In an effort to shed light on the largely unregulated Internet market of drugs and pharmacies, structural biology Prof. David McKay, and his wife, Sheila, are suing a Colorado physician and an online pharmacy for negligence and wrongful death one year after their 19-year-old son committed suicide as the result of a prescription given without a doctor consultation.

John McKay had just finished his first year at Stanford. The nationally recognized, four-year president of the Menlo-Atherton High School debate team formed VOICES, a foundation to promote high school debate during his first year at the University.

After his freshman year ended, McKay visited the Web site usanetrx.com, which offers customers the chance to obtain drugs “without the embarrassment of talking to a doctor.” McKay purchased 90 capsules of an antidepressant, Prozac (also known as fluoxetine), from the online pharmacy site. Dr. Christian Hageseth of Colorado signed off on McKay’s order without a consultation, the suit alleges. The Mississippi-based pharmacy filled the prescription and shipped the order to McKay’s home in California.

McKay committed suicide on Aug. 2, 2005; he died of carbon monoxide and alcohol poisoning. At the time of his death, he had Prozac in his system.

In the first lawsuit of its kind, the parents are not suing the drug’s manufacturer, but rather the online pharmacy and the doctor.

The spokesperson for the Web site named in the suit referred all calls to the company’s attorneys due to the ongoing nature of the litigation; these lawyers were not available for comment by press time.

Under the California Business and Professions Code 2242.1, the state prohibits the prescription and administration of a drug without a “good faith” prior examination and medical indication.

The McKays are seeking to set a precedent that both proves the damages due to the online pharmacy and orders it shutdown. They hope this would allow for the eventual closing of other online pharmacies that are operating illegally.

The particular pharmacy McKay used does not require a faxed or mailed prescription from a licensed physician, similar to most online pharmacies.

Most online pharmacies operate in such a way that anyone can fill in a questionnaire can fill out a form to get whatever they want.

“I think the pharmacy thought that the doctor had a license, but he was making judgments solely on an online form, with no medical history of the patient,” McKay said in an email.

“He literally filled out the blanks in a short form, submitted information for a valid credit card, and received the prescription a couple days later by FedEx,” he said. “I am sure he thought that this was perfectly safe and he could solve his own problems; he did not appreciate the risks.”

Further investigation has shown Hageseth had a restricted medical license and was prohibited from filling prescriptions at the time.

Hageseth, who has since surrendered his license, told the San Jose Mercury News in March that he does not feel responsible for the teen’s death.

“When somebody commits suicide usually there are many factors,” he said.

Hageseth’s defense attorney will likely argue that the San Mateo County cannot hold a doctor practicing in another state accountable for negligence.

The McKay family hopes to aid in the fight against online pharmacies that reduce regulation and control of drug distribution and use.

“We hope to establish a precedent whereby if an online pharmacy supplies prescription drugs without a legal prescription from a licensed physician, they can be held accountable for the consequences if there is a negative outcome, as there was in my son’s case,” McKay said.

The Food and Drug Administration has published several articles over the past few years indicating the increased risk for suicide upon taking antidepressants such as Prozac. The inappropriate consultation, prescription and administration of this drug can lead down a dangerous road. Therefore physicians and families must be able to monitor patients during their use of the drug.

McKay’s parents did not have this opportunity.

“Since he was able to get the prescription without interacting with any medical professional, no one spoke to him or to anyone in his family at any time about possible risks or side effects,” McKay said. The FDA public health advisory warns of the serious risks of enhanced suicidal thought or behavior during the early stages of use of antidepressants of the selective serotonin reuptake inhibitor class.”

“My son was working at a debate camp in Los Angeles and visiting his friends in Minnesota for most of the period he was in possession of the prescription, so the family had little opportunity to observe him,” McKay added.

Since the filing of the McKay’s wrongful death lawsuit in federal court in February, a preliminary hearing has not yet been set for their case, but a judge refused to dismiss criminal charges Aug. 2.