A complaint was filed with the North Carolina Medical Board against Joseph Jemsek, M.D., an infectious disease specialist who has been licensed since 1979, for unorthodox diagnosis and treatment of Lyme disease in 10 patients. He also was accused of failing to inform the patients that his methods were a departure from recognized standards.

Each patient presented with non-specific symptoms such as fatigue, non-localized aches and pains, and decreased concentration, with little or no historical, physical, or serological evidence supporting a diagnosis of Lyme disease. However, in Dr. Jemsek’s view, chronic forms of the disease are often misdiagnosed by reliance on standard tests. He had the reputation of being a leading Lyme care provider, seeing hundreds of patients at his clinic near Charlotte.

Dr. Jemsek treated these 10 patients with oral or intravenous antibiotics for months — and in some cases, years — even though there is a risk of infection with long-term use of intravenous antibiotics. In fact, some of them did suffer infections. One young woman had five infections in an 18-month period from her indwelling catheter.

Responding to the disciplinary complaint, Dr. Jemsek acknowledged that he was the only North Carolina physician using these methods to diagnose and treat Lyme disease. He testified that his diagnosis and treatment of the 10 patients was correct. Two expert witnesses agreed that standard tests for diagnosing Lyme disease are not reliable. They said a diagnosis should also be based on the presence of symptoms, such as headache, joint pain, memory loss and confusion. However, the experts questioned the long-term use of oral and intravenous antibiotics to treat Lyme disease.

Many patients of Dr. Jemsek and various Lyme disease support groups rallied to his cause, raising funds for his defense and testifying on his behalf.

The Connecticut Medical Examining Board Responds

“We have a very similar, high profile case right now in our state,” said Dennis O’Neill, M.D., chairman of the Connecticut Board. “It has pitted the Health Department and the Medical Board against zealous patients and patient-advocates who are strong supporters of the doctor and his methods. He is a medical crusader who says he has treated hundreds of patients successfully.”

Dr. O’Neill said he couldn’t predict the outcome of the Connecticut case. The case is being heard by the Connecticut Hearings Panel, and then the full board will be asked to approve, modify or reject its findings.

Connecticut is one of the states where Lyme disease is common. The bacterial infection, usually transmitted by a tick bite, was named after a cluster of cases in Lyme and Old Lyme, Conn.

The Kentucky Board of Medical Licensure Responds

If such a case came before the Kentucky Board, Chairman Danny M. Clark, M.D., said the board would start by reviewing all of the information presented along with the views of the board’s own infectious disease consultants.

Then, “The Board’s Inquiry/Hearing Panel would probably be faced with two options. The first would be to file a complaint and allow the process to go through an administrative hearing, which most likely would result in some form of Order restricting the physician.”

Dr. Clark added that the second option would be to find that the physician’s misconduct warrants only a “Letter of Admonishment,” directing the physician to inform his patients in writing prior to treatment that his method of diagnosing and treating Lyme disease is a departure from recognized standards.

The Wisconsin Medical Examining Board Responds

Steven M. Gloe, general counsel for the Wisconsin Department of Regulation and Licensing, said: “My response assumes the evidence was sufficient to establish Respondent’s conduct fell below the minimum standard of care in the following ways:

  1. Respondent failed to adequately inform patients of treatment options and the unorthodox nature of the treatment he administered.

  2. Respondent failed to consider differential diagnoses for the patients’ symptoms.

  3. After commencing a course of treatment, Respondent failed to adequately monitor and evaluate the treatment’s efficacy.

  4. In the absence of evidence that the treatment was effective, Respondent failed to discontinue the use of intravenous antibiotics when the patient developed repeated infections.

“The investigative team would consult with a case advisor from the board, as well as an independent medical expert. Assuming Respondent had no prior discipline, cooperated fully with the investigation, and ultimately agreed to alter his practice methodology, the disposition would probably include these features:

  1. A reprimand

  2. Limitations on Respondent’s license to practice medicine, including:

    • Passing scores on an assessment of Respondent’s diagnostic skills

    • Completion of board approved continuing education in the diagnosis and treatment of Lyme disease; patient communication and counseling; and, if indicated by the board’s assessment, other courses designated by the board

    • Peer monitoring by a board approved mentor for a period of not less than two years

  3. Respondent must pay costs of the investigation, costs associated with continuing education, and costs associated with monitoring

After hearing Dr. Jemsek’s case, the North Carolina Medical Board decided to suspend his license for one year, and then stayed the suspension, with the following terms and conditions:

  1. Dr. Jemsek must develop an informed consent form approved by the board president.

  2. If a patient’s diagnosis is not supported by the current Center for Disease Control criteria, then the patient must have a consultation or second opinion from another North Carolina physician specializing in infectious diseases and approved by the board president.

  3. Any antibiotic treatment longer than two months must be included in a formal research protocol with Institutional Review Board supervision.

  4. Any complications of treatment must be addressed immediately.

R. David Henderson, executive director of the North Carolina Board, explained, “The Order of Discipline reflects the Board’s belief that Dr. Jemsek can practice safely with these conditions and, thus, not deprive patients of their physician. In sum, the Order in the case of Dr. Jemsek imposed discipline, brought the physician’s practices within acceptable and prevailing standards of medical practice, and most importantly, protected the public.”