In the US, doctors are licensed to practice medicine by state medical boards. These boards can investigate complaints, discipline doctors, and suspend or revoke their licenses. I have often wondered about the many cases where the punishment doesn’t seem sufficient to fit the crime, or where the main crime goes unpunished and the doctor is instead punished for minor peripheral peccadillos like poor record-keeping. What is going on in those cases? What are the board members thinking? Are they doing what is convenient rather than what is right? How much is politics involved? Is legal maneuvering perverting justice?
Thomas Keech worked for 13 years as counsel to the Maryland State Board of Physicians. He knows the system from the inside. He has written a novel, Doc Doc Zeus, about a physician being investigated by the board. Fiction can go where non-fiction can’t. An omniscient narrator can tell us what really happened, and what the characters are thinking and feeling. This book provides unique insights into these investigations and the many complicated factors involved in a board’s final decisions.
Background: some questionable board decisions
I’ll just mention a few of the medical board decisions that have particularly bothered me.
I reported a Washington State chiropractor who was apparently delusional and who was not practicing what she claimed to be practicing (upper cervical chiropractic). A TV news magazine showed her treating patients by making a cracking sound with her own wrists and not touching the patient at all. When confronted and made to watch the video, she said, “My whole thing is that I am touching.” They declined to investigate. I filed a second complaint. They still declined to investigate because “no patients had been harmed.” They did eventually investigate her for “unprofessional conduct,” failing to keep adequate treatment and diagnostic records of patients, failing to re-examine a patient after treatment, and failing to document a care plan for a patient. They said nothing about her no-touch techniques or her delusion that she was touching after being shown that she wasn’t. (Incidentally, the technique she claimed to be using but wasn’t, upper cervical chiropractic, is a very dubious invention not even accepted by most chiropractors.)
In another Washington State case, a doctor’s license was suspended because he used a bogus electrodiagnostic device. He was ordered to stop using the device and pay a fine, after which his license would be reinstated. His bogus diagnoses and treatments and his unscientific beliefs were not addressed. He had even claimed that he was able to replicate what the machine could do telepathically(!!) Should someone who is so obviously fooling himself be treating patients? I don’t think so.
Jonathan Wright, MD, has had repeated run-ins with the law, including having his clinic raided by the FDA. His clinic’s website said they were using an illegal electrodiagnostic device. When I reported this to the board, Wright’s lawyers wrote letters to individual board members threatening legal action if they proceeded, so they declined to investigate.
Burzynski, the infamous provider of antineoplaston therapy for cancer, has been extensively covered on SBM and elsewhere. The Texas medical board has twice tried to revoke his license. On the second attempt, the board identified a pattern of misleading patients at the Burzynski Clinic with misrepresentations that could lead to direct harm to the public if left unchecked. They cited a total of over 130 violations. Instead of revoking his license, they put him on probation, ordered him to make changes in his practice and allow his practice to be monitored, required him to enroll in 72 hours of medical education, ordered him to pay $20,000 in restitution to a former patient, and fined him $40,000 – a drop in the bucket compared to the huge profits he has made charging his patients for an investigational treatment.
William Rea is notorious for diagnosing and treating “multiple chemical sensitivity,” a diagnosis generally considered to be bogus. The Texas Medical Board charged him because he (a) used pseudoscientific test methods, (b) failed to make accurate diagnoses, (c) provided “nonsensical” treatments, (d) failed to properly inform patients that his approach is unproven, (e) practiced in areas for which he has not been trained, and (f) represented himself as certified by a board that is not recognized by the American Board of Medical Specialties. The case ended in a mediated consent order in which he agreed to revise his consent form; all the other charges were dropped.
The novel
The name Doc Zeus suggests the character’s feelings of entitlement and his God complex. He is a real piece of work: a narcissistic, manipulative, amoral psychopath. He is being investigated for raping an adult patient in his office during an exam, but the investigation has stalled. The woman is reluctant to testify, and it boils down to a he said/she said case that the prosecutors think is unlikely to succeed in court. Meanwhile, Zeus indulges in a “consensual” relationship with a minor, a vulnerable 16-year old who was influenced by a cult-like church group to carry her pregnancy to term and give the baby up for adoption. To facilitate his seduction and his control of her, he tries to get her hooked on drugs, writing multiple prescriptions for opioids and forcing pills on her during their encounters. She thinks they are in love and believes Zeus will get a divorce and marry her.
The plot is thickened by a novice investigator who is disturbed to find his hands tied in various ways by the bureaucracy and who wants to cut through the red tape to see justice done. This is not great literature, and the characters didn’t entirely convince me, but the story is compelling. I couldn’t stop reading because I couldn’t wait to find out whether Dr. Zeus was going to get his comeuppance (no spoiler alert: you’ll have to read the book to find out). There was a lot of fun along the way: car chases, marital feuds, bribery, entrapment of a hospital official by putting him in a compromising position and lying about it, blackmail threats, naked people locked out of hotel rooms, a mistress, a stalker, lies galore. The behind-the-scenes manipulations and shenanigans by Zeus and his lawyers were virtuoso performances; I don’t know how often such manipulations really happen, but I don’t doubt that they sometimes do. It’s chilling to think how easily justice might be perverted.
The issues
Reading the novel helped me understand what might be going on behind the scenes in medical board cases, and made me think about a number of the issues involved.
It is hard to get patients to testify against a doctor. In the case of sexual misconduct, it often boils down to “he said/she said,” and doctors will accuse patients of lying or discredit them by diagnosing them with mental illness. Victims are ashamed and may think they are partly responsible. They dread the publicity and dread being attacked on the witness stand by an aggressive lawyer for the defense. In the novel, we know what the doctor did; in the real world, there is always room for doubt.
Doctors and lawyers are ingenious in making up alternative explanations for everything that happened. They can literally argue their way out of anything. No one can be sure what actually happened in a doctor-patient encounter, what words were used, how body language and other factors contributed to persuasion. Even when documented in the medical record, we can’t be sure the documentation accurately reflects the truth. Records can be altered; sometimes the alterations are detected, sometimes not. More often, records simply fail to document crucial information.
I think when investigators realize how hard it would be to get a conviction on the major issues, they are likely to bow to harsh reality and try to cut their losses by attacking minor malfeasances that can be proven and successfully prosecuted, such as failure to maintain adequate records and failure to follow up.
For questionable medical treatments and diagnostic methods, there are always “experts” who are willing to testify in their favor. With all the “shruggies” and the infiltration of quackademic medicine, those “alternative truths” are harder than ever to counteract. And the defendant can usually flood the witness pool with grateful patients.
There may be things going on behind the scenes that we will never know about. Financial shenanigans, personal considerations, friendships, bribery, manipulations, fear of retaliation, etc.
Pursuing justice can be painful for all concerned. It’s understandable that some board members would seek the path of least resistance, the most comfortable route.
I imagine some board members think “There but for the grace of God…” They wonder if they are doing things that might be fodder for investigation someday. No one is perfect, and they may think of mistakes they have made and things they have done that aren’t quite kosher. The instinct of self-preservation kicks in. “Let’s give our colleague the benefit of the doubt, and maybe they will cut me some slack if I am ever investigated.”
Conclusion: food for thought
Sometimes fiction is the best way to get insight into reality. Stories are compelling. Fiction can go where nonfiction can’t. Fiction can help us understand what people might be thinking and feeling, recognize that there might be important factors that we don’t know about, and understand how various kinds of conflicts can lead to less-than-ideal outcomes. Doc Doc Zeus raises a number of issues that are worth thinking about. I only wish there were a way to make medical boards more responsible and to achieve true justice. Suggestions are welcome in the comments.