A state appeals court panel Friday upheld a former Rowland Heights osteopathic doctor’s second-degree murder conviction for the prescription drug overdose deaths of three of her patients within less than a year.

The three-justice panel from California’s 2nd District Court of Appeal found that there was “overwhelming evidence” of Hsiu-Ying “Lisa” Tseng’s “knowledge of risk and reckless indifference to her patients’ lives in her prescribing practices to support her convictions.”

Tseng was convicted in October 2015 of three counts of second-degree murder stemming from the deaths of Vu Nguyen, 28, of Lake Forest; Steven Ogle, 24, of Palm Desert; and Joseph Rovero III, a 21-year-old Arizona State University student from San Ramon, between March and December 2009.

Tseng, who was the first doctor in California to be charged with murder for the deaths of patients given prescriptions for drugs, was also convicted of 19 counts of unlawful controlled substance prescription and one count of obtaining a controlled substance by fraud.

“The record discloses overwhelming evidence that Tseng’s treatment of Nguyen, Ogle, Rovero and other patients was well below the standard of care in the practice of medicine and prescribing opioid medications,” the panel found in its 45-page ruling.

“As a licensed physician, Tseng had expert knowledge of the life-threatening risk posed by her drug prescribing practice. She knew that the drugs she prescribed were dangerous and that the combination of the prescribed drugs, often with increasing doses, posed a significant risk of death,” the appellate court justices wrote, in rejecting the defense’s claim that there was insufficient evidence to support her murder convictions.

The panel also rejected the defense’s contention that jurors should not have heard about the deaths of six other of Tseng’s patients — for which she was not charged, noting that evidence about those deaths “helped the jury assess Tseng’s level of awareness of the risk in determining whether, at the time of the murders, she acted with conscious disregard for human life.”

The justices noted that Tseng was aware of the overdose deaths of two of her earlier patients before she started treating Nguyen and learned of the death of a third patient while she was treating Nguyen, and that a comparison of patient records seized in 2010 and 2012 showed that she had altered patient records while she was under investigation.

Tseng was sentenced in February 2016 to 30 years to life in state prison, with Los Angeles Superior Court Judge George G. Lomeli saying then that Tseng was “responsible in part, no matter what she may state, for the tragic deaths of three men.”

The judge called Tseng’s conduct ”reckless” and said he found it “egregious” that the highly educated doctor continued her prescribing practices after getting “ample warnings” about deaths of patients that she had treated. Lomeli said Tseng sought to “put the blame on someone else,” including her patients, other doctors and pharmacists who filled the prescriptions.

In a brief statement before she was sentenced, the former osteopathic doctor said she wanted to apologize to the patients and their family members and would do everything she could to “take responsibility.”

“No words can really properly describe the sadness and remorse that I feel, and I cannot imagine what you have gone through,” Tseng said. “It’s very tragic for anyone who suffered such great loss, but most especially tragic for those who lost their children and their siblings. I know I cannot turn back the clock.”

In a more detailed letter to the judge, Tseng said she wanted him to “understand how shameful and remorseful I feel as a result of having broken all the professional rules and standards while practicing medicine and having my treatment and prescriptions be part of my patients’ addictions.”

She wrote that she realized she was in denial over her prescribing practices and their effects and knows she was not properly trained in addiction medicine or pain management and for writing pain management prescriptions.

“I know that being remorseful for my failures as a doctor and as a person does not reverse time or does not help the families heal their grief,” Tseng wrote. “I would like to think that the past four years in county jail in solitary lockup 23 hours a day has helped me partially earn the right to write about my remorse.”

Tseng also noted in the letter that she offered to enter a plea before trial in exchange for a 20-year term that would give her hope in getting out of prison to see her two children — who were then 8 and 11 — and other family members, but that no such deal was worked out.

Tseng’s trial attorney, Tracy Green, told the judge that her client had “taken a lot of responsibility in this case,” but she said it was “not fair in this case to blame her (Tseng) solely.”

“Lisa Tseng is here as one piece of a puzzle that affected a lot of individuals’ lives,” Green told the judge, noting that the prescriptions were filled by pharmacies and that some of Tseng’s patients were seeing other doctors, as well.

Deputy District Attorney John Niedermann told the judge he was “flabbergasted that even to this day the defense is trying to shift (the) blame.”

The prosecutor said Tseng had received calls from coroner’s officials about the deaths of some of the patients she had seen, along with fielding calls from family members who had told her not to prescribe to or to see their loved ones.

Rovero’s mother, April, formed a national coalition against prescription drug abuse after her son’s death.

Attorney Larry Eisenberg handled eight wrongful death lawsuits against Tseng that have been settled. He called the sentence “exceedingly fair,” saying then that there “were no true mitigating factors in this case. Dr. Tseng had to know what she was doing, and what she actually did through her conduct was she perpetuated the addiction of her patients, both physically and emotionally.”

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