New medical board rules will allow doctors’ misdeeds to go unnoticed
If you are looking for a loophole in the Medical Board of California’s pending rules for posting disciplinary records online, consider the case of Dr. James Privitera.
In about one month, Dr. Privitera’s entire medical board history will be subject to removal under the current rules. On Nov. 17, 2004, Privitera was issued a public letter of reprimand by the medical board. Now that 10 years has passed, Privitera’s case should disappear from view online, according to a state law put in place in 2003. The medical board sponsored legislation this year that will change the rules beginning in 2015 and allow many types of discipline to be posted online indefinitely.
But not reprimands.
Those will only stay up for up to 10 years. So, Privitera’s reprimand would be considered ready for removal next month.
And patient safety advocates will tell you that’s a shame because the doctor’s history – no matter how old – would be of interest to patients.
You see, Privitera has been promoting unproven, nutritional supplement therapies for cancer and other conditions for more than 40 years, according to medical board records. The board found out about one patient who suffered fatal consequences from these alternative approaches and went after Privitera, according to board records. The patient, known as Hilda in the board’s records, started seeing Privitera in 1991 at his clinic in Covina, Calif., where he had a “private practice in allergy and nutrition,” according to board records. Hilda signed an agreement with him that, according to medical board records, said she acknowledged that the doctor’s “viewpoint concerning nutrition and the need for certain nutrients was not necessarily shared by the American Medical Association, the Food and Drug Administration, the American Cancer Society, and others.”
Hilda saw Privitera for the last time in March 1999. As the medical board described it:
She was at that point 71 years of age and weighed 106 pounds with a documented history of diabetes and hypertension, cardiomyopathy, atrial fibrillation, and rectal bleeding. She also had been having left arm pain for the past few days.
While waiting for her appointment to begin, Hilda complained of a headache and asked for some Tylenol, medical board records show. Instead, Privitera ordered 20,000 units of the blood thinner heparin. About 20 minutes later, he had his staff give her another 20,000 units. After Hilda became dizzy, started vomiting and ultimately lost consciousness, the staff called 911. The paramedics found her unresponsive and took her to Citrus Valley Medical Center in Covina. Not long after arrival, she was declared clinically brain dead and died the next day “from a massive hemorrhage in the head,” according to medical board records.
The medical board noted in its disciplinary record that Privitera had not documented any good reason to prescribe the blood thinners that may have caused Hilda’s hemorrhage. The board wrote:
[Privitera] has admitted that he did not note a history, physical examination, assessment, or rationale for treatment in his records for Hilda, and admitted that he did not obtain a blood test result for blood coagulation prior to ordering the administration of Heparin. When interviewed, [Privitera] stated that he had been accustomed to treating headaches with Heparin on a routine basis and believed this gave prompt relief.
You read that correctly. This wasn’t the first time that Privitera had a patient complain of a headache and receive blood thinners as a treatment.
The medical board charged him with gross negligence, repeated acts of negligence, incompetence, and prescribing without indication. The board did not mince words:
He overdosed his patient with Heparin, resulting in harm rather than benefit.
But medical board cases often are negotiations. This time, the board and Privitera worked out a stipulated settlement in which Privitera only admitted to part of the charges against him. In medical board records, he admitted that he had subjected his license to discipline “for failing to perform an adequate history and physical of a patient before commencing treatment and for failing to maintain adequate and accurate records of the care and treatment provided to a patient.”
The board’s discipline was not a license revocation or a period of probation. Instead, it ended up being a letter of reprimand issued on Nov. 17, 2004. That letter and the decision against Privitera will disappear from the online medical board database under the new rules.
Also, it’s worth noting that Privitera has a criminal history. Dr. Stephen Barrett at Casewatch wrote about Privitera in 2005, explaining that Privitera had been sentenced to six months in prison in 1975 for prescribing Laetrile, a drug promoted as an alternative cancer therapy against mainstream medical advice. Barrett wrote:
In 1980, after the appeals process ended, he served 55 days in jail but was released after being pardoned by California Governor Jerry Brown. Shortly afterward, because Privitera had been prescribing unapproved substances for the treatment of cancer, the California Board of Medical Quality Assurance suspended his medical license for four months and placed him on ten years' probation under board supervision. During the probationary period, Privitera was 'prohibited from making any representation that he is able to cure cancer through nutrition.'
Does Privitera have a legitimate reason to want his past medical board problems to disappear after a certain period of time? Sure. And patients have legitimate reasons for wanting to find out for themselves how effective and safe a physician has been in the past. If a case involving a patient death can be negotiated down to a form of discipline so weak that it slips from the online records after just 10 years, you can bet that physicians’ attorneys are going to be pulling out all stops to make that happen.
Photo by Yuri Samoilov via Flickr.
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