Lisa Tseng during her arraignment in a Los Angeles court in 2012. Photo: AP

Joey Rovero was just five months from graduation. It was December of 2009 and the healthy, handsome, athletic Arizona State University senior had finished his second-to-last semester. It was time to blow off some steam.

So Rovero and his ASU frat buddies took a road trip: 580 kilometres due west. Their destination wasn't the beach or a chic Hollywood club or even a campground in the countryside.

It was a doctor's office.

Died of an overdose in Arizona ... Joey Rovero on his twentieth birthday. Photo: The Washington Post

From a small practice inside an orange strip mall, Dr Hsiu-Ying "Lisa" Tseng allegedly had earned a reputation for hastily doling out powerful drugs. And true to that reputation, she allegedly quickly prescribed Rovero more than 200 pills, including nearly a hundred 30-milligram doses of Roxycodone, a potent and addictive painkiller.

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Rovero and his friends filled their prescriptions and drove back to Tempe, their car practically rattling with pills.

Nine days later, Rovero was dead: the victim of a lethal mix of alcohol and the pills Tseng had prescribed him.

Normally, Rovero would have become a grim statistic: one of the roughly 100 Americans who die each day from a drug overdose. But Rovero's case is different.

That's because his doctor has been charged with his murder.

On Monday, Tseng went on trial in Los Angeles County Superior Court for the alleged murder of Rovero and two other young men: all patients who came to her looking for painkillers and died from an overdose shortly after. She has pleaded not guilty.

It's a high stakes case that has drawn national scrutiny and stirred a thorny debate over medical ethics. Tseng's attorneys say it wasn't her fault that patients abused their prescriptions. Some medical experts, meanwhile, have warned that a guilty verdict could have a chilling effect as good doctors shy away from prescribing needy people medications.

But for families like Rovero's, Tseng's trial is a rare chance to hold accountable the doctors enabling the addiction of thousands of Americans, and perhaps to put a dent in the scourge.

"It was basically a pill mill operation — nothing more than legalised drug dealing, when it comes down to it," Joey Rovero's mother, April, told The Washington Post on Monday night.

"What our family has been through, losing our beautiful son, has been devastating," she said. "But we are just one family of many. And there are other dirty doctors out there, over-prescribing and causing damage in catastrophic ways."

Like Rovero, prosecutors are hoping to make an example out of Tseng.

On Monday, Deputy District Attorney John Niedermann showed jurors a series of powerful photos: dead bodies of Tseng's patients next to the prescriptions she signed for them.

"He overdosed and died," Niedermann said, scrolling through photo after photo, according to the Los Angeles Times.

The prosecutor told jurors that Tseng had been notified of her first patient's death by overdose in September 2007, just two days after handing him prescriptions for Oxycodone, Xanax and Soma, according to the Associated Press. The next overdose came six months later.

More than a dozen times, officials called Tseng to tell her a patient had overdosed, Niedermann said. One overdose occurred in the hallway of her clinic.

"The defendant was repeatedly notified by law enforcement that her patients were dying on her," Niedermann told jurors, according to the AP. "The evidence will show that during this period of time, the defendant's practice of prescribing did not change at all."

According to prosecutors, Tseng routinely handed out prescriptions to patients in as little as three minutes, without a physical exam and despite evidence of addiction. The Drug Enforcement Administration says she wrote more than 27,000 prescriptions in just three years, at an average of 25 a day. Once, when Tseng's receptionist told her that the waiting room was overflowing with anxious patients, the doctor replied: "They're druggies, they can wait," Niedermann said.

Tseng has pleaded not guilty to three counts of second-degree murder for the deaths of Rovero, 21; Vu Nguyen, 28; and Steven Ogle, 25. She is also facing several other felony counts of prescribing drugs to people not in need of medication. If convicted, she faces life in prison.

Her attorney, however, painted a portrait of Tseng as a Taiwanese immigrant with good intentions who came to the United States at age 15 and specialised in infectious diseases, only to get pulled into her husband's family practice.

"She was not street-smart," attorney Tracy Green told the jury, according to the Los Angeles Times. "She just got in over her head."

Tseng wasn't trained in pain management and was only trying to treat her patients, Green said. According to the Los Angeles Times, Tseng graduated in 1996 from Michigan State University's College of Human Medicine with a degree in osteopathy.

"She was trying to help … She wasn't callous or indifferent," Green told the court on Monday, the AP reported. "Lisa Tseng did not murder those three men."

April Rovero begs to differ.

"There was a lack of human decency" on Tseng's part, Rovero told The Post. "We knew from the start that her main defense was to blame the victims … and to suggest that it was our fault that our son passed away because of the pills she gave him is ludicrous."

Tseng's case is not the first of its kind in California, but it is the first to go to trial. In 2002, another doctor was arrested and charged with murder after three of his patients overdosed. Prosecutors accused him and two pharmacists of creating a "public health epidemic with attendant abuse, addiction, overdose and death," according to the Sacramento Bee. But the murder charges were dropped.

In Florida, several doctors have also faced serious charges after patients overdosed on painkillers. In 2002, Dr James Graves was convicted of manslaughter in connection with the death of four OxyContin patients. And in 2005, a jury acquitted Dr Denis Deonarine of murdering a college student who he prescribed drugs without the proper tests, but convicted the doctor of drug trafficking. A judge sentenced him to 25 years in prison.

Another Florida doctor, Gerald Klein, is currently on trial for murder.

Rovero and her husband have played a role in bringing their son's doctor to trial. Joey had never had problems with drugs prior to his overdose, the family says, and they were startled by the pill bottles found in his Tempe apartment bedroom. So they filed a complaint against Tseng with federal officials, only to learn that the doctor was already under DEA investigation.

"He was everybody's friend," Rovero said of her son. "He was not a kid on the fringe of life. He was very vibrant and he was a part of many people's lives."

"We were a completely normal family and it still hit us," she said, referring to America's drug addiction crisis.

In August of 2010, after a series of complaints from bereaved families, Tseng was stripped of her ability to prescribe medication.

"They call me all sorts of names … drug doctor, drug-dealing doctor," Tseng said at the time.

"I prescribe based on what I know and what I feel and what I see," she told the LA Times. "If it is a new patient, there is no way for me to determine … if they are legitimate or not."

"I never intended to kill anybody."

Tseng was arrested in March of 2012 and has spent the past three years in jail awaiting trial.

April Rovero admits that she has some sympathy for the doctor. Rovero said she was saddened to see Tseng's own mother at the trial on Monday, for instance.

"I really feel bad for her," Rovero said of Tseng's mother. "As a mum, I can put myself in her shoes. We have lost our son and she has lost her daughter, too. She's seen her daughter in shackles: this woman who had such promise at one point, her little girl, now going through this disgraceful situation."

But Rovero said she still can't wrap her head around how Tseng, who has young children of her own, could so casually give Joey the drugs that would kill him.

"I remember thinking initially she can't be a mom because no mom would ever do what she's done," she told The Post. "You don't expect them to be so heartless and prescribe something that is obviously going to be so dangerous to someone else's child."

"We very much want to send a message with this trial," said Rovero, who launched a non-profit organisation to combat prescription pill addiction after Joey's overdose. "It's important that doctors that do this kind of thing are held accountable."

"There are more doctors like her out there," she said of Tseng. "They are not above the law."

The Washington Post