Medical Ethics – Physician Goes to Jail for Pain-killer Prescriptions

There is an image from the Los Angeles Times from February 5, 2016 that is very disturbing to me. It is a physician, Dr. Hsiu-Ying “Lisa” Tseng who is sitting in a courtroom dock in a Los Angeles. She is an M.D., and only 46 years of age. She is wearing a blue prisoner’s outfit that says “County Jail,” and her hands are bound in chains. She has just been sentenced for 30 years for second-degree murder.  This is Medical Ethics gone wrong!

She prescribed painkillers that ultimately killed three patients who overdosed. It is said she not only failed patients to supervise patients with addictive personalities but she blamed everyone other than herself for their deaths. She blamed the patients, she blamed the pharmacists and she even blamed other doctors; she never blamed herself.  Every choice has a consequence and in the medical ethics world the mirror reflects the one looking in it.  In this case Dr. Hsiu-Ying Tseng.

Dangerous combinations

One of her patients, an alcohol and drug abuser mixed the “blindly prescribed” pain-killers with Xanax and alcohol. She felt no remorse. In fact, on numerous occasions the coroner was said to have called her office with the message that her patients died. She was even said to have prescribed twice as many painkillers as needed to patients by including the names of family members in addition to the patients on prescriptions for pain-killers.

The case of “Lisa” Tseng, M.D. has rippled through the entire medical community, and physicians are scared that they could potentially be arrested for murder for prescribing pain-killers. I think it’s a bit of an overreaction and I also believe that most patients and their physicians know that, however when considering the issue of medical ethics the bar is set high.

There are situations where drugs such as oxycodone must be prescribed. There are indeed patients who suffer from intractable pain or following surgery where there is intense, acute pain that must be controlled. However, when a patient is prescribed strong, narcotic-like pain-killers, they are supervised and the physician understands who is receiving them – and why.

Ethically, the arrest of Dr. Tseng for murder does evoke some important issues that we should discuss.

• Overwhelmed physicians – In my conversations with many M.D.’s, I have been shocked as to how little time insurance providers will allow physicians to spend with each patient. In many cases, it can be as little as seven minutes! From a clinical point of view, I suppose it is enough time to view major organ systems and get blood tests but what about the psychological make-up of the patient. Is he a drug and alcohol abuser? Is she clinically depressed? How would a physician know that if the only exposure is once a year for five minutes?
• Pain – Numerous studies show the rise in painkiller abuse across the United States. On average, it is about 83 prescriptions per 100 patients. In some states for example, Alabama it is more than 100 painkiller prescriptions for every 100 patients. In 2012, something like 43 patients died each day from prescription narcotic overdoses. How did we get to this point? Have we gotten so afraid of “our pain” that we can’t imagine being in any pain? Sorry to say this, but have a percentage of us become wimps? What of physicians who say “no?”
• Lack of Empathy – Has medical science swung so far in the direction of computer modeling and communications, analytics and digitized results that the medical community is being forced from empathy to dispassion? It is a question worth asking. How distant are patients becoming from their healthcare providers? Is the distance to the point where even when a patient who believes she/he has an addiction problem feels too far removed from their physician to confide that they have the problem?

Is there a system in place that subtly encourages some patients to become or to continue being abusers? Ethically, it is a question well worth asking.

Where do we go from here?

The questions I raise above are only the tip of the iceberg. Indeed, as we discuss this we might ask how the pharmaceutical industry itself is progressing with research that might better address pain-killer addiction. Are there new therapies that are as effective? This, we don’t know. Then there is the most troubling question of all: are drugs such as oxycodone so inexpensive to produce, and so profitable, that despite the “casualties,” they still make them the very best choice?

One thing is clear to me, far more than research, or treatments; insurance issues or addictions, the need for ethical training and an ethical examination of the issues must be implemented as soon as possible. This must be done at every level of the healthcare/patient continuum. It must start now.