State: 'Integrative Medicine' Doc Left Woman's Cancer Untreated

Oct 11, 2016
Originally published on October 11, 2016 8:45 am

Stephanie Sofronsky was just 23, close to graduation from Florida Atlantic University, when she learned she had lymphoma.

She didn’t want to believe it. So she sought a second opinion from Moffitt Cancer Center in Tampa and a third opinion from Mayo Clinic in Jacksonville, state records show. Moffitt double-checked with the National Cancer Institute. 

All confirmed that Sofronsky had Hodgkin lymphoma, a cancer that attacks white blood cells. They said she had an 80 percent chance of beating it with chemotherapy.

But she never got the chemo.  And for that, state health officials blame Dr. Kenneth Woliner, an integrative medicine specialist in Boca Raton. A move to revoke his license is pending before the Florida Board of Medicine.

That is the recommendation of Administrative Law Judge Mary Li Creasy, who held two days of hearings in February and issued her opinion in late April. Health Department prosecutors proved by “clear and convincing evidence” that Woliner committed medical malpractice and financially exploited his patient, Creasy wrote.

He knew that Sofronsky had lymphoma and yet took no action to see that she got the chemotherapy that could have saved her life, the hearing officer wrote. She called his conduct “astounding.”

What Is ‘Integrative Medicine’?

The case may raise the profile of “integrative medicine,” a newly-recognized specialty sponsored by the American Association of Physician Specialists, a Tampa-based group. Woliner’s website says he is certified by that group’s American Board of Integrative Medicine.

James Marzano, director of public relations for the association, declined in an e-mail to comment, saying the Woliner case “has nothing to do with board certification.”

At his Holistic Family Medicine center in Boca Raton, the hearing officer’s report shows, Woliner repeatedly analyzed Sofronsky’s blood. He ordered iron shots, herbal supplements, and antibiotics.

According to testimony from the patient’s mother, Martha Sofronsky, Woliner said he didn’t think Stephanie had cancer, that it was “low on his list” of possible reasons for her symptoms, according to the hearing officer’s report. She said his case notes indicated Woliner seemed more inclined to think Sofronsky’s symptoms came from allergies to mold and other substances.   

On Feb. 10, 2013, nearly two years after seeking Woliner’s help, Sofronsky died. An autopsy by a Palm Beach County medical examiner attributed her death to untreated Hodgkin lymphoma (also called Hodgkin’s disease).

It is highly unusual for a single incident of alleged malpractice to end in a revoked license, even if the patient dies. But this incident doesn’t fit the pattern for malpractice complaints, which tend to involve a late diagnosis or an error in treatment.

In the Sofronsky case, hearing officer Creasy said, Woliner knew the diagnosis and chose not to believe it, or at least failed to follow up.

Woliner’s Arguments

Woliner’s current attorneys, George Indest III and Lance Leider of The Health Law Firm in Altamonte Springs, have filed numerous objections to Creasy’s legal conclusions and are expected to mount a fierce defense. In written motions, they argue:

-- Sofronsky was a mentally competent adult who had been advised of her cancer diagnosis by at least five cancer specialists. “Dr. Woliner cannot be held responsible” for her failure to take their advice, they wrote.

-- The hearing officer erred in calling Woliner Sofronsky’s primary care physician, who would have been required to refer her to an oncologist and counsel her to go through with the chemotherapy. They argue that as an integrative medicine specialist, he was not her primary care physician.

“Dr. Woliner was engaged to investigate Sofronsky’s thyroid issues, not to diagnose or treat her cancer,” they wrote.

Even though he was trained in Family Medicine, Woliner was no longer practicing that specialty, his attorneys say. He was practicing “integrative medicine,” and thus could only be reviewed on that basis.

The American Board of Integrative Medicine, which certifies Woliner has training and experience in the specialty, defines it as “the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing.” 

Author Andrew Weil, MD, who helped develop integrative medicine as a specialty, says on a YouTube video that it is the “intelligent combination of conventional and alternative medicine,” not just a reliance on one or the other.

-- Neither of the two expert witnesses for the state was qualified to judge Woliner’s handling of the case because neither of them practices or is trained in integrative medicine, the attorneys argue. One was Dr. Roy Ambinder, a cancer specialist in Altamonte Springs, and the other was Dr. Charles Powers, a Family Medicine specialist in St. Cloud. Both said Woliner’s treatment amounted to malpractice.

But Woliner’s attorneys said the hearing officer should have listened to defense witness Dr. Stephen Silver of Boca Raton, the only integrative medicine specialist who testified. He said Woliner’s treatment was appropriate.

-- The hearing officer permitted the state to use information learned from an illegal tape recording, Woliner’s attorneys argue.

Martha Sofronsky, the patient’s mother, made a secret recording of her conversation with Woliner on April 29, 2013, two months after her daughter died, according to the defense. Department of Health prosecutors used the tape to undermine the credibility of Woliner when he testified, the defense attorneys argue. The tape prejudiced the hearing officer against Woliner, they said.

Under Florida law, it is illegal to record a private conversation without the participants’ consent. Woliner said he did not know the patient’s mother was recording their conversation. But other testimony indicated Woliner allowed patients to record their sessions as an aid to remembering what he’d said.

A curable cancer

Hodgkin lymphoma, also called “Hodgkin’s Disease,” is one of the most curable forms of cancer, according to the Leukemia & Lymphoma Society. A patient has a 90 percent rate of five-year survival if it is caught early and treated with the right drugs, the society says. Even at Stage 3 discovery, as in Sofronsky’s case, the odds are 80 percent.

Lymphoma treatment typically is handled by a hematologist, an oncologist who specializes in blood cancers. A number of hematology experts at Moffitt, NCI and Mayo collaborated in Sofronsky’s diagnosis, according to  the hearing officer.

At one point, records show, Sofronsky saw a West Palm Beach hematologist, Neal Rothschild. But she canceled the chemotherapy after consulting Woliner, Creasy’s report says.

Woliner said at his February hearing that he assumed Sofronsky was being treated by Rothschild.  But the hearing officer said that was “not credible,” since if it were true, he would have been coordinating his care with the cancer specialist to prevent drug interactions.

Another argument of Woliner’s that failed to sway Creasy was his refusal to call himself a primary-care physician. Since he doesn’t engage in primary care, he argued, he should not be held responsible for making sure that Sofronsky followed through on her cancer treatments.

Creasy ruled that Woliner was acting as Sofronsky’s de facto primary-care physician, since the young woman and her mother “relied nearly exclusively on him for all … medical advice, recommendations, referrals, guidance and treatment.”

Cash only

Woliner’s practice bears little resemblance to that of most doctors with board certification in family practice. Indeed, his website calls Holistic Family Medicine “a unique functional medical practice that blends the best of mainstream medical science with natural treatments through diet, vitamin, herbs, and nutritional therapies.”

His goal, he says, “is to treat your disease or condition and relieve symptoms by using the most effective, least toxic therapy possible.”  

Woliner, who doesn’t accept health insurance, requires cash or credit-card payment. He collected $2,990 from Martha Sofronsky, the patient’s mother, during nearly two years of treatment, the hearing officer wrote.

The doctor’s website says he specializes in “hard-to-treat” ailments including: “thyroid conditions, obesity, Crohn’s Disease, Fibromyalgia, Candida (Yeast Infections), Chronic Fatigue Syndrome, Weight Loss Resistance, Diabetes, Menopause, and Men’s Health.”

In February 2015, Woliner’s website says, he  became certified by the American Board of Integrative Medicine, one of about 18 offered by Tampa-based American Board of Physician Specialties.

Neither Woliner nor his attorneys at The Health Law Firm returned phone and e-mail messages requesting comment.