David C. Wright: Disciplined after mistreated patient gets C. diff

David Craig Wright, MD is the owner of a for-profit infusion clinic in Pacific Grove, CA. In 2015, he was disciplined by the Medical Board of California after his appalling treatment of a patient K.B. landed her in the hospital with crippling C. difficile.

As is typical of “Lyme literate” quacks, Wright inappropriately diagnosed K.B and sold her a harmful antibiotic regimen.

In addition to developing C. difficile and other side effects of the regimen, K.B had to have her gallbladder removed after developing gallstones. Gallstones are a well-established complication of ceftriaxone, an antibiotic that Wright sold K.B.

In the 1990s, the CDC documented an alarming number of adolescent girls who had their gallbladders removed after unwarranted ceftriaxone treatments for unsubstantiated Lyme infections.

Incredibly, even after the gallbladder removal, the accusation indicates that Wright continued selling antibiotics to K.B.

Unethical “young blood” trial

As discussed in Popular Science, David Wright helped run a bizarre clinical trial for a purported “anti-aging” treatment that involved infusing patients with the blood of young people.

A startup company called Ambrosia charged $8,000 to be guinea pigs in the trial, which was registered in 2016. Without a control group, the outcome of the trial would be meaningless.

New Scientist documented adverse events, including a serious anaphylactic reaction, associated with the young blood infusions.

HuffPost reported that Wright eventually had a falling-out with Jesse Karmazin, the founder of Ambrosia. After the FDA condemned the young blood infusions, Ambrosia halted the treatments.

Accusation details

In 2014, the Medical Board of California accused Wright of unprofessional conduct for Gross Negligence, Repeated Negligent Acts, and inadequate record keeping.

Ultimately, Wright (“respondent”) agreed that at an administrative hearing, the Board could establish a prima facie case with respect to the charges and allegations contained within the accusation.

An excerpt from the accusation, which resulted in the 2015 discipline, is below:

B. Patient K.B., a 32 year old female, came under respondent’s care and treatment on or about January 28, 2013. In her initial communications with respondent, K.B. gave a history of multiple symptoms following a several year period during which she lived in Israel.

K.B. also reported frequent contact with head lice and one occasion when she pulled “a black bug the size of a tick” from her hair. She also reported that the person with whom she lived in Israel had been diagnosed with tick-borne relapsing fever.

K.B. had learned of respondent from a patient blog on tick-borne infections called “The Tick That Bit Me” and she contacted respondent for the name of a physician in her area who might evaluate and treat her symptoms. Respondent recommended that K.B. come to his clinic in California for treatment which she did, in part because of her reliance on the information contained in the patient blog. Respondent did not disclose to K.B. that the author of the blog was a member of respondent’s family.

C. At her first office visit on January 28, 2013, respondent advised K.B. that based upon her history and symptoms, he believed that she suffered from a chronic tick-borne infection caused by pathogen Borrelia persica, which is endemic to Israel and the Middle East.

He recommended that she undergo six weeks of daily IV antibiotic treatment with ceftriaxone. The record of that encounter is significant for the absence of a documented discussion regarding possible alternative diagnoses, the possible risks of the proposed course of IV antibiotic treatment or alternatives to that treatment.

D. Multiple laboratory tests for different tick-related Borrelia and Bartonella strains were ordered by respondent, but the results of all of them were negative. While serologic tests for Borrelia persica are not commercially available in the United States, respondent did not order an examination of blood smear samples to detect the organisms and thereby support his diagnosis of Borrelia persica.

In fact, that diagnosis was not supported by objective findings and the proposed treatment with six weeks of daily IV ceftriaxone was neither the generally accepted modality for treatment of tick-borne relapsing fever caused by Borrelia persica, nor the recommended treatment duration.

E. K.B. began the recommended daily antibiotic treatment, which respondent administered via a peripheral IV that he placed himself. When K.B. and her mother commented that respondent did not wear gloves or appear to wash his hands when administering the infusion therapy, respondent advised them that it wasn’t necessary.

Although K.B. experienced various problems related to the treatment, these problems are frequently omitted from respondent’s records due to the fact that the electronic chart notes were copied from visit to visit. As a result of this template-use of prior chart notes, respondent’s records are in many instances neither adequate nor accurate records of what actually transpired at each visit.

F. K.B. had significant side effects as a consequence of the ceftriaxone therapy and, after K.B. developed a rash while receiving ceftriaxone, respondent changed her medication to ertapenem on February 23, 2014. Respondent’s review of systems, however, states “negative for rashes.”

G. As her treatment progressed, K.B. experienced increasing abdominal pain, although this is not noted in respondent’s chart until March 2, 2013 — after K.B. had presented to a local hospital emergency room. On March 5, 2013, K.B. underwent a laparoscopic cholecystectomy for gallstones, described to her as biliary sludge, and which may have resulted from her ceftriaxone therapy.

H. K.B. completed respondent’s prescribed six week course of daily infusion therapy on March 11, 2013. Although respondent’s chart notes stated that K.B.’s nausea and vomiting had resolved as of March 6, in fact K.B. became increasingly ill with fever and vomiting.

She went first to a local emergency room and then to a hospital in the San Francisco Bay Area, where she was diagnosed with Clostridium difficile colitis (a possible consequence of the ceftriaxone therapy) and required a prolonged hospitalization for treatment of that bacterial infection.

The accusation concluded:

Respondent is guilty of unprofessional conduct and subject to disciplinary action under section 2234, and/or 2234(b) and/or 2234(c) and/or 2266 of the Code in that respondent was grossly negligent and/or committed repeated negligent acts and/or failed to maintain adequate and accurate medical records, including but not limited to the following:

A. Respondent failed to maintain appropriate records, instead copying them from visit to visit resulting in each chart note being an inaccurate record of what transpired at each of the patient’s visits;

B. Respondent diagnosed a presumptive chronic Borrelia persica infection without an adequate objective basis;

C. Respondent recommended and administered an atypical treatment for presumptive Borrelia persica infection without an adequate basis in the medical literature;

D. Respondent failed to discuss and/or failed to document the risks and alternatives to the proposed treatment;

E. Respondent failed to follow standard guidelines for hand hygiene in the placement of peripheral intravenous catheters;

F. Respondent utilized a patient blog as an endorsement without disclosing that the blog’s author was a family member.

* Note that the date February 23, 2014 seems to be an error in the accusation, and it should probably be February 23, 2013.

Reprimand

In 2015, Wright and the Medical Board of California settled the charges in the accusation. Wright was required to take a medical record keeping course and the following Public Reprimand was issued:

Between January 28, 2013, and March 11, 2013, you administered daily antibiotic infusion therapy to Patient K.B. for a presumed tick-borne infection caused by the pathogen Borrelia persica without an adequate objective basis, a confirmed diagnosis or a documented discussion of treatment risks and alternatives.
This treatment caused significant side effects and contributed to the patient’s subsequent diagnosis with a C. Difficile infection.