After teen's suicide, doctor in court for 'telemedicine' practice

In August 2005, John McKay, a 19-year-old Stanford student and former high school debate champion, committed suicide by rolling up the windows in a car at his mother's Menlo Park, Calif., home and piping in exhaust fumes.
In the next few weeks, a Colorado doctor who prescribed a generic form of Prozac for McKay after receiving his request over the Internet -- without ever seeing or examining him -- will go on trial in Redwood City, Calif. The doctor faces possibly precedent-setting charges of practicing medicine in California without a license.
A conviction of Dr. Christian Hageseth, 67, "would send a clear message to those individuals who are blindly writing prescriptions to patients they know nothing about," said the youth's father, David McKay, a former Stanford professor now living in Colorado.
Hageseth's lawyer, Carleton Briggs, sees the issue differently. The case may determine, he said, whether California can reach across state lines to prosecute practitioners of "telemedicine," an increasingly common source of health care.
So far, though, courts have rejected Briggs' attempts to get the charge dismissed, including a civil suit claiming the prosecution is an unconstitutional attempt by California to regulate interstate commerce. A San Mateo County Superior Court judge threw the suit out Dec. 17, but Briggs said he'll raise the issue in an appeal if Hageseth is convicted.
The case has already had a legal impact. In a May 2007 ruling against Hageseth, the First District Court of Appeal in San Francisco said a California county can prosecute someone who writes a prescription in another state for a Californian, knowing that the medicine will be delivered in this state.
In the absence of any federal regulation of unlicensed drug prescription and sales over the Internet, "the denial of state jurisdiction to punish the practice would provide the unscrupulous physicians who engage in it even greater freedom to do so," said presiding Justice J. Anthony Kline.
He noted that state law allows out-of-state doctors to practice "telemedicine" through the Internet or interactive audio or video transmissions, as long as they act in consultation with a licensed California physician.
San Mateo County, Calif., authorities were alerted to the case by the state Medical Board, which receives nearly 20 complaints a year about Internet prescriptions, the board's executive director, David Thornton, said in a court declaration in Hageseth's case.
In John McKay's case, he had just completed his freshman year at Stanford in June 2005 when he ordered 90 capsules of the antidepressant fluoxetine, the generic version of Prozac, from the India-based Web site usanetrx.com. In a questionnaire that accompanied the order, he said he would use the drug to treat "adult attention deficit disorder in relation to depression" and also said he was not suicidal.
The site operator forwarded the order to a Texas company, JRB Solutions, which relayed it to Hageseth, its physician contractor in Fort Collins, Colo.
Hageseth quickly filled the prescription without contacting McKay and returned it to JRB, which had the pills shipped to Menlo Park from a pharmacy in Mississippi.
At the time, the U.S. Food and Drug Administration required Prozac and similar antidepressants to carry warning labels saying they increased the risk of suicidal thoughts and behavior in children and adolescents. The FDA asked manufacturers in 2007 to expand the warning to cover patients ages 18 to 24 in the early weeks of treatment, but that won't affect the criminal case against Hageseth, who is charged only with practicing medicine illegally and not with prescribing the wrong drug or causing McKay's death.
Traces of fluoxetine were found in McKay's body after his death, along with alcohol. In a civil suit by his parents against the Mississippi pharmacy, JRB and Hageseth, however, a federal judge said experts on both sides of the case had concluded the drug was not a cause of his death.
"I have strong opinions about how the drug was affecting my son. You can't do a post-mortem diagnosis, but I think it was driving him off the deep end," McKay said."The real problem is negligence on the part of the physician," he said. "Any competent psychiatrist talking to (John McKay) for five minutes on the telephone would have realized something was wrong and would have encouraged him to seek direct help."
McKay's parents settled their suits against the pharmacy and JRB and dropped their suit against Hageseth, who surrendered his Colorado medical license after coming under investigation in the youth's suicide.
In contrast to the civil suit, which would have required the parents to prove that Hageseth's actions contributed to their son's death, San Mateo County prosecutors must show only that he practiced medicine in California without a license.
A conviction can be punished as either a misdemeanor, with as much as a year in jail, or as a felony, with as much as three years in prison.
The trial is scheduled Feb. 9, but defense attorney Briggs said he will ask for a 30-day delay because Hageseth recently underwent open-heart surgery.

(E-mail Bob Egelko at the San Francisco Chronicle at begelko(at)sfchronicle.com.)

(Distributed by Scripps Howard News Service, www.scrippsnews.com.)
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