Update on Dr. Jennifer Daniels: are state medical boards biased against racial and ethnic minorities?

Townsend Letter for Doctors and Patients, May, 2005 by Marcus A. Cohen

I devoted my first column in Townsend to Dr. Jennifer Daniels (Feb./March 2004). New York's Office of Professional Medical Conduct (OPMC) had indefinitely suspended her license to practice in 2001--punishment for her refusal to submit to a comprehensive review of her records. Dr. Daniels went into State court, seeking judicial review of the indefinite suspension, and two years later the court ruled that New York law did not allow indefinite suspensions of medical licenses. The court remanded her case to the New York Health Department with instructions for an administrative review board (ARB) to come up with an "appropriate" penalty.

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I promised an update on the ARB's new penalty and subsequent actions in Dr. Daniels' case: early in 2004, the ARB suspended her for three years, stayed the penalty, and commuted it to probation for three years. As usual, terms were attached to the probationary period. Among the conditions imposed, she had to practice under supervision by a physician approved by the OPMC, and she had to double the amount of her malpractice insurance--from three to six million.

Dr. Daniels found a mainstream MD willing to supervise her. The agency rejected her choice, stating that this physician was unfamiliar with complementary and alternative medicine (CAM). Up to that moment, Dr. Daniels had no idea that the Health Department had classified her with CAM practitioners. In retrospect, she's reconstructed how the OPMC had associated her with CAM.

Her therapeutic approach at the start was mainstream. Nonetheless, insurance companies resisted reimbursement to claims put in by her or her patients. At meetings with other Afro-American MDs in her area, she discovered that those associated with white doctors received payment. Those in solo practice were experiencing the same difficulty in getting insurers to cover their treatments.

Turning to her patients, she asked them what sort of care they would pay for out of pocket. The majority favored alternatives to the expensive, invasive treatments for many conditions recommended by most mainstream physicians; Dr. Daniels boned up on herbal, homeopathic, and nutrition-based therapies, offering these as options to her patients.

With her first choice nixed by the OPMC, she then asked a number of CAM practitioners to supervise her. Since that would involve submitting periodic reports to the Health Department, with their names attached (in effect, red-flagging them as CAM doctors), they declined.

Doubling her insurance: No insurer would cover her unless she served a year as a resident in an area hospital willing to pay half the cost of the premiums. She would have to work without pay during the whole of that period, impossible for her to do with three adolescent children to support. Further, as a resident, she would have no say over the patients she saw. Her former patients, happy under her care when she was in private practice, were unlikely to have access to her at the hospital.

Discouraged, Dr. Daniels gave up on returning to practice, only she didn't advise the OPMC of her decision in writing--a violation of the terms of probation in the OPMC's view. Charging her with probation violation, they opened hearings on revocation of her license. Dr. Daniels attended the first hearing, where the OPMC advised her that if she voluntarily surrendered her license--a kind of negotiated settlement of her case--she could apply for re-licensing in three years. (The ordinary waiting period is five years.) She accepted voluntary surrender.

In January of this year, the US Department of Health and Human Services (HHS) warned Dr. Daniels in writing that she would be barred from participation in any medical program--in any occupational capacity (clerk, cook, etc., never mind as a provider of health care)--funded in whole or part by the Federal government, if she did not apply for and regain her license in New York. Should she qualify for a medical license in any other state, the HHS ban would still be binding. As a refresher on Dr. Daniels' career, I quote from my previous column about her:

"Jennifer Daniels grew up on the south side of Syracuse in a low-income, predominantly Afro-American community. Intent on 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.

"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.