Risk Manager
Beware of "Internet Pharmacies"
Some companies that use the Internet to sell prescription drugs may ask you to violate basic rules of medical ethics.

BY JEFFREY D. WEINSTOCK, ESQ.

 The huge popularity of trendy drugs such as the sexual aid Viagra and the pain reliever Vioxx has created an opportunity for Internet entrepreneurs who specialize in getting drugs to individuals who want to avoid the time, expense and embarrassment of being examined by a physician. Customers of these "Internet pharmacies" can obtain a supply of the drugs they desire, even if they're not actually suitable candidates for these particular pharmaceuticals.

The Internet pharmacies that operate in this manner enlist physicians to write the actual prescriptions. In this article, I'll explain why it's a bad idea to associate yourself with an Internet pharmacy that fills prescriptions for unexamined "patients."

DOCTORS ACT AS "RUBBER STAMPS"

Doctors who work with unethical Internet pharmacies are sometimes asked to review basic health questionnaires filled out by customers of the Internet pharmacies -- and then write prescriptions based on the answers to the questionnaires. They write the prescriptions without ever having seen the patients who request the drugs. The physicians literally serve as "rubber stamps" for the Internet pharmacies.

Physicians who are willing to do this are taking huge risks. They really can't be sure of the identity, age, sex and general physical condition of the person who's going to get the prescription. They also don't know if the individuals they're prescribing for are going to get high-quality products at a fair price.

If you're ever contacted by an Internet pharmacy and asked to review applicants for prescriptions, you should keep these two important considerations in mind:

No examination; no prescription. Although each state has its own regulations for prescribing and dispensing drugs, you'll be on shaky legal and ethical ground if you write any prescription without examining the patient. No questionnaire, no matter how extensive, can take the place of a physical examination that establishes the physician-patient relationship. Follow a firm policy of "no examination, no prescription" to avoid potential trouble.

You can't prescribe where you're not licensed. Any doctor who approves a prescription by reviewing a questionnaire supplied by an Internet pharmacy can't be sure where the "patient" actually lives. If you're licensed in Ohio and approving prescriptions based on answers to questionnaires, you may actually be prescribing for people living in Florida, Georgia and who knows where. You could wind up being charged for practicing medicine in a state in which you don't have a medical license.

Until now, the entire realm of online prescribing has been a "gray area" of medicine, leaving many doctors uncertain as to when it's appropriate or inappropriate to use the Internet and e-mail for prescription-related activities.

States have recently become more active in regulating online prescribing and cracking down on those Internet Web sites that attempt to evade accepted prescribing practices. Several states, including Kansas, Washington, Florida and New Jersey have filed suit against online pharmacies that market prescription drugs to state residents. In addition, the National Association of Boards of Pharmacy has created a program to identify online pharmacy sites and determine whether they're operating legitimately.

KNOW THE LAW IN YOUR STATE

State regulation of online prescribing will increase, as more states develop regulations in this area. Check to see whether your state has any rules governing online prescribing or Internet pharmacies. If you have any questions about whether a specific activity is permitted in your state, consult your attorney.

Jeffrey D. Weinstock, Esq., is the Assistant General Counsel of Cyber-Care, Inc. Based in Boynton Beach, Fla., Cyber-Care is a technology-assisted health management company. Risk Manager provides a general summary of legal issues and should not be construed as personal legal advice. Application of these principles varies according to individual situations.