'I don't deserve to have my medical license revoked'

February 1, 2005

Dr. Joe is a dermatologist who is board certified in both dermatology and immunodermatology.He often uses U.S. Food and Drug Association (FDA)- cleared drugs for off-label uses, something he understands from both his medical and legal colleagues is perfectly legal.

Dr. Joe is a dermatologist who is board certified in both dermatology and immunodermatology.He often uses U.S. Food and Drug Association (FDA)- cleared drugs for off-label uses, something he understands from both his medical and legal colleagues is perfectly legal.

He often uses U.S. Food and Drug Association (FDA)- cleared drugs for off-label uses, something he understands from both his medical and legal colleagues is perfectly legal.

Although not a standard approach, and clearly, an off-label use of the drug, this method of treatment had been reported in some non-U.S. medical journals.

Dr. Joe provided three expert physicians to testify on his behalf at the board hearings.

The board recognized the credentials of all three physicians, but ruled that because Dr. Joe used a technique not generally accepted, the experts would not be allowed to testify. Dr. Joe lost his license to practice medicine. Dr. Joe appealed his case to the court system. Can the board have so much power to revoke his license without even giving him a full hearing?

Not far-fetchedThis case may seem far-fetched, but it is not.

The Medical Board of California filed an accusation against Robert Sinaiko, M.D., a board certified internist and immunologist, alleging that his treatment of a 9-year-old child, and several other patients, was an "extreme departure from prevailing standards of practice." The allegations centered on Dr. Sinaiko's use of anti-fungal agents and dietary restrictions to treat allergies and other chronic immunologic disorders. Because Dr. Sinaiko was using drugs for off-label, FDA purposes, and engaged in "improper experimentation" without adequate informed consent, the board sought to revoke his medical license.

Day in courtA 26-day administrative hearing followed in which both the board and Dr. Sinaiko offered medical expert testimony.

The administrative law judge (ALJ) recommended that the board revoke Dr. Sinaiko's license based on his conclusion that Dr. Sinaiko's experts "were of questionable credibility in that their testimony was not based on generally accepted scientific and medical principles." The board adopted the ALJ's decision and revoked Dr. Sinaiko's license. The board found that although his experts were credible in their fields, they were not qualified for the purposes of the hearing. Their testimony was never heard. The board however did listen to their own experts' testimony.

AppealDr. Sinaiko ultimately appealed to the California Court of Appeals.

The court ruled that the board's disqualification of Dr. Sinaiko's experts rendered the hearing fundamentally unfair as a matter of law. Because the board had disqualified Dr. Sinaiko's experts, and only listened to their own experts who testified that Dr. Sinaiko's treatments fell below the standard of care, the Board decision was not based on any reasonable standard of fairness.