Disciplinary Action against Carolyn Dean, M.D.
Stephen Barrett, M.D.
In 1995, after reviewing her care of 36 patients, the College of Physicians and Surgeons of Ontario (Canada) concluded that Carolyn Dean, M.D. was unfit to practice and revoked her registration certificate. The College's case summary (shown below) states:
- After being notified in 1993 that a disciplinary hearing would be held, Dean relocated to New York and did not contest the charges against her.
- Dean had used unscientific methods of testing such as hair analysis, Vega and Interro testing, iridology and reflexology as well as treatment not medically indicated and of unproven value, such as homeopathy, colonic irrigations, coffee enemas, and rotation diets.
- She did not individualize her patients and objectively try to reach an appropriate diagnosis and treatment. Rather she allowed her bias toward candidiasis and perceived immunodeficiency problems to cause her to pre-diagnose patients without individualizing them.
Dean obtained a California medical license in 1993 but does not appear to have practiced there. After her Ontario license was revoked, the California authorities initiated action that led to a stipulated decision and order in 1999 under which she was placed on three years' probation but could not practice until she passed the Special Purpose Examination (SPEX), a test used to to determine basic medical knowledge. She was also required to take 120 more hours of continuing medical education than is normally required for license renewal.
Dean's current Web site states that she "specializes in managing and healing misdiagnosed and chronic conditions such as digestive problems, hormone imbalance, yeast overgrowth (Candida) recurring infection, irritable bowel syndrome, widespread inflammation, allergies, anxiety, fibromyalgia, mood swings, chronic fatigue syndrome, fluid retention, lost vitality, and other conditions that are not satisfactorily controlled." During the past several years, she has offered email and telephone consultations for which she charges $200 per hour. In 2008, she notified her supporters that she was moving to Hawaii and in 2010 would open a "medical spa" called VitaCosta in Costa Rica.
THE COLLEGE OF
PHYSICIANS AND SURGEONS OF ONTARIO
Dean, Carolyn Flora Anne CPSO# 30780Committee: Discipline
Appeal Status: No Appeal
Hearing Date: 24 Jul 1995 Decision Date: 24 Jul 1995 Publication Date: March/April 1996
Dr. Dean was not present at her hearing and was not represented by counsel.
Counsel for the College alleged that Dr. Dean displayed in her professional care of 36 patients a lack of knowledge, skill or judgment or disregard for the welfare of the patients of a nature or to an extent that demonstrated she is unfit to continue in practice, and that she is guilty of professional misconduct for failure to maintain the standard of practice of the profession as displayed in her professional care of 36 patients and disgraceful, dishonourable or unprofessional conduct.
These allegations were based upon the statements of three patients of Dr. Dean and upon the findings and opinions of an expert for the prosecution, Dr. A, following his review of the charts of 36 patients, 33 of which were randomly selected.
Counsel for the College filed the Affidavit of a legal associate, outlining the history of contacts between College prosecutors and Dr. Dean. The Affidavit indicated that Dr. Dean had received and acknowledged the Notice of Hearing in June 1993 at her address in New York City. She subsequently moved to California, providing the College with a phone number and a facsimile number, but declining to provide her address in California. Subsequent to this Dr. Dean did not respond to further telephone calls and facsimilies informing her of the details of the College case against her and the timing of the Discipline hearing.
After considering this matter, and considering the advice of its counsel that the College had more than fulfilled its legal obligation to give proper notification to the physician, the Committee ruled that the hearing should proceed in the absence of Dr. Dean.
Case for the College
Counsel for the College explained that following the receipt of complaints from three patients, the College had ordered an investigation of Dr. Dean s practice by Dr. A. This investigation consisted of a detailed assessment of 36 patient files.
Testimony was heard from Ms. B, a former patient of Dr. Dean s. This woman had become ill in 1990 with recurring infections and had received much investigation and had been treated with many antibiotics. Her disability continued and was attributed to persisting infection with the Epstein-Barr virus. She was referred by her family physician to Dr. Dean in March 1991.
The witness testified that when she made the appointment with Dr. Dean she was instructed to bring $20.00 which was a requirement for seeing the doctor. At the office she filled out a questionnaire and subsequently saw Dr. Dean who, after reading her questionnaire, diagnosed candidiasis, recommended a blood test for confirmation, and instructed the patient to make a return appointment in two weeks. She was also instructed in a change in diet and given other printed information about candidiasis.
Following this interview Ms. B was upset and complained to the College immediately following the visit. Her complaint included: the requirement to bring $20.00 to the first visit which she considered to be extra-billing, the making of a new diagnosis of candidiasis based upon a brief interview which did not include a physical examination and was punctuated by frequent interruptions and, the requirement to pay $100.00 for a blood test.
Subsequent to Ms. B' s complaint to the College, Dr. Dean telephoned her twice at home apologizing for the situation. Dr. Dean told her that the payment of money was not an absolute requirement and asked her to withdraw her complaint to the College.
The witness declined to return to Dr. Dean. She did receive by mail a report of her blood test for Candida antibodies which the Committee noted came from a laboratory whose address was the same as Dr. Dean s. The test reported levels of antibodies which were above those considered normal by the laboratory. The witness also received a copy of a report sent by Dr. Dean to her family physician detailing her diagnosis and proposed treatment.
Dr. A testified. He is a well qualified specialist in internal medicine with special expertise in immunology, who practices in a major city health centre.He is an Associate Professor of Medicine at the University.
At the request of the College, Dr. A had reviewed 36 patient files from Dr. Dean s practise. These included pre-selected charts of the three patients who had complained to the College and 33 charts selected at random by College investigators. Dr. A prepared a report of his findings which was filed and read by the Committee members. Copies of all the charts assessed were available to the Committee and were referred to as required.
Dr. A testified in great detail as to his findings in Patients #1 and #2, somewhat less detail regarding Patients #3 through #8, and then summarized his findings and conclusions for the entire 36 patients.
His significant findings are summarized as follows:
- The patients exhibited a pattern of anxiety states, depression, phobias, panic attacks, hyperactivity and general inability to cope;
- Dr. Dean cared about her patients and tried to help them;
- Dr. Dean misused and misunderstood laboratory tests and often ordered repeated expensive tests which were not indicated (examples of such tests included: serum protein electrophoresis and immuno-electrophoresis, T-cell assays, serum ferritin, and serum folate);
- Dr. Dean incorrectly attributed her patients symptoms to dysfunctions in the immune system;
- Dr. Dean misused immunoglobulin antibody levels to Candida to falsely diagnose and treat Candidiasis where it did not exist. She ignored the fact that scientific studies have shown no correlation between blood levels of antibodies to Candida and patients symptoms of ill-health;
- Dr. Dean did not individualize her patients and objectively try to reach an appropriate diagnosis and treatment. Rather she allowed her bias toward candidiasis and perceived immunodeficiency problems to cause her to pre-diagnose patients without individualising them;
- Dr. Dean did infrequent and incomplete physical examinations;
- Dr. Dean relied for patient histories on questionnaires that the patients completed and which were biased to confirm her prejudged diagnoses;
- Dr. Dean used unscientific and discredited methods of testing such as hair analysis, Vega and Interro Testing, Iridology and Reflexology;
- Dr. Dean used treatment not medically indicated and of unproven value, such as homeopathy, colonic irrigations, coffee enemas and rotation diets; and
- There was no evidence that Dr. Dean had harmed any patient by her treatment.
Dr. A expressed the opinion that Dr. Dean, despite being a caring physician, fell below an acceptable standard of medical practice and was unfit to continue in practice.
- Dr. Dean has displayed in her professional care of 36 patients a lack of skill and judgment and a disregard for the welfare of these patients of a nature and to an extent that demonstrated that she is unfit to continue in practice.
- Dr. Dean is guilty of professional misconduct for failure to maintain the standard of practice of the profession as displayed in her professional care of 36 patients.
- Had the Committee not found Dr. Dean guilty of professional misconduct for failing to maintain the standard of practice, it would have found her guilty of professional misconduct for an act relevant to the practice of medicine that, having regard to all the circumstances, would reasonably be regarded by members as unprofessional.
Reasons for the Decision
The evidence before the Committee was clear and uncontradicted.
The Committee was very aware that no defence had been presented and therefore approached its deliberations with due caution. Nevertheless, the Committee was bound to consider only the evidence before it, which evidence was both credible and convincing.
Of the evidence against Dr. Dean, the Committee placed more weight on her failure to be objective in assessing and treating patients than it did upon her use of questionable diagnostic and therapeutic methods.
Counsel for the College urged revocation of Dr. Dean's certificate of registration as the only appropriate penalty in view of the Committee s decision. Currently Dr. Dean is presumed to be residing in California, but is still licensed to practice in Ontario.
The certificate of registration of Dr. Dean shall be revoked forthwith.
This page was revised on August 15, 2009.