Two years ago, Christian Hageseth logged on to the Internet in Colorado and prescribed anti-depressant drugs to a California teenager with a history of mental illness and alcohol abuse. A few months later, 19-year-old John McKay killed himself in his family home.
Upon learning that Hageseth had treated McKay, and that he didn’t have a license in California, state medical investigators urged local prosecutors to charge him with a felony. Last year they did, accusing him of practicing without a California license. The maximum penalty, according to the prosecution, would be three years in state prison and state fines.
Now Hageseth — who had a restricted license in Colorado when he prescribed McKay’s medication, according to court documents — is trying to get the case dismissed, claiming that the state courts lack jurisdiction to try him under California law. Though a San Mateo County judge refused his request, Hageseth’s attorney has persuaded the 1st District Court of Appeal to consider issuing a writ that would overturn that decision.
But, if the 1st District agrees with the government’s application of medical licensing laws, thousands of out-of-state doctors could face felony prosecution.
The appeal court took the rare step of asking for additional briefing on the court’s jurisdiction over out-of-state doctors, suggesting the parties might want to seek out amici like the Medical Board of California.
MEDICINE FROM AFAR
Telemedicine refers to the delivery of medicine from afar, and it can occur in many ways. The broad term might refer to two doctors discussing a case over the phone or the Internet, for example. Or it might involve direct patient interaction with physicians located far away.
The American Telemedicine Association doesn’t keep hard statistics on how many doctors incorporate telemedicine into their practice, but California state law requires medical practitioners to conduct a good-faith exam before prescribing medication. The California Medical Association (CMA) declined to weigh in with an amicus brief on Hageseth’s behalf, because of the lack of a good-faith exam.
ROUTING THE ORDER
McKay was connected with Hageseth in June 2005 through an overseas Web site called Usanetrx.com, an Internet portal registered in India, offering access to discount prescription drugs. After transmitting his credit card number and some details about his medical history, McKay placed an order for fluoxetine, a generic alternative to Prozac.
The order was then routed through JRB Health Solutions, a Florida company with which Hageseth worked to prescribe medication. A Mississippi pharmacy used by JRB then filled McKay’s order and shipped the meds directly to him.
A few weeks later, after McKay committed suicide by carbon monoxide poisoning, alcohol and fluoxetine were detected in his bloodstream.
Last year, McKay’s parents sued Hageseth, JRB Health Solutions and the Mississippi pharmacy, among others, in California’s Northern District federal court. That case is still pending. But so far Hageseth is the only defendant who’s faced criminal prosecution, though his doctor argues that the state’s licensing requirements don’t apply to Hageseth because he never set foot in California while acting as McKay’s doctor.
In court papers, Hageseth claims the teenager wrote in his questionnaire that he had been prescribed anti-depressants before, and that he neglected to mention his alcohol use. But prosecutors counter that this argument is a gratuitous attack on the victim, not to mention irrelevant because the doctor did nothing to verify McKay’s claims.
Hageseth surrendered his Colorado license after medical officials here contacted him about McKay. “Hageseth doesn’t take the position that what he did is right. He takes the position that he did not commit a crime,” said his California attorney.