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A doctor who gave alternative care to a Dutch actor and comedian, Sylvia Millecam, who was dying of cancer has seen his punishment increased from suspension from the medical register for six months to removal from the register for life.
The judgment is seen as a clear warning to doctors that when practising alternative care they must still adhere to their professional standards.
The unnamed doctor is both a member of the Dutch Association of Internists and a practitioner of alternative medicine. He treated Ms Millecam, who died of breast cancer at 45 years of age, in 2001.
The doctor was originally suspended from the medical register for six months by the Amsterdam regional medical tribunal (BMJ 2006;332:929 doi: 10.1136/bmj.332.7547.929-a). He appealed, but the central tribunal took a harsher view, saying that his treatment was “a serious threat for public health,” and removed him from the register for life.
This is the severest penalty available to the Central Disciplinary Tribunal for Medical Care, equivalent to the UK General Medical Council. The Healthcare Inspectorate welcomed the ruling, saying it makes “crystal clear” that a doctor involved in alternative medicine does not discard his professional authority.
In May 2000 Ms Millecam sought alternative treatment after a lump in her breast measuring 3-4 cm had been diagnosed as cancer. In July the doctor treated her with magnetic field therapy. He later prescribed more alternative cures and “let slip” that he saw “no indication for cancer.”
He last saw Ms Millecam in December 2000, by which time an investigation in a private clinic identified a tumour of 10-15 cm. She died the next August.
The doctor argued that the patient's rights were paramount. She had refused mainstream treatment, and he feared that if he was confrontational he would “lose his patient.”
But the central tribunal judged that his care fell far short of the particular diagnostic care and treatment required from an internist confronted with a patient requiring oncological care. In particular there was inadequate physical examination, so a judgment could not be made over the progression of the tumour. “The possibility of curing the patient during this period cannot be ruled out,” it states.
The tribunal also emphasised other serious disciplinary matters, including “completely inadequate” patient's notes and the failure to obtain any information from her GP or other doctors in mainstream care. The central tribunal was particularly concerned over the doctor's failure to challenge the “unfounded diagnosis” of non-medical alternative healers, including a clairvoyant and a salt therapist, which encouraged Ms Millecam's belief that she did not have cancer.
The tribunal ruled that a doctor is “first and foremost bound to treat his patients with care that under specific circumstances can be expected from a doctor offering reasonable treatment and competence.” This includes referring the patient for diagnostic tests and informing the patient of the existence and merits of treatment in mainstream and alternative medicine.
The Healthcare Inspectorate said, “Doctors can no longer escape punishment if they treat a patient using alternative medicine who requires care only available from mainstream medicine.”
The tribunal also upheld, on appeal, the punishment imposed on two other doctors involved in Ms Millecam's alternative care. One had been struck off and the other suspended from the professional register for one year.