1 NEW YORK STATE ASSEMBLY
STANDING COMMITTEE ON HEALTH
3 CHRONIC LYME DISEASE AND
LONG-TERM ANTIBIOTIC TREATMENT
Hamilton Hearing Room (B)
15 Legislative Office Building, 2nd Floor
Albany, New York
Tuesday, November 27, 2001
17 10:00 a.m.
1 COMMITTEE MEMBERS:
2 ASSEMBLYMAN RICHARD N. GOTTFRIED, CHAIR (Health)
ASSEMBLYWOMAN MAUREEN O'CONNELL (Health)
3 ASSEMBLYMAN JOEL MILLER (Health)
ASSEMBLYWOMAN NETTIE MAYERSOHN (Health)
4 ASSEMBLYMAN MICHAEL COHEN
Patricia Smith 12
3 President, Lyme Disease Association
(Exhibit 1, 79 pages)
Kenneth Liegner, M.D., Physician 27
5 Associate Editor, Journal_of_
___________ _ __________ ________
6 (Exhibit 2, 95 pages)
7 Honorable Richard Blumenthal 62
8 State of Connecticut
9 Alan Muney, M.D., Chief Medical Officer 81
Oxford Health Plans
10 (Exhibit 3, 5 pages)
11 Steven Phillips, M.D., President-Elect 137
International Lyme & Associated
12 Diseases Society
(Exhibit 4, 7 pages)
Steven Schutzer, M.D. 175
14 Associate Professor of Medicine
University of Medicine and Dentistry
15 of New Jersey
16 Brian Fallon, M.D., M.P.H., M.Ed. 185
Columbia University, Department of
17 Psychiatry; Director, Lyme Disease
Research Program of the New York
18 State Psychiatric Institute
19 Carolyn Britton, M.D., Neurologist 192
Columbia Presbyterian Hospital
20 (Exhibit 5, 1 page)
1 Marilynn Barkley, M.D., Ph.D., Researcher 199
University of California at Davis
Robert Bransfield, M.D. 228
3 Lyme Alliance, Inc., Professional
4 (Exhibit 6, 60 pages)
5 Carl Brenner 244
Columbia University, Member, Chronic
6 Lyme Disease Study Committee of the
Institute of Allergy and Infectious
8 Sarah Rude 258
9 Alan Barbour, M.D. (Telephonic) 268
University of California at Irvine,
10 Departments of Microbiology &
Molecular Genetics and Medicine
Pam Weintraub, Reporter 295
12 HMS_Beagle; Former Editor,
Jill Auerbach 306
14 Hudson Valley Committee for Lyme
Disease Patient Advocacy
Robert Clydesdale 321
Evin White 328
Joanna Amato 333
Lia McCabe 336
Howard Hindin, D.D.S. 348
20 Foundation for the Advancement
of Innovative Medicine
21 (Exhibit 7, 3 pages)
22 Norman Rosenthal 355
1 ASSEMBLYMAN RICHARD N. GOTTFRIED,
2 CHAIRMAN, COMMITTEE ON HEALTH: If people could take
3 seats and quiet down, we will begin the hearing.
4 We've got a long list of witnesses. Folks, if people
5 in the audience could find seats and quiet down, we
6 would like to begin the hearing.
7 Good morning. I'm Richard Gottfried; I
8 chair the Assembly Health Committee. Joining me this
9 morning -- and there are other legislators who are
10 expected -- but at this point, joining me are:
11 Maureen O'Connell, the ranking Minority member on the
12 Assembly Health Committee; Dr. Joel Miller, who is
13 also a member of the Health Committee -- and just for
14 clarity, he's a dentist, not a physician, just in
15 case any of you were thinking he's a physician; and
16 Assembly Member Michael Cohen from the Borough of
17 Queens. We are expecting to be joined shortly by
18 Nettie Mayersohn, also from Queens, also a member of
19 the Health Committee, who called from the road; she's
20 been tied up in traffic, apparently, but will be here
22 A couple of procedural points.
23 One is, as was stated in the hearing
24 notice and has been the Health Committee's practice
25 for many years, all witnesses at this and all other
1 Health Committee hearings will be testifying under
2 oath. So, when you come up to testify, the
3 stenographer will swear you in. And we don't do it
4 like Ollie North; you don't have to stand up and hold
5 up your hand or anything. And you can affirm if you
6 don't want to swear.
7 Secondly, there will be several
8 witnesses; three, I believe, who will be testifying
9 through the speakerphone up here. They are scheduled
10 at various times, and so we may need to interrupt a
11 witness at some point to accommodate that. The
12 first, scheduled for 11 o'clock is Richard
13 Blumenthal, the Attorney General of the State of
15 We will be going straight through. We
16 will not take a lunch break, although at some point,
17 probably in a couple of hours or so, we will take a
18 short break, even if just to allow the stenographer
19 to flex her fingers or whatever she needs to do. And
20 speaking of the stenographer, since some of the
21 testimony here today may be using some medical
22 terminology -- if that does come up in your
23 testimony, if you could do that slowly and carefully
24 so that it gets taken down correctly by the
1 Before we call the first witness, which
2 will be Patricia Smith, I just want to say a couple
3 of words. It is not the business of the Legislature
4 or a legislative committee to be making scientific
5 judgments about medical diagnosis, and so the -- it's
6 a fair question, why are we holding this hearing on
7 the question whether chronic Lyme disease is a valid
8 diagnosis and whether long-term antibiotic treatment
9 is a legitimate treatment? The reason is that this
10 question, as many do, has spilled over into some
11 public policy issues, particularly insurance
12 reimbursement, as well as the question whether some
13 physicians who believe in this diagnosis and believe
14 that long-term antibiotic treatment is an appropriate
15 treatment, whether they have essentially
16 inappropriately been singled out for physician
17 discipline/prosecution by the State.
18 Now, today's hearing is not going to be
19 about those physician discipline questions or cases,
20 although sometime in the coming year we are going to
21 be holding a hearing on the physician discipline
22 system and some of those issues could arise at that
23 time. But because of those sort of public policy
24 consequences of the medical question, we're holding
25 today's hearing to try to shed some light on where
1 reasonable medical opinion falls on these questions.
2 Whether there are legislative remedies that might be
3 appropriate will depend a little bit on what we learn
4 here today and perhaps, as well, at the hearings in
5 January and February on the Office of Professional
6 Medical Conduct and its process.
7 I just want to note: Some of you, if
8 you've looked at the witness list, may think that it
9 would have been good if the State Health Department
10 had testified at this hearing, and I think that would
11 have been appropriate. We invited them; they
12 declined. We do have the capacity as a legislative
13 committee in this state to do more than invite
14 witnesses, including state agencies. We can get a
15 little heftier in how we get them here. We tend not
16 to do that except in special circumstances. I do
17 intend to have the Health Department here at our
18 hearing on the Office of Professional Medical
19 Conduct, at which time some of the Lyme-related
20 issues will be dealt with.
21 What the Department said in declining
22 our invitation was, we don't really have anything to
23 say on this topic; we just follow the CDC guidelines,
24 and so we don't really think we have anything to say.
25 I don't think that's an adequate response, but as I
1 say, we will explore that further with the
3 Those are my comments. I don't know
4 whether any of my colleagues want to say anything.
5 ASSEMBLYWOMAN MAUREEN O'CONNELL: Just
6 briefly. Thank you, Chairman Gottfried.
7 My name is Maureen O'Connell. It's a
8 pleasure to be here today to begin to address a
9 problem that is very pertinent, particularly in the
10 district that I represent on Long Island, and I know
11 that I'm joined by my colleague, Dr. Miller. This is
12 a problem that has affected Dutchess County probably
13 more so than any other county right now. I want to
14 thank each and every one of you for coming out here
15 today to share with us some of your experiences, as
16 well as some of the witnesses who have come forward.
17 Like any other disease entity, we have
18 much to learn about this disease, and I think today
19 is the beginning of shedding some important light on
20 what we know now and what we don't know. And I think
21 that is probably one of the most important things to
22 recognize, that there perhaps is much we don't know.
23 But, yet, as Chairman Gottfried said, there are some
24 policy implications here that we feel very strongly
25 about. We want to make sure that patients have
1 access to whatever treatments their physicians deem
2 necessary, and that physicians have their judgment
3 protected. That's something very important to us.
4 And I just, again, say thank you all
5 for coming today. I look forward to the testimony
6 we're about to hear.
7 Thank you, Chairman Gottfried.
8 MR. GOTTFRIED: And, by the way, I
9 should have mentioned that Dr. Miller is not the only
10 person up here who, in his professional capacity,
11 sometimes can wear a white coat. Maureen O'Connell
12 is also a registered nurse. So, there are some of us
13 up here who actually know a little something about
14 what we're talking about.
15 Dr. Miller?
16 ASSEMBLYMAN JOEL MILLER: Thank you. I
17 like the opening comments, which pretty much said,
18 you know, are you a dentist or a real doctor? But
19 we'll let that slide.
20 MR. GOTTFRIED: I didn't say that.
21 DR. MILLER: In spite of that comment,
22 I have to tell you that Richard Gottfried is an
23 exceedingly fair individual, and his ears will be
24 open and he will be listening, and that's essential.
25 So, this panel has no particular slant that should
1 disturb you.
2 The other thing is - and Chairman
3 Gottfried did allude to that - we're not here to make
4 the decision between what is an appropriate treatment
5 and what is an inappropriate treatment. And as
6 testimony goes on which you may disagree with, I
7 don't want you to take the position that we're either
8 winning or we're losing. What we have to demonstrate
9 today is that the scientific answer is not in yet;
10 that science has not ruled out chronic Lyme or the
11 treatment for chronic Lyme using long-term
12 antibiotic. And that's the goal of this hearing, is
13 to demonstrate that there is validity to maybe both
14 sides, but certainly the side with chronic Lyme.
15 Because after all, if there was no problem with
16 chronic Lyme, you wouldn't be here; right? I am sure
17 that you took great comfort in knowing that if you
18 had a month's antibiotic treatment, that you were
19 cured and well and you can go on with your life and
20 that everything else was just your imagination.
21 In any case, that is the reason these
22 hearings will take place. And it should be an
23 interesting day, so sit back and relax and enjoy it.
24 And remember, this is -- there will be things that
25 you hear that you don't particularly like, but that's
1 not how the hearing will make up its mind on where
2 it's going. So, enjoy the day. Thank you.
3 MR. GOTTFRIED: Mike?
4 ASSEMBLYMAN MICHAEL COHEN: For the
5 sake of brevity, I will associate myself with
6 previous speakers' remarks, and I look forward to the
7 first witness.
8 MR. GOTTFRIED: Okay. And the day will
9 go more quickly and we'll have more time to hear more
10 people's full testimony if we don't have to have
11 pauses for expressions of either exuberance or the
13 Assembly Member Mayersohn has
14 advertised his (sic) arriving.
15 Okay. Our first witness is Patricia
16 Smith, president of the Lyme Disease Association.
17 Okay. Are we all set?
18 MS. PATRICIA SMITH, PRESIDENT, LYME
19 DISEASE ASSOCIATION: Thank you, Mr. Chairman and
20 Members of the Committee. I wasn't too nervous until
21 I heard a little bit earlier that you have two
22 committee members from Queens. And my daughter lives
23 in Queens, and I just wondered if you know something
24 about the health of Queens that I don't know and I
25 should know, as a mother.
1 Anyway, thank you for inviting us
2 today. We appreciate the opportunity to talk to you
3 about something that we consider to be very serious.
4 I would like to also say I am the former Chair of the
5 New Jersey Governor's Lyme Disease Advisory Council;
6 I'm the former president of the Wall Township Board
7 of Education; and I also sit on the Board of
8 Directors of the International Lyme and Associated
9 Diseases Society, ILADS, which is a professional
10 medical society.
11 The Lyme Disease Association is an
12 all-volunteer national organization providing Lyme
13 disease research, education and research funding.
14 Along with an affiliate, the Greenwich Lyme Disease
15 Task Force, the Lyme Disease Association is prepared
16 to open with Columbia University a research center,
17 an endowed research center at Columbia. We're
18 working on the logistics right now.
19 Lyme is the fastest growing
20 vector-borne disease in the United States, yet it is
21 rarely given the weight that if deserves. The
22 situation facing patient and physicians in New York
23 is not unique; it mirrors the nation. Patients
24 frequently cannot obtain diagnosis, treatment,
25 insurance reimbursement, disability, education, or
1 even understanding from their families and their
2 peers. Treating physicians have faced a variety of
3 licensure sanctions, including being supervised,
4 fined, not allowed to treat Lyme patients, and
5 license suspension and revocation.
6 In one of the earliest responses to
7 Lyme problems, New Jersey enacted the first
8 Governor's Lyme Disease Advisory Council in 1991.
9 California and Rhode Island are following suit.
10 Minnesota, Connecticut, New Jersey, and even New
11 York, with their Tick-borne Disease Institute, and
12 Pennsylvania have enacted or introduced legislation
13 addressing issues from treatment and tick control to
14 mandatory in-service for educators in the schools.
15 At the federal level, several pieces of
16 legislation are before Congress. Additionally, in
17 1993, Senator Edward Kennedy heard a prominent New
18 York physician testify in Senate hearings in
19 Washington concerning the problems facing treating
20 physicians, and I quote from his testimony:
21 "A few state health departments have
22 now begun to investigate in a very threatening way
23 physicians who have more liberal views on Lyme
24 disease diagnosis and treatment than they do. And,
25 indeed, I have to confess that today I feel I am
1 taking a personal risk, a large one, because I am
2 stating these views publicly," unquote. That doctor
3 was later charged by the New York OPMC.
4 In other areas at the federal level,
5 the United States Army Centers for Health Promotion
6 and Preventive Medicine has developed has a
7 pocket-size lab to test ticks in the field. Soldiers
8 may receive immediate treatment if bitten by ticks
9 that test positive for Lyme disease. Babesiosis and
10 ehrlichiosis are also being studied by them. Tick
11 populations are being mapped. Satellites are beaming
12 the data to special prototype helmets worn by the
13 soldiers in the field, allowing armies to maneuver
14 around heavy tick populations. NASA and the NIH have
15 a joint culturing project for Lyme disease bacteria
16 using microgravity chambers, which mimic conditions
17 in space and in the human body.
18 New York, with its highest reported
19 Lyme disease cases, joins its contiguous states,
20 Connecticut, Pennsylvania and New Jersey,
21 constituting a block of the top four states in the
22 nation in reported cases. Reported cases have to
23 meet the Centers for Disease Control surveillance
24 criteria. And what that is, is that a person has to
25 have either a physician's diagnosed bull's-eye rash
1 or positive bloodwork and other system involvement.
2 So, the actual number of Lyme cases is estimated to
3 be ten times higher than the reported cases. The
4 Centers for Disease Control reports 3,626 Lyme
5 disease cases in New York for the year 2000. That
6 actually equals 36,260 actual cases for that one year
7 alone. Nationally, in 2000, the reported number is
8 15,328, which equals 153,280 actual new cases for
9 that year.
10 According to the CDC, the surveillance
11 criteria is not to be used for diagnosis, since
12 patients often do not meet the strict surveillance
13 definition. Despite the CDC warnings, many
14 physicians use the surveillance criteria to diagnosis
15 cases, and many insurance companies deny treatment to
16 anyone not meeting those criteria. Excerpts from two
17 Lyme protocols used by insurance companies seem to
18 base coverage on the surveillance criteria, since
19 they require symptoms supported by positive antibody
20 response tests. And that's included in your packet.
21 Additionally, I just obtained yesterday
22 a communication -- it was written in 1996, but the
23 mail is a little slow these days, and I just received
24 it. It was from the New York Department of Health to
25 the Centers for Disease Control. And in that
1 communication, the New York Department of Health
2 indicated that if they followed the two-tier testing
3 requirement for their 1995 cases, 81 percent of cases
4 without rashes would not have been confirmed as Lyme
6 Insurance companies use graphs
7 depicting antibiotic prescribing patterns and they
8 often do not except doctor-prescribed testing such as
9 PCR, which shows the presence of the DNA of the
10 infecting organism, although PCR is accepted for
11 other diseases such as HIV, hepatitis, TB and, I
12 understand now, even anthrax. They limit treatment
13 to 28 days, sometimes they substitute orals for IV,
14 and they use the surveillance criteria for
15 reimbursement determination. Therefore, our doctors
16 face a tremendous dilemma: They have to treat sick
17 patients who do not meet the surveillance criteria.
18 Privately, several doctor have revealed that their
19 insurance carriers strongly suggested they either
20 leave the plan or stop treating Lyme patients long
21 term. A few continue to treat, some refer their
22 patients to long-term treating physicians, while
23 others, fearing reprisals or facing economic
24 hardship, stop seeing Lyme patients.
25 An insurance company letter to a New
1 Jersey patient states, quote, "Unfortunately, a
2 number of unscrupulous practitioners in this and
3 neighboring states have held themselves out as
4 experts in the treatment of Lyme disease. These
5 individuals have subjected patients to improper
6 diagnoses, excessive treatments, inordinately long
7 courses of intravenous therapy, and other activities
8 not support by science or generally accepted
9 standards of medical practice. Because our
10 organization has been appropriately vigilant and
11 aggressive in dealing with certain practitioners,
12 they have chosen to leave our network." I would say
13 that's some choice.
14 At issue nationally to patients and
15 doctors is the volume of complaints by medical boards
16 against these treating physicians who already
17 constitute a very small number overall. To address
18 this situation in New Jersey, in 1993, Congressman
19 Christopher Smith, who is now the chair of the
20 Veteran's Committee in the House of Representatives,
21 held a public Congressional Lyme forum. And last
22 year, the New Jersey State Board of Medical Examiners
23 met with Smith's office and -- which was followed by
24 a meeting with the Lyme Disease Association and a
25 Lyme-literate physician. The LDA has also held other
1 meetings on the controversy with state health
2 commissioners in Connecticut, Rhode Island and New
3 Jersey, and we addressed the Pennsylvania House of
4 Representatives majority caucus.
5 I also have with me today - it also
6 arrived too late to be included, but it is in your
7 packet - a letter from Congressman Joseph Pitts from
8 Pennsylvania. He has one statement which reads, "We
9 believe that Lyme disease is a scientific controversy
10 and, consequently, medical boards should not
11 prosecute physicians based on their long-term
12 treatment of this devastating illness."
13 What we are trying to do is advocate a
14 regional approach to the disease.
15 Today's hearings are not without
16 precedent. Besides Attorney General Blumenthal's
17 Connecticut hearings, Texas recently held state
18 Senate hearing on the harassment of physicians who
19 treat Lyme. A recommendation from that hearing
20 committee, quote, "Directed the Texas Board of
21 Medical Examiners to develop review guidelines for
22 doctors who provide medical care related to
23 tick-borne illnesses," unquote.
24 In New York, we met with
25 representatives from the OPMC, Health Department and
1 the Governor's office, motivated by the fact that
2 almost 60 percent of doctors who treat chronic Lyme
3 disease in New York State have faced OPMC scrutiny
4 the past year. At a meeting this year, OPMC reps
5 said that "some of our best tips come from insurance
6 companies." New York law prevents doctors from ever
7 knowing the original complaint or complainant, thus
8 treating doctors run the risk of spending tens of
9 thousands of dollars defending their right to treat a
10 patient, even when the patient has improved, the
11 patient is not complaining, and the patient objects
12 to his or her records being used against the doctor.
13 And I've included a letter of testimony Dr. Sowell,
14 who is a patient, in the packet.
15 In a letter from Congressman Smith to
16 the New York Assembly Health Committee, he states,
17 quote, "While it is the job of state boards of
18 medical examiners to review complaints logged against
19 doctors and to take action when needed, a concern
20 that was expressed in my state was that some of the
21 complaints were filed not by patients, but by
22 insurance companies - and entities associated with
23 them - who did not want to pay for the costs
24 associated with treating Lyme patients under an
25 aggressive antibiotic regimen. Using a state panel
1 that is supposed to investigate malpractice to help
2 achieve financial gain is simply wrong," unquote.
3 Additional concerns arose from the New
4 York meetings when officials repeated assured that
5 none of the charges against the New York physicians
6 was related to Lyme diseases. We subsequently
7 discovered the word "Lyme" appears a total of 41
8 times in the factual allegations against two of the
9 doctors. A New York assemblyman who viewed the
10 charges confirmed at the meeting with the Governor's
11 chief counsel that the charges were, indeed,
13 The Department of Health indicated it
14 was not actively soliciting complaints against
15 treating doctors. A patient letter suggesting
16 otherwise details her call to the New York Department
17 of Health and two subsequent calls to her from them.
18 Only seeking information on Lyme and other tick-borne
19 diseases, she was subject to her diagnosis being
20 questioned, told to see another physician other than
21 her own, received an unsolicited complaint form in
22 the mail from the Department of Health, and was
23 pressured to file a complaint against her treating
24 doctor. The DOH told her that he and the DOH could
25 attain anyone's records that they chose, including
1 hers. She never filed a complaint; however, her
2 medical records were pulled soon after the call, and
3 she never heard from that doctor again. Her treating
4 physician eventually faced charges.
5 Lyme disease is so complicated that
6 physicians whose publications are often quoted to
7 deny persisting infection have been shown to make
8 statements that appear to be conflicting. Witness a
9 1990 response letter from a prominent rheumatologist
10 to the Connecticut Department of Health. He refers
11 to a specific doctor, quote, "treating these people
12 with prolonged courses of antibiotic therapy ...
13 patients have usually not required the prolonged
14 courses of antibiotics suggested in his handout ... I
15 think it is unfortunate that the Lyme Borreliosis
16 Foundation and the doctors often associated with them
17 have been become major spokesmen for Lyme disease. I
18 believe they are the principal force leading to the
19 overdiagnosis and overtreatment of this illness. Do
20 you have any ideas regarding what to do about this,"
21 unquote. Coincidentally, the two physicians named in
22 the letter by the rheumatologist were subsequently
23 charged in their respective states.
24 In 1994, that same rheumatologist wrote
25 to patients, "I would like to invite you to
1 participate in long-term follow-up studies of our
2 patients who have had Lyme disease. It has becoming
3 increasingly apparent that the Lyme disease
4 spirochete ... may persist in some patients for
5 years. Of particular concern, recent studies have
6 shown that the spirochete may persist in the nervous
7 system in a small percentage of patients and may
8 cause chronic neurologic involvement," unquote.
9 Before I close, I would like to take
10 this opportunity, first of all, to present the
11 committee with a little what I consider to be weighty
12 evidence. In this book are the documents which we
13 believe support the persisting infection of Lyme
14 disease. It has already been presented to the
15 Governor's office, and also I presented it to Senator
16 Hannon in a prior meeting. And I would like to say
17 that you obviously have the opportunity to view it or
18 not and make your own judgments. However, the
19 doctors in New York who are charged do not
20 necessarily have the opportunity to present this
21 evidence. They have told us that when they go before
22 the hearing body, that oftentimes the evidence, which
23 is peer-reviewed literature, is not accepted; they
24 are not allowed to present it to defend themselves
25 and their right to treat.
1 One other comment that I would like to
2 make, and I guess this is -- I'm going to call this a
3 hypothetical question. If, at this time, I were to
4 announce right now that I'm the CEO with a major
5 pharmaceutical company, I would ask you how that
6 would make you feel about my testimony. Would you,
7 perhaps, have selected someone else to testify today?
8 Would you be going back now over my testimony to
9 determine what weight you would now give it, as
10 prepared (sic) to before, when you didn't think I was
11 a CEO? The reason I'm bringing that up is, we
12 determined in the meetings with the OPMC that they do
13 not have a disclosure provision and so, therefore,
14 the witnesses that are used against our physicians,
15 they do not have to disclose any monetary gain that
16 they may be receiving, which of course would
17 obviously change your testimony. And I would also
18 like to add for the record that I'm not the CEO of a
19 major pharmaceutical company. And please let my
20 husband know that, because he might wonder where I'm
21 hiding the money.
22 Lyme is an enigma. While the debate
23 rages over proper diagnostic and treatment
24 procedures, patients get sicker and some even die.
25 The rational answer to this medical and moral dilemma
1 lies in a quote from Ansel Marks, M.D., J.D., who is
2 the Executive Secretary for the Board of Professional
3 Misconduct. In a letter to a Lyme patient who filed
4 a complaint against a doctor opposed long-term
5 treatment, Dr. Mark states, quote, "As defined by
6 law, a difference of medical opinion in and of itself
7 is not medical misconduct," unquote.
8 Thank you for your time.
9 MR. GOTTFRIED: Just one question. You
10 made reference to several insurance companies using
11 the CDC reporting guideline as a basis for payment
12 decisions, and I guess the footnote in your testimony
13 mentions in particular Aetna. It will be useful if
14 you have documentation of other insurance companies
15 doing similar things -- if you could provide that to
16 us as a follow-up afterwards, that would be useful.
17 MS. SMITH: Thank you. I think I
18 presented Aetna; and there was a Prudential, I
19 believe, guideline from 1995 also in there. I don't
20 know if that's their current -- that's as current as
21 we have. I'll try to get you some other material.
22 Thank you.
23 MR. GOTTFRIED: Thank you. That would
24 be useful.
25 DR. MILLER: Just one question. You
1 mentioned the Tick-Borne Diseases Institute in New
2 York State. Could you tell us how much money that
3 institute receives to do all of the work that it has
4 to do on ticks and Lyme disease?
5 MS. SMITH: Well, I hope my memory
6 serves me correctly, but I believe it was $150,000.
7 I think that the remaining funding that was supposed
8 to go there, I believe, goes to another institution
9 in New York. I suggest you reserve that question for
10 Mrs. Auerbach. She's very knowledgeable in that
11 area, and she can probably provide you with the
13 DR. MILLER: Thank you.
14 MR. GOTTFRIED: We're looking into the
15 source of the static. Thank you very much.
16 Oh, I'm sorry, Ms. Smith. Nettie
17 Mayersohn has a question. I'm sorry.
18 ASSEMBLYWOMAN NETTIE MAYERSOHN: Maybe
19 it's my voice. Hello? I can hear you now.
20 Do you know of any cases that have been
21 brought against doctors for undertreatment of Lyme
22 disease as a result of patient complaints?
23 MS. SMITH: To answer your question, I
24 know of several that were -- complaints that were
25 initiated; none, to my knowledge, have, you know,
1 borne out.
2 MS. MAYERSOHN: Okay. We should have a
3 list of those cases so we can follow up on them.
4 Thank you.
5 MS. SMITH: I'll see if we can fine
6 them. Thank you.
7 MR. GOTTFRIED: Okay. Thank you.
8 It is now just about 11, and we are
9 working to make the telephone connection with the --
10 Attorney General Blumenthal of Connecticut. So, I
11 guess we will sort of stand at ease until we do that,
12 or sit at ease, as the case may be.
13 (A recess was taken.)