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1 NEW YORK STATE ASSEMBLY

STANDING COMMITTEE ON HEALTH

2

PUBLIC HEARING:

3 CHRONIC LYME DISEASE AND

LONG-TERM ANTIBIOTIC TREATMENT

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Hamilton Hearing Room (B)

15 Legislative Office Building, 2nd Floor

Albany, New York

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Tuesday, November 27, 2001

17 10:00 a.m.

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1 COMMITTEE MEMBERS:

2 ASSEMBLYMAN RICHARD N. GOTTFRIED, CHAIR (Health)

ASSEMBLYWOMAN MAUREEN O'CONNELL (Health)

3 ASSEMBLYMAN JOEL MILLER (Health)

ASSEMBLYWOMAN NETTIE MAYERSOHN (Health)

4 ASSEMBLYMAN MICHAEL COHEN

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1 INDEX

Page

2

Patricia Smith 12

3 President, Lyme Disease Association

(Exhibit 1, 79 pages)

4

Kenneth Liegner, M.D., Physician 27

5 Associate Editor, Journal_of_

_______ __

Spirochetal_&_Tick-Borne_Diseases

___________ _ __________ ________

6 (Exhibit 2, 95 pages)

7 Honorable Richard Blumenthal 62

Attorney General

8 State of Connecticut

9 Alan Muney, M.D., Chief Medical Officer 81

Oxford Health Plans

10 (Exhibit 3, 5 pages)

11 Steven Phillips, M.D., President-Elect 137

International Lyme & Associated

12 Diseases Society

(Exhibit 4, 7 pages)

13

Steven Schutzer, M.D. 175

14 Associate Professor of Medicine

University of Medicine and Dentistry

15 of New Jersey

16 Brian Fallon, M.D., M.P.H., M.Ed. 185

Columbia University, Department of

17 Psychiatry; Director, Lyme Disease

Research Program of the New York

18 State Psychiatric Institute

19 Carolyn Britton, M.D., Neurologist 192

Columbia Presbyterian Hospital

20 (Exhibit 5, 1 page)

21

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24

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1 Marilynn Barkley, M.D., Ph.D., Researcher 199

University of California at Davis

2

Robert Bransfield, M.D. 228

3 Lyme Alliance, Inc., Professional

Advisory Panel

4 (Exhibit 6, 60 pages)

5 Carl Brenner 244

Columbia University, Member, Chronic

6 Lyme Disease Study Committee of the

Institute of Allergy and Infectious

7 Diseases

8 Sarah Rude 258

9 Alan Barbour, M.D. (Telephonic) 268

University of California at Irvine,

10 Departments of Microbiology &

Molecular Genetics and Medicine

11

Pam Weintraub, Reporter 295

12 HMS_Beagle; Former Editor,

___ ______

Omni Magazine

____

13

Jill Auerbach 306

14 Hudson Valley Committee for Lyme

Disease Patient Advocacy

15

Robert Clydesdale 321

16

Evin White 328

17

Joanna Amato 333

18

Lia McCabe 336

19

Howard Hindin, D.D.S. 348

20 Foundation for the Advancement

of Innovative Medicine

21 (Exhibit 7, 3 pages)

22 Norman Rosenthal 355

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1 ASSEMBLYMAN RICHARD N. GOTTFRIED,

2 CHAIRMAN, COMMITTEE ON HEALTH: If people could take

3 seats and quiet down, we will begin the hearing.

4 We've got a long list of witnesses. Folks, if people

5 in the audience could find seats and quiet down, we

6 would like to begin the hearing.

7 Good morning. I'm Richard Gottfried; I

8 chair the Assembly Health Committee. Joining me this

9 morning -- and there are other legislators who are

10 expected -- but at this point, joining me are:

11 Maureen O'Connell, the ranking Minority member on the

12 Assembly Health Committee; Dr. Joel Miller, who is

13 also a member of the Health Committee -- and just for

14 clarity, he's a dentist, not a physician, just in

15 case any of you were thinking he's a physician; and

16 Assembly Member Michael Cohen from the Borough of

17 Queens. We are expecting to be joined shortly by

18 Nettie Mayersohn, also from Queens, also a member of

19 the Health Committee, who called from the road; she's

20 been tied up in traffic, apparently, but will be here

21 shortly.

22 A couple of procedural points.

23 One is, as was stated in the hearing

24 notice and has been the Health Committee's practice

25 for many years, all witnesses at this and all other

 

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1 Health Committee hearings will be testifying under

2 oath. So, when you come up to testify, the

3 stenographer will swear you in. And we don't do it

4 like Ollie North; you don't have to stand up and hold

5 up your hand or anything. And you can affirm if you

6 don't want to swear.

7 Secondly, there will be several

8 witnesses; three, I believe, who will be testifying

9 through the speakerphone up here. They are scheduled

10 at various times, and so we may need to interrupt a

11 witness at some point to accommodate that. The

12 first, scheduled for 11 o'clock is Richard

13 Blumenthal, the Attorney General of the State of

14 Connecticut.

15 We will be going straight through. We

16 will not take a lunch break, although at some point,

17 probably in a couple of hours or so, we will take a

18 short break, even if just to allow the stenographer

19 to flex her fingers or whatever she needs to do. And

20 speaking of the stenographer, since some of the

21 testimony here today may be using some medical

22 terminology -- if that does come up in your

23 testimony, if you could do that slowly and carefully

24 so that it gets taken down correctly by the

25 stenographer.

 

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1 Before we call the first witness, which

2 will be Patricia Smith, I just want to say a couple

3 of words. It is not the business of the Legislature

4 or a legislative committee to be making scientific

5 judgments about medical diagnosis, and so the -- it's

6 a fair question, why are we holding this hearing on

7 the question whether chronic Lyme disease is a valid

8 diagnosis and whether long-term antibiotic treatment

9 is a legitimate treatment? The reason is that this

10 question, as many do, has spilled over into some

11 public policy issues, particularly insurance

12 reimbursement, as well as the question whether some

13 physicians who believe in this diagnosis and believe

14 that long-term antibiotic treatment is an appropriate

15 treatment, whether they have essentially

16 inappropriately been singled out for physician

17 discipline/prosecution by the State.

18 Now, today's hearing is not going to be

19 about those physician discipline questions or cases,

20 although sometime in the coming year we are going to

21 be holding a hearing on the physician discipline

22 system and some of those issues could arise at that

23 time. But because of those sort of public policy

24 consequences of the medical question, we're holding

25 today's hearing to try to shed some light on where

 

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1 reasonable medical opinion falls on these questions.

2 Whether there are legislative remedies that might be

3 appropriate will depend a little bit on what we learn

4 here today and perhaps, as well, at the hearings in

5 January and February on the Office of Professional

6 Medical Conduct and its process.

7 I just want to note: Some of you, if

8 you've looked at the witness list, may think that it

9 would have been good if the State Health Department

10 had testified at this hearing, and I think that would

11 have been appropriate. We invited them; they

12 declined. We do have the capacity as a legislative

13 committee in this state to do more than invite

14 witnesses, including state agencies. We can get a

15 little heftier in how we get them here. We tend not

16 to do that except in special circumstances. I do

17 intend to have the Health Department here at our

18 hearing on the Office of Professional Medical

19 Conduct, at which time some of the Lyme-related

20 issues will be dealt with.

21 What the Department said in declining

22 our invitation was, we don't really have anything to

23 say on this topic; we just follow the CDC guidelines,

24 and so we don't really think we have anything to say.

25 I don't think that's an adequate response, but as I

 

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1 say, we will explore that further with the

2 Department.

3 Those are my comments. I don't know

4 whether any of my colleagues want to say anything.

5 ASSEMBLYWOMAN MAUREEN O'CONNELL: Just

6 briefly. Thank you, Chairman Gottfried.

7 My name is Maureen O'Connell. It's a

8 pleasure to be here today to begin to address a

9 problem that is very pertinent, particularly in the

10 district that I represent on Long Island, and I know

11 that I'm joined by my colleague, Dr. Miller. This is

12 a problem that has affected Dutchess County probably

13 more so than any other county right now. I want to

14 thank each and every one of you for coming out here

15 today to share with us some of your experiences, as

16 well as some of the witnesses who have come forward.

17 Like any other disease entity, we have

18 much to learn about this disease, and I think today

19 is the beginning of shedding some important light on

20 what we know now and what we don't know. And I think

21 that is probably one of the most important things to

22 recognize, that there perhaps is much we don't know.

23 But, yet, as Chairman Gottfried said, there are some

24 policy implications here that we feel very strongly

25 about. We want to make sure that patients have

 

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1 access to whatever treatments their physicians deem

2 necessary, and that physicians have their judgment

3 protected. That's something very important to us.

4 And I just, again, say thank you all

5 for coming today. I look forward to the testimony

6 we're about to hear.

7 Thank you, Chairman Gottfried.

8 MR. GOTTFRIED: And, by the way, I

9 should have mentioned that Dr. Miller is not the only

10 person up here who, in his professional capacity,

11 sometimes can wear a white coat. Maureen O'Connell

12 is also a registered nurse. So, there are some of us

13 up here who actually know a little something about

14 what we're talking about.

15 Dr. Miller?

16 ASSEMBLYMAN JOEL MILLER: Thank you. I

17 like the opening comments, which pretty much said,

18 you know, are you a dentist or a real doctor? But

19 we'll let that slide.

20 MR. GOTTFRIED: I didn't say that.

21 DR. MILLER: In spite of that comment,

22 I have to tell you that Richard Gottfried is an

23 exceedingly fair individual, and his ears will be

24 open and he will be listening, and that's essential.

25 So, this panel has no particular slant that should

 

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1 disturb you.

2 The other thing is - and Chairman

3 Gottfried did allude to that - we're not here to make

4 the decision between what is an appropriate treatment

5 and what is an inappropriate treatment. And as

6 testimony goes on which you may disagree with, I

7 don't want you to take the position that we're either

8 winning or we're losing. What we have to demonstrate

9 today is that the scientific answer is not in yet;

10 that science has not ruled out chronic Lyme or the

11 treatment for chronic Lyme using long-term

12 antibiotic. And that's the goal of this hearing, is

13 to demonstrate that there is validity to maybe both

14 sides, but certainly the side with chronic Lyme.

15 Because after all, if there was no problem with

16 chronic Lyme, you wouldn't be here; right? I am sure

17 that you took great comfort in knowing that if you

18 had a month's antibiotic treatment, that you were

19 cured and well and you can go on with your life and

20 that everything else was just your imagination.

21 In any case, that is the reason these

22 hearings will take place. And it should be an

23 interesting day, so sit back and relax and enjoy it.

24 And remember, this is -- there will be things that

25 you hear that you don't particularly like, but that's

 

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1 not how the hearing will make up its mind on where

2 it's going. So, enjoy the day. Thank you.

3 MR. GOTTFRIED: Mike?

4 ASSEMBLYMAN MICHAEL COHEN: For the

5 sake of brevity, I will associate myself with

6 previous speakers' remarks, and I look forward to the

7 first witness.

8 MR. GOTTFRIED: Okay. And the day will

9 go more quickly and we'll have more time to hear more

10 people's full testimony if we don't have to have

11 pauses for expressions of either exuberance or the

12 opposite.

13 Assembly Member Mayersohn has

14 advertised his (sic) arriving.

15 Okay. Our first witness is Patricia

16 Smith, president of the Lyme Disease Association.

17 Okay. Are we all set?

18 MS. PATRICIA SMITH, PRESIDENT, LYME

19 DISEASE ASSOCIATION: Thank you, Mr. Chairman and

20 Members of the Committee. I wasn't too nervous until

21 I heard a little bit earlier that you have two

22 committee members from Queens. And my daughter lives

23 in Queens, and I just wondered if you know something

24 about the health of Queens that I don't know and I

25 should know, as a mother.

 

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1 Anyway, thank you for inviting us

2 today. We appreciate the opportunity to talk to you

3 about something that we consider to be very serious.

4 I would like to also say I am the former Chair of the

5 New Jersey Governor's Lyme Disease Advisory Council;

6 I'm the former president of the Wall Township Board

7 of Education; and I also sit on the Board of

8 Directors of the International Lyme and Associated

9 Diseases Society, ILADS, which is a professional

10 medical society.

11 The Lyme Disease Association is an

12 all-volunteer national organization providing Lyme

13 disease research, education and research funding.

14 Along with an affiliate, the Greenwich Lyme Disease

15 Task Force, the Lyme Disease Association is prepared

16 to open with Columbia University a research center,

17 an endowed research center at Columbia. We're

18 working on the logistics right now.

19 Lyme is the fastest growing

20 vector-borne disease in the United States, yet it is

21 rarely given the weight that if deserves. The

22 situation facing patient and physicians in New York

23 is not unique; it mirrors the nation. Patients

24 frequently cannot obtain diagnosis, treatment,

25 insurance reimbursement, disability, education, or

 

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1 even understanding from their families and their

2 peers. Treating physicians have faced a variety of

3 licensure sanctions, including being supervised,

4 fined, not allowed to treat Lyme patients, and

5 license suspension and revocation.

6 In one of the earliest responses to

7 Lyme problems, New Jersey enacted the first

8 Governor's Lyme Disease Advisory Council in 1991.

9 California and Rhode Island are following suit.

10 Minnesota, Connecticut, New Jersey, and even New

11 York, with their Tick-borne Disease Institute, and

12 Pennsylvania have enacted or introduced legislation

13 addressing issues from treatment and tick control to

14 mandatory in-service for educators in the schools.

15 At the federal level, several pieces of

16 legislation are before Congress. Additionally, in

17 1993, Senator Edward Kennedy heard a prominent New

18 York physician testify in Senate hearings in

19 Washington concerning the problems facing treating

20 physicians, and I quote from his testimony:

21 "A few state health departments have

22 now begun to investigate in a very threatening way

23 physicians who have more liberal views on Lyme

24 disease diagnosis and treatment than they do. And,

25 indeed, I have to confess that today I feel I am

 

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1 taking a personal risk, a large one, because I am

2 stating these views publicly," unquote. That doctor

3 was later charged by the New York OPMC.

4 In other areas at the federal level,

5 the United States Army Centers for Health Promotion

6 and Preventive Medicine has developed has a

7 pocket-size lab to test ticks in the field. Soldiers

8 may receive immediate treatment if bitten by ticks

9 that test positive for Lyme disease. Babesiosis and

10 ehrlichiosis are also being studied by them. Tick

11 populations are being mapped. Satellites are beaming

12 the data to special prototype helmets worn by the

13 soldiers in the field, allowing armies to maneuver

14 around heavy tick populations. NASA and the NIH have

15 a joint culturing project for Lyme disease bacteria

16 using microgravity chambers, which mimic conditions

17 in space and in the human body.

18 New York, with its highest reported

19 Lyme disease cases, joins its contiguous states,

20 Connecticut, Pennsylvania and New Jersey,

21 constituting a block of the top four states in the

22 nation in reported cases. Reported cases have to

23 meet the Centers for Disease Control surveillance

24 criteria. And what that is, is that a person has to

25 have either a physician's diagnosed bull's-eye rash

 

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1 or positive bloodwork and other system involvement.

2 So, the actual number of Lyme cases is estimated to

3 be ten times higher than the reported cases. The

4 Centers for Disease Control reports 3,626 Lyme

5 disease cases in New York for the year 2000. That

6 actually equals 36,260 actual cases for that one year

7 alone. Nationally, in 2000, the reported number is

8 15,328, which equals 153,280 actual new cases for

9 that year.

10 According to the CDC, the surveillance

11 criteria is not to be used for diagnosis, since

12 patients often do not meet the strict surveillance

13 definition. Despite the CDC warnings, many

14 physicians use the surveillance criteria to diagnosis

15 cases, and many insurance companies deny treatment to

16 anyone not meeting those criteria. Excerpts from two

17 Lyme protocols used by insurance companies seem to

18 base coverage on the surveillance criteria, since

19 they require symptoms supported by positive antibody

20 response tests. And that's included in your packet.

21 Additionally, I just obtained yesterday

22 a communication -- it was written in 1996, but the

23 mail is a little slow these days, and I just received

24 it. It was from the New York Department of Health to

25 the Centers for Disease Control. And in that

 

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1 communication, the New York Department of Health

2 indicated that if they followed the two-tier testing

3 requirement for their 1995 cases, 81 percent of cases

4 without rashes would not have been confirmed as Lyme

5 disease.

6 Insurance companies use graphs

7 depicting antibiotic prescribing patterns and they

8 often do not except doctor-prescribed testing such as

9 PCR, which shows the presence of the DNA of the

10 infecting organism, although PCR is accepted for

11 other diseases such as HIV, hepatitis, TB and, I

12 understand now, even anthrax. They limit treatment

13 to 28 days, sometimes they substitute orals for IV,

14 and they use the surveillance criteria for

15 reimbursement determination. Therefore, our doctors

16 face a tremendous dilemma: They have to treat sick

17 patients who do not meet the surveillance criteria.

18 Privately, several doctor have revealed that their

19 insurance carriers strongly suggested they either

20 leave the plan or stop treating Lyme patients long

21 term. A few continue to treat, some refer their

22 patients to long-term treating physicians, while

23 others, fearing reprisals or facing economic

24 hardship, stop seeing Lyme patients.

25 An insurance company letter to a New

 

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1 Jersey patient states, quote, "Unfortunately, a

2 number of unscrupulous practitioners in this and

3 neighboring states have held themselves out as

4 experts in the treatment of Lyme disease. These

5 individuals have subjected patients to improper

6 diagnoses, excessive treatments, inordinately long

7 courses of intravenous therapy, and other activities

8 not support by science or generally accepted

9 standards of medical practice. Because our

10 organization has been appropriately vigilant and

11 aggressive in dealing with certain practitioners,

12 they have chosen to leave our network." I would say

13 that's some choice.

14 At issue nationally to patients and

15 doctors is the volume of complaints by medical boards

16 against these treating physicians who already

17 constitute a very small number overall. To address

18 this situation in New Jersey, in 1993, Congressman

19 Christopher Smith, who is now the chair of the

20 Veteran's Committee in the House of Representatives,

21 held a public Congressional Lyme forum. And last

22 year, the New Jersey State Board of Medical Examiners

23 met with Smith's office and -- which was followed by

24 a meeting with the Lyme Disease Association and a

25 Lyme-literate physician. The LDA has also held other

 

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1 meetings on the controversy with state health

2 commissioners in Connecticut, Rhode Island and New

3 Jersey, and we addressed the Pennsylvania House of

4 Representatives majority caucus.

5 I also have with me today - it also

6 arrived too late to be included, but it is in your

7 packet - a letter from Congressman Joseph Pitts from

8 Pennsylvania. He has one statement which reads, "We

9 believe that Lyme disease is a scientific controversy

10 and, consequently, medical boards should not

11 prosecute physicians based on their long-term

12 treatment of this devastating illness."

13 What we are trying to do is advocate a

14 regional approach to the disease.

15 Today's hearings are not without

16 precedent. Besides Attorney General Blumenthal's

17 Connecticut hearings, Texas recently held state

18 Senate hearing on the harassment of physicians who

19 treat Lyme. A recommendation from that hearing

20 committee, quote, "Directed the Texas Board of

21 Medical Examiners to develop review guidelines for

22 doctors who provide medical care related to

23 tick-borne illnesses," unquote.

24 In New York, we met with

25 representatives from the OPMC, Health Department and

 

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1 the Governor's office, motivated by the fact that

2 almost 60 percent of doctors who treat chronic Lyme

3 disease in New York State have faced OPMC scrutiny

4 the past year. At a meeting this year, OPMC reps

5 said that "some of our best tips come from insurance

6 companies." New York law prevents doctors from ever

7 knowing the original complaint or complainant, thus

8 treating doctors run the risk of spending tens of

9 thousands of dollars defending their right to treat a

10 patient, even when the patient has improved, the

11 patient is not complaining, and the patient objects

12 to his or her records being used against the doctor.

13 And I've included a letter of testimony Dr. Sowell,

14 who is a patient, in the packet.

15 In a letter from Congressman Smith to

16 the New York Assembly Health Committee, he states,

17 quote, "While it is the job of state boards of

18 medical examiners to review complaints logged against

19 doctors and to take action when needed, a concern

20 that was expressed in my state was that some of the

21 complaints were filed not by patients, but by

22 insurance companies - and entities associated with

23 them - who did not want to pay for the costs

24 associated with treating Lyme patients under an

25 aggressive antibiotic regimen. Using a state panel

 

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1 that is supposed to investigate malpractice to help

2 achieve financial gain is simply wrong," unquote.

3 Additional concerns arose from the New

4 York meetings when officials repeated assured that

5 none of the charges against the New York physicians

6 was related to Lyme diseases. We subsequently

7 discovered the word "Lyme" appears a total of 41

8 times in the factual allegations against two of the

9 doctors. A New York assemblyman who viewed the

10 charges confirmed at the meeting with the Governor's

11 chief counsel that the charges were, indeed,

12 Lyme-related.

13 The Department of Health indicated it

14 was not actively soliciting complaints against

15 treating doctors. A patient letter suggesting

16 otherwise details her call to the New York Department

17 of Health and two subsequent calls to her from them.

18 Only seeking information on Lyme and other tick-borne

19 diseases, she was subject to her diagnosis being

20 questioned, told to see another physician other than

21 her own, received an unsolicited complaint form in

22 the mail from the Department of Health, and was

23 pressured to file a complaint against her treating

24 doctor. The DOH told her that he and the DOH could

25 attain anyone's records that they chose, including

 

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1 hers. She never filed a complaint; however, her

2 medical records were pulled soon after the call, and

3 she never heard from that doctor again. Her treating

4 physician eventually faced charges.

5 Lyme disease is so complicated that

6 physicians whose publications are often quoted to

7 deny persisting infection have been shown to make

8 statements that appear to be conflicting. Witness a

9 1990 response letter from a prominent rheumatologist

10 to the Connecticut Department of Health. He refers

11 to a specific doctor, quote, "treating these people

12 with prolonged courses of antibiotic therapy ...

13 patients have usually not required the prolonged

14 courses of antibiotics suggested in his handout ... I

15 think it is unfortunate that the Lyme Borreliosis

16 Foundation and the doctors often associated with them

17 have been become major spokesmen for Lyme disease. I

18 believe they are the principal force leading to the

19 overdiagnosis and overtreatment of this illness. Do

20 you have any ideas regarding what to do about this,"

21 unquote. Coincidentally, the two physicians named in

22 the letter by the rheumatologist were subsequently

23 charged in their respective states.

24 In 1994, that same rheumatologist wrote

25 to patients, "I would like to invite you to

 

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1 participate in long-term follow-up studies of our

2 patients who have had Lyme disease. It has becoming

3 increasingly apparent that the Lyme disease

4 spirochete ... may persist in some patients for

5 years. Of particular concern, recent studies have

6 shown that the spirochete may persist in the nervous

7 system in a small percentage of patients and may

8 cause chronic neurologic involvement," unquote.

9 Before I close, I would like to take

10 this opportunity, first of all, to present the

11 committee with a little what I consider to be weighty

12 evidence. In this book are the documents which we

13 believe support the persisting infection of Lyme

14 disease. It has already been presented to the

15 Governor's office, and also I presented it to Senator

16 Hannon in a prior meeting. And I would like to say

17 that you obviously have the opportunity to view it or

18 not and make your own judgments. However, the

19 doctors in New York who are charged do not

20 necessarily have the opportunity to present this

21 evidence. They have told us that when they go before

22 the hearing body, that oftentimes the evidence, which

23 is peer-reviewed literature, is not accepted; they

24 are not allowed to present it to defend themselves

25 and their right to treat.

 

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1 One other comment that I would like to

2 make, and I guess this is -- I'm going to call this a

3 hypothetical question. If, at this time, I were to

4 announce right now that I'm the CEO with a major

5 pharmaceutical company, I would ask you how that

6 would make you feel about my testimony. Would you,

7 perhaps, have selected someone else to testify today?

8 Would you be going back now over my testimony to

9 determine what weight you would now give it, as

10 prepared (sic) to before, when you didn't think I was

11 a CEO? The reason I'm bringing that up is, we

12 determined in the meetings with the OPMC that they do

13 not have a disclosure provision and so, therefore,

14 the witnesses that are used against our physicians,

15 they do not have to disclose any monetary gain that

16 they may be receiving, which of course would

17 obviously change your testimony. And I would also

18 like to add for the record that I'm not the CEO of a

19 major pharmaceutical company. And please let my

20 husband know that, because he might wonder where I'm

21 hiding the money.

22 Lyme is an enigma. While the debate

23 rages over proper diagnostic and treatment

24 procedures, patients get sicker and some even die.

25 The rational answer to this medical and moral dilemma

 

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1 lies in a quote from Ansel Marks, M.D., J.D., who is

2 the Executive Secretary for the Board of Professional

3 Misconduct. In a letter to a Lyme patient who filed

4 a complaint against a doctor opposed long-term

5 treatment, Dr. Mark states, quote, "As defined by

6 law, a difference of medical opinion in and of itself

7 is not medical misconduct," unquote.

8 Thank you for your time.

9 MR. GOTTFRIED: Just one question. You

10 made reference to several insurance companies using

11 the CDC reporting guideline as a basis for payment

12 decisions, and I guess the footnote in your testimony

13 mentions in particular Aetna. It will be useful if

14 you have documentation of other insurance companies

15 doing similar things -- if you could provide that to

16 us as a follow-up afterwards, that would be useful.

17 MS. SMITH: Thank you. I think I

18 presented Aetna; and there was a Prudential, I

19 believe, guideline from 1995 also in there. I don't

20 know if that's their current -- that's as current as

21 we have. I'll try to get you some other material.

22 Thank you.

23 MR. GOTTFRIED: Thank you. That would

24 be useful.

25 DR. MILLER: Just one question. You

 

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1 mentioned the Tick-Borne Diseases Institute in New

2 York State. Could you tell us how much money that

3 institute receives to do all of the work that it has

4 to do on ticks and Lyme disease?

5 MS. SMITH: Well, I hope my memory

6 serves me correctly, but I believe it was $150,000.

7 I think that the remaining funding that was supposed

8 to go there, I believe, goes to another institution

9 in New York. I suggest you reserve that question for

10 Mrs. Auerbach. She's very knowledgeable in that

11 area, and she can probably provide you with the

12 details.

13 DR. MILLER: Thank you.

14 MR. GOTTFRIED: We're looking into the

15 source of the static. Thank you very much.

16 Oh, I'm sorry, Ms. Smith. Nettie

17 Mayersohn has a question. I'm sorry.

18 ASSEMBLYWOMAN NETTIE MAYERSOHN: Maybe

19 it's my voice. Hello? I can hear you now.

20 Do you know of any cases that have been

21 brought against doctors for undertreatment of Lyme

22 disease as a result of patient complaints?

23 MS. SMITH: To answer your question, I

24 know of several that were -- complaints that were

25 initiated; none, to my knowledge, have, you know,

 

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1 borne out.

2 MS. MAYERSOHN: Okay. We should have a

3 list of those cases so we can follow up on them.

4 Thank you.

5 MS. SMITH: I'll see if we can fine

6 them. Thank you.

7 MR. GOTTFRIED: Okay. Thank you.

8 It is now just about 11, and we are

9 working to make the telephone connection with the --

10 Attorney General Blumenthal of Connecticut. So, I

11 guess we will sort of stand at ease until we do that,

12 or sit at ease, as the case may be.

13 (A recess was taken.)

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