Limited, and they were considering updating their regulations on how such digital prescriptions could be issued, particularly involv- ing painkillers. It appeared, in other words, as if Pennsylvania might be on the verge of declaring one or all of the network's three biggest sellers—Ultram, Soma, and Fioricet—controlled substances. Tumpati contacted an attorney, who contacted the board, trying to assess whether Tumpati had run afoul of any laws. “The mes- sage from the state attorney to our attorney was that it's a good idea, with an abundance of caution, not to continue,” Tumpati said.

He'd already grown frustrated with his contact at RX Limited, Aaron Johnson, who seemed uninterested in pushing further in the direction of cutting-edge telemedicine. “I had so many conversa- tions with these people, Aaron Johnson in particular, on how to improve the system,” Tumpati said. “I was not trying to make a quick buck. In fact, I was so upset and angry at these people that are paying me only two, three dollars, and I had to fight with them every day trying to increase the rate from two to two fifty to three dollars.”

Even if Pennsylvania was changing its laws, Tumpati held a New York medical license. He could have simply uploaded it to the RX Limited system and continued prescribing as a New York doctor. But he decided against it. “I said, ‘Well, you know, there are some changes coming up. I don't want to take any risk,’ ” he said. “I didn't think I was taking a risk.” So, after earning a million dollars over three years writing online prescriptions for RX Lim- ited, in March 2011 he quit.

That June, Tumpati sent an email to his close friend and col- league in Pennsylvania, Anu Konakanchi, whom he'd signed up to write prescriptions for a commission, warning her that he was get- ting out. “As you can see, they are specifically trying to target the questionnaire based telemedicine,” he wrote, including a link to the proposed state rules. “I am not sure when they will publish the final rule but just wanted to let you know that they are trying to change the rules. It is possible to use existing technology to objec-