After 3 1/2 years of legal proceedings, Dr. Hellfried Sartori, a former nutritionist and cancer specialist in Rockville, lost his license to practice medicine in Maryland last month because he was found to be "professionally incompetent."
The ruling has had little effect on Sartori. Two years ago he moved his operations to an apartment building on upper Connecticut Avenue in the District of Columbia, where he continues to practice medicine. He plans to appeal the Maryland ruling.
His office exudes the garlicky odor of DMSO, a drug used chiefly for veterinary purposes and for one relatively rare human bladder ailment. Sartori says he continues to use DMSO and cesium chloride, a lab chemical that he sells to patients to sprinkle on their food, as part of his $2,000 cancer treatments. Neither substance is approved for such use by the U.S. Food and Drug Administration.
Sartori's case is an example of the problems that state governments face in trying to discipline doctors who hold licenses in several states. Fifteen states have laws permitting their disciplinary boards to take action against a doctor who has been disciplined in another state. The other states wait until they develop charges based on complaints of patients in their own state.
The District of Columbia is one of the 15 jurisdictions that does have legal authority to use the results of another state's board. But the board has a practice of waiting to take action, even if the subject has moved into Washington, until the other board has acted, according to the D.C. commission director.
The medical licensing board in the District, the D.C. Healing Arts Commission, tells callers that Sartori is a licensed doctor in good standing "with no complaints." Maryland officials say they have informed the District and expect its commission to begin taking action based on the Maryland revocation.
"Until the matter goes to a public hearing, all complaints remain confidential," said P. Joseph Sarnella, director of the D.C. commission. "It kills us to sit here and tell people nothing," said Sarnella.
Sarnella said he tries to use voice inflections or indicate familiarity with an unfit doctor by immediately knowing his first name as a tip-off to callers seeking information. "I subtly try to turn people away from him a doctor under investigation because of complaints. "
The Maryland Commission on Medical Discipline ruled on Sept. 20 that Sartori lacked medical knowledge and used unproven techniques on his patients, including having them swallow capsules that emit radio waves to determine the acidity of the stomach.
"This is just misinformation," Sartori said of the Maryland action. "If there was anything wrong, they should have taken action four years ago when they first came to me."
On a counter top in his office, sits a stack of photocopies of a letter from the American Board of Family Practice, announcing that his recertification in the reputable specialty board was renewed this month for six more years.
"We are proud that you have satisfactorily met the requirements of this Board," the letter states, noting that "an attractive certificate" will be sent to Sartori.
Doctors who are certified by one of medicine's specialty boards are considered to be more experienced and membership often is considered an indication of quality by consumers.
The executive director of the amily practice board, Dr. Nicholas Pisacano of Lexington, Ky., said, "We didn't know that he lost his license. . . . Are we supposed to check up on every single doctor?"
Pisacano said the board has no system for finding out whether any of its members have been judged unfit by state or federal authorities. There are two voluntary clearinghouses of disciplinary actions against doctors, but Pisacano said his organization does not receive reports from either of them.
"We have no way of knowing," said Pisacano. "We rely on the doctors to give us true information."
Maryland's licensure action took 3 1/2 years to achieve, mainly because the 11-member commission meets only twice a month and because of several changes of attorneys, according to Avon Bellamy, director of the Maryland commission.
The case -- with each side running through three sets of lawyers -- took a full 16 hearings. The drawn-out proceedings, which began in 1980, have set a commission record for length, according to Bellamy said.
In 1982, the State of Maryland also brought criminal action against Sartori charging mail fraud involving promised Medicare reimbursement for his treatments and that he distributed cesium chloride to three cancer patients with the intent to defraud and mislead.
The mail fraud charges were dropped and the federal judge in the cesium chloride case, Joseph H. Young, declared a mistrial during the trial after deciding that his own work on the American Cancer Society's national board could taint his impartiality in the case.
A second judge ruled that a new trial against Sartori would constitute double jeopardy.
Sartori, who holds medical licenses in at least four other states, said that Maryland officials simply did not like his unorthodox methods of practicing medicine.
"I'm definitely going to appeal it," said Sartori, who lives in Arlington. "It's erroneous statements that I use anything in my office that has not been used by a significant number of doctors."
But the Maryland commission concluded that Sartori used "unvalidated" techniques, including hair analysis to diagnose metal or lead intoxication; cytotoxic testing, or blood testing to determine food allergies; thermography, or measuring blood flow by the warmth it gives off; and the Heidelberg pH capsule transmitter to determine the acidity of the gastrointestinal tract.
These techniques "have not been scientifically demonstrated" to be valid and reliance on them could endanger patients' health, the commission found.
A study of Sartori's records found that he used the techniques in some cases to perform chelation therapy for those afflicted with hardening of the arteries, a process the FDA disapproves of for that ailment.
In addition, the commission found that Sartori did not take adequate patient histories or give full physical exams and that his records were disorganized, lacking progress notes, lab results and medically acceptable rationales for treatment.
Certain tests also were over-used, the commission found.
Members of the University of Maryland School of Medicine interviewed Sartori and "found that he was seriously deficient in medical knowledge and clinical judgment," the commission's order states. " . . . In their opinion, no remedial education program could correct this deficit."