Warning to Docs About Peer Review

On Wed, Jun 6, 2012 at 9:22 PM, AfterTheBite wrote:

A few years ago, supporters of a poorly written Lyme bill (HB 290) approached the Maryland Board of Physicians after their bill failed to pass out of Committee due to strong and rightly objections by ILADS and the rest of the Lyme Community.

The supporters THEN insisted the Board of Physicians "do something", which meant the BOP being charged with addressing the Lyme policies already in place. At that time Maryland did NOT have a "set" standard of quality care for Lyme- allowing our doctors and patients to utilize ILADS guidelines.

And to our benefit the Maryland policy also included wording designed to help protect our Lyme-treating doctors, making Maryland one of the safest places to practice.

Background- https://sites.google.com/site/lymelegislation/2010-hb-290

The fox, having been handed the key to the hen house, jumped at the chance to address the "rogue" LLMD's. Maryland, to our dismay, now has a set "standard of care" for Lyme disease (IDSA); and no current ILADS guidelines on the National Guideline Clearing House to refer to in support of non-IDSA treatment protocols.

Since the changes were made, several of our Lyme treating doctors have been harassed and/or investigated, some charged, some sanctioned, with some cases still unresolved.

Keeping that in mind, currently the Board of Physicians is proposing a set of regulatory changes. Statements such as the one copied below (and others) appear to be something our doctors and/or their attorneys may want to address during the open comment period that ends July 2, 2012.

Additionally, I would urge doctors and support groups outside of Maryland to carefully monitor what their own state medical boards are doing. This smells awfully fishy to me.

"These regulations will govern how the Board of Physicians handles complaints, investigations, disciplinary hearings, and sanctioning of individuals licensed by the Board."

D. Review by the Peer Reviewers.

(1) The Board shall contract for peer review services if a question of standards of quality care in the practice of medicine arises. [ MY NOTE- Consider who hires themselves out for any attack that can be had against our Lyme doctors. Also, some big rats were recently brought into Maryland from out-of-state to testify in Lyme-related trials/hearings against people in the Lyme Community. At least one attorney is now bragging and spreading the word about the rats as a "sure thing" for Lyme-related trials against us, according to some talk that was overheard.]

(2) The Board shall obtain reports from at least two different peer reviewers in each case.

(3) If one or both peer reviewers conclude that a violation of the standard of care has occurred, the Board shall make the final peer review report , consisting of the reports of each individual peer reviewer, available to the respondent for review before the Board considers whether to issue charges. The Board shall redact the names of the peer reviewers before making the report available under this section. [MY NOTE- Besides dangerous, is this a due process violation?]

(4) The respondent may provide a written response to the peer review report within 10 business days after the report was sent to the respondent.

(5) The Board shall:

(a) Consider both the final peer review report and any written response submitted within the time period specified in §D(4) of this regulation; and

(b) Determine whether there is reasonable cause to charge a respondent with failure to meet appropriate standards of quality care .

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MORE INFO

Last known policy concerning Lyme disease in Maryland is below. This policy was issued by the Maryland Board of Physicians in response to the pressure placed on them from the failed bill supporters.

Web site: www.mbp.state.md.us http://www.mbp.state.md.us/forms/spring2010.pdf

Lyme Disease

Lyme disease continues to be the most commonly reported vector-borne illness in the United States, especially along the Eastern seacoast. When it is diagnosed and treated early, treatment with antibiotics may be successful.

Early symptoms include the characteristic “erythema migrans” rash at the site of the bite, chills, fever, headache, stiff neck, tiredness, joint pains, swollen lymph nodes, and a rash spreading to other parts of the body. Without treatment, the disease may progress to arthritis, meningitis, facial nerve paralysis, or hearing abnormalities.

There is a considerable controversy about the appropriate therapy when Lyme disease is not diagnosed early or does not respond to the standard course of treatment.

Many patient advocacy groups claim that medical boards are disciplining physicians for use of non-standard treatment models, thus discouraging physicians from deviating from standard treatment protocols. The Maryland Board of Physicians has never sanctioned a physician for over-prescribing antibiotics or for treatment of patients with confirmed or suspected Lyme disease.

The Board of Physicians recommends that any physician using non-standard treatments for any patient adhere to the following principles:

1. Adequate diagnosis and an explanation of options should be provided to the patient;

2. The non-scientific method should not be used to the exclusion of scientifically proven effective methods;

3. Use of alternative therapies does not relieve a physician from the duty to refer to appropriate professionals or to keep a complete medical record;

4. If the patient rejects a scientific modality of diagnosis or treatment in favor of an unproven method , a meaningful informed consent must be completed and documented in the medical record;

5. An unproven treatment should not be pursued indefinitely in the face of failure to achieve the desired effect ; and

6. The unproven method should not have the potential to harm the patient .

Adherence to these principles and documentation in the patient’s medical record should improve patient satisfaction and treatment outcomes as well as protecting the physician from a charge of failure to meet the standard of quality care .

On Jun 6, 2012, at 9:54 PM, Dr. X wrote:

TinCup: May I:

1) share with my Attorney, Mr. xxx

2)Share with xxxx, legislative assistant to Mr. XXX, Chair NYS Assembly Committee XXX, & possibly with xxxx, Congressman xxx District Manager.

All are keenly involved in NYS developments with 90% of Lyme treating physicians under simultaneous "investigation". This speaks to a nationwide (dare I say it) conspiracy to destroy opponents politically, using state "boards of medical practice" as handy tools to do so.

Lemme' know ASAP.

Dr. x