Prolotherapy Practitioner Severely Disciplined
Stephen Barrett, M.D.
In 2002, the Maryland State Board of Physicians reprimanded Donald H. Hislop, M.D., for failing to keep adequate records and placed him on probation with requirements for remedial education and peer review of his patient care. In 2005, after the peer reviewers complained that his care still failed to meet quality standards, an Administrative Law Judge held a four-day evidentiary hearing that evaluated his care of six patients. The judge concluded that Hislop had improperly evaluate and treated various patient complaints and had inappropriately administered prolotherapy to three patients without trying less conservative measures. (Prolotherapy is a questionable treatment for chronic musculoskeletal pain. It involves injections of an irritant solution near the site of connective tissue dysfunction. Proponents claim this can resolve pain by increasing the thickness and strength of the ligaments.) The judge also concluded that Hislop had failed keep adequate medical records and, despite his previous reprimand, had even failed to note the contents of his prolotherapy injections. The board (see below) then placed Hislop's license on indefinite suspension until he completed extensive remedial training and could satisfy the board that he was competent to resume practice. In 2006, the board denied his application for reinstatement. However, in 2008, it ruled that if he satisfies further training requirements, the suspension would be terminated and followed by a minimum of two years of probation.
IN THE MATTER OF
Donald Hislop, M.D.,
License No. 008293
BEFORE THE MARYLAND
STATE BOARD OF
Case No. 2000-0551
FINAL DECISION AND ORDER
Based on a complaint filed in February of 2000, the Board previously charged Donald Hislop, M.D. ("Dr. Hislop") with violations of the Medical Practice Act. On August 28th of 2002, Dr. Hislop entered into a Consent Order with the Board. In this Consent Order, Dr. Hislop was found to have failed to keep adequate medical records within the meaning of Md. Health Occ. Code Ann. § 14-404 (2) (40). Dr. Hislop was reprimanded for that offense and was required to conform to certain conditions, including certain education courses, including a medical records course, and was to be subject to peer review of his medical care.
This case arose out of that subsequent peer review. The peer reviewers alleged that Dr. Hislop failed in many of the cases reviewed to meet the standard of quality medical care and failed to keep adequate medical records. Dr. Hislop was thus charged in this case with violations of Md. Health Dcc. Code Ann. §§ 14-404 (a) (22) and (40).
A four-day evidentiary hearing was held before an Administrative law Judge ("AlJII) beginning on February 22, 2005. Six medical experts testified and 28 exhibits, including extensive medical records, were admitted. The AlJ issued a detailed Proposed Decision on May 24, 2005. The ALJ proposed a finding that Dr. Hislop had violated the standard of quality care in his treatment of Patients A, B, C, D and F, and that he failed to keep adequate medical records in the cases of Patients A, B, C, D, E and F.
Dr. Hislop filed written Exceptions to the Proposed Decision, and an oral Exceptions Hearing was held before the full Board on October 26,2005. The Board has considered the entire record in this case, including all of the exhibits and testimony presented at the administrative hearing, and has considered all of the Exceptions filed before the Board by Dr. Hislop. The Board finds Dr. Hislop's Exceptions to be without merit. For the most part, these Exceptions request the Board to make different assignments of weight and credibility to the expert witnesses than did the AlJ. The Board declines to do this. The Exceptions also complains that, although Dr. Hislop had completed the didactic part of his medical record keeping course by November of 2002, the use of some records dating from December 1, 2002 in this case was unfair. The Board disagrees. Dr. Hislop at that point had been a practicing physician for 28 years. He had been disciplined for inadequate medical records in 2002. He had completed the didactic part of the medical records course required as a part of the previous Consent Order, which course requirement was over and above all of the normal continuing medical education requirements. Nothing in the Consent Order absolved him from keeping adequate medical records until after the completion of the follow-up to the medical records course. Dr. Hislop had been on notice for over two years that his record keeping was inadequate, and his failure to note in the record such basic information as what substance he was injecting into a patient is inexcusable. The Board has also considered Dr. Hislop's other Exceptions and finds them to be without merit.
FINDINGS OF FACT
The Board adopts the findings of fact proposed by the ALJ. These factual findings were proved by clear and convincing evidence. The Proposed Decision of the ALJ is incorporated into and attached to this Final Decision and Order as Attachment A.
CONCLUSIONS OF LAW
The Board adopts the conclusions of law proposed by the ALJ. The Board also adopts the "Discussion" section of the ALJ's Proposed Decision at pages 21 through 49, exclusive of the discussion of the proper sanction to be imposed.
The Board will modify the sanction proposed by the ALJ. The Board does not believe that the Institute for Physician Evaluation course in Philadelphia is presently available. In addition, the Board believes that an indefinite period of suspension, with a return to practice contingent on a demonstration to the Board of current competence, and subject to further possible restrictions if return to practice is granted I is in this case the preferable way to structure this particular sanction. The Board is extremely concerned about the possible danger to the patient public posed by Dr. Hislop, especially in the light of the apparently unsuccessful attempts at remediation since the date of the Consent Order.
It is therefore ORDERED that Dr. Hislop is SUSPENDED from the practice of medicine effective fifteen calendar days from the date of this ORDER; and it is further
ORDERED that the suspension will remain in effect INDEFINITELY and the suspension may be stayed or lifted only if all of the following conditions are met:
1. Dr. Hislop obtains at his own expense a formal assessment of his competence from the Center for Personalized Education for Physicians ("CPEP") and arranges for the formal CPEP assessment to be forwarded to the Board1; in the alternative, Dr. Hislop may provide an assessment from the Medical Review and Accrediting Council, sponsored by the Federation of State Medical Boards, provided that this assessment is in the Board's judgment the equivalent of a formal CPEP assessment; Dr. Hislop has the burden of demonstrating to the Board in writing in advance the equivalency of this alternative program;
1Dr. Hislop should be aware that such as assessment may require the submission of patient charts. To the extent that these charts may be required, it is Dr. Hislop's responsibility to initiate the assessment at a time when charts are available to him.
2. After the Board has received the formal assessment required under Condition 1, Dr. Hislop submits a written petition to appear before a panel of the Board to discuss the assessment;
3. The Board panel determines in the exercise of its judgment that Dr. Hislop is competent to practice medicine in light of the assessment, either with or without conditions, which conditions may include a stayed suspension or a period of probation (with or without terms and conditions), or both, and makes that recommendation to the full Board;
4. The full Board, after considering the recommendations of the Board panel, determines in the exercise of its discretion that Dr. Hislop is competent to practice medicine in light of the assessment and approves the lifting of the suspension with or without conditions, which conditions may include a stayed suspension or a period of probation (with or without terms and conditions), or both, and issues a subsequent Order effectuating its decision; and
5. Dr. Hislop, if required by any terms or conditions of any probation or stay of suspension imposed by the Board, upon such a lifting or stay of the suspension, performs and continues to perform these terms or conditions at his own expense, including if applicable the costs of any educational program required as a condition of probation or a condition of the stay of the suspension; and it is further
ORDERED that nothing in this Order is meant to imply that the Board must at any time approve a stay or termination of the suspension imposed in this ORDER; and it is further
ORDERED that if the Board, upon receipt of the assessment called for in this Order, determines that in its judgment that Dr. Hislop is not competent to practice medicine, the suspension will continue, and Dr. Hislop will thereafter have the right at yearly intervals to petition the Board to stay or terminate the suspension; and Dr. Hislop will have the burden of demonstrating to the satisfaction of the Board that he had taken steps subsequent to the original assessment which have rendered him competent to practice medicine again; and it is further
ORDERED that Dr. Hislop shall be responsible for all costs incurred in complying with or fulfilling any conditions of any part of this ORDER, including any terms of any subsequent order staying or terminating the suspension; and it is further
ORDERED that this ORDER is a public document pursuant to Md. State Gov't Code Ann. § 10-611 et seq.
SO ORDERED this 23rd day of November, 2005.
C. Irving Pinder, Jr., Executive Director
Maryland State Board of Physicians
This page was posted on March 23, 2008.