Physician keeps a practice online Investigation: A Baltimore doctor prescribes drugs to patients around the world, as authorities try to figure out whether that is illegal.

September 03, 1998|By Michael James and Joan Jacobson | Michael James and Joan Jacobson,SUN STAFF

No one has stopped Baltimore's "telemedicine man." Not the federal agents who raided his offices, not the state physicians' -- board that has subpoenaed his records, not the former patients who claim he is a reckless doctor loose on the Internet.

Eleven months after the widely publicized raid that appeared to end Dr. Pietr Hitzig's medical practice, the resilient and computer-savvy doctor is still online and running a downtown Baltimore treatment center.

He has no examining room, no stethoscope, no lab coat.

He sits in front of a computer and answers phone calls from patients thousands of miles away whom he's never physically examined.

He claims to be treating nearly 1,000 patients around the world for nearly every ailment, including hay fever, obesity, cancer and Lou Gehrig's disease.

"It's a wonderful tool, this Internet," Hitzig says in his downtown office, with his Harvard and Columbia degrees framed behind him.

"What I'm doing is ethical and, as far as I know, legal."

What he's doing is also the focus of a unique federal investigation that has precedent-setting implications for telemedicine.

Although the doctor has a devoted following of patients, state and federal investigators are trying to figure out whether he's breaking the law.

Undercover federal agents have e-mailed Hitzig, posing as overweight businessmen in order to gain insight into his practices.

Hello to the DEA

Hitzig claims his phones are tapped, prompting him at times during phone conversations to suddenly declare, "Say hello to Sergeant McElroy of the Drug Enforcement Administration, who's listening in."

"They've also followed the woman I was dating -- with helicopters," the doctor claims.

But while there may be some madcap elements to the Hitzig investigation, the heart of the issue is telemedicine -- and how it should be regulated.

Laws are cloudy relating to doctors who rely on the Internet and e-mail as the heart of their practice. As a result, prosecutors say ,, they're in uncharted waters.

"We're going where no man has gone before," said First Assistant U.S. Attorney Stephen M. Schenning. "This is new territory."

Medical and legal experts say there have been no other documented cases on such a large scale involving doctors engaged in questionable telemedicine practices.

Hitzig's practice of writing prescriptions and faxing them by the hundreds to pharmacies around the country is not accepted medical practice, according to an affidavit filed in U.S. District Court in Baltimore. But there is no state or federal law prohibiting it.

State laws "were developed for disciplining doctors before there was an Internet," said J. Michael Compton, executive director of the Maryland Board of Physician Quality Assurance.

The physicians' board sparked the criminal investigation in 1996 by notifying the U.S. Drug Enforcement Administration that Hitzig was involved in the "illegal distribution" of phentermine, fenfluramine and temazepam from California to Florida, court papers said.

Authorities raided Hitzig's home and office in September 1997 to gather information to show that he was prescribing drugs to patients without the required doctor-patient relationship. But Hitzig has never been charged with any wrongdoing.

The quality assurance board, which oversees state-licensed physicians, recommends that doctors examine patients and have a record on them before prescribing drugs. While admitting he rarely meets patients, Hitzig says he examines them in other ways.

"Basically the information I want from patients can be collected through interviews and by various types of testing, including psychological testing," said Hitzig, whose Web site advertises miraculous relief for everything from hives to AIDS.

"I don't do lab testing for my patients here or anywhere, nor am I interested in the size of my patient's liver."

Beyond fen-phen

Hitzig once touted himself as the "father of fen-phen," the diet drug combination that was pulled off the market by the U.S. Food and Drug Administration after a study linked it to heart damage. He has moved on to a new drug combination called "phen4, the next generation."

On his Web page, he says the pills help reduce pain from chronic illness, prompt weight loss without dieting or exercise, and provide "remarkable relief" from common colds. Without a visit or physical examination, patients anywhere in the world can receive Hitzig's "treatment protocol" for $1,154, according to the DEA affidavit.

Those claims, while criticized as unrealistic by some former patients, are not at stake in the criminal case. The issue is whether medication should be prescribed electronically without a doctor's exam or visit.

Such a practice is generally accepted in emergencies, such as when a patient needs an antibiotic for a sudden illness. But Hitzig routinely prescribes medications without seeing patients -- practice he defends.

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