Thursday, May 19, 2011

Charges Levied Against Mark and David Geier

On April 27, 2011, the Maryland Board of Physicians issued an order for summary suspension of Dr. Mark Geier's license to practice in that state. He was investigated for prescribing Lupron to children with autism, using an unapproved chelating drug, keeping inadequate and incomplete patient records, inappropriately and incorrectly diagnosing patients and so on. Dr. Geier tried and failed to persuade the board to restore his license at a hearing on May 11, 2011. On May 12, the board issued an Order for the Continuation of Summary Suspension for Medical License, meaning that Dr. Geier's license is still suspended. He has until May 22 to file a written appeal.

In the original order, it was also mentioned in passing that Dr. Geier's son, David Geier, may have practiced medicine without a license. From reading the order, it appeared that Mr. Geier performed medical procedures, prescribed tests and made diagnoses. He does not have a medical degree, nor is he licensed to practice medicine in the state of Maryland (or any other state). Mr. Geier was also, inexplicably, appointed as a "diagnostician" in 2009 to Maryland's Autism Commission.

As Kathleen Seidel wrote at the Neurodiversity Blog, charges have been brought against both Dr. Mark Geier and Mr. David Geier.

Dr. Mark Geier

Dr. Geier has been charged, under the Maryland Medical Practice Act, Sec. 14-404(a), with the following:
  • Unprofessional conduct
  • Willfully making or filing a false report or record
  • Willfully failing to file or record any medical record as required under law
  • Practicing medicine with an unauthorized person or aids an unauthorized person
  • Grossly overutilizing health care services
  • Failing to meet appropriate standards as determined by appropriate peer review for the delivery of quality medical and surgical care performed in an outpatient surgical facility, office, hospital or any other location in the state
  • Failing to keep adequate records as determined by appropriate peer review
The majority of the document enumerating the charges and evidence is similar to the order of summary suspension. However, there is one section worth quoting completely. The board writes:

The Respondent [Mark Geier] endangers autistic children and exploits their parents by administering to the children a treatment protocol that has a known substantial risk of serious harm and which is neither consistent with evidence-based medicine nor generally accepted in the relevant scientific community.

This concise statement pretty accurately sums up everything that Dr. Geier does. Based on the evidence provided, he preys upon children and their parents. He takes their (or the insurance companies') money and subjects children to needless tests and dangerous drugs. As a result of his actions, the board can impose revocation of his license, suspension (already done) or reprimand, as well as placing him on probation and imposing a monetary fine.

There is not a great deal new here, however. The original findings supporting the suspension are largely replicated here. What is really of interest are the charges against David Geier (PDF). The board is charging him under Section 601 of the Health Occupations Article, Title 14, using the definitions found in Section 101.

Mr. David Geier

Mr. Geier, as you may recall, has a Bachelor of Art degree in biology. While he has taken some graduate courses, he has not earned any advanced degree, let alone a medical degree. He does not hold a medical license in Maryland or any other state. He holds positions on several different organizations:

  • ASD Centers, LLC - Co-founder and current Executive Director. Dr. Geier is co-founder and President.
  • MedCon, Inc. - Founded in 1999 and current President. Address is his home address, where he lives with his father.
  • Genetic Centers of America - "On staff" since 2004.
  • Institute of Chronic Illnesses, Inc. - Founded in 2006 and current Vice President. Registered as a 501(C)(3). Address is his home address.
  • CoMeD, Inc. (Coalition for Mercury-Free Drugs) - Founded in 2007 and current Vice President. Registered as a 501(C)(3). Address is his home address.
Patient A: The charges start with allegations concerning 10-year-old Patient A (Patient C in the original Order of Summary Suspension against Dr. Geier). Patient A's mother (Parent A) brought her son into Genetic Centers of America on May 19, 2008. Mr. Geier discussed genetic testing, and, without asking many questions about Patient A's medical history or symptoms, told her that her son appeared to be a "typical high-testosterone kid". He allegedly stated that he needed an ultrasound of the boy's thyroid and used an ultrasound wand on Patient A, tapping the boy on the neck and abdomen as he walked around the room. Notes from the visit indicated that "comprehensive" ultrasounds of the abdomen and thyroid were performed. Mr. Geier also noted that the boy's physical appearance was advanced for his age and that he seemed to be "potentially and significantly aggressive to himself and/or others." The latter was noted despite Parent A's indication that her son's aggressive behaviors were not serious.

David Geier also made notations regarding psychological diagnosis for Patient A. In addition to diagnoses of insomnia and "Unspecified Metabolic Disorder", he wrote that:

It is apparent based upon examination of the DSM-IV criteria that [Patient A]'s present symptoms are compatible with a diagnosis of pervasive developmental delay - not otherwise specific [sic].

Parent A also reported that Mr. Geier discussed the cost of lab tests and reliability of some labs. When she said that cost did not matter, he reportedly told her that he would have the lab order forms mailed to her. This initial order form covered four tests: 5-Androstane-3, 17-Diol Glucuronide; Androstendione; DHEA and testicular function. None of these, however, were the genetic tests that Parent A and Mr. Geier had discussed. Another lab order was then sent to Parent A covering over twenty tests, at an invoiced amount of $3,915.96, from another lab (Laboratory B). Lab B personnel were apparently quite surprised at the amount of blood that was ordered for the tests, but it got Parent A questioning.

She looked online for more information about the Geiers' practice and discovered that Mr. Geier was not actually a physician. She did not return to the Geiers' office after the May 19 visit. Despite not returning, she received a bill covering the initial visit plus three more:

  • May 19, 2008 - Office Consultation (99215) - $150.00
    • Neck Ultrasound (76536) - $225.00
    • Abdominal Ultrasound (76700) - $225.00
    • Psychiatric Diag[nostic] Interview Exam (90801) - $150.00
  • May 22, 2008 - Prolonged 1st hour Eval[uation] and Management (99358) - $150.00
  • June 17, 2008 - Prolonged 1st hour Eval and Management (99358) - $150.00
  • June 18, 2008 - Prolonged 1st hour Eval and Management (99358) - $150.00
Parent A requested the test results and all records of the May 19 evaluation. She received the test results but not any of the other records. Through the Board's investigation, they found that a Phone Contact Sheet in Patient A's chart had three entries. The second and third were written and initialed by Mr. Geier:

5-22-08: Mailed lab specimen
6-17-08: 2 p.m. Consultation with [Patient A]'s mother re: lab testing for her son. Reviewed lab scripts and testing procedures at [Laboratory A] v. [Laboratory B]
6-18-08: 9 p.m. Registered & completed lab script for [Patient A] with [Laboratory B] using online 360 software.

This was the most detailed case presented by the Board in their charges, and the only one that caught my eye in the Order for Summary Suspension from April. It was not, however, the only case in which Mr. Geier allegedly practiced medicine. He was involved with three more of the nine patients whose cases were reviewed by the Board. In all three cases, Mr. Geier initialed his handwritten notes. Dr. Geier did not "initial, co-initial or sign these notes as he did in other notes, nor did [David Geier] indicate...that Dr. Geier was present...or that it was Dr. Geier who made the treatment recommendations."

Patient B (Patient E in the original Order): Mr. Geier met with the patient's mother to examine the effects of increasing Lupron dose. According to the notes, the plan was to stay with the present dosing and to reevaluate when the dosing labs came back. He also noted that the mother questioned the use of antiviral meds. He wrote that "[a]t present time, [illegible] [medication] has been agreed by mutual consent to be put off."

Patient C (Patient H in the original Order): Mr. Geier documented an office examination, review of lab results and discussion of possible treatment plan. The charges specifically cite:

Assessment is that pt has a toxic encephalopathy & associated [increased] body-burden of heavy metals, particular [sic] Hg [mercury], bas upon [increased] urinary porphyrins. Pt also has evidence of mitochondrial dysfunction. Additionally, pt has evidence of premature puberty with associated pituitary dysfunction...Plan is to: 1) start Lupron SQ & IM, & Aldactone 50 mg BID for premature puberty; 2) start Carnitor liquid for mitochondrial dysfunction; 3) start B-12 - folonic acid for sulfur-bearing amino SNPs in MTHFR; 4) start vitamin D 1,000 mp IU BID for low vitamin D; 5) start melatonin sublingual for sleep disturbance; & 6) will start metal DMPS in futer [sic] @ present stop all chelation.

The charges also indicated that Mr. Geier "authorized with pharmacist 6 additional refills of Lupron Dept 15 mg kits..."

Patient D (Patient I in the original Order): Mr. Geier met with the mother regarding blood in the patient's stool. He noted:

Mother reported she has been recently administering [Patient D] mega-doses of vitamin C...Plan is as follows: a) told mother to keep [Patient D] off high-dose vitamin C...Mother will follow up with us re [Patient D]'s clinical status.

He also reportedly decided to get Patient D a prescription for Camitor and called it in to the pharmacy.

But That's Not All

The Board did not stop their investigation of David Geier with just the nine cases that were reviewed as part of Dr. Geier's license suspension. They also reviewed public postings on chat groups that cater to the parents of autistic children. There were numerous posts from 2007 in which parents relate their consultations with Mr. Geier in which he discussed symptoms, the role of hormones, adjusting doses/dose schedules. He appears to have downplayed the risks of Lupron, saying that it would make a child "not as strong." There were posts about David and his father as a team. One parent reports e-mailing bother Geiers with questions or concerns and that, with anything urgent, "one of the two gentlemen has always called me right away." Finally, there was a post from one parent mistakenly thinking that David was a physician and another in which a health care provider felt that Mr. Geier may have been practicing without a license.

In all, the charges against both Geiers are pretty damning and, as noted in the footnotes of each, the evidence laid out "do not necessarily represent a complete description of the evidence, either documentary or testimonial, to be offered against" father and son. It bears repeating that, at least in the case of David Geier, if found guilty, he will have a felony conviction on his record, not to mention being required to pay a fine.

A Case Resolution Conference for both Geiers is scheduled for July 6, 2011.

It bears repeating that these charges are for the state of Maryland only. Dr. Geier is still licensed in California, Florida, Hawaii, Illinois, Indiana, Kentucky, Missouri, New Jersey, Virginia and Washington. The pair also have clinics in several other states. The charges against David Geier raise more questions, as well. Given the charges submitted to Parent A, was there fraudulent billing taking place? Will they be investigated for possible insurance fraud? Also, are the various organizations listed above legitimate? Will the IRS take a look at them for any possible financial misconduct? And what about Governor Martin O'Malley, who appointed David Geier to the Autism Commission? He picked Mr. Geier, out of an apparently competitive pool of candidates, despite Mr. Geier lacking any qualifications as a "diagnostician." Will the governor face any consequences for his actions?

Based on the Maryland findings, it seems clear that they are, indeed, an immediate danger to children. Everyone who cares for the well-being of young people, parents or otherwise, should be outraged at the Geiers' conduct. We'll all need to keep a close eye on these two and their related operations.

For those seeking the text of the charges, please visit Ms. Seidel's site for now. Direct links will be added later.

Disclaimer: This post represents my understanding of the facts of the case and my interpretation and opinions thereof. They do not constitute declarations of fact in and of themselves and should not be interpreted to be libelous. If any errors of fact are discovered, I am more than willing to review my words and change them as appropriate.
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