Source: Oakland Tribune Contact: Sun, 06 Sep 1998 Author: John Jacobs PHYSICIANS BEWARE When a physician has his or her license to practice medicine taken away, it is usually a personal tragedy, sometimes the result of alcohol or drug addiction, sometimes incompetence, greed or worse. But it is also, usually, a social good, a determination by the disciplinary body that this doctor is a danger to the community and should no longer be free to practice. Unfortunately, the case of Dr. Robert Sinaiko, a San Francisco internist and allergist, is not quite so simple. Sinaiko, 53, is an impressively credentialed physician whose practice consists of treating difficult cases involving complicated environmental and other allergies with experimental therapies. He works on the frontiers of medicine, where there are no easy or well-trod paths to clinical success. Sinaiko's license was revoked last month by an Oakland administrative law judge after a 25-day hearing. The decision was approved by the Medical Board of California. He also was fined $99,000 for the cost of the proceeding. No patient complained about Sinaiko's treatment. No patient testified against him. No patient was shown to have been harmed. Judge Ruth Astle ruled that Sinaiko was practicing "fringe" medicine because he was prescribing experimental drugs in four specific cases, including drugs for "off-label" uses -- that is, for things other than what the label calls for. This, she said, constituted" an extreme departure from the prevailing standard of practice among the community of licensed California practitioners," even though many physicians assert that they do this all the time. In the case that triggered the initial investigation by the attorney general's office, Sinaiko was caught in the cross-fire of a divorce and child custody dispute in which the parents differed over the treatment he prescribed for their hyperactive child. He has appealed the decision to the Medical Board, which has grated as stay until Sept. 14, when it will decide the appeal. If this decision is allowed to stand, Sinaiko's attorney, Richard Turner, wrote in his petition, "All doctors who say to a patient,'I'm not sure what's wrong with you. Let's try this,' now risk losing their license. All progress in medicine through clinical observation of patients in day-to-day medicine will become too hazardous." The license revocation has outraged many in the medical community, who have come to Sinaiko's defense, including the California Medical Association, highly reputable medical school physicians and even San Diego attorney Robert Fellmeth of the Center for Public Interest Law, which has often challenged the Medical Board for going too easy on disciplining bad physicians, The grounds cited for revocation, they say, threaten and chill every doctor who practices medicine in California. One of Sinaiko's defenders is Dr. Phillip Lee, a former chancellor of the UC San Francisco medical school. One of the most respected physicians in the nation. Lee until last year served four years as U.S. assistant secretary for health in the Department of Health and Human Services. Lee was one of some 10 expert witnesses who testified for Sinaiko. All of their testimony was dismissed by Astle with one sentence in a 27-page decision. These experts, who testified on such things as chronic fatigue syndrome, attention deficit hyperactivity disorder, multiple chemical sensitivity and other areas at the crux of his practice, "were of questionable credibility in that their testimony was not based on generally accepted scientific and medical principles," she concluded. "Absolutely no analysis was given to these experts individual, and no explanation was offered as to where or how their testimony failed to be based on 'generally accepted scientific principles,'" CMA President Robert Reid wrote in a blistering letter to the Medical Board this week. "There were no patient injuries, no patient complaints, and much of the medicine alleged to be inappropriate by the Medical Board.," Reid wrote, "apparently has ay least a significant, if not a majority, following among the medical profession. "The Medical Broad's decision does not inspire confidence," Reid continued. "The decision fails to show how the Medical Board proved by clear and convincing evidence that Dr. Sinaiko was guilty of the charges alleged." Indeed, Reid said, the board's action "raises a question as to exactly why the Medical Board went after Dr. Sinaiko with such vengeance, a vengeance reflected amply in its ($99,000) cost recovery bill. If the Medical Board just wants to 'get the doctor' it any cost, this decision shows how its (sic) done." Unrepentant because he believes he has done nothing wrong, Sinaiko faces bankruptcy, professional ruin and years of expensive legal appeals. "This is an abuse of the Medical Board's authority," said Lee. "The judge went to extremes to dismiss our testimony as though it had no legitimacy. We have alcoholic doctors and drug-addicted doctors. We put them in rehab and suspend their license for a month. Here we take his licence away. The remedy far exceeds the alleged infraction." So why did the Medical Board pursue Sinaiko so vindictively? John Jabobs is political editor for McClatchy Newspapers. His e-mail address is OR - --- Checked-by: Joel W. Johnson