The recent federal conviction of Done Global’s CEO, Ruthia He, and its clinical president, psychiatrist David Brody, on November 20, 2025, has brought long-standing concerns about virtual ADHD prescribing into undeniable focus. A San Francisco jury found both executives guilty of conspiring to distribute Adderall and other Schedule II stimulants, along with health care fraud and (for He) obstruction of justice. According to the Department of Justice, Done Global generated more than $100 million in revenue by enabling the distribution of over 40 million stimulant pills, often in ways that ignored the most basic principles of psychiatric practice.

For many clinicians, the verdict merely confirmed what had been apparent for years: Done Global represented not the promise of telehealth, but its most predictable failure.

Telehealth itself can be transformative. It expands access for patients who previously faced geographic, financial, or stigma-based barriers. Used responsibly, it allows for continuity, flexibility, and improved follow-up, essential elements in behavioral health. But the Done model was something very different. It functioned as a subscription-based stimulant pipeline, driven by algorithms, advertising, and volume. Clinical judgment, when it existed at all, appeared to be treated as a revenue obstacle rather than a safety requirement.

Federal investigators described a system engineered to provide “easy access” to stimulants under the guise of convenience. The company’s “auto-refill” function allowed patients to obtain monthly stimulant prescriptions through automated emails, with little or no clinical interaction. Some nurse practitioners were allegedly paid as much as $60,000 per month to renew prescriptions without a meaningful examination, follow-up visit, or review of risks.

These practices were not oversights. They were part of the business model.

When medicine becomes subordinated to a subscription service, safety becomes secondary. Done’s platform relied heavily on deceptive advertising that targeted individuals seeking stimulants without a legitimate medical need. The system limited information available to prescribers, restricted follow-up care, and placed “hard limits” on clinical discretion. In some cases, clinicians were discouraged from obtaining collateral data or verifying diagnostic criteria. Even as misuse, diversion, and one reported death surfaced among patients associated with the platform, the model remained unchanged.

From a psychiatric standpoint, the concerns were obvious. ADHD is a real and often life-altering condition, but diagnosing it thoughtfully requires time, history, context, and continuity. Stimulants can be enormously helpful when used correctly, but they require monitoring and follow-up, safeguards that exist not to create bureaucracy, but to protect patients. Reducing these steps to a short intake and an automated refill mechanism is not innovation. It is abandonment of the most basic elements of care.

The Done case also exposes regulatory vulnerabilities. The DEA and FDA had been aware of stimulant shortages since 2022, and some experts quietly questioned whether diversion and overprescribing played a role. During the COVID-19 pandemic, waivers to the Ryan Haight Act appropriately expanded access to controlled-substance prescribing through telehealth. But those temporary measures also created opportunities for exploitation, and Done Global capitalized on them aggressively. Oversight simply did not keep pace.

The fallout has been wide. Pharmacies across the country began refusing prescriptions from digital-only platforms, creating unintended barriers for patients who genuinely benefit from telepsychiatry. Some insurers and state boards tightened requirements. And now, with this conviction, there is a real risk that the public will conflate irresponsible business models with telemedicine itself.

That would be a mistake. Telehealth did not fail in this case. A company did.

Responsible telepsychiatry remains not only possible but essential. Many clinicians provide careful, ethical, patient-centered care through virtual platforms every day. But the Done Global verdict reminds us that when a business model is designed around speed, scale, and subscription revenue, it can distort clinical priorities in ways that endanger patients and erode trust.

The involvement of licensed physicians in these practices is particularly troubling. The profession’s ethical standard (to place patient welfare above all else) is incompatible with systems that reward shortcuts or discourage thoughtful evaluation. When clinicians are pressured to prioritize volume over judgment, the field is diminished.

The lesson is not that telehealth is unsafe. The lesson is that telehealth must be structured with the same rigor and ethical grounding as any traditional medical practice. That means meaningful evaluation times, appropriate follow-up, protection of clinical autonomy, and stronger oversight of prescribing practices. It means resisting business models that promise convenience while quietly dismantling the safeguards that make psychiatric care safe.

The Done Global conviction is not the end of this story. It is a signal, and a warning. Innovation must never come at the expense of integrity. And patient safety cannot be optional, regardless of whether care takes place in an office or through a screen.

Timothy Lesaca is a psychiatrist in private practice at New Directions Mental Health in Pittsburgh, Pennsylvania, with more than forty years of experience treating children, adolescents, and adults across outpatient, inpatient, and community mental health settings. He has published in peer-reviewed and professional venues including the Patient Experience Journal, Psychiatric Times, the Allegheny County Medical Society Bulletin, and other clinical journals, with work addressing topics such as open-access scheduling, Landau-Kleffner syndrome, physician suicide, and the dynamics of contemporary medical practice. His recent writing examines issues of identity, ethical complexity, and patient–clinician relationships in modern health care. His professional profile appears on his ResearchGate profile, where additional publications and information are available.