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Snake Oil Salesmen Hit Jackpot in Nevada |
 Snake Oil Salesmen, medical results Given the Medical Board's conception of a homeopathic license as blanket protection from disciplinary action, as well as its policy of consulting the accused to determine which regulations it ought to enforce, dually licensed doctors in Nevada routinely get away with misconduct that would cost them their credentials in other states. For example, when James Forsythe, a dually licensed physician, was indicted by federal officials for drug-smuggling and other violations in 2005, the Reno Gazette Journal revealed that at least 19 people had filed complaints against him with the Medical Board, and a state investigator described him as "one 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 maintained that his mistreatment of these patients fell within the scope of his homeopathic license. A Medical Board member asserted at a public meeting in December 2006 that the Board does take action against dually licensed doctors who violate the rules of allopathic medicine, but cases such as Forsythe's indicate that the Board has given extraordinarily wide latitude to homeopaths to evade supervision and, has, consequently, created a class of doctors who can injure patients at will without regard to sanctions that would ensue elsewhere in the country. The incapacity or unwillingness of the Medical Board to take action against renegade physicians is evident in Forsythe's brazen manipulation of the media before, during, and after his trial. Contrary to a press release that he circulated among local news outlets and various "health freedom" web sites in August, Forsythe was not cleared of drug-trafficking and other charges at that point, nor did the FDA ask him to author protocols for the proper use of human growth hormone. His trial began in Reno on October 23, 2007, and he was acquitted on November 1. While the FDA may appeal the verdict, the proceedings were significant because they revealed that Forsythe had improperly diagnosed a patient, who was actually an undercover FDA agent, with hypopituitism without conducting relevant tests, obtained hGH by claiming in a letter to U.S. Customs that he needed it for "personal use," and sold it directly to the patient rather than writing a prescription that could be filled at an ordinary pharmacy. In another state, the medical board would take pains to hold a licensed physician accountable for these violations of professional ethics and ordinary standards of medical care. But, of course, in Nevada, proactive efforts to protect public health and safety are out of the question. Forsythe will, consequently, probably go forward with his long-scheduled presentation at the 15th Annual Congress on Anti-Aging Medicine in Las Vegas on December 14, 2007, which he had confidently arranged before he went on trial. It will be interesting to see if he disavows prescribing hGH for anti-aging, which is how he wriggled out of a guilty verdict this time around.
The shady history of Frank Shallenberger, MD, HMD, who originally inspired my research into medical misconduct in Nevada, provides another chilling illustration of the state's inept approach to healthcare regulation. I began collecting information about Shallenberger after my late sister, Ellen M. Gallagher, was taken by her domestic partner, Caryn King, from her home in California for weeks-long treatments at Shallenberger's Center of Alternative and Anti-Aging Medicines in Carson City, over the objections of our family. At the time, April and May 2006, Ellen, who suffered from an undiagnosed brain disorder, could not walk, talk, or assist in any way in her own care. As soon as I heard that Shallenberger was going to infuse Ellen with anabolic steroids and other drugs over several weeks in preparation for illegal stem-cell therapy, I started to research his history to find out what kind of doctor would formulate such an outlandish plan. I soon discovered that Shallenberger, like other licensed homeopaths in Nevada, had surrendered his medical license in California after the Medical Board there found him subject to multiple disciplinary actions due to "gross incompetence," "repeated acts of gross negligence," and "acts of dishonesty and corruption which are substantially related to the qualifications, functions, or duties of a physician and surgeon." Since Shallenberger's negligence in treating our late sister replicated his dangerous misconduct in California, my sister, Anne Gallagher, and I complained to the Nevada State Board of Medical Examiners, which began an investigation. Not being from Nevada, we were shocked when we learned that Shallenberger was countering the complaint by claiming that he had treated our sister in his capacity as a homeopath rather than as a medical doctor. Since Shallenberger had never used the term "homeopathy" in conversations with our family, and since his infusions of various substances through a medically prescribed PICC line did not resemble homeopathic treatment, we could not imagine how any doctor might get away with such a defense. That's when we discovered that healthcare providers in Nevada are not held to the standards that prevail in other states. For instance, a state investigator confirmed that Shallenberger had admitted ordering the PICC line to be installed in our sister based solely on information provided by her domestic partner during a telephone conversation. Shallenberger said that he had to write this prescription because Ellen's primary care doctor refused to participate in his treatment plan. Consequently, using his credentials as an allopathic doctor, he ordered the installation of the PICC line at a Nevada hospital before he had ever examined our sister or reviewed her medical records. Our sister's partner, who believed Shallenberger's promises that the trip to Nevada would somehow "regenerate Ellen's brain," stopped on the way to his clinic to have the PICC line installed by allopathic practitioners in a hospital setting. But even though this procedure, which was extraordinarily painful due to Ellen's comprised medical condition, could not be described as "homeopathic" under any circumstances—including any statutes of Nevada state law—the Medical Board decided that it would not hold Shallenberger responsible for his misconduct because he claimed, long after the fact, that he had been acting as a homeopath. When asked why the Board had chosen to view Shallenberger's prescription for the catheter as homeopathic even though homeopaths are not allowed to order or perform such procedures, Bonnie Brand, in her capacity as the Board's General Counsel, explained that she had no idea what homeopaths are permitted to do in Nevada.
Jaclyn O'Malley, a reporter for the Reno Gazette Journal, recently published a detailed account of the Medical Board's handling of complaints against Shallenberger. In addition to relating the facts of our case, O'Malley reported on another complaint, which arose from Shallenberger's misdiagnosis of a patient's colon cancer and mistreatment of him with witch-hazel and other ineffectual remedies. In that case, even though David Horton, the fatally injured patient, had gone to Shallenberger specifically seeking homeopathic treatment, the Medical Board pursued the case and found Shallenberger guilty of medical malpractice. Although Shallenberger had arrived at his misdiagnosis by performing a "dark field" examination of Horton's blood and later attempted to treat his cancer with Insulin Potentiation Therapy (IPT) and laetrile, the Medical Board decided that these alternative approaches violated ordinary standards of allopathic medical care.
The Medical Board thus directly
contradicted spokesperson
Bonnie Brand's declaration that the Board has no
jurisdiction over dually licensed practitioners of homeopathy. In line with its history of
keeping dangerous doctors in business, however, the Board
determined that Shallenberger's direct contribution to his
patient's death merited, not the revocation of his license, but
a $5,000 fine and an order to pay investigative costs of
approximately $6,500. In contrast to what happens at other
medical boards, where previous misconduct in another
jurisdiction is usually taken into account, the NSBME apparently
did not consider Shallenberger's documented history of
corruption and incompetence in California, nor did the Board
disclose whether it had dismissed similar complaints made
against him in the past. In short, even though the Board
departed from its usual policy of letting dually licensed
doctors get off scot-free, it stayed true to its tradition of
enabling those who would be or actually have been found unfit to
practice elsewhere to keep on injuring patients in Nevada.
What is especially disconcerting about the Medical Board's dealings with Shallenberger is that Board members and staff seem to be oblivious to his flagrant defiance of the regulations that normally govern medical care. For instance, at its public meeting last December, the Medical Board gave Shallenberger a forum to discuss his illegal 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 Board 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." When I brought this inadequate reply to the attention of state officials, Medical Board attorney Bonnie Brand responded:
Of course, even people who are not medical experts know that there is no such thing as "off-label" use of hGH for anti-aging, and Brand could have stumbled upon this well-known fact had she bothered to read the newsletters published by her employer:
In view of the woeful ignorance displayed by its personnel, it's no wonder that Nevada's Board of Medical Examiners ranks 47th 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. And it also seems fitting that the only continuing education course offered by the Board, which is purportedly designed to teach "medical ethics," is entitled "Protecting Your Medical License," even though tort reform has already made it nearly impossible for patients in Nevada to take action against dangerous doctors, and the Board fails to act on most complaints.
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