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SHOCKED TACTICS
CELTIC CONNECTIONS: WHEN MICHELLE SHOCKED PLAYS CELTIC CONNECTIONS NEXT MONTH SHE’LL PREACH RELIGION RATHER THAN REVOLUTION … BUT FAITH HAS NOT DULLED HER ANGER
BY ANDREW PURCELL
Sunday Herald

THERE’S ONLY two things you don’t talk about in polite company - one is politics, the other is religion.” Michelle Shocked delivers her favourite line with a shrug that signals her intention to talk about faith, politics and little else. No-one has ever called her polite, but that’s how she likes it.

Shocked defined herself through confrontation the moment she ran away from her strict Mormon upbringing in East Texas to become a folk singer. Her rebellious streak landed her in mental hospitals, jail cells and homeless shelters in San Francisco. The cover of her debut album, Short Sharp Shocked, showed her being manhandled by riot police, a choke hold stifling her shout of protest. From the name down, she was outraged, appalled, and ready to fight.

She struggled against misappropriation of her music, taking her label to court and winning on the grounds that her contract amounted to slavery. She passionately condemned US foreign policy, speaking out against the invasion of Iraq back when it meant career suicide. She confounded the expectations of the music industry and her fans by refusing to stick with any one style, singing folk, blues, rock, gospel, swing, latino and Disney songs as the mood took her. She has no regrets.

Interviewing her is bracing, but never bland. “I find the question to be a particularly British type of journalistic tedium,” she tells me at one point, adding that she would like to put her hands around my throat and strangle me. “I really want to get to the soul of this, but you already have your questions. If you just want Q&A then I’ll give you answers, but don’t waste any more of my time. I’m trying to get to some heart matters here, man.”

Shocked is passing through New York on a tour to promote To Heaven U Ride, a live Sunday morning gospel set that she released on her own label, Mighty Sound, earlier this year. After a trip to a hat shop to get her trademark silk fedora professionally cleaned, we take tea at Starbucks. Shocked thinks that “people are hypocritical” in their attitudes to the corporate coffee chain, and in any case, she really likes the chai there. Knowing what your cuppa will taste like is important when you’re living out of a suitcase for weeks on end.

She pays with a gold American Express card, but times are evidently tight. She is staying at a grim hostel in Chelsea and travels from gig to gig in a small car barely big enough for her guitars and her three backing singers. “We wanted to go home with some money,” she says, “so the tour budget kept shrinking until we were sharing a room.”

Not that she is complaining. Shocked lived in enough squats and slept in enough doorways when she was young to know better than to get too comfortable with stardom when it arrived in the late-1980s. “I have never, ever, written songs to make money,” she says. “It’s something that I love to do. The fact that it becomes a recording is secondary.

“I’ve weeded out all the tourists by now. By now I probably have fans that I could put out a neo-Nazi album and they’d say, I sure didn’t see that one coming’. When you stop being cool, that’s when you can start calling people fans.”

Her gospel album comes with a “womanifesto” that begins: “Ask me about my religion. Of course no-one ever does.” But whether she is asked or not, the conversation returns again and again to her faith. Her political ideals, her feminism, her family relationships - all are expressed in the language of destiny and belief.

Fifteen years ago, Shocked was saved, at the charismatic Church Of God In Christ, close to her home in South Central Los Angeles. She went along for the singing, thinking that “this music would be so good if they’d just give that Jesus crap a rest”, but then, to continue the well-worn story, “stayed one Sunday too often”.

“When I made the altar call I was crying,” she says. “It’s almost like crawling across broken glass. The preacher said, This is the happiest day of your life’, but it took me a long time to understand.”

She soon joined the choir, as the only white woman in an African-American chorus, an occasional soloist with her own unofficial title: Sister Shocked. “My sister said, Chelle, you look like a grain of rice in a bag of chocolate chips’.”

Shocked was born Karen Michelle Johnson, in Dallas in 1962. After her parents divorced, when she was three years old, she was raised as the eldest of eight children by her mother and step-father, an “army brat” moving from base to base in the US and Germany. In her teens, the family returned to Kelsey - a one-church, one-store, one-cemetery town founded by Mormons in East Texas, in the middle of beautiful Bush-backing nowhere.

Her father, “Dollar” Bill Johnson, was a part-time musician who taught her blues and folk songs on weekends and holidays, but otherwise she was raised according to rigid Mormon dogma - no tea, no coffee, no fun on Sundays. “I was taught to be a racist. I believed God was racist,” she remembers. As soon as she was old enough, she ran away, ever further each time: to Dallas, to Austin, to San Francisco, to New York, to Amsterdam, to Rome.

In San Francisco, she was arrested at a squatter’s rights demonstration, given a shot of the now-discredited control drug Thorazine and taken to a psychiatric ward in handcuffs. Not long after she was released, she suffered a “psychotic episode” and was committed to a second mental hospital, in Texas, by her own mother.

After a month of therapy, medication and electric-shock treatment, her family’s health insurer declined to pay the bill and sent her home. This time, she left for good. She would not even speak to her mother for the next 25 years.

“I thought I had rejected religion whole qua, until I took the bad acid,” she says. “I was having apocalyptic, nihilistic visions that were part and parcel of the Mormon indoctrination of my youth. I was wandering around in the rapture. They got to me young and the more I tried to run, the more I tried to reject it. It became an antithesis to the thesis. I looked at my idealism, sincerity, passion and commitment and realised that the source of it all was a profound need for spiritual succour.”

Five years ago, she finally got back in touch with her family. “I’d already forgiven my mother many years prior but I just hadn’t had the courage to let her know. So I called her up. She was very gracious.”

That bond has been re-established, but some wounds remain raw. “I get reports that my sister is basically pretending she doesn’t know me,” Shocked says, with a tangible note of hurt in her voice. “She’s embarrassed to know me. They’re in East Texas and Bush plays really well there.”

The record that lifted her up, out of the squat scene, away from fiddle festivals and hardcore punk gigs, was the Texas Campfire Tapes. Englishman Pete Lawrence ran a tiny independent label, Cooking Vinyl. When he met Shocked at the Kerrville Folk Festival in Southern Texas, he was so entranced by her finger-picking guitar style, her beguiling voice, by turns pure and half-spoken, and her unselfconscious, storytelling lyrics that he asked if he could record her performing. He only had a Walkman, running low on batteries, but it would have to do.

Lawrence claimed to be a writer for Folk Roots magazine, but when he got back to Britain he released the set as a live bootleg without her permission. The collection of songs, punctuated with banter and laughter, with grasshoppers chirping loudly in the background, became the surprise hit of 1986. It topped the indie charts, got hours of airplay on Radio 2 and earned Shocked a major label deal, but it didn’t make her any less angry.

Oddly enough, To Heaven U Ride was never supposed to be released either. When Shocked performed at the Telluride Blues Festival in 2003 she had a clause in her contract that forbade organisers from taping her set. No-one told the team in the recording truck, so they taped her anyway.

Three years later, Shocked listened back to the performance and was impressed with what she heard. For an artist so determined to retain control over her music, who likens taking Mercury Records to court in the mid-1990s to David’s fight with Goliath; it was a confusing experience. Shocked is bitter that her wishes were ignored, but pleased with the results.

“This is about control of my destiny, which is very much in God’s hands,” she offers. “The fact that he may use bootleggers and pirates to guide that destiny is obviously something I don’t have a say in.”

At the live show in New York, Shocked’s rambling confessional stories threaten to eclipse the songs. Cover versions are chosen at the intersection of sacred and secular: Sister Rosetta Tharpe, The Band, The Staple Singers and Billie Holiday. Stripped of a rhythm section, it is up to Shocked to provide the intensity, while her backing singers fill out the sound.

One thing she does not talk about much, either on stage or in interviews, is her sexuality. In 1989, at the New Music Awards, when she beat Tracy Chapman, the Indigo Girls and Phranc to the title of “Best Female Singer or Group”, she accepted her trophy with a smile and an offhand comment: “This category should have been called Best Lesbian Vocalist’.”

A year later, she told Chicago’s OutLines magazine that “it would have made all the difference had I grown up knowing that the reason I didn’t fit in was because they hadn’t told me there were more categories to fit into”. She has remained a gay icon ever since, despite being married to music journalist and producer Bart Bull for a decade. “I have a lot of contradictions,” she says.

After her marriage disintegrated five years ago, Shocked fell “madly, passionately in love” with graphic artist David Willardson, whose Disney meets Pollock canvases are massively popular in Japan. They live in separate houses, a short drive apart in Los Angeles, and are working together on a collection of songs and paintings about iconic cultural figures: Audrey Hepburn, Frida Kahlo, Georgia O’Keefe and so on.

She has reconciled her sexuality with her faith, despite occasionally encountering conservative, homophobic attitudes within the church. When a visiting pastor preached that the Bible clearly defines homosexuality as a sin, she collared him afterwards and made her views known, but more generally she has accepted that it’s best to agree to disagree. “You cannot make a round peg like me fit into a square hole like organised religion,” she says, “but there’s lots of things that I can use.”

When Shocked opposed the invasion of Iraq with characteristic vehemence, the response from a section of her audience was “ridicule, hostility, outright rejection, people walking out of shows”. She also found that booking gigs was suddenly much harder than it used to be. However, the experience has not tempered her willingness to say the unsayable. She is happy to suggest that the USA deserves to be a terrorist target, for instance, paraphrasing an infamous Malcolm X quote in the process. “September 11 was just chickens coming home to roost,” she says. “The violence, the aggression, the inherent contradictions and the ultimate dysfunction of American society has led to this juncture.”

Her anti-authoritarian world view remains much the same as it was when she was younger. What has changed is the nature of her activism. This radical feminist, who never missed a chance to attack political oppression, sexism or racial intolerance, has now concluded that power and wealth have become so concentrated that prayer, not revolution, is the only option.

She says: “Folks, you’d better start praying like hell. This is truly gonna take a miracle to sort out. The good people had better start calling on a superpower to resolve this thing that is beyond human power. Look to Mahatma Gandhi, look to the Reverend Martin Luther King. They put the principle of non-violence to work. Power should not have ceded its authority without a bloody struggle, but it did.”

Shocked remains a professionally awkward customer who never backs down from a confrontation on principle. She last tussled with security guards earlier this year, on a Southwest Airlines flight, when a jobsworth steward flexing his post-September 11 powers wouldn’t let her sit on an exit row. “Move or I’ll call the cops,” he told her, so she refused, knowing she’d be thrown off the plane.

Is she more or less angry now that she is older and spiritually at peace? “Oh, I’m more angry, but I’m also more effective,” she says. “I’m still angry, but I have a few more skills, a few more credit cards, a few more contacts and a lot more experience.”

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Professor: 67 percent of elderly are depressed; ECT could be a “useful treatment”
December 13, 2007
‘ECT — most useful to treat depression’
Daily Times, Lahore Pakistan

Staff Report

LAHORE: Despite all myths and misconceptions, electro-convulsive therapy (ECT) also known, as electric shock treatment, is most effective treatment to treat depression, said Dr Ashar Khan, Bond University, Australia.

He was delivering a lecture on ECT – An Evidence-based Approach on Monday at the University of Health Sciences (UHS). UHS vice chancellor Prof Malik Hussain Mubashir, senior professors and postgraduate medical students attended the lecture.

Highlighting the history, types and procedure of ECT, Dr Ashar said it had been shown clinically to be the most effective treatment of severe depression and to result in improved quality of life in both short and long-term. He said ECT was also being used in the treatment of mania, catatonia, schizophrenia and Parkinson’s disease.

Dr Ashar said it was widely accepted that ECT did not cause brain damage, though its side effects included confusion and memory loss around the time period of the treatment. He maintained that the treatment was also safe during pregnancy.

He informed the audience that ECT was generally reserved for use as a second-line treatment for patients who had not responded to drugs. The first-line use of treatment, he said, was for situations where immediate clinical intervention needed or alternative treatments were not advisable. Its effectiveness had not been demonstrated in substance abuse, anxiety or personality disorders, he added.

Dr Ashar said hundreds of thousands of people across the world had received ECT every year, usually in a course of 6-12 treatments administered 2 or 3 times a week. After the treatment, he said, drug therapy could be continued and some patients received continuation/maintenance ECT.

Prof Malik said about 67 percent elderly people in Pakistan were suffering from depression. He said for these people ECT could be a useful treatment. He said ECT was useful in ischemic heart diseases than tricyclic anti-depressants.

Prof Haroon and Prof Riaz Bhatti also spoke on the occasion.

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NZPA | Tuesday, 27 November 2007

A committee of MPs says electro-convulsive therapy (ECT) should only be used as a treatment of last resort.

Under ECT, specialised medical equipment is used to induce an epileptic seizure by passing a small electrical current across the brain.

Parliament’s health select committee has been considering a petition by doctor Helen Smith who wants ECT to be voluntary, and its use with children, pregnant women and the elderly either banned or severely restricted.

Dr Smith argued the elderly should be given the opportunity to formally decline ECT prior to becoming elderly or unwell.

She also said there should be stricter regulatory reporting and controls in place for ECT use.

The health select committee, in its report on Dr Smith’s petition, has agreed with her in some areas.

It recommended that ECT “should only be used as a treatment of last resort when all other options have been considered”.

It said the Royal Australian and New Zealand College of Psychiatrists should urgently developing its guidelines into a national professional standard.

The circumstances for a patient to be required to undergo ECT should be more restricted, it said.

The committee also recommended the Mental Health (Compulsory Assessment and Treatment) Act 1992 be amended to ensure ECT was administered only with a patient’s consent where this was possible.

Where this was not possible it should be administered on the basis of a “truly independent second opinion” from certifying clinicians that were not attached to the institution from which the first opinion was obtained.

A majority on the committee recommended ECT be administered to pregnant women with informed consent only in cases of emergency where there was no other option available.

It wanted data on the rate ECT was administered to pregnant women to be collected and reported annually.

It said ECT should only be administered to children and young people “where in the opinion of certifying clinicians there is no other option available”.

The majority of the committee recommended that consideration be given to requiring an order under the Protection of Personal Property Rights Act when ECT was administered to the elderly, because of its presumption of competence and the least restrictive intervention.

The majority on the committee also recommended that where patients had made valid advance directives that they did not wish to undergo ECT, that these directives should be given effect.

ECT is used to treat severe depression and some other mental disorders.

Side effects include headaches, muscle aches or soreness, nausea, confusion and memory loss.

Critics condemn its use but the Ministry of Health says it is a valuable and sometimes life-saving treatment.

The Ministry of Health said 70 to 80 per cent of patients who received ECT responded to it well.

In 2004/05, 307 people received ECT. In the 2003/04 year, 305 received it.

Disproportionately more women than men received ECT and the committee was not given a satisfactory reason why this was the case.

While no statistics were given, the college of psychiatrists said it was rare to treat pregnant women with ECT.

In the 2003/04, 2004/05 and 2005/06 years five, two and one person under the age of 20 received ECT treatment.

The elderly were the main group to receive ECT.

The committee said in its report, tabled in Parliament today, that it was concerned about wide regional variations in its use. Some district health boards were administering as many as 18 treatments as part of a course of ECT, when guidelines stated six to 10 treatments.

“Given it is a controversial treatment, we consider it is essential that ECT be governed by a national standard and not by just guidelines,” the committee said.

The National Party had a minority view included in the committee’s report on the petition.

It felt the use of ECT was “an important life-saving treatment option that must remain available to clinicians”.

It said ECT was already generally a treatment of last resort, and there was “a very real risk of suicide” if the patient were left untreated.

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CVMC seeks OK for shock therapy

November 5, 2007
By Mel Huff Times Argus Staff

BERLIN – Central Vermont Medical Center is seeking state approval to provide electroconvulsive therapy to a small number of psychiatric patients so they can receive treatment closer to home.

“On the average, CVMC has been treating six to 12 patients a year who are subsequently sent to Dartmouth or Fletcher Allen for electroconvulsive therapy, so the ability to have this in the community is important,” said Dr. Peter Thomashow, CVMC’s medical director of inpatient psychiatry.

Once referred to as electroshock, the treatment now called ECT has changed substantially and been refined since it was first introduced in the early 1940s.

“Generally, this is a treatment reserved for patients with severe depression, depression with psychotic features and sometimes for very agitated depressions. It is rarely used first-line,” Thomashow said, explaining that in most cases psychiatrists turn to it only after drug therapy has proven unsuccessful or in situations where the depression is life-threatening.

No patients from Vermont State Hospital or the Vermont Department of Corrections will be treated if approval is granted for CVMC, Thomashow said.

Thomashow cited “lethal catatonia” as an example of a life-threatening condition where electroconvulsive therapy might be used as a first-line treatment. “Someone in severe catatonia can be so impaired that they don’t eat or drink, they don’t move,” he said. “ECT is the most effective treatment for this kind of catatonia.”

All patients who come to the unit for care will get a comprehensive screening, including “a full battery of blood tests to rule out any possible medical causes for their depression. Sometimes, patients will get a CT scan or an MRI of the brain to rule out any medical condition such as a brain tumor that could cause their depression,” he said.

For many, the public image of ECT comes from the movie of Ken Kesey’s “One Flew Over the Cuckoo’s Nest,” in which actor Jack Nicholson undergoes the process. But both the equipment and the sophistication of its use have changed considerably.

Thomashow and the other two psychiatrists at CVMC, Dr. Kenneth Adler and Dr. Paul Cameron, had a weeklong fellowship at Columbia University School of Medicine, where much of the research in ultra-brief unilateral electroconvulsive therapy – the kind that CVMC plans to use – has been done. The nursing staff has also gone through training.

“The ultra-brief unilateral ETC is a fairly recent development,” Thomashow said, explaining that the machine CVMC purchased is able to deliver stimulus to just one side of the brain, which “has far less side effects and is much better tolerated than bilateral (both sides of the brain) ETC.”

Jim Tautfest, the nurse director of inpatient psychiatry, noted that the new machines can be adjusted to a variety of pulse-widths, frequencies and durations of stimulus. This flexibility enables the psychiatrist to provide effective treatment with fewer side effects.

The most common side effect is short-term, and in some cases also long-term, memory loss. The degree of memory loss is the subject of substantial debate.

The decision to use electroconvulsive therapy will be made by a treatment team, Thomashow said, and will include extensive records reviews, consultation with the primary care physician and interviews with the patient and his family, along with a full medical work-up.

With a patient who presents special concerns, Thomashow said, tests will be done to determine if electroconvulsive therapy will work or pose problems. Elderly patients will get cardiograms, and patients over 50 will get chest X-rays. A patient who has had a recent heart attack would not receive electroconvulsive therapy, Thomashow noted.

He added that “there’s a very detailed informed consent process that is supervised by the state of Vermont. There’s quite a lot of oversight and regulation.” Patients and families will be shown an informational videotape produced by Dartmouth Hitchcock Medical Center and will discuss the risks and benefits of electroconvulsive therapy before consenting to the treatment.

“There’s no question that it’s a very effective treatment in the right individual,” Thomashow said, offering benefits to some “individuals who have suffered for prolonged periods of time, whose lives have changed and who have not been able to function.”

CVMC’s application is the first the Department of Mental Health will act on since the Legislature charged it in 2000 with oversight. Fletcher Allen Health Care, White River Junction VA Medical Center and Retreat Healthcare in Brattleboro are already providing ECT.

Dr. Bill McMains, the medical director of the Department of Mental Health, said officials will conduct a review to make sure that the hospital’s standards for ECT comply with national standards, as well as meet extra state requirements to ensure “the safety of the person and making sure that people are adequately educated about what they’re doing.”

Vermont has “a very in-depth consent form” that hospitals must agree to use in order to get certified, he added. The form was developed through two years of negotiations with treatment experts and hospitals that were delivering electroconvulsive therapy at the time. McMains noted that Rep. Anne Donahue, R-Northfield, who follows mental health issues closes, was “very much a party” to developing the document.

The form, which all Vermont hospitals must use, requires that hospitals obtain the patient’s consent after every 12 treatments. “So a person doesn’t give ‘forever’ consent,” McMains observed. “It’s only good for 12 treatments, and then you have to go over it and get consent for any more.”

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Christian Hageseth just can’t seem to stay out of trouble.

It seemed certain that things couldn’t get any worse for the Colorado man when he was caught prescribing medications online - in violation of the terms of his restricted medical license - and a California teenager died. The former psychiatrist, who once billed himself as the “compassionate” ECT doc, was finally out of business and surrendered his medical license, admitting he knew he had violated the restrictions.

But Karma - and California prosecutors - weren’t quite done: in October, he was arrested in Nebraska and later extradited to California to face a felony charge of practicing medicine without a license..

After years of scandal and lawsuits that reached theatrical levels, Hageseth lost his Colorado medical license. The licensing board ruled he had violated ethical standards by romancing a patient, which resulted in the destruction of two marriages. He was kicked out of the American Psychiatric Association. He fought to regain his license and won a partial victory: his medical license was reinstated, with severe restrictions. Those restrictions basically limited his practice of medicine to research and he told the board he had accepted a position at a pharmaceutical research clinic.

Apparently the research position did not work out and Hageseth began prescribing medications at an online pharmacy. When quoted in the media after the young man died, he complained that the internet pharmacy was the “last possible thing” he could do in medicine and that he was now poor and unemployed.

Whether he thought he wouldn’t get caught, he misunderstood the terms of his restricted medical license, thought the Internet didn’t count, or in some other way justified his actions in his own mind, only he could possibly know. He likely could have continued to quietly write prescriptions to anonymous patients online had it all not turned deadly in 2005. That’s when he wrote a prescription for Prozac to a depressed teenager he never met.

A year earlier the FDA ordered antidepressant manufacturers to include a “black box warning” on the packaging and issued a public health advisory, warning the medical community of an increased suicide risk in children and teens who take the medications. The advisory stressed the need for “close monitoring of patients as a way of managing the risk of suicidality.”

http://www.fda.gov/bbs/topics/news/2004/NEW01124.html

The teenager committed suicide after taking the Prozac prescribed by Hageseth.

When attorneys for the young man’s family began investigating the online pharmacy, they discovered Hageseth’s little secret: his license restrictions prohibited him from prescribing medications.

On August 12, 2005, ten days after John McKay committed suicide, Christian Hageseth signed documents with the Colorado licensing board stating that he admitted he prescribed medications via the Internet in violation of the restrictions on his medical license.

The McKays filed suit, and Hageseth was back in the news. Instead of expressing sympathy for the boy’s family, he complained to the media that this was the last job he could get (medically at least - McDonald’s is still hiring), that he was “poor” and “unemployed.”

That would have been the end of the saga, but officials in California, where the young man lived, were not going to let it slide. They filed criminal charges against Hageseth, for practicing medicine without a license.

A legal tug of war insued, with California issuing an arrest warrant, but Hageseth’s attorney fought extradition and Hageseth remained free.

Then he was stopped for speeding in Sidney, Nebraska.

When the police officer checked the computer, he saw the arrest warrant and Hageseth found himself in the Cheyenne County (Nebraska) jail. He was released, then returned to jail until he was extradited to California after Gov. Arnold Schwarzenegger approved a special request from prosecutors.

Bail was originally set at half a million dollars, then reduced to $250,000. He has apparently been released from jail, though details concerning who paid his bond are not known. According to jail officials, release from jail would have required a non-refundable cash payment of $25,000 or property in the amount of $500,000 being used as bond.

Documents:

Christian Hageseth medical license surrender order

Christian Hageseth medical license restrictions order

Links to legal discussions:

Is it a Crime to Prescribe Medication in Cyberspace?
A California Court Says It May Be, If the Prescriber Is Not Licensed by the Relevant State, and Has Not Met His Patient

Law.com: Web Prescription Tests California Medical License Law

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Colo. doctor extradited to Calif. over illegal Web prescription
The Associated Press
11/30/2007 12:39:19 AM PST

REDWOOD CITY, Calif.—A Colorado doctor accused of illegally prescribing Prozac for a Stanford student who later committed suicide has been extradited to San Mateo County to faces charges.

Dr. Christian Hageseth III was extradited from Nebraska, where he was recently arrested during a traffic stop. He was scheduled to enter a plea Friday to one count of practicing medicine without a license, but the matter was delayed until Dec 4.

Authorities say Hageseth prescribed Prozac for John McKay through the online pharmacy USAnewRX.com. At the time, Hageseth’s restricted medical license did not allow him to give prescriptions.

Two months later, McKay killed himself and was found with alcohol and the drug in his system.

McKay’s parents, David and Sheila, also sued the doctor and pharmacy, alleging negligence and wrongful death, but the lawsuit was dismissed.

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Doc pleads not guilty to practicing sans license
Colorado physician accused of prescribing Prozac online

By Michael Manekin, STAFF WRITER

San Mateo County Times
12/05/2007

REDWOOD CITY — A Colorado doctor accused of filling an online Prozac prescription for a Stanford student who later committed suicide pleaded not guilty Tuesday to charges that he practiced medicine without a California license.

Dr. Christian Hageseth, 46, was extradited last week from Nebraska, where he had been cited for speeding, and was being held in San Mateo County jail in lieu of $500,000 bail.

Moments after Hageseth entered his plea, a Superior Court judge lowered his bail to

$250,000, explaining that the doctor may still pose a threat to the public, but never illegally dodged criminal charges in San Mateo County.

County prosecutors have tried to bring Hageseth to justice since filing charges in May 2006. But Hageseth has long fought county prosecutors’attempts to extradite him, claiming that filling a drug prescription from Colorado via the Internet grants him immunity from charges that he illegally practiced medicine in California.

Superior Court Judge Barbara Mallach said Tuesday that Hageseth never “eluded authorities” when he fought extradition to San Mateo County. Rather, the physician was merely “using his legal remedies” to fight the charges against him.

Then, she cut the doctor’s bail in half.

Deputy District Attorney Jennifer Ow said outside of court that she was relieved that the judge didn’t set bail any lower.

“(Two-hundred fifty thousand dollars) is still a significant amount of money, and hopefully it will
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ensure that if the defendant is able to post (bail), then he will continue to appear in court,” Ow said.

If the judge slashed Hageseth’s bail even further, prosecutors would have been concerned that the doctor might leave the state, Ow said.

Defense attorney Anthony Gibbs assured the judge in court that his client “has every probability of returning for trial.” He then told the judge that the physician had voluntarily surrendered his license to practice medicine in Colorado, adding “it would be ludicrous to think that Dr. Hageseth will go out and fill prescriptions.”

In June 2005 Hageseth prescribed generic Prozac online to 19-year-old John McKay, a freshman at Stanford University. On Aug. 2, 2005, McKay committed suicide by carbon monoxide poisoning, reportedly with alcohol and the generic Prozac in his bloodstream.

McKay linked up with Hageseth through a Web site called Usanetrix.com, an Internet portal advertising prescription drugs. Unlike visits with a conventional doctor, patients who visit the online pharmacy do not submit to a physical examination. Instead, prospective buyers fill out an online questionnaire which a doctor is supposed to review before prescribing the medication.

Hageseth filled the prescription of generic Prozac for McKay without a consultation, according to prosecutors.

The California medical board investigated the incident and urged the San Mateo County District Attorney’s Office to file criminal charges. Nearly a year after McKay’s death, prosecutors charged Hageseth with one count of practicing without a state medical license.

Hageseth’s lawyers filed a motion in Superior Court to try to get the case dismissed on the grounds that the state court lacked jurisdiction to try the doctor under state law, but a judge refused the request. The attorneys then appealed the decision; however, a state Appeals Court ruled in May that county prosecutors could try the doctor.

Defense attorney Carlton Briggs has argued that if Hageseth is convicted, many more out-of-state physicians prescribing medication online in California would be vulnerable to prosecution.

However, Deputy District Attorney Steve Wagstaffe argues that the case against Hageseth will not “open up doors to additional prosecution … because, whatever the outcome, it will send a message to any doctor who is thinking prescribing drugs online is a lucrative business.”

Meanwhile, David and Sheila McKay have filed a civil lawsuit in federal court against Hageseth and two companies affiliated with the online pharmacy, alleging negligence and wrongful death of their 19-year-old son. A federal judge in the state’s Northern District dismissed the suit in September, but the McKays have appealed the ruling.

Sheila McKay said outside of court Tuesday that a criminal conviction for Hageseth represents an opportunity to send a clear message to online pharmacies and doctors that “it’s not OK to churn out prescriptions to young people.”

Hageseth is scheduled to return to the Hall of Justice on Dec. 19 to set a preliminary hearing date. He faces up to three years in state prison and a $10,000 fine if convicted.

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Doctor extradited to face charges in patient’s suicide
By Coloradoan staff

Dec. 1, 2007

Dr. Christian Hageseth III of Fort Collins has been extradited to California to face charges that he illegally prescribed Prozac for a Stanford student who later committed suicide.

Hageseth, a psychiatrist, was to enter a plea Friday in San Mateo County, Calif., to one an count of practicing medicine without a license. However, the judge delayed the hearing until Tuesday so that she could consider defense motions filed earlier this week regarding Hageseth’s bond.

Hageseth is expected to enter a not-guilty plea to the charge, San Mateo County Chief Deputy District Attorney Steve Wagstaffe said.

Hageseth was extradited from Nebraska, where in October he was arrested near Sidney during a traffic stop.

Authorities say Hageseth prescribed Prozac for John McKay through the online pharmacy USAnewRX.com. At the time, Hageseth’s restricted medical license did not allow him to give prescriptions.

Two months later, McKay killed himself. He was found with alcohol and the drug in his system.

Hageseth lost his license in Colorado in 1999 due to a relationship that led to his marriage to a former patient, Laurel Burson. However, in 2001, the state Court of Appeals reversed the Colorado State Board of Medical Examiners decision and reinstated Hageseth’s medical license. Still, under the conditions of his reinstated license, he was not allowed to write prescriptions.

Hageseth is being held on $500,000 bond.

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Fugitive doctor jailed

By Michelle Durand
The Daily Journal, San Mateo County, California

Nov. 26, 2007

The Colorado doctor facing prosecution for filling a Stanford student’s online Prozac prescription prior to the teen committing suicide is back in San Mateo County after failing to fight extradition from Nebraska where he was recently arrested on a traffic charge.

Dr. Christian Ellis Hageseth III, 66, will appear in court Nov. 30 to enter a plea and hear a defense motion to reduce his $500,000 bail.

Hageseth had been in custody in Cheyenne County, Neb. while awaiting extradition back to California on a $500,000 arrest warrant. Hageseth’s defense attorney Carl Briggs hoped his client could avoid extradition as he had on an earlier warrant seeking his transport from Colorado. However, Hageseth lost his legal battle last week and is now in the Maguire Correctional Facility in Redwood City awaiting prosecution on one count of practicing medicine without a license.

In June 2005, John McKay, a freshman at Stanford University and former student at Menlo-Atherton High School, purchased 90 capsules of generic Prozac via credit card at the online pharmacy site USAnewRX.com which was then shipped from the Mississippi-based Gruich Pharmacy Shoppe.

Online sites like the one used by McKay do not require a physical examination prior to receiving a prescription. Instead, the buyer fills out an online questionnaire which a doctor is supposed to review before signing off on the drugs. Hageseth signed off on the prescription of fluoxetine without a consultation. On Aug. 2, 2005, McKay committed suicide by carbon monoxide poisoning, reportedly with alcohol and fluoxetine in his system.

At the time of McKay’s online purchase, Hageseth was not allowed to fill prescriptions because he had a restricted medical license because of an unrelated relationship with a patient he later married.

The following February, McKay’s parents, David and Sheila, filed a federal lawsuit against Hageseth and the pharmacies, alleging negligence and wrongful death. That lawsuit has now been dismissed.

Meanwhile, the Medical Board of California launched its own investigation and the San Mateo County District Attorney’s Office filed criminal charges last May.

Instead of coming to California, Hageseth began a legal battle to remain in Colorado. Briggs has consistently maintained his client is not on the lam because he cannot legally be prosecuted when he wasn’t physically in the state when the prescription was issued.

A state Appeals Court recently ruled that Hageseth can be prosecuted in this state and local prosecutors expected him to voluntarily surrender.

Instead, in October, Sidney, Neb. police stopped him for allegedly speeding and learned of his outstanding arrest warrant.

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Colo. Doctor Charged In Web Prescription Flap

CBS4, Denver
November 29, 2007

FORT COLLINS, Colo. (CBS4) A Colorado doctor has been arrested in California, facing felony charges for prescribing medicine over the internet.

Officials said Fort Collins psychiatrist, Dr. Christian Hageseth, apparently knew nothing about the patient before prescribing Prozac, an antidepressant. The patient later committed suicide.

The criminal charges against Hageseth are not related to the patient’s death, but he faces civil charges for that. The criminal charges are based on a violation of California law, but both California and Colorado regulators say when it comes to the internet, the boundary lines are hard to draw.

The patient, John McKay, was a student at Stanford University. He committed suicide two years ago after buying Prozac from an online pharmacy. Studies have shown the drug can lead to suicidal thoughts and patients should be monitored.

Hageseth was the doctor who approved the online prescription, but he never met or talked to McKay.

“Prescribing medication is practicing medicine,” San Mateo County Deputy District Attorney Steve Wagstaffe said. “You can’t do that in this state if you’re not licensed by this state, and he is not licensed by the State of California.”

Hageseth’s attorney argues that’s not true.

“He ‘e-prescribed.’ He wrote an e-prescription in Colorado and uploaded it to a server in Texas,” attorney Carl Briggs said.

“A Colorado doctor is using a server in Texas to get meds to a kid in California; those are very difficult lines to trace back through, so it is a concern to the Board of Pharmacy,” Chris Lines with the Colorado Department of Regulatory Agencies said.

Hageseth also violated Colorado rules.

“There has to be a preexisting patient practitioner relationship to be in compliance with the regulations as they are,” Lines said.

However, regulators admit right now, there’s no good way to make sure doctors are following the rules on the internet. It’s a concern for in every state in the U.S.

“I think everyone would like a precedent set where everyone’s needs were met and everyone was protected,” Lines said. “The internet opens up a whole new series of freedom of speech questions and freedom of activity questions that at this point, it doesn’t seem we’re prepared to deal with.”

For now, it’s one case at a time, which will begin to set a precedent. All eyes are on this case, including those of the patient’s father, David McKay, who is also suing Hageseth.

“I would hope it would send a message to those who are operating illegally that they will be held accountable,” McKay said.

Hageseth was also working with a restricted license, under investigation for having an improper relationship with a patient. Although those charges were later dropped and his license re-instated, he was not allowed to write prescriptions for anyone during the time he filled McKay’s online request.

Hageseth was extradited to California and is being held on a $500,000 bond.

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Web Doc Accused Of Aiding Bay Area Teen’s Suicide
REDWOOD CITY (CBS 5)

San Francisco
Nov 28, 2007

A Colorado-based doctor is facing criminal charges, after prescribing medication over the Internet to a Bay Area teen who committed suicide.

Christian Hageseth is accused of practicing medicine without a license by prescribing Prozac to John McKay, a student at Stanford. In 2005, McKay committed suicide after buying the anti-depressant drug Prozac from an online pharmacy.

Hageseth’s attorney told CBS 5 his client didn’t break any California laws because he was never in California. CBS 5 Legal Analyst LaDoris Cordell believes this case is the first of its kind, and could lead to major changes.

Our video report has more.

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2000 document from UBC Department of Psychiatry and the BC Ministry of Health

Download PDF File (3.7 mb)

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BRIEF: Prof. sues doctor after son’s 2005 suicide
December 5, 2007
By Andrew Valencia

Stanford Daily

San Mateo County, Calif. — Structural biology Prof. David McKay has filed a lawsuit against a Colorado doctor who illegally prescribed Prozac to the professor’s son, John McKay ‘08, prior to his suicide. In the summer of 2005, Dr. Christian Hageseth III prescribed the medication to John McKay via an online pharmacy called USAnewRX.com. At the time, Hageseth did not have a valid medical license to prescribe medication, and McKay committed suicide two months later on Aug. 2, 2005. The medication was found in his system along with alcohol.

Prof. McKay has filed the suit against Hageseth in San Mateo County court, where Hageseth has been extradited to face criminal charges for practicing medicine without a license.

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Thomas F. O’Neil III and Melinda H. Waterhouse
DLAPiper

Dec. 6, 2007

As federal and state enforcement authorities pursue companies and corporate officers with ever-increasing fervor, they are developing novel theories of liability to expand dramatically the targets of their investigations. Over the past decade, both chief legal and compliance officers have found themselves in the spotlight previously beamed on their colleagues in accounting and finance. A recent case in the health care sector highlights the potential exposure.

In September 2007, the United States Department of Justice (DOJ), through DOJ’s Civil Division and the United States Attorney’s Office for the Southern District of Florida, filed a lawsuit against Christi Sulzbach (Sulzbach), former general counsel to Tenet Healthcare Corp. (Tenet or the Company), seeking tens of millions of dollars under the False Claims Act (the FCA or the Act). In a novel application of the FCA, the complaint (filed in federal court in Miami) alleges that Sulzbach submitted one or more false sworn compliance declarations required by a corporate integrity agreement imposed on Tenet’s predecessor, National Medical Enterprises, Inc. (NME), thereby causing the government to pay claims erroneously.

Sulzbach was not involved in any facet of the claims at issue, so the lawsuit epitomizes the zeal of current recovery initiatives. It also raises important questions regarding internal investigations, settlement agreements, and voluntary disclosures.

The Corporate Integrity Agreement
In June 1994, NME settled an investigation of, among other things, alleged kickbacks, and the Company agreed to pay a then unprecedented fine of over $350 million. The Company also entered into a corporate integrity agreement (CIA) with the Office of Inspector General of the Department of Health and Human Services (HHS). Sulzbach executed the settlement agreement and the CIA on behalf of NME.

The CIA required NME to submit to HHS annual compliance reports, which would include certifications regarding the company’s compliance or non-compliance with federal program legal requirements and the status of any relevant ongoing investigations. The CIA remained in effect after NME and American Medical Holdings, Inc. merged in 1995 to form Tenet. Sulzbach became Tenet’s associate general counsel and corporate integrity program director.

The Internal Investigation
According to the complaint, in February 1997 an executive at Tenet drafted a memorandum expressing concerns regarding the legality of certain contracts with physicians. The executive later met with Sulzbach, and she retained outside counsel to conduct an internal investigation.

In or about June 1997, the law firm submitted the final version of its report, determining, in essence, that the contracts at issue had in fact violated a federal statute known as the Stark Law which prohibits kickbacks and payments for physician referrals. Those findings and conclusions were not disclosed to enforcement officers.

The CIA Compliance Reports
After receiving the report from outside counsel, Sulzbach submitted reports under the CIA in 1997 and 1998; in each instance, she certified that, to the best of her knowledge and belief, Tenet was in material compliance with the terms of the CIA and federal program legal requirements. Sulzbach filed the 1997 compliance report four days after receiving outside counsel’s findings concerning violations of the
Stark Law.

Notably, the DOJ complaint also details an apparent effort by Sulzbach to correct the situation. Roughly a month after she submitted to HHS the 1997 compliance report, Sulzbach issued an internal memorandum to a colleague whom the executive had originally contacted, directing him to implement corrective action recommended by outside counsel, advising him that failure to do so could trigger the disclosure provisions of the CIA, and requesting that he send her a written status report within 30 days. The complaint suggests that Sulzbach failed to follow up on this memorandum and that as a result, the violations continued.

The Qui Tam Litigation
A former Tenet employee filed a qui tam action against the Company in May 1997, claiming that it had violated the FCA by, among other things, billing Medicare for referrals from the physicians who had been identified by the executive several months earlier. Tenet denied the allegations in that case and, during discovery, asserted evidentiary privileges with respect to over 15,000 documents, including the report from outside counsel and the internal memorandum from Sulzbach to her colleague.

The government intervened in that case and filed a motion to compel production of documents identified on the privilege logs; this motion was pending when the litigants settled in 2004.

The 2006 Settlement
In 2006, the Company resolved a Medicare fraud inquiry by the government. Under the settlement agreement, Tenet agreed to pay $920 million and to produce certain documents that had been withheld as privileged, including some materials from the long-settled qui tam action. That concession resulted in the disclosure of two versions of the 1997 report from outside counsel and the internal memorandum thereafter authored by Sulzbach.

The following year, the DOJ sued Sulzbach under the FCA in a
three-count complaint seeking treble damages and civil penalties.

The Act
Congress enacted the FCA during the Civil War to empower citizens to pursue fraud claims against contractors, usually in situations where contractors had made false claims or falsified records to receive payment from the government. By the late 1990s, the Act had become a significant weapon in the arsenal of federal enforcement officials and private-sector whistleblowers, primarily in the defense and health care sectors.

The FCA prohibits:

• knowingly presenting or causing to be presented to the government a false or fraudulent claim for payment or approval;
• knowingly making, using, or causing to be made or used a false record or statement to receive payment or approval for a false claim from the government;
• conspiring to defraud the government by obtaining approval or payment from the government for a false or fraudulent claim;
• intending to defraud the government or conceal property from the government by delivering less property than the receipt indicates;
• intending to defraud the government by certifying a receipt for property used by the government without knowing the truth of the information in that receipt;
• knowingly buying or receiving public property from the government when this acquisition is unlawful; or knowingly making, using, or causing to be made or used a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit property to the government.

Under the FCA, the United States can recover civil penalties of $5,000 to $10,000 per violation. The government is also entitled to recover treble damages, except when the target has provided the government information about the violation within 30 days of obtaining the information; the violator has cooperated fully with the government; and no criminal prosecution, civil action, or administrative action had previously commenced regarding the violation. Finally, the government can recover the costs of any civil action brought under the Act.

Ramifications for Legal and Compliance Officers
The heart of the DOJ’s case against Sulzbach is the notion that, as associate general counsel and corporate integrity program director, she was personally responsible for investigating alleged violations of any federal program legal requirements and for reporting to HHS the existence and status of any such internal inquiry.

That factual assertion hardly seems debatable. It has, however, given rise to a new theory of liability under the FCA. DOJ’s ardor in this case quite clearly was fueled by the alleged failure to follow through on the corrective measures and by the vigorous defense of the qui tam action.

Perhaps this aggressive pursuit of compliance and legal officers under the Act will be confined to exceptional circumstances involving a confluence of aggravating factors. Case-specific facts notwithstanding, all compliance and legal officers operating in regulated industries should review this decision carefully. The imposition of a CIA is a serious matter, as is the subsequent submission of contractually mandated compliance reports. Furthermore, the potential consequences of a privilege waiver in a settlement agreement must be analyzed comprehensively before negotiations are concluded.

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