License Suspension of
Eric R. Braverman, M.D. (1996-97)

Stephen Barrett, M.D.


In July 1996, following a hearing, the New Jersey Board of Medical Examiners temporarily suspended the license of Eric Braverman, M.D. and ordered him to stop seeing patients. The temporary suspension order (shown below) included the following allegations:

A petition from the Pennsylvania Medical Board, which reviewed what New Jersey was doing, indicates that a consultant who had evaluated the patient charts for the New Jersey Board had concluded that in 10 of the 11 cases, Braverman had administered or ordered diagnostic testing without indication—which "represented a significant deviation from the normal practice of medicine and allowed Braverman to charge exorbitant fees to his patients."

In May 1997, the charges were settled with a consent order under which (a) Braverman was reprimanded for inadequate record keeping and doing an incomplete examination of one of the patients, (b) Braverman agreed to pay $20,000 for costs, complete two specified continuing medical education courses, and have patients charts monitored by another physician for one year, and (c) the suspension was lifted. Quackwatch has a detailed report about Braverman.


STATE OF NEW JERSEY
DEPAR'I'MENT OF LAW &. PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
STATE BOARD OF MEDICAL EXAMINERS
DOCKET NO.

IN THE MATTER OF THE SUPENSION
OR REVOCATION OP THE LICENSE OF

ERIC BRAVERMAN, M.D.

TO PRACTICE MEDICINE AND SURGERY

IN THE' STATE OF NEW JERSEY
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Administrative Action


ORDER OF TEMPORARY
SUSPENSION

This matter was initially opened to the New Jersey State Board of Medical Examiners on application for temporary suspension of respondent's license to practice medicine brought by Attorney General Deborah T. Poritz, Brenda T. Lewis, Deputy Attorney General appearing. An Order to Show Cause was signed by Board President Robert Johnson (served on respondent on July 1, 1996) scheduling a hearing before the Board which was held on July 10, 1996.

The verified Complaint, filed simultaneously with the Order to Show Cause, alleges in twelve counts that respondent's continued practice poses an imminent danger to the citizens of New Jersey. As to the first eleven counts, the Attorney General generally charges that respondent's diagnosis and treatment of 11 different patients1 was so inappropriate or unsafe, evidencing gross misdiagnosis and/or mismanagement of a wide variety of patient complaints, that the health or lives of his patients are endangered. The Attorney General asserts that respondent represents clear and imminent danger to the public pursuant to N.J,S.A. 45:1-22. By the twelfth count of the complaint, the State alleges that writings of respondent contained in an "Updated Holy Bible" published by him, including the statement "the Lord said . . . I am YHWH from Yahweh . . ." taken in aggregate with other, circumstances, such as respondent's license plate which reads "YHWH MD," indicate that respondent may suffer from a mental disorder, Within its application for temporary suspension of license, the State seeks an Order requiring respondent: to submit to psychiatric and psychological evaluations.

1Upon a motion made by the Attorney General, without objection by respondent, the Board ordered the identities of the patients sealed to protect their confidentiality. All individuals present were admonished to refer to patients by initials only.

At the hearing upon the application for temporary licensure and suspension on July 10, 1996, Deputy Attorney General Brenda T. Lewis appeared for complainant Attorney General of New Jersey, .and Steven I. Kern, Esq. appeared for respondent. Complainant's application for temporary suspension as presented at the hearing was supported by a report of an expert witness (with attached certification), Dr. Peter Vasquez, M.D. ; his curriculum vitae; a letter authored by Frank Hopkins Duffy, M.D.; a copy of an Order of  the Superior court for access to and impoundment of, inter alia, patient records of Dr. Braverman; a sworn statement of Cheryl Cascella-Aspelund, (a former employee of Dr, Braverman); a book entitled "Updated Holy Bible Renewed Covenant Continued," by Rabbi Eric. R. Braverman, M.D.; a certification of James Melchionda, an investigator for the Division of Consumer Affairs; a photograph of Dr. Braverman's license plate on an automobile; and 11 original patient medical records.2

2The Board accepted the application as sufficiently verified over the objection of respondent that the copy of the application he received contained an unsigned complaint, no certification of Dr. Vasquez, and was otherwise insufficiently verified. The Board round that; the application as presented at the time of hearing contained sufficient verified material for its consideration under N.J.S.A.45:l-22. The Board noted that it regularly considers materials submitted by expert witnesses in letter form. Despite the technical requirements of the statute for a verified application, the Board believes it may review all of the' materials which have been presented, and notes that it reviewed uncertified documents submitted by both parties, including another letter authored by Dr. Duffy which was submitted by respondent. The Board further finds that in this particular matter a verification of the allegations of the complaint: by the Deputy Attorney General it would serve little purpose given the almost exclusively medical nature of the allegations.

Complainant offered each of the aforementioned documents into evidence and also proffered documents, (as Exhibit P-8) which were represented to have been filed and utilized in a recent Superior Court proceeding against respondent in Somerset County. The Board was asked to take judicial notice of these items as public records. Following extensive objections 1:0 each of the documents offered, the Board determined to admit all documents with the exception of P-8 into evidence, and to give them appropriate weight. The Board deferred ruling as to exhibit P-8 and informed the State that it might re-proffer those documents later in the proceeding.3

3A full list of all items entered into evidence at the time of hearing is contained in the appendix hereto. The arguments of counsel as to objections to each item of evidence, and the response of the Board are contained in the transcript of this proceeding. Because of the emergent nature of the proceeding and notification of the intent to file an appeal, full details are not included herein. However, respondent's objection to the admission of his own patient records (P-9 through P-19) is noteworthy. He alleged that a chain-of-custody was not shown, and that the copies he received were sometimes incomplete and illegible. The state responded that these were the, original patient records removed from Dr. Braverman's office pursuant to a Superior Court Order (attached as Ex. C. to the Complaint), that they were competent evidence and should be admitted. The Board admitted Dr. Braverman's patient records into evidence. Respondent was advised to inform the Board of whatever he alleges is missing, only one or two specific claims of this nature were raised at any time during this eleven hour proceeding.

Respondent also objected to the expert report of Dr. Vasquez, claiming inter alia, that he is a "homeopathic" physician, that he lacked appropriate training or experience as an expert, and that respondent believes he reviewed copies of the patient charts which were illegible or missing critical pages. The Board found that Dr, Vasquez, as a fellow of the American Academy of Family Physicians and a Diplomate of the American Board of Family Practice, with the training, experience and practice as described in his curriculum vitae (P-2) is qualified to render an expert opinion in this matter. The Board noted that while respondent's claim that Dr. Vasquez is a homeopath was simply not established, Dr. Vasquez's willingness to utilize non-traditional therapies in a traditional practice indeed may render him uniquely suited to comment on when it is wholly inappropriate to eschew the therapies mandated by standard of care. The Board accepted the representation of the Attorney General that Dr. Vasquez had been provided with. the original patient records.

Respondent did not testify before the Board but relied upon a thirty-five page "Verified Answer" with his attached certification. This was submitted to the Board with attachments approximately 2-1/2 hours following commencement of the hearing. It was admitted into evidence without objection of the Attorney General, (as was respondent's brief, which was offered 7 hours after commencement of the hearing). Within his answer, respondent essentially denies the charges against him and sets forth in detail the management of each of the eleven patients in question and his justification therefor. Respondent also submitted attachments to the answer numbered 1 through 6 consisting of letters of Frank Duffy, M.D., Martin Haydon, Ph.D., a certification of Lance Gould, M.D. with attachments, a letter of Kenneth Blum, Ph.D. (with certification), a letter of Frank E. Kaiser, M.D. and a letter of Norman Sussman, M.D. Additionally attached are numerous exhibits beginning with Exhibit A and ending with Exhibit nn which include his curriculum vitae (Exhibit A) and a letter confirming the status of "Programs for Achieving Total Health Incorporated" as a tax exempt organization (Exhibit C). The bulk of the remaining materials consist of numerous articles 'and letters and/or certifications of several physicians discussing one or another aspect of the care administered by Dr. Braverman in the cases in question.4 Respondent further relied upon numerous certifications and/or letters from physicians attesting generally to his competence, stable temperament and character. Also attached were certifications of several employees indicating they did not "push" respondent's religious books on patients or employees and a certification of an addiction counselor who works under the direction of respondent and of a physician employed by respondent attesting to their views of his care of patients.

4For example, Exhibit LL, a certification of Dr. James Halikas, M.D, Professor of Psychiatry at the. University of Minnesota." addresses the use of Ritalin in patients (like Mr. R.V.) who have a history of cocaine abuse. While recognizing that such use is generally contraindicated, Dr. Halikas discusses the fact that there have been clinical trials of the use of Ritalin for cocaine patients at several universities in cases where it may be used as an adjunctive therapy for patients with accompanying Attention Deficit Disorder. Dr. Halikas further notes that the patients must be carefully monitored, and should be followed with other medications as well as in a psychosocial treatment program.  

Respondent also presented an expert witness, Daniel Jass, M.D., a Board certified family physician who serve as director of a residency program in family practice. He attested to respondent's intelligence and breadth of knowledge as well as remarking favorably on the extensive patient histories, and other aspects of the patient records. He was unable to offer an opinion of respondent's practice, stating it is "alternative," that is, the methodologies employed are outside of the field of family practice. Jass denied any special knowledge of the therapies respondent offered.

DISCUSSION

The Board has reviewed with care the report of Dr. Vasquez, as well as respondent's many submissions and the presentation made on his behalf.5 Most importantly, the Board carefully scrutinized the eleven patient records admitted into evidence. It has concluded that the Attorney General has palpably demonstrated that respondent's continued practice would constitute a clear and imminent danger to the public.

5Respondent did not testify at the proceeding and thus the Beard was unable to hear respondent's own account, subject to cross-examination, of how he made certain diagnosis and why he chose the therapeutic options that he did. During the course of the proceeding, a number of members of the Board, anxious to better understand the rationale set forth in respondent submissions, sought clarification on various issues. Since many of the questions were highly technical in nature respondent endeavored to relay his proposed responses through Mr. Kern. Ultimately Mr. Kern objected to questioning by Board members and the inherent difficulties in this awkward arrangement became apparent.

In reaching this decision, the Board has directed its attention, almost exclusively, on the quality of respondent's medical treatment. However, it is important to recognize what this case, at this juncture, does not involve. Although much of the hearing related to questions pertaining to respondent's psychiatric integrity and. the admissibility and reliability of evidence offered in support of the Attorney General's demand for an order compelling psychiatric evaluation, this was not the focus of our review.6 Quite simply, the case that we are deciding now does not address the "dangers" that the Attorney General alleges are evident upon the review of the "Updated Holy Bible" or the doctor's license plate. It is not about religion; it is not about; psychiatric diagnosis; it is not about findings made or not made in the context of other court proceedings relating to marital disputes past and present. Although some of these issues may become relevant in the context of the plenary hearing we are deliberately concentrating on cur mission—to protect patients in New Jersey, Accordingly, this case is about the quality of medical care which respondent has provided to his patients.

6In our view, given the remedy ordered—a cessation of practice—any further evaluation of these allegations would be best addressed, after the parties have had an opportunity to fully brief· the various objections and ancillary issues relating to claimed protections accorded to respondent under various federal laws. It is for these reasons that we declined to admit P-8 into evidence during this proceeding. .

Nor is this case, at this juncture, about the scientific merits of "alternative" medicine, chelation therapy or BEAM testing. Respondent's charts are replete with examples of deviations from the standard of care that all practitioners owe their patients. His pattern of practice evidences four therapeutic strategies that place patient at risk.

Sometimes respondent embarks on a "poly-pharmacy" plan of treatment—instituting a combination of pharmacologic agents—wholly unrelated to symptoms or complaints presented by the patients.

Sometimes, after extensive testing, he establishes multiple diagnoses and then proceeds to embark on a treatment regimen ignoring those very serious conditions.7

Sometimes he reaches a diagnosis which lacks any clinical support in his own record of examination and testing.

And sometimes, he initiates therapeutic approaches contraindicated by patient history or symptoms.

We will highlight several patient records which illustrate the risks.

7Respondent's counsel argues that: the delineation of multiple diagnoses on insurance claim forms ought not to be read as definitive diagnosis. He claims that it was respondent's practice to write down a differential diagnosis listing all of the possible causes of a patient's symptomolgy. The Board is at a loss to understand why a differential diagnosis would appear on an insurance claim form. If we conclude the diagnoses appearing in his record are mere suppositions as to what might be underlying a symptom, they ought not be offered in support of a. claim for reimbursement,

By way of example, patient A. C., the subject of Count II, is a nine (9) year old child who presented with blind rages, violence, and a previous diagnosis of Attention Deficit Disorder. Respondent's record reflects diagnoses of hypothyroidism, intestinal malabsorption, temporal lobe disorder, and organic brain dysfunction without any record of medical indicia supporting these diagnoses. Respondent began treating .the child with medications including Cataprex, Atarax and Klonopin, a medication generally not used in children even for the disorders listed. The polypharmacy without evidence in A.C.'s record was undertaken without appropriate consultations or  investigative protocols. We concur with Dr. Vasquez that such prescribing presented a danger to the health and safety of the patient. Just as importantly, we note that respondent did nothing to treat the serious diagnoses which he noted within his record namely malabsorption syndrome and hypothyroidism. Given these diagnoses, respondent's failure to provide work-up and treatment is equally troubling and dangerous.

The case of A.B. (Count VIII) involved a thirty-nine (39) year old female patient who presented for a second opinion regarding treatment. for OB/GYN concerns including menorrhagia, endometriosis, uterine fibroids and endometrial polyp, Our review of the record and. documents and explanation of respondent leads us to the conclusion, that; under the guise of a psychiatric diagnosis (schizophrenia) and other diagnoses not corroborated by testing or examination (including hypothyroidism, corticoadrenal insufficiency and cerebral dysrhythmia), respondent instituted an unusual and inappropriate combination of medications (Navane and Fastin and Paxil for example). At the same time, he apparently ignored a serious gynecological diagnosis and in so  doing delayed the initiation of appropriate surgical therapy (hysterectomy). We find at this juncture that this patient was endangered by the delay attendant to Dr. Braverman's multiple diagnoses and treatment for which there was no support in the chart. We agree with Dr. Vasquez that the treatments instituted for diagnoses unsupported in the regard also endangered this patient.

Patient A.K. (Count V) was a twenty-seven (27) year old male patient suffering from terminal cancer who presented to Dr. Braverman for another opinion after diagnosis of "spindle cell carcinoma metastatic diffusely", including evidence of ascites. Despite respondent's claim that this patient wished alternative therapies in a hopeless terminal case, we agree with Dr. Vasquez and find based on the evidence before us, that his diagnosis· of pituitary insufficiency and the treatment provided therefor without appropriate clinical support indicated a lack of clinical judgment and inappropriate diagnostic skills.

Patient M.M., (count VI) is a fourteen (14) year old girl who presented with. a previous history of lyme disease and symptoms that included headache and fatigue. Respondent's record reflects that he initiated· this patient on medications including Klonopin, Tofranil, Ritalin and Fiorinal #3, without properly evaluating the patient. Indeed respondent ignored the patient's complaint of headache while on Ritalin, failed to adequately assess the underlying etiology of the headache, and added a painkiller which could mask a potentially dangerous and important headache symptom, posing a risk of harm to the patient. We also agree with Dr. Vasquez that there was no clear indication in the record for respondent's diagnoses (immune mechanism disease, lyme disease, cerebral dysrhythmia, organic brain syndrome, petit dysrhythmia) and that the medical regimen engaged in for this child endangered her health.

Patient, E.B. (Count I) presented with wrist pain and swelling of several months duration. Respondent failed to work-up the patient for the presenting complaint, instead instituting a series of' tests ill-suited to address the presenting problem {toxicity profile, immune competence profile,  pulmonary function testing, serum DHEA and testosterone, and a psychological inventory (Millon). His record reflects a diagnosis of hypothyroidism (despite normal thyroid test results). Again we observe an example of failure to appropriately diagnose and treat the symptoms presented. Despite respondent's pointing out one almost illegible reference to carpal tunnel syndrome as a diagnosis on an insurance claim form, there is no work-up for this condition or follow-up treatment reflected in the record. Although an untreated orthopedic problem may not put the patient's life at risk, it does however relegate the patient to suffer from a painful condition without relief.

Patient Mr. R.V.(2), (Count XI) presented with allergy symptoms I for weight loss, and had a history of' acknowledged cocaine use. The record fails to establish any clear indication for the diagnoses made by respondent (immune deficiency, petit mal epilepsy, pituitary and corticoadrenal insufficiency, Gonadal dysgenesis, COPD and hypothyroidism). Not withstanding these diagnoses, we agree with Dr. Vasquez and find the medications. utilized in this patient (Tenuate, Ritalin and Fastin) to be inappropriate in a known cocaine user,· Even more significant is the failure of Dr. Braverman to appreciate and properly evaluate the complaint of the patient on January 10, 1994 of chest tightness or pulling. In a documented cocaine abuser this symptomatology is indicative of a potentially life-threatening condition (via a myocardial infarction). Respondent's failure to immediately follow-up such complaints is a dramatic example of the risk to which respondent appears willing to put his patients.

The examples set forth above are merely illustrative of the pattern of failures to appropriately evaluate and treat potentially serious complaints involved in the patient cases at issue and his willingness to record diagnoses unsupported by clinical indicia. Taken as a whole, these records establish a pattern of clinical confusion which places patients at real risk. Respondent has repeatedly shown a willingness to subrogate the patient's best interest in advancement of his own investigational theories. He does so without the safety net afforded to patients participating in the university studies done pursuant to investigational protocols by some of the experts submitting statements on his behalf.

Respondent argues that we are foreclosed from acting to protect the public because the Attorney General has not shown that any patient was actually, harmed. We disagree; we need not stand by and ignore a medical practice which so convincingly and repeatedly deviates from the standard of care expected of all physicians. We will not view our role so narrowly—that respondent and his patients have avoided serious mishap is fortunate; we must act to assure that respondent's future activities do not threaten his patients.

Upon review and consideration of the evidence before us, we unanimously conclude that the threshold showing necessary to support the temporary suspension of respondent's license has been made, N.J.S.A.45:1-22 provides that a Board may temporarily suspend the license of a practitioner upon a verified application palpably demonstrating a clear and imminent danger to the public health, safety and welfare. The Board has carefully considered the actual patient records involved in this matter and the report of Dr. Vasquez as well as respondent's answer and submissions, By applying its own medical expertise to the record the Board concludes that a sufficient showing has been made that the continued practice of respondent in the manner in which he is practicing medicine would pose a clear and imminent danger to the public,

The records admitted into evidence show time and again that that respondent fails to adhere to minimum standards of care, and in so doing he places patients at risk. Respondent fails to appropriately consider potentially serious patient complaints; makes diagnoses unsupported by clinical symptoms and history; fails to consider harmful consequences of his failure to properly diagnose and then offers treatment for the misdiagnosed condition, often in an inappropriate manner for that diagnosis. These failures  are so central to the core of the practice of medicine that we find that we can fashion no remedy which we believe will be adequately protective of the public, Therefore we have no alternative but to temporarily suspend his license pending plenary hearing.

There are certain basic standards of care that all licensees must meet, in every branch of medicine, alternative or otherwise, that they practice. We therefore reject respondent's apparent contention that. his practice is so unique that no expert can be offered to judge its merits and no other physician can treat his patients. We note that Dr. Braverman's own expert, Dr. Jass, a family practitioner, testified that as Dr. Braverman has "an alternative" practice he does not feel competent to critique or comment upon his methodology. As a family practitioner, he testified that it was difficulty to answer whether anything in Dr. Braverman's practice was inappropriate as he represents himself as an individual who performs alternative practice for people who have "failed" with family practice.

We specifically reject the contention that Dr. Braverman is beyond the review of other physicians because his practice is so unique. This case is not about the merits of alternative medicine. Rather, there are certain basic standards of care that all licensees must meet regardless of the manner in which they choose to characterize their practice. The record thus far has demonstrated that respondent has failed to meet that standard of care in such a way that his patients are endangered. Our conclusions are not altered by his own expert's presentation (in which we note he could not express an opinion on the merits of Dr. Braverman's practice) or by the documents submitted by respondent. These documents include submissions by several practitioners at universities who appear to be involved in investigational or "cutting edge" utilization of a variety of testing techniques and treatment modalities. However, many of those physicians did not express specific knowledge of the facts and circumstances of the cases in which Dr. Braverman utilized the treatment at issue and these physicians appear to be practicing pursuant to investigational protocols in major research institutions, a situation very different from the private clinical practice of Dr. Braverman which does not include approved research protocols with informed consent of the participants.

Accordingly, we find the extensive pattern of endangering patients demonstrated by the Attorney General's application to justify the grant of the State's motion to temporarily suspend Dr. Braverman's license.

'I'HEREFORE, IT IS ON THIS 17TH DAY OF JULY, 1996

ORDERED:

  1. EFFECTIVE ONE WEEK PROM THE ORAL ANNOUNCEMENT OF THIS ORDER ON THE RECORD ON JULY 11, 1996, respondent's license to practice medicine and surgery in the State of New Jersey shall be temporarily suspended pending disposition of the plenary proceedings in this matter. In the interim, respondent shall see no new patients, and shall arrange for the orderly transfer of his current patients to the care of another physician. As of July 18, 1996, he shall cease, desist and refrain from any practice of medicine in New Jersey, including but not limited to providing or offering to provide any treatment or advice in response to reports of patient ailments, disease, pain, injury, deformity, or mental or physical condition.

  2. Respondent shall comply which all directives applicable to suspended licensees as outlined in the attached document.

  3. The motion of the Attorney General seeking an order requiring psychiatric evaluation of respondent is denied at this time.

NEW JERSEY STATE BOARD OF MEDICAL EXAMINERS

By________________________________
Robert L. Johnson, M.D., F.A.A.P., President

This page was posted on February 7, 2015.

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