November 30, 2007 In a decision with national implications for how suspected cases of Lyme disease are treated, a state physician review panel is recommending that controversial pediatrician Charles Ray Jones be reprimanded and put on two years' probation for his diagnosis and treatment of two Nevada children.
If the panel's recommendation is upheld next month, the New Haven area pediatrician — who gained support across the nation because of his willingness to ignore consensus treatment guidelines and prescribe long-term antibiotics to children with symptoms of Lyme — would also have to pay a $10,000 fine and pay a doctor to review records of his patients.
The decision calls into question the medical validity of treating patients who show symptoms of Lyme disease — such as aching joints and fatigue — but don't meet the criteria established by mainstream doctors.
Advocates for patients who say they have chronic Lyme disease argue those criteria are too narrow and lead to needless suffering.
But the panel from the Connecticut Medical Examining Board upheld most, though not all, of the state health department's allegations about Jones' diagnosis and treatment of two Nevada children in 2004 and 2005, which came into question during a bitter custody dispute.
Jones prescribed antibiotics to the son of Jeffrey and Robin Sparks and told the boy's school principal that he had diagnosed late-stage Lyme disease without having seen the boy, the panel found.
Jones also prescribed antibiotics to the Sparkses' daughter before examining her.
When Jones finally did see the Sparks children, he persisted in his diagnosis of Lyme disease for children without compelling medical evidence to support his diagnosis, the three-member panel found.
"The respondent diagnosed a disease when the exposure risk was extremely low, medical history was non-specific, the signs and symptoms were non-specific, and the laboratory tests were negative," the panel found.
Jones defended his actions, saying he has successfully treated thousands of patients with Lyme disease.
The panel's finding, which will be reviewed next month by the full board, goes to the heart of a bitter feud over Lyme disease.
The majority of medical experts say there is little evidence to support the idea that Lyme disease, if treated properly, will nonetheless continue to cause ongoing symptoms, a view that has been bolstered by the treatment guidelines issued by two medical associations for the disease.
There is no good evidence, these doctors say, that extended courses of antibiotics have long-term benefits for patients with Lyme-like symptoms. And symptoms experienced by these patients are more likely attributable to causes other than a lingering infection from the tick-borne pathogen.
But advocates for Lyme patients insist there is abundant evidence that the bacterium that causes Lyme can persist for years, even after initial antibiotic treatment, and often eludes detection by existing tests. They believe that thousands suffer needlessly because their doctors do not recognize clinical signs of Lyme and refuse to prescribe long courses of antibiotics.
Members of the so-called long-term Lyme camp crowded Jones' hearings, which lasted more than a year, in support of the doctor. They raised money to aid in his defense.
"Dr. Jones is being charged with improperly diagnosing and treating Lyme disease after having treated and cured two children whose health was of great concern to their mother for years," said Jones' attorney, Elliot Pollack. "Instead of being sanctioned, he should be complimented."
Jones treated three of Maggie Shaw's children for Lyme disease and all got better, the Newtown mother said.
"My concern is not only for my kids, but how will this affect treatment for all children," Shaw said.On the other side of the divide, the decision was well-received by the doctors who argue that treating patients with Lyme-like symptoms with long-term antibiotics is not only misguided, but can lead to a failure to properly diagnose other ailments in those patients.
"This decision sends a message to a very small cadre of physicians who do not conform to standards of care for diagnosing and treating Lyme disease," said Dr. Lawrence Zemel, chief of rheumatology at the Connecticut Children's Medical Center in Hartford and professor of medicine at the University of Connecticut School of Medicine.
That view was bolstered by a recent review in the New England Journal of Medicine.
In addition to the fines and probation, the panel is recommending that Jones hire a doctor to review his treatment regimens quarterly while he is on probation. Future misconduct could lead to a suspension of his license.
The full board is scheduled to review the findings on Dec. 18. It can confirm, reject or modify the findings of the panel.
To read the board's findings, visit www.courant.com/lyme.
Source: WILLIAM HATHAWAY | Courant Staff Writer
