Disciplinary Action against John E. Gambee, M.D.
Stephen Barrett, M.D.
In September 2010, the Oregon Board ordered an emergency suspension of the license of John E. Gambee, M.D. The board's order (shown below) states:
- Gambee's license was revoked in 1994 for engaging in unscientific practices that included diagnosing and treating patients without performing appropriate tests to assess their thyroid function.
- In 1997 Gambee was permitted to practice again with limitations (modified in 2004) that included appropriate management of patients with suspected or actual thyroid disorders.
- In 2009, the opened an investigation, during which Gambee signed a interim stipulated order pledging not to inappropriately prescribe thyroid hormone or testosterone.
- A few months later, after reviewing five charts, the board concluded that Gambee's"behavior displayed "repeated disregard for terms of the Board's stipulated orders" and that his continued practice of medicine would "pose an immediate danger to the public and to his patients.
In July 2011, the board revoked Gambee's medical license and assessed him $59,068.45 for the cost of a hearing in which he objected to the board's complaint. The revocation order includes this explanation of the board's action:
Licensee repeatedly violated prior Board orders. He has a history of a prior revocation and reinstatement. Considering Licensee's history and the evidence of the conduct supporting the current proposed revocation, Licensee has demonstrated that he will not practice medicine in the areas of thyroid and testosterone replacement therapies in a safe manner. Licensee has been undeterred by prior Board orders. He maintains that his practice in these areas is safe and argues that his view is supported by recent reliable analysis and expert recommendations. Licensee's sources did not withstand scrutiny as to the safety of the position taken by those whose recommendations regarding thyroid and testosterone treatments practices Licensee follows.
OREGON MEDICAL BOARD
STATE OF OREGON
In the Matter of
JOHN EDWIN GAMBEE, MD
ORDER OF EMERGENCY
The Oregon Medical Board (Board) is the state agency responsible for licensing, regulating and disciplining certain health care providers, including physicians, in the state of Oregon. John Edwin Gambee, MD (Licensee) is a licensed physician in the state of Oregon and holds an active medical license.
2.1 The Board previously revoked Licensee's medical license on December 31, 1994, in part for having "repeatedly demonstrated a willingness to move into uncharted waters in his practice without regard to the scientific merits of the proposed modality." The Board also found that Licensee "treated patients for hypothyroidism without performing thyroid function tests to determine the level of thyroid hormone." Licensee applied for re-licensure on May 20, 1996. In April 1997, the Board granted Licensee a license to practice medicine subject to a Stipulated Order Pursuant to Request for Voluntary Limitation. On January 15, 2004, the Board issued an Order Modifying the Stipulated Order, which required License in paragraph 5.5 to comply with the following practice limitations:
"Licensee shall use thyroid function blood tests (with appropriate documentation in the patient charts), to include blood tests that measure the amount of thyroid hormone (free T4) and thyroid-stimulating hormone (TSH) in conjunction with the history and physical findings in making the decision whether to use thyroid medication. Licensee will not use thyroid medication in treatment unless the blood tests find a TSH level greater than the normal range and a free T 4 below the normal range on a test. While treating patients with thyroid medication, Licensee shall periodically retest the TSH level of his patients' blood no later than six weeks after initiating treatment with thyroid medication and no less than annually thereafter. Licensee shall reduce the level of thyroid medication if the level of TSH falls below the normal range."
2.2 The Board opened an investigation that included a review of Licensee's management of a number of cases that revealed an on-going pattern of medical practice that violated paragraph 5.5 of the Order Modifying the Stipulated Order, dated January 1, 2004, as well as constituting unprofessional or dishonorable conduct and gross or repeated negligence that exposed his patients to the risk of harm, as set forth in the Board's Complaint and Notice of Proposed Disciplinary Action, dated May 11, 2009.
2.3 During the investigation, the Board and Licensee entered into an Interim Stipulated Order (ISO) on March 18, 2010 to address concerns that the Licensee was in violation of the 2004 Modifying Order referenced above. The ISO set forth the following conditions in subparagraph 3:
3.1 Licensee will not recommend, prescribe, or direct any patient to take thyroid unless patient TSH levels exceed 10 uIU/mL, except that Licensee may recommend, prescribe or direct a patient to take thyroid supplementation if patient TSH levels are between 5 and 10 uIU/mL and the patient has also been diagnosed with goiter or positive anti-thyroid peroxidase antibodies (or both).
3.2 Licensee will require any patient taking thyroid from a non-prescription source to undergo thyroid blood tests on a regular basis (at least every 6 months) and that Licensee will direct such patients to adjust their dose to bring their TSH level into the range recommended by the American Association of Clinical Endocrinologists (AACE) (the target TSH level is between 0.3 and 3.0 uIU/mL). If any patient declines to follow this direction, Licensee will provide 30 day prior written notice to the patient and then terminate the physician - patient relationship.
3.3 In the event Licensee decides to prescribe, recommend, direct a patient to take testosterone, or to follow a patient taking testosterone, Licensee must comply with the guidelines recommended in the article "Risks of Testosterone Replacement Therapy and Recommendations for Monitoring," published in the New England Journal of Medicine, 350:5, January 29, 2004. Specifically, Licensee will ensure that either he or another physician has conducted and documented a recent digital rectal examination and that at a minimum, blood tests for baseline testosterone and PSA levels have been performed. Licensee must not prescribe, recommend, or direct a patient to take testosterone for patients with a PSA level above 4.0 ng/mL as well as patients with a yearly PSA increase of 1.5 ng/mL or more, or 0.75 ng/mL per year or more over two years. If any patient insists that they want to take testosterone in the face of such PSA levels, Licensee will provide 30 day prior written notice to the patient and then terminate the physician - patient relationship.
3.4 Licensee must make appropriate and timely chart entries to demonstrate that he is complying with the terms of this Order.
3.5 Licensee's practice is subject to no notice compliance inspections by Board staff.
3.6 Licensee understands that violating any term of this Order will be grounds for disciplinary action under ORS 677.190(17).
3.7 Licensee understands this Order becomes effective the date this Order is signed by the Board Chair.
2.4 On July 19, 2010, a Board Compliance Officer conducted an audit of Licensee's clinic and obtained copies of five charts, randomly drawn from a list of patients that were taking testosterone and/or thyroid medication. A review of these charts reveals that Licensee has failed to comply with the terms of the Interim Stipulated Order, to include continuing to treat patients with thyroid medication who have TSH levels that do not exceed the levels specified in the ISO. In addition, Licensee is not complying with the ISO by treating patients with testosterone who do not have abnormal testosterone levels, and failing to conduct or document a recent rectal prostate examination for these patients.
Based on the above information, the Board has determined that from the evidence available to the Board at this time that Licensee's continued practice of medicine would pose an immediate danger to the public and to his patients. Licensee's behavior displays repeated disregard for terms of the Board's stipulated orders that were designed to protect the public. This behavior causes the Board to conclude that it would be subjecting patients to the risk of harm if Licensee were allowed to continue to practice while this case remains under investigation.
Licensee is entitled to a hearing as provided by the Administrative Procedures Act (chapter 183), Oregon Revised Statutes. Licensee may be represented by legal counsel at a hearing. If Licensee desires a hearing, the Board must receive Licensee's written request for hearing within ninety (90) days from the date the mailing of this Notice to Licensee, pursuant to ORS 183.430(2). Upon receipt of a request for a hearing, the Board will notify Licensee of the time and place of the hearing and will hold a hearing as soon as practical.
The Board orders that pursuant to ORS 677.205(3), the license of John Edwin Gambee, MD, be suspended on an emergency basis and that Licensee immediately cease the practice of medicine until otherwise ordered by the Board.
IT IS SO ORDERED THIS 8TH Day of SEPTEMBER 2010.
OREGON MEDICAL BOARD
State of Oregon
LISA A. CORNELIUS, DPM
This page was posted on September 23, 2011..