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An illustration of a paper trail leading to health records.

Retired Dentist Seeks (and Challenges) Alternative Care Methods

A retired dentist known for using alternative methods of care himself requested the use of alternative methods with his chiropractor. After experiencing a stroke, the dentist filed a complaint against his DC for failure to refer, among other allegations.

Dr. Mya Tomos, DC, DABCI, was a chiropractic internist with an active solo practice. Throughout her career, Dr. Tomos treated numerous patients through chiropractic adjustments and other modalities, but her focus was to serve patients as their primary care provider — her Diplomate of the American Board of Chiropractic Internists (DABCI) degree allowed for such treatment.

Dr. Tomos’ DABCI designation required her to take 300 additional course hours beyond her chiropractic degree. The program allows advanced degrees in other specialties, including orthopedics, radiology, neurology, pediatrics, etc.

Dr. Tomos’ practice offered services including weight counseling, blood reviews through CBCs and supplements in an effort to achieve overall body health. Dr. Tomos did not restrict her patients from being treated by other health care professionals, but her practice did attempt to provide patients with alternatives to medical care.

In that endeavor, Dr. Tomos had a patient, Dr. James Reicoff, who was a retired orthodontist. His retirement was the result of an automobile accident that left him with a disability in his right arm. Dr. Reicoff entered her practice with a very serious kidney disorder, autosomal dominant polycystic kidney disease (ADPKD), for which he was treated by his primary care physician, a medical doctor, neurologist and nephrologist.

Dr. Reicoff, age 60, was interested in alternative medicine to assist him with his kidney issues. He had been advised by at least two nephrologists that he would someday require dialysis. As the cost of dialysis can be $150,000 per year, he was doing all he could to avoid that alternative.

Dr. Reicoff’s son was a chiropractic physician, so he was familiar with the practice of chiropractic and its philosophy. Dr. Tomos was aware of Dr. Reicoff’s condition and the complications that came along with the diagnosis, including increased risk of stroke.

The Facts

Dr. Tomos treated Dr. Reicoff from Oct. 30, 2009, through July 26, 2010. Dr. Reicoff had a hemorrhagic stroke on Aug. 2, 2010. His intake requested assistance to reduce cysts in kidneys, improve blood valve function and filtration. 

Dr. Tomos did not perform an examination on the initial encounter but went through his goals for treatment. He listed that he was being treated by “Dr. Reed – nephrologist and Dr. Monis – nutritionist.” 

Between 11/11/09 and 7/26/10, Dr. Reicoff was treated 20 times, by Dr. Tomos and other physicians, with regular blood pressure readings that fluctuated between 110/70 and 162/110.

Dr. Tomos obtained records from Dr. Reicoff’s nephrologist and retained what she needed for her chart (blood work and laboratory results). Within the first two weeks, Dr. Tomos advised Dr. Reicoff to get another blood study which was completed on Nov. 12, 2009, at the local hospital. She was able to examine those results, as well as his April 2009 blood results, to form her initial differential diagnosis of kidney and liver disease and polycythemia (a thickening of the red blood cells).  

During her treatment, Dr. Tomos recommended hydrochloric acid therapy in an effort to assist Dr. Reicoff with digestion. Hydrochloric acid therapy is used to increase digestion so that the patient can extract nutrients from their food and natural medicines.

Dr. Reicoff also complained of blood in his urine and ejaculate, itchy skin, red spots on his skin and the “worst bloody nose of his life (one time).” The blood in his urine and ejaculate presented as early as 2004 while he was being treated by other medical doctors, while evidence showed that Dr. Reicoff consulted with Dr. Tomos about the bloody nose and wondered about the cause. She did not believe it was being caused by the supplements, however, she advised Dr. Reicoff to come off all natural medicines on April 23, 2010. 

The Allegations

Plaintiff filed a two-count complaint — one count against Dr. Tomos, individually, and one count against her practice. 

Dr. Tomos advertised treatment with natural medicines and Dr. Reicoff, drawn to being treated by her, essentially, disregarded treatment with all other medical providers.

During Dr. Reicoff’s treatment from Oct. 30, 2009, through his stroke on Aug. 2, 2010, Dr. Tomos ordered bloodwork that found abnormal values. Dr. Tomos should have referred Mr. Reicoff to a medical doctor for examination of the elevated laboratory values as his care was beyond the scope of a chiropractic physician.

Plaintiff also alleged that Dr. Tomos prescribed natural medicines which were singularly or in combination, contraindicated for the increasingly abnormal laboratory test results.

Plaintiff claimed that, during the course of treatment, Dr. Reicoff was hypertensive and none of the treatments, including the natural medicines, treated his hypertensive issues.

The plaintiff took issue with his creatinine levels, eGFR and platelet count. The following are those readings:

11/12/09

Creatinine       1.57 (Should be between .76 and 1.46)

Platelets           132,000 (Should be greater than 140,000)

eGFR              45L (Should be greater than 60)

2/25/10

Creatinine        1.55

Platelets           129,000

eGFR              46L

6/8/10

Creatinine        1.71

Platelets           116,000

eGFR              41L

Interestingly, Dr. Reicoff’s readings from the urologist were as follows:

4/23/09

Creatinine        1.75

Platelets           142,000

eGFR              40L

Plaintiff alleged that Dr. Tomos ignored or did not understand the significance of Mr. Reicoff’s complaints and needed to consult with his medical doctors, nephrologist, urologist, PCP. Her failure to have those respective doctors’ medical records in her chart showed she was treating Dr. Reicoff without any consultation. She had reviewed the medical records from the nephrologist and urologist but did not retain them in her file. There was no electronic footprint to show she had reviewed the files or used them for her diagnosis and treatment.

Plaintiff claimed that as a result of these actions or inactions, Dr. Reicoff had an intracranial hemorrhage.

Defenses to Allegations

Dr. Reicoff, DDS, was an intelligent, educated, well-read man. He was known for practicing in a non-traditional manner—attempting non-surgical temporomandibular procedures by fitting patients with molds to increase the strength in their joints.

He was fully aware he was seeking alternative care with Dr. Tomos, telling her that he was unhappy with traditional medicine and with what his nephrologist and urologist were doing for him. Dr. Tomos never suggested he should stop going to his nephrologist. Unfortunately, Dr. Tomos’ record is not as clear as Dr. Reicoff’s intentions. Had she used a consent form or some other form with explanation of treatment, a lawsuit may have never been filed.  

NCMIC authorized the retention of experts including standard of care, causation and pharmacology. The plaintiff was seeking more than $9 million.

After a two-week trial and over 25 witnesses, the jury was out for under 30 minutes, before returning a defense verdict for Dr. Tomos.


What Can We Learn?

  • Use consent forms that detail treatments explicitly for the patient and that cover yourself from malpractice lawsuits.
  • Consider electronic health records as they can create a footprint for what you use/review in making a determination on treatment.
  • Use your notes to explain what you are doing and why you are doing it. For example, a note by Dr. Tomos outlining that she was aware of the other medical providers’ treatment, that she had reviewed the nephrologist/urologist records and that Dr. Reicoff was looking for alternative care, could have prevented this lawsuit.
  • One issue with a jury trial, is that you can never be sure if what they find or don’t find is compelling enough to lead to a verdict. In this case, the jury listened carefully to the Court's instructions in the finding for the DC.

About the Author

Kenneth A. Scaz is a founding member of Golden Scaz Gagain. Ken has been a member of the Florida Bar since 1998. He is licensed to practice in the United States District Courts, for the Northern, Southern and Middle Districts of Florida. Ken is also licensed to practice before the U.S. Court of Appeals for the 11th Circuit.

Ken has successfully served as lead counsel on trials involving trucking accidents, automobile accidents, chiropractic malpractice, legal malpractice, negligent security cases, contract claims, workers compensation claims, unemployment compensation claims and general liability claims. Ken also appears before the Florida Administrative Boards to advocate on behalf of doctors.

Ken earned his law degree from Gonzaga University School of Law in 1998 and his undergraduate degree from King’s College, where he was a member of the All-Academic Middle Atlantic Conference baseball team.

Ken has lectured to clients in other states including Texas, Tennessee and Arkansas on issues of consumer law, auto insurance, premises liability, medical malpractice, negligent security, bad faith, punitive damages and joint and several liability.

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