http://www.poughkeepsiejournal.com/article/20130601/NEWS01/306010021/N-Y-Lyme-bill-would-protect-physicians
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N.Y. Lyme bill would protect physicians
Doctors get scrutiny over controversial long-term treatmentA
LYME DISEASE - The so-called "Lyme wars": Lyme disease is easy to diagnose, easy to cure. That’s largely what the CDC and a group of prominent scientists say. Others, mostly Lyme doctors and a few maverick scientists, think the picture is much more complicated.
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Doctors who prescribe longer-term antibiotics for Lyme disease would be protected from charges of medical misconduct under a bill introduced by two state legislators from Dutchess County, where rates of the tick-borne disease are among the nation’s highest.
The Physician Protection Bill is sponsored by Assemblywoman Didi Barrett of Millbrook and Sen. Terry Gipson of Rhinebeck, both Democrats. It has 11 co-sponsors in the Assembly but none so far in the Senate.
Advocates for Lyme disease patients said the bill would be essential to protect Lyme-treating physicians who have been targeted for investigation by the state Office of Professional Medical Conduct, which licenses and disciplines doctors. No figures were available on the number of Lyme physicians censured, but since 1999 at least one was put on probation by the oversight board; another had his license revoked (it was later reinstated), and a third settled “nondisciplinary” charges.
“The doctors need to be allowed to prescribe treatment as they see fit, and they need to be protected from targeted harassment and intimidation,” said Chris Fisk, a board member of Lyme Action Network, a Glens Falls-based advocacy organization, and co-owner of Jimapco, a map publisher.
Treatment guidelines of the Infectious Diseases Society of America maintain that the Lyme pathogen — a spirochete, like syphilis — is almost always killed off after 14 to 28 days of antibiotic treatment. The guidelines are endorsed by the U.S. Centers for Disease Control and Prevention and the state Department of Health, which manages the licensing board and declined comment on the bill.
A spokeswoman for the diseases society, however, indicated opposition to such legislation, which already protects Lyme doctors in Rhode Island, Connecticut, Maine and New Hampshire.
“We do not think it is appropriate for state legislatures to step in to protect doctors who prescribe unproven treatments that may harm patients,” Diana Olson said in a statement. Prolonged antibiotic treatment is ineffective, she wrote, and “puts patients at risk for complications such as deadly blood infections, serious drug reactions and C. difficile diarrhea.”
'Supplant judgment'
Some physicians and Lyme advocates favor courses of antibiotics of several months and occasionally years for advanced Lyme cases, usually taken orally and in a minority of cases intravenously. They note that the guidelines themselves, adopted in 2006, stipulate that “they are not intended to supplant physician judgment,” which is what critics say they have done.
The Poughkeepsie Journal reported in August that at least five Lyme disease physicians in New York were under investigation by the licensing board. Gipson said he knew of three or four currently. Two Dutchess physicians have faced scrutiny, a threat that Jill Auerbach, chairperson of Hudson Valley Lyme Disease Association, said has a “chilling effect” on Lyme treatment generally.
Gipson agreed. “When doctors are threatened, you are threatening the health and safety of patients … Those with Lyme disease may find it difficult to find doctors who will treat them,” he said in a telephone interview.
Jeffrey Hammond, a Health Department spokesman, said the licensing board “has disciplined physicians for negligence in the treatment of the Lyme disease” and not “simply because ‘traditional’ treatment protocols are not followed.”
Gipson and Barrett said the bill had a good chance of passage, in particular because many legislators know family members, friends and constituents who have had Lyme disease, often diagnosed by the presence of a red rash that can assume different shapes.
Barrett said constituents treated with long-term antibiotics have told her, “This is working for me; I don’t know if I ever would’ve gotten to this stage, gotten my life back, if not for this.”
She said the Assembly bill received a major boost when the Health Committee chairman, Richard Gottfried, signed on as a sponsor.
'Patient protection'
Kenneth Liegner, a Pawling internist who treats Lyme disease, said, “The doctor protection bill actually is a patient protection bill.” In endorsing the society’s treatment guidelines, Liegner said, federal health officials “are being improperly partisan in a legitimate scientific debate in which there exists two schools of thought
Those schools differ over the ability of the Lyme spirochete to survive antibiotic treatment and, consequently, whether so-called chronic Lyme disease is real. Liegner and other Lyme physicians think it is; the CDC and infectious diseases group do not.
The Physician Protection Bill would mandate that doctors keep good records, monitor care and otherwise follow standard medical practices in administering antibiotics for Lyme disease. The bill does not define “long-term” treatment, except to say that it is longer than four weeks.
The bill is one of two Lyme bills in the Legislature. The other, sponsored by Gipson and Assemblyman Kevin Cahill, D-Kingston, would mandate that insurance companies pay for long-term care. The refusal of insurers to pay for costly intravenous care is another serious impediment to Lyme treatment, advocates say, and one they think has spurred state probes.
“What we found out is that insurance companies had been in the past reporting the doctors (to the state board) who were costing them a lot of money” through intravenous care, said Auerbach, a Town of LaGrange resident. Together, the bills would address the cost and delivery of care, she said.
Barrett said doctors need the bill’s protection.
“The notion that a course of treatment would be denied and that doctors … would be harassed while looking for best solutions is impossible for me to understand,” she said.
