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By STEVE WIEGAND, Sacramento Bee
SACRAMENTO, Calif.
(July 23, 2002 4:17 p.m. EDT) - In the first case of its kind in
California, a doctor faces the loss of his medical license for allegedly
prescribing drugs illegally through the Internet.
Jon Steven Opsahl is accused of writing more than 8,000 prescriptions
for antidepressants and painkillers to patients he never examined.
The Medical Board of California alleges Opsahl prescribed the drugs,
during the course of a year, after talking on the telephone to patients
from around the country who were referred to him by operators of a
Texas-based Web site. According to the complaint, he received $60 for
each consultation sent his way by the Web site, called Office In A Snap.
The Medical Board contends Opsahl violated an 18-month-old state law
that bans physicians from dispensing potentially dangerous drugs via the
Internet without first conducting a "good faith examination." The board
has interpreted that phrase, in almost all situations, to mean an exam
done in person.
Law enforcement and health officials say Opsahl's case, which goes
before an administrative law judge Thursday in San Diego, is just the
beginning of what they expect will be a steady stream of confrontations
between traditional medical protocol and cyber-pharmacies.
"It's going to be a lot more common in the future," said Sanford
Feldman, the deputy attorney general representing the Medical Board.
Opsahl maintains that while patients were referred to him through the
Web site, the telephone consultations provided him with enough
information to responsibly prescribe the drugs, and in fact represent a
more efficient way of practicing medicine.
"I'm getting punished just because I didn't follow in goose-step
marching order an outdated medical model that insists on a physical exam
that isn't always necessary," he said.
There is no federal law regulating Web site pharmacies, leaving it to
individual states to determine what is legal or not in dispensing drugs
using the Internet.
Some sites, most of them approved by the National Association of Boards
of Pharmacy, require written authorization from a customer's physician
before filling prescriptions online.
But for a fee that can range from $40 to $120, many other sites offer to
fill a prescription, often through another Web site, following an online
or telephone consultation with a physician.
Others, especially sites based in other countries, require only that
customers check a box affirming they are at least 18 years old and don't
plan to abuse the drugs.
Internet pharmacies, known as "pill mills," send out thousands of
unsolicited e-mails promising few-questions-asked delivery of drugs.
Those who respond are directed to Web sites where they fill out
questionnaires, use credit cards to pay often-exorbitant prices, then
wait for the pills to be mailed.
To combat the pill mill problem, the California Legislature approved a
bill that went into effect last year. The law specifically bans filling
prescriptions via the Internet unless there was first a "good faith
examination" by a qualified physician. It sets a fine of $25,000 for
each prescription illegally approved by a California physician or filled
by a California-based Web site.
Two months ago, the pharmacy board used the law for the first time, to
fine a Los Angeles drugstore and two pharmacists for filling Internet
prescriptions without a medical examination. But the doctors involved
were from out of state and were not cited. The case is being appealed.
In addition to the legal problems they pose, non-accredited sites often
charge prices far above those charged at approved sites. One offshore
pharmacy, for example, recently was charging $129 for 50 tablets of
Valium.
There is also the question of what you're getting.
"Drugs from those kinds of sites could be adulterated, they could be
expired, they could be anything," said Patricia Harris, executive
officer of the California Board of Pharmacy. "There's no guarantee they
are anything close to what they purport to be."
While the Food and Drug Administration sets standards for drug purity,
neither it nor any other federal agency does much to patrol Internet
pharmacies. California health and law enforcement officials say it's a
decidedly uphill battle to deal with sites that can be based anywhere in
the world.
In the Opsahl case, for example, the Web site that connected patients
with doctors for phone consultations was based in San Antonio. The site
since has closed, and a San Antonio phone number for the company has
been disconnected.
Absent an overriding federal law, state officials rely on each other to
chase down rogue Internet physicians and pharmacies.
The Federation of State Medical Boards has run a clearinghouse for
medical boards and law enforcement for the last two years, where state
officials can trade information.
Although Opsahl is the first California physician to face disciplinary
action for prescribing via the Web, Medical Board spokeswoman Candis
Cohen said formal charges have been filed against two other doctors in
California and 25 other investigations are under way.
Opsahl acknowledged that he did prescribe the antibiotic Cipro over an
Internet site without a telephone consultation after the
anthrax-in-the-mail scare of last October, but he said he stopped after
being ordered to by the Medical Board.
Administrative Law Judge Stephen Hjelt, in an April order that suspended
Opsahl's license until his case is heard, took a different view.
"Respondent's belief that talking over the phone with patients satisfied
the requirement of a good faith examination is profoundly disturbing and
demonstrates a combination of incredible arrogance and a woeful lack of
judgment," Hjelt wrote.
If Opsahl is found guilty, the Medical Board can take a wide range of
actions, from placing him on probation to stripping him of his license.
Whatever happens, Deputy Attorney General Feldman said, "this won't be
the last case of its kind in California."
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