The Internet Internist

Dr. Pietr Hitzig of Maryland has prescribed a fen-phen panacea for all manner of ailments to thousands of patients he has never met. One of them, Alvin Chernov, killed himself.

Chernov returned the next day, the Knights say, collected a basket of his clothes and left again minutes later, saying little. He left a note that instructed the couple to call Paul Coppinger if they needed anything.

Debbie Knight introduced herself to Coppinger by phone on August 6. It was then she learned that Chernov had been fired weeks earlier. Coppinger also told her about the e-mails and the order of protection against her brother. In turn, Knight informed Coppinger that her brother seemed unstable.

Coppinger agreed to call Valley mental-health authorities, which he did on August 7. That jump-started the county's emergency commitment process.

The next day, Debbie Knight spoke to Pietr Hitzig for the first time. She documented the call in her journal, dated August 8, 1997, 6:51 p.m.:

"Called Hitzig at home. Said Alvin appears to be fine. Not suicidal at all, plans to write a book . . . Then spoke with Coppinger. Paul wondered about a doctor treating Alvin from Maryland. He thought that was rather strange. So do I, frankly."

Coppinger was doing more than wondering. He told Hitzig by e-mail last August 10: "People are harmed and die when doctors believe that their decisions are unimpeachable and their moral foundations secure. I believe that in matters of life and death you get no second chances, and I refuse to gamble with the safety of those I hold dear. Would you do otherwise?"

Hitzig replied that day, also by e-mail: "After reading your intemperate note, I can see why Alvin Chernov dislikes you so much . . . In fact, if Alvin called you any disparaging name he must be correct. Why don't you get under the rock you came from?"

On August 14, Debbie Knight again spoke to Hitzig, and told him she'd spoken to Coppinger. She noted his response in her journal: "'Oh, he's [Coppinger] insane and completely antagonistic. I can see why Alvin dislikes him.' He [Hitzig] did say he had received the e-mails [from Chernov to Coppinger] and he didn't think they were that bad."

Later that day, Chernov called his sister in a rage.
"I do not appreciate you calling my doctor!" he shouted into a message machine. "Leave my fucking doctor alone!"

After a brief investigation, ComCare officials on August 15 asked a Superior Court judge to order Chernov's psychiatric evaluation at Maricopa Medical Center.

The judge signed the order and, that night, Tempe police delivered Chernov to the hospital.

Alvin Chernov was not a willing participant in his mental evaluation and treatment. Records of his 11-day stay say he insisted that he was fine and needed to get on with his life.

He tested positive for amphetamines on the day he arrived, which doctors later attributed to fen-phen. Chernov told doctors he'd stopped taking the Carbidopa/Levodopa combination. But he said he'd been using fen-phen up to the day of his commitment.

On August 19, hospital records indicate, Chernov told a doctor that fen-phen "could have been a problem" for him. But he also expressed concern that no one from the hospital had contacted his doctor, Pietr Hitzig.

Treating psychiatrist Michael Brennan spoke with Hitzig the following day. From Dr. Brennan's notes:

"Dr. Hitzig insists that Alvin does not belong here in the hospital. He admits, '[Alvin] got manic, and I told him to lower the medications.'"

Hitzig says he sent e-mail to his Arizona patients--about 25 at the time, he estimates--asking them to intervene:

"I asked them to do anything they could to help this kid who was being kept locked up unjustly. Alvin was totally balanced on my program--and the psychometric tests [a standarized questionnaire of 90 queries] proved it--until those doctors did those crazy things to him."

On August 22, Dr. Glenn Lippman, a psychiatrist at Maricopa Medical Center, spoke to Hitzig by phone in the presence of several associates.

"Dr. Hitzig insists that the patient needs fen-phen and other meds to 'modulate his seratonin/dopamine' which he was prescribing via Internet for patient's 'addiction and depression,'" Lippman's notes say. (Seratonin and dopamine are the brain chemicals altered by fen-phen.)

". . . Dr. Hitzig confirmed that he has never seen patient and evaluated via Internet and [psychological test] at last 'eval' in early August. And Hitzig stated that he never performed or recommended any physical exam, labs or vital signs because in his experience with over 7,000 patients it hasn't been needed. Dr. Hitzig stated patient had positive response to his medications . . . Dr. Hitzig ended conversation stating that he disagreed with our clinical approach to not continue fen-phen."

Social worker Margaret Lothian's written recollection of the call added another dimension: ". . . [Hitzig] said repeatedly that patient will become mentally ill if he's not on these meds."

But Alvin Chernov already was mentally ill.
"He continues to believe the CIA wants him to work for them," Brennan noted on August 22. "He continues to have the idea that Ms. Brooks would be receptive to his dating her."

Arizona laws mandate the placement of the mentally ill in "least restrictive" settings. That sometimes means the premature release of patients who may be left to fend for themselves--for better or worse.

Chernov's attorney, assistant public defender Mary Miller, requested a hearing to consider his release to "outpatient" status. On August 26, a court commissioner ruled that Chernov was "persistently or acutely disabled, is in need of treatment, and is either unwilling or unable to accept voluntary treatment." At the same time, however, commissioner Jane Bayham-Lesselyong ordered Chernov's immediate release, with one year of mandatory outpatient treatment with a ComCare psychiatrist.

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