Florida revokes medical license of "integrative" physician after patient dies of untreated cancer

Florida revokes medical license of "integrative" physician after patient dies of untreated cancer

On November 3rd, The Florida Board of Medicine revoked the license of Kenneth Woliner, MD, an "integrative medicine" doctor whose misattribution of a college student's advancing cancer symptoms to allergies and other minor illnesses led to her death. Even though Woliner knew his patient, Stephanie Sofronsky, had been diagnosed with Stage 3 Hodgkin's lymphoma by experts in oncology, he discouraged her from believing her diagnosis and was a factor in her rejection of conventional cancer treatment.

In reaching its decision, the Board followed the April recommendation of an administrative law judge (ALJ) that Woliner's license be revoked, made after a two-day hearing. The Board agreed with the ALJ that Woliner had committed malpractice but was more divided in determining whether he had also financially exploited his patient, although it ultimately ruled against him on that issue as well. A few days before her death, for example, Woliner gave Sofronsky an injection of iron even though her blood test showed she didn't need it. 

Woliner is  board certified in "integrative medicine" by the American Board of Integrative Holistic Medicine, a specialty board recognized by the American Board of Physician Specialties (ABPS), not the American Board of Medical Specialties. ABPS board certifications are not recognized by all state medical boards, although they are in Florida. Applicants for board certification in integrative medicine, if they apply before December 1, 2016, merely need to pass an exam; no residency training is required.

Woliner sells patients Metagenics-brand dietary supplements and his website has an online store. His specialty list includes candida, thyroid conditions (even though he is not an endocrinologist or an ENT), food allergies (even though he is not an allergist) and "bioidentical hormones" (a marketing, not a medical, term). If you click on any of these headings expecting to find more information on the topic, you won't. Instead, you'll find anecdotes describing cases in which Woliner was able to figure out what was really wrong with the patient and how he successfully treated that condition, usually after other doctors had failed.  Woliner's charming anecdotes are a perfect lesson in how unsuccessful cases are excluded from testimonials, one reason they are worthless as evidence of safety and effectiveness.

At the hearing before the ALJ, the state's case was supported by two expert witnesses. One, an oncologist, testified to the scope of practice of an oncologist, necessary to establish the state's point that Woliner was practicing outside of his scope of practice in this case by, among other things, questioning the cancer diagnosis made by several oncologists. The other expert, a board-certified family practitioner, testified that Woliner fell below the standard of care for a family practice physician.

At both the administrative hearing and before the Board, Woliner's attorneys argued that Woliner was acting in his capacity as Sofronsky's "integrative" physician, not as her family practice PCP, his other medical specialty. (He is a board-certified family practice physician.) They argued the state's experts were not qualified to testify on the standard of care for integrative physicians, which, they claim, is a separate medical specialty with a unique standard of care. Woliner's own expert, an integrative doctor who practices medical astrology, opined that Woliner, as an integrative physician, didn't owe the same duty of care to his patient as a family practice doctor. The ALJ rejected that assertion as "specious," finding that Woliner was indeed acting as the deceased student's primary care provider (PCP). As the state noted in its arguments, Woliner's expert, while distancing "integrative" medicine from "conventional" care, never said exactly what the standard of care should be for integrative medicine.

This is not Woliner's first disciplinary case. In a 2005 settlement with the Board, Woliner admitted he had, among other things:

  • diagnosed a patient with Hashimoto's thyroiditis who had no indication thereof clinically or biochemically,
  • diagnosed the patient with adrenal insufficiency who showed no biochemical indication,
  • overdosed the patient on thyroid medication, making him hyperthyroid, and
  • failed to consult with an endocrinologist instead of "treating conditions that did not exist."

Yet, he continues to tout his "individualized treatment of thyroid disorders" on his website and supposed thyroid problems were one of the conditions he diagnosed in Sofronsky, in lieu of recognizing the obvious symptoms of progressing Hodgkin's lymphoma.

Woliner's attorneys said he will appeal the Board's decision and they have 30 days to do so. Under Florida law, Woliner has a right to a stay of his license revocation "upon such conditions as are reasonable" unless the state can convince the court of appeals that a stay "would constitute a probable danger to the health, safety, or welfare of the state." It remains to be seen whether the state will oppose the stay or what conditions it might ask the court to impose on Woliner pending appeal. Considering his disciplinary history, I hope that the state will, at the least, ask the court to require both some sort of supervisory oversight of his practice by another family practice physician and that Woliner properly refer all specialty cases to appropriately educated and trained physicians.

It also remains to be seen if Woliner's attorneys will raise the issue of whether the state's experts were incompetent to testify as to the standard of care for an "integrative" physician before the appellate court.  This argument hinges on his assertion that he wasn't acting as Sofronsky's PCP. But the ALJ found, as a matter of fact, that Woliner was indeed acting as Sofronsky's PCP, calling Woliner's assertions otherwise "specious." The appellate court cannot substitute its judgment for that of the Board (which is based the ALJ's decision) as to the weight of any evidence on any disputed finding of fact, although it can find that a particular finding is "not supported by competent, substantial evidence in the record." I cannot see the appellate court deciding, on the record in this case, that the ALJ's finding was not supported by "competent, substantial evidence." Whatever his role as an "integrative" MD, since he was acting as her PCP, he was held to a PCP's standard of care, and the state's experts were qualified to testify that he both fell below the standard of care and that he was acting outside his scope of practice in treating Sofronsky. 

As David Gorski, MD, PhD, has pointed out, integrative medicine is simply an excuse to incorporate quackery into medical care. Quackery, by definition, falls below the standard of care for medical practice. (Even Florida's statute allowing "complementary and alternative" health care practices specifically states that it does not alter the standard of care for practitioners nor override prohibitions against fraud and exploitation of patients.) Thus, it is incumbent upon integrative physicians to convince medical boards and courts that integrative medicine has a distinct standard of care, one that finds pseudoscience acceptable as evidence of safety and efficacy for diagnoses and treatments. 

Points of Interest 11/08/2016
Points of Interest 11/04/2016