Parents Sue Online Pharmacy, Doctor — (San Jose Mercury News)

Original article no longer available

San Jose Mercury News

3/14/2006

Barbara Feder Ostrov

Christian Hageseth in more trouble; was prescribing meds at online pharmacy 

John McKay’s family may never know why he turned to the Internet to heal his psyche. But they believe that what he found there killed him.

Last summer, just after his freshman year at Stanford, the nationally known debate champ from Menlo-Atherton High School bought a generic version of Prozac from an Internet site believed to be based in Texas.

A Colorado doctor with a troubled past signed off on McKay’s request for the anti-depressant without seeing or talking to him. A pharmacy in Mississippi filled the prescription and mailed it to McKay’s Menlo Park home.

He never told his parents. Less than seven weeks later, on Aug. 2, McKay killed himself. He was 19.

Now, in what is believed to be one of the first lawsuits of its kind, McKay’s parents are suing the Internet site’s operators, the doctor and the pharmacy for wrongful death and negligence. They are not suing the drug’s manufacturer.

John’s suicide was “completely unexpected,” said David McKay, a professor of structural biology at Stanford University who is devastated by his son’s death. “There were no obvious signs of depression.

“I think John would still be alive if he hadn’t been able to get these pills. He didn’t realize the risks. They didn’t inform him of the risks. I’d like to see these people held responsible.”

The lawsuit, filed late last month in federal court in San Francisco, shines a rare light on the poorly regulated world of Internet pharmacies.

“Anyone that has a credit card and a computer can get controlled prescription drugs over the Internet,” said Richard D. Mulieri, a spokesman for the National Center on Addiction and Substance Abuse at Columbia University. “It’s much too easy.”

Mulieri says parents should monitor their children’s Internet use and check the family mail for suspicious packages. It is important to keep credit cards and documents with credit card numbers away from children, too, he said.

The pharmacy McKay used, USAnetRX.com, does not require a faxed or mailed prescription from a licensed physician, as many mainstream online pharmacies do.
In California, prescriptions must be written by a licensed California physician after a physical examination of the patient.

Instead, USAnetRX.com asked patients to submit an online questionnaire that would be reviewed by one of its physicians before dispensing the drug. The site offers painkillers, Viagra, herpes medications, anti-depressants, weight-loss drugs and antibiotics, all ordered “from the comfort of your own home . . . without the embarrassment of a doctor’s visit.”

McKay used a credit card to purchase 90 capsules of fluoxetine, the generic name for Prozac. He requested the drug for treatment of adult attention deficit disorder and “moderate” depression, according to the San Mateo County Coroner’s Office. In his online application, McKay said he had been prescribed the drug before and that he was not suicidal.

The Colorado doctor, psychiatrist Christian Hageseth III, took him at his word.
Hageseth told the Mercury News that while the suicide of any young person is a “tragedy,” he does not feel responsible for McKay’s death. “When somebody commits suicide usually there are many factors,” he said.

What the McKay family did not know — until its lawyers started investigating — was that the Colorado medical board had restricted Hageseth’s license because of an improper relationship with a patient. He was not allowed to prescribe medication when he signed off on McKay’s medication. Hageseth has since surrendered his license.
“This was the last possible thing I could do in medicine,” Hageseth admitted, noting that he is now “unemployed” and “very poor.”

Frank Gruich Jr., of the Mississippi-based Gruich Pharmacy Shoppe, which took Hageseth’s prescription and shipped the generic Prozac to McKay, said he had not seen the lawsuit. But he also said he did not feel responsible for the teen’s death.
The operators of USAnetRX.com could not be reached for comment.

By taking fluoxetine without medical monitoring, McKay was treading into potentially dangerous territory.

Prozac and similar anti-depressants have been linked to suicides in children and adults, although no study has conclusively proven a connection. The U.S. Food and Drug Administration is reviewing whether anti-depressants cause suicidal thoughts and behavior.

Anti-depressants now carry the FDA’s strongest “black box” warning, which notes the link between anti-depressants and suicide in children and adolescents. The warning urges doctors to closely monitor their young patients on these drugs, particularly at the start of treatment.

It is unclear why McKay felt he needed an anti-depressant. His parents, who divorced in 2004, told investigators that McKay had not recently had any medical or psychological treatment.

“I think he had some issues he was fighting and he tried to fight them alone,” David McKay said, declining to elaborate. His mother, Sheila McKay, declined to be interviewed but told investigators that John may have had a diagnosis of obsessive-compulsive disorder, according to the coroner’s report.

An autopsy found that he died from a combination of carbon monoxide and alcohol poisoning. He also had fluoxetine in his system.

If his parents never saw it coming, neither did his friends.

McKay started the debate team at Menlo-Atherton as a freshman. By his senior year, he had rocketed to a kind of superstardom in the highly competitive world of high school debate, becoming the top-ranked high school debater in the nation in the 2003-2004 season.

His death rocked the debate community. Dozens of students he had coached and befriended wrote moving tributes to him on debate Web sites, describing his inclusive nature and prowess at poker. He was coaching a debate camp in Los Angeles and was between sessions when he took his life.

“His success in the debate world was so great, it was like being with your childhood hero,” said friend Byron Ruby, a 16-year-old Menlo-Atherton student. “He was funny, real cool, really nice. A lot of people still miss him.”

Ruby said he and another friend detected a change in McKay’s personality shortly before his suicide. McKay didn’t hide the fact that he was taking anti-depressants, but he didn’t tell Ruby where he got them, either.

“He was a poker player; he could hide as much as he wanted to,” Ruby said. “I can only see it now, in hindsight. He was acting weirdly. He went from being happy to sad, back and forth. I didn’t think you could even buy this stuff online.”