Communications to the Editor |

Physician Interaction With Internet Pharmacies Is Risky FREE TO VIEW

Jeffrey L. Cohen, Esq
Author and Funding Information

Delray Beach, FL

Correspondence to: Jeffrey L. Cohen, Esq, Strawn, Monaghan, and Cohen, P. A., 54 Northeast Fourth Ave, Delray Beach, FL 33483

Chest. 2005;127(4):1462. doi:10.1378/chest.127.4.1462
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Published online

To the Editor:

Florida physicians who fill prescriptions for patients who seek medication via Internet pharmacies are at significant risk in the State of Florida. Florida law requires that a proper doctor/patient relationship exist before a Florida physician can prescribe legend drugs via the Internet. Florida Tele-Medicine Regulations, 64B8–9.014, F.A.C. (2003) require, among other things, a history and physical and a discussion to occur between the physician and the patient regarding treatment options and the risks and benefits of treatment prior to prescribing legend drugs to patients through the Internet, telephone, or facsimile. Florida law also requires, as always, the creation and maintenance of contemporaneous medical records by the physician.

A new Florida statute effective this year also specifies, in part, that: (1) any Internet pharmacy that dispenses of drugs to Floridians must obtain a permit, (2) dispensing drugs to Floridians without a permit after July 2004 is a felony, and (3) pharmacies and pharmacists must ensure that a proper physician/patient relationship exists before filling a prescription. Additionally, Florida physicians should be aware of appropriate Drug Enforcement Administration guidance on the topic. For instance, Federal law also requires the existence of a bona fide doctor/patient relationship.

The risk of violation in Florida is not merely theoretical. It is real. For instance, in June 2004, a Final Order was enter into the case of Department of Health v. Serge Lefevre Alexandre. Dr. Alexandre was fined $10,000, required to pay $18,000 in Department of Health costs, required to perform 50 h of community service, and obtain an additional 10 h of continuing medical education arising out his violation of the law. The pertinent facts in that case are as follows: (1) a patient in Texas logged onto an Internet pharmacy and selected doxycycline, a legend drug; (2) the Web site contained a “Consent Medical Care” questionnaire, which the patient completed; and (3) based on the patient’s completion of the form, the doctor prescribed the doxycycline, and the prescription was filled at a Florida pharmacy.

The doctor never personally interviewed or examined the patient, nor did he ever rely on information provided by another qualified medical professional who had personally interviewed and/or examined the patient. In fact, the doctor had no communication of any kind with the patient other than interaction via the Internet Web pages. Under these circumstances, the Board found that the doctor failed to establish a proper physician/patient relationship. The Board was helpful, however, in clarifying that the following is required under these circumstances: (1) a personal interview between the physician and patient via a mode of communication that is controlled by the doctor or a “Qualified Medical Professional,” and (2) an examination if necessary by the physician or the qualified medical professional. A “Qualified Medical Professional,” according to the Board of Medicine, means a licensed physician, nurse practitioner, or physician’s assistant.

Moreover, the Board stated that it was necessary for the doctor’s medical records to contain adequate evidence that the physician/patient relationship had been developed, that an adequate medical history had been taken, that the physician had made a diagnosis, and that the physician had developed an adequate treatment plan. None of these things were present in the case before the Board.

In truth, Dr. Alexandre’s punishment was fortunate since the Board revoked a physician’s license a couple of months earlier under similar circumstances. Florida physicians should take great care to ensure they comply with applicable law when dealing with Internet pharmacies. Merely relying on an Internet questionnaire and/or even an interview by someone who is not a Florida physician may expose Florida doctors to significant risk and penalties.




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