"Constitutional Homeopath" Loses Medical License

Stephen Barrett, M.D.


In 1992, the New York State Board of Professional Medical Conduct revoked the license of Warren Metzler, M.D. based on his management of four patients, one of whom died as a result of lack of appropriate treatment. Metzler testified that he practiced "constitutional homeopathy" using homeopathic remedies to "treat the entire person" rather than treating diseases. He also testified that illness is the result of a restricted spirit, there is no such thing as an incurable illness, and that it was necessary to do standard diagnostic testing or repeated physical examinations. As noted below, the board sustained charges of gross negligence, negligence on more than one occasion, and failure to maintain records. Metzler requested an administrative review in which he asserted that practicing a field of medicine that differs from the weight of medical authority does not constitute negligence. The review board said there was no separate standard for homeopathic medicine.


STATE OF NEW YORK       :       DEPARTMENT OF HEALTH
STATE BOARD FOR PROFESSIONAL MEDICAL CONDUCT

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IN THE MATTER

OF

WARREN METZLER, M.D.

:

:

:

DETERMINATION

         AND

ORDER

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -   ORDER NO. BPMC-92-66

SHARON C.H. MEAD, M.D., Chairperson, DANIEL A. SHERBER, M.D. and MSGR. PETER J. OWENS. duly designated members of the State Board for Professional Medical Conduct, appointed by the Commissioner of Health of the State of New York pursuant to Section 230(1) of the Public Health Law, served as the Hearing Committee in this matter pursuant to Section 230(10)(e) of the Public Health Law. On June 8, 1992, Msgr. Owens replaced Eugenia Herbst, an original panel member, who was present at the March 31, 1992 hearing. Msgr. Owen filed a statement pursuant to Section 230(10)(f) that he has read the entire transcript and reviewed all of the evidence in this matter. MICHAEL P. MCDERMOTT, ESQ., Administrative Law Judge, served as the Administrative Officer for the Hearing Committee.

After consideration of the entire record, the Hearing I Committee submits this Determination and Order.

SUMMARY OF THE PROCEEDINGS

Notice of Hearing and
     Statement of Charges:
March 5, 1992
Pre-hearing Conference March 26, 1992
Hearing Dates: March 31, 1992
June, 8, 1992
July 1, 1992
Place of Hearing: NYS Department of Health
5 Penn Plaza
New York, New York
Date of Deliberations: July 21, 1992
Petitioner appeared by: Peter J. Millock, Esq.
General Counsel
NYS Department of Health
By: David Smith, Esq.
       Assistant Counsel
Respondent appeared by: David M. Ettinger, Esq.
145 East 49th Street
New York, New York 10017

STATEMENT OF CHARGES:

Essentially, the statement of Charges, charges the Respondent with:

(a) Practicing with gross negligence
(b) Practicing with negligence on more than one occasion
(c) Failing to maintain records

The charges are more specifically set forth in the statement of Charges, a copy of which is attached hereto and made a part hereof.

WITNESSES

For the Petitioner:

1) Howard Chester, M.D.

For the Respondent:

1) Warren Metzler, M.D.

FINDINGS OF FACT

Numbers in parentheses refer to transcript page numbers or exhibits. These citations represent evidence found persuasive by the Hearing Committee in arriving at a particular finding. Conflicting evidence, if any, was considered and rejected in favor of the cited evidence. All hearing Committee findings were unanimous unless otherwise specified.

GENERAL FINDING

1. The Respondent is a physician duly licensed to practice medicine in the state of New York under license number 137028 issued by the State Education Department (Pet's. Ex. 2).

2. The Respondent graduated from medical school in 1977.He trained for a year as an intern at the Public Health Service Hospital on Staten Island and for six months as a surgical resident at the Staten Island Hospital. He opened a private practice in homeopathy in October 1980 (Resp's. Ex. B).

3. The Respondent does not practice allopathic medicine. He practices homeopathy which he describes as treating the restrictions the person has in mastering life. Each case is studied to determine the primary pattern of limitation. The limitation pattern of the patient is then matched up to the homeopathic remedy with that pattern. The Respondent claims that in his experience a curative response always occurs after a correct remedy; nothing can interfere (Resp's. Exs. B and C).

4. The Respondent is a self taught "constitutional homeopathist" which he described as one who uses homeopathic remedies to treat the entire person instead of using homeopathic remedies to treat the diseases. He believes that illness is the result of a restricted spirit and that there is no such thing as an incurable illness (Resp's. Exs. A and B; Tr. 259, 262-261).

5. Homeopathy is not recognized in New York State as a separate branch of medicine nor is the Respondent separately licensed as a homeopathic physician (Tr. 258).

6. Each patient in this case (Patients A, B, C and D) were advised of the type of treatment and the alternate choices of treatment afforded by the Respondent (Tr. 220-221).

FINDINGS OF FACT AS TO PATIENT A

7. Patient A was the Respondent's Patient from December, 1985 through June 1986. On the first visit, Patient A presented symptoms of swollen glands and a productive cough (Pet's. Ex. 3; Tr. 22, 26).

8. Patient A presented with similar symptoms on each subsequent visit (Pet's. Ex. 3).

9. On Patient A's second visit, the Respondent performed a limited physical examination which revealed enlarged lymph nodes which he noted as "imp. chronic inflam" (impression chronic inflammation) (Pet's. Ex. 3).

10. The Respondent never ordered or performed any laboratory' tests or diagnostic procedures on Patient A (Pet's. Ex. 3).

11. The Respondent did not obtain an adequate medical history on Patient A (Pet's. Ex. 3).

12. The Respondent treated Patient A homeopathically, prescribing pulsatilla and phosphorus but he never prescribed any allopathic medicines. Patient A's condition became progressively worse (Pet's Ex. 3; Tr. 31-33, 36-37, 225 231-232).

13. Patient A's last visit to the Respondent was on June 27, 1986. On the following day, Patient A was admitted to the Hospital where he died five days later of AIDS and pneumocystis pneumonia (Pet's. Exs. 3 and 7; Tr. 41, 44-47).

14. The Respondent was not aware that Patient A was HIV positive during the period that he was under his care (Tr. 225).

CONCLUSIONS AS TO PATIENT A

Patient A presented with physical signs and symptoms which the Respondent failed to investigate, diagnose and treat. He failed to order or perform any laboratory tests or diagnostic procedures.

The Respondent did treat Patient A homeopathically, prescribing homeopathic remedies. The patient's condition worsened and he eventually died from AIDS and pneumocystis Pneumonia six days after his last visit to the Respondent. The Respondent was totally unaware that Patient A had AIDS.

The Hearing Committee unanimously concludes that the Respondent's treatment of Patient A did not meet the minimum standards of acceptable medical practice and was so egregious as to constitute gross negligence.

FINDINGS OF FACT AS TO PATIENT B

15. Patient B was the Respondent's patient from May, 1988 through October, 1988. She presented with severe menstrual flow, swollen legs and tender breasts (Pet's. Ex. 4; Tr. 57).

16. Patient B suffered from phlebitis in 1981, had a pulmonary emboli5m in 1987 and was currently taking Coumadin, 5 mg per day (Pet's. Ex. 4).

17. The Respondent obtained an adequate medical history, however, he never performed an adequate physical examination on Patient B. His physical examination did not address the areas of the patient's complaints (Pet's. Ex. 4).

18. The Respondent never ordered or performed indicated laboratory tests for Patient B's condition (Pet's. Ex. 4; Tr. 59, 163-164).

19. There is nothing in the record to indicate that the Respondent advised Patient B to stop taking the anti-coagulant medication. (Pet's. Ex. 4)

20. The Respondent should have referred Patient B to a gynecologist under the circumstances (Pet's. Ex. 4; Tr. 66). 21. The Respondent treated Patient B homeopathically, prescribing calcaria carbonicum, seria and conium maculatum (Pet's. Ex. 4; Tr. 238-240).

CONCLUSIONS AS TO PATIENT B

The Respondent never performed an adequate physical examination on Patient B nor did he ever order or perform indicated laboratory tests for Patient B's condition.

Under the circumstances of this case, the Respondent should have referred Patient B to a gynecologist.

The Respondent's treatment of Patient B did not meet the minimum standards of acceptable medical practice. In his treatment of this patient he failed to exercise the care that would be exercised by a reasonably prudent physician under the circumstances.

FINDINGS OF FACT AS TO PATIENT C

22. Patient C was the Respondent's patient from August 1983 through March 1987. Patient C presented with a diagnosis of bronchial asthma and soft signs of cystic fibrosis (Pet's. Ex. 5).

23. The Respondent obtained an adequate medical history. He' also performed an adequate physical examination which indicated a possible undescended testicle (Pet's Ex. 5).

24. The Respondent never ordered or performed indicated laboratory tests or diagnostic studies on Patient C (Pet's. Ex. 5; Tr. 68-81).

25. The Respondent treated Patient C homeopathically, prescribing kali carbonicum, sepia, lycopodium, petrolatum and caladum (Pet's. Ex. 5; Tr. 240-245).

26. Patient C was receiving concurrent treatment from an allopathic physician during the time he was being seen by the Respondent. However, there is no evidence of any communication between the Respondent and the allopathic physician (Pet's Ex. 5).;

CONCLUSIONS AS TO PATIENT C

The Respondent never ordered or performed indicated laboratory tests or diagnostic studies for Patient C's condition. The Respondent's treatment of Patient C did not meet the minimum standards of acceptable medical practice. In his treatment of this patient, he failed to exercise the care that would be exercised by a reasonably prudent physician under the circumstances.

CONCLUSIONS AS TO PATIENT C

27. Patient 0 was the Respondent's patient between June 1985i and March 1986. She presented with symptoms of exhaustion, sleepiness after work and unrefreshed sleep (Pet's. Ex. 6).

28. Prior to her first visit with the Respondent, Patient D had had a biopsy in June 1985 which was diagnosed as cancer of the breast (Pet's. Ex. 6; Tr. 248).

29. Sometime between December 1985 and March 1986, Patient 0 returned to an allopathic physician and had a CAT scan and mammogram performed, both of which proved negative. The allopathic physician also recommended a follow-up biopsy (Pet's. Ex. 6; Tr. 249).

30. There is no record of any communication between the Respondent and the allopathic physician (Pet's. Ex. 6).

31. The Respondent obtained an adequate medical history on Patient D (Pet's. Ex. 6).

32. The Respondent performed an adequate physical examination on Patient D (Pet's. Ex. 6).

33. The Respondent failed to order or perform indicated laboratory or diagnostic tests for Patient D's exertional chest pain, continual exhaustion and dyspnea on exertion (Pet's. Ex. 6 ) .

34. The Respondent treated Patient D homeopathically, prescribing nux vomica and natrium sulphuricum (Pet's. Ex. 6).

CONCLUSIONS AS TO PATIENT D

The Respondent failed to order or perform indicated laboratory tests or diagnostic studies for Patient D's condition. The Respondent's treatment of Patient D did not meet the minimum standards of acceptable medical practice. In his treatment of this patient, he failed to exercise the care that would be exercised by a reasonably prudent physician under the circumstances.

VOTE OF THE HEARING COMMITTEE

All votes were unanimous unless otherwise specified:

FIRST SPECIFICATION (Practicing with gross negligence):

SUSTAINED as to the charges specified in paragraphs A and A.1-­A.4 of the Statement of Charges.

SECOND SPECIFICATION (Practicing with negligence on more than one occasion):

SUSTAINED as to the charges specified in paragraphs A and A.1A.4; Band 8.2-B.4; C and C.3, C.4, C.5; D.3, 0.4,D.5, and D.6 of the Statement of Charges.

NOT SUSTAINED as to the charges specified in paragraphs B.1, B.3, C.1 C.2, D.1 and D.2 of the Statement of Charges.

THIRD THROUGH SIXTH SPECIFICATIONS. (Failure to maintain records):

SUSTAINED as to the charges specified in paragraphs A and A.1, A.4; Band B.2, R.4, C and C.3, C.4. C.5; D and D.3, D.4, D.5, and 0.6 of the Statement of Charges.

NOT SUSTAINED as to the charges specified in paragraphs B.1, B.3, C.1, C.2, 0.1 and D.2 of the statement of Charges.

DETERMINATION

The Respondent does not recognize the existence of disease and does not consider any disease to be incurable. He also does not recognize the necessity for laboratory tests or diagnostic studies or the need for repeated physical examinations.

The Respondent's treatment of Patient's A, B, C and D did not meet the minimum standards of acceptable medical practice.

The Hearing Committee has sustained charges of gross negligence; negligence on more than one occasion and failure to maintain records against the Respondent.

The Hearing Committee unanimously (3-0) determines that the Respondent's license to practice medicine should be REVOKED.

ORDERED

It is hereby ORDERED that the Respondent's license to practice medicine in the state of New York be REVOKED.

DATED. Massapequa, New York
AUGUST 12, 1992

________________________
SHARON C.H. MEAD, M.D. (Chairperson)!

DANIEL A. SHERBER, M.D.
MSGR. PETER J. OWENS

This page was posted on January 31, 2009.

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