National pathology firm ignores state licensing laws and is rewarded in state after state

Dr. Patrick Dean has pulled off a magic trick to make Houdini proud.

The founder and president of GI Pathology, a national testing laboratory based in Memphis, Dean has practiced medicine without a license in at least two states. Practicing without a license is often a career killer for a physician. Not so with Dean.

Instead, he has been able to gain new medical licenses in state after state and broaden the clientele for his national testing business year after year. His story begs for a deeper investigation into how national testing companies, such as Quest Diagnostics, have become the dominant forces in their fields.

Dean started his company in 1995, and initially obtained medical licenses in three states: Massachusetts, Tennessee and Arkansas.

That didn't stop him from practicing in other states, though.

By reviewing medical tests submitted from other states where he and his employees had no licenses, he was essentially practicing medicine in other states without a license.

In North Carolina, Dean's company reviewed more than 600 patient specimens without a license. In October 2004, one of his clients asked him about whether he had a license in that state. He responded that he was in the process of getting one and downplayed his client's risk of getting in trouble for working with an unlicensed medical practitioner.

The risk, in my estimation, is weak...there has never been an example of "prosecution or termination of license for the proposed activities."

Clearly the idea that Dean needed a license to practice medicine in a state touched a nerve because he went on to say:

Finally, it would appear that the legalistic concern regarding licensure has not been raised out of high minded concern for ethics and the law. Since GI Pathology Partners delivers the finest quality and service to gastroenterologists (fellowship-educated gastrointestinal pathologists only diagnosis [sic] and next day turnaround time nationwide). I will not kowtow to venal arguments designed to scare little children in the dark.

Dean was confident for good reason.

Two years after Dean sent this letter, he and North Carolina worked out a deal to allow him to have a medical license. The pattern would hold true in state after state. Even after state medical boards found out that he had practiced medicine without a license, they either slapped him lightly on the wrist, granted him a license to do business or both. By 2009, he had won the license to practice in a total of 17 states.

Think medical licensure is no big deal? Tell that to the doctors who work their tails off to meet the specific requirements each state has for new licensees. In order for pathologists to examine samples from a specific state and render a diagnosis for patients in that state they have to be licensed in that state. This holds true for any practitioner. Radiologists reading X-rays in Illinois for a patient in North Carolina would be in violation unless they had a North Carolina license. Doctors prescribing drugs on the internet for patients in states where they have no license would be in violation and have had their operations shut down for this very thing.

Were the typical independent practitioner without a corporate title and without a successful national company on his letterhead to set up shop in most of these states and treat 600 patients without a license -- as Dean did in North Carolina - he or she would end up being charged by the medical board and, at a minimum, be put on probation with license restrictions. In 2008, Tahnya See continued to prescribe drugs to patients after her license in Tennessee had expired. Did Tennessee, as it did in Dean's case, give her a second chance? Did it grant her a license extension? No, the board revoked her license and fined her.

In 2007, Bertha Bugarin was caught running an abortion clinic in California without a medical license. Did the state hand her the medical licensure requirements and help her fill in the boxes? No. She was charged with nine felony counts of practicing medicine without a license and one felony count of grand theft. She is now in jail.

Anyone interested in digging into how exactly Dean was able to pull off his magic trick and turn GI Pathology into a multistate testing powerhouse should follow this timeline:

August 1982: Dean is licensed to practice medicine in Massachusetts.

May 1983: Dean is licensed in Tennessee.

July 2004: Dean starts practicing in North Carolina without a license.

September 2006: North Carolina orders Dean to pay a fine for practicing without a license but also gives him a license to practice there.

October 2006: Connecticut, where Dean was licensed in May 2006, and Pennsylvania, where Dean was licensed in May 2005, decide not to go after Dean for practicing the North Carolina case. California and Dean work out a deal based on the North Carolina case. He is publicly reprimanded.

November 2006: Arizona asks Dean (38046) whether his company has practiced medicine without a license there. Yes, he replies, in at least five cases.

December 2006: Colorado and Georgia, where dean was first licensed in July 2005, decide not to pursue Dean's case. But the Georgia Composite State Board of Medical Examiners does say, "the Board does wish to express...its concern regarding unlicensed practice." Georgia, by the way, has a great site that gives a complete list of all the states where Dean has been disciplined.

January 2007: Illinois, where Dean was licensed in February 2005, and Ohio don't do anything. Tennessee, however, issues a public reprimand. Iowa, where Dean has been licensed since May 2005, issues a "letter of warning," which has about as much weight as a 42 cent stamp will cover.

March 2007: Michigan, where Dean was licensed in March 2005, fines Dean $100.

April 2007: Kansas, where Dean was licensed in April 2006, decides not to pursue Dean's case.

June 2007: Arizona denies Dean's application for a license. The Arizona Medical Board's executive director Timothy C. Miller issues the most strongly worded letter to date about Dean's conduct:

You do not have a professional record that indicates that you have not committed any act or engaged in any conduct that would constitute grounds for disciplinary action against you under Arizona law...Specifically, the Board's investigation revealed that you practiced medicine in North Carolina without a license and as a result you were formally reprimanded by the North Carolina Medical Board...Additionally, the investigation revealed that you also practiced medicine in Arizona without a license...This conduct has not been corrected, monitored and resolved and there are no mitigating circumstances that prevent the resolution of this conduct.

August 2007: Florida issues Dean a license. But, his appeal to receive a license in Arizona is denied. Texas, meanwhile, reprimands Dean.

February 2008: Dean argues with the Arizona Medical Board about his case, saying that he has put in technology that will insure that only licensed doctors in Arizona who work for his company will review specimens from Arizona. The state gives him a license and, at the same time, he is fined $5,000.

July 2008: Based on Arizona's action, Colorado reconsiders and decides that Dean (DR-43904), who was licensed there in 2005, deserves a reprimand. He also is fined $3,000, as can be seen on the Department of Regulatory Agencies site. Hawaii, which licensed Dean in June 2007, reprimands Dean and puts him on one year of probation.

January 2009: Virginia, where Dean was licensed in December 2004, reprimands Dean.

May 2009: Pennsylvania reconsiders and reprimands Dean.

September 2009: Massachusetts reprimands Dean and fines him $5,000.

Also, Dean was licensed in Arkansas in 1996, but to find out if he ever got in trouble, you have to write the state a formal request.

Happy hunting!