Notes for 2019 Proposed Bill- Maryland- Doctor Protection
Two MAIN take away points concerning the doctor protection bill from the 2018 based on comments shared by legislators at the hearing in the House. Comments below the two main points are my ROUGH notes on what the legislators said.
1.) Although legislators totally sympathize and understand your intent and plight, they stated that the bill is the wrong way to do what you want to do.
LEGISLATORS COMMENTS
This is a really specific bill for a really specific thing… it’s the wrong approach to try to do the right thing.
Delegate Hill said directly to Mr. Dumoff- You’re an attorney, so you KNOW about the problems with this bill!
Hill- Often Board goes after medical records so that is common. It (the bill) is the wrong way to go about changing this.
Not sure this bill is the right tool. Medicine is always evolving. Ulcers used as an example.
More constructive way to go is a bill that says these are the conditions they CAN bring charges for. Make bill say the opposite- that these are behaviors to expect, might have to do with not charging, sliding scale, time till improvement specified, etc. [I don’t particularly agree with this approach- too many variables, but that format- using fields- was used for the naturopathic bill that was trashed, watered-down and eventually passed. < An example of “passing a bill” just to have a bill passed. Not good at all.]
Mr. Wise, is this bill a proper remedy for what has been outlined? No. Specifically for Lyme disease- not good.
It (meeting) is opportunity for docs to present their side. It is messy and it is not always clear- science & medicine changing. This bill says it is ok not to follow standard of care.
Hill again- following standards and having two reviewers- that is the end of it. They don’t have a pool of people for the Board- that would need a change to the Board [members]- by way of a bill- to get alternative doc to be a peer-reviewer. (Wrong approach with THIS bill.)
If investigated, legislator suggests they can note medical records problems, but not prosecute for them. If we don’t know what to do, you can’t go too far down the path of picking new Board members.
What are your thoughts if we had everyone together to come up with something agreeable? [As opposed to doing a bill.]
Delegate Young- What are your thoughts, she asks Med-Chi, Consumer AG office- and wants supporters of the bill to come up with agreeable standards of care, not a bill. [Watch for her or someone else to sponsor a bill this year on doctor protection.]
2.) As Delegate Hill said- patients are not protected against “shysters” in this bill. [This latest bill doesn’t adequately addresses the Board, Med-Chi, legislator’s concerns or complaints about “shyster” because it ties the Board’s hands for everything except the most egregious cases. Example- IV Oatmeal. Additionally, ozone is specifically mentioned in the IDSA guidelines as NOT recommended, as are herbs, vitamins, long term antibiotics and which ones, etc. The IDSA/CDC, MDOH, Board, Med-Chi, etc. don’t want any of that sanctioned as viable treatment. They see that- even the most benign alternative therapy as "shyster- like". They want the doors open and this bill closes the door.]
LEGISLATORS COMMENTS
The way the bill is worded… as long as you give disclosure to patients the Board can’t act. [Meaning alternative physicians and/or anyone not following any standard of care would be exempt from rules set in place decades ago to protect patients.]
These are legit arguments, but the problem we have is there really are “shysters”. [Hill used term 2 or 3 times.] Laetrile used as example.
Question legislator asked… Under this bill what could a practitioner be disciplined for? If you are wrong, or a shyster, or 20 people treated and not cured, [as a patient] what can I go after you for?
Hill again, the Board can’t bring charges when things go wrong if we do this [pass this bill].
You can’t do this [bill]… this blanket statement doesn’t give Board flexibility to protect patients. [Wrong way referral again.]
But there should be some kind of standard that professionals agree are on the right side of schystering.
It [Board & rules] is only thing we have to protect patients. Best thing to do is to have 2 peer reviewers, which they do, and if they don’t agree then there is not enough ground to move forward. He thinks correction in the previous bill (?) is enough to fix this situation. [If this info below is the results of the bill- I don’t think it is strong enough to protect alternative docs as Mr. Wise reported and a legislator agreed with at the time.]
Research Notes- Delegate Hill mentioned Brian Fallon’s name. She went to Columbia where he is bullied into submission and people are told his methods are “far out”, yet his publications while there have been ultra conservative (forced). She is also not a doctor- no license in Maryland for over 10 years (+/-), so her opinions aren’t based on recent trends or science.
Maryland Peer Review Statute
The information on this page was last updated by Horty, Springer & Mattern on June 14, 2018.
MARYLAND
PEER REVIEW
Md. Code Ann., Health Occ. § 1-401. Medical review committees
Link Here- https://www.hortyspringer.com/peer-review-statutes-by-state/maryland-peer-review-statute/
2018 Legislative Bills
https://sites.google.com/site/lymelegislation/2018-maryland-bills
Susan Green and Young…
https://sites.google.com/site/lymelegislation/2016-hb-399/Susan%20Green%2C%20Delegate%20Kathy%20Afzali%20%26%20Karen%20Lewis%20Young-%20H.B.%20399.png
https://sites.google.com/site/lymelegislation/2016-hb-399
Young says… she knows all about the Lyme wars and knows exactly what the problem is… yet blows it by saying ILADS is the infectious disease society. The fact no one caught that mistake means the committee isn’t educated enough on the topic and will follow Hill’s lead. Young says she doesn’t want to get in the middle of the political stuff- SHE ALREADY IS!
Rules governing physicians
http://www.dsd.state.md.us/comar/comarhtml/10/10.32.03.11.htm
Sanctions for breaking rules
http://www.dsd.state.md.us/comar/comarhtml/10/10.32.02.10.htm
June 2018 Townsend Letter article
http://www.townsendletter.com/June2018/legislation0618.html
Hearing Video
Med-Chi Opposition Letter
Med-Chi 2016 Opposition Letter
IDSA Letter To Legislators Opposing Lyme Related Bills- Example (Note- ALL Lyme related bills have been opposed by the IDSA, even one that provided the IDSA with additional funding for Lyme research.)
House- Health Committee
House
Contact
More legislators comments… So, discipline over charting is what you are concerned about?
Not unusual for docs to practice outside of the standards until we can prove what we are doing is the right thing to do. [Basically, she is saying, so everyone does it. Deal with it.]
It doesn’t matter if it is Brian Fallon, different way to treat. [She knows of Brian Fallon’s work, so she has pre-conceived- negative- notions.
Delegate Barren- Wanted examples of non-traditional, alternative treatments?
Ozone, herbs, etc. was answer from David London. (No current standard of care for those treatments, or that covers using them in Lyme or other patients.)
Integrative- Integrative Medicine combines conventional medical treatment, complementary therapies, and lifestyle changes. It encourages a compassionate, healing relationship between patients and caregivers. Integrative Medicine views the whole person – mind, body, and spirit.
Complementary- Alternative medicine practices are used instead of standard medical treatments. Alternative medicine is distinct from complementary medicine which is meant to accompany, not to replace, standard medical practices. Alternative medical practices are generally not recognized by the medical community as standard or conventional medical approaches.
Alternative medicine includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, and spiritual healing. Examples of complementary therapies include yoga, massage, acupuncture, herbal therapy, dietary supplements, meditation, hypnosis, chi gung, tai chi, and reiki.
Alternative- Complementary and alternative medicine (CAM) can include the following:
Alexander technique,
aromatherapy,
Ayurveda (Ayurvedic medicine),
biofeedback,
chiropractic medicine,
diet therapy,
herbalism,
holistic nursing,
homeopathy,
hypnosis,
massage therapy,
meditation,
naturopathy,
nutritional therapy,
osteopathic manipulative therapy (OMT),
Qi gong (internal and external Qiging),
reflexology,
Reiki,
spiritual healing,
traditional Chinese Medicine (TCM), and
yoga.
Nonconventional- “Non-conventional” is synonymous with “unorthodox”, “different” from biomedicine.
This revised bill, as it relates to Lyme patients, is a doctor protection bill, NOT a Lyme patient’s rights bill and does not include/cover:
The administering or extension of necessary antibiotics past the 10 days/2 weeks/28 days listed in the current stand of care. BIG difference for patients who need 6 to 9 months of one or more IV antibiotics, picc line, home health care.. and someone who needs a few OTC supplements and a heating pad.
IDSA recommended traditional treatment now is the same for all stages of Lyme- early/acute, neuro, arthritic, relapsing, late-stage ACA, heart, persistent, refractory, etc. That must change and patients must have options. Those traditional medicine options are not provided for in this bill.
The bill goes on and on about consent. That is already covered by LLMD’s in great detail, and no one should treat a Lyme patient or any patients without it. This written consent issue has been covered in the Lyme community for at least 15-20 years now for those who have their thinking caps on and have educated themselves on the issues, are using any common sense at all, or who took ILADS training. Those who didn’t, shame on them.
Minimal consent form- example- https://www.lymedisease.org/wp-content/uploads/2018/05/Informed-consent-for-Lyme-treatment.pdf
More detailed consent form- example- http://lymeresourcemedical.com/wp-content/uploads/2015/07/icftpl.pdf
Includes some IV specific consent and studies referenced- example- http://www.pacificfrontiermedical.com/resources/Informed%20Consent%20for%20Treatment.pdf
Naturopaths in Maryland are not able to prescribe RX yet (that ability taken out of their bill) so physicians specifically need to be covered when RX antibiotics and other meds.
The IDSA standard of care’s type and length of treatment will be lower once new IDSA guidelines are published. (Watch for ILADS guidelines to expire like they did last time- less than a year now to renew them. Dr. C has not mentioned any update.)
Bill doesn’t refute IDSA recommendations and allow combo meds, or deviation from Doxy/Amoxy- standard recommended meds.
Not able to refute IDSA’s definition of a clinical diagnosis in absence of a rash, positive tests, history and known tick bite (24-48 hours stuff), etc.
What isn’t in the final bill will solidify/support the under-treatment of patients and basically allow the IDSA guidelines to be/remain mandatory.
What isn’t in the final bill will make it next to impossible to get covered by insurance now or in the future for any kind of treatment.
Not all patients can get by with alternatives. Other provisions must be made.
Draft of bill more in tune with Lyme patients need…
