INTERNET DOCTOR'S CASE REFLECTS NATIONAL TREND

Internet pharmacies and Internet doctors, not illegal by themselves, can
become a recipe for disaster when Internet prescribing is added to the mix.
An Oklahoma City doctor was among the first in the country to be convicted
of prescribing addictive narcotics via the Internet without physically
examining patients, a situation becoming more common nationwide. Dr. Ricky
Joe Nelson, 45, is being held in the Oklahoma County jail and is expected
to be sentenced near the end of this month.

He was convicted in late January, and his lawyer plans to file an appeal
following sentencing. Nelson was part of a system that allowed patients to
order controlled dangerous substances, including the highly addictive
painkiller hydrocodone. "One difference from the street drug dealer is
because of the doctor's medical license, he or she has the unique ability
to dispense the drugs, and that's one reason why this crime is so worrisome
because doctors have been given a special responsibility in our society to
be able to decide who gets controlled dangerous drugs," said Robert
McCampbell, U.S. attorney for Oklahoma's western federal judicial district.
To begin the process, a customer would log on to NationPharmacy.com and
request a drug. On a questionnaire, the person would provide a brief
description of the ailment, a doctor's name and location, and other
information. Customers testified at Nelson's trial that they gave false
answers to most of the questions. The request was forwarded to a list the
doctor could access to approve the prescription. When approved, the request
was accessible at MainStreet Pharmacy in Norman, where pharmacist Jerry
Shadid filled the prescription and sent the drugs to the address provided.
"They weren't performing any checks.

This Internet pharmacy was providing the doctor for you. He was getting
paid by the pharmacy for each prescription, so if he didn't approve the
prescription, he didn't get paid," said Cindy Hamilton, compliance officer
for the state Pharmacy Board. "It's basically dealing drugs on the
Internet, and it's just as dangerous if not more than dealing them on the
street except you have complete anonymity on the Internet," Hamilton said.
"It's a danger to the public's health." More than 94 percent of the drugs
Nelson prescribed were controlled dangerous substances, and 77 percent were
hydrocodone. "Both of those percentages are incredibly large in comparison
to a normal doctor, even a normal doctor with a specialized practice,"
McCampbell said. A 100-count bottle of hydrocodone sold for more than $200
through MainStreet Pharmacy. The state Pharmacy Board found that the same
drug at the same strength averaged less than $100 at 10 independent, chain
and Internet pharmacies it surveyed. "If the patient can obtain the drug
legitimately, they have a legitimate need for them, then they don't need to
pay those high prices," McCampbell said. "So you're necessarily going to
draw a disproportionate share of patients who need to obtain the drugs not
through legitimate means.

In a little more than 50 days, McCampbell said, Nelson approved more than
5,000 prescriptions for controlled dangerous substances not including
refills. "Think about a drug dealer who's got 5,000 customers, and that's
essentially what this case is about.

Dr. Nelson was charged with conspiracy to illegally distribute drugs, and
that's what he was convicted of," he said. Dr. Gerald Zumwalt, secretary
and medical director of the state Board of Medical Licensure and
Supervision, said the board will request Nelson's license be revoked at its
May 9 meeting. He said a conviction does not bring an automatic revocation,
and that it depends on "what the circumstances are and what he was
convicted for." The board's stance on Internet prescribing is that "for
there to be proper prescribing, it requires at least one face-to-face
examination. And that there must be a family history taken and at least one
annual re-examination," Zumwalt said. "Complete management of a patient by
Internet, e-mail or other forms of electronic communications is
inappropriate," states the board's policy adopted November 2000. Zumwalt
testified at Nelson's trial that a physical examination is critical to
safely prescribing medications, especially ones such as hydrocodone. "The
point of the crime is there is no questionnaire that you could develop
which would give the doctor all the information he or she needs to
prescribe a controlled dangerous substance," McCampbell said. "It's simply
impossible. The doctor has to see the patient in a face-to-face
examination." In this case, that's the line between legal and criminal,
proper and dangerous. "There's nothing evil about the Internet," Zumwalt
said. "Proper Internet prescribing is not dangerous. "It's a perfectly
legitimate way to do business," McCampbell said. "It happens all the time
that a person sees a doctor, gets a legitimate prescription and fills that
through an Internet pharmacy. "That doctor has to be somebody you have a
legitimate physician/patient relationship with, meaning at some time that
doctor's given you a physical examination. What we have here is a doctor
who's never examined patients," he said. The National Association of Boards
of Pharmacy provides a list of Verified Internet Pharmacy Practice Sites.
The association lists only sites that have been inspected and found to be
operating properly, Hamilton said. To find out if a pharmacy meets those
criteria, log on to www.nabp.net/vipps. Those sites are also identified by
a seal displayed on the site. As the former pharmacist at MainStreet,
Shadid testified against Nelson at trial.

Shadid was sentenced March 25 to 150 days of home confinement and more than
100 hours of community service.

He is one of the first pharmacists in the country to be sentenced in such a
case. Shadid continues as a practicing pharmacist under a license suspended
until July 2008. MainStreet and NationPharmacy.com are out of business, and
pharmacy owner Clayton Fuchs' pharmacist license was revoked in late March
2001. Nelson's lawyer, Paul Antonio Lacy, offered nothing in the doctor's
defense. "That will all come out in the appeal," Lacy said.

No action was taken against patients in this case, McCampbell said, because
"most of them had either done treatment or were in treatment at the time of
the trial." "But obviously the patient does face some legal risk in doing
this. The patient is illegally obtaining the drugs just as the doctor is
illegally dispensing the drugs," he said. "Just like an on-the-street drug
deal: The customer buying the drugs is guilty just like the drug dealer is
guilty." This case will likely set a precedent for cases across the country.

A Texas federal grand jury issued an indictment alleging that three doctors
and a pharmacist illegally distributed hydrocodone and addictive
tranquilizers through The Pill Box, an Internet pharmacy. "I hope doctors
will be deterred from committing this crime," McCampbell said. "Certainly
every doctor should be aware that this is a crime that we treat with utmost
seriousness, and Dr. Nelson is getting ready to pay a severe price for
having broken the law." "Although the Internet has made our lives better
and easier in many areas, some things simply cannot be done in cyberspace,"
he said. "And prescribing controlled dangerous substances is one of those
things."