On November 3rd, The Florida Board of Medicine
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 sells patients Metagenics-brand dietary supplements and his website has an online store. His specialty list includes
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
- 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,