Leila Zackrison, M.D., Reprimanded
by Virginia Board of Medicine


In 2013, the Virginia Board of Medicine reprimanded Leila Zackrison, M.D., after concluding that she had inappropriately diagnosed and treated a woman from 2003 through 2007. The board's order (shown below) indicates tha Dr. Zackrison made unsubstantiated diagnoses of arthritis/spondyloarthropathy, pseudogout, salmonella infection, babesiosis, and Lyme disease and inappropriate administered antibiotic therapy during most of this period. In 2005, the Board had similar concerns about her management of three patients but concluded that "while the care . . . rendered to Patients A, B and C was not optimal, a violation of the Board's statutes or regulations was not established by clear and convincing evidence" and the matter was therefore dismissed.


VIRGINIA:

BEFORE THE BOARD OF MEDICINE

IN RE:
LEILA HADDAD ZACKRISON, M.D.
License No.: 0101-045689

ORDER

In accordance with Sections 54.1-2400(10), 2.2-4019, and 2.2-4021 of the Code of Virginia (1950), as amended ("Code"), an informal conference was held with Leila Haddad Zackrison, M.D., on August 22, 2013, in Henrico, Virginia. Members of the Virginia Board of Medicine ("Board") serving on the special Conference committee ("Committee") were: Stephen E. Heretick, J.D., Chair; Kenneth J. walker, MD.; and Robert Hickman, MD. Dr. Zackrison appeared personally and was represented by R. Harrison Pledger, Jr., Esquire and Jacques Simon, Esquire.

Tracy E. Robinson, Adjudication Specialist, was present as a representative for the Administrative Proceedings Division of the Department of Health Professions.

The purpose of the informal conference was to inquire into allegations that Dr. Zackrison
may have violated certain laws governing the practice of medicine in the Commonwealth of Virginia, as set forth in a Notice of Informal Conference dated April 25, 2013.

FINDINGS OF FACT AND CONCLUSIONS OF LAW

Now, having properly considered the evidence and statements presented, the committee makes the following Findings of Fact and Conclusions of Law:

1. Leila Haddad Zackrison, M.D., was issued license number 0101-045689 by the Board to practice medicine and surgery in the Commonwealth of Virginia on August 1, 1990. Said license is currently active and will expire on September 30, 2014, unless renewed or otherwise restricted.

2. Dr. Zackrison violated Sections 54.1-2915.A(3)1 and (13) of the Code in the care and treatment of Patient A from 2003 through 2007, in that:

1Prior to July 1, 2003, Section 54.1-2915.A(3) was codified as Section 54.1-2915.A(4) as written to include gross ignorance or carelessness in the practice, or gross malpractice. After July 1, 2003, it was rewritten to include intentional negligent conduct in the practice that causes or is likely to cause injury to the patients.

a. In or about May 2003, Dr. Zackrison diagnosed Patient A with reactive arthritis/ spondyloarthropathy. The patient was HLA B27 negative, making this diagnosis less likely, although it would not exclude this diagnosis. However, the clinical presentation and lack of radiographic findings, such as sacroiliitis, are not supportive of a diagnosis of chronic reactive arthritis.

b. In or about February 2005, Dr. Zackrison diagnosed Patient A with calcium pyrophosphate dihydrate ("CPPD") disease/pseudogout and prescribed colchicine to treat the condition, although the basis of the diagnosis in the patient's medical records is unclear. Medical records do not include radiographic documentation of chondrocalcinosis or synovial fluid crystal analysis that would diagnose pseudogout.

c. In regards to Dr. Zackrison's diagnosis and treatment of Patient A for Lyme disease beginning in or about October 2003:

i. After initial lab tests (Western blot and ELISA) were negative, Dr. Zackrison ordered repeat tests on approximately 16 occasions, with each result being negative. Moreover, on approximately nine occasions Dr. Zackrison ordered polymerase chain reaction ("PCR") tests on urine, although this test is not approved by the U.S. Food and Drug Administration to diagnose Lyme disease.

ii. On two occasions for durations of approximately three months each (November 6, 2004 to February 13, 2004; and July 28, 2006 through November 2, 2006), Dr. Zackrison treated Patient A with long-term antibiotic therapy (ceftriaxone), although there was no credible objective evidence that the patient had Lyme disease based on the medical record.

d. In regards to Dr. Zackrison's diagnosis and treatment of Patient A for salmonella, salmonellosis, and! or reactive arthritis due to chronic salmonellosis beginning in or about May 2003:

i. Dr. Zackrison diagnosed the patient with salmonella without any positive cultures of blood, stool, or urine to support the diagnosis. Although the patient had multiple positive serologic screens for salmonella, such tests cannot distinguish between past and present infection.

ii, Despite the lack of usefulness of serologic tests for salmonellosis, Dr. Zackrison ordered such tests on approximately nine occasions.

iii. Although Patient A lacked any culture-confirmed evidence of salmonella infection, Dr. Zackrison treated her with ciprofloxacin for approximately five months (May 5, 2004 through October 18,2004).

e. In regards to Dr. Zackrison's diagnosis and treatment of Patient A for babesiosis and! or reactive arthritis due to babesiosis beginning in or about January 2004:

i. Dr. Zackrison diagnosed the patient with babesiosis without positive identification of the parasite on thin blood smears and in the absence of suggestive clinical signs and symptoms of the disease, such as fever, hemolytic anemia, or thrombocytopenia, as well as nonspecific symptoms such as headache, chills, myalgias, and arthralgias.

ii. After ordering an initial blood test for Babesia antibodies, Dr. Zackrison ordered repeat tests on approximately 17 occasions, although the patient never had positive identification of the parasite on thin blood smears and she no longer had exposure to potential infection from Babesia during the time she was under Dr. Zackrison's care.

iii. Even if the diagnosis of babesiosis had been correct, Dr. Zackrison incorrectly and excessively treated Patient A with antibiotics for this disease. Standard treatment for babesiosis lasts 7 to 10 days, unless continued parasitemia on blood smears is documented. However, without such test results, Dr. Zackrison treated the patient with antibiotics during the following approximate date ranges:

Medication

Date(s)

Biaxin 2/16/04 to 5/5/04
2/3/06 to 6/20/06
5/21/07
Atovaquone 2/16/04 to 5/5/04
3/3/05 to 5/21/07
Ketek 4/13/05 to 5/13/05
Clindamycin 4/21/06 to 9/15/06
Azithromycin 6/20/06 to 7/25/06 (intravenous)
4/21/06 to 5/21/07 (oral)

f. In or about October 13, 2003, Dr. Zackrison diagnosed Patient A with /I candida yeast infection of stool/ gut," and treated the patient with fluconazole as prophylaxis to prevent fungal infections related to her prolonged antibiotic therapy for a one-year period (October 13,2003 to October 18, 2004). The Committee determined that this was an excessive and inappropriate use of fluconazole.

g. Although established diagnoses of multiple suspected infections were not objectively supported in the patient's medical records, as discussed above, Dr. Zackrison treated Patient A with antibiotics for multiple conditions on an approximate continuous basis from approximately late 2003 to mid-2007. Additionally, the medical records lack a treatment plan to document improvement, to reevaluate the success of therapy and to help guide its duration, and to reconsider the appropriateness of Dr. Zackrison's working diagnoses for Patient A.

3. In explaining her rationale for repeating tests that were consistently negative (see e.g., 2(c)(i) 16 repeat tests, 9 repeat PCR tests: 2 (e)(ii) 17 repeat test), Dr. Zackrison said that she does not trust such lab test results or believe they are accurate unless they are positive. However, she continues to order the tests to see if they will confirm her diagnosis. She only believes in a positive test result but does not need the lab tests to be positive in order for her to treat the patient.

4. Dr. Zackrison stated that she treats atypical patients whose conditions are very unusual and complex. Dr. Zackrison also noted that not all guidelines apply to all patients, so she has to modify her understanding based on their presentation. There is nothing tried and true with these patients, and she has to diagnose them clinically and review the options and risks of treatment.

ORDER

WHEREFORE, based on the above Findings of Fact and Conclusions of Law, it is hereby ORDERED that Dr. Zackrison be, and hereby is, issued a REPRIMAND.

Pursuant to Sections 2.2-4023 and 54.1-2400.2 of the Code, the signed original of this Order shall remain in the custody of the Department of Health Professions as a public record, and shall be made available for public inspection and copying upon request.

Pursuant to Section 54.1-2400(10) of the Code, Dr. Zackrison may, not later than 5:00 p.m., on October 3,2013, notify William L. Harp, M.D., Executive Director, Board of Medicine, 9960 Mayland Drive, Suite 300, Henrico, Virginia 23233, in writing that she desires a formal administrative hearing before the Board. Upon the filing with the Executive Director of a request for the hearing, this Order shall be vacated.

Therefore, this Order shall become final on October 3, 2013; unless a request for a formal administrative hearing is received as described above.

FOR THE BOARD

____________________
William L. Harp, M.D.
Executive Director
Virginia Board of Medicine

ENTERED: 8/30/13

This page was posted on September 13, 2013.

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