Lawrence Zemel
Letter from Dr. Zemel to CT Department of Public Health
Newington Children's Hospital
September 14, 1993
Donna Brewer
Department of Public Health and Addiction Services
Hearing Office
750 Washington Street
Hartford, CT 06106
Dear Ms. Brewer:
I am concerned about the medical and ethical practices of a Bristol based physician, Dr. Phillip Watsky, a self proclaimed expert in Lyme disease. I have three related concerns about his care of patient with Lyme disease:
1. He seems to be over diagnosing Lyme Disease
2. He is grossly over treating Lyme Disease.
3. He may be profiteering from unnecessary therapies
For the past few years I've heard second hand reports, mostly from families of children that I treat that Dr. Watsky was prescribing months of IV antibiotics, contrary to mainstream Lyme Disease therapy. Initially I wrote him off as one of the several "fringe" physicians who were not following scientific principals in managing patients with Lyme Disease.
Recently, however, an acquaintance called me and described some of her symptoms and wondered if she may have Lyme Disease. Based on her symptoms and her negative testing I felt she probably did not but should be throughly evaluated by her physician. She then told me how she phoned a Lyme Disease information number advertised in the Hartford Courant, 1-800-TICKBITE.
Based on the same description she gave them, they felt she most likely had chronic Lyme Disease and referred her to Dr. Watsky. It is fairly common knowledge that the 800 phone number is located in the offices of a home infusion company which clearly stands to profit from intravenous therapy.
Ms. Donna Brewer
September 14, 1993
Another anecdote involves my lecturing at one of the local insurance companies, LIMRA. This was a community lecture sponsored my the Arthritis Foundation on Lyme Disease.
At the conclusion of my talk the woman who organized the lecture started to tell me about her husband who had been on intravenous antibiotics for three months and was still having Lyme symptoms. I asked if her husband's physician was Dr. Watsky and she was quite surprised that I guessed who his physician was.
I continue to hear similar stories about this physician and I feel it is time that he was exposed if a fair investigation bears out my impression that he is practicing dangerous medicine.
I would suggest the following lines of investigations:
1. Interview reputable are physicians who know of Dr. Watsky's practices: a starting list would include Drs. Michael Gerber, Henry Feder, Steven Padula (all at Uconn), Dr. Robert Schoen (Yale), and some of the physicians in Bristol.
2. Examine insurance records of some of the major carriers in the state to see if he is a consistent outlier in terms of duration of home intravenous therapy.
3. Have one of your staff investigators pose as a patient, complete with vague symptoms and negative Lyme results but insisting she have Lyme Disease. I would be happy to rehearse that investigator.
4. Examine records of patients treated over the past few years for Lyme Disease to see if they truly fulfill established criteria for Lyme Disease.
5. Investigate whether there are pay backs or kick backs from home infusion companies to Dr. Watsky or whether he profits directly as a result of an in office administration of parenteral antibiotics.
Good luck with your investigation. I would be happy to assist in any way possible.
Sincerely,
Lawrence Zemel, M.D.
Director, Pediatric Rheumatology
LZ/lo
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HARTFORD COURANT
January 30, 1996
LYME DISEASE DEBATE SPAWNS INVESTIGATION
JOHN SPRINGER; Courant Staff WriterTHE HARTFORD COURANT
A bitter debate in the medical community over diagnosing and treating Lyme disease has spawned a state investigation into a doctor's contention that another doctor is unnecessarily treating patients who don't have the disease.
Dr. Phil Watsky, the target of a 30-month investigation by the state health department, said he fears that the freedom of physicians to determine treatment of often bewildering infectious diseases is in jeopardy.
"Lyme disease is an emerging disease that we still don't know a lot about. For us to sit down and write a cookbook on how to diagnose and treat Lyme disease, there's just not enough information," said Watsky, a Bristol internist.
"I'm doing what I think I have to do, ethically, morally and medically necessary."
The state Department of Health and Addiction Services is investigating a complaint that Watsky overdiagnoses and overtreats Lyme disease, which is spread primarily by infected deer ticks.
Watsky learned of the complaint when a health maintenance organization refused to admit him in December 1994.
After the health department disclosed the investigation to Watsky, he was shocked to learn that it was another doctor -- not a patient -- who had complained.
"He seems to be overdiagnosing Lyme disease . . ., overtreating Lyme disease [and] may be profiteering from unnecessary therapies," Dr. Lawrence Zemel wrote in the complaint.
Zemel is the director of pediatric rheumatology at the Connecticut Children's Medical Center, formerly Newington Children's Hospital.
Zemel said Watsky was promoting himself as a Lyme disease expert, and suggested Watsky might be taking kickbacks from medical supply companies.
"I found that letter insulting," Watsky said. "I was very upset . . . I've never told anyone I was an expert on anything. There are no experts in Lyme disease."
"There's a tone of professional jealousy," said Watsky's attorney, Kosta Diamantis. "I think my client has improved the treatment of Lyme disease, and I think there's some jealousy on the part of this doctor and his friends."
The health department has concluded that Watsky is not involved in any medical supply companies.
The department is expected to decide in February whether to charge him formally with failing to properly treat one patient.
Watsky said the case hinges on the treatment of a man who is still Watsky's patient and has never complained to state officials.
In November, another doctor, recommended by Zemel, reviewed the patient's file for the health department.
Dr. Henry M. Feder Jr. concluded that there was "neither serologic nor objective clinical evidence of Lyme disease."
"I don't know what else the state has or what else they talked to Dr. Watsky about," said Feder, of the University of Connecticut Health Center. "There has to be more than the [review] I did for them."
Donna Brewer, chief of the department's public hearing office, was reluctant to discuss the investigation.
"I can say that we have allegations of overtreatment of Lyme disease and those allegations were not lodged by a patient in particular," Brewer said.
Lyme disease sufferers, their support groups and the Tolland-based Lyme Disease Foundation are watching the Watsky case closely.
"Who's going to want to treat a disease where, based on second- hand information, you're going to be investigated? It's absurd," said Thomas E. Forschner, the foundation's executive director. "The diagnosis of chronic Lyme disease is still up in the air. For anybody to come along and say that you are treating outside the guidelines is ridiculous."
The medical community is sharply divided, not only over how to diagnose the disease, but also when and how long to use long-term intravenous therapy for chronic cases.
On one side are doctors who believe that Lyme disease should not be diagnosed or treated unless the federal Centers for Disease Control and Prevention reporting standards are met.
The federal agency requires doctors reporting Lyme disease to first establish that the patient has the telltale rash and a seropositive test for Lyme disease.
"I think the mainstream physicians who treat Lyme disease follow certain medical standards in diagnosing and treatment," said Zemel, who stands by his complaint. "The majority of patients who have symptoms but no objective clinical findings and positive lab results do not have Lyme disease."
Most physicians agree that oral antibiotics are the best treatment for patients with early-stage Lyme disease.
The debate gets fiercest when doctors diagnose late-stage, or chronic, Lyme disease, and order long-term intravenous antibiotic therapy.
Watsky is an advocate of intravenous therapy in extreme cases.
Zemel said he does not oppose intravenous therapy, but shares the concerns of other physicians who worry that treatment longer than four weeks can damage the gall bladder and liver and reduce the number of infection-fighting white blood cells.
"I have no qualms with treating someone with well-defined Lyme disease with prolonged courses of antibiotics. I do have a problem with treating people with no clear Lyme disease with costly and potentially dangerous drugs," Zemel said.
Some doctors find that the disease defies exact definition. They find serology tests unreliable and believe that the organism that causes Lyme disease can hide in the body, in some cases lying dormant, only to come back stronger after antibiotic therapy is stopped.
They complain that the federal reporting standards are meant to track the epidemic, not to substitute for a physician's clinical diagnosis.
Watsky and others advocate long- term intravenous antibiotic therapy when oral antibiotics have failed.
"My feeling is that if you take a person who has Lyme disease and stop treating it, the disease will come back and it will come back stronger and harder to treat," Watsky said. "But the majority of my patients never even receive IV therapy . . . It's only for those patients who are the sickest patients, who have the most symptoms of the illness, who have heart problems and who are debilitated by the illness."
Watsky said intravenous therapy can cost $5,000 to $10,000 a month.
Those rallying behind Watsky say academic disagreements should not be decided by regulatory agencies based on complaints such as Zemel's.
"I'm appalled that was the way to approach the problem. If you have a complaint against a fellow physician, I think you try to work it out with them," said Dr. Sam T. Donta, professor of infectious diseases at Boston University Medical Center. "Even if Dr. Zemel was well-intentioned, which is hard to believe, I guess the issue here is: Do we really know what Lyme disease is all about? I think we don't have all the answers."
"If they go after a doctor who treats, no one else is going to want to treat anyone who is sick," said Sandy Cifone, founder of the Bristol-Burlington Lyme Support Group.
"The patients are being put in the middle. They are sick and just want to get better," said Cifone, whose daughter has Lyme disease. "All they see is doctors fighting all around them."
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Link To Article
https://www.courant.com/news/connecticut/hc-xpm-1996-01-30-9601300283-story.html
Last Updated- December 2019
Lucy Barnes
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