Disciplinary Actions against Deborah Metzger, M.D.
Stephen Barrett, M.D.
Deborah Metzger, M.D. is a gynecologist with a Ph.D. is molecular endocrinology. From 2004, through 2014, she operated Women's Harmony Health in Los Altos, California. Her clinic Web site described her as "recognized as one of the leading authorities in the integrative and holistic treatment of endometriosis and chronic pelvic pain" and "an expert in chronic fatigue, fibromyalgia and Lyme disease." However, documents from the Medical Board of California suggest to me that this description is not justified.
In 2004, the board charged her with incompetence, gross negligence, repeated negligence, excessive treatment, and/or creating false medical documents in connection with her management of six surgical patients. This case was settled with an agreement under which she was (a) placed on probation for five years (b) prohibited from practicing surgery, (c) required to have her practice and billing monitored, and (d) assessed $25,000 to cover the cost of the board's investigation and prosecution. Her probation ended in 2010, but in 2012, as shown below, she was charged again with repeated negligence and inadequate recordkeeping in her management of three patients. These charges were settled with an agreement under which she was placed on probation for three years and ordered to either undergo a lengthy assessment and education program or have her practice monitored. A message posted to a doctor evaluation site states that in April 2014, she notified patients by e-mail that she was retiring.
JOSE R. GUERRERO
Supervising Deputy Attorney General
Deputy Attorney General
State Bar No. 111898
455 Golden Gate Avenue, Suite 11000
San Francisco, CA 94102-7004
Telephone: (415) 703-5539
Facsimile: (415) 703-5480
Attorneys for Complainant
DIVISION OF MEDICAL QUALITY
MEDICAL BOARD OF CALIFORNIA
DEPARTMENT OF CONSUMER AFFAIRS
STATE OF CALIFORNIA
In the Matter of the Accusation Against:
DEBORAH METZGER, M.D.
Physician's and Surgeon's License
Case No. 19-2010-204971
FILED: January 27, 2012
1. Linda K. Whitney (Complainant) brings this Accusation solely in her official capacity as the Executive Director of the Medical Board of California, Department of Consumer Affairs.
2. On or about November 20, 1998, the Medical Board of California issued Physician's and Surgeon's Certificate Number C50171 to Deborah Metzger, M.D. (Respondent). At all relevant times, said certificate has been current and valid. Effective February 25, 2005, Respondent's Physician's and Surgeon's Certificate was revoked, and the revocation was stayed, provided that Respondent successfully complete the terms and conditions of a five year probation. Respondent completed that probation on February 25, 2010. Unless renewed, the certificate will expire on March 31, 2012.
3. This Accusation is brought before the Medical Board of California (Board 1) under the authority of the following laws. All section references are to the Business and Professions Code unless otherwise indicated.
4. Section 2004 of the Code provides, in pertinent part, that the Medical Board shall have responsibility for:
"(a) The enforcement of the disciplinary and criminal provisions of the Medical Practice Act.
(b) The administration and hearing of disciplinary actions.
(c) Carrying out disciplinary actions appropriate to findings made by a panel or an administrative law judge.
(d) Suspending, revoking, or otherwise limiting certificates after the conclusion of disciplinary actions.
(e) Reviewing the quality of medical practice carried out by physician and surgeon certificate holders under the jurisdiction of the board ... "
5. Section 2227 of the Code provides that a licensee who is found guilty under the
Medical Practice Act may have his or her license revoked, suspended for a period not to exceed one year, placed on probation and required to pay the costs of probation monitoring, or such other action taken in relation to discipline as the Board deems proper.
6. Section 2228 of the Code provides that a probation imposed by the Board may include, but is not limited to the following:
"(a) Requiring the licensee to obtain additional professional training and to pass an examination upon the completion of training. The examination may be written or oral, or both, and may be a practical or clinical examination, or both, at the option of the board or the administrative law judge."
"(b) Requiring the licensee to submit to a complete diagnostic examination by one or more physicians and surgeons appointed by the board. If an examination is ordered, the board shall receive and consider any other report of a complete diagnostic examination given by one or more physicians and surgeons of the licensee's choice."
"(c) Restricting or limiting the extend, scope, or type of practice of the licensee, including requiring notice to applicable patients that the licensee is unable to perform the indicated treatment, where appropriate."
Section 2234 of the Code provides:
"The Division of Medical Quality shall take action against any licensee who is charged with unprofessional conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not limited to, the following:
" . . . (c) Repeated negligent acts. To be repeated, there must be two or more negligent acts or omissions. An initial negligent act or omission followed by a separate and distinct departure from the applicable standard of care shall constitute repeated negligent acts. "(1) An initial negligent diagnosis followed by an act or omission medically appropriate for that negligent diagnosis of the patient shall constitute a single negligent act.
"(2) When the standard of care requires a change in the diagnosis, act, or omission that constitutes the negligent act described in paragraph (1), including, but not limited to, a reevaluation of the diagnosis or a change in treatment, and the licensee's conduct departs from the applicable standard of care, each departure constitutes a separate and distinct breach of the standard of care.
Section 2234.1 provides, in pertinent part:
"(a) A physician and surgeon shall not be subject to discipline pursuant to subdivision (b), (c), or (d) of Section 2234 solely on the basis that the treatment or advice he or she rendered to a patient is alternative or complementary medicine, including the treatment of persistent Lyme disease, if the treatment or advice meets all of the following requirements:
"(1) It is provided after informed consent and a good-faith prior examination of the patient and medical indication exists for the treatment or advice, or it is provided for health or well-being.
"(2) It is provided after the physician and surgeon has given the patient information concerning conventional treatment and describing the education, experience, and credentials of the physician and surgeon related to the alternative or complementary medicine that he or she practices.
"(3) In the case of alternative or complementary medicine, it does not cause a delay in, or discourage traditional diagnosis of, a condition of the patient.
"(4) It does not cause death or serious bodily injury to the patient. .. "
Section 2266 of the Code provides that it is unprofessional conduct for a physician to fail to maintain adequate and accurate medical records.
10. As set forth above, Respondent's Physician's and Surgeon's Certificate was placed on probation, effective February 25, 2005. Included in the terms and conditions of Respondent's probation was the requirement that her medical practice be monitored by a physician and surgeon in her specialty. Respondent proposed, and the Board approved, a physician with training and experience in OB/GYN and Integrative Medicine. Over the course of nearly five years, Respondent in concert with that monitor developed and implemented certain protocols and procedures for her medical practice and record keeping. The agreed protocols and procedures included asking all new patients about their desire for future fertility, asking all patients about their method of contraception and last menstrual period at every visit, and counseling patients regarding preconception preparation and potentially toxic or teratogenic effects of their medications and supplements.
11. For several years, Respondent appeared to have brought her practice into conformity with the agreed protocols and procedures; however, in or about late 2009, the practice monitor learned that the charts she had reviewed had been reviewed by Respondent prior to the monitor's review. The monitor was concerned that Respondent might be concealing deficiencies in her practice and record keeping, so she then selected patient charts for review without advance notice to Respondent. In the selected cases, the monitor discovered that Respondent was not in compliance with the agreed protocols and procedures. The Board was notified and an investigation ensued, resulting in the charges set forth in this Accusation.
FIRST CAUSE FOR DISCIPLINE
(Repeated Negligent Acts/Inadequate Records)
2Patient names are abbreviated to protect privacy.
12. Respondent is subject to disciplinary action under sections 2234(c) and 2266, in that Respondent was repeatedly negligent in her care and treatment of Patient M.H., and failed to keep adequate and accurate records relating to the patient. The circumstances are as follows:
A. According to Respondent's records Patient M.H., who was then aged 42, first consulted with Respondent on March 23, 2006. At that time, M.H. reported multiple medical issues, including chronic fatigue, infertility, chronic pelvic pain, fatigue, and Irritable Bowel Syndrome and migraine headaches. At the initial visit Respondent obtained a history and performed a comprehensive, albeit not exhaustive, physical examination. Vital signs were recorded and abnormal findings on the examination were noted in the records.
B. Patient M.H. continued under Respondent's care and treatment through June 2010. Respondent rarely recorded the patient's vital signs at each visit and, after 2008, discontinued charting them at all.
C. After the initial evaluation in March 2006, and continuing through 2010, and despite the patient's multiple continuing medical problems, Respondent routinely did not perform and/or document a physical examination on each visit. Respondent's records are notable for containing only one complete physical examination in four years, with only one or two intervening, focused examinations of the patient's abdomen.
13. Respondent's Physician and Surgeon's Certificate is subject to disciplinary action pursuant to sections 2234(c) and 2266, in that Respondent was repeatedly negligent in her care and treatment of M.H., including but not limited to the following:
A. Respondent routinely failed to assess and/or to record the patient's vital signs;
B. Respondent routinely failed to perform and/or failed to chart a physical examination of the patient.
SECOND CAUSE FOR DISCIPLINE
(Repeated Negligent Acts/Inadequate Records)
14. Respondent is subject to disciplinary action under sections 2234(c) and 2266, in that Respondent was repeatedly negligent in her care and treatment of Patient K.K., and failed to keep adequate and accurate records relating to the patient. The circumstances are as follows:
A. Patient K.K., a 37 year old woman living in North Carolina, came under Respondent's care and treatment in January 2008 and continued to consult with her, by telephone and in person, through February 2010. Respondent's records fail to specify which medical consultations were by telephone and which were office visits, but at least two, and likely three, were in-person medical visits.
B. On January 14, 2008, Patient K.K. contacted Respondent for initial evaluation with chief complaints that included endometriosis, infertility, chronic pelvic pain, dysmennorhea, depression and weight issues. Patient K.K. indicated that she was interested in fertility enhancement and she provided several completed questionnaires, including such health concerns as fertility, polycystic ovary syndrome, chronic pelvic pain and endometriosis. There is no record of a physical examination on this occasion (which may have been a telephone consultation), nor are any vital signs recorded. Respondent developed a problem list that included 16 medical concerns, including (and listed as problems 1-4): Endometriosis, chronic pelvic pain, fertility and abnormal vaginal bleeding.
C. On March 31, 2008, Patient K.K. had her second encounter with Respondent. Albeit correspondence from the patient indicates that this was an office visit, a physical examination was not performed and/or was not documented in Respondent's chart. Albeit the patient stated that she wanted to become pregnant, the date of the patient's last menstrual period is also not noted. Respondent performed a glucose challenge test and based on two elevated insulin levels, made a diagnosis of insulin resistance; despite the fact that the diagnosed insulin resistance increased the patient's risk of high blood pressure, no blood pressure reading or other vital signs are recorded. At that time, based upon positive Western blot test results, Respondent diagnosed Lyme disease and wrote that Lyme disease was possibly the main culprit in K.K.' s fertility and allergy issues. Respondent prescribed multiple, potentially teratogenic medications and supplements to treat the disorder, including Artemisin, Biaxin, Diflucan, Doxycycline, Hydroxychloroquine and Samento. Respondent explained some, but not all, of the potential teratogenic effects of the drugs and supplements prescribed by her.
D. Following the March office visit, Patient K.K. continued treatment under Respondent's direction for more than 18 months without a documented face-to-face evaluation and examination. In the course of the approximately 12 interim encounters with the patient during this period, Respondent consistently failed to document the patient's last menstrual period.
E. Respondent tested and treated K.K. for serotonin and progesterone allergies. In 2008-2009, Respondent prescribed sublingual hormone drops. Although Respondent obtained K.K. 's informed consent to allergy testing, she failed to obtain and/or failed to document the patient's informed consent to treatment with experimental therapies for these diagnoses.
F. On October 12, 2009, the patient returned to Respondent's office. At that time she reported feeling much improved and that she was on a five week pulsing course of Samento for Lyme disease. Respondent either did not perform or did not document a physical examination, nor did she record the patient's vital signs. The date of her last menstrual period was also not recorded.
G. On February 10, 2010, Patient K.K. again consulted with Respondent, apparently by telephone. She reported that she continued to suffer headaches and Pre-Menstrual Syndrome symptoms before her period; however, Respondent did not note when her last period occurred.
15. Respondent's Physician and Surgeon's Certificate is subject to disciplinary action pursuant to sections 2234(c) and 2266, in that Respondent was repeatedly negligent in her care and treatment of K.K., including but not limited to the following:
A. Respondent failed to perform and/or failed to document a physical examination of the patient on the occasions when the patient presented for an office visit;
B. Respondent failed to document vital signs, including but not limited to blood pressure, on those occasions when K.K. presented to her office -- despite the fact that the patient's history and condition placed her at increased risk for elevated blood pressure;
C. Respondent did not document the date of the last menstrual period for Patient K.K. after the initial encounter;
D. Respondent failed to counsel Patient K.K. regarding all potential teratogenic effects of the medications and supplements prescribed by Respondent or their compatibility with the patient's desire to become pregnant;
E. Respondent failed to advise Patient K.K. regarding the experimental status of hormone and neurotransmitter allergies and, for that reason, did not obtain the patient's
THIRD CAUSE FOR DISCIPLINE
(Repeated Negligent Acts/Inadequate Records)
16. Respondent is subject to disciplinary action under sections 2234(c) and 2266, in that Respondent was repeatedly negligent in her care and treatment of Patient L.G., and failed to keep adequate and accurate records relating to the patient. The circumstances are as follows:
A. Patient L.G., a 42 year old woman, came under Respondent's care and Treatment on July 24, 2008. At that time, L.G. reported multiple symptoms related to Lyme disease and gave a history of a positive Western blot test and treatment with doxycycline for the disorder.
B. At the initial evaluation, Respondent performed a comprehensive physical examination and recorded the date of the patient's last menstrual period and her vital signs. However, on each of the nine subsequent visits (and albeit Respondent had undertaken to prescribe L.G.'s contraceptives as of March 2009), Respondent failed to document the date of L.G.'s last menstrual period or vital signs. On only one of the intervening visits (which took place on November 13, 2008) did Respondent document findings on physical examination.
C. On August 31, 2009, Respondent performed an "annual" medical examination, which included a comprehensive physical examination, the date of the patient's last menstrual period, and vital signs; thereafter, she returned to her prior pattern of omitting this documentation and these omissions continued from visit to visit, through June 2010.
D. Over the course of two years, Respondent treated Patient L.G. with prolonged courses of antibiotics, herbs and supplements; however, she either failed to discuss and/or to document counseling Patient L.G. on the risk of contraceptive failure while on extended courses of antibiotics.
17. Respondent's Physician and Surgeon's Certificate is subject to disciplinary action pursuant to sections 2234(c) and 2266, in that Respondent was repeatedly negligent in her care and treatment of L.G., including but not limited to the following:
A. On all but two occasions, Respondent failed to record the patient's vital signs;
B. On all but three occasions, Respondent failed to document findings on physical examination;
C. Respondent repeatedly failed to record the date of the patient's last period or the characteristics of her menses;
D. Respondent failed to counsel and/or to document counseling regarding the potential for contraceptive failure as a consequence of long-term antibiotic therapies.
WHEREFORE, complainant prays that a hearing be held and that the Board issue an order:
1. Revoking or suspending Physician's and Surgeon's Certificate number C50 171, issued to Deborah Metzger, M.D.;
2. Prohibiting Deborah Metzger, M.D., from supervising a Physician Assistants;
3. Ordering Deborah Metzger, M.D" if placed on probation, to pay the costs of probation monitoring;
4. Taking such other and further action as may be deemed proper and appropriate.
DATED: January 27, 2012
LINDA K. WHITNEY
Medical Board of California
Department of Consumer Affairs
State of California
ComplainantThis page was posted on June 17, 2015.