Consulting a physician over the Internet might not have been feasible a couple of years back. Technology and innovative business models, however, currently allow the offering of services that years ago required the real-time presence of the parties. For instance, people can now consult a physician over the Internet. Hence, the regulatory compliance of these professional consultations is still under development. A physician consultation that involves prescription of controlled medicines is serious business, and state governments and regulatory boards will most likely enact rules to regulate this professional practice and protect the patients and society in general. This article presents an interesting case involving the online prescription of medicines in Missouri.
In the case of Thompson v. State Bd. of Registration for the Healing Arts, 244 S.W.3d 180 (Ct. App. Missouri 2007), the court of Appeals of Missouri was to decide whether a physician who prescribed medicines through an online consultation that did not involve sufficient examination, just a review of an online form, violated Mo. Rev. Stat. § 334.100.2(4)(h). This statute prohibited the prescription of controlled substance medicines without sufficient examination.
A physician licensed by the state of Missouri provided consulting and prescribing services to the owners of a website called www.ePrescribe.com. Users would fill out an online consultation form so that the physician could evaluate it and prescribe medicines if necessary. In 2000, when this occurred, Missouri had no regulations concerning physician who prescribed medicines online. The Board of Registration for the Healing Arts (the Board) filed a complaint against this physician before the Administrative Hearing Commission (AHC) seeking to discipline the physician. The Board presented evidence about the risks of prescribing Meridia without sufficient examination. As a result, the physician was sanctioned.
An undercover agent posing as a patient paid an online medical consultation with ePrescribe.com. The undercover agent filled out the consultation form and provided the information required. The physician prescribed Meridia, a controlled weight loss medication. The undercover agent sought a second online consultation posing as another patient and he was also prescribed the controlled medicine. The controlled medicine prescribed was delivered from Missouri to another state.
The Board in its complaint claimed that the physician violated Mo. Rev. Stat. § 334.100.2(4)(h) and AHC disciplined the physician for prescribing a controlled substance without sufficient medical examination in violation of this Missouri Statute. AHC also disciplined the physician for prescribing medications outside the manufacturer''''''''''''''''''''''''''''''''s recommendations and for conduct that might be harmful or dangerous to the public health or for incompetency. The disciplinary action consisted of a public reprimand to the physician"s license and a prohibition from prescribing medicines over the Internet. The physician sought legal review. The circuit court confirmed the AHC''''''''''''''''''''''''''''''''s disciplinary action. The physician appealed and the court of appeals confirmed the circuit court''''''''''''''''''''''''''''''''s decision.
The court held that the physician was not sanctioned for prescribing medicine over the Internet. Instead, the court held, the physician was sanctioned for prescribing controlled medicines without sufficient examination as the Missouri statute required. The court held that the online consultation filled out by users did not constitute sufficient examination for a doctor to prescribe controlled medicines.
The unregulated prescription of controlled substances by doctors is under scrutiny in the U.S. after the death of renowned figures such as Michael Jackson and Anna Nicole Smith. The online prescription of medicines is still regulated by state and regulatory bodies through existing legislation and rules. Yet, specific rules are to be enacted to control this practice that although convenient for the public, it may be misused or abused.