Doctor Who Prescribed Over Internet Gets 9 Months

Dr. Christian Hageseth, a Colorado psychiatrist, was sentenced to 9 months in prison today for practicing medicine in California without a license. He prescribed Prozac to a college student in California over the internet after reviewing his online application.

His case is one of the first criminal prosecutions of a practitioner of "telemedicine," the furnishing of medical advice by phone or the Internet, for failing to have a license in the patient's state.

Two months after filling the prescription, the student killed himself. While there were trace amounts of Prozac in his system, it was later determined the prozac did not cause or contribute to his suicide. [More...]

At the time he prescribed the drug, Hageseth was allowed to practice medicine in Colorado and renew drug prescriptions, but he was not allowed to write new prescriptions.

Hageseth's lawyer says:

"Telemedicine is now dead," he said. "No doctor in his or her right mind would now pursue telemedicine unless licensed in all 50 states," which would be prohibitively expensive.

I think he's right, despite the prosecutor's disingenous attempt to makes it seem like they targeted Hageseth because he was an unqualified quack.

Deputy District Attorney Jennifer Ow said the prosecution was targeted at an illegal practitioner who "was not licensed in any state to do what he did."

What she doesn't say:

Hageseth was operating under a restricted license only because of an investigation by the medical board into whether he had an improper relationship with a patient. The patient later became his wife.

While he did have a "restricted" license during the time he prescribed the drug in question, his license was later reinstated .

Hageseth was also working with a restricted license, under investigation for having an improper relationship with a patient. Although those charges were later dropped and his license re-instated, he was not allowed to write prescriptions for anyone during the time he filled McKay's online request.

...At the time he prescribed the drug, Hageseth was allowed to practice medicine in Colorado and renew drug prescriptions, but he was not allowed to write new prescriptions. The Colorado State Board of Medical Examiner's took away his right to practice medicine in 1997 after he married Laurel Burson, who he counseled through a divorce.

The Colorado Court of Appeals reversed the board's decision in 2001 and reinstated Hageseth's medical license but still did not allow him to write prescriptions.

The Sheriff in San Mateo disputes the charges had anything to do with his Colorado license:

San Mateo Deputy District Attorney Steve Wagstaffe...said the Feb. 24 prosecution of Hageseth had nothing to do with his licensure status in Colorado but was because he practiced medicine in California without approval from the California Medical Board.

The prosecutor tries to make it sound like this wouldn't happen to another doctor in good standing in their home state, but that rings hollow. I think Hageseth's lawyer is correct....doctors have a lot to fear by engaging in telemedecine.

Here's what Dr. Hageseth has to say.

Right now depressed people still turn to the internet for antidepressant drugs. But they are likely to get drugs manufactured in a foreign country with no review by any medical professional. The need and demand for such prescriptions does not disappear simply by outlawing it in the United States.

Hageseth, who surrendered his license after this investigation began, will serve his sentence in Colorado where he's recovering from heart surgery.

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    I guess I've been living under a rock (5.00 / 1) (#1)
    by nycstray on Fri Apr 17, 2009 at 05:19:09 PM EST
    I didn't know you could prescribe online and without an exam. Telemedicine sounds ripe for abuses on both sides.

    He filled the order after examining McKay's answers on a questionnaire but without examining or contacting McKay.

    Aside from greedy, that's (5.00 / 1) (#23)
    by nycstray on Fri Apr 17, 2009 at 11:24:09 PM EST
    downright scary. One thing if I skyped with my Dr who I had an ongoing relationship with to ask questions about a new med or something else I would call the office for, whole 'nother deal that any Dr in my "network" would be willing to "take" me online for "extra income". The "as much as you want" just blows my mind. Nice to see the mention of malpractice insurance covered right up in the beginning of the "sell". We need to be encouraging office visits, not making health care an online quickie. There are many things that are caught during "unrelated" visits. Then there's also checkups and preventive care, which I can see going out the window (for some people) if online "visits" become encouraged by the insurance industry. When I was younger and in CA, all my doctors would notice some of my moles and always looked them over and gave me advice, no matter why I was there. They were all in heavy exposure areas :) That's not going to happen online, TYVM.

    We really need to get our health care back in the hands of the people, not the insurance companies.


    Agree (5.00 / 1) (#25)
    by seeker on Sat Apr 18, 2009 at 12:41:20 AM EST
    It's probably the death of irresponsible telemedicine--that which is practiced without having seen the patient in person at least once and perhaps once a year or two.

    It says nothing about responsible telemedicine--where the practitioner has seen the patient in person at least once and porobably once a year or two.


    Without a doubt. (none / 0) (#9)
    by Fabian on Fri Apr 17, 2009 at 06:48:06 PM EST
    Doctor shopping.
    Multiple prescriptions from different doctors.
    Obtaining prescription medications for illegal resale.

    A coworker once complained that she "had to" have an office visit to get her Xanax prescription refilled. (restless leg syndrome)  She hadn't seen her doctor in over a year.  I think she was just whining about the added expense and inconvenience.  

    She didn't find a sympathetic audience - we all worked in a hospital and had some understanding of the reasons why patients taking medications were monitored.  It's more than potential abuse.  There are potential complications.  Plus drugs are cleared from the body via kidneys and/or the liver, so it's important to make sure those organs are functioning properly.


    Good! (5.00 / 1) (#4)
    by Fabian on Fri Apr 17, 2009 at 05:55:29 PM EST
    Patients taking psychoactive drugs should be monitored closely.  There's a host of potential side effects, some of them quite nasty and some of them potentially fatal.

    No doctor should prescribe these drugs unless they plan on doing the proper follow up.  Prescribing drugs to unknown patients without a physical exam, with only an online questionnaire is risky.  I have no idea why any doctor would do this.  Better to refer someone to whatever resources are available locally than to prescribe medications over the internet.  

    And the doc could have contributed (5.00 / 1) (#8)
    by Cream City on Fri Apr 17, 2009 at 06:45:48 PM EST
    to the suicide specifically because the Prozac made no difference.  Patients need to be monitored to find alternatives if one isn't helping as well as for side effects.  And patients need to know to find another doc if the doc isn't working, either.

    And nothing can make someone more suicidal than to see that their appeal for help and their use of the help they get isn't helping at all.  


    Please, (none / 0) (#26)
    by seeker on Sat Apr 18, 2009 at 12:51:24 AM EST
    do not limit this to psychoactive drugs.  All prescription drugs must be monitered.

    True, some of them will become OTC as soon as the patent ends.  But that is an artifact of our patent laws.  Without a change in those laws, prescription status is the only index of potential harm we have.  


    Other drugs are prescribed (none / 0) (#30)
    by Fabian on Sat Apr 18, 2009 at 12:08:08 PM EST
    on more objective data, so it's easier to check both the diagnosis and the outcome.

    Psychoactive drugs are prescribed on more subjective information and it's harder to tell if you have the correct diagnosis and the outcome is less clear as well.  Especially drugs which have a slow onset - six weeks can be a long, long time if you are having a mental health crisis.  


    Sound like a reasonable... (5.00 / 1) (#5)
    by MileHi Hawkeye on Fri Apr 17, 2009 at 06:07:37 PM EST
    ...regulatory requirement to me.  An insurance agent is required to be licensed in every state that they solicit business (even over the internet), why should those who practice medicine be held to any less of a requirement?  

    Does Colorado law/statute not require doctors who practice medicine in Colorado be licensed here?  

    And we won't even get into the huge role personal interaction plays in the responsible, effective practice of health care.  

    Absolutely. (5.00 / 1) (#7)
    by Fabian on Fri Apr 17, 2009 at 06:16:03 PM EST
    If all a doctor is doing is writing prescriptions based on a questionnaire, then we may as well skip all the expensive training and education and create a computer program to do it.  It'd be ever so much cheaper!

    Ok, here's an interesting problem (5.00 / 2) (#11)
    by andgarden on Fri Apr 17, 2009 at 06:58:35 PM EST
    Suppose I run out of medicine while I'm away for a few months in another state. Under this rule, is it correct that my Doctor from home can't call in a prescription refill where I'm staying?

    What If I live in one city and see a doctor across the street, which happens to be in another state: do I have to get all of my Rxs filled in the Doctor's state?


    We'll assume... (5.00 / 1) (#12)
    by MileHi Hawkeye on Fri Apr 17, 2009 at 07:06:05 PM EST
    ...for argument sake that you saw your local MD to get the Rx in the first place.  The Rx would then be written in the State they are licensed and legal.  It can be refilled anywhere in the World since that is an extension of the original, legal Rx.  

    As to the border question, you would be in the State that the MD is licensed, so that too would be a valid, legal Rx.


    What happens if the prescription has run out and a (none / 0) (#14)
    by jawbone on Fri Apr 17, 2009 at 07:28:39 PM EST
    new one has to be issued? I've had that happen and had no problems, but it's sounding as if a doc get into hot water over that.

    And what will happen when we have single player, universal healthcare?


    Wouldn't that depend on if the prescription (none / 0) (#15)
    by nycstray on Fri Apr 17, 2009 at 07:42:12 PM EST
    is renewable or not? Don't they generally want to see you again if it's non renewable? Renewables should be ok to be refilled anywhere. It's been ages, but I seem to recall you just take the bottle in and they slap a new label on the refill?

    Same basic theory... (none / 0) (#16)
    by MileHi Hawkeye on Fri Apr 17, 2009 at 07:44:50 PM EST
    ...I would think.  Instead of refilling an Rx, you're essentially renewing or extending an existing one.  My PK Rx can't be refilled, I either get it mailed to me or pick it up at the Dr's office.  But I don't think there's any law prohibiting my Dr. faxing or phoning an out-of-state pharmacy.  

    As to UCH, you should still be able to have your primary care physician--or go see any provider whenever you may travel as their would be no network restrictions.  Getting an appointment might be a problem though.  Or not.  I just hope we get to find out someday.  


    Smells like drug war... (5.00 / 1) (#20)
    by kdog on Fri Apr 17, 2009 at 10:11:22 PM EST
    b.s. to me...if the guy doesn't get his drugs from this doctor he drives down to Tijuana and gets all he wants, or from a guy in his dorm.

    Of course it should be highly recommended that you see a doctor before taking mind-altering drugs, but not required...why play tyrannical games?

    The suicide is a tragedy of course, but I don't see no crime.


    He filled out a questionnaire (5.00 / 1) (#22)
    by nycstray on Fri Apr 17, 2009 at 11:09:49 PM EST
    and got a prescription. How does one decide which anti depressant is right for him? Or if he has other underlying problems (for my Dad it was Parkinson's, my niece, bi-polar)? I don't think this is drug war BS. You really can't apply that tag to everything that involves drug/medical prosecution. The Dr was using the internet to diagnose and as an alternative to visits. That's a dangerous thing to promote right there. Prescribing drugs from a questionnaire is pretty dicey also. If someone chooses to cross the border for drugs, that's their decision, but I would hope Drs would be a bit more responsible or at least have better decision making skills.

    Agreeing with you Kdog (none / 0) (#33)
    by Militarytracy on Sun Apr 19, 2009 at 08:02:28 AM EST
    My daughter and I have spoke a bit about the prevalence of some of the drugs her generation chooses to experiment the most with.  She will laughingly tell you stories about some of her more entreprenerial classmates looking up the symptoms of ADHD and then faking them in order to acquire the prescription meds, which they usually sold.  Xanax is all over the place, where the heck is all of that coming from?  They call the dosage that is bar shaped xandy bars.

    That's what I mean by... (5.00 / 1) (#34)
    by kdog on Sun Apr 19, 2009 at 08:39:35 AM EST
    "playing games", going to the doctor with a tall tale to get your drug of choice...I have no patience for playing games, so I dislike the prescription "permission slip" model.

    I enjoy an Adderall during an all-night poker session to stay awake and alert..my one buddy who works the graveyard shift went to a doc with a tall tale about falling asleep at work and having trouble concentrating to get a permission slip for those.

    The friendly Dr. Feelgood has been around as long as prescription system has been in effect...for the life of me I don't why we bother playing these games...freedom fosters more honesty and is less expensive. Prescription drug prices would come down too I think if we scrapped the permission slip system and the associated costs...and with so many of the sick having trouble paying for their meds that can only help.  The only downside is the knuckleheads who will self-diagnose and hurt themselves....chalk it up as a cost of freedom...it's not free.


    then sen. bill frist (5.00 / 2) (#21)
    by cpinva on Fri Apr 17, 2009 at 10:43:00 PM EST
    was rightly castigated, when he made a medical diagnosis in the terri schiavo case, based on a review of some video tape.

    how does this differ significantly from what dr. hageseth did, except sen/dr. frist actually saw the patient, albeit on video, not in person? had this young man been a patient of the dr's already, and this was merely a refill, i'd say colorado overreached.

    the fact is, dr. hageseth violated his own profession's code of ethics, as well as two state's laws, by his actions. while arguably he may (i'm sure) have only had the boy's best interests at heart, his actions resulted, at least in part, in the failure of his "patient" to seek professional help, in person, locally.

    i believe the hippocratic oath states, in part: "first, do no harm." dr. hageseth caused harm by omission.

    This makes me all the more grateful (5.00 / 2) (#24)
    by Cream City on Sat Apr 18, 2009 at 12:17:26 AM EST
    for my very good doctor.  I have some unusual health conditions, and he has saved me from some potentially problematic interactions of meds -- because he monitors very closely.

    The doctor did not fulfill his responsibility (none / 0) (#2)
    by StevenT on Fri Apr 17, 2009 at 05:35:59 PM EST
    There is no evidence showing that the prescription did not cause the suicide. If the doctor had done his job by consulting with the student, this could have been prevented. Instead, he chose to just prescribed the anti-depressant to the student. It might not be the doctor's intention to cause injury of any sort, but this is definitely assisted murder. You have a student who needed help and chose to go to a doctor, but the doctor did not fulfill his responsibility. The sentencing of 9 months if definitely too short.

    False (none / 0) (#3)
    by Jeralyn on Fri Apr 17, 2009 at 05:40:54 PM EST
    The cororner's report said it didn't -- and a judge found both sides, including the student's parents, agreed the drug did not contribute or cause his suicide.

    Coroner's reports determined the prescribed drug did not contribute as a cause of death, according to San Mateo Deputy District Attorney Steve Wagstaffe.

    Do not post false information here. You will be banned if you do it againg.


    The drugs (none / 0) (#6)
    by StevenT on Fri Apr 17, 2009 at 06:15:56 PM EST
    I'm not implying that the drugs cause him to commit suicide but rather the doctor's choice of giving him the prescription. You already have a depressed student seeking help and the doctor did not fulfill his responsibility. Surely you can see the difference.

    Was it the correct treatment (none / 0) (#10)
    by nyjets on Fri Apr 17, 2009 at 06:57:33 PM EST
    But was the drug the correct treatment?
    In otherwords, did the doctor make the correct diagnosis. The drug was not responsible for the kids death. However the untreated condition killed the kid and the condition was untreated because the doctor blew the diagnosis.
    This is like when a doctor gives asprin for a headache when the patient has a brain tumor. The doctor blew the diagnosis. The asprin is harmless, however the untreated tumor killed the patient.

    I read the doctor's website. (none / 0) (#13)
    by Fabian on Fri Apr 17, 2009 at 07:08:52 PM EST
    His argument was that his internet prescription service was better than was currently available on the internet.  (No proof of this claim was offered.)  

    Better than a quack?  Maybe.  

    Hence I have founded Depression Care Access, Inc, a nonprofit 501 (c) 3 corporation which will provide financial assistance to uninsured and underinsured people who feel they are suffering from depression. The financial assistance will be for two visits to the doctor of their choosing in their own community. This is my way of making the internet work for the uninsured depressed without violating any state law.
    Definitely an improvement over giving strangers prescriptions over the internet.

    I'm glad he found a better way.

    Does he (none / 0) (#27)
    by seeker on Sat Apr 18, 2009 at 01:02:16 AM EST
    spend time interacting with the "patient" over the internet?  A questionare might be answered easdily by someone with some knowledge of the ailment.  It might be harder to answer appropriately in real time.

    Face-to-face contact at least once and at infrequent intervals seems to me the most sensible, though.


    Considering (none / 0) (#29)
    by Fabian on Sat Apr 18, 2009 at 12:03:26 PM EST
    how easily people game the system to get drugs in person, gaming the system over the internet would seem to be even easier.

    gaming the system (none / 0) (#35)
    by diogenes on Mon Apr 20, 2009 at 11:37:26 AM EST
    However, not too many people game the system to get prozac, nor do they inject it or shoot it up.

    Doctor Who (none / 0) (#19)
    by squeaky on Fri Apr 17, 2009 at 09:37:43 PM EST
    Over the internet, oy. BBC must be suing as well.

    Hmm... didn't hear about this. (none / 0) (#31)
    by KoolJeffrey on Sat Apr 18, 2009 at 01:14:22 PM EST
    This snippet from an article on June 28, 2008 suprised me:

    The Drug Enforcement Administration will soon propose a rule change to allow doctors to prescribe painkillers and other potentially dangerous drugs electronically.

    Can't see how this is a good thing.


    That sounds like they have to (none / 0) (#32)
    by nycstray on Sat Apr 18, 2009 at 02:59:20 PM EST
    see the doctor first and then he could electronically send in the prescription, if I'm reading it right. Not much different than faxing one in. My vet suggested I shop around for a prescription I needed (expensive!) and then he spoke with them to adjust the dosage etc to get me the best price, and then had to follow up with a fax to the online pharmacy. Paper trail/for the record. Since it was refillable, I could then deal with the online pharmacy for ordering, instead of ordering more than I needed of this expensive med (we didn't know how long my kitty would live). It was all very proper though. Exact same as if I was dealing with my local pharmacy. It was nice being able to research and to get it delivered to my door vs calling and running all over NYC to get it. Even if I had needed a simple antibiotic, my cat would have to have been seen by my vet as they need to examine/test to see which antibiotic to give. I know when my cats need antibiotics, but I don't have the resources to properly test to determine the best one  ;)