In June 2014, Stephen L. Smith, M.D., who operates the Northwest Healthcare and Wellness Center in Richland, Washington, was charged with unprofessional conduct in connection with his management of an autistic teenager. The statement of charges (shown below) alleged that Smith fell below the standard of care by:
- Failing to record a detailed history and document appropriate physical examinations
- Diagnosing malabsorption without documenting an appropriate management plan
- Diagnosing toxic encephalopathy or lead poisoning despite the fact that there was no evidence to support this diagnosis
- Treating the boy with probiotics, medication and a variety of supplements that cannot cure autism, did not address the patient’s symptoms, and were potentially dangerous
- Failing to document many of the supplements he provided
- Failing to attempt to have the boy evaluated by appropriate specialists
In November 2014, Smith signed a consent agreement in which he stipulated that the charges were fact-based and the board ordered him to (a) pay a $1,000 fine, (b) stop treating patients under the age of 18, and (c) stop doing provoked testing. He must also refrain from treating adults who are not also under the care of a primary-care provider or a physician who is board-certified in a subspecialty of internal medicine.
This is the second time Smith got into trouble. In 2006, he was charged with unprofessional conduct for relying on unreliable diagnostic tests and failing to provide or refer the patient for appropriate treatment. The questionable tests included hair analysis and a provoked urine test for mercury toxicity. Smith’s inappropriate “working diagnoses” included mold contamination, organ inflammation due to rapid detoxification, mercury toxicity, probable Lyme disease, and a viral inflammation of the abdomen for which he prescribed intravenous hydrogen peroxide. In 2007, he was ordered to pay a $5,000 fine, undergo a practice evaluation, and do what the evaluators recommended.
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
MEDICAL QUALITY ASSURANCE COMMISSION
In the Matter of the License to Practice
STATEMENT OF CHARGES
Filed JUN 12, 2014
The Executive Director of the Medical Quality Assurance Commission (Commission) is authorized to make the allegations below, which are supported by the evidence contained in file number 2012-7950. The patient referred to in this Statement of Charges is identified in the attached Confidential Schedule.
1. ALLEGED FACTS
1.1 On June 30, 1981, the state of Washington issued Respondent a license to practice as a physician and surgeon. Respondent is not board-certified. Respondent’s license is currently active.
1.2 Respondent began treating Patient A, a fifteen-year-old boy, on May 5, 2011. Patient A had been diagnosed with autism at the age of four. Patient A had been treated by a physician in Oregon for several years until Patient A’s father transferred care to Respondent. Respondent considered himself to be Patient A’s primary care provider.
1.3 Respondent did not document a physical examination on the first visit. Respondent documented that “we will continue to follow the protocol set up by Dr. Green,” but does not document the elements of the protocol.
1.4 Respondent noted that a lab report in the file showed very high levels of lead, consistent with the finding of autism; however, there is no corroborating lab report in the patient’s record provided by Respondent. Respondent diagnosed Patient A with toxic encephalopathy, delayed milestones, and malabsorption.
1.5 Respondent next saw Patient A on May 11, 2012. Respondent’s documentation of a physical exam consisted of stating that he was healthy and happy. Respondent noted that Patient A was “still having bowel issues.” Respondent’s assessment was still toxic encephalopathy, delayed milestones, and malabsorption. Respondent reported changes to the protocol to add Deplin, increase vitamin D, add fire homeopathic sprays, and Bio-GGG.
1.6 Respondent next saw Patient A on August 3, 2012. Respondent’s · documentation of a physical exam consisted of “skin is good. He seems calm, follows instructions. He does not talk much.” Respondent’s assessment was still toxic encephalopathy, delayed milestones, and malabsorption. Respondent noted that Patient A was having bowel issues, including constipation and gas. Respondent documented that he placed Patient A on Neuroflam, Probiotic HCL, Wood HP, BetaTCP, Proschol, and PCA-RX push. Respondent provided a number of additional supplements that he did not document in the medical record. These included Reconostat 100mg one tablet, phenylalanine 500mg one tablet, Gota kola 475 mg six tablets, Calcium one tablet, amino acid complex with starch, L-tryptophan 500mg one tablet, phosphocholine four tablets, methyl B-12 5000 mg one tablet, Co-Q enzyme 100 mg, psyllium husk 500mg three tablets, L-Carnitine 1000 mg one tablet, flax, alive multi vitamin, super B complex one tablet, Vitamin E 200mg one tablet, fish oil two tablespoons, and prune juice.
1.7 A lab test of August 14 and 15, 2012, showed Patient A’s lead level at 3.7 μg/dl.
1.8 Respondent next saw Patient A on September 28, 2012. Respondent’s assessment was toxic encephalopathy, delayed milestones, malabsorption and MTHFR 677 heterozygous. Respondent noted that Patient A’s medications were Bethanechol chloride and Deplin. Respondent documented that his plan is to continue current supplementation plan, add 1-carnitine or acetyl carnitine, change probiotic to two HLC mind link, continue NDF. Respondent did not documen.t the complete list of supplements provided to Patient A.
1.9 Respondent failed to meet the standard of care in his treatment of Patient A in the following respects:
1.9.1 Respondent failed to document appropriate physical examinations of Patient A.
1.9.2 Respondent failed to document many of the supplements he provided to Patient A.
1.9.3 Respondent failed to attempt to have Patient A evaluated by a board-certified pediatrician, a child neurologist, or a child psychiatrist to provide the testing and clinical examination to substantiate the diagnosis of autism or one of the autism spectrum disorders.
1.9.4 Respondent failed to document a standard pediatric database from which one could reference in order to understand the nature of Patient A’s diagnosis. A standard pediatric database would include a detailed history of the circumstances surrounding the pregnancy at birth, early childhood development, medical history of .illness, medication exposure, history of injury, any underlying systemic medical conditions, family history, and etiological basis for autism.
1.9.5. Respondent diagnosed delayed milestones, but failed to document the specific developmental milestones that were delayed. Respondent did not document a workup to find the etiology for the delayed developmental milestones. There are many pediatric diseases, brain and otherwise, that can result in delayed milestones, many of which are treatable.
1.9.6 Respondent diagnosed Patient A with malabsorption, but failed to document a plan to address Patient A’s malabsorption. If Patient A had an intestinal malabsorption disorder, the standard of care requires that Patient A be seen by a board-certified pediatrician and a pediatric gastroenterologist.
1.9.7 Respondent treated Patient A with probiotics, medication and a variety of supplements that cannot cure autism, do not address the symptoms, and are potentially dangerous. It is possible that this caused Patient A’s gastric issues.
1.9.8. Respondent diagnosed Patient A with toxic encephalopathy or lead poisoning despite the fact that there was no evidence to support this diagnosis. Patient A had no signs of lead poisoning and no history of exposure to lead. Patient A’s lead levels were in the normal range. If Respondent believed that Patient A had lead poisoning, the standard of care would require Respondent to refer Patient A to a board-certified toxicologist and a board-certified pediatrician.
2. ALLEGED VIOLATIONS
2. 1 Based on the Alleged Facts, Respondent has committed unprofessional conduct in violation of RCW 18. 130.180 (4), which provides:
RCW 18.130.180 Unprofessional conduct. The following conduct, acts, or conditions constitute unprofessional conduct for any license holder or applicant under the jurisdiction of this chapter: (4) Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. The use of a nontraditional treatment by itself shall not constitute unprofessional conduct, provided that it does not result in injury to a patient or create an unreasonable risk that a patient may be harmed;
2.2 The above violation provides grounds for imposing sanctions under RCW 18.130.160.
3. NOTICE TO RESPONDENT
The charges in this document affect the public health, safety and welfare. The Executive Director of the Commission directs that a notice be issued and served on Respondent as provided by law, giving Respondent the opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline and the imposition of sanctions under Chapter 18.130 RCW.
DATED: June 11, 2014.
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
MEDICAL QUALITY ASSURANCE COMMISSION
KRISTIN G. BREWER, WSBA #38494
ASST. ATTORNEY GENERAL
This page was posted on December 4, 2014.