Townsend's New York observer - New Column

Townsend Letter for Doctors and Patients, Feb-March, 2004 by Marcus A. Cohen

The Curious Case of Dr. Jennifer Daniels

Jennifer Daniels grew up on the south side of Syracuse in a low-income, predominantly Afro-American community. Intent upon becoming a physician from elementary school on, she earned a scholarship to Harvard, graduating from the pre-med program with honors. She then earned an MD at the University of Pennsylvania and an MBA at the Wharton School, simultaneously gaining both degrees in four years.

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In 1991, she opened a family practice in her old south side neighborhood, resettling with her children in a house a few blocks from her office. Until she returned to provide medical care, her neighbors had to travel far outside their community to see a physician.

Borrowing from a local bank, Dr. Daniels bought a vacant lot and constructed her own medical building. Six weeks after completion she began laying aside money to pay off the loans, repaying all $190,000 borrowed for construction within three years.

Impressed by her business sense, The Wall Street Journal featured Dr. Daniels in its "Black Entrepreneurship" column in 1993. Only 35 at the time, she had become a role model for many Afro-Americans in Syracuse, an outspoken advocate for safeguarding and revitalizing the inner-city area where she lived and worked.

Dr. Daniels' career took a nightmarish turn in 1999. A 19 year-old man consulted her about diabetes. Notes on the patient's chart say she offered three treatment options: insulin injections, consultation with a diabetes specialist, or nutritional management (with Dr. Daniels monitoring his blood sugar levels and ready to prescribe insulin if he worsened). The young diabetic opted for the last.

For a short period he followed the nutritional protocol, controlling his condition. Then, on a college break in the Bahamas he went on a drinking binge. (An affidavit from a classmate who accompanied him attests to the alcoholic excess.) Back in Syracuse, the patient wound up in a hospital emergency room with elevated sugar levels, and an ER doctor admitted him for treatment. During the hospital stay, the patient insisted he had stuck to the nutritional approach, saying nothing about the alcohol.

Not long afterward, acting on a formal complaint against Dr. Daniels, New York's Office of Professional Medical Conduct (OPMC) requested the patient's file. Dr. Daniels sent the file; however, when the OPMC followed with an order for a comprehensive medical review of all her patient records (CMR), she refused to comply. The OPMC charged her with professional misconduct and scheduled a hearing.

Dr. Daniels produced the diabetic's chart with supportive documentation at the hearing, but the Administrative Law Judge (ALJ) barred it as evidence, ruling that the prosecution solely concerned her refusal to comply with the OPMC's demand for a CMR. The hearing panel then recommended indefinite suspension of Daniel's license. She took the matter to the state court.

Forbidden by law to treat patients as her case crept toward a judicial opinion, and thus unable to gain income, she poured money saved for her children's education and her retirement into maintaining her medical office, hoping to recover her license and reopen.

When the court handed down an opinion in June, 2003, it held that the OPMC could not suspend Dr. Daniels indefinitely: "The statute setting forth the permissible penalties for professional medical misconduct does not authorize a license suspension continuing until compliance with a CMR order. Public Health Law ... authorizes suspension of a medical license wholly or partially for a fixed period of time."

Annulling the OPMC suspension, the court remitted the matter to a Health Department Administrative Review Board (ARB) "for imposition of an appropriate penalty." The New York Department of Health appealed, arguing that the Daniels' decision would restrict the OPMC's ability to enforce CMR orders. The state Court of Appeals denied the appeal, letting the lower court's decision stand.

In early December 2003, Dr. Daniels heard from the ARB that it would consider briefs in late December and make a final determination some 45 days after receiving the briefs. The OPMC's brief urges revocation.

Recently, Dr. Daniels spoke with an attorney representing several physicians indefinitely suspended by the OPMC. He informed her that he was studying the judicial "precedent" in her case. The Health Department, in anticipation of other defense attorneys citing Daniels' case, will depend on the ARB voting to revoke her license.

If the ARB does vote to revoke, Dr. Daniels is likely to go to court again for a ruling on the severity of the penalty. Doubtless, her lawyer will argue that it's inappropriate. The OPMC has never publicly alleged that Daniels' nutritional approach to diabetes showed medical incompetence or negligence. Further, a lesser penalty won't affect compliance with CMR orders: New York Law (again quoting the court opinion) "specifically provides a means to judicially compel such compliance while affording the person subject to the order an opportunity to obtain judicial review of its factual basis."