A family practitioner operated a private practice. According to his website, his practice focused on diagnosing and treating Lyme disease and other tick-borne co-infections.
On 1/14/2009, a 26-year-old female patient was seen at the family practitioner’s office for evaluation of possible Lyme disease. An initial history and examination was conducted by a physician assistant. The patient reported a tick bite in December 2008 as well as prior tick bites in 2005 or 2006. She did not recall developing any rash or lesions. She reported numerous complaints, including memory problems, fever, headaches, mood swings, poor sleep, muscle and joint pain, slurred speech, and numbness and tingling in her extremities and face. She reported having been diagnosed with attention deficit disorder as a child. She reported seeing a psychiatrist for depression and questionable borderline personality. She was taking Adderall and Ambien. The physician assistant’s assessment was “multisystemic complaints with recent tick bite.”
Zithromax, an antibiotic, was prescribed, and laboratory tests were ordered. There was no evidence that the family practitioner examined the patient during this initial visit; however, the family practitioner initialed the patient’s chart.
The patient returned to the family practitioner’s office on 2/3/2009 to review laboratory results. Immunoglobulin M (IgM) and Immunoglobulin G (IgG) Western Blots were negative for Lyme disease under the Center for Disease Control (CDC) criteria. Additionally, laboratory results were negative for Babesia; negative for Bartonella; negative for Human Monocytic Ehrlichiosis (HME); and Lyme Polymerase Chain Reaction (PCR) was negative. However, the physician assistant noted that the IgM Western Blot was positive (apparently under a lower criteria) and that Human Granulocytic Ehrlichiosis (HGE) was positive. Her assessment was “lyme,” “HGE,” and “possible co-infections despite neg tests.” The patient was continued on Zithromax and was also prescribed doxycycline, another antibiotic. She was also started on BLT (Bartonella-Lyme Tincture) and Enula, both herbal remedies. The family practitioner initialed the patient’s chart.
The patient was next seen by the physician assistant for a follow-up examination on 3/9/2009. The patient continued to have multiple complaints, but no significant objective findings were noted. No vital signs were recorded. The patient was continued on Zithromax, discontinued doxycycline, prescribed Bicillin, another antibiotic, and prescribed Plaquenil and Malarone, both anti-malarial drugs. The patient was continued on BLT and started on a “stress buster kit,” “detox and drainage” kit, and “pinella” — all homeopathic and/or herbal remedies. The family practitioner initialed the patient’s chart.
The patient was next seen by the physician assistant on 4/6/2009. Examination revealed “slight inflammation of cuticles on forefingers.” No vital signs were recorded. The patient’s dosage of Bicillin was increased, and she was continued on Malarone, Zithromax, and Plaquenil. Alinia, an antiprotozoal drug, and Singulair, a drug to treat asthma, were also added to her treatment regimen. The family practitioner initialed the patient’s chart.
The patient was next seen by the physician assistant on 5/11/2009. No vital signs were recorded. The patient was continued on Bicillin, Zithromax, Plaquenil, and Alinia. Mepron, another antiprotozoal drug, was added. The patient was also started on “200 mg of [Z]en,” and the family practitioner initialed the patient’s chart.
On 6/10/2009, the patient was seen by the family practitioner. The family practitioner noted that the patient was “doing poorly with significant fatigue, malaise, weakness, headaches, irritability, and tremors.” No vital signs were recorded. The family practitioner’s assessment was “Neurologic Lyme and likely Babesia.” The family practitioner’s treatment plan included: “continue Bicillin for now,” “use Cat cream and fish oil,” “stop Plaquenil,” “follow-up with [a chiropractor],” “obtain thyroid, PTH, vitamin D, and neurotransmitters,” and “consider colon hydrotherapy and vitamin D as well as Adrena Calm cream.”
The patient continued to see the family practitioner and the physician assistant on approximately a monthly basis through at least March 2011. The patient’s vital signs were not recorded during these visits. The family practitioner’s last office visit notes for the patient dated 3/30/2011, which showed an assessment of Lyme, Bartonella, and Babesia. During this time, the family practitioner prescribed numerous additional medications, supplements, and herbal remedies, including intravenous (IV) Rocephin, IV Glutathione, L-Drain, K-Drain, UltraInflamX, Biaxin, minocycline, Darvocet, Chlorella, enzyme, HCL betaine, Actigall, Bactroban, Burbur, Notatum/Quentens nasal spray, Bronchi Pertu, Lyrica, Trental, IV amino acids, Zenpep, IV Zithromax, IV Invanz, bee venom injections, IV doxycycline, IV Silver, Cortef, Nuvigil, IV ketamine, Tindamax, Cipro, amoxicillin, Artemisinin, and IV garlic.
At the family practitioner’s recommendation, the patient also consulted with and received treatment from a naturopath.
There was no evidence that the family practitioner received informed consent from the patient regarding treatment with IV glutathione, IV amino acids, IV silver, or IV garlic. On 5/3/2011, the patient developed acute and severe symptoms, including abdominal pain, nausea, and vomiting, after self-administering IV garlic received from the family practitioner’s office. On 5/4/2011, the patient’s parents took her to the emergency department where she was admitted to the ICU. She was found to be hypotensive secondary to bacterial sepsis. She was diagnosed as having catheter-related polymicrobial septicemia; candida fungemia; mild renal impairment; mild hepatitis; cavitary lesions/microabscesses; and herpetic cold sores. She was hospitalized for 8 days and discharged on 5/11/2011.
The family practitioner’s overall conduct and acts and omissions with regards to the patient constituted unprofessional conduct through gross negligence and repeated acts of negligence as followed: the family practitioner subjected the patient to unnecessary and unconventional therapeutic regime, including IV garlic, which resulted in serious harm; he prescribed IV ketamine without medical indication; he did not obtain consent regarding treatment with IV glutathione, IV amino acids, or IV garlic; and he failed to routinely assess and document the patient’s vital signs.
The Medical Board of California ordered that the family practitioner be publicly reprimanded and attend 65 hours of an education course.
Date: November 2013
Significant Outcome: N/A
Case Rating: 1
Link to Original Case File: Download PDF
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