Complaint
The Commissioner received the following complaint from the consumer, Mrs A, about services provided to her by Dr D, general practitioner, between March and October 1998:
- On 19 March 1998 Dr D diagnosed dermatitis due to chemical poisoning, to be treated with a twelve-week course of homeopathic Paraquat injections and drainage.
- Dr D gave an unconditional guarantee that he was able to cure Mrs A.
- Dr D gave Mrs A the first Paraquat injection at the first visit and advised Mrs A to inject herself once a week for a period of 12 weeks. She was told not to apply any topical ointments or preparations apart from BK Lotion.
- Mrs A conveyed her concerns about the use of BK lotion, but was given reassurances by both Dr D and his nurse.
- Over the next three months Mrs A progressed from having eczema on her hands, to having hands that were so swollen she was unable to use them and her face had swollen so much she was unable to see. Mrs A was unable to look after herself, she felt unable to leave her property due to her looks and she was unable to drive.
- By July the situation was no better, but Dr D was insistent that Mrs A was on the right track. Mrs A experienced difficulty in her attempts to speak with Dr D.
- By September 1998 Mrs A's condition was not better and on returning to Dr D he did some more testing and changed his diagnosis to Psoriasis caused by Legionnaires Disease. At this time Dr D suggested that they pray. Mrs A was also prescribed Histafen tablets, a drug Mrs A had been on for much of her life, for six more days as Dr D said he had changed her DNA structure.
- During the next month Mrs A got progressively worse and Dr D advised her that she had Multiple Chemical Sensitivity and that someone in the neighbourhood must have been spraying.
- Dr D did more testing, told Mrs A that the sun was causing an electrical reaction to her skin and that things in her home like the stove and computer were putting too much electricity into her.
- In seven months Mrs A had progressed from having sore hands through a range of diseases and she had intensely itchy, reddened skin. She went to a dermatologist, who is concerned at the condition of her skin. Mrs A is $1500.00 poorer with a worse skin condition than she had previously.
Investigation Process
The complaint was received on 20 October 1998 and an investigation commenced on 23 December 1998. Information was received from:
| Mrs A | Consumer |
| Mr B | Consumer's Husband |
| Mrs C | Consumer's Mother |
| Dr D | Provider / General Practitioner |
| Ms E | Dr D's Practice Nurse |
| Dr F | Dermatologist |
| Dr G | General Practitioner |
| The New Zealand Charter of Health Practitioners Inc | |
Relevant medical records were reviewed. Advice was obtained from a homeopath and a general practitioner. Following Dr D's response to my provisional opinion, advice was obtained from a general practitioner and physician who also practises homeopathy, and a medical microbiologist.
Information Gathered During Investigation
The consumer, Mrs A, had suffered from eczema since she was a young baby, and used steroid creams and prednisone medication to control her condition. Mrs A explained that conventional treatments had provided her with some relief in the past, but that over time her eczema would flare up again. Over the last decade her eczema became worse and dermatologists she consulted could only provide temporary relief. Mrs A advised me that a work acquaintance of her husband recommended she consult general practitioner Dr D, at a medical clinic, as he used a combination of homeopathy and conventional medicine. Mr B and Mrs A thought that Dr D would be able to provide her with the best of both schools of thought and felt confident about consulting him, as he was a registered general practitioner. They felt that he would not just be "dabbling in hocus pocus".
Dr D is a general practitioner who provides both conventional and homeopathic treatments at the Medical Centre. Dr D stated that his practice philosophy is "to provide a wide range of modalities mostly unavailable from other medical practitioners to give patients a wider choice of options for treatment than is available elsewhere".
When asked to detail his alternative medicine and homeopathy qualifications, Dr D stated:
" ...
First let me point out once again, that what I do is not alternative, but complementary as it is called in England by the British Medical Association, as I use all the modalities of traditional medicine, in fact in many cases more than my colleagues. ...
My knowledge of Complementary Medicine and Homeopathic Medicine, started when in 1984, me and my whole family accidentally got arsenate poisoned ... . From this we developed full-blown ME, from which we had to find our own way out. This started off my own personal struggle to get this condition recognised in NZ, successfully, I might say, against opposition from the Medical Council ... .
Since these early beginnings, I have pursued various homeopaths for help in recovery, attended all the that I can in the emerging disciplines of the branches of (1) Isopathy HOMEOPATHY and (2) Complex HOMEOPATHY. I have read vociferously in these areas, attended all the courses offered by [Dr H] and inculcated them into my practice of medicine. ...
I attend the conferences run under the auspices of the American Environmental and Toxicology groups at Dallas Texas, headed up under Dr Bill Rae, the head of the Dallas Environmental Health Clinic. ...
I am a Member of the College of General Practitioners (MRNZCGP) and a member of the NZ Medical Association. I attend the required number of hours for continuing Medical Education (CME) and attend numerous conferences each year, ... . There are no Complementary Medical Associations in NZ because unlike the situation in England, this Medical Council will not allow any to be registered under a medical umbrella, in their own right. ...
The training that I have received in the bio-energy paradigm started first in 1983 with learning Acupuncture under [Dr H] in [the city]. ...
Since [Dr H] began offering teaching in these areas, including the areas of Isopathy and Complex Homeopathic, I have attended all that he has offered, have all the manuals, and got and read all the books on offer. There is only Classical Homeopathy offered by the NZ Society of Homeopathy, and this has very little application in the busy world of General Practice. I have attended the appropriate conference overseas and keep up with Saturday clinical meetings up at [the city] when they are on offer in these fields. ... "
Dr D has provided me with extensive material to support his belief that his diagnostic and treatment techniques are standard, proven, and effective.
On 19 March 1998 Mrs A consulted Dr D, seeking treatment, and a long-term cure, for the recurrent eczema on her hands. Mrs A's mother, Mrs C, accompanied her to the consultation. As the practice nurse had instructed her when making the appointment, Mrs A took two samples of water to the first consultation (one from her jug and one from the tap at her house).
Mrs A stated that Dr D asked her why she was consulting him, and she told him that she had ezcema on her hands. After a quick glance at the rash on her hands, Dr D said that she did not have eczema but was suffering from dermatitis due to chemical poisoning. Mrs A said that Dr D then proceeded to question her about her medical history.
Dr D advised me that during this first consultation he visually examined Mrs A's hands and discussed her medical history, before concluding that she was suffering from dermatitis caused by chemical poisoning. Their discussion of her medical history is documented in Dr D's record of this visit. Dr D's notes record the history of Mrs A's skin problems and her agricultural work history. Her current symptoms, as well as medical history are also briefly noted. Dr D explained to me that conventional diagnoses and treatments had not given Mrs A any relief from her symptoms, which suggested to him that the conventional diagnoses had not been correct.
After muscle testing Mrs A, Dr D determined that exposure to the herbicide Paraquat had caused her skin problems. Dr D explained to me that a diagnosis of Paraquat poisoning is a visual one, as is a lot of dermatology, and that Paraquat poisoning appears as a highly irritated skin with a degree of thickening never found in eczema. Also, that there is:
"a different kind of feel to the skin, the difference of which can only be gained from experience in feeling the skin of such people who have acquired the problem having a clear history of personal usage, plus or minus spillage on the skin."
Dr D explained that Mrs A's presentation was consistent with other cases of Paraquat poisoning he had seen. He also stated:
"There is at present a lack of recognition of [paraquat poisoning] by medical professionals, even though the common symptoms found in people with paraquat poisoning cannot be explained in the conventional framework."
Dr D advised me that the lack of laboratory tests in NZ to diagnose paraquat poisoning means that muscle testing is the only way to do so. In a letter to me dated 22 December 1999 Dr D elaborated on his diagnosis:
" ...
Paraquat diagnosis is in the first instance a visual thing like over 95% of all dermatology, however once seen, never forgotten. I have been paraquat poisoned, and so have two of my family members.
Not that our GP at the time, or dermatologist had any idea at all what it was or how to treat it. ... With the painful, itchy and scaly exematous looking, but clearly not quite eczema, we were stuck without treatment, so once again, as with our ME I was stuck with finding out what it was, and how to treat it - hence my interest in this area, and subsequent expertise, when other people deserted by the medical profession on a lifetime of skin-thinning steroid, found out I might be able to help. ...
There is no general literature that I am aware of dermatologically speaking, [about the diagnosis or treatment of paraquat poisoning] as none of the local dermatologists knew anything about any of the cases that I have ever sent to them, and poo-hoo-d the idea. ... The short answer is, that we can't diagnose it in this country, but it can be done in Sweden. That leaves doctors in this country with observational diagnosis, if they know what they are looking at, or what I do, or better still, both. ... "
Mrs A advised Dr D that her eczema had been present since she was a young baby, and asked him how it was possible to suffer Paraquat poisoning, as she was not aware of ever having had any contact with Paraquat. Dr D replied that it was not important how she had got the poisoning, and told Mrs A that other doctors had wrongly diagnosed her condition. Dr D advised me that he believed it was highly likely Mrs A was suffering from Paraquat poisoning although she could not recall having used Paraquat. Dr D stated that at the consultation on 21 May Mrs A informed him that she had been exposed to Paraquat previously. This information confirmed his diagnosis.
Mrs A explained that although a former employer had used Paraquat, she had not carried out any spraying herself or come into direct contact with the chemical. Paraquat was not used in the area of the farm that Mrs A had worked in.
Dr D tested Mrs A against a "diagnostic set of KUF Paraquat Vials" at each consultation (muscle testing). Mrs A described sitting on a chair while holding an agricultural chemical book on her knees. Dr D used wires to connect her to a small machine that contained a metal plate. He gave her a little electric shock in each finger, then placed samples of various substances on the plate and gave her small vials to hold in her hands. Dr D held Mrs A's hands and small movements in her fingers gave Dr D the results of each test. At the first consultation, on 19 March, Dr D tested Mrs A through her mother Mrs C, as Mrs A's hands were so badly affected by her eczema. Mrs C held her hands over the plate and vials, and Mrs A put her hand on her mother's arm. Dr D stated that Mrs A returned a strong positive result to this test which confirmed to him the clinical appearance of Paraquat poisoning.
Dr D described and explained to me the testing procedure he used as follows:
" ...
The muscle testing procedure is based on the patented 'double 'O' - ring' test, that was awarded to a Japanese Professor of Medicine. It has been taken up into world wide usage, without use of paying patent usage, because the point of patenting it, is to make the point that you can't patent rubbish, ie something that doesn't work and is a sham. The technique in its simplest application, has been renamed as Peak Muscle Resistance Testing (PMRT) as a more descriptive title, to give some understanding as to what actually takes place when the technique is applied.
The items of equipment ... include an aluminium plate on which the person to be tested places their hand in an upturned position. Attached to the plate is a wire which goes to a honeycomb, which is a solid piece of aluminium, drilled with holes sized to accommodate standard vials. This honeycomb has placed in it 4 vials of Epiphysis D26 which are augmenting vials to make the signal on the plate clearer, by making the distinction greater between signals, either weak or strong. Then the person being tested touches test vials with an aluminium probe. The whole test relies on the well established phenomena in physics called resonance to occur when the person being tested touches a test vial, which contains a substance that is present at the same resonance in their body. The phenomena of resonance can be measured a number of ways, and there are a number of patented methods of doing this, ranging from electrical mechanical and pneumatic. ...
The actual practice of the technique is as follows:
The person being tested first places his hands, one at a time, palm down onto the aluminium plate. The Tester then applies a current to the 'ting' points of the fingers using a piezo crystal device (similar to the device that you use to light a barbecue, except there is a flat head not a spark head on the instrument as the intention is to transfer charge, not give the person a 'shock' as such). The person being tested then places their left hand, palm side up, onto the aluminium plate, and opposes the thumb and fourth finger, forming an 'O' - ring shape ... . The Tester then holds the hand of the person being tested in such a way that he can apply pressure to pull these two fingers apart, while the person being tested attempts to apply maximum pressure between the thumb and the fourth finger. ... There are various procedures that are gone through to ensure that the person is able to be tested ... before the actual testing can begin.
Testing proper then can begin, first with the Biological Score to get an objective measure of where the Testee is in terms of mesenchymal toxicity. This scale is derived from human mesenchyme tissue and ranges from 1-21 vials, giving a scale against which the testee can be measured. Treatment can be compared against this at any time to see if the treatment is curative ... or suppressive. What follows next is a long and involved testing procedure with hundred of vials tested against the Testee with orders, and patterns according to what the responses of the testee are to any given challenge. ... These may include various bacteria or viruses, toxins of various kinds such as chemical, petrochemical, electromagnetic stress etc.
It needs to be stressed from the outset that this is never a stand alone test, but simply a complementary modality to the normal medical work-up, of history, examination and blood tests, as I have shown in [Mrs A's] case ... ."
Dr D stated that his working diagnosis at this point was first of Paraquat poisoning, and secondly a strong atopic tendency (predisposition to allergies) evidenced by previously active eczema and active asthma. Dr D said that he then explained to Mrs A that his proposed treatment had been very successful in treating other patients with Paraquat poisoning. He also said that she could have a high expectation of her skin looking like clear normal skin if she followed the treatment through and no other problems arose. If this treatment was unsuccessful, Dr D planned to try other techniques, including homeopathic skin drainage for unknown toxins, specific homeopathic skin drainage for known toxins and constitutional remedies for skin and other things.
During this Mrs A stated that Dr D told her that a 12 week course of homeopath Paraquat injections and drainage treatment would leave her with "skin like a baby". Mrs A stated that Dr D gave her an unconditional guarantee that he could cure her and she would have no further skin problems. Dr D told Mrs A he had never had a case of Paraquat poisoning he had not cured, and at no time gave her any indication that problems might arise during treatment or that the treatment might not be successful.
Dr D subsequently explained his use of the "placebo effect" in treating patients. His approach is to build up "realistic hope" in his patients, in order to motivate them to persist with treatment that may be difficult, and he estimated that this results in up to a 20% improvement in treatment outcomes. Dr D explained the disadvantage of this approach being that patients may misunderstand and mistakenly believe that he has guaranteed them a cure. Dr D stated that he never uses such guarantees to motivate people.
Dr D said that he gave Mrs A a full explanation of the two options for treating Paraquat poisoning. These were hyperbaric oxygen therapy, also known as decompression chamber therapy (at a cost of between $800.00 and $1000.00 for two weeks' treatment, available only in the city), or homeopathic detoxification through a course of injections. Dr D advised me that he informed Mrs A that the injection treatment could aggravate her eczema before it got better and that she would not be able to use her usual steroid creams during this process. There is no record of these explanations in the record Dr D kept of this consultation. Mrs A stated that Dr D did not tell her that the Paraquat injections would aggravate her eczema.
Mrs A stated that Dr D gave her no option other than homeopathic Paraquat injections for her treatment. She was clear that he did not mention oxygen or other therapy. Although he initially told Mrs A that she could either have injections or drops, he later said that due to the extent of her Paraquat poisoning she would need to be treated with injections as drops would not be effective. Mrs A stated that when she asked what was in the Paraquat injections Dr D told her that it was homeopathic Paraquat, which was "harmless".
Dr D explained to me that:
" ...
The paraquat injections are a series prepared by the German company 'STAUFEN' ... . They are an internationally accepted company and treatment for chemical poisoning, and have a huge range of products for homeopathic treatment. The ingredients are a standard potentised preparation, in this case made from paraquat as the base molecule, as we are of course talking about paraquat treatment. They appear in a series increasing potencies of the X or D series from D5 to 30D potency. ... "
Dr D then asked Mrs A how she was feeling generally. Mrs A replied that she was "okay". Dr D then told her that she could not be feeling okay, as her energy levels were far too low. He told her that she was used to feeling that way so did not realise how bad she really was. Dr D told Mrs A that once the Paraquat was out of her system her energy levels would increase once more.
Mrs A decided to proceed with the homeopathic detoxification and Dr D prescribed BK and Pinetarsol lotions for her to use during the treatment (to help control the itching). He told her not to use any other topical ointments or preparations. BK lotion contains lanolin, which had previously caused Mrs A problems. When she asked Dr D about this he tested her again and determined that "she was not at that time lanolin sensitive". Dr D explained to me that from his experience BK and Pinetarsol are the most effective lotions to relieve discomfort from symptoms, while the causes of Paraquat poisoning are being treated. He stated that he explained to Mrs A that her skin would initially sting a little when using these lotions, and that she accepted that she would have to deal with short-term discomfort in order to obtain long-term benefits. Mrs A said that Dr D did not tell her this.
At her first consultation Dr D gave Mrs A a one page information sheet entitled "Taking Homeopathic Medicine (Naturopharm)". This sheet stated that homeopathic drainage remedies prevent newly mobilised toxic substances such as chemicals, poisons and bacterial toxins from rebinding to tissue. These toxins can then be excreted through urine, faeces, skin and hair. Other instructions on the sheet related to the storage of homeopathic remedies, foods, products and medications to avoid taking during the homeopathic process, and how to take oral homeopathic medicine.
Mrs A was to have one injection each week, as well as taking drainage drops, grape powder, and vitamin C powder for 10 weeks, then drainage drops only for two more weeks. There were also dietary restrictions, which were explained on the handout she was given. Dr D's nurse gave Mrs A the first injection at the first consultation and instructed her how to inject herself with the Paraquat. The injection site was one hand width up from the anklebone and half of each vial was to be injected in each leg. The nurse mentioned to Mrs A that some people have a "flare up" when they first use the treatment. Mrs A said that Dr D did not mention this possibility to her.
Mrs A explained that there was no English language and no usage instructions on the packaging of the Paraquat injections. She was given all ten vials at once to take home with her.
Mrs A's diary entry for 19 March 1998 describes her consultation with Dr D. She concluded that she did not understand Dr D's approach to treatment, and that she had found the consultation strange.
Mrs A explained to me that the day after this first consultation her hands became swollen and painful and her skin was hot and oozing. Dr D told her that the bad reactions she had to the Paraquat injections confirmed his diagnosis of Paraquat poisoning. Her hands became even more irritated after she applied the BK lotion. In the past when Mrs A had used lanolin products her skin stung badly. She suffered the same reaction every time she used the BK lotion prescribed by Dr D. In spite of Dr D's assurances to the contrary, Mrs A said that the BK lotion "burnt" when applied to her intact skin and was even more painful when applied to the raw and weeping areas that later developed.
On 27 March 1998 Mrs C rang Dr D's clinic and spoke to his practice nurse, Ms E, to discuss these developments. Ms E assured Mrs C that everything was fine, that it was all "part of the process", and recommended Mrs A should sit in a cold bath to ease the symptoms. Mrs A said to me that cold baths did not ease her symptoms much.
Mrs A administered the weekly Paraquat injections as Dr D had instructed. Her diary entries show that her symptoms were worse on the days immediately following each injection, and she felt her best on the days immediately before each injection. As Mrs A continued with the Paraquat treatment she visited Dr D approximately once a fortnight. Each consultation was approximately 20 minutes long and Dr D charged $3.00 per minute. The initial consultation had been about an hour long. During May and June, Mrs A's whole body continued to be itchy, painful and swollen, sometimes with open weeping wounds. She described feeling extremely miserable and despaired of ever being cured.
On 9 April 1998 Mrs A visited Dr D. She was concerned because her skin continued to get worse. Blood test results indicated to Dr D that Mrs A would benefit from taking vitamin B12 tablets. Mrs A said that when he muscle-tested her, however, he found that vitamin B12 would put her out of "balance". Dr D suggested that they say a prayer, which she thought was weird, but consented to try. When Dr D tested her again following the prayer, Mrs A was back in balance with vitamin B12. Mrs A said to Dr D that she did not really understand how and why that had happened, but Dr D told her that was not important. After praying, Dr D explained that Mrs A would no longer suffer allergic reactions as God had "balanced" her. Dr D stated that addressing her low B12 levels would assist Mrs A's skin to heal.
Dr D explained that he uses prayer to reduce the time and cost of the treatments that he offers. He described his work in this area as "pioneering" and has acknowledged that there have been some teething problems.
Mrs A said that she questioned Dr D about the testing he was carrying out and asked him why other doctors were not using it. Dr D replied that the testing was used extensively overseas but New Zealand doctors were between seven and 10 years behind the times. Mrs A said that this statement indicated to her that Dr D was not practising mere "gobbledegook". When Mrs A asked specifically about Dr D's process he told her that her understanding of the process was not important.
Mrs A advised me that at one consultation she asked Dr D how he had found out about Paraquat poisoning and the treatment he was offering. Dr D replied that "necessity was the mother of invention", and that while in Papua New Guinea with his family he walked through a field that had been sprayed with Paraquat. He later became ill and, when conventional medicine could not help, Dr D conducted his own research into a cure.
On 23 April Mrs A's face was extremely sore and she had another consultation with Dr D. Dr D told her he was pleased with her progress and that her liver was coping very well so her drainage treatment remained the same. Dr D's receptionist showed Mrs A pictures of another woman said to have had Paraquat poisoning, both during and after her treatment. Mrs A described these pictures as "an inspiration". Dr D advised me that the skin on Mrs A's forearms and feet had improved, and that "the skin thickening was much less", the first improvement she had had in five years. These observations are not in Dr D's record of the consultation, and Mrs A does not agree that this was the case.
On 7 May Mrs A again consulted Dr D. He expressed to her his surprise at how much Paraquat was still in her system and at the terrible condition her hands were in. She was given a follow-up appointment two weeks later, and he reassured her that the treatment was still on track and that her problems would improve. Dr D's notes record that Mrs A felt terrible, and that there was marked excoriation.
At the consultation on 21 May 1998 Mrs A received her final Paraquat injection from Dr D. After giving the final injection, Mrs A recalled Dr D took the box containing Paraquat vials off her abruptly, saying that he needed it. Dr D then used a laser, which he told Mrs A was to take the remaining Paraquat out of an energy spot in her right ear. He stated that this was the "high frequency paraquat 200D". Mrs A was told everything was alright, and to go back for a blood test in six weeks, then for a check-up in seven weeks. She had four more weeks of drainage drops to take.
Mrs A again asked Dr D about the testing process that he used. Dr D explained to her that it was based on the radio frequencies given off by all substances, and that it worked on the same principles as colour therapy except that colour therapy was evil.
Mrs A told me that during June her skin continued to deteriorate. The skin on much of her body became sore. Her face was so swollen that she was unable to see and the condition of her hands was so bad she could not drive. Mrs A kept a diary during this period in which she described constant pain and discomfort from a very unsightly rash on her face, neck and hands. The rash spread, became scarlet then broke and became weepy. Mrs A's face swelled up and her eyebrows fell out. The skin on her neck, under her eyes and on her forehead cracked and began oozing. She also had the rash on her arms and thighs. There were lumps on her eyes and eyelids, which made it very difficult for her to see. She was unable to carry out her normal household duties or walk around the farm. Personal cares such as brushing her hair and washing became so difficult that her mother had to help her.
On 5 June 1998 Mrs A discussed her situation with Dr D's practice nurse, Ms E. She said Ms E explained that her problems were to be expected as Paraquat is very hard to get rid of, and suggested that Mrs A double the dosage of drainage drops she was taking. Ms E also described to her the plight of another woman who had suffered Paraquat poisoning, whose arms had swollen so much she could not care for her own baby.
On 15 June 1998 Mrs C insisted Dr D needed to see Mrs A. At this consultation Dr D admitted to Mrs A that something had definitely gone wrong, noted that she was not happy and that her skin excoriation had become worse. Dr D said she had a longstanding infection, probably due to glandular fever, even though Mrs A was not aware of ever having had glandular fever. Dr D assured her she would be fine, and stated again that all traces of Paraquat were gone from her system, except for some remaining higher frequencies. He again used a laser on her ear to remove what he said was the remaining Paraquat. Dr D gave Mrs A Zyrtec, an anti-histamine, and made a follow-up appointment two weeks later. Mrs A stated, "I had now reached the time when he had told me I would be better but the condition of my skin was worsening".
Mrs A described her condition at this point as follows:
"[Dr D] gave further assurances to my family that the 'cure' was in sight. I had merely experienced setbacks. The fact that now the skin on my whole body was affected, red and sore as well as oozing was largely ignored - I was making 'good progress'. Over the last three months I had progressed from having eczema only on my hands, to complete disability as they were so swollen they were useless, my face had also swollen so much that I was unable to see. My husband had to have time off work as I was unable to care for myself. Through this period I felt unable to leave our property, except for visits to [Dr D], because I looked revolting, with a swollen featureless face. I was also unable to drive due to the condition of my hands."
Mrs A explained that at about this time Dr D prescribed her a short course of Betnovate (a corticosteroid cream used in the treatment of inflammatory skin conditions) and that her skin temporarily improved as a result. There is no record of this prescription in Dr D's notes.
Mrs A recorded in her diary that Dr D confirmed at the consultation on 29 June 1998 that there was no more Paraquat in her system. He gave her antibiotics for an infection that he said was affecting her leg and face, put her back on homeopathic drainage therapy and gave her four drops of Aurum Metallica to get rid of a longstanding infection. Mrs A expected to improve within a brief time.
Dr D informed me that on 29 June 1998 it became apparent to him that something other than Paraquat poisoning had intervened in the treatment. He checked Mrs A further and found that she was "showing up an old toxin, a cytomegalovirus, that she had previously overcome". He advised that he discussed this with Mrs A and they decided to leave treating this until the Paraquat treatment was complete. He also stated that at this point Mrs A's skin had improved and her hands were excellent. The homeopathic Paraquat treatment was finished but bioenergetic testing showed that cytomegalovirus was aggravating her and that more Aurum Metallicum was needed.
Dr D subsequently explained to me that whereas conventional blood tests would only be able to ascertain whether there was currently or had previously been an infection with cytomegalovirus, muscle testing can detect whether a "toxic viral residue" is still present and causing "viral fatigue", which can be cured homoeopathically.
Dr D explained that Mrs A had developed a cellulitis from a streptococcus infection, which is what had caused her eyelids to swell and get "boggy". He explained that this was an unfortunate event, unrelated to her treatment, and that Mrs A was extremely unlucky to have caught this infection while her other conditions were being treated. Dr D gave Mrs A four drops of a constitutional remedy (Aurum Metallicum) to try to improve the ability of her skin to bounce back and recover, and prescribed Klacid antibiotics for ten days to treat the infection.
Dr D explained to me that the cellulitis was a complication of the previous steroid treatment Mrs A had had. The steroids had thinned her skin, rendering her vulnerable to infection. Dr D explained that cellulitis symptoms are simple - swelling, heat, pain, redness - and that an educated guess is needed to ascertain which bacteria is causing the problem in order to decide on appropriate antibiotic treatment. There is no laboratory test for cellulitis. In Mrs A's case Dr D confirmed his diagnosis and choice of antibiotic through muscle testing, and stated that the successful outcome proved the validity of his testing.
Mrs A did not agree with Dr D's conclusion, and pointed out that although her hands were often badly cracked and she worked on a farm, she had never before suffered from skin infections.
At the next consultation, on 9 July, Dr D told Mrs A that although she now had another infection her immune system was in fact improving. Mrs A recalled being told that she was recovering well given the number of things that had been wrong with her. Dr D told her there would be two more sets of drainage over the following five weeks, after which she should be fine.
On 9 July 1998 Dr D advised that he attempted a "double detox" with homeopathic remedies, of both the cytomegalovirus and the streptococcus toxin. He also prescribed Urea cream 10% and aqueous creams. Dr D told Mrs A that she was still doing well.
On 30 July Mrs A telephoned Dr D to explain her worsening condition again. Dr D's receptionist promised to return her call but did not.
On 31 July Mrs C telephoned Dr D on her daughter's behalf. Dr D's receptionist explained to Mrs A that it would take time to be healed as there had been a lot wrong with her, and that Dr D had yet to return her call from the previous day as he was researching what to do next. Mrs A's hands were swollen and Dr D's notes describe her skin as "grotty". At this time Ms E told Mrs A that "the squeaky wheel gets the most oil", and that she should complain more. However, Mrs A stated that as Dr D had only three 30 minute "call in" times per week, it was difficult to discuss her concerns with him. Ms E added that Mrs A could see Dr D in a week's time if she was no better. Dr D recommended some homeopathic treatment (Cellular Recharge and hom. Sodium) to reduce the swelling on Mrs A's hands, and sent her two new kinds of homeopathic drops. He insisted she was "on the right track" to be healed. Mrs A said that according to the labels on the bottles, these drops were to treat back pain. Dr D did not see Mrs A on this occasion.
On 5 August 1998 Mrs A had a cough which Dr D diagnosed as a bacterial throat infection. His muscle tests showed a "streptococcium infection" and he prescribed Ceclor antibiotic tablets. Dr D told Mrs A her immune system had improved and that she was to apply tea tree oil and arnica to her hands. Mr B attended this consultation with his wife, and asked Dr D whether her skin was improving. Mrs A stated that Dr D assured them that her skin would be fine once it settled, and that it would never flare up again.
There was another discussion by telephone with Dr D on 24 August, and he agreed to prescribe Mrs A Advantan cream (a corticosteroid used to treat eczema), to use until her skin condition settled.
On 3 September 1998 Mrs A consulted Dr D again. Dr D recorded that Mrs A's cough was almost gone and her tonsils and larynx felt normal. He stated that blood tests showed nothing unusual from an orthodox point of view. He noted that although her face had improved, Mrs A's hands were still peeling. Dr D found this development perplexing and after muscle testing decided that the peeling was caused by a legionella infection. He told Mrs A that his diagnosis was now psoriasis caused by Legionnaires Disease, and that research he had done on the internet had confirmed a correlation between Psoriasis and Legionnaires Disease.
Dr D has subsequently explained that muscle testing showed the legionella bacteria had caused a bowel infection. He put forward information to support his hypothesis that it is feasible that legionella is a water borne bacteria that may be found in household hot water systems, and that it may be present in the bowel. Dr D also stated that he is currently setting up a research project into his theory. Dr D explained that Mrs A's blood test results were consistent with malabsorption due to an unrecognised low-grade bowel bug.
Dr D recommended that Mrs A pray, and said that the best treatment was rest and an improvement in the patient's overall health. He explained to me that prayer, as a means of positive thought, can be very powerful; prayer has been a source of healing since long before conventional medicine developed. Dr D wrote:
"After the prayer the test signal disappeared, which showed that the bug was dead, though the toxin of course remained in the tissue. At this time I was able to look at the bloods and see evidence of this particular bug being present as a bowel bug, a most unusual situation as this bug is usually an air-borne bacteria. It had been present for some time but the signal was overwhelmed by the other more powerful energetic signals of the other things. The body heals from superficial to deep, and this bug is a deeply imbedded one in an intracellular hiding place, and is one of the last ones usually to be pushed up by the body."
Dr D subsequently explained to me that Legionella is intracellular in the human body, and that "it is easier on the body to deal with extracellular bugs before intracellular bugs".
Dr D noted in Mrs A's records that she found this diagnosis discouraging, but she complied with taking the homeopathic detox drops for the Legionella bacteria.
Dr D told Mrs A not to have another appointment for another two and a half months. At this consultation Dr D also told Mrs A she was only to take six more Histafen tablets (which she had been taking for years to control urticaria) as God had told him they were no longer necessary. Mrs A said that Dr D explained that he had changed the structure of her DNA, but that they did not discuss constitutional remedies at this time.
Dr D said that he did not tell Mrs A that she had psoriasis, but that legionella had been implicated in skin conditions as diverse as psoriasis to dermatitis. He also explained that he could not explain Mrs A's reference to DNA changes, but he wondered if she might have misunderstood his explanation about the constitutional remedy.
On 22 September 1998 Dr D recorded in Mrs A's notes that her skin was going well until Saturday, when it had suddenly gone "yucky". Mrs A told him she was standing in the sun and that the skin exposed to the sun went red. Dr D initially said that she may have had a multiple chemical sensitivity and that a neighbour may have been using a chemical spray. He then tested her and decided that Mrs A had become sensitive to electromagnetic radiation. Mrs A recalled that Dr D explained that she had had a bad reaction to the sun, which short-circuited her system. She was full of electricity that was draining her system. Dr D explained to her that household appliances such as the stove and computer were putting too much electricity into her system. Dr D advised me that "this is not uncommon following an altercation with Legionella toxin", and that Mrs A opted to pray to settle the reaction to sunlight down as quickly as possible.
Dr D subsequently explained the diagnosis of sensitivity to electromagnetic radiation to me as follows. The symptoms include: becoming tired in sunlight; red/itching/burning skin in sunlight; shocks off car door handles; making syntax errors while working on a word processor; tiredness in front of electrical equipment including TV, stove, microwave or computer; wrist watch will not keep proper time while being worn; and odd sensations on the side of the body on which a wristwatch is worn. According to Dr D this diagnosis can be made after questioning patients about their symptoms, and is confirmed through muscle testing, which was also used to determine a suitable homeopathic remedy. Dr D stated that "[Mrs A] gave a superb description of suddenly becoming EMR [electromagnetic radiation] sensitive. She stood out in the sun - her neck, arms and hands went red and her skin which was going well until Sat[urday] suddenly went yukky."
Dr D stated that he also told Mrs A at this consultation that as her skin was so reactive she needed to give it time to settle. She was to keep the lotions she was already using, and a vitamin C lotion, grapeseed powder, a multivitamin and mineral ("Cardiocare"), and vitamin B12 were added to her medications. Dr D explained that Mrs A was to return one month later, but that he wrote repeat prescriptions for three months of medications that she would normally receive from her usual GP. Dr D believed that Mrs A confused these two timeframes and mistakenly believed that she was not to return to him for three months.
Dr D stated to me that at this consultation he discovered that Mrs A had now lost her asthma, which had been present since she was six years old. Mrs A recalled telling Dr D that her asthma had improved significantly, not that it had disappeared.
Mrs A had the impression that towards the end of her treatments Dr D no longer wanted to see her, and that she had been placed in his "too hard basket". She felt that his nurse would "fob her off". Mrs A felt that Dr D tried to place a lot of the blame for her condition on her. For example, during the consultation when he told her she had an allergy to the sun the first thing Dr D said to her was "What have you done?". Mrs A advised that she had followed all of Dr D's instructions to the letter; she had eaten only what he said and had avoided everything he said must be avoided. Mrs A believed Dr D was trying to blame her condition on something she had done or omitted rather than accepting that his treatment had not worked.
Dr D subsequently explained to me that he had not intended to blame Mrs A for the deterioration in her condition. Rather, he was wondering whether she had used oil or a lotion that her skin was intolerant to. Dr D also explained that he believed Mrs A's perception of having been abandoned was incorrect; he had put her onto a one month maintenance program.
On 14 October 1998 Mr B tried to telephone Dr D to discuss his wife's condition and their dissatisfaction with the services Dr D had provided. Mr B made it clear that he wanted to speak with Dr D himself. Mr B was unable to speak with Dr D and the practice nurse advised that Dr D could not see Mrs A until 27 October 1998. She explained to Mr B that as Dr D was a specialist he cannot be expected to be available like a general practitioner. Mr B explained that Mrs A had run out of Histafen tablets and her skin was intensely itchy, and was told that Dr D would prescribe more Histafen but still could not see Mrs A until 27 October.
Dr D stated to me that Mr B made no attempt to discuss these matters with him. The telephone call Mr B made was while Dr D was with another patient and unable to come to the phone. He explained that Mr B was told to either call him during a "phone-in time" or to come in, and that he was offered an appointment without charge. Dr D believed that there was no medical urgency for him to be directly consulted at this time. Dr D said that his staff told Mr B that Dr D was a "specialist in his field", which meant that he was not a standard general practitioner. Dr D described himself to me as a general practitioner who specialises in problems such as environmental medicine, fatigue problems and ME.
Mrs A commented that she often had difficulty contacting Dr D to discuss her medical condition. There was only a recorded answerphone message, and no facility to leave messages. Dr D advised that since this complaint he has increased his "ring in" times and it is now easier for patients to contact him to discuss any matters of concern. He said that his practice is to make it easy for patients who are having trouble to telephone him or to come in for an explanatory consultation, for which no charge is made. He stated that he was working three out of four weekends during the time Mrs A was under his care.
Mrs A did not return to Dr D for further consultations, and on 14 October 1998 returned to her general practitioner, Dr G, who referred her to dermatologist Dr F. On 30 October 1998 Dr F diagnosed endogenous hand and food dermatitis (skin inflammation, not from external causes), urticaria (vascular reaction of the skin marked by the transient appearance of slightly elevated wheals), and folliculitis (inflammation of hair follicles), and began her on a course of conventional treatment. Mrs A said that her skin condition has now improved but it is still worse than it was before she first consulted Dr D.
Mrs A stated to me that Dr D did not explain the adverse effects his treatment might have on her before she consented to treatment. In fact, he told her that the Paraquat injections were harmless. She was not warned that she could be incapacitated during the treatment. When Mrs A first consulted Dr D her skin problems were limited to her hands. Since his treatment the problems spread to areas previously unaffected, such as her back, chest, inner thighs and face. She has developed an intolerance to the sun and is on a very heavy drug regime to try to settle her skin conditions.
Dr D, however, stated that Mrs A improved while under his care: her asthma disappeared and she lost all the lichenification, thickening, itchiness and redness on her forearms, arms and feet, but was left with exfoliative dermatitis on her hands. He explained that following the 13 week treatment for Paraquat poisoning, a series of additional infections and complications occurred, which were beyond his control or ability to anticipate. Dr D stated that he did not ignore Mrs A's needs, but that there was no "magic solution" for her problems and his practice nurse did what she could to help Mrs A through the difficult stages of her cure. Dr D concluded that, in reality, there is often nothing that he can do.
Dr D explained to me that he believes Mrs A's worsening condition was "rebound dermatitis" caused by her return to conventional treatment. Had she persevered with his treatment programme then these ongoing problems would not have occurred. He criticised conventional medicine as only able to offer a description of Mrs A's problems and symptomatic treatments, whereas his homeopathic Paraquat treatment, or hyperbaric oxygen therapy, are the only real ways of treating Paraquat poisoning. Dr D explained that other medical practitioners in New Zealand either let people die from Paraquat poisoning, or just treat the symptoms.
Mrs A, however, talked of an improvement in her condition only after recommencing conventional treatment. The deterioration in her symptoms occurred while she was under Dr D's care.
During the time she received treatment from Dr D, Mrs A stated that Dr D actively discouraged her from consulting her regular doctor, as he wanted to ensure Mrs A's "balance" was maintained. Mrs A said that when she expressed concerns about Dr G's reaction to her appalling appearance, Dr D offered to prescribe repeats of medications she would usually have returned to Dr G to obtain.
Dr D subsequently stated to me that he gives "huge amounts of information" to his patients and that he tries to adjust what he says to people's level of understanding, so that although what he says may not be "rigorously scientifically exact", it is "descriptive at their level". Dr D stated that Mrs A has reinterpreted what she perceived that he said, and has incorrectly quoted him as having unconditionally guaranteed to cure her. Dr D stated that he actually said that as he has personally suffered from Paraquat poisoning, he is able to speak from experience:
"I am probably the only doctor in the [area] who can diagnose chemical poisoning and treat it. I believe from the experience I have, I can bring the skin back to normal with time. It will get worse before it gets better, but me and my staff will walk you through it. All things being equal and IF nothing else crops up - it will take about a year.
This is not a boast but a statement based on thousands of chemical cases successfully treated."
Mrs A informed me that she spent about $1500.00 on her treatment with Dr D, and provided receipts for payments to Dr D totalling $1212.45.
Dr D stated that his records show total payments of $1294.45, although he advised that repeat medications dispensed at Mrs A's request may account for the higher figure provided by Mrs A. Dr D advises that Estrafem, Aropax, Pulmicort and Advantan cream were originally prescribed for Mrs A by other doctors but repeat prescriptions for the medication were provided by him, at her request.
Mrs C, Mrs A's mother, accompanied her to all but one consultation (on 5 August Mr B went instead). Mrs C's account of events confirmed Mrs A's recollection.
To summarise, Mrs A wrote:
"If I had one wish it would be that I had never heard of [Dr D], Paraquat poisoning, muscle-testing and the associated hocus-pocus that goes along with it. I expect a doctor to make sane, sensible decisions, to do the best that he can for his patient, certainly not to make the condition worse and pray to God when it all goes wrong."
Independent Advice to Commissioner
Expert advice was obtained from an independent general practitioner and an independent homeopath.
General practitioner
" ...
1. [The general practitioner, Dr D] checked [the consumer, Mrs A] on 29 June 1998 and apparently found from a blood test that she had come into contact with CMV (Cytomegalo virus). From that he said that this was showing up an old toxin. There is in fact no known blood test that is able to diagnose the presence of such a toxin as blood tests simply show whether or not we have antibodies in response to any previous infection with CMV. This is presumably what he found although I do not have any documentary evidence of this.
However, it needs to be said that there is no known recognised test which states that CMV has produced a toxin which is detectable.
2. It would appear from [Dr D's] notes and diagnosis that [Mrs A] developed cellulitis from a Streptococcus infection (although this is not shown to be proved) and that [Dr D] stated that this was a complication of previous steroid treatment. Again, [Dr D] is not a specialist and he cannot make this statement with any degree of surety. Therefore one cannot say that this statement is correct. If in fact [Mrs A] did have such a cellulitis then [Dr D's] treatment with antibiotics was appropriate.
3. [Dr D] apparently performed some sort of testing which showed that [Mrs A] had a Legionella infection. It is unclear to me just what testing this was as it was certainly not conventional medical testing. Again it is totally unclear to me from any conventional medical practice how prayer could change the test signal which would show that the bacterium was dead. This is not conventional evidence-based medicine.
4. It is certainly impossible for [Dr D] to look at blood tests and see evidence that the Legionella bacteria was present as a bowel bacterium. Again, conventional evidence-based medicine would say that this is an impossible diagnosis to make.
5. [Dr D's] comment that 'The body heals from superficial to deep and this bug is a deeply embedded one in an intracellular hiding place, and is one of the last ones to be pushed up by the body' is unprovable and an inappropriate comment to make to [Mrs A]. This assertion is entirely untestable.
6. Likewise it is totally impossible for [Dr D] to conclude from any sort of testing that [Mrs A] has become sensitive to electromagnetic radiation and that this was [not] uncommon following an altercation with Legionella toxin. Again, this is simply not acceptable in our model of conventional medicine.
7. Again, it is not acceptable to say that prayer is an appropriate medium to settle the reaction to sunlight.
8. It can be reasonable that homeopathic [medicine] be prescribed alongside traditional medicine.
9. Clearly [ ... ] [Dr D's] explanations to [Mrs A] were inappropriate and not sufficiently clear. She was clearly confused and the explanations themselves, for the most part, do not make conventional sense at all.
10. [Dr D] is not a specialist in any formal recognised conventional medicine. He may call himself an alternative medical practitioner but it is a falsehood to label [himself] as a 'specialist' in conventional medicine.
11. The Medical Council has recently put out Guidelines on Complementary, Alternative or Unconventional Medicine [1999]. I enclose a copy of these guidelines and in particular draw your attention to the last portion of it which is concerned with assessing complaint or concerns. I draw your attention to:
Part (a): I do not believe, looking at [Dr D's] notes, that an adequate patient assessment was carried out.
Part (b): I do not believe that the methodology promoted is as reliable as other available methods of diagnosis.
Part (c): it is clear to me that the risk/benefit for [Mrs A] was not acceptable for her condition.
Part (d): there is no evidence that the treatment proposed for [Mrs A] and given to her was in any way extrapolated from reliable scientific evidence.
Part (e): is also contentious as it is unclear to me what reasonable expectation that the treatment offered would result in favourable patient outcome for this patient.
Part (f): with regard to the compensation for service provided, it would appear to me that $1,294 is a very high compensation provided.
Part (g): it is unclear to me what reliable scientific evidence was part of this treatment.
Part (h): it appears to me that placebo alone probably would not have done any worse for this particular problem.
Part (i): there is no accurate documentation in the medical records of the patient's full consent of the treatment.
Part (j): I do not know of a formally constituted ethical committee which has given approval for such a treatment.
Thus, under all the criteria for assessing this complaint, it would appear that this particular treatment, of this particular patient, failed to reach acceptable guidelines for treatment."
Homeopath
" ...
Much of the evidence provided has been very bewildering and the facts obscured at times due to the omission of vital details or the rewriting of accepted scientific concepts. However, [Mrs A] was led to believe that she was being treated homeopathically to 'a twelve week course of Paraquat injections', and [Dr D] makes repeated reference to homeopathic medications and apparent homeopathic drainage and other procedures. Therefore the perspectives provided in this report are based on standard homeopathic principles.
...
I. Was [Dr D] able to conclude from his examination of [Mrs A] that she was suffering from Paraquat poisoning and was the treatment for Paraquat poisoning appropriate?
[Dr D] did not provide much rational evidence in any conventional homeopathic sense to justify his diagnosis and the prescription of homeopathic Paraquat injections. ... (The testing is presumed to be muscle testing, but there is no confirmation of this. Muscle testing is not a homeopathic procedure at all ... .)
No explanation is given to the uninitiated as to what K.U.F. Paraquat vials are. ... We therefore have to assume at an initial and critical stage of treatment, and continuing therapy during the full course of treatment that [Dr D] used muscle testing as his main means of diagnosis ... . He did not provide any credible evidence of the matching of any of [Mrs A's] symptoms (or even taking them down adequately) in the conventional homeopathic manner and matching them to a well defined set of symptoms produced by Paraquat poisoning i.e. the Laws of Similars from a MATERIA MEDICA.
I have gone to considerable length to find if any reputable 'proving' has ever been done on Paraquat anywhere in the world, but to no avail. Having used this little known remedy, [Dr D] should have had this information in order to match [Mrs A's] symptoms to those produced by Paraquat poisoning.
...
[H]omeopaths will have little problem if no other choice is available in a crisis in acknowledging reliable medically recorded symptoms produced in a case of Paraquat poisoning. ... Paraquat poisoning is not as insidious as [Dr D] would have us believe. There is reliable evidence for example that 'Paraquat can be used safely as a herbicide by workers repeatedly exposed to it over long periods without fear of lethal or dangerous systemic effects'. ... Paraquat is highly toxic if ingested in material doses affecting mainly internal organs such as lungs, gastro-intestinal tract, kidneys, liver and possibly skin. ... Very serious consideration and matching of symptoms to remedy would have to be applied before responsibly prescribing such a remedy without possible harm to the patient by the appearance of 'proving' symptoms manifesting ... .
The most authoritative set of medical symptoms of Paraquat poisoning (that could be acceptable to homeopathic practitioners in an emergency although incompletely repertrised) is that provided by the Martindale Extra Pharmacopoeia 31st edition of 1996, and recognised by medical and pharmaceutical authorities world wide as well states 'CONCENTRATED solutions of Paraquat may cause irritations of skin, inflammation and possibly blistering, cracking and shedding of nails and delayed healing of cuts and wounds It is NOT significantly absorbed from UNdamaged skin'. ... There is no mention of a predilection area of skin being damaged such as in [Mrs A's] case with dermatitis on the hands only.
[Dr D] appears to have based his diagnosis and consequent treatment on assumptions, some of which are totally foreign to conventional homeopathic principles: