An excerpt from “A Return to Healing, Radical Health Care Reform and the Future of Medicine,” by Len Saputo, MD
Sometime in my third decade as a successful practicing physician, I received a surprising call from the local office of the Medical Board of California.
“Is this Dr. Leonard Saputo?”
“Yes,” I answered.
“This is the Office of the California Medical Board. You are being advised to get an attorney. The California Medical Board is intending to revoke your license.”
“For what?” I retorted, with a rising sense of shock.
“We are not required to provide that information to you at this time. However, we are demanding that you forward the chart [of the patient] to us immediately, or you will be fined $1,000 per day after one week for each day it is late.”
I soon discovered what had happened: One of my patients had submitted a bill for the specialty tests I had ordered, and it was summarily rejected.
Every insurance company has its own idiosyncratic version of what tests and procedures it will cover, and this company was no different. They did not understand what the tests were for, and rather than do some due diligence on the sound science behind my request, they had arbitrarily decided not to pay for the tests. When my patient informed me of this, I sent several letters to the company explaining that the patient was greatly improved because of the treatment that resulted from my having ordered the tests. I explained that the tests and the treatment weren’t expensive, and that the insurer should indeed pay for them.
This patient was suffering from irritable bowel syndrome (IBS). He had needed a workup to find out why he had it, to determine its severity and to establish an effective treatment strategy. He had been to other physicians, who had followed the standard approaches designed to suppress his symptoms. These did not work very well and had also produced troubling side effects—which is why this man had come to me. I ordered two straightforward tests: a Comprehensive Digestive Stool Analysis (CDSA) and an intestinal permeability test. These led me to the correct treatment that solved his IBS symptoms.
Rather than listen to reason or at least engage in dialogue, this insurance company went straight to the Medical Board of California and informed the board that I’d ordered tests that they thought were not indicated. They further stated that this practice should be stopped immediately, and that disciplinary action be administered. The Medical Board did in fact obtain a consultation from a general-practice professor at a local medical school. The professor had never heard of the tests, stated in his deposition that there could be no reasonable indication for doing them, and advised them to take punitive action.
What was occurring here was nothing short of a power struggle over what constitutes “good science” in the practice of medicine—and here was one representative case among thousands illustrating that, all too often, politics and even business determines what can be called legitimate science. Concealed at a deeper level is an even more severe clash between opposing scientific paradigms.
Meanwhile, my patient was delighted with the results of his treatment. Yet this was of no interest to the insurance company, the professor, or the Medical Board. No one even bothered to look into what the tests actually did or to appreciate that the laboratories doing the tests were approved by the federal government for quality assurance. No one was interested in looking at the scientific research underlying these tests. The Medical Board was skipping all that and was indeed intending to revoke my license to practice medicine forthwith!
I was forced to hire an attorney. Meanwhile, I also did some homework. It turned out that the Medical Board was offering continuing medical educational credits in several of their approved courses for physicians who wanted to learn about these very same cutting-edge tests that I had already incorporated into my medical practice! Today, these tests are mainstream and remain important in the diagnosis and management of IBS.
Of course, I won the case. But it cost me thousands of dollars to defend, and I was not able to recoup any part of these expenses because the Medical Board is protected by state law from either financial or personal injury recourse, whether right or wrong. The entire process took months of my time and caused considerable emotional distress for me, my office, and my family. As if this was not sufficient injustice, the Medical Board sidestepped the issue they initiated, citing me for having chart notes that were “not complete,” and fined me $350 for this “misdemeanor.” Apparently, this tactic has been a common practice used when the Medical Board wants to save face when they have lost a case. I never received an apology from the Medical Board, from the professor who provided an incompetent review of my case, or from the insurance company that reported me to the Medical Board. No action was taken against the insurance company or the general-practice professor providing incompetent testimony.
I tell this story because it illustrates what innovative physicians are up against when they face the power of politically aligned gatekeepers who are ignorant of the advances of medical science and are often profiting from the status quo—or who hold out against new science because of a dogmatic commitment to the reductionist disease care paradigm of mainstream medicine.