Christian Hageseth has conviction.

Prosecutors would say it is the no contest plea the former Colorado psychiatrist entered Friday to a felony charge of practicing medicine without a license by approving an online request for generic Prozac used by a Stanford University student who later killed himself.

Hageseth, 68, would say it is his new calling to help those without medical insurance or easy access to care receive help and medication for depression — a condition that has touched his life on numerous levels, including John McKay’s suicide.

Hageseth said while as a contractor for the online pharmacy he truly felt he was providing a needed service for those who can’t afford medical service or live in rural areas. He only filled renewals, not initial prescriptions, and wouldn’t issue controlled substances like Valium and Vicodine, he said.

“The 800 pound gorilla in the room is that 70 million people lack adequate health care; 1.4 million with severe depression can’t afford to see a doctor. They are turning to the Internet for the drugs they need,” Hageseth said.

McKay’s two-page medical questionnaire was just one of approximately 45 a day Hageseth reviewed at his Fort Collins, Colo. home. McKay indicated Attention Deficit Disorder — which Hageseth said gave him pause — and claimed to have taken the drug previously.

There is no way to tell if a patient is lying or formally diagnosed so the approval is based simply on the paperwork — a telemedicine shortcoming which needs improvement and regulation, such as random interviews of patients by a third party and restrictions on allowable drugs, he said.

Silver lining

Better yet, Hageseth believes the silver lining he’s found in his conviction could redirect thousands from using the Internet to medicate depression and push them into face-to-face interviews with physicians.

Hageseth founded a nonprofit, Depression Care Access, Inc., which will use grants and donations to give those believing they are depressed two vouchers, one for two visits to a doctor of their choosing, and another for medication.

Hageseth concedes social stigmas can prove as much a barrier as economic challenges but that other common online prescriptions such as for Viagra do not carry the same jeopardy as patients with potential mental illness. He also concedes any telemedicine doesn’t adequately replace individual consultations and diagnoses.

Yet, it’s a start. And rather than focus on anger or frustration at being prosecuted, Hageseth said he’s trying to believe it has led him to a better way to aid those suffering with depression.

“I’ve got to think there’s a way I can still help,” Hageseth said.

While he may believe telemedicine is a way to improve access and affordability, Hageseth’s entry into online territory came from a more basic need: Money.

In 1999, the Colorado Medical Board revoked Hageseth’s license for sexual misconduct. Hageseth had since married the woman, his now-wife of 11 years, Laurel, but said the board acted on a lingering malpractice accusation brought by her husband at the time.

“Yes, I’ve got a scarlet letter,” Hageseth said.

Making a living

The appellate court overturned the revocation but taking classes and fighting the medical board for an unrestricted license was too costly, he said.

Instead, he worked with a a research institute on new depression drugs and said he was allowed to write prescriptions under the tenets of the Declaration of Helsinki which addressed human test subjects. When the job ended in 2004, he needed to make a living and opted for telemedicine although he disputes the assumption it is easy money for doctors churning out prescriptions.

“Yes, it is easy and yes, it is money but it’s nothing compared to what a full-time doctor makes,” Hageseth said, estimating he pulled in about $58,000 that year. “And, I thought I could still do good.”

According to Hageseth, some of those online prescriptions fit that description. One woman in rural Alabama thanked him for depression medicine for her mother, saying in a letter that without it she was ready to kill both of them. Another man thanked him for refilling his Keflex without expensive treks to new doctors after relocating.

But while those may be people for whom Hageseth’s services proved beneficial, the online patient with whom he is most identified is the one no longer alive.

Legal battle

Only days after McKay killed himself — months after Hageseth approved a three-month refill of generic Prozac — he said he received a call from the teen’s aunt promising to make his life hell and subsequent calls from the California Medical board who said he would be charged with negligent homicide. The charge actually ended up being practicing medicine without a California license and Hageseth began a multi-year judicial battle against extradition and if the state even had jurisdiction.

Hageseth said although he was not required to speak with McKay before prescribing the drug, “I made a decision to drop below the standard of care.” Medical ethics define that standard as having an interview with a patient before a prescription — a description that means a number of doctors still working online are also dropping below, he said.

And if a doctor asked if they should issue prescriptions online?

“Don’t do it. Not unless there are federal guidelines. Not now,” he said.

He doesn’t assume McKay would have sought in-person help had he not approved the prescription; the freshman had exhibited alcoholic and suicidal tendencies previously but wasn’t convinced to seek a doctor by his parents or anybody else close to him, he said.

Sorry for family’s loss, hope for the future

While he didn’t know McKay personally and has never spoken personally to his parents, Hageseth said he understands being “a player in that drama” and feels for their loss.

“I would tell them I’m really, really sorry your son died and I hope this helps you move on.”

On Friday, after receiving a nine-month sentence on the felony, Hageseth broke the silence he said had frustrated him for those years. Hours after accepting his term and arranging service near the community he calls home, Hageseth is interrupted by phone calls from his two sons, sharing support and checking the outcome. Finances are back to being tight and he continues recuperating from heart surgery, he said, but he and his wife are rich in friends who have provided much-needed support.

He claimed to understand the drama of the case — the novelty of unregulated telemedicine and the tragic suicide of a young man — but said the focus on him and the McKays too greatly overshadows the need for accessible and affordable care.

The attention on him while others remain untreated is like the media gathering for the O.J. Simpson murder trial while millions die away from the cameras in Rwanda, he said.

Yet, despite a desire to focus on the future, Hageseth cannot ignore the past that got him here. The road began when he met Laurel, because the subsequent medical board action led to his online work. If he didn’t love her as much life would be easier now, he admits. Similarly, life would be easier without a criminal conviction, he said, although it is what brought him to his new online cause.

“It’s a role I accept,” he said. “I hope something good can come from all of this.”

Michelle Durand can be reached by e-mail: michelle@smdailyjournal.com or by phone: (650) 344-5200 ext. 102.