Binyamin Rothstein, D.O.
Physician's license revoked for curing his
patients with alternative medicine. Medical board admits there were no injuries
nor complaints.
"Dr. Rothstein had been in practice for over 20 years, dedicating himself to finding the most effective, inexpensive and safe approaches to treat his patients. When he got too close to really curing serious diseases the Maryland Board of Physicians used their power to continually harass him. During this process he had to undergo monthly reviews of his charts. In 10 years of chart review, there was never found an inappropriate treatment nor patient injury. He got rave reviews from his supervisors, each time the Maryland Board of Physicians would "fire" his supervisor and replace that one with a different supervisor. Finally, after they could not find anyone to find fault with him, they hired doctors who knew nothing of the kind of work he did, to criticize him. Then ignoring the administrative judge's findings, they revoked his license.
Dr. Rothstein's license was revoked, not because he injured anybody nor because there were any complains, rather because he cured his patients."
Quote by Judge Sander Goldberg
(based upon an independent review by Judge Goldberg of the Maryland Tax Court)
To read the full analysis by Judge Sander Goldberg please click here.
The purpose of this web site is to show the other of the side of the story: All of the facts stated herein are true and supported by the record of the case. You be the judge.
Please bear in mind that this is the only case where the Maryland Board of Physicians has revoked a physician's license despite the fact that there were no complaints by any patient and that all of the patients that were investigated responded well and that there were no injuries, ever. In addition, the Maryland Board of Physicians had 10-15 patient charts reviewed each month for 10 years and they were never able to find a misdiagnosis nor a mismanagement and that every investigator became either a patient of mine, a student of mine or offered me a job.
Dr.
Binyamin Rothstein
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Enclosed herein is the Revocation of Dr. Rothstein's license and his rebuttal. You may judge for yourself after you've read his rebuttal to all of their claims.
Dr. Rothstein's comments are in blue.
IN THE MATTER OF BINYAMIN ROTHSTEIN, D.O. Respondent. License No. H 30277 * * * * BEFORE THE MARYLAND STATE BOARD OF PHYSICIANS Case No. 1994-0718 * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
On August 13, 2003, the Board charged Dr. Rothstein with: (1) violation of a Consent Order executed on February 23, 2000 ("Consent Order II") ; (2) failing to meet the appropriate standards for the delivery of quality medical of care within the meaning of Md. Health Occ. Code Ann. § 14-404 (a) (22); and (3) failing to cooperate with a lawful investigation of the Board within the meaning of Md. Health Occ. Code Ann. § 14-404 (a) (33). An eight-day hearing was held before an Administrative Law Judge ("ALJ") of the Office of Administrative Hearings in March of 2004. Dr. Rothstein was represented by counsel and the State was represented by the Administrative Prosecutor. Eight witnesses testified, including six expert witnesses. Eighty-five exhibits were admitted into evidence. ALJ Richard O'Connor issued his Proposed Decision on June 21,2004, recommending that the charges be upheld in part and dismissed in part. Both the State and Dr. Rothstein filed Exceptions to the ALJ's Proposed Decision, and both parties filed responses to each other's written Exceptions. An oral Exceptions Hearing was held before the Board on September 22, 2004. This decision constitutes the Board's Final Opinion and Order in this case. In making this decision, the Board has considered the entire record in this case, including the transcript of the hearing and all exhibits admitted into evidence, the Proposed Decision of the AU and all of the arguments made during the Exceptions process by each of the parties. The Board incorporates by reference and attaches as Attachment A to this Final Opinion and Order the Proposed Decision of the ALJ issued on June 21, 2004. III. FINDINGS OF FACT a. Standard of Proof Employed The Board has applied the following standard of proof. With respect to allegations that Dr. Rothstein violated the standard of quality medical care, those allegations are treated as allegations of statutory violations of § 14-404 (a) (22)only, and all findings made have been made under the "clear and "convincing" evidentiary standard. With respect to the allegations of violations of conditions of probation specifically set out in Consent Order II (but excluding any general requirement in Consent Order \I that Dr. Rothstein "comply with all laws governing the practice of medicine under the Act"), and also with respect to violation of § 14-404 (a) (33) of the Medical Practice Act, the preponderance of the evidence standard has been applied. The Board thus rejects the Administrative Prosecutor's Exception regarding the standard of proof. The Board notes, however, that the proof in these latter two categories was also clear and convincing in any case. b. History of Prior Discipline First Charges: 1995
On June 28, 1995, the Board first charged Dr. Rothstein with violating appropriate standards of medical care within the meaning of Section 14-404 (a) (22) of the Medical Practice Act, Md. Health Occ. Code Ann. § 14-404 (a) (22). Dr. Rothstein was charged with: (1) failing to evaluate or treat a patient presenting with symptoms of meningitis, and instead treating the patient with intravenous hydrogen peroxide; This patient had already been seen by his internist who missed the diagnosis. I diagnosed the patient, treated him with a peroxide drip and the next morning he was symptom free. He did not have a true meningitis, he had a meningismus. There was no fever, no obtundation, no mental confusion, no ataxia. Patient was not in acute distress. He responded well to treatment. (2) failing to evaluate, diagnose, treat or refer to another physician a two-month-old baby who was experiencing seizures, and instead performing a manipulation; This baby was brought to me by his mother and grandmother. The child was in the emergency room for an asthmatic attack. The emergency room doctors over treated the infant inducing seizures because of overdosing medication. The mother and grandmother panicked, left the hospital and brought the child to me. Within an hour of my treating him and utilizing osteopathic manipulation, the seizures subsided and his asthma resolved. (3) failing to refer to the emergency room a 67-year-old patient with an x-ray finding of pneumonia and complaints of chest pain, shortness of breath, fever and a cough with bloody production, and instead administering four intravenous hydrogen peroxide treatments and three injections of vitamins and minerals; The patient was seen by me with fever and shortness of breath. I diagnosed him as having pneumonia and immediately referred him to his internist. I saw him again after he was seen by his internist who prescribed antibiotics. I supplemented his treatments with peroxide drips. Within 2 weeks, this 67 yr. old gentleman was symptom free from a severe case of pneumonia. (4) diagnosing an prescribing medication for high blood pressure for a 57-year-old patient whose blood pressure readings were all normal, failing to order a chest x-ray after that patient had a positive tuberculosis test, failing to follow up on complaints suggestive of unstable angina, and failure to follow up on treatment administered by covering physician for a dental abscess, and instead administering hydrogen peroxide and mineral injections without a history or physical examinations supporting their use; This gentleman was from England. He had a BCG vaccine which will always turn a TB test positive. Medication prescribed was a diuretic for fluid retention, not for hypertension. He did not have unstable angina, he had plantar fasciitis causing difficulty walking and using his crutches caused his chest pain and arm pain.
(5) failing, in the case of an
82-year-old patient with dyspnea, swollen ankles, rales, pitting edema,
wheezing, coughing and abdominal fluid, to treat the symptoms suggestive of
congestive heart failure, and instead administering hydrogen peroxide
intravenously; This patient was
followed carefully primarily because of abdominal distention. The definitive
test, abdominal ultrasound, was performed. The problem was then discovered that
her distended abdomen was caused by excessive adiposity (i.e. fat). Her obesity
was the cause of her symptoms, she did not have congestive heart failure. She
was treated symptomatically and with some life style changes she lived well into
her 90’s. (6) failing to adequately
evaluate a patient complaining of back pain who was in fact suffering from
metastatic bone cancer, and instead injecting vitamins;
This was a woman who I saw on only one occasion, and
despite my making several attempts, she would not come for a follow-up
examination. It would have been impossible to make a diagnosis on an initial
visit. In addition to her back pain, she was a heavy smoker and was experiencing
much fatigue. I administered osteopathic manipulation and provided her with
nutritional support in the form of intravenous nutrients to help alleviate her
symptoms and improve her overall condition. .
(7) failure to do an adequate examination of the cause of fainting accompanied
by shortness of breath and chest pain in a 72-year-old patient who died shortly
thereafter of a myocardial infarction and congestive heart failure, and instead
administering intravenous vitamins; This
patient was consistently under the care of an internist. My care was only
supplementary care. My administering intravenous vitamins and minerals, which
have been shown to be beneficial to the ailing heart, was only to facilitate his
ongoing medical care by his internist with whom I was in communication.
Ironically ,
the internist was never questioned, perhaps that is because it was he that
turned me in to the board (8) failing to
adequately examine and evaluate a 46-year-old male complaining from lower back
pain who was in fact suffering from metastatic bone cancer, and instead
injecting intravenous vitamins and minerals;
This patient was seen by me after he was seen by his internist and a physical
medicine specialist. It is interesting to note that he had almost complete
resolution of his symptoms, enough so that he was able to take his long awaited
trip to Israel. After he returned from his vacation to Israel, his back pain
returned. He again saw his internist who only then discovered the cancer. This
was the same internist that claimed that claimed that I missed the diagnosis
even though he had already seen him on numerous occasions (is a pattern begining
to emerge here?) (9) administering intravenous
hydrogen peroxide and vitamins after an inadequate examination which was not
detailed enough to support the diagnoses of a patient complaining of dry throat,
fatigue, muscle aches and lack of coordination; and (10) diagnosing a patient
and treating that patient by intravenous hydrogen peroxide and vitamins and
manipulation over eleven visits without a valid basis for that diagnosis in the
physical findings. Highly diluted, medically
prepared hydrogen peroxide, given intravenously, has been shown to be effective
for treating many diseases, especially infections. Given properly, side effects
are extremely rare, the most common being an irritation to the vein where the
needle is placed. Hydrogen peroxide is also indicated for many inflammatory
conditions, poor circulation, emphysema and enhances the recovery of stroke
victims. They forgot to mention that the patient got well.
First Consent Order: 1996 Those charges were settled by a Consent Order of March
28, 1996. Under the terms of that Consent Order, Dr. Rothstein admitted that his
care did not meet the statutory standard in these cases. Dr. Rothstein's license
was suspended for ninety days and he was placed on probation for a period of
three years. Dr. Rothstein was also required to employ a Board-approved mentor
to monitor his care of patients, to develop Board-approved consent forms for
alternative medicine, (note: these are the
forms the Board later accused me of having in my charts as a further indictment
of wrong doing) to complete a Board-approved
documentation course, to complete a Physician Refresher or Retraining Program,
and to complete a Board-approved course in electrocardiogram interpretation. He
was also subject to subsequent peer review. Second Charges; Consent Order II:
2000 On September 15, 1999, the Board charged Dr. Rothstein with violating the
terms of the probation in the previous Consent Order by failing to meet
appropriate standards of patient care. These charges were settled by a second
Consent Order ("Consent Order II ") executed on February 23, 2000. In Consent
Order II, Dr. Rothstein admitted once again that he had violated appropriate
medical standards in the treatment of nine (of ten) patients whose care was
reviewed by the Board. I did not admit, but was
coerced into signing the second consent order. Within the consent order is
clearly written that I do not agree with the allegations, but in order to
continue my practice I acquiesced under duress. (a classic example of the Alford
plea.) The violations admitted in Consent
Order II were similar to the original violations that had first caused the Board
to charge Dr. Rothstein. All but one patient was given chelation therapy
These patients came to me requesting Chelation therapy
because their conditions were not treated adequately by their conventional
physicians, and they wished to avoid by-pass surgery and/or amputation. NIH is
now funding studies to demonstrate the effectiveness of Chelation therapy. ,
vitamin injections and/or hydrogen peroxide injections, and many patients were
given other treatments such as flaxseed oil; Flaxseed oil is an omega-3 fatty
acid. It took conventional practitioners over 10 years to realize the value of
omega-3 fatty acids, and even with overwhelming evidence of the value of omega-3
fatty acids, the MBP still refuses to accept it’s validity in treating chronic
diseases. but once again serious medical problems for which conventional
treatments are available were not evaluated or, if evaluated, not properly
treated. If this were the case, why was it that all of these patients came to me
because their conventional doctors failed to help them? Why is it that the
conventional doctors who failed to help them were not investigated, whereas I,
who did help them, was investigated? In one patient, he failed to address the
patient's shortness of breath, wheezing, high cholesterol and epigastric
discomfort upon exertion, and he misinterpreted the patient's EKG. The EKG was
reread by a cardiologist who agreed with my interpretation. The patient was
treated with chelation therapy and his symptoms resolved. In another patient he
also misinterpreted an EKG, failed to address the patient's Chronic Obstructive
Pulmonary Disease, wheezing, and profound exercise intolerance, failed to order
any pulmonary function tests, failed to monitor for the possible side effects of
chelation therapy and failed to make any assessment of whether chelation therapy
was effective. The patient’s symptoms were all taken into consideration, he had
failed conventional treatment and came to me specifically for chelation therapy.
Chelation therapy is a means to remove toxic metals from the body thereby
decreasing the free radical load. As the free radical load is reduced, the
body’s reparative mechanisms can then function more efficiently, circulation is
improved and nervous function is likewise improved. In this patient, chelation
therapy was extremely effective in alleviating his symptoms. He had no side
effects from the chelation therapy. When the MBP states that he was not
monitored for side effects, it is unclear what they meant, the patient had his
blood pressure taken at least twice with each session, he had routine blood
tests for renal function, urine was checked before each session to look for
microhematuria and proteinuria, and he got a physical exam including EKG and
blood tests after every 10 treatments. Further
testing for pulmonary treatments. Further
testing for pulmonary function would have been an unwarranted expense with no
positive gain and no effect on his treatment regimen.
In another patient, he again failed to monitor
for side effects of chelation therapy, failed to properly address the patient's
high blood pressure
Again, it is unclear as to what is meant by
failing to monitor for side effects of chelation therapy, as stated above, all
chelation patients received careful monitoring of blood pressure at least twice
with each treatment, urine testing for microhematuria and proteinuria, regular
check-ups with EKG and blood tests. The protocol for proper use of chelation
therapy was carefully followed.
and diagnosed a patient without a sufficient
examination, based on the patient's word that her daughter had the disease.
This one escapes me. I have no idea of what
they’re talking about.
He prescribed a steroid to a patient whose
blood levels of that steroid were normal, though that steroid could exacerbate
her already high cholesterol problem, and he did not discuss the cholesterol
problem with her.
When a blood test result is within the normal
range, all that means is that it is normal for somebody. This is the meaning of
normal range, what is right for one person may not be right for someone else.
Any physician who determines the correctness of a treatment based solely on
normal ranges is sorely mistaken. It is an absolute requirement of every
physician to first listen to the patient and examine them and then with the aid
of laboratory testing to determine the most appropriate treatment.
He treated a patient who had a history of
cancer and a non-healing fracture of the right fibula with hydrogen peroxide and
manipulation, but he failed to order an x-ray to check for metastatic cancer.
The MBP failed to mention that the patient
responded well to the treatment and that the oncologist was neglectful in
following up on that patient. My focus was not on whether or not the patient may
have had metastasis, that was the job of the oncologist, my focus was on
treating the patient suffering with pain and a non-healing fracture.
He failed to evaluate another patient's chest pain. In another patient with
shortness of breath and angina-like pain, he failed to address the angina issue
at all and also failed to address the patient's abnormal thyroid tests or to
address or treat the patient's elevated cholesterol.
The patient developed chest pains not from
angina but from using his crutches. His was a clear case of muscular skeletal
pain. This patient did not have an abnormal thyroid test, and in cases like this
one, where the cholesterol is only slightly elevated, it is the standard of care
to first attempt controlling cholesterol with lifestyle changes.
In Consent Order II, Dr. Rothstein agreed with
the facts alleged in the charging document and agreed to a disposition of the
case by the imposition of probation and numerous conditions.
Even a cursory review of the document will show
that I did not agree to any of these statements because they are all false and
are at best distortions of the truth. The only reason that I consented to the
probationary period was because I could not bear the expense of more legal fees.
The Board placed Dr. Rothstein on probation
for three years and imposed many conditions, including the following conditions
especially relevant to this case:
1. Dr. Rothstein was required to cease his practice of alternative or
complementary medicine, and practice only traditional, conventional or
osteopathic medicine. The term "alternative or complementary medicine" was
defined as including chelation therapy, hydrogen peroxide therapy, and vitamin
therapy except for prescriptions for vitamins approved by the supervisor;
2. Dr. Rothstein was required to cooperate fully with the Board and its agents
and employees in the monitoring, supervision and investigation of his compliance
with the terms of the order.
c. Current Charges of Violating the Standard of Quality Care
Patient A
The Board adopts the ALJ's proposed findings of fact numbers 23 through 30. Dr.
Rothstein, upon observing that his patient had a petechial rash over his entire
back, failed to treat the rash or to order any tests to determine its cause. A
petechial rash is a sign or thrombocytopenia, and it is a matter of some urgency
that a CBC be ordered to evaluate the platelet count. Dr. Rothstein's failure to
order a CBC in these circumstances constituted a violation of the standard of
quality medical care.
In reality the term “petechea” means small red
dots, medically it could mean a sign of thrombocytopenia. Thrombocytopenia is a
serious life threatening condition which will present with petechea (lots of
little red dots) but it will also present with large bruises over various parts
of the body. The only time you will see petechea on the back is on a bed ridden
patient. Furthermore, petechea do not go away spontaneously which in this case
they did. The patient did not have thrombocytopenia, the rash resolved by
itself. My only error was that I should have written “little red dots” instead
of petechial rash.
Again with respect to Patient A,
the Board adopts the AU's proposed findings of fact # 31 through 36. The Board
additionally finds that Dr. Rothstein violated the standard of quality medical
care when, upon observing atrophy in the patient, he failed to conduct or to
order tests of motor function or reflexes or to offer the patient a referral to
a neurosurgeon or other specialist who might conduct such an evaluation. The AU
found that Dr. Rothstein did evaluate the patient's reflexes and strength
(finding # 38), but the ALJ failed to note that this evaluation took place a
month before the finding of atrophy. The Board finds as additional facts that
Dr. Rothstein did not evaluate the patient's reflexes and strength at all
subsequent to his finding of thoracic outlet syndrome or his finding of
atrophy.1 The AU apparently failed to appreciate the significance of these
findings or the fact that such findings call for subsequent strength and reflex
testing or evaluation. The Board, therefore, finds that Dr. Rothstein's failure
to conduct such tests, order tests or to offer a referral to specialist in the
face of his own findings violated the standard of quality medical care. The
Board credits the expert testimony of Dr. MacGregor on this point. The Board is
not faulting Dr. Rothstein for his use of osteopathic manipulation on this
patient, but he has an obligation as well to recognize the signs and symptoms
that require medical testing and evaluation. As in the case of the petechial
rash, Dr. Rothstein recorded a symptom clearly calling for further medical
evaluation but failed to perform or order that evaluation. This places a patient
in danger and violates the standard of quality medical care.
Thoracic outlet syndrome is a common disorder
that can result in irritation of the nerves to the arm resulting in pain and
atrophy. It is easily diagnosed, especially by the skilled osteopathic
physician, and it is easily treated by a skilled osteopathic physician. I
diagnosed the condition, treated it appropriately and the patient got well.
Because of the paucity of education of the typical allopathic physician (M.D.)
they cannot conceive of making such a diagnosis and treatment without extremely
expensive diagnostic tests and risky treatments, such as removing a rib to
alleviate the pain which can cripple the patient for life.
Footnote 1: See State's Ex. 11, FS 1004, 1003.
Patient B
The Board adopts the ALJ's proposed findings of fact # 39 through 42. The Board
also agrees with the reasoning of the AU on this issue. The standard of quality
care requires that, when prescribing testosterone to a female patient, the
patient be individually warned of the possible severe side effects of the
treatment, which include virilization (increased facial hair, deepening of the
voice, and acne) and also that the warning be documented in the patient's chart.
Dr. Rothstein violated this standard.
The hypocrisy of this statement defies
imagination. In addition to informing every patient of the side effects of
testosterone therapy, every patient for which testosterone therapy is indicated
is given a copy of the newsletter I wrote about testosterone therapy (which
includes the possible side effects.) Is the Board saying that every physician
must document in every chart that the patient was told of the side effects of
every medication they prescribe or be guilty of violation of standard of care?
Does every physician in MD even tell the patient all of the side effects of all
the medications they prescribe? That I did not document that my patient was
informed of the side effects and given the newsletter is my only offense here.
Again with respect to Patient B, the Board
adopts the ALJ's proposed findings of fact # 43 through 52. Dr. Rothstein
improperly diagnosed and treated this patient for hypothyroidism with Armor
Thyroid when the only acceptable test for hypothyroidism showed a THS of 3.88,
which was within normal limits. Again, when the patient's THS subsequently was
measured at 2.4, another normal reading, Dr. Rothstein not only continued Armor
Thyroid inappropriately but also tripled the dose of Armor Thyroid to 45 mg.2
Whether caused by a lack of knowledge of appropriate diagnostic or treatment
standards or by a simple unwillingness to accept them, Dr. Rothstein's provision
of medical care to this patient was substandard. With respect to the charge that
Dr. Rothstein failed to consider that his prescribing of Armor Thyroid may have
caused this patient to develop iatrogenic3 hyperthyroidism, the Board disagrees
with the proposed finding of the ALJ. The ALJ failed to appreciate the
significance of the possible effects of hyperthyroidism, which include loss of
bone mass and cardiac toxicity which could possibly cause cardiac arrhythmias,
including atrial fibrillation. The Board is not finding that Dr. Rothstein
caused severe iatrogenic hyperthyroidism in this patient, but his tripling of
the dosage of Armor Thyroid in the face of continuing normal THS values raised
the very real possibility of iatrogenic damage, and his chart shows no
recognition of the possible danger to which he was subjecting this patient. Dr.
Rothstein's treatment of this patient with Armor Thyroid was not only
unjustified by the patient's condition, but it also subjected this patient to
the possibility of damage from this unnecessary treatment.
Footnote 2: The Board has considered Dr. Rothstein's evidentiary arguments
against the ALJ's proposed findings on this issue but rejects them.
Footnote 3: Iatrogenic means caused by the treatment itself.
This is such twisting of the facts on the part
of the Board that it borders on the bizarre. What’s considered a normal range
has a large amount of variability. Only a foolish doctor would rely on normal
range to make an assessment of a patient without taking into account their
symptoms. The normal range is where 95% of “normal” people fall in to. But
what’s normal for one person may not be normal for another person. Just because
a doctor is incapable of diagnosing a patient despite the results being within a
normal range, does not give them the right to condemn those of us who are
capable. It is interesting to note, however, that recently “normal range” has
dropped to a maximum of 2.5 for TSH.
In regards to “tripling the dose”, the Board fails to note that a full dose is
180 mg. and I took the patient’s dose from 15 to 45 mg. 45 mg. is a subclinical
dose incapable of causing the side effects which the Board fabricates. The fact
of the matter is, the patient’s dose was reduced to 30 mg. and she did extremely
well.
Again with respect to Patient B, the Board
finds, in accordance with Dr. MacGregor's testimony, that there was no clinical
indication for the prescription of progesterone to a woman post-hysterectomy who
was not both: (1) experiencing hot flashes, and (2) intolerant of estrogen. This
patient did not present both symptoms. Dr. MacGregor's testimony was based on
sound medical principles, while that of the defense experts appears to the Board
to be based on little more than medical wishful thinking. The Board credits the
opinion of Dr. MacGregor and gives it more weight than did the ALJ on this It is
surprising the level of ignorance of Dr. MacGregor.
To think that progesterone’s only action is upon the uterus indicates she has
not read a medical journal or text in 30 years. Progesterone has been shown to
prevent breast cancer, enhance estrogen’s effect on the brain to improve memory,
and help maintain bone density. It is a stimulator of GABA receptors in the
brain inducing calmness and deep sleep at night and it is a natural diuretic.
Patient C
The Board adopts the ALJ's proposed findings of fact # 53-73. In addition, the
Board adopts the ALJ's reasoning set out on pages 40 through 47 of the proposed
decision. Once again, Dr. Rothstein failed to advise a female patient of the
possible side effects of the testosterone he prescribed.
This has already been addressed in patient B.
Patients come in requesting testosterone therapy because they know of my
expertise. Every patient gets a copy of my newsletter discussing testosterone.
This is another example of the MBP’s attempt at a fault finding mission.
Dr. Rothstein once again used the incorrect
standard in deciding to treat this patient with Armor Thyroid, and he failed to
consider that his administration of Armor Thyroid may have caused iatrogenic
hyperthyroidism. In fact, in this case, Dr. Rothstein's treatment actually did
cause iatrogenic hyperthyroidism. In addition, although the chart showed that
this patient had been noncompliant in the past, and the test results at one
point strongly pointed toward noncompliance, Dr. Rothstein also failed to
inquire about compliance before carrying out his treatment. He recognized that
the patient had hypertension, and he prescribed appropriate medications at
times, but he failed to check her blood pressure over a period of over four
months. Each of these failures constitutes a violation of the standard of
quality medical care.
Again the Board refuses to look at the entire
picture. This was a very complex patient who responded well to my treatments.
Her blood-pressure came under control. Her depression lifted, her fluid
retention was alleviated and she never experienced symptoms of hyperthyroidism.
What the Board is alluding to is the fact that her dose had to be titrated which
means adjusting her dose. The fact that her TSH went too low, and then her
medication was adjusted to bring it to an acceptable number is a clear
indication of high quality care and follow-up. All physicians adjust medication
doses on their patients.
The Board rejects Dr. Rothstein's evidentiary arguments in his Exceptions that
he met the standard of quality care in his treatment of Patients A, B and C. The
findings above reflect substandard care, not reasonable "differences of opinion"
or "differences in semantics about a rash." Dr. Rothstein provided substandard
care to these patients.
Of course the Board rejects all of my
evidentiary arguments. Arguments were concise, logical, complete, and supported
by literature. National experts testified that my care was certainly within the
standard of care and my patients all did well. Unfortunately, the Board chose to
accept the opinion of a geriatric physician who did not understand Osteopathic
care, is out of date with her information about hormones, and does not
understand thyroid in their effort to substantiate their case against me.
d. Failure to Cooperate with a Lawful
Investigation of the Board
The Board adopts the AU's proposed factual findings # 20 through 22.
When Dr. Rothstein received the Board's subpoena for any and all medical records
for six patients, he supplied some of the records but failed to supply the
patient consent forms which he had had the patients sign. Almost two years
later, and then only in response to a second subpoena specifically naming the
patient consent forms, did Dr. Rothstein produce these forms.
In regards to my responding to the subpoena, it
is noteworthy that the MBP deliberately failed to mention that they had sent me
a letter informing me they were sending a subpoena for my medical records in
which all they wanted were the treatment records for the specified dates. It
wasn’t until 2 years later that they decided that they also wanted to see that I
had consent forms. I sent them the forms immediately and they responded that I
had failed to fully cooperate with a lawful investigation by the Board.
The Board agrees with the ALJ's evaluation of
the evidence on this issue set out on pages 50-51 of the Proposed Decision. The
Board, like the ALJ, finds Dr. Rothstein's testimony on this issue not credible.
The patient consent forms, in and of themselves, were strong evidence that Dr.
Rothstein may have been intentionally violating Consent Order II. For example,
the patient consent forms describe his treatment unequivocally:
It is important to understand that these theories and treatments are considered
by most physicians to be "alternative treatment" and not supported by generally
accepted scientific evidence.
Considering that Dr. Rothstein was under an obligation under Consent Order II to
cease his practice of alternative or complementary medicine, and practice only
traditional, conventional or osteopathic medicine, these consent forms were, on
their face, strong evidence that Dr. Rothstein may have intentionally violated
Consent Order II. The Board infers that Dr. Rothstein's failure to provide the
patient consent forms in response to the subpoena was not inadvertent or the
result of a misreading of Board communications, but was a deliberate act
calculated to prevent the Board from obtaining evidence in the medical record
which might show that he was guilty of violating Consent Order II.
This accusation is the direct result of a scheme to
conjure up a rationale to convict where there is no real evidence. As stated
above, the board had sent a letter clarifying exactly what they wanted, the
treatment records and that is exactly what they got, when they demanded the
consent forms, that is exactly what they got. Now they claim that I failed to
comply with a lawful investigation by the Board
Kali Bich is an old folk remedy
for sinus infections. The fact that the MBP is intolerant of this is just
another demonstration of their unwillingness to accept harmless remedies for the
treatment of non-critical illness.
Footnote 5: There is no issue of Kali Bich being an osteopathic treatment.
Footnote 6: The Board notes that even Dr. Teitelbaum was unfamiliar with the
substance, and that Dr. Blood does not use it.
Dr. Rothstein also clearly violated Consent Order I by administering intravenous
colchicine to Patient A. Although colchicine is not a vitamin, Dr. Rothstein
included it in his "vitamin cocktails" for this patient. Dr. Rothstein was
charged with practicing alternative or complimentary medicine by the use of
these "cocktails" containing colchicine. See Charges # 25 & 26.7 The expert
testimony of Drs. MacGregor and Braman was more convincing to the Board than the
testimony to the contrary. Treatment with colchicine, which can cause GI
toxicity and possible cardiac arrhythmias, does not constitute conventional or
traditional medical treatment, except for acute gouty arthritis. This patient
did not suffer from acute gouty arthritis. The testimony of these experts also
comports with the Board's own experience. The Board also notes that Dr.
Rothstein himself admitted on one of his patient forms that the administration
of colchicine was considered alternative medical treatment. This was a clear and
obvious violation of Consent Order II.
There are 2 basic tenents of the practice of
medicine that the MBP conveniently leaves out. The first is that any approved
medication can be used for any purpose under the direction of a qualified
physician. This is called “off-label” use of medication. The art of medicine not
only allows for, but encourages this. The MBP is unclear as to where they draw
the line between “off label” use of a drug and forbidden alternative medicine.
Colchicine has been shown to be highly effective in the treatment of radiculitis.
My use of colchicine was a legitimate use of a legitimate medication. To
mislabel this as alternative medicine is another clear indication of the MBP’s
misuse of power because of prejudice.
The second rule of medicine is that all medications have side effects, all
surgeries have the possibility of a fatal outcome, and that there is no one
treatment to which all patients respond. To state with such pompous
condescension that colchicine has side effects is nothing less that a feeble
attempt to find fault where there is none.
Footnote 7: The ALJ's statement that the administration of colchicine was not an
issue is simply not correct.
The Board agrees with the AU that the evidence was insufficient to prove that
the osteopathic treatment provided to these patients violated Consent Order II
or the standard of quality care in and of itself.
Dr. Rothstein also violated Consent Order II by providing intravenous vitamins
to all four of these patients. The ALJ found that there was no serious dispute
that the provision of intravenous vitamin therapy constitutes alternative
medicine, and the Board agrees. Consent Order II explicitly prohibited Dr.
Rothstein from practicing alternative medicine for the term of probation. In
addition to prohibiting alternative medicine in general, Consent Order II also
specifically prohibited "vitamin therapy," with the exception of "prescriptions
for vitamins approved by the physician's supervisor."
Dr. Rothstein's argument, that the exception for "prescriptions" overrides not
only the specific prohibition of "vitamin therapy" but also the general
prohibition of alternative medicine, is rejected. Even under the definition put
into evidence by Dr. Rothstein, a prescription is an "order for medication,
therapy or therapeutic device which ultimately goes to a person properly
authorized to dispense or perform the order." (Rothstein Exhibit 1) This
definition comports with the Boards' understanding of a prescription to mean an
order by a physician to someone else (usually a pharmacy but at times other
practitioners, such as nurses or physical therapists) for medication or
treatment. It certainly does not mean a physician's decision to perform a
treatment himself or herself without the involvement of another provider. Dr.
Rothstein's notations in the chart that he performed these treatments do not
constitute prescriptions. These notations do not even meet even the basic
requirements for a medical "order," since they do not even indicate the dosage.
And in any case, the Board concludes that a physician's decision to personally
perform a treatment is not a prescription. In addition, in the grammatical
context of Consent Order II, to read the exception for "prescriptions" to allow
intravenous vitamin therapy would be illogical, for there would be no need for
the express prohibition of "vitamin therapy" if there was an exception which
allowed all types of vitamin therapy. Since Dr. Rothstein was performing
"alternative" medical treatment and "vitamin therapy," this was an additional
violation of Consent Order II.8
This is a matter of law presented before a
judge who clearly decided in my favor. The contractual agreement composed by the
MBP was vague at best; I did my best to comply and the judge agreed with my
interpretation of the agreement, so did both of my physician supervisors. Once
again the board in a rampage to vilify me refuses to accept the state’s own
authority on matters of law.
Consent Order II came about because Dr.
Rothstein had violated the standard of quality medical care numerous times and
had been charged on two separate occasions. On the first occasion, Dr. Rothstein
administered intravenous hydrogen peroxide to several patients but failed to
evaluate symptoms of meningitis, pneumonia, unstable angina and congestive heart
failure; he prescribed intravenous injections in other patients while failing to
evaluate bone cancer (twice) and congestive heart failure. On the second
occasion, he provided chelation therapy and intravenous vitamin injections but
failed to properly evaluate shortness of breath (twice), EKGs (twice), high
blood pressure, and the indications of cancer.
The distortion of truth is so rampant in this
statement by the MBP that it defies imagination. I was the one to diagnose the
meningitis in the patient after his internist missed the diagnosis and my
treatment cured him of his symptoms. I was the one to diagnose the pneumonia,
referred him to his internist and despite the fact that the patient was almost
70 years old he was cured in less than 2 weeks. The claims of unstable angina
and heart failure are blatantly wrong. There was no unstable angina. The other
patient with the supposedly congestive heart failure was found to be suffering
from obesity. Her distended abdomen and shortness of breath were entirely a
result of obesity. The bone cancer patient came to me after his internist and
physical medicine specialist cleared him of any pathology and I was just to
treat him for his back pain. The back pain did indeed go away but after he
returned home from a vacation to Israel his back pain returned. He revisited his
internist who then discovered his cancer. Neither of the other doctors were
investigated for missing the diagnosis.
Footnote 8: Even if Dr. Rothstein had produced persuasive evidence that "IV
Vitamin Cocktails" now had scientific backing—and he did not—"IV Vitamin
Cocktails" would still constitute "vitamin therapy" and thus still be prohibited
by Consent Order II. His Exception raising this point is thus rejected.
The judge agreed that my limited and authorized use of
vitamins did not constitute a violation of the agreement and also prohibited me
from producing scientific evidence for the use of vitamin therapy. The board’s
insinuation is unjustified. Even at the board’s own hearing they refused to
accept any scientific validation on the use of vitamin therapy to treat disease.
One or more of these three alternative
medicine treatments were involved in almost all of these instances of
substandard care: (1) hydrogen peroxide injections; (2) chelation therapy; and
(3) intravenous vitamin therapy. It is
preposterous that safe, effective and inexpensive treatments, judiciously used,
and preferred by the patients in question should be considered substandard care.
When Consent Order II provided specifically that "chelation therapy, hydrogen
peroxide therapy and vitamin therapy" were prohibited, the obvious intent was to
prohibit especially these three particular alternative medicine treatments that
had repeatedly distracted Dr. Rothstein in the past from dealing with his
patients' critical medical problems. To read the word "prescriptions" as
overruling the entire prohibition of vitamin therapy would be unjustified in the
face of the Board's obvious concern that Dr. Rothstein had been using
intravenous vitamin therapy, chelation therapy, and hydrogen peroxide therapy
while ignoring his patients' potentially fatal symptoms. It is clear that the
intent of Consent Order II was to protect the public by prohibiting all three
(not just two) of those specific practices which had so distracted Dr. Rothstein
from providing adequate medical care in the past.
IV. CONCLUSIONS OF LAW
By providing substandard care to Patients A, Band C, as set out in the findings
of fact above, Dr. Rothstein failed to provide "quality medical or surgical
care" as those terms are used in the Medical Practice Act, in violation of that
Act at Md. Health Occ. Code Ann. § 14-404 (a) (22).
Dr. Rothstein failed to cooperate with a lawful Board investigation within the
meaning of Md. Health Occ. Code Ann. § 14-404 (a) (33) when he withheld the
consent forms from his response to the Board's investigative subpoena for any
and all medical records.
Dr. Rothstein violated the
probationary terms of the Consent Order of February 23, 2000 by practicing
alternative medicine during the term of the probation.
V. SANCTION
The Board has attempted to work with Dr. Rothstein for a decade. In the first
Consent Order, every effort was made to accommodate his desire to practice
alternative medicine, as long as he provided his patients with informed consent,
did his patients no harm and did not neglect their conditions that required
traditional medical evaluation or treatment. The first Consent Order was not
effective in protecting the public health, because he continued to neglect his
patients' serious medical symptoms and conditions. Despite this failure, the
Board once more entered into a consent order, Consent Order II, with Dr.
Rothstein. This second time, however, the Board attempted to alleviate any
danger to the public by prohibiting him from practicing alternative medicine and
requiring that he practice competent conventional medicine. He was also ordered
to "cooperate fully with the Board at all times" in the Board's oversight of his
practice.
Dr. Rothstein did not cooperate with the Board, and in fact he failed to
disclose to the Board in response to its investigative subpoena certain
documents from the medical files which on their face appeared to show that he
was continuing to practice alternative medicine in violation of Consent Order
II. This violation of Section 14-404 (a) (33) is extremely serious in the
Board's view, since it has destroyed the trust which the Board must have in the
cooperation of a physician before it can allow that physician to practice
medicine even under supervision.
After years of probation, peer reviews and supervision, Dr. Rothstein continues
to practice substandard medicine. His failure to order a CBC when Patient A
displayed a petechial rash, his treatment of Patient B with Armor Thyroid
without medical justification, and his inappropriate treatment of Patient C with
Armor Thyroid without consideration of the fact that his treatment may be
causing iatrogenic hyperthyroidism, are alone sufficient examples of continued
substandard care to convince the Board that Dr. Rothstein is not capable of
being re-educated and will pose a danger to the public if allowed to continue to
practice. The additional findings of substandard care proposed by the ALJ and
found by the Board are also of serious concern to the health of his patients.
The Board will revoke his license to practice medicine and will not entertain
any reapplication for at least five years.
The Board also has made findings of violations of the standard of quality care
which were in addition to those recommended by the ALJ. The Board also made the
additional finding that Dr. Rothstein violated Consent Order II. The additional
findings of violations made by the Board are additional indications that Dr.
Rothstein should not be practicing medicine and cannot be trusted to respond
appropriately to any sort of probationary arrangement. Even without these
additional findings, however, the Board would have imposed the same sanction.
The Board simply cannot allow Dr. Rothstein to continue to practice substandard
medicine on the public after two unsuccessful efforts to rehabilitate his
practice.
The Board rejects Dr. Rothstein's repeated statement in his Exceptions that the
Board is disciplining him because he advocates for the practice of alternative
and complimentary medicine.
If this were the case then why did they prevent
me from practicing alternative and complementary medicine? Why were they so
opposed to chelation therapy and hydrogen peroxide therapy especially when it
worked so well? Why do they feel so compelled to deprive the citizens of
Maryland of freedom of healthcare? Their actions are in contrast to their words,
it is they who cannot be trusted.
The Board's past rulings on this issue were
accurately summarized in the article cited in State's Exhibit 10 and will not be
repeated at length here. The Board is not concerned with the fact that Dr.
Rothstein advocates for the use of alternative and complimentary medicine. The
Board is concerned that Dr. Rothstein is placing his patients in danger by
ignoring serious symptoms which could be treated or at least evaluated by
conventional medicine, that he is misinterpreting the results of conventional
medical tests and that this problem has endured for years despite the Board's
attempts to help him remediate these problems.
The Board notes that Dr. Rothstein admitted during the Exceptions process that
many of the most serious charges relating to Patients A, Band C had nothing to
do with alternative or complimentary medicine. Dr. Rothstein characterizes these
problems as "niggling matters." The Board strongly disagrees. These were serious
medical lapses which could have resulted in serious patient injury or death. The
fact that none of this particular set of patients died does not detract from the
seriousness of the continuing deficiencies in Dr. Rothstein's practice of
medicine.
Not only did no one die but they all got
better! Why is it that conventional doctors refuse to learn from others who are
able to help their patients?
The Board has also considered all of the
remaining exceptions filed by Dr. Rothstein but finds them to be without merit.
THIS BLATANT MISUSE OF POWER COUPLED WITH
MISSTATEMENT AND/OR DISTORTIONS OF THE FACTS EMPHASIZES THE OBVIOUS PREJUDICE OF
THE MARYLAND BOARD OF PHYSICIANS EVEN TO THE POINT OF JEPORDIZING THE HEALTH OF
THE CITIZENS OF MARYLAND.
VI. ORDER
It is hereby ORDERED that the medical license of Binyamin Rothstein, D.O., be
and it hereby is, REVOKED; and it is further ORDERED that the Board will not
consider any application for reinstatement before five years from the date of
this order. So ordered the 26th day of May, 2005.
_____________________________
Irving Pinder, Jr., Executive Director
Maryland State Board of Physicians
NOTICE OF RIGHT TO APPEAL
Pursuant to Maryland Health Occ. Code Ann. § 14-408 (b), Dr. Rothstein has the
right to take a direct judicial appeal. Any appeal shall be filed within 30 days
from the receipt of this Final Opinion and Order and shall be made as provided
for judicial review of a final decision in the Maryland Administrative Procedure
Act, State Gov't Article § 10-222 and Title 7, Chapter 200 of the Maryland Rules
of Procedure.
If Dr. Rothstein files an appeal, the Board is a party and should be served with
the court's process. In addition, Dr. Rothstein should send a copy to the
Board's counsel, Thomas W. Keech, Esq. at the Office of the Attorney General,
300 West Preston Street, Suite 302, Baltimore, Maryland 21201. The
Administrative Prosecutor is not involved in the case at this point and need not
be served with or copied on the pleadings.