A suburban St. Louis physician should be disciplined for filling a prescription over the Internet without properly examining the would-be patient, a Missouri tribunal has ruled, but it left open the question whether some Internet patient examinations would be acceptable as a basis for physician prescribing.
The "patient" in this case turned out to be an undercover Connecticut drug-control agent who got a prescription in 2000 from William Thompson, M.D. for diet drug Meridia by filling out a questionnaire through online pharmacy ePrescribe.com.
Thompson never physically examined or talked to fictitious patient "Kim Davis." But Thompson, of St. Charles, Mo., told the independent Missouri Administrative Hearing Commission that he got all the information medically needed before prescribing the drug.
Looking to curb such sales, a measure introduced earlier this year by Reps. Tom Davis (R-Va.) and Henry Waxman (D-Calif.) would, among other things, bar domestic Internet sites from writing and filling prescriptions without seeing patients.
That measure has the backing of state medical boards, doctors' groups and many pharmacists.
In the Missouri matter, the commission noted that issuing prescriptions online "is an evolving area of medicine and law," and that the panel was "sympathetic" to Thompson, licensed by Missouri since 1987 as a physician and surgeon.
"This decision does not limit the concept of a sufficient examination to a face-to-face contact in every situation," June Striegel Doughty wrote for the commission in the case brought in April 2002 by the regulatory State Board of Registration for the Healing Arts.
But, Doughty added, Missouri law says an examination "requires more than a questionnaire."
"Whether the doctor is seeing or otherwise examining the patient through the use of video conferencing or is otherwise examining the patient by touch, there must be some examination," she wrote in a decision first reported last week by Missouri Lawyers Weekly, a legal newspaper.
"This case is about a person who lied in order to obtain Meridia, and we feel that the likelihood of public harm under these circumstances is small," given that Meridia has no street value and "would be of little interest to drug-seeking patients," Doughty wrote.
Still, she added, "we find that Thompson committed misconduct and unprofessional and ethical conduct because he prescribed Meridia without a sufficient examination."
The commission makes no recommendation about the severity of any discipline; Missouri's Board of Registration for the Healing Arts decides that, ranging from a reprimand letter to license revocation.
Thompson may sue to sue to challenge any of the rulings.
Messages left Monday with his attorneys were not returned.
Last December in Virginia, Thompson was among five doctors federally indicted along with three companies on charges of illegally selling weight-loss drugs, including Meridia, and other prescription drugs over the Internet.
According to that indictment, the online drug ring allowed customers to order drugs through Web sites, where customers were allowed to order an unlimited supply, selecting the type and dose.
Prosecutors said site visitors answered questions on a medical form, but no one verified the accuracy of the information and no one ever met a doctor in person, as required by law.
In February in Florida, Thompson was among defendants named in a wrongful-death lawsuit by a woman who blamed her 57-year-old husband's August 2002 death on diet pills he got online.
Laura Ritzert Neale's lawsuit accused Thompson of writing prescriptions for Phentermine for Corey Neale based only on questions he answered online.
An autopsy after Corey Neale's death found that the diet pills increased Neale's demand for oxygen in his heart -- a demand that couldn't be met because Neale had narrowed coronary arteries, the lawsuit alleges.
The lawsuit argues that Thompson and other defendants violated rules of the Florida Board of Medicine, which requires that a doctor meet personally with the patient, do "an appropriate physical exam" and discuss "the potential benefits versus potential risks of weight-loss treatments."