"Toxic Mold" Guru (Andrew Campbell. M.D.)
Surrenders Medical License

Stephen Barrett, M.D.


Andrew W. Campbell, M.D., as medical director of the Medical Center for Immune &Toxic Disorders in Spring, Texas, was prone to conclude that patients who consulted him were suffering from allergic disorders related to "toxic mold" exposure. In 2001, at a hearing held by the Texas Department of Insurance, he testified that his center was seeing 50 such patients per week. Additional information about his practices and fees were revealed in two reports by a Vaccine Court special master who denied petitions former patients who sought compensation for an alleged vaccine injury. One report indicated that Campbell had charged $12,123 for the first visit and about $47,000 more for about 16 more visits plus intravenous treatments between 1999 and 2002. The other report did not state the cost of visits in 1997 and 1998 but described fees totaling more than $30,000 between 1999 and 2002. In 2011, after more than ten years of involvement with the Texas Medical Board, Campbell surrender his medical license.

The Texas Board began investigating Campbell in 2001 and filed its first complaint against him in 2004. The allegations were described in detail in second amended complaint, filed in 2006, which stated that in seven cases, he had "relied on junk science," ordered inappropriate tests, and improperly diagnosed "toxigenic mold exposure." The Administrative Law Judge's report provided more details.

In 2007, Texas Board issued an order that Campbell appealed to the local district court, which ordered the Board to lessen its penalties. In response, in November 2009, the Board entered a Final Order reprimanding Campbell and suspending his medical license for eight months, after which his practice would be monitored for five years. It also ordered him to (a) take 25 hours of continuing medical education in the legal obligations that accompany the physician/patient relationship, (b) take 25 hours of CME in the standard of care on the use of new techniques or medications and/or the new uses of existing techniques or medications, and (c) pay an administrative penalty of $64,000 plus $8,396.50 for transcription costs.

In August 2009, the Board charged Campbell with misdiagnosing and mistreating seven more patients. This complaint, shown below, stated:

In August 2011, Campbell was charged with inappropriate treatment of eight more patients whom he had treated for chronic pain. In November 2011, the pending complaints were resolved by voluntary surrender of his medical license. The surrender order permits him to apply for reinstatement once a year. If he does, however, I doubt that he will succeed.


HEARING CONDUCTED BY THE
TEXAS STATE OFFICE OF ADMINISTRATIVE HEARINGS
SOAH DOCKET NO. 503-08-4400
LICENSE NO. G-7790

IN THE MATTER OF THE

COMPLAINT AGAINST:

ANDREW WILLIAM CAMPBELL, M.D.

|
|
|
|
|

BEFORE THE

TEXAS MEDICAL BOARD

FIRST AMENDED COMPLAINT

THE HONORABLE TEXAS MEDICAL BOARD AND THE HONORABLE ADMINISTRATIVE LAW JUDGES EGAN AND SMITH;

COMES NOW, the Staff of the Texas Medical Board ("the Board"), and files this Original Complaint against Andrew William Campbell, M.D., ("Respondent"),based on Respondent's alleged violations of the Medical Practice Act ("the Act"), TEX. Occ. CODE ANN., Title 3, Subtitle B, Chapters 151-165, and would show the following:

I. INTRODUCTION

The filing of this Complaint and the relief requested are necessary to protect the health and public interest of the citizens of the State of Texas, as provided in Section 151.003 of the Act.

II. LEGAL AUTHORITY AND JURISDICTION

1. Respondent is a Texas Physician and holds Texas Medical License Number G-7790, issued by the Board on June 9, 1985, which was in full force and effect at all times material and relevant to this Complaint.

2. Respondent received notice of three Informal Settlement Conferences ("ISC"). The ISCs were held on July 19, 2007, September 24, 2007, and February 28, 2008, respectively. Respondent waived appearance on July 19, 2007, and appeared in person at the other two ISCs. The ISCs were conducted in accordance with §2001.054(c), GOV'T CODE and § 164.004 of the
Act. All procedural rules were complied with, including but not limited to, Board Rules 182 and 187, as applicable.

3. No agreement to settle any of the three matters.

4. All jurisdictional requirements have been satisfied.

III. FACTUAL ALLEGATIONS

Board Staff has received information and on that information believes that Respondent violated the Act. Based on such information and belief, Board Staff alleges:

A. General Allegations:

1. On each and every patient herein, Respondent has relied on junk science to support his medical diagnosis and treatment of illnesses allegedly attributable to "toxigenic mold exposure." Respondent's reliance on junk science in making medical diagnosis, treatments and decisions is below the standard of care. Respondent's position on mold exposure is contrary to the nationally recognized positions of medical organizations including the Texas Medical Association  (TMA), Center for Disease Control (CDC), Environmental Protection Agency (EPA), and American College of Occupational and Environmental Medicine (ACOEM).

2. On each and every patient herein specified, Respondent made medically and scientifically unsupported findings of "toxigenic mold exposure." There is no scientific support, peer reviewed studies, or generally accepted medical studies, literature or testing that has demonstrated a causal connection between mold exposure and neurological diseases diagnosed by Respondent. The reliance on unproven science when making a medical diagnosis or to reach medically unreasonable conclusions regarding a diagnosis that is not recognized or generally accepted in the medical and scientific community is below the standard of care.

3. On each and every patient herein specified, Respondent performed inadequate medical history and physicals before reaching a medically unsupported finding of "toxigenic mold exposure." The diagnosis of "toxigenic mold exposure" is not generally accepted in the medical community and cannot be determined from a medical history and/or a physical examination.

4. On each and every patient herein specified, Respondent ordered serum blood testing due to "toxigenic mold exposure" that is medically unnecessary, unreasonable, and improper.

5. On each and every patient herein specified, Respondent ordered medically and scientifically unsupported, unnecessary, unreliable, and inadequate diagnostic blood serum testing. The diagnostic blood serum tests are not reliable to substantiate a diagnosis of "toxigenic mold exposure." The use· of these tests is not generally accepted in the medical community_ The reliance of Respondent on blood serum testing that is not recognized or generally accepted.in the medical community as a useful, necessary, or reliable diagnostic test is below the standard of care. Respondent's finding of "toxigenic mold exposure" is medically unsupported.

6. On each and every patient herein specified, Respondent ordered blood serum testing for extensive potential "toxic" exposures that were not supported by medical information provided by the patient. Ordering such tests without supporting medical information is below the standard of care, and such tests cannot be used to support to a medical decision or diagnosis.

7. On each and every patient herein specified, Respondent ordered blood serum testing that he claims demonstrates "toxigenic mold exposure." However, the blood testing ordered cannot tell if the exposure is from mold or other organisms; it cannot determine if the exposure is old, recent, acute, chronic, or any other information; it can only demonstrate that a patient was exposed to some foreign body that caused the body to produce an anti-body. The reliance on unproven science or testing when making a medical diagnosis or to reach medically unreasonable conclusions regarding a diagnosis that is not recognized or generally accepted in the medical and scientific community is below the standard of care.

8. On each and every patient herein specified, Respondent made medically and scientifically unsupported findings of "toxigenic mold exposure," without any differential diagnosis to rule out other causes of the symptoms. There is no scientific support, peer reviewed studies, or generally accepted medical studies, literature or testing that has demonstrated a causal connection between mold exposure and the various diseases, including neurological diseases diagnosed by Respondent.

9. On each and every patient herein specified, Respondent made medically and scientifically unsupported jumps in logical conclusions by finding ''toxigenic mold exposure" based on "home-brew tests" results from a laboratory in California that Respondent used for the "mold" patients identified in the Board's Complaint. Such leaps in logical conclusions are below the standard of care as being scientifically and medically unsound reasoning.

10. On each and every patient herein specified, Respondent's ordering and billing for "mold exposure" blood serum testing that is not medically reasonable, necessary, or indicated constitutes improper hilling.

11. On a number of patients herein specified, Respondent made medically unsupported findings/conclusions of "abnormal neurological examination." Respondent ordered medically unnecessary testing, including Electroencephalogram (EEG), Visual Audio Evoked Response (V AER), Brain Audio Evoked Response (BAER), Current Perception Threshold (CPT), and Nerve Conduction Velocity (NCV), as a result of his conclusion of "abnormal neurological examination."

12. On a number of patients herein specified, Respondent made medically unsupported findings/conclusions of "abnormal neurological examination." Respondent ordered medically unnecessary laboratory testing, including basic serum myelin protein, as a result of his conclusion of "abnormal neurological examination."

13. On a number of patients herein specified, Respondent made medically unsupported findings/conclusions of "abnormal neurological examination." Respondent performed an incomplete examination and failed to perform the medically necessary diagnostic testing required before arriving at such a diagnosis pursuant to the guidelines of the American Academy of Neurology. 14. On a number patients herein specified, Respondent's ordering and billing for neurological testing ·due to "mold exposure" is not medically reasonable, necessary or indicated and constitutes improper billing.

15. On a number of patients herein specified, Respondent made medically and scientifically unsupported findings of "neuropathy, polyneuropathy, and/or demyelinating polyneuropathy," without meeting any of the medical and diagnostic criteria required before arriving at such a diagnosis, including failing to perform tests pursuant to the guidelines of the American Academy of Neurology to confirm such a diagnosis. The standard of care requires that, to· make a diagnosis of demyelinating polyneuropathy, certain tests must be run, and produce results as outlined by American Academy of Neurology criteria. Respondent. failed to do this required testing.

16. On a number of patients herein specified, Respondent ordered treatment with Sporanox, without meeting any of the medical· and diagnostic criteria required before prescribing the treatment. Therefore, the treatment is medically unnecessary, and constitutes non-therapeutic prescribing.

17. On a number of patients herein specified, Respondent ordered treatment with IVIG, without meeting any of the medical and diagnostic criteria required before prescribing the treatment. Therefore, the treatment is medically unnecessary and constitutes non-therapeutic prescribing.

18. On a number of patients herein specified, Respondent's determinations/diagnosis of "toxigenic mold exposure" as a cause of various neurological conditions are not supported by peer-reviewed studies or established science.

19. On each and every patient herein specified, Respondent haS made medical decisions, including treatment with Sporanox and IVIG, based on theories, opinions, and analysis that have not been sufficiently tested. His approach and conclusions regarding "toxigenic mold exposure" as a cause of these. patient's vague non-specific symptoms is not generally accepted in the medical community, and is not supported by established scientific evidence.

20. On each and every patient herein specified, Respondent's ordering and billing for neurological and/or blood serum testing due to "mold exposure" is not supported by adequate documentation. Due to the failure to provide documentation Respondent improperly charged and billed the patient for the medically unnecessary, improper, unreasonable services.

21. On each and every patient herein specified, Respondent coded laboratory testing as global charge, meaning he charged for both performing the test (technical component) and interpreting the results (professional component). Respondent then also charged a separate professional component. This practice is double hilling for the same service. Additionally, in these cases Respondent failed to provide adequate documentation to show he performed the professional component. Due to the failure to provide the required documentation Respondent improperly charged the patient for the professional component twice.

B. Allegations Regarding Individual Patients

1. Patient M.D.

a. Headache Diagnosis and Treatment

1. M.D. presented to Respondent with a primary complaint of one-sided severe headaches with unilateral pupil dilation. M.D. continued to complain of headaches and unilateral pupil change while under the care and treatment of Respondent.

2. Respondent failed to obtain appropriate diagnostic testing for M.D. 's headaches, complaints, and clinical presentation.

3. Respondent failed to perform a proper work-up, including a differential diagnosis concerning M.D. 's headaches.

4. Respondent failed to address or appropriately treat M.D. 's headaches.

5. M.D. died of a sub-arachnoid hemorrhage that Respondent failed to diagnose, treat or timely refer to another physician.

b. Neuropathy Testing, Diagnosis and Treatment

6. Respondent diagnosed M.D. as suffering from neuropathy or demyelinating polyneuropathy, secondary to toxic mold exposure.

7. Respondent made medically and scientifically unsupported findings of "polyneuropathy," or "demyelinating polyneuropathy" without meeting any of the criteria required before arriving at such a diagnosis, including failing to perform tests pursuant to the guidelines of the American Academy of Neurology.

8. Respondent ordered a SPECT scan and myelin basic protein tests, neither of which are appropriate to diagnose neuropathy.

9. Respondent ordered treatment with IVIG for the polyneuropathy without meeting any of the medical and diagnostic criteria required before prescribing the treatment. The prescribing of IVIG by Respondent is non-therapeutic, medically unnecessary, unreasonable, and improper.

c. Toxic Mold Testing, Diagnosis and Treatment

10. The Respondent also diagnosed M.D. with suppressed immune system secondary to toxic mold exposure.

11. Respondent failed to make any differential diagnosis for M.D. Respondent never ruled out any other possible causes for M.D. 's symptoms but concluded M.D. was suffering from toxic mold exposure without exploring any other causes.

12. Respondent ordered an extensive· battery of unnecessary tests for "toxic mold" exposure. Respondent ordered an extensive range of tests including a broad series of blood serum testing panels for mold anti-bodies.

13. The blood serum testing panels Respondent ordered, on numerous occasions, through ImmunoScience Labs, Inc. were medically unnecessary. This testing was excessive and not within the standard of care. Because these tests are not medically necessary they constitute overbilling  and unprofessional conduct.

14. The Respondent diagnosed M.D. with fungal infections and prescribed treatment with Sporanox. Because there is no evidence M.D. had a fungal infection, Respondent's prescribing of Sporanox was non-therapeutic, medically unnecessary, unreasonable, and failed to meet the standard of care.

15. Respondent's fungal treatments related to "toxic mold" exposures were not medically necessary and constitutes overbilling  and unprofessional conduct.

16. The practice of ordering excessive and/or marginal tests without scientific and/or medical support is inconsistent with public health and welfare, represents non-therapeutic prescribing, and flagrant or persistent over-treating and over-charging, and constitutes unprofessional conduct.

17. Respondent failed to maintain adequate medical records to justify the necessity of the above listed diagnostic evaluations, testing, and treatments.

Patient A.N.

8. Neuropathy Testing, Diagnosis and Treatment

A.N. presented to Respondent complaining of possible mold exposure. Respondent diagnosed A.N. as suffering from neuropathy or demyelinating polyneuropathy secondary to toxic mold exposure.

3. Respondent made medically and scientifically unsupported findings of "polyneuropathy," or "demyelinating polyneuropathy" without meeting any of  the medical criteria required to such a diagnosis, including failing to perform tests pursuant to the guidelines of the American Academy of Neurology.

4. A.N. had a normal brain MRI, a normal CT of the chest and abdomen, and a nerve conduction study that showed· mild ·bilateral carpal tunnel syndrome. None of the tests demonstrated any findings that would support a diagnosis of demyelination or neuropathy.

5. Respondent ordered a non-specific SPECT scan and myelin basic protein tests. Neither of these tests are appropriate to diagnose neuropathy.

6. Respondent treated A.N. for polyneuropathy, with intravenous immunoglobulin (IVIG) infusion therapy, when it was not medically indicated or necessary.

7. Respondent ordered treatment with IVIG for the polyneuropathy without meeting any of the medical and diagnostic criteria required for the diagnosis before prescribing the treatment. The prescribing of IVIG by Respondent is non-therapeutic, medically unnecessary, unreasonable, improper, and failed to meet the standard of care.

b. Toxic Mold Testing, Diagnosis and Treatment

8. Respondent ordered an extensive range of tests including a broad series of blood serum panel tests for exposure to molds and fungus.

9. There is no evidence in the medical records that patient AN had any fungal'infection.

10. Respondent assigned no less than 61 International Classification of Diseases ("ICD-9") codes, including Blastomycosis, Coccidiomycosis, Histoplasmosis, Candidiasis, and opportunistic mycosis—all with a normal Chest CT Abdominal CT, Brain MRI, and no localizing findings whatsoever, and no positive culture results or ongoing fungal infection.

11. The blood serum testing panels Respondent ordered on numerous occasions, through ImmunoScience Labs, Inc., were medically unnecessary. This testing was excessive and not within the standard of care. Because these tests are not medically necessary they constitute overbilling  and unprofessional conduct.

12. The Respondent's treatment with Sporanox an anti-fungal medication without meeting any of the medical and diagnostic criteria required for the diagnosis before prescribing the treatment. The prescribing of Sporanox by Respondent is non-therapeutic, medically unnecessary, unreasonable and improper and failed to meet the standard of care.

13. Respondent fungal treatments related to "toxic mold" exposures were not medically supported and constitutes overbilling  and unprofessional conduct.

14. The practice of ordering excessive and/or marginal tests without scientific and/or medical support is inconsistent with public health and welfare, represents non-therapeutic prescribing, and flagrant or persistent over-treating and over-charging, and constitutes unprofessional conduct.

15. Respondent's billings for the excessive evaluations, excessive diagnostic tests, and consultations were improper, unreasonable, and/or for services not medically or clinically necessary, and a violation of Section 311.0025 of the Texas Health and Safety Code, which provides that a health care professional may not submit to a patient or a third party payor a bill for a treatment that professional knows was not provided or knows was improper, unreasonable, or medically or clinically unnecessary.

16. The Respondent's medical records are inadequate.

Patient M.F.

a. Neuropathy Testing, Diagnosis and Treatment

1. On or about August 30, 2004, M.F. presented to Respondent complaining of possible mold exposure.

'2. Respondent diagnosed M.F. as suffering from neuropathy or demyelinating polyneuropathy secondary to toxic mold exposure.

3. Respondent made medically and scientifically unsupported findings of "polyneuropathy," or "demyelinating polyneuropathy" without meeting any of the medical criteria required for such a ,diagnosis, including failing to perform tests pursuant to the guidelines of the American Academy of Neurology.

4. Respondent ordered a non-specific SPECT scan and myelin basic protein tests. Neither of these tests are appropriate to diagnose neuropathy.

5. Respondent treated M.F. for neuropathy, with intravenous immunoglobulin (IVIG) infusion therapy that was not medically indicated or necessary.

6. Respondent ordered treatment with IVIG for the polyneuropathy without meeting any of the· medical and diagnostic criteria required for the diagnosis before prescribing the treatment. The prescribing of IVIG by Respondent is non-therapeutic, medically unnecessary, unreasonable, improper, and failed to meet the standard of care.

b. Toxic Mold Testing, Diagnosis and Treatment

7. Respondent ordered an extensive range of tests including a broad series of blood serum panel tests for exposure to molds and fungus.

8. There is no evidence that M.F. had any fungal infection.

9. Respondent assigned no less than 24 ICD-9 codes, including Blastomycosis, Coccidiomycosis, Histoplasmosis, Candidiasis, and opportunistic mycosis—all with a normal  Chest CT Abdominal CT, Brain MRI, and no localizing findings whatsoever, and no positive culture results or ongoing fungal infection.

10. The blood serum testing panels Respondent ordered on numerous occasions, through ImmunoScience Labs, Inc., were medically unnecessary. This testing was excessive and not within the standard of care. Because these tests are not medically necessary they constitute overbilling  and unprofessional conduct.

11. The Respondent's treatment with Sporanox an anti~fungal medication without meeting any of the medical and diagnostic criteria required for the diagnosis before prescribing , the treatment. The prescribing of Sporanox by Respondent is non-therapeutic, medically unnecessary, unreasonable, improper and failed to meet the standard of care.

12. Respondent fungal treatments related to "toxic mold" exposures were not medically supported and constitutes overbilling  and unprofessional conduct.

13. The practice of ordering excessive and/or marginal tests without scientific and/or medical support is inconsistent with public health and welfare, represents non-therapeutic 'prescribing, and flagrant or persistent over-treating and over-charging, which is unprofessional conduct.

14. Respondent's billings for the excessive evaluations, excessive diagnostic tests, and consultations were improper, unreasonable, and/or for services not medically or clinically necessary, and a violation of Section 311.0025 of the Texas Health and Safety Code, which provides that a health care professional may not submit to a patient or a third party payor a bill for a treatment that professional knows was not provided or knows was improper, unreasonable, or medically or clinically unnecessary.

15. The Respondent's medical record keeping in this case is inadequate.

Patient J.M.

a. Toxic Mold Testing, Diagnosis and Treatment

J.M. presented to Respondent complaining of possible mold exposure. Respondent diagnosed J.M. as suffering from neuropathy or demyelinating polyneuropathy secondary to toxic mold exposure.

3. Respondent ordered a non-specific SPECT scan, myelin basic protein tests, and nerve conduction study.

4. Respondent made medically and scientifically unsupported findings of "demyelinating neuropathy" without meeting of the medical criteria required to support such a diagnosis, including failing to perform tests pursuant to the guidelines of the American Academy of Neurology.

5. Respondent also ordered an extensive range of tests including a broad series of blood serum panel tests for exposure to molds and fungus.

6. There is no evidence that J .M. had any fungal infection.

7. Respondent assigned multiple ICD-9 codes, including Blastomycosis, Coccidiomycosis, . Histoplasmosis, Candidiasis, and opportunistic mycosis—all with no localizing findings whatsoever, and no positive culture results or ongoing fungal infection.

8. The blood serum testing panels Respondent ordered on numerous occasions, through ImmunoScience Labs, Inc., were medically unnecessary. This testing was excessive and not within the standard of care. Because these tests are not medically necessary they constitute overbilling  and unprofessional conduct.

9. The Respondent treated J.M. with Sporanox and Cancidas, anti-fungal
medications without meeting any of the medical and diagnostic criteria required for the
diagnosis before prescribing the treatment. The prescribing of Sporanox and Cancidas by Respondent is non-therapeutic, medically unnecessary and unsupported, unreasonable, improper, and failed to meet the standard of care.

10. Respondent's fungal treatments related to "toxic mold" exposures were not
medically supported and constitute overbilling  and unprofessional conduct.

11. The practice of ordering excessive and/or marginal tests without scientific and/or
medical support is inconsistent with public health and welfare, represents non-therapeutic prescribing, and flagrant or persistent over-treating and over-charging, which is unprofessional conduct.

12.. Respondent's billings for the excessive evaluations, excessive diagnostic tests,
and consultations were improper, unreasonable, and/or for services not medically or clinically necessary, and a violation of Section 311.0025 of the Texas Health and Safety Code, which provides that a health care professional may not submit to a patient or a third party payor a bill for a treatment that professional knows was not provided or knows was improper, unreasonable, or medically or clinically unnecessary.

13. The Respondent's medical record keeping in this case is inadequate.

5. Patient D.H.

a. Misdiagnosis/Unprofessional Conduct

1. The Respondent evaluated DH for the first time as a new patient on or about January 15, 2008, for evaluation of possible toxic mold exposure.

2. The Respondent elicited multiple complaints including shortness of breath, fatigue, lack of energy, chest pain, palpitations, muscular weakness, dry eyes, depression, recurrent flu-like illnesses, headaches, cough, visual disturbances, and ringing in the ears. The physical examination performed included findings of: very dry skin, and deep tendon reflexes diminished in upper extremities bilaterally.

3. Respondent diagnosed Opportunistic mycoses; Aspergillosis; Candidiasis; Hypersensitivity Pneumonitis; histoplasmosis; blastomycosis; and demyelinating disease of central nervous system.

4. Respondent recommended extensive tests for fungal infections including, but not limited to fungal antibodies/antigen testing, high resolution CT scanning of chest, pulmonary function testing, neurophysiological testing, immunological testing to rule out an immune deficiency (including IgG, IgM, and IgA), serology for multiple fungal and neurological autoantibodies.

5. At the conclusion of his office visit with D.H. Respondent told D.H. and his mother that if DH. would die unless they carne up with $4200 for the recommended testing and treatment.

6. Patient A.S.

a. Neuropathy Testing, Diagnosis and Treatment

A.S. presented to Respondent complaining of possible mold exposure. Respondent diagnosed A.S. as suffering from toxic mold exposure. Respondent made medically and scientifically. unsupported findings of "polyneuropathy," or "demyelinating polyneuropathy" without meeting any of the medical criteria required to such a diagnosis, including failing to perform tests pursuant to the guidelines of the American Academy of Neurology.

4. Respondent ordered a non-specific SPECT scan, which is not appropriate to diagnose neuropathy.

5. Respondent ordered immunoglobulin (IVIG) infusion therapy for A.S. for polyneuropathy that was not medically indicated or necessary.

6. Respondent ordered treatment with IVIG for the polyneuropathy without meeting any of the medical and diagnostic criteria required for the diagnosis before prescribing the treatment. The prescribing of IVIG by Respondent is non-therapeutic, medically unnecessary, unreasonable, improper, and failed to meet the standard of care.

b. Toxic. Mold Testing, Diagnosis and Treatment

7. Respondent ordered an extensive range of tests including a broad series of blood serum panel tests for exposure to molds and fungus.

8. There is no evidence- in the medical records that patient A.S. had any fungal infection.

9. The blood serum testing panels Respondent ordered, through ImmunoScience Labs, Inc., were medically unnecessary. This testing was excessive and not within the standard of care. Because these tests are not medically necessary they constitute overbilling  and unprofessional conduct.

10. The Respondent's treatment with Sporanox an anti-fungal medication without meeting any of the medical and diagnostic criteria required for the diagnosis before prescribing the treatment. The prescribing of Sporanox by Respondent is non-therapeutic, medically unnecessary, unreasonable and improper and failed to meet the standard of care.

11. Respondent also ordered Cancidas (anti-fungal) to be administered through a PICC line for Aspergillus

12. . Respondent fungal treatments related to "toxic mold" exposures were not medically supported and constitutes overbilling  and unprofessional conduct.

13. The practice of ordering excessive and/or marginal tests without scientific and/or medical support is inconsistent with public health and welfare, represents non-therapeutic prescribing, and flagrant or persistent over-treating and over-charging, and constitutes unprofessional conduct.

14. Respondent's billings for the excessive evaluations, excessive diagnostic tests, and consultations were improper, unreasonable, and/or for services not medically or clinically necessary, and a violation of Section 311.0025 of the Texas Health and Safety Code, which provides that a health care professional may not submit to a patient or a third party payor a bill for a treatment that professional knows was not provided or knows was improper, unreasonable, or medically or clinically unnecessary.

Patient S.A.

a. Toxic Mold Testing, Diagnosis and Treatment

1. S.A. presented to Respondent complaining of possible mold exposure.

2. Respondent diagnosed S.A. as suffering from toxic mold exposure.

3. Respondent ordered an extensive range of tests including a broad series of blood serum panel tests for exposure to molds and fungus.

4. There is no evidence in the medical records that patient S.A. had any fungal infection.

5. The blood serum testing panels Respondent ordered, through lmmunoScience Labs, Inc., were medically unnecessary. This testing was excessive and not within the standard of care. Because these tests are not medically necessary they constitute overbilling  and unprofessional conduct .

6. The Respondent's treatment with Sporanox an anti-fungal medication without meeting any of the medical and diagnostic criteria required for the diagnosis before prescribing the treatment. The prescribing of Sporanox by Respondent is non-therapeutic, medically unnecessary, unreasonable and improper and failed to meet the standard of care.

7. Respondent also ordered Cancidas (anti-fungal) to be administered through a PICC line for Aspergillus.

8. Respondent fungal treatments related to "toxic mold" exposures were not medically supported and constitutes overbilling  and unprofessional conduct.

9. The practice of ordering excessive and/or marginal tests without scientific and/or medical support is inconsistent with public health and welfare, represents non-therapeutic prescribing, and flagrant or persistent over-treating and over-charging, and constitutes unprofessional conduct.

10. Respondent's billings for the excessive evaluations, excessive diagnostic tests, and consultations were improper, unreasonable, and/or for services not medically or clinically necessary, and a violation of Section 311.0025 of the Texas Health and Safety Code, which provides that a health care professional may not submit to a patient or a third party payor a bill for a treatment that professional knows was not provided or knows was improper, unreasonable, or medically or clinically unnecessary.

8. Summary of Respondent's Conduct and Violations

1. Respondent's actions in this case is below the standard of care due to one or more of the following: failure to meet the standard of care; negligence in providing medical services; failure to use diligence; poor medical judgment; poor decision making; and non-therapeutic prescribing and/or treatment.

2. Respondent's treatment and testing of these patients demonstrates a pattern of inadequate medical history and examination to substantiate the diagnoses listed. Respondent's treatment(s) is not logical, and is not based on reasonable evidence-based standards.

3. The Respondent's work-ups and treatment patterns are incoherent, and do not follow any recognizable pattern of rational medical thinking. They are not performed in a stepwise fashion, and do not follow commonly accepted patterns of rational medical thought.

4. The testing ordered and conducted· by Respondent is excessive, unnecessary, improper and medically unrelated to the patients' chief complaints. Many of the tests ordered by Respondent are not supported by history, complaints, or findings in the patients' records.

5. Respondent relies on theories and opinions that have no scientific support, peer reviewed studies, and are not generally accepted in the general medical community.

6. The actions .of the Respondent as specified above violate one or more of the following provisions of the Medical Practice Act:

a. Respondent is subject to disciplinary action pursuant to Section 164.051 (a)(I) of the Act based on Respondent's commission of an act prohibited under Section 164.052 of the Act.

b. Respondent is subject to disciplinary action by the Board pursuant to Section 164.051(a)(3) of the Act by committing or attempting to commit a direct or indirect violation of a rule, to wit, Board Rule 165, which requires that a physician maintain adequate medical records.

c. Respondent is subject to disciplinary action by the Board pursuant to Section 164.0S1(a)(6) of the Act by failing to practice medicine in an acceptable professional manner consistent with public health and welfare.

d. Section 164.051(a)(6) of the Act, failing to practice medicine in an acceptable professional manner consistent with public health and welfare, is further defined by Board Rule 190.8( 1 )(A), the failure to treat a patient according to the generally accepted standard of care; Board Rule 190.8(1 )(B), negligence in performing medical services; Board Rule 190.8(1)(C), failure to use proper diligence in one's practice; Board Rule 190.8(1 )(D), failure to safeguard against potential complications; Board Rule 190.8(1)(G), failure to disclose reasonably foreseeable side effects of a procedure or treatment; and Board Rule 190.8(1)(H) failure to disclose reasonable alternative treatment to the proposed treatment or treatment.

e. Respondent has committed a prohibited act or practice within the meaning of Section 164.052(a)(5) of the Act based upon unprofessional or dishonorable conduct that is likely to deceive or defraud the public or injure the public.

f. Board Rule 190.8(2)(J), provides that upon unprofessional or dishonorable conduct that is likely to deceive or defraud the public or injure the public includes the providing medically unnecessary services to a patient or submitting a hilling statement to a patient or third 'party payor that the licensee knew or should have known was
Improper .

g. Respondent is subject to disciplinary action by the Board pursuant to 164.053(a)(1) of the Act by Respondent's commission of an act ; that violates any law of this state if the act is connected with Respondent's practice of medicine. In accordance with Section 164.053(b), a complaint, indictment, or conviction of a violation of law is not necessary for enforcement of Section 164.053(a)(I).

h. Respondent is subject to disciplinary action by the Board pursuant to 164.053(a)(5) of the Act by prescribing or administering a drug or treatment that is nontherapeutic in nature or nontherapeutic in the manner the drug or treatment is administered or prescribed.

i. Respondent is subject to disciplinary action by the Board pursuant to 164.053(a)(6) of the Act by prescribing, administering or dispensing in a manner inconsistent with public health and welfare

j. Respondent is subject to disciplinary action by the Board pursuant to 164.053(a)(7) of the Act by violating Section 311.0025 of the Texas Health & Safety Code.

10. This case involves patient harm, economic harm to patients and entities, increased potential to harm the public, premeditated, intentional or knowing conduct, prior similar violations, and multiple violations of the Act and Board rules.

v. APPLICABLE STATUTES, RUL.ES, AND AGENCY POLICY

The following statutes, rules, and agency policy are applicable to the conduct of the contested case:

1. Section 164.007(a) of the Act requires that the Board adopt procedures governing formal disposition of a contested case before the State Office of Administrative Hearings.

2. 22 TEX. ADMIN. CODE, Chapter 187 sets forth the procedures adopted by the Board under the requirement of Section 1 64.007( a) of the Act.

3. 1 TEX. ADMIN. CODE, CHAPTER 155 sets forth the rules of procedure adopted by SOAH for contested case proceedings.

4. 1 TEX. ADMIN. CODE, CHAPTER 155.507, requires the issuance of a Proposal for Decision (PFD) containing Findings of Fact and Conclusions of Law.

5. Section 164.007(a) of the Act, Board Rule 187.37(d)(2) and Board Rule 190 et. seq., provides the Board with the sole and exclusive authority to determine the charges on the merits, to impose sanctions for violation of the Act or a Board rule, and to issue a Final Order.

VI. NOTICE TO RESPONDENT

IF YOU DO NOT FILE A WRITTEN ANSWER TO THIS NOTICE WITH THE STATE OFFICE OF ADMINISTRATIVE HEARINGS WITHING 20 DAYS OF THE DATE NOTICE OF ADJUDICATIVE HEARING WAS MAILED, A DEFAULT ORDER MAY BE ENTERED AGAINST YOU, WHICH MAY INCLUDE THE DENIAL OF LICENSURE OR ANY OR ALL OF THE REQUESTED SANCTIONS INCLUDING THE REVOCATION OF YOUR LICENSE. IF YOU FILE A WRITTEN ANSWER, BUT THEN FAIL TO ATTEND THE HEARING, A DEFAULT JUDGMENT MAY BE ENTERED AGAINST YOU, WHICH MAY ALSO INCLUDE THE DENIAL OF LICENSURE OR ANY OR ALL OF THE REQUESTED SANCTIONS INCLUDING THE REVOCATION OF YOUR LICENSE. A COPY OF RESPONSE YOU FILE WITH THE STATE OFFICE OF ADMINISTRATIVE HEARINGS SHALL ALSO BE PROVIDED TO THE HEARINGS COORDINATOR OF THE TEXAS MEDICAL BOARD.

IF YOU FAIL TO ATTEND THE HEARING, THE ADMINSTRATIVE LAW JUDGE MAY PROCEED WITH THE HEARING AND ALL THE FACTUAL ALLEGATIONS LISTED IN THIS NOTICE CAN BE DEEMED ADMITTED, AND THE RELIEF, SOUGHT IN THIS NOTICE MIGHT BE GRANTED .

WHEREFORE, PREMISES CONSIDERED, Board Staff requests that an administrative law judge employed by the State Office of Administrative Hearings conduct a contested case hearing on the merits of the Complaint, and issue a Proposal for Decision ("PFD") containing Findings of Fact and Conclusions of Law necessary to support a determination that Respondent violated the Act as set forth in this Complaint.

Respectfully submitted,

By:
___________________
Scott M. Freshour
State Bar No. 00789299
Texas Medical Board
333 Guadalupe, Tower 3, Suite 610
Austin, Texas 78701
Telephone: (512) 305-7096
Fax: (512) 305-7007

Filed with the Texas Medical Board on this 7th day of August, 2009.

__________________
Mari Robinson, J.D .
Executive Director
Texas Medical Board

This page was revised on January 24, 2012.

Links to Recommended Companies