Substantial evidence supported physician’s three convictions for second degree murder of patients who died from drug overdoses where the physician was aware her prescribing practices posed a risk of death. Tseng, a doctor, worked in a clinic that had a reputation as a place where patients could easily obtain prescriptions for controlled substances. Between 2007 and 2009, nine of Tseng’s patients died from drug overdoses. She was prosecuted for three counts of second degree murder and found guilty. On appeal, she argued there was insufficient evidence of implied malice to sustain the convictions. Held: Affirmed. The malice required for second degree murder may be either express or implied. Implied malice exists when an intentional act naturally dangerous to human life is committed by a person who knows that her conduct endangers the life of another and who acts with conscious disregard for life. Implied malice is determined by examining the defendant’s subjective mental state to see if she appreciated the risk of her actions. As a doctor, Tseng had expert knowledge of the life-threatening risk posed by her drug prescription practices; she knew that the drugs she was prescribing for anxiety and vague pain complaints were addictive and typically only prescribed for cancer and broken bones. After several larger pharmacies refused to fill her prescriptions, Tseng directed her patients to smaller pharmacies that would fill the prescriptions. She knew the three patients at issue were “drug-seeking,” and were using drugs prescribed by other doctors, yet she failed to consult these physicians regarding the type and dosage of drugs they prescribed. She prescribed drugs in high doses and rewrote prescriptions “early” after the patients had gone through the prescriptions more quickly than prescribed. After learning of the deaths of several prior patients from drug overdoses, she continued her prescription practices, and altered her records. There was substantial evidence of implied malice to support the murder convictions.

There was sufficient evidence that defendant’s acts were the cause of her patients’ deaths. Tseng argued that the presence of other substances in two of the deceased patients’ systems constituted an unforeseen independent intervening cause of their deaths, which absolved her of criminal liability. An independent intervening cause must be unforeseeable, and an extraordinary occurrence which rises to the level of an exonerating, superseding cause. However, a defendant may be criminally liable for a result directly caused by her acts even if there is another contributing cause. Based on the expert testimony presented, the jury could reasonably conclude that the presence of other substances in the patients at the time of their deaths was not an unforeseen, independent intervening event that relieved Tseng of criminal liability for their deaths. The Court of Appeal will not reweigh the evidence and draw inferences that the jury rejected.

The full opinion is available on the court’s website here: https://www.courts.ca.gov/opinions/archive/B270877.PDF