posted
I am a law student at The John Marshall Law School in Chicago. I have a former co-worker and friend who suffered from persistent Lyme disease, and she introduced me to this site.
I am planning on writing a law review aticle in our journal about the legal issues with doctors who provide long term antibiotic care and state medical boards stipping these doctors of licenses. The article will advocate that doctors should not fear losing their license for providing this treatment.
I know that a few states have enacted legislation to protect doctors. (California Business and Professions Code Section 2234.1 and Rhode Island Gen. Laws 5-37.5-4).
I was wondering if anyone could lead me to any documentation of medical board hearings in states where doctors have been stripped of their licenses, especially if those doctors have attemped to appeal the medical board ruling.
I also want to know about the process by which state medical boards go about deciding which Lyme disease treaments are acceptable and which are not. Why do medical boards side with the IDSA treatment guidlines, and not the ILADS treatment guidlines? Is it though a simple vote of the medical board, or are their certain administrative and statutory guidlines in place which require the board to go one way or the other?
If anyone has gone though the legal process of having your license reviewed for providing long term antibiotic care for Lyme disease, I would love to hear from you.
You can post on this board, or send me an email at [email protected]. I am primarily looking for documents in the public record, so I wont use anyone's information in my article if they do not want to be identified.
Thank you.
[ 06. September 2007, 11:39 AM: Message edited by: lawstudent74 ]
Posts: 2 | From Chicago | Registered: Sep 2007
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dmc
Frequent Contributor (1K+ posts)
Member # 5102
posted
stuff like that in CT....yep, were "supposed" to be a lyme knowledgable state.
the world reknown lyme knowledgable peditrician is being harrassed.
contact any of the ct lyme support groups for details
Posts: 2675 | From ct, usa | Registered: Jan 2004
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posted
Sorry I don't have specific answers for you, but here's an important article of interest:
Johnson L, Stricker RB. Treatment of Lyme disease: a medicolegal assessment. Expert Rev Anti Infect Ther. 2004 Aug;2(4):533-57.
[California Lyme Disease Association, Ukiah, CA 95482, USA. [email protected]]
Abstract: Lyme disease is the most common tick-borne disease in the world today. Despite extensive research into the complex nature of Borrelia burgdorferi, the spirochetal agent of Lyme disease, controversy continues over the diagnosis and treatment of this protean illness. This report will focus on two aspects of the treatment of Lyme disease. First, the medical basis for diagnostic and therapeutic uncertainty in Lyme disease, including variability in clinical presentation, shortcomings in laboratory testing procedures, and design defects in therapeutic trials. Second, the standard of care and legal issues that have resulted from the clinical uncertainty of Lyme disease diagnosis and treatment. Specifically, the divergent therapeutic standards for Lyme disease are addressed, and the difficult process of creating treatment guidelines for this complex infection is explored. Consideration by healthcare providers of the medicolegal issues outlined in this review will support a more rational approach to the diagnosis and treatment of Lyme disease and related tick-borne illnesses.
PMID: 15482219 [PubMed - indexed for MEDLINE]
Posts: 621 | From US | Registered: Jun 2006
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Bugg
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Member # 8095
posted
Lawstudent--
First, I would just try "Googling" lyme disease and medical board. You'll probably pull up a few sites which you refer you to licenses of LLMD's being suspended such as that of Dr. Jemsek. As for specific federal or state statutes, I would highly doubt there are any specific statutes which specifically address guidelines pertaining to physician practice and diagnosis/treatment of lyme disease. Rather, it's my understanding most states have statutes and/or regulations which address unprofessional conduct and unethical behavior of treating physicians within that state. Pursuant to those statutes, the State Medical Board has the power to suspend or terminate the license of a practitioner if, upon the Board's review, it is determined the physician is practicing in an unethical and improper manner. Reliance upon the IDSA guidelines is just part of the evidentiary process utilized against that particular physician (these may be given more weight given a particular state's political climate/physician lobbying power/insurance lobbying power). You must remember that not only can a patient bring the physician's practice into question but also fellow physicians. Unfortunately, it seems that several LLMDs have been "turned in" by members of their own profession. As for the Cal. Business and Profess. Code citation, I haven't looked at it but I seem to recall that has more to do with the "corporate practice of medicine." As I'm sure you're aware, that's a separate and distinct issue from the one at-hand. It's my belief the "corporate practice of medicine" would only come into play as a possible defense by a physician who is being charged by the Board. Finally, as I'm sure you also know, negligence suits brought by patients are distinct causes of actions which are governed by state and possibly federal statutes. However, in order for the Medical Board to review the licensure of a physician pursuant to that state's ethics and professionalism statute, there does not have to be a case of injury to a patient.
Hope the aforementioned helps..
Posts: 1155 | From Southeast | Registered: Oct 2005
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Ann-OH
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Member # 2020
posted
Lorraine Johnson, JD, MBA can probably be contacted at the e-mail address given with her article above. I am sure she would be a big help.
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Doctor discipline--or "medical McCarthyism"?
Licensing boards say they're protecting patients from dangerous mavericks. The doctors say they're being persecuted for deviating from medical orthodoxy.
By Mark Crane Senior Editor
Are physicians who treat patients they diagnose with chronic Lyme disease charlatans who need to be disciplined to protect the public? Or are they victims of "medical McCarthyism" instigated by managed care companies that just don't want to pay the bills?
That was the issue as a group of doctors and about 400 of their patients gathered on a Manhattan sidewalk recently. They were protesting medical board investigations of physicians who use long-term antibiotic therapy to treat Lyme disease.
"It's almost certain that if a physician treats a significant number of patients with Lyme for an extended period, he'll be investigated by health plans and licensing authorities," says Michael Schoppmann, an attorney based in Bridgewater, NJ, who has represented more than 40 doctors in board hearings in the Northeast. "A number of physicians have lost their licenses, because boards are punishing those who dissent from the prevailing view about how to treat the disease. This has had a chilling effect on the willingness of physicians to help patients."
Many health plans don't recognize the diagnosis of chronic Lyme disease and balk at paying for long-term antibiotic therapy. They argue that such treatment is dangerous and that some physicians appear to have a financial interest in the regimen.
Schoppmann acknowledges that the treatment of Lyme disease in the past has been replete with fraud, with home infusion companies and physicians engaging in phony billings. But he argues that honest physicians are being tarred with the same brush of suspicion. "There is a medical controversy when we get into the ongoing, recurrent symptoms of Lyme, and many physicians are being persecuted because they believe in the concept of chronic Lyme status.
"Some physicians favor long-term therapy, and some don't. But this is a debate that should be taking place within medicine: in journal articles, conferences, and clinical trials. Licensing boards have no business picking sides and punishing a legitimate but minority point of view."
Most of the impetus for actions against doctors' licenses have come from managed care companies, Schoppmann says. "Not one of the cases I've handled has involved a complaint by a patient," he maintains. "The complaints are instigated by health plans. The licensing boards act like the attack dogs for the insurance industry. They rely too much on academic infectious disease experts and ignore the opinions of primary care physicians who have extensive experience.
"The treatment of Lyme disease and its financial implications are one of the insurance industry's worst nightmares," he continues. "No one dies from Lyme disease, no one is cured, and many patients require years of expensive treatment."
Several patients of a New York physician who's been brought up on charges before the state Office of Professional Medical Conduct attended the rally. They complained that their medical files had been used by the state without their knowledge, and said that the doctor being charged had brought them back to health or had improved their conditions. The physician, internist Joseph J. Burrascano Jr. of East Hampton, has been accused of failing to make a proper diagnosis and failing to follow up adequately with his patients.
"To have taken my files and put together any case against Dr. Burrascano is a kind of medical McCarthyism," a 77-year-old patient told The New York Times. "He slowly brought me along, with detailed explanations of what he was planning to do, trying different treatments, different kinds and dosages of antibiotics, trying physical therapy--until I finally returned to my old self."
Hearings regarding Burrascano, who has treated more than 7,000 Lyme patients from around the world over the past 15 years, are expected to take several months, attorneys predict. "Under state law, we cannot comment on the specific allegations against this physician while the matter is pending," says Kristine Smith, spokesperson for the New York State Department of Health.
Medical boards and health plans strongly disagree with the accusation that they're penalizing innovators. "There's a wealth of literature from major medical centers showing that many patients are being mistreated by long-term antibiotic therapy," says internist Charles M. Cutler, chief medical officer of the American Association of Health Plans.
"Many patients aren't being appropriately diagnosed. When they are sent to medical centers with broad experience, it turns out they don't meet the criteria for Lyme disease. Health plans have a responsibility to see that patients receive appropriate care. When something is amiss, plans have filed complaints with medical boards, and we make no apologies for that."
Indeed, plans could face penalties of their own if they are aware of potential misconduct and fail to report it, notes Kristine Smith.
"We have no position on the efficacy of long-term therapy," she says. "We are required to review all complaints of misconduct, no matter where they originate. If there's any evidence, we follow up on a case-by-case basis. The issue isn't the type of treatment per se, but whether that treatment meets the accepted standard of care as determined by a rigorous peer review process."
Smith mentions another New York physician whose license was revoked over his treatment of Lyme patients. "The issue wasn't the modality of treatment, but whether the overall treatment met the basic standard of care," she says. "We found it didn't. Some very basic medical practices weren't followed. That physician is appealing the ruling."
Although attorney Schoppmann and the demonstrators claim that investigations of physicians who treat Lyme disease are a national problem, health officials disagree. "The number of these controversial cases around the country is relatively small," says James R. Winn, an FP and executive vice president of the Federation of State Medical Boards, based in Euless, TX.
"What often happens in these situations is that advocacy groups for some unconventional therapy argue that the investigative focus is about the therapy itself," says Winn. "But when a medical board looks at a case, it focuses on the individual care that's rendered. There's a full peer review process at every board I'm aware of."
While the number of cases may be few, Winn says the debate over how physicians treat patients with Lyme disease is important. "There are severe complications with long-term antibiotic therapy," he says. "If a doctor is going to prescribe it, he'd better be damn sure the patient really has the disease."
Mark Crane. Doctor discipline--or "medical McCarthyism"?. Medical Economics 2001;6:51.
posted
Thanks, the information has been great so far.
Does anyone know how I can get my hands on some of the Medical Board rulings and appeals that have been made? I can't seem to find any in the Lexis or Westlaw databases.
Posts: 2 | From Chicago | Registered: Sep 2007
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You have received several great replies. My 2 cents: state Medical Review Board decisions are not grist for the Westlaw mill. Also, I think IDSA is Lexis' ghost writer.
Med review cases arise in multiple states, and results vary. So far no pattern to sway courts.
-------------------- Neil Posts: 697 | From Tucson, AZ USA | Registered: Apr 2002
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