Doctor Charged With Murder for Patient Overdose

Last Updated on: 14th December 2025, 10:50 pm

Doctor Charged With Murder for Patient Overdose

If one of your patients has died from an overdose of medications you prescribed, you need to understand something that will fundamentally change how you think about your situation. You may face murder charges. Not malpractice. Not negligence. Murder – the same charge that applies to someone who takes a gun and intentionally kills another human being.

This is not theoretical. Doctors across the country have been charged with murder for prescribing opioids to patients who later died. Some have been convicted and sentenced to decades in prison. The first doctor convicted of murder for prescription deaths, Dr. Hsiu-Ying “Lisa” Tseng of California, received a sentence of 30 years to life. She will die in prison unless she is paroled – for writing prescriptions to patients who came to her office seeking pain relief.

The legal theory that makes this possible is called “implied malice” or “depraved indifference to human life.” Prosecutors do not have to prove you wanted your patients to die. They only have to prove that you acted with conscious disregard for human life – that you knew or should have known your prescribing practices could kill people, and you kept prescribing anyway. When patients die, juries often find that standard was met.

When Prescriptions Become Murder Weapons

Heres the paradox that every prescribing physician needs to understand. The same opioid prescription that is legitimate medicine when given appropriately becomes a murder weapon when prosecutors convince a jury it was given recklessly. The drug itself dosent change. The patient dosent change. The only thing that changes is how the jury interprets your intent.

Dr. Lisa Tseng wrote prescriptions for hydrocodone, oxycodone, and other controlled substances. Her patients came to her complaining of pain. She examined them. She wrote prescriptions. At least twelve of her patients died from overdoses involving drugs she prescribed.

Prosecutors argued that Tseng prescribed “crazy, outrageous amounts” of painkillers to patients showing obvious signs of addiction and drug-seeking behavior. They argued she ignored red flags. They argued she kept prescribing despite multiple patient deaths. The jury agreed. Tseng was convicted of second-degree murder for three deaths and sentenced to 30 years to life.

Heres what makes this case so significant. Dr. Tseng was the first physician in American history to be convicted of murder for prescribing controlled substances. She was not the last. Since her conviction, prosecutors across the country have brought murder charges against doctors whose patients died from overdoses.

The message is clear: if your patients die from drugs you prescribed, you may be treated as a murderer.

The Legal Standards That Can Send You to Prison for Life

Heres the system revelation that determines whether you face murder charges or lesser crimes. Murder requires “malice” – but malice dosent mean what you think it means. There are two types of malice under the law: “express malice” and “implied malice.”

Express malice is intent to kill. If a prosecutor has to prove express malice, they have to prove you actually wanted your patients to die. Thats almost impossible to prove against a doctor – no physician intends for their patients to die.

But implied malice is different. Implied malice exists when someone acts with “conscious disregard for human life.” It dosent require intent to kill. It requires only that you knew your conduct was dangerous to human life and you did it anyway.

Heres how prosecutors apply that standard to prescribing physicians. They argue that you knew – or should have known – that prescribing high doses of opioids to patients showing signs of addiction was dangerous. They argue that you continued prescribing despite warning signs. They argue that patient deaths were foreseeable. And they argue that your conscious decision to keep prescribing despite the danger constitutes implied malice.

Implied malice turns opioid prescribing into murder. You dont have to intend to kill anyone. You just have to keep prescribing when you should have known people might die.

The alternative charge is manslaughter – killing without malice. Manslaughter requires recklessness rather than conscious disregard. The distinction matters becuase manslaughter carries much lighter sentences. Dr. Barry Sloan of New York was convicted of manslaughter for patient overdose deaths and sentenced to 4-9 years. Thats still prison, but its not 30 years to life.

Why Patient Deaths Years Ago Still Put You at Risk

Heres the uncomfortable truth about timing. There is no statute of limitations on murder in most states. If a patient died from an overdose of drugs you prescribed five years ago, ten years ago, twenty years ago – you can still be charged with murder today.

The investigation may have been building for years without your knowledge. The DEA has records of every Schedule II prescription you wrote. Those records dont disappear. They sit in databases waiting for someone to connect the dots. A patient death that happened in 2015 can result in murder charges in 2025.

And heres the hidden connection that makes old patient deaths so dangerous. Prosecutors dont charge murder for a single patient death in isolation. They look for patterns. One patient death might be tragedy. Multiple patient deaths from the same doctor look like recklessness. Pattern evidence – the fact that several of your patients died from drugs you prescribed – becomes proof of implied malice.

Dr. Tseng’s jury heard about twelve patient deaths. She was convicted of murder for three. But all twelve deaths were presented as evidence of her pattern of reckless prescribing. The first death should have warned her. The second death should have stopped her. By the third, fourth, fifth death – she clearly knew her prescribing was killing people and she kept doing it anyway.

Thats how pattern evidence works. Each patient death makes the previous deaths look worse. And each death makes the next prosecution more likely.

The Pattern Evidence That Destroys Your Defense

Heres the specific number that destroyed Dr. Xiulu Ruan’s defense. His clinic wrote over 475,000 prescriptions for opioids in four years. Four hundred seventy-five thousand. Prosecutors didnt have to prove each prescription was improper. They just had to show the jury that number and let it speak for itself.

Volume becomes evidence of intent. High-dose prescribing becomes evidence of recklessness. Multiple patient deaths become evidence of conscious disregard for human life. Your own medical records – the records you created trying to document legitimate care – become the prosecution’s exhibit list.

And heres the consequence cascade that turns one patient death into multiple murder charges. A patient dies. The medical examiner finds opioids in there system. The death is reported to authorities. Investigators pull your DEA records. They see how many controlled substance prescriptions you wrote. They identify other patients. They discover more deaths.

What started as one tragic overdose becomes an investigation into your entire practice. Every patient who died while taking drugs you prescribed becomes a potential murder charge. Every high-dose prescription becomes evidence. Every refill becomes proof that you knew and kept prescribing anyway.

Dr. William Husel of Ohio was charged with 25 counts of murder for patient deaths. Twenty-five. The charges were eventually reduced to 14 counts – still fourteen separate murder charges for a single physician. Husel was ultimately acquitted, but he spent years fighting charges that accused him of being one of the most prolific murderers in American medical history.

Your patient deaths – however many there are – will be presented as a pattern. And patterns are very difficult to explain away.

What Ruan v. United States Changed

Heres the system revelation that changed the landscape for physician prosecutions in 2022. The Supreme Court’s decision in Ruan v. United States established that prosecutors must prove a physician knew there prescriptions were not authorized – not just that they should have known.

Before Ruan, prosecutors could argue that a physician was criminaly liable if there prescribing fell outside the usual course of professional practice, regardless of whether the physician believed there prescriptions were medically appropriate. After Ruan, prosecutors must prove the physician knew or subjectively believed there prescriptions were unauthorized.

This matters becuase it creates space for a “good faith” defense. If you genuinley believed your prescriptions were medically appropriate – if you genuinley believed you were helping your patients – that belief may protect you from criminal liability. The question is no longer just “was this prescription outside normal practice” but “did this physician know it was outside normal practice.”

But heres the uncomfortable truth about Ruan. Dr. Xiulu Ruan won at the Supreme Court. His conviction was vacated and his case remanded. And hes still serving 21 years in federal prison. The Supreme Court victory didnt set him free. It didnt even reduce his sentence. The good faith defense that Ruan established didnt actualy save Ruan himself.

Why? Becuase the pattern evidence against him was so overwhelming that even under the new, more favorable standard, the jury still found him guilty. 475,000 opioid prescriptions. Two patient deaths. A practice that prosecutors called a “pill mill.” Good faith only protects you if the jury believes you actualy acted in good faith. When the volume of prescriptions is high enough, juries dont believe it.

Murder Charges vs. Federal Drug Charges

Heres the hidden connection that creates double jeopardy for physicians facing patient death investigations. Murder is a state crime. Drug distribution resulting in death is a federal crime. You can face both simultaneously – and an acquittal on one does not prevent prosecution on the other.

Dr. Husel was acquitted of murder charges in Ohio state court. That acquittal protected him from state prosecution. But if federal prosecutors had charged him with drug distribution resulting in death under federal law, the state acquittal would provide no protection. Different sovereigns, different charges, different trials.

And heres the uncomfortable truth about federal drug charges. The federal charge for drug distribution resulting in death carries a mandatory minimum of 20 years in prison. If there are multiple deaths, the sentences can be consecutive. Federal prosecutors dont need to prove murder. They only need to prove illegal drug distribution and a resulting death.

So even if your state murder case results in acquittal – even if the jury finds you didnt act with implied malice – federal prosecutors can still charge you with illegal drug distribution. They can still prove that your prescriptions fell outside legitimate medical practice. They can still connect those prescriptions to patient deaths. And they can still send you to prison for decades.

The pattern evidence that failed to prove murder may still prove illegal distribution. The patient deaths that didnt rise to the level of conscious disregard for human life still constitute deaths resulting from drug distribution. You can win the murder case and lose the federal case – and spend the rest of your life in prison anyway.

Defense Strategies That Rarely Work

Heres the irony that catches physicians who think they have an obvious defense. The most common defense in these cases – that patients lied to get prescriptions – rarely works. Dr. Tseng’s lawyers argued exactly that. They said patients lied about there symptoms. They said patients hid there addiction. They said patients went to multiple doctors and multiple pharmacies.

The jury didnt care. Dr. Tseng was still convicted of murder.

Why dosent this defense work? Becuase the murder charge dosent depend on whether patients were honest. It depends on whether you should have recognized the red flags regardless of what patients told you. Prosecutors will argue that patients showing obvious signs of addiction – drug-seeking behavior, multiple prescriptions, escalating doses – should have triggered your suspicion. Prosecutors will argue that a reasonable physician would have investigated. Prosecutors will argue that you saw the signs and chose to ignore them.

The “patients lied” defense actualy confirms the prosecution’s theory. If patients were lying and you believed them, that shows you werent carefully evaluating there condition. If patients were lying and you didnt investigate, that shows you were prescribing without adequate safeguards. The defense that seems obvious actualy makes you look negligent.

Another common defense – that you were practicing compassionate medicine and genuinley trying to help patients in pain – also faces problems. Compassionate intentions dont negate implied malice. You can genuinley want to help patients and still be guilty of murder if your prescribing practices show conscious disregard for human life. Good intentions are not a defense to recklessness.

The good faith defense that Ruan established provides some protection, but only if the jury believes you. When patients are dead and prosecutors are showing years of high-volume prescribing, juries tend to be skeptical of good faith claims.

The Doctors Who Were Convicted – And What Happened to Them

The outcomes for physicians convicted of murder or related charges should terrify every prescribing doctor.

Dr. Hsiu-Ying “Lisa” Tseng – convicted of second-degree murder for three patient deaths, sentenced to 30 years to life. She was 45 years old at sentencing. Without parole, she will die in prison.

Dr. George Blatti – charged with five counts of murder in New York for prescribing from hotel parking lots and Dunkin Donuts. The case showed a physician whose practice had devolved into meeting patients in his car to write prescriptions.

Dr. Barry Sloan – convicted of manslaughter for patient overdose death, sentenced to 4-9 years. Manslaughter is a lesser charge than murder, resulting in a significantly lighter sentence.

Dr. Xiulu Ruan – convicted of drug distribution charges, still serving 21 years in federal prison despite winning at the Supreme Court. His case established the “good faith” defense standard that didnt save him.

Dr. William Husel – charged with 14 counts of murder for ICU patients who recieved high doses of fentanyl. Husel was ultimately acquitted, but only after years of legal battle that destroyed his career, reputation, and livelihood.

These cases show the range of outcomes. Murder conviction means decades in prison. Manslaughter means years in prison. Federal drug charges mean mandatory minimums. Even acquittal means years of fighting, massive legal expenses, and complete career destruction.

None of these physicians is practicing medicine today.

What You Should Do If You’re Under Investigation

If you have any reason to believe investigators are looking at patient deaths connected to your prescribing, heres what you need to do immediatley.

Get a criminal defense attorney who specializes in healthcare cases. Not a malpractice lawyer. Not a medical board defense attorney. A criminal defense lawyer who understands how murder and federal drug charges work in the context of medical practice. This is not optional. This is survival.

Do not talk to investigators without your attorney present. DEA agents may approach you. Local police may contact you. Federal agents may want to interview you. Say nothing. Every word you say can and will be used against you. The “good faith” defense requires careful presentation – you cannot establish good faith through a casual conversation with investigators.

Preserve your medical records but do not alter them. Altering records is obstruction of justice and will be used as evidence of consciousness of guilt. Your records are what they are. Changing them makes everything worse.

Understand that the investigation has probly been ongoing for longer then you know. By the time you learn your being investigated, authorities may have years of prescription data, patient interviews, and expert opinions already compiled. You are behind. You need to catch up.

Prepare for the possibility of multiple charges. State murder charges. Federal drug charges. Medical board proceedings. OIG exclusion. Each requires separate defense strategy. Each can destroy your career independantly.

Accept that your medical career may be over regardless of the outcome. Even if you are acquitted, the publicity of murder charges against a physician is career-ending. Even if you never face criminal charges, the investigation itself may result in DEA revocation and medical board action. Plan accordingly.

The patient deaths that occurred under your care are not going away. The investigation is not going away. The only question is whether you will have the best possible defense when charges are filed. Make sure you do.

The Reality You Face

Heres the uncomfortable truth about being a physician in the age of opioid prosecutions. If your patients die from overdoses of drugs you prescribed, you may be charged with murder. Not becuase you intended to kill them. Not becuase you ran a pill mill. But becuase prosecutors believe your prescribing practices showed conscious disregard for human life – and juries often agree.

The legal standards that apply to murder cases now apply to medical practice. Implied malice. Depraved indifference. Conscious disregard. These concepts from homicide law are being applied to physicians who wrote prescriptions.

You can be a caring doctor who genuinley wanted to help patients in pain. You can believe with absolute sincerity that every prescription you wrote was medically appropriate. And you can still be convicted of murder if prosecutors convince a jury that you should have known better.

Thirty years to life. Thats what Dr. Lisa Tseng got. Thats what any prescribing physician faces when patients die.

The prescription pad you use to help patients is also the instrument that prosecutors will use to send you to prison. Understand that reality. Prescribe accordingly. And if patient deaths have already occurred – if the investigation has already begun – understand that your freedom, your career, and your life are on the line.

Murder charges against doctors are real. Convictions are real. Life sentences are real. This is not a theoretical risk. This is the world you practice medicine in today.