Suspension Not Due to Patient Complaints

In response to the [Letter from the Publisher, January 2011], I would like to make a statement.  

The Oregon Medical Board (OMB) complaints regarding my medical practice have nothing to do with harming a patient, or even complaints from patients I have treated. They appear to center on the 1995 amendment to the Medical Practice Act, ORS 677.190(A). This amendment allows the alternative treatment of medical conditions with methods not currently considered “mainstream,” or “conventional.” These treatments are considered to be as safe as the traditional treatments by the doctors using them and the patients receiving them.

The OMB wants to decide what is the safest of the choices, or what constitutes an alternative medical practice. This desire of the OMB was rejected when it was proposed in 1995 during hearings on this bill. The legislature clearly asserted that it was the doctors that were to make that decision and overrode Gov. Kitzhaber’s veto almost unanimously.

The therapeutic choices in these cases are backed by current, peer-reveiwed, medical literature. For example, the decision to use testosterone in a patient with prostate cancer to improve quality of life is not some crazy idea. A review article of this topic can be found in Urology Clinics of North America 34 (2007)555-563, or in Medical Clinics of North America, Supplement 1, 2006 pg 23, or The New England Journal of Medicine Jan 29, 2004, pg 482, or J of Steroid Biochemistry & Molecular Biology 102(2006) 261 – 266, etc., etc. This and much more was presented to the OMB and ignored.

The fallacy of the TSH test in determining the need for thyroid hormone replacement was another bone of contention with the OMB, despite the presentation of an alternative point of view that considers the safety of and many benefits of adequate thyroid hormone replacement.

One set of guidelines which the OMB insist that I follow was issued by the Endocrine Society regarding the use of testosterone. By the author’s own admission, as stated in the article, a review of the evidence used as the basis for these guidelines, is “very poor quality” evidence 75% of the time; 25% of the guidelines were based on “poor” quality evidence; and none were based on “moderate” or “high” quality evidence; so much for “evidence-based” medicine. See J of Clinical Endocrinology & Metabolism, June 2010, 95(6):2536-2559 see esp “Methods of Development of Evidence-based Clinical Practice Guidelines” page 2539.

The patient charts that were the basis of the complaint and emergency suspension were reviewed by three and sometimes four other Oregon physicians. In each of these cases the reviewing doctor felt that there was no violation of the Medical Practice Act or violation of the Stipulated Orders the OMB had placed on my practice.

Peer-review is a basic tenet of the practice of medicine. Typical of the OMB, none of the “experts” testifying against my practices had heard of the amendments to the Medical Practice Statute, made in 1995, and were unaware of legitimate alternative practices.

My “emergency suspension” was based on the fact the the OMB alleged that I had failed to do a prostate exam on two patients when the chart notes on both of these patients clearly demonstrated that the exam had been done. The reviewing doctors and one of the OMB consultants at the hearing concurred with our opinion that no violation of the OMB order had been committed. Despite this fact, the OMB issued an emergency suspension, and has refused to consider lifting the suspension at this writing, four months later.

Generously, after suspending my license, the OMB reminds me that I have the right to hire an attorney to defend myself. Were it not for the generosity of my attorney William Wheatley, a volunteer staff, and donations from like-minded patients, I would definitely by out on the streets again.

There is nothing to hide in these cases. I have offered to sign a release of information on any of the records, or complaints the OMB has in my file. The OMB does not allege that I have harmed a patient, it is always that I might, even after practicing medicine in Oregon since 1979.

Go figure!

John E. Gambee, MD

www.drgambee.com