMBINED WITH ALCOHOL (.10 -- .13)
DECEASED
DECEASED

DECEASED
DECEASED

LANA RAULANA RAU
OCTOBER 5, 2009OCTOBER 5, 2009

LANA RAULANA RAU
Went to Dr. Tseng for pain medication.
Paid $110 for each visit. One payment
for her and one for Joseph.
Sometimes she would wait for Dr.
Tseng in the storage room when she
was in a hurry. Was coming in every 6
days and was taking up to 70 pills a
day. Dr. Tseng would write
prescriptions under Joseph’s name at
her request. He was not there with her
when she asked for this.

LANA RAULANA RAU
FINKFINK
Was taking twice the
amount of a toxic dose
of acetaminophen every
day.
Writing prescriptions for Lana
Rau under the name of Joseph
Rau is exceptionally bizarre
behavior. I just can’t wrap my
head around it. I have only seen
this in my career once, right now.
I’m never going to see this again.

LANA RAULANA RAU
20072007
20082008
20092009

SEPTEMBERSEPTEMBER
20082008
KENNEYKENNEY NGUYENNGUYEN
MARCHMARCH
20092009
5 ½ MONTHS5 ½ MONTHS 4 WEEKS4 WEEKS
OGLEOGLE
APRILAPRIL
20092009
KATSNELSONKATSNELSON
APRILAPRIL
20092009
8 DAYS8 DAYS
ROVEROROVERO
DECEMBERDECEMBER
20092009
8 MONTHS8 MONTHS
PATTERNPATTERN
APPRECIATION OF THE RISK/CONSCIOUS DISREGARDAPPRECIATION OF THE RISK/CONSCIOUS DISREGARD

Web only rx16 len-tues_330_1_kougasian-sakacs_2niedermann

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Web only rx16 len-tues_330_1_kougasian-sakacs_2niedermann

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