Friday, May 6, 2011

A Close Look at David Geier

UPDATE: Please click here for an important update to this story.

Medical ethics, health law and policy. Those things are important to me. I can get pretty passionate about them. My interest in them is what drove me to learn about drug and medical device regulations, to actually take formal courses to learn about them beyond merely looking at laws on my own, unguided. The medicines that are offered for our use should be only the best that can be given. I want to be a part of the process, to have an active role in making certain that the medicines that are developed, the clinical trials that are conducted, have the benefit and welfare of patients as the utmost goal.

When I see those values that I so strongly value and hold very highly flaunted or abused, I get mad. I don't much care what a person chooses to do with their own body, money or time, but I get really angry with those who would take advantage of people by cheating them with substandard or even quack treatments. When the victims of that charlatanry are children, I am livid. Quacks and charlatans, those who would prey on others, taking advantage of their emotions and pain, exploiting patients and their children, should face justice. And there is just such a person that I feel is deserving of at least some scrutiny.

Yet before I dive into that, I need to remind myself that it is very, very easy to let my emotions take over, extraordinarily tempting to let the anger or even rage flow forth. And I must remember to breathe, to take a step back and look at the facts. Stick to what is known and avoid the desire to speculate. So that is what I will try to do here, as we take a look at Mr. David Geier.

On Tuesday, I wrote about the Maryland State Board of Physicians' decision to summarily suspend Dr. Mark Geier's medical license. I very briefly mentioned Dr. Geier's son, David, and how it seemed to me that he may be guilty of practicing medicine without a license.

The basis for this thought was that the Maryland Board's order (PDF) against Dr. Geier mentioned that David Geier
ordered an extensive number of laboratory studies of Patient C, noting "insomnia" and "metabolic disorder" as diagnoses. (Order page 12)
Patient C is a boy who was 10 years old when first seen by Dr. Geier in 2005. He was brought in for a visit in 2008 at the age of 13 and, since Dr. Geier was not present, the boy's mother met with Dr. Geier's "unlicensed son." (Order page 26)

The document goes on to state that:
The note of the visit34 indicates that "comprehensive" abdominal and thyroid ultrasounds were performed...The Impression portion of the note states: 1) PDD-NOS, 2) Sleep problems (insomnia) and 3) Unspecified Metabolic Disorder...At the 2008 visit, an extensive and unnecessary work-up was ordered that is not part of the standard of care to assess or treat autism. (Order pages 26-27)
From this, it appears that David Geier performed medical tests on the boy, made diagnoses and prescribed further lab tests to be done. The question, then, is whether or not such actions constitute "practicing medicine" under Maryland state laws.

To find the answer, we need to turn to the Health Occupations Article - Title 14, Section 101 (Definitions). The legislation defines "Practice medicine" as follows:
(1) "Practice medicine" means to engage, with or without compensation, in medical:
(i) Diagnosis;
(ii) Healing;
(iii) Treatment; or
(iv) Surgery.
(2) "Practice medicine" includes doing, undertaking, professing to do, and attempting any of the following:
(i) Diagnosing, healing, treating, preventing, prescribing for, or removing any physical, mental, or emotional ailment or supposed ailment of an individual:
(1) By physical, mental, emotional, or other process that is exercised or invoked by the practitioner, the patient or both; or
(2) By appliance, test, drug, operation, or treatment;
Based on this definition, David Geier was practicing medicine, assuming the accuracy of the Board's findings. Looking at the regulations a bit further, we find, in Section 301, that:
Except as otherwise provided in this title or § 13-516 of the Education Article, an individual shall be licensed by the Board before the individual may practice medicine in this State.

And Section 601 states:
Except as otherwise provided in this title, a person may not practice, attempt to practice, or offer to practice medicine in this State unless licensed by the Board.
Mr. Geier is not licensed in the state of Maryland to practice medicine. Unless he meets the exceptions from licensing (Section 302), which he does not appear to do, he is operating in violation of Maryland state medical law. He furthermore is not qualified for licensing, as he does not have a doctor of medicine degree (according to one bio I found, his only degree is a Bachelor of Arts in biology with a minor in history).

Thus far, it is my opinion, based on the facts available to me, that David Geier was in violation of Maryland state law by practicing medicine without a license. This is a matter that the Board should investigate to determine if this is, indeed, the case. If it is true, then the penalties for Mr. Geier are:
(4) Except as provided in paragraph (5) of this subsection, a person who violates § 14-601 of this subtitle is:
(i) Guilty of a felony and on conviction is subject to a fine not exceeding $10,000 or imprisonment not exceeding 5 years or both; and
(ii) Subject to a civil fine of not more than $50,000 to be levied by the Board.
That's a felony conviction with some hefty fines and some jail time. It is my understanding that this penalty could be levied for each instance in which he has been found to have practiced medicine, according to the definition above. That could potentially add up to quite a bit of money and jail time.

As I looked into this issue, I also became aware that Mr. Geier sits on the state's Autism Commission as a "diagnostician." This is a position that is appointed by the governor of the state. According to a May 5 article in the Baltimore Sun, Mr. Geier had been listed as a doctor until May 4, 2011. The article also states that he had been asked to resign his position, following his father's license suspension, but refused.

The commission was established by Senate Bill 963. Unfortunately, the bill provides no definitions of "diagnostician" nor does it specify the qualifications required for any of the members. That said, one would expect that it means "an expert in making diagnoses" or something similar. In other words, that it would need to be someone licensed to practice medicine (remember that "engaging in diagnosis" bit?) in the state of Maryland.

The responsibility for making the decision about who should fill which role on the commission falls to the governor, a position held by Martin O'Malley since 2007. Frankly, Gov. O'Malley failed to adequately assess the qualifications and credentials of Mr. Geier, who was one of many applicants for the position, before appointing him. Ultimately, the governor bears responsibility for that appointment, not anyone below him. It may be that he was misled. It may be that he did not do his due diligence. It may even be that he was influenced by organizations with a particular interest or favorable view of Mr. Geier. There are a lot of possibilities, and I cannot begin to guess what went on in the decision process. Suffice it to say that Gov. O'Malley made the decision. By law, the responsibility is his and his alone to make the appointment, and any fallout from that appointment, any negative consequences that result, should be borne by him.

In the end, the order against Dr. Mark Geier has set off a chain of events that may have significant political (and possibly criminal) repercussions for a number of individuals, including not only Dr. Geier's son, David, but also the governor of Maryland himself. And these events may extend to the 10 other states in which Dr. Geier is licensed, spawning further investigations and inquiries. And I think this is a good thing.

Laws such as those I described above are there for a reason. They are meant to keep people safe, to protect them from charlatans and con men who would take advantage of them, as well as the perhaps well-meaning individuals who nonetheless lack the training and education necessary to provide quality, safe health care. Imagine, for a moment, someone who has no medical training telling you that your child has a metabolic disorder and causes completely unnecessary and potentially dangerous procedures or even drugs to be used. When I think of that, I get scared. I want people like that to be held accountable. They should be investigated. Let the facts come out. It may be that I am wrong about David Geier. He might not have engaged in the illegal practice of medicine. And if that is the case, I offer my sincere apologies. But if I am right. If he has practiced without a license; if he has subjected children to unwarranted tests and misled their parents to waste money on useless, dangerous treatments, then he deserves the full weight of the law brought against him. And those who put him in a position to do so are just as deserving of the legal repercussions that are their due and the shame and ridicule that may follow.

I very strongly urge the Maryland Board of Physicians to investigate this issue, determine the truth of the matter and, if warranted, mete out the just punishments due. I call on them to do their duty to protect the patients, the parents and children, they are sworn to defend.

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