NEW YORK (AP) — One patient died of an overdose after getting a prescription for scores of painkillers and anti-anxiety medications despite telling the doctor he was taking the drugs faster than intended, prosecutors said Wednesday as the physician's manslaughter trial opened. Another patient was prescribed dozens of pills three times in five weeks before he took too many and died, slumped over one of the bottles. A third patient overdosed five times but survived and kept getting scripts, prosecutors said.
Dr. Stan Li, who also prescribed to a man who killed four people while robbing a Long Island pharmacy, ignored warning signs so he could cash in on selling prescriptions to addicts, authorities said.
The manslaughter case — believed to be the first in New York against a doctor in an overdose death — illustrates the growing reach of criminal prosecutions against physicians amid concerns about prescription drug abuse.
Li saw as many as 90 patients a day in a weekend storefront clinic that charged on a per-prescription scale, putting "money before lives," prosecutor Charlotte Fishman said in an opening statement.
But Li's lawyer portrayed a conscientious physician who tried to assuage chronic pain and ended up getting arrested because patients misled him and misused medications without his knowledge.
"Doctors are not trained to be police officers. They're not trained to be detectives," attorney Raymond Belair told jurors.
Amid spiking painkiller abuse and overdose deaths, law enforcement officials around the country have used criminal laws to pursue doctors suspected of acting as drug dealers with prescription pads. While it's difficult to get a full, current picture of cases in federal courts and 50 states, a 2008 study in the medical journal Pain Medicine counted 335 such cases nationwide between 1998 and 2006.
Manslaughter — sometimes, even murder — charges are uncommon, but some have grabbed headlines.
Perhaps most notoriously, former cardiologist Conrad Murray was convicted of involuntary manslaughter for allegedly giving pop superstar Michael Jackson a lethal dose of the anesthetic propofol as a sleep aid in 2009.
A Des Moines physician is set to go on trial soon on involuntary manslaughter charges stemming from the overdose deaths of 10 patients, including Paul Gray, a founding member of the metal band Slipknot. A former Oklahoma City doctor was charged in January with murder in nine deaths: eight overdose victims and one who died in a car accident caused by one of his patients.
Authorities say they bring criminal charges only against egregious offenders. Still, such cases have spurred some debate over whether they chill prescribing of needed medications or unfairly punish doctors who get deceived by addicts.
Li, 60, of Hamilton, N.J., faces manslaughter charges in two deaths, plus reckless endangerment connected to two other deaths and several other patients who survived.
Joseph Haeg, 37, already had a painkiller problem when he went to Li, who wrote him prescriptions for a total of nearly 800 tablets of the powerful painkillers oxycodone and Percocet and the anti-anxiety drug Xanax within a month and a half, said Fishman, of the city Special Narcotics Prosecutor's office. Haeg told Li he was running through his supply faster than he should have, but Li renewed his prescription Dec. 26, Fishman said. Haeg was found dead of an oxycodone overdose three days later, after failing to show up to play Santa Claus at a family holiday party.
Other doctors called Li to tell him each of the five times that Elizabeth Cranmore overdosed on medications, but he kept prescribing her more despite knowing she was sometimes suicidal, Fishman said. Nor did Li quit issuing scripts to Grace Papazian after her relatives wrote to him that she was trading the pills for heroin, or even after her father went to Li's office to implore him to stop, Fishman said.
"Dr. Li knew what his patients were doing," but he overlooked it to make at least $450,000 two years from his Queens clinic, on top of his six-figure salary as a New Jersey hospital anesthesiologist, the prosecutor said.
The defense said Li wasn't enabling addiction but rather treating people who often had become physically dependent on pain medications. He often reduced dosages other doctors had prescribed, Belair said. He also issued "narcotics contracts" obliging patients to take the pills as ordered and sometimes stopped treating patients who didn't, Belair said.
"He didn't sell prescriptions. He saw a patient in pain, and he continued to prescribe," Belair said.
Li, who trained in his native China and in the United States, also faces charges of selling prescriptions to patients including David Laffer, who shot and killed two employees and two customers while holding up a Long Island pharmacy for painkillers in June 2011. Laffer pleaded guilty to murder and is serving a life sentence.