Internet Prescription Malpractice-Part II

An Illinois internet prescription malpractice case that I tried last year now has resulted in the indictment of the very doctors sued. The doctors were charged in the civil suit with: (1) prescribing Xanax and Ultram to a patient they had never seen or examined; (2) prescribing excessive dosages and; (3) practicing medicine in the state of Illinois without a license.

As reported in last months’ post on internet prescription malpractice, the plaintiff, a 30 year old husband and father ordered Xanax and Ultram over the internet. The plaintiff had previously successfully completed a drug rehabilitation program through Hazelton, and had been clean and sober for a long time. However, looking at his e-mails one day in May 2004 he succumbed and ordered the anti-anxiety drug Xanax and the pain killer Ultram via an internet questionnaire. As he testified before a jury in U.S. District Court in Chicago, he took these drugs partially for back pain and partially for recreation.

After consuming these drugs the next thing he recalls is waking up in a hospital in suburban Chicago three weeks later. The drugs repressed his breathing causing a hypoxic event that landed him in a coma. Neither Dr. Klinman. a Pennsylvania internist, whose name was on the bottle of Xanax nor Dr. Ahlawat, a New Jersey internist, whose name was on the bottle of Ultram, had ever seen plaintiff or spoken with him. All the information they had was contained on the online questionnaire that he filled out.

As reported in a recent article in Business Week by Keith Epstein, an ambitious internet doctor typically earns up to $10 per each prescription. In a recent indictment naming Steven Klinman, M.D. and Ranvir Ahlawat, M.D. and returned by the Grand Jury in the U.S. District Court for the Eastern District of Pennsylvania, Dr. Ahlawat is charged with approving 184,450 prescriptions for one online pharmacy between Sept. 2003 and May 2004, and Dr. Klinman is charged with approving 38,931 prescriptions in the same time frame through one online pharmacy.

At a rate of $10 per prescription Dr. Ahlawat would have received $1,844,500 and Dr. Klinman $389,310 for approving prescriptions for controlled and non-controlled substances to patients during a nine month time frame to patients they had neither seen nor examined. The pharmacy involved in this conspiracy received approximately $38 million during this same nine month time frame according to the grand jury indictment. Lucrative indeed!

Dr. Klinman, who prescibed 2 mg Xanax tablets to plaintiff based solely on internet questionnaire, took the Fifth Amendment during discovery, and his insurer decided to offer $650,000 immediately before jury selection. The offer was accepted. The case proceeded to trial as to Dr. Ahlawat, but the jury decided that the brain damage was caused by an overdose of Xanax and that the Ultram he prescribed did not harm plaintiff
These internet prescribing doctors prey on patients with substance abuse problems by providing them with drugs in precisely the same way drug dealers push drugs for profit. No ethical physician would ever prescribe a controlled substance to a patient they had never seen based solely on an online questionnaire. A valid credit card is all you need, and if the recipient is a child, so be it. There are no checks, just fill in your age on the questionnaire, no one calls, no one checks, no one cares.

Times are changing. The U.S Attorney for the Eastern Dist. of Pennsylvania has indicted Dr. Klinman, Dr. Ahlawat, and various internet pharmacies and charged them with (1) conspiracy to distribute controlled substance, 21 U.S.C. 846; (2) distribution of controlled substances, 21 U.S.C. 841(a)(1); and (3) money laundering, 18 U.S.C.1956. While the overwhelming majority of physicians would never approve prescriptions for patients they have never seen solely for profit, civil and criminal liability may be the best deterrent to put a halt to this despicable practice.