Policy Statement- Board of Physicians & DHMH

Policy Statements

The Maryland Board of Physicians, Maryland Department of Health and Mental Hygiene, Lyme Disease Education and Support Groups of Maryland and the Maryland Lyme Disease Advisory Subcommittee of the Inter-Agency Vector-Borne Workgroup developed these policies to assure health care professionals and patients that the diagnosis and treatment of Lyme and tick borne diseases is not restricted or limited by one set of guidelines and the Board of Physicians will not target treating doctors or restrict the treatment of Lyme and tick borne diseases.

These policies were clarified and published in the documents listed below.

Maryland Department of Health and Mental Hygiene

Lyme Disease Prevention and Control in Maryland

A Strategic Plan

Public Policy Issues:

A public policy topic area group was not assembled. However, the subcommittee members discussed related public policy issues. Concern was raised that the Maryland Board of Physicians would follow the lead of similar agencies in several other states in which legal action was initiated against providers who chose to practice according to ILADS guidelines.

In its Fall 2005 Newsletter⁴, the Maryland Board of Physicians clarified that:

• It does not target or restrict the treatment of LD.
• It does not support the concept of “immunization” of any physician from scrutiny because of the particular disease, patients treated or location of practice.
• The Board does not create, promulgate, or endorse in advance specific guidelines regarding any disease state.

Link to Newsletter (pg 7)- Click Here

Link to Task Force Report- Click Here

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Maryland Board of Physicians

Fall 2005 Newsletter

LYME DISEASE ADVISORY SUBCOMMITTEE

The Lyme Disease Advisory Subcommittee of the Inter-Agency Vector-Borne Workgroup has met several times over the course of the summer and fall months with participants traveling from all over Maryland to voice their opinions and make recommendations. Lyme Disease inflicts a major burden on the residents of the state of Maryland. More than 700 Lyme Disease cases were reported in Maryland in 2002, an annual total that surpasses the combined yearly totals of acute hepatitis A, B, and C. Maryland is among the states in which Lyme Disease is most frequently reported.

The goal of the Lyme Disease Advisory Subcommittee is to develop a set of recommendations, in the form of a strategic plan, for the prevention and control of Lyme Disease and other tick-borne illnesses, whether occurring alone or as co-infections. The subcommittee has arranged for the Maryland Vector-Borne Disease Inter-Agency Workgroup to review their recommendations which will be forwarded to the Department of Health and Mental Hygiene (DHMH) as a resource.

The subcommittee identified six topic areas as its major focus issues:

• * Diagnostic best practices - need for accurate diagnosis of Lyme Disease and other tick-borne diseases.
• * Treatment guidelines - currently, there are two treatment guidelines published by the Infectious Diseases Society of America and the International Lyme and Associated Diseases Society. A review of other treatment guidelines was suggested by the subcommittee.
• * Surveillance - there is a pressing need to improve the reporting system and find out if any barriers exist. Reported illnesses that fail to meet the Center for Disease Control (CDC) case definition require consistent follow-up.
• * Ecology of Lyme Disease - the epidemiology of Lyme Disease in Maryland parallels that of West Nile virus in that both tend to cluster in "hot spots." The subcommittee suggested using strategy models from other states to generate preliminary ideas for recommendations to decrease exposure from ticks.
• * Public awareness and education - a representative from the Anne Arundel County Health Department provided an example of how department staff educates the public about Lyme Disease protective measures. This example will be used as a model to train local health department staff in other jurisdictions.
• * Public policy considerations - to be determined.
• DHMH is aware that this serious disease must be brought under control through the essential role of physicians in recognizing and controlling it. The Maryland Board of Physicians ("the Board") is not targeting or restricting the treatment of Lyme Disease. There has never been a disciplinary action initiated against any physician for their treatment of Lyme Disease, according to Board member Paul Fleury, M.D. As is true with all the care that the Board reviews, documentation is key to the justification of any physician's medical decision-making. In areas where the course of action to be taken is unproven or the chosen course is contrary to guidelines, an explicit discussion and documentation of treatment goals, options, risks and benefits of the treatment is appropriate.
• The Maryland Board of Physicians does not support the concept of "immunization" of any physician from scrutiny because of the particular disease that he or she treats, the particular group of patients treated, or the location in which he or she practices. The Board, in its mission to license and regulate the practice of medicine in Maryland generally does not create, promulgate, or endorse in advance specific diagnostic or treatment guidelines regarding any disease state.
• For more information, please call the Maryland Board of Physicians at 410-764-4777.

Link to Policy- Click Here