Malathy Sundaram: Disciplined after patient complaints

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Malathy Sundaram is a medical doctor in Sanford, ME. She was disciplined by the medical boards of Maine and New Hampshire after three patients and an aide of a dementia patient made complaints about her behavior.

In October 2018, Malathy Sundaram’s license to practice medicine was suspended by the Maine Board of Licensure in Medicine after it determined that Sundaram failed to comply with the Consent Agreement she signed in 2017.

Dr. Sundaram does not appear to have any recognized advanced credentials in infectious disease. Nevertheless, she diagnosed two of her patients with “chronic Lyme disease,” which is not a condition recognized by medical science.

Appalling treatment of patients

At the time these two patients were treated, four randomized controlled trials showed antibiotics longer than one more were not necessary or safe for Lyme disease. Even though no trial justified longterm antibiotic treatment, the demonstrably incompetent Dr. Sundaram prescribed it anyway.

Like the majority of victims of chronic Lyme quackery, both patients appeared to have no evidence to support a Lyme disease diagnosis at all. Sundaram decided one patient had Lyme based on CD57 testing, which was discredited in 2009.

The Vitamin B-12 shots and “magnet treatments” Sundaram wanted her patients to try sound like snake oil.

The following is excerpted from the 2017 Consent Agreement:

2. On August 6, 2015, the Board received a complaint from Patient 15-116 alleging that Dr. Sundaram treated her for Lyme disease from 2012 until April 2015. Patient 15-116 stated that her treatment included long term IV and oral antibiotics and vitamin B-12 shots. She told the Board that she was ill for years from all the medications that were prescribed by Dr. Sundaram. She also alleged that Dr. Sundaram wanted her to have a port placed in her chest and suggested that she receive magnet treatments which the patient refused. The patient alleged that she changed providers to an infectious disease specialist, and her medical records were never sent by Dr. Sundaram as requested. Patient 15-116 stated that her new provider took blood work and told her that she never had Lyme disease. The Board docketed that complaint as CR15-116, and sent it to Dr. Sundaram for a response.

3. By letter dated November 2, 2015, Dr. Sundaram responded to complaint CR15-116. Dr. Sundaram explained that she provided treatment to patient 15-116 for about three years and initially saw her for a complaint of weakness and worsening fatigue. Dr. Sundaram noted that the patient also reported arthritis with back and joint pain. Dr. Sundaram explained her basis for diagnosing and treating chronic Lyme disease based on the patient’s symptoms, report of a tick bite fifteen years earlier, and CD-57 lab results. Dr. Sundaram initially prescribed oral antibiotics. Dr. Sundaram acknowledged that she discussed with the patient trying IV antibiotics, and in November 2012, ordered the insertion of a PICC line for Patient 15-116 at a local hospital. Due to the closure of the hospital infusion center during Thanksgiving holidays, Dr. Sundaram ordered the administration of intramuscular injections of Rocephin on four days during the holiday period. Patient 15-116 was administered a four week course of IV antibiotics in November and December 2012. Dr. Sundaram reported to the Board that she stopped administering IV medications in her practice in December 2013. She indicated that she began to order weekly vitamin B-12 injections for Patient 15-116 from May 2013 through April 2015 to help with the patient’s symptoms of “persistent Lyme disease.” Dr. Sundaram stated that she believed, and the patient reported, that the B-12 injections were helpful. Dr. Sundaram provided a copy of the informed consent form for vitamin B-12 injections that she has utilized since 2013 that was signed by Patient 15-116. The informed consent form included an initial statement that “most physicians do not believe in monthly or biweekly Vitamin B-12 injections as there is no scientific proof that it helps” and also lists several potential side effects. Dr. Sundaram stated that the patient picked up a copy of her entire medical record.

4. Patient 15-116 submitted a rebuttal to Dr. Sundaram’s response, which was received by the Board on November 12, 2015. In her rebuttal, Patient 15-116 stated that she initially saw Dr. Sundaram for blood pressure issues, she had to request her records more than once, and her new provider told her that she never had Lyme disease. Patient 15-116 reiterated how the treatment prescribed by Dr. Sundaram made her sick for more than two years.

5. On or about September 12, 2015, the Board received a complaint from Patient 15-137 alleging that Dr. Sundaram diagnosed her in February 2012 with chronic Lyme disease and that she underwent insertion of a PICC line at a local hospital, was administered IV antibiotics for three and one half months, and took oral antibiotics for an extended period which caused severe diarrhea and dehydration. She reported that she went to Dr. Sundaram for weight management and complained of chronic fatigue. Patient 15-137 stated that she had previously been treated by another provider for hypothyroidism and that Dr. Sundaram told her that she no longer needed her thyroid medication. Patient 15-137 stated that Dr. Sundaram started treating her with vitamin B-12 shots twice a week. Patient 15-137 indicated that subsequent providers told her that she did not have Lyme disease. Patient 15-137 also indicated that Dr. Sundaram failed to provide her medical records as requested to another provider, but acknowledged that she was provided a copy directly by Dr. Sundaram’s office. The Board docketed that complaint as CR15-137, and sent it to Dr. Sundaram for a response.

6. Dr. Sundaram responded to complaint CR15-137 by letter dated November 24, 2015. Dr. Sundaram started treating Patient 15-137 in November 2010 after a referral from her primary care provider for weight loss treatment. Patient 15-137 was suffering from low back pain. She was not Patient 15-137’s primary care provider. Dr. Sundaram diagnosed Patient 15-137 with chronic Lyme disease in December 2012 based upon her complaints of significant fatigue, joint pain, tingling and numbness in her upper extremities, and her CD-57 test results. She acknowledged that there was no history of a tick bite for Patient 15-137. Dr. Sundaram described her treatment for Patient 15-137 in her response, which included initial treatment of oral antibiotics for six months, followed by two and one half months of IV antibiotics, and vitamin B-12 injections. Dr. Sundaram reported that she engaged Patient 15-137 in a discussion in May 2013 that treatment for chronic Lyme disease is not an FDA approved treatment and that the patient expressed understanding. Dr. Sundaram denied that she advised Patient 15-137 to discontinue her thyroid medication. She treated Patient 15-137 until June 2013.

The Board Acts

According to the 2017 Consent Agreement, here’s what happened when the Board received the complaints:

12. On January 12, 2016, the Board reviewed complaints CR15-116, 15-137, and 15-178, and voted to obtain an independent outside review of twenty of Dr. Sundaram’s patient charts. Following receipt of Complaint CR 16-33, the Board staff included those records in the independent outside review.

13. On August 12, 2016, the Board received the independent outside review from a Maine licensed physician who is board certified in family practice and geriatric medicine by the American Board of Medical Specialties (“ABMS”). Based upon a review of the patient charts, the independent outside reviewer identified several issues related to medical decision-making, medical knowledge, and prescribing practices/ ordering of tests, and medical record documentation.

14. On June 9, 2015, the Board issued a Letter of Guidance to Dr. Sundaram discussing the importance of maintaining clear communication of prescribing policies, treatment plans, and documentation in the medical record.

15. On October 13, 2015, the Board issued a Letter of Guidance to Dr. Sundaram following a complaint revealing areas of concern related to her informed consent process, medical record documentation, and prescribing practices. The Board recommended that she continue with implemented practice changes regarding pharmacology and prescribing practices.

Disciplinary action

Given the complaints, Dr. Sundaram brokered the Consent Agreement with the Board:

16. Pursuant to 32 M.R.S. § 3282-A(2)(E), the Board may impose discipline if the licensee has engaged in conduct that evidences a lack of ability or fitness to discharge the duty owed by the licensee to a client or patient or the general public, or that evidences a lack of knowledge or inability to apply principles or skills to carry out the practice for which the licensee is licensed.

17. Pursuant to 32 M.R.S. § 3282-A(2)(F), the Board may impose discipline if the licensee has engaged in conduct that violates a standard of professional behavior that has been established for the practice of medicine.

18. On September 13, 2016, the Board reviewed complaints CR15-116, 15-137, 15-178, and 16-33, and voted to set these matters for an adjudicatory hearing.

19. Legal counsel for Dr. Sundaram and the Board have negotiated this Consent Agreement in order to resolve these matters without completing an adjudicatory hearing.

20. Dr. Sundaram does not admit the facts above, but agrees that if the Board were to conclude an adjudicatory hearing in these matters, the Board would have sufficient evidence by a preponderance of the evidence by which it could find that grounds for discipline exist pursuant to 32 M.R.S. §§ 3282-A(2)(E),(F). The Board hereby finds that grounds for discipline exist pursuant to 32 M.R.S. §§ 3282-A(2)(E),(F).

According to the Agreement, Dr. Sundaram, in part, agreed to:

  • obtain a Clinical Competence Assessment (“the CPEP Assessment”) from The Center for Personalized Education for Physicians (“CPEP”);
  • promptly engage CPEP to develop and implement a CPEP Education Plan, if the CPEP Assessment report identified areas for performance improvement that could be remediated;
  • enroll in the CPEP Practice Monitoring Program, upon completion of any completed CPEP Education Plan; and
  • reimburse the Board for costs related to the investigation and hearing, which were $8,479.00.

Like so many quacks, Dr. Sundaram essentially received a slap on the wrist.

 

News

Maine Board of Licensure in Medicine: Sanford Physician Placed on Probation

Bangor Daily News: Two southern Maine doctors put on probation

Journal Tribune: Suspended Sanford doctor says she hopes to soon restore her medical license

Quackwatch/Casewatch: Malathy Sundaram

Documents

Maine Board of Licensure in Medicine: Malathy Sundaram Consent Agreement

New Hampshire Board of Medicine: Malathy Sundaram Settlement Agreement