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.
"If you ever can get a doctor, a very fine doctor, with a couple drinks under their belt, they'll tell you how unrewarding a physical exam is when dealing with patients that have compulsions or emotional problems," he says.
What will happen to Hitzig remains unclear.
His lucrative practice was initially devastated by the raid. In 1995, Hitzig drew a $269,000 salary, court records said. But in 1997, shortly after news of the investigation broke, he filed for bankruptcy.
"The so-called fen-phen scandal was a combination of mass hysteria and a very well-planned negative campaign," Hitzig said last week. "And now, they've spent 11 months and a lot of money investigating me, and they've found nothing. They've got too much invested to just stop now."
No plans to stop
Hitzig says he has no intentions of curbing his practice. He reports that his latest Web site has been getting 1,000 hits a day, at times bringing in six new patients a week. The doctor who once seemed to have been felled by the spectre of a far-reaching federal investigation is apparently back on his feet.
The phen4 combination, he says, can be used for any chemical imbalance but mainly for controlling addictive behaviors, mood swings and even compulsion for sex. He suggested that President Clinton "would do fantastically" with the treatment.
"O. J. Simpson would be leading his vacuous upper-class life in Brentwood and not been obsessed with cocaine and sex had he taken it," Hitzig said while showing off his computerized medical pitch.
Yet a number of patients have taken issue with Hitzig's treatment, going after him in legal and medical complaints. A $9 million malpractice suit filed by a Pikesville woman in Baltimore County Circuit Court alleges that Hitzig and the makers of phentermine and fenfluramine caused damage to her heart valve.
Other complaints have been made through the physicians' board. Jill Hoge filed one in October 1993, after her father died of malnutrition, weighing 103 pounds. She said he took "unlimited" drugs prescribed by Hitzig.
The complaint said Hitzig, who treated Hoge's father for chronic pain, gave him undated prescriptions for the painkillers percocet and dalmane.
"He never weighed my dad," said Hoge of her father, Billy Finley, a retired math teacher and assistant football coach at Towson High School when he died in 1993.
Hoge's mother sued Hitzig, but a jury found in the doctor's favor.
Hitzig blames other doctors who he says withdrew medication from Finley. "I'm very proud of the care I gave [him]," he said.
Patients seem to flock to Hitzig's Web page and to him. On a recent day in his office, the phone was ringing with patients calling from around the country.
On his home page, the controversial doctor says he has treated more than 8,000 patients in the past six years.
He points to patients such as Michael Poff, a high school English teacher in Huntington Beach, Calif., as examples of how his treatment can work.
Poff said he lost 100 pounds under Hitzig's care and the medications have given him new-found energy.
"I used to be a slug, now I swim and surf. It's a whole new life," he said. "I feel as if he's on to something that should be looked at."
Carrie Baggen, a co-owner of a video production business in Corvallis, Ore., said she lost 110 pounds, suffered no ill health effects, and found Hitzig to be "a very caring man."
Alluring personality
But the doctor's critics say he has an alluring personality that TTC mesmerizes needy people cruising the Internet looking for treatment of emotional and diet disorders.
Debbie Knight, of Marysville, Calif., said she filed a complaint last year when her brother -- Alvin Chernov of Arizona -- committed suicide after taking fen-phen, prescribed by Hitzig for depression.
Shortly before her brother's suicide, when he appeared agitated and sleepless, Knight called Hitzig in alarm.
But the doctor assured her there was nothing wrong with her brother. "Right now I am everything to him," she recalls the doctor telling her.
"I thought, 'Oh, my God, my brother's in a cult,' " said Knight. "I wondered what he was getting himself into."
Hitzig said Chernov killed himself after he stopped taking fen-phen. "They can't blame me for something that didn't happen on my watch," he said.
Further compounding the difficulty of regulating telemedicine is confusion over how medical guidelines are to be interpreted from state to state, according to Compton of the state physicians board.
The Internet has complicated enforcement of medical regulations because treating a patient in another state means the doctor is technically practicing medicine there.
"The practice of medicine occurs where the patient is, not where the doctor is," Compton said. "Electronically he's leaving the state and he's practicing medicine in Georgia or wherever."
But the Arizona Board of Medical Examiners, where Debbie Knight filed a complaint about Hitzig after her brother committed suicide, has a different view.
"Because he's not licensed here, we can do nothing about his license," said Eric Nickell, the Arizona board's ombudsman.
Pub Date: 9/03/98