Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Sunday, October 09, 2005

Critics seek audit of homeopathy board

Doctor licensing under scrutiny

Critics seek audit of homeopathy board

Robbie Sherwood
The Arizona Republic
Oct. 9, 2005 12:00 AM

A California doctor spent five years in prison for performing thousands of unnecessary eye surgeries before being allowed to practice homeopathic medicine in Arizona.

A New Mexico doctor illegally borrowed hundreds of thousands of dollars from more than 100 of his own patients before becoming a homeopathic physician in metropolitan Phoenix, a crime that recently resulted in felony convictions.

Over the past five years, the Arizona Board of Homeopathic Medical Examiners has licensed four doctors who have been convicted of felonies in other states and six others who have lost their licenses or been disciplined elsewhere. A review of public records shows that homeopathic physicians rarely face sanctions from the board, even in instances when prescribed remedies reportedly caused serious harm or, in one case, death.

Thousands of patients in Arizona have turned to homeopathy, a technique that uses diluted amounts of substances to treat symptoms, for an alternative to traditional medicine.

But unlike other Arizona medical boards, the homeopathic board has not been audited for 20 years. Some homeopathic physicians and former board members are questioning what they consider a lack of proper regulation. Carolyn Allen, chairwoman of the state Senate Health Committee, called Wednesday for an audit by the state Auditor General's Office of the board before it faces a 10-year "sunset review" in 2006. The review will determine whether the board will continue, be disbanded, or face reforms.

"I absolutely believe that an audit is warranted; 20 years is too long," Allen said. "There have been a lot of allegations about this board, but the key word is 'allegations.' We need to, hopefully through an audit, see if the allegations have any merit. I'm not necessarily digging for any unethical behavior, but after 20 years, I think we should take a look."

Because the homeopathic board is relatively small, with only 113 licensees, a state lawmaker has to specifically request such a review for it to be carried out. The board passed a 10-year sunset review in the mid-1990s without a performance audit.

The technique

Homeopathy is based on the medicinal value of diluted substances: Believers say that if bee venom, for example, can cause pain and swelling, then very small amounts of the substance can reverse the symptoms. Advocates consider it essential to the well-being of patients whose symptoms have not responded to traditional forms of medicine. Skeptics say any benefits are the result of a placebo effect: Patients feel better simply because they believe the treatment will help them.

The technique is not generally covered by insurance in Arizona.

Members of the homeopathic board say they have welcomed doctors to Arizona who have been disciplined unfairly in other states and whose skills could benefit patients seeking alternative remedies. Until recently, a Web page operated by the Arizona Homeopathic and Integrative Medical Association urged homeopathic doctors to come to Arizona if they have been "oppressed" by medical boards elsewhere.

"There are doctors that have been enlightened as far as natural cures that have been around for hundreds of years, and their medical boards take them up on charges," said Dr. Bruce Shelton, former Arizona homeopathic board chairman. "Those doctors are welcomed here to practice integrative medicine."

Critics say board members have acted against the best interest of patients in many cases. Those critics include a pair of longtime public board members who said their concerns went unheeded because they were outvoted by the four licensed homeopaths on the board. The six-member board consists of four homeopaths and two members of the public.

"There have been doctors that they've licensed that I wouldn't send my worst enemy to," said Anna Prassa, who spent six years as a public member of the board and who is now one of its sharpest critics. "They just want one more boy in the band. They don't care."

Prassa said she believes in homeopathic medicine and still uses it but is concerned about the number of troubled doctors licensed by the board. Former public board member Joan Heskitt agreed and said the board should have more laypeople as members.

Some homeopathic physicians contacted by The Republic said they believe the board is doing a good job and does not need to be scrutinized. Other practitioners said that while they strongly believe in the principles of homeopathic and holistic medicine, they want to share their concerns with lawmakers about the board's approach to licensing. The doctors include a licensed homeopathic physician and the director of a homeopathic school that trained two of the current board members.

"I'm very motivated to see the Legislature and the Auditor General's Office be fully aware of some of the decisions the board has made and some of their methods," said Amanya Jacobs of Chandler, who directs a school of homeopathy.

The board

The Arizona Board of Homeopathic Medical Examiners was created in the early 1980s to help ensure that patients seeking alternative cures get the best possible treatment. The board is considered necessary in part because traditional homeopathy is just a small part of what licensees are allowed to do in Arizona. They may prescribe any drugs, do minor surgery and practice a wide variety of alternative medical treatments. Those include chelation, an intravenous injection of substances designed to rid the body of heavy metals such as mercury.

One of those alternative treatments allegedly resulted in the death of a New York man whose homeopathic physician in Patagonia injected him with adrenal fluids from a cow. The patient's family sued for malpractice in 2001, saying the injections resulted in a deadly gangrene infection. The doctor denied liability, but the case was settled out of court. The homeopathic board later concluded that the man died of other causes, and the board rejected a complaint against the doctor's license.

To practice homeopathic medicine in Arizona, a licensee must have an unrestricted osteopathic or medical license obtained in any state. Some of the homeopaths with disciplinary problems in other states either had their licenses restored in at least one state or were granted their Arizona licenses before their home-state medical board took action. Additionally, doctors must pass a 40-hour course in homeopathy, or they may have 90 hours of "approved homeopathic training." They must pass a written exam and then give an oral case history before the homeopathic board. If a doctor has enough experience in alternative medicine, the board can waive the written exam.

Outside of those who have encountered legal problems, many of the licensed homeopaths who have had disciplinary troubles in other states were investigated for offering alternative therapies that are legal in Arizona, said Board Chairman Charles Schwengel.

"Frequently, when a doctor is under investigation, it's for doing things that benefit the patient but are not in the scope of their practice," Schwengel said. "For example, giving vitamin B-12 shots."

The public records

The Arizona Republic examined detailed records of the board's meetings and actions over the past five years. The Republic also obtained information about licenses that have been revoked since the board was created.

While dozens of homeopaths have let their licenses lapse in Arizona, the board has revoked only two licenses in its 23-year history. One of those stripped belonged to its co-founder and former chairman, Dr. Harvey Bigelsen, who held the first homeopathic license ever granted in the state.

Bigelsen wrote the law that created the board in 1982 and was appointed by Gov. Bruce Babbitt as the first chairman. But 10 years later, a federal grand jury indicted him on 63 counts of Medicare fraud, 44 counts of mail fraud and eight counts of obstruction. In a plea bargain, all but three of the counts were dropped and he was sentenced to five years of probation. Bigelsen surrendered both his medical and homeopathic licenses and opened a cancer clinic in Mexico.

The board's other co-founder, Dr. Abram Ber of Scottsdale, had one disciplinary hearing before the board in a case in which a patient was allegedly injured. Ber was brought up two years ago on a complaint that his treatment hurt a patient, but it was dismissed with a non-disciplinary "letter of concern."

A patient of Ber's who lived in Florida had to have a large part of her intestine removed after swallowing an experimental Russian device called a "Sputnik" that Ber had prescribed over the telephone to kill parasites in her colon.

The board found neither a record of consent from Ber's patient nor a record of an examination. The woman needed surgery to remove the device.

Ber said that he was wrong to send the Sputnik to the woman with no examination and that he thought the warning from the board was the appropriate action.

"The point is I admitted I did something wrong, and it was for a friend of mine," Ber said. "This board is meticulous. The people on this board are the most respected holistic physicians in the U.S., not just in Arizona. While it may look lax to you, you are talking about an elite group of people. They are doing a great job."

Convicted felons

Arizona law says medical doctors and homeopathic physicians may have their licenses revoked for a felony conviction, but the law does not absolutely ban such doctors from practicing in the state.

Those who came to practice homeopathic medicine in Arizona after being convicted of crimes include Dr. Jeffrey Rutgard, a once phenomenally successful eye surgeon from San Diego. He served five years in prison for bilking Medicare by performing thousands of "medically unnecessary" procedures on mostly elderly patients in the late 1980s and early 1990s. In November 2004, Rutgard applied for and received an Arizona homeopathic license.

Attempts to locate Rutgard were unsuccessful. Rutgard is believed to be in California and has not yet come to Arizona to practice, although he told board members in 2004 that he intended to relocate here.

Other felons licensed by the board include Dr. Rick Shacket of San Diego and Dr. Robert Rowen, also of California. Both were convicted in tax cases. Dr. Joseph Collins of New Mexico was facing accusations of illegally borrowing money from more than 100 patients when licensed in Arizona, though the board granted the license during a window when his case was temporarily thrown out of court. Prosecutors appealed and Collins was convicted earlier this year in New Mexico of multiple securities fraud felonies.

A loss of inhibition

Troubled physicians licensed by the board include Dr. Charles Crosby, who obtained his Arizona homeopathic license in May 2004 despite revealing to the board that he had been ordered to have counseling for a "perceived loss of social inhibition" in his home state of Florida. It later became known that Crosby had been accused of fondling patients and of having a breast fetish. A report on the case in Florida said Crosby had developed "a special technique of manipulating women's breasts to treat pain in other areas of their body."

The suspension of Crosby's license in Florida triggered a inquiry before the Arizona homeopathic board in July. At the meeting, Schwengel, the board president, said he did not find any specific examples that showed Crosby had acted unprofessionally, according to meeting minutes.

Other members expressed concern about Crosby's behavior, but they did not suspend his license, instead giving him until November to undergo an independent mental evaluation to determine if he is competent to practice here.

A second chance

Board members said they believe doctors who have gotten in trouble but who have "paid their debt to society" deserve a second chance to make a living, especially when they may have spent thousands of dollars on medical training.

"We can always take a doctor's license, but let's assume that we live in a country in which, if you've paid your debt to society, that you can be rehabilitated," said longtime board member Dr. Gary Gordon.

The Arizona homeopathic board has worked under the legal guidance of the Arizona Attorney General's Office. Veteran board members believe they have done an outstanding job of protecting patients and the public, as well as promoting the benefits of homeopathy and alternative medicine.

"What we look at is, do we want to try and resurrect a troubled physician and keep them under control, or do we want to throw them away and let them dig ditches?" Gordon said. "Once you take a doctor's license away, they don't really have a particular skill that they're qualified to do."

Dismissed complaints

The homeopathic board has dismissed at least five complaints against its own members over the past five years, including one in which a patient suffered kidney failure after treatment, as well as an alleged incidence of sexual harassment.

The complaint involving kidney failure was lodged against board member Dr. Annemarie Welch in March 2003. The woman who lodged the complaint fell ill after seeking treatment from Welch for an infected blister on her toe. Welch treated the infection with "vitamin C therapy," according to board meeting minutes.

After the woman suffered "acute renal failure," she filed a complaint against Welch with the Arizona Medical Board, which also licenses Welch.

The homeopathic board argued for primary jurisdiction of the Arizona Medical Board complaint against Welch, arguing that she had primarily used homeopathic procedures. Once the homeopathic board had control of the case, it dismissed the complaint.

According to meeting minutes, board members did not believe there was a correlation between the vitamin C therapy and the patient's kidney failure. They also noted that the patient didn't comply with Welch's treatment recommendations. Welch pointed out the Medical Board also found no wrongdoing in its investigation.

A Phoenix woman lodged a sexual harassment complaint against board member Gordon in May 2001. The woman said he had spontaneously kissed her on the mouth after she stopped to speak with him at his booth at a medical trade show.

The homeopathic board dismissed the woman's complaint because she did not show up to the May 2001 meeting at which her complaint was scheduled to be heard. She apparently had a family emergency and wrote to the board that she could not make it. Board members questioned Gordon about the allegation, which he denied. The woman did show up at the next board meeting and asked to refile her complaint, but board members voted 2-2 against it.

Other boards

Other medical boards have faced criticism in recent years for their approach to regulating doctors. A March 2004 review by the state Auditor General's Office, for example, questioned the dismissal of five complaints against traditional doctors by the Arizona Medical Board. A similar review of the Board of Osteopathic Examiners in April 2001 said that board needs to make improvements to its complaint investigation process as well as its record-keeping.

But the homeopathic board has not faced such scrutiny from the Auditor General's Office since 1985. Recent questions about the board's performance have come from a small group of homeopathic doctors and former board members who have expressed concerns about leniency when it comes to disciplinary actions. Current board members say that, generally, those critics have an ax to grind. One of the doctors, for example, had multiple fee complaints before the board.

The homeopathic board's realm is much smaller than the state Medical Board. Only about 113 homeopaths are currently licensed in Arizona, and 163 licenses have been granted during the board's history, compared with more than 16,000 traditional medical doctors. The homeopathic board has conducted an average of 15 to 20 investigations each year since 2000, compared with about 1,000 a year by the Medical Board.

Only two other states, Nevada and Connecticut, license homeopathic physicians, but Arizona allows the widest range of alternative medical practices. Advocates say doctors and patients alike benefit from Arizona's integrative approach. Board members have also begun encouraging patients to embark on an aggressive letter-writing campaign to lawmakers based, in part, on The Republic's investigation.

Linda Heming of Sun City is one of those patients. She says her life literally depends on the Legislature renewing the homeopathic board for 10 more years. Heming, 61, is a longtime patient of board co-founder Ber. She said he treats her for free because she has gone through hard financial times, and she credits him with curing her of cancer, congestive heart failure, Lyme disease and a host of other ailments when traditional approaches failed. Heming said she has "not slept in two weeks" because of worry that recent criticism might persuade lawmakers to disband the board and strip homeopathic licenses.

"If they take away my right to his treatment, I could die," Heming said. "This is very upsetting to people whose lives have been saved by alternative medicine."

Without the license, the traditional over-the-counter homeopathic remedies would still be available, but other alternative treatments would not.

More scrutiny

Shelton said he expected some scrutiny when the board came up for its 10-year sunset review, and he thinks the board will come out looking good in the end. It is considered unlikely that legislators would disband the board, leaving the state without regulation of homeopaths, but reforms are considered a possibility.

"I believe that we meticulously protected the patients and the public's rights in all cases," Shelton said. "I used to go home feeling like I did the right thing."

Prassa, the public member, said she used to go home from board meetings with a very different feeling. "You don't know how many times I left that meeting and wanted to call a reporter and say somebody needs to look at this," Prassa said. "I don't know why I didn't. I was busy with my business, and I didn't want to be a tattletale and cause trouble."

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