Doctors Behaving Badly: After diabetes missteps, Maryland doc gets another sweet deal

Dr. Panayiotis Baltatzis has been given many chances.

In 1995, the Maryland State Board of Physicians placed Baltatzis on probation after other physicians in a peer review process found that he had, among other things, prescribed narcotics to patients he had not adequately evaluated. The doctor, who practices in Baltimore area, was supposed to take a class in prescribing controlled substances and submit to annual peer review of his practice.

Three years later, the board told him to take more prescribing courses and to submit to more monitoring.

In 2005, Baltatzis was in trouble again. This time the board found that he was not documenting his treatments in a way that would allow other physicians to pick up where he left off or, more importantly, allow the board to see what he was doing. They also found that he had failed to meet the standard of care in treating diabetic patients. An administrative law judge thought at the time that Baltatzis had been given enough leeway. The judge recommended that his license be taken away.

Instead, the board put him back on probation. Again peer reviewers appointed by the board looked at some of Baltatzis' cases. Out of 10 patients, they found problems with seven. New charges were filed in April 2008.

No one will ever know how each of the hundreds of patients treated by Baltatzis over the past 14 years have fared, but consider the snapshot of cases called out by the board – the majority of the patients. Their blood sugar levels were not carefully monitored, even though in treating diabetes this is priority number one. Care wasn't taken to make sure patients saw podiatrists and ophthalmologists, despite the fact that diabetes wreaks havoc on the eyes and extremities. And they weren't screened adequately for kidney damage, another common problem.

So, the question is, if the doctor wasn't paying attention to blood sugar, to kidney damage or to problems with the patients' eyes and feet, what was he doing? According to the board's Web site, Baltatzis told the board that he is board-certified in internal medicine. Antidote checked. He is not. Nor is he certified in endocrinology, where most diabetes specialists work.

The board wrote in its October 2009 final decision against the doctor:

Despite extraordinary remedial instruction and Board monitoring, Dr. Baltatzis has continued to fail to meet the standard of quality of care and persists in failing to maintain adequate medical documentation. It is disconcerting that Dr. Baltatzis has not significantly improved over the course of the 14 years he has been monitored by the Board. The Board has expended a great deal of resources in an attempt to re-educate and remediate Dr. Baltatzis so that the medical care he provides meets the standards of quality care.

No more chances, right?

Wrong.

The board put Baltatzis on five more years of probation and ordered him to take more classes.

Know Your Doctor: Much of Baltatzis' case turned on the "standard of care." In this case, the judges and the board relied heavily on the standards set by the American Diabetes Association. The drafting of standards like these can sometimes be political or tainted by industry influence, but patients and health writers should know the associations and their guidelines to have a baseline for what acceptable treatment should be. In this case, the guidelines were clear and widely accepted as the norm.