AN OPEN LETTER TO NEVADA STATE GOVERNMENT OFFICIALS
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TO: |
NEVADA STATE BOARD OF MEDICAL EXAMINERS; NEVADA STATE BOARD OF HOMEOPATHIC MEDICAL EXAMINERS; NEVADA ATTORNEY GENERAL CATHERINE CORTEZ MASTO; NEVADA GOVERNOR JIM GIBBONS |
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FROM: |
SUSAN E. GALLAGHER |
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SUBJECT: |
THE BREAKDOWN OF HEALTHCARE REGULATION IN NEVADA |
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DATE: |
9/12/2007 |
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CC: |
VARIOUS MEMBERS OF THE NEVADA STATE LEGISLATURE |
I am not a medical expert, lawyer, or lobbyist, but I began to research medical misconduct in Nevada after my late sister, Ellen M. Gallagher, who died of an undiagnosed brain disease in September 2006, was mistreated by Frank Shallenberger, MD, HMD, at the Nevada Center for Anti-Aging and Alternative Medicine in Carson City. In the course of my research, I discovered so much dangerous disarray within your system of healthcare regulation that I created a web page based on my findings on my faculty web site at the University of Massachusetts,
Snake Oil Salesmen Hit Jackpot in Nevada ( http://faculty.uml.edu/sgallagher/NIRB.htm ). The web page documents ongoing efforts by homeopaths and legislators to promote health tourism by establishing mechanisms to legalize medical devices and treatments that are outlawed elsewhere in the country. Since the Nevada State Board of Medical Examiners (NSBME) and the state legislature have so far turned a blind eye to the unethical, illegal, and unprofessional conduct of the charlatans involved in this scheme, I offer the following summary of their activities in hopes that you will act to restore the integrity of health care regulation in your state.When I first looked into Dr. Shallenberger's past and found that the Medical Board of California had forced him to surrender his medical license in 1995, I assumed that his history of negligence and dishonesty was anomalous among physicians in Nevada. Since his treatment plan for my sister, which he formulated before he had ever met her or reviewed her medical records, included infusing her with anabolic steroids to prepare for stem cell therapy that is illegal in this country, I thought that he was an unrepresentative renegade who had somehow fallen through the cracks. That's when I discovered that healthcare providers in Nevada are not subject to the standards that prevail in other states. In contrast to what happens elsewhere, even in states where homeopaths are licensed, Nevada permits medical doctors such as Shallenberger to violate ordinary standards of medical practice if they are also licensed as homeopaths. Moreover, dually licensed doctors in Nevada can avoid discipline for providing incompetent or negligent care even when their treatments have nothing in common with homeopathy.
Thus, after my sister, Anne K. Gallagher, and I filed a complaint with the NSBME detailing Shallenberger's clear-cut violations of basic rules of medical care, we were told that the Medical Board might not be able to discipline him because he claimed that his misconduct fell within the scope of his homeopathic license. Having first assumed that this defense was irrelevant because his treatments did not resemble homeopathy, we soon learned that other homeopathic doctors in Nevada had successfully employed the same excuse. For example, when James Forsythe, a dually licensed physician, was indicted for drug smuggling in 2006, the Reno Gazette Journal revealed that 19 people had filed complaints against him with the NSBME, and a state investigator described him as ʺone of the five most serious physician offenders known in the state of Nevada." However, the Medical Board failed to act on any of these complaints because Forsythe claimed that his mistreatment of these patients fell within the scope of his homeopathic license and, consequently, did not affect his status as a licensed MD.
One might expect that injured patients and their loved ones could turn to the Nevada State Board of Homeopathic Medical Examiners for relief in such situations. Unfortunately, according to public records, the Homeopathic Board has never followed any coherent procedures, nor has it properly disciplined incompetent physicians since its inception in 1983. In fact, according to two state audits conducted in 2006, the Homeopathic Board did not formulate any written policies until after the audits had gotten underway. Moreover, during 2005 and early 2006, under the leadership of Daniel Royal, DO, HMD, JD, the Homeopathic Board ran up a debt of at least $83,000 to the Attorney General's Office, mainly for litigation to carry on disputes among members and defend itself against lawsuits brought by its own licensees. According to the audits, the Homeopathic Board not only failed to make any effort to recover legal costs or fine errant licensees, it also failed to follow proper reporting procedures and to keep adequate records of payments made to Board members and their business associates for travel expenses and lobbying fees.
Remarkably, the state legislature has ignored the obvious incompetence at the Homeopathic Board and decided to provide its members with extraordinary power over medical research and treatment in Nevada. In 2005, after less than five minutes of discussion in the Senate Committee on Commerce and Labor, legislators created the Nevada Institutional Review Board (NIRB), which was designed to promote medical tourism by permitting a select group of homeopaths to approve and help to sell medical devices and treatments that are illegal in other states. Then, in June 2007, after this dubious scheme nearly collapsed amid months of irrational bickering among Homeopathic Board members, under the guise of a bill that would have eliminated the NIRB in July, the legislature voted without any public discussion to extend its existence for two more years.
It's not clear how this legislation, an amended version of
SB432 , came to pass, but one of its most disconcerting features is that it authorizes the NIRB “to contract with a private company to conduct studies or other work related to non‐embryonic stem cells in bio-regenerative technology.” What is amazing about this turn of events is that the legislature took this action without hearing any public testimony from anyone with any expertise or credentials related either to institutional review boards or to stem cell research. According to meeting minutes, public discussion of an earlier version of the final bill occurred on April 13, 2007, when unlicensed pharmacist Dean Friesen, Director of Dan Royal's New Hope Medical Clinic, testified before the Senate Committee on Commerce and Labor. In unanimously supporting the proposed bill, which was sponsored by Senator Michael Schneider, Committee members stressed that they had worked closely with Friesen to refine provisions on stem cell research and "transitioning" to clinical applications. But even though they are charged with overseeing state licensing boards, no Committee members expressed concern about Friesen's status as an unlicensed pharmacist. Silence likewise prevailed in regard to Friesen and Royal's obvious lack of knowledge about this area of medical science, nor did lawmakers call attention to ongoing investigations by the Attorney General's Office of Friesen and Royal's apparent violations of state and federal law during and after their tenure on the NIRB.While I have no idea how these men managed to gain so much influence over state legislators, I do know that Royal has no compunction about violating professional codes of conduct in order to intimidate his critics into silence. For instance, on May 25, 2007, Royal faxed a letter to my university demanding that I "cease and desist" from assaulting him with "libelous accusations that are false on their face" (see facsimile below). Royal contended, without citing any evidence, that I have "a history of purveying falsehoods as facts, and inaccuracies as truth, with clear malicious intent." Royal also demanded that I publish corrections of defamatory assertions that I had made about him both on my web page and in e-mails sent to state legislators. However, just as he failed to supply any support for his claims about my history, Royal failed to identify a single inaccuracy in either the web page or in my e-mail, which, by the way, he somehow obtained even though he was not among its recipients.
What is most significant about Royal's attempt to curtail my right to free speech is that he focused on an email sent to state legislators summarizing documented aspects of his performance as a public official. Since Royal is an attorney, he certainly knows that citizens' communications with lawmakers are absolutely protected as essential to open political debate. Moreover, his threatening letter violates various provisions of the Nevada Rules of Professional Conduct, which prohibit attorneys from issuing insupportable statements and from representing themselves in matters related to their service as public officials.
Public records indicate that Royal has yet to be held to account for other violations of state law related to his activities as President of the Homeopathic Board, as a paid lobbyist, as a fundraiser for the NIRB, and as a member of both the Homeopathic Board and the NIRB. Consequently, I doubt that he will get into trouble for making illegal threats against me. Like who knows how many other homeopathic physicians who have engaged in illegal or unethical behavior, Royal has every reason to feel complacent. As you can see if you visit my web site, he and his fellow homeopaths have kept up a host of questionable activities for years without eliciting any appropriate response from other government boards and agencies.
For example, at its public meeting last December, the allopathic Medical Board gave Shallenberger a forum to discuss his
reckless use of human growth hormone. After listening to Shallenberger describe how he administers human growth hormone to elderly patients and others in violation of FDA regulations, a few doctors present said that they prefer to follow FDA rules in their practices. However, it never occurred to any NSBME members to suggest that Shallenberger stop his unorthodox therapies. Instead, the discussion ended when Board President Dr. Javaid Anwar said that the Board does not issue any guidelines, though it "does look at what falls within the good practice of medicine and what falls outside of it." In other words, even the head of the Medical Board seems not to realize that its fundamental mandate is to stop physicians such as Shallenberger from flouting clear-cut standards of medical care. It is, consequently, not surprising that Nevada's Board of Medical Examiners ranks 46th in Public Citizen's latest survey of the effectiveness of state medical boards, despite a $3.35 million surplus that it has been trying to spend down since 2003.
The time is long overdue for you to abolish the Board of Homeopathic Medical Examiners and to force the NSBME to hold homeopathic physicians to the same standards that apply to ordinary MD's. After all, the ongoing chaos at the Homeopathic Board and its offshoot, the NIRB, is due, not to any problems inherent in alternative medicine, but to the consistent refusal of the practitioners involved to conform to state and federal rules and regulations. If Nevada truly wants to move ahead in promising areas such as stem-cell treatment, the state needs to enlist the help of legitimate researchers with appropriate credentials rather than pinning its hopes on unlicensed pharmacists and other snake oil salesmen. The notion that "anything goes" may have enabled your state to rake in millions from gambling and prostitution, but as you can see from the ridiculous schemes of Dan Royal and Dean Friesen, as well as the irrational treatments pushed by the likes of Frank Shallenberger and James Forsythe, adopting this mentality in healthcare is an obviously irresponsible error.
Susan E. Gallagher, Associate Professor, Political Science Department
University of Massachusetts at Lowell
Director of Digital Resource Development, 2007‐2008
http://faculty.uml.edu/sgallagher Susan_Gallagher@uml.eduSources:
Audit Report on the Nevada State Board of Homeopathic Medical Examiners, Legislative Counsel Bureau
Medical Board of California, Accusation against Frank Shallenberger
" Maverick Doctor Under Fire,” Reno Gazette Journal, October 8, 2006. (James Forsythe)
Meeting Minutes, Nevada State Board of Medical Examiners, December 1 & 2, 2006
Public Citizen Survey of State Medical Boards
Nevada Legislature, Senate Daily Journal, 73r
d Session, June 3, 2007, 386‐390.Infomercial for New Hope Medical Clinic (annotated)
Senator Schneider's Royalist Healthcare Agenda
Snake Oil Salesmen Hit Jackpot in Nevada
