Quackwatch Home Page Disciplinary Actions against Dr. Richard Gorringe Stephen Barrett, M.D. In 2003, New Zealand's Medical Practitioners' Disciplinary Tribunal found Richard Warwick Gorringe, MB, ChB, of Hamilton, New Zealand, guilty of two charges of professional misconduct and one of disgraceful conduct in relation to his care of two patients he treated in 1998.. Gorringe is a general practititioner who uses homeopathy and other methods that he refers to as "complementary." This is the first case involving such practices to be adjudicated under New Zealand's Health and Disability Commissioner Act, which was passed in 1994 to promote the rights and responsibilities of consumers and providers and to resolve complaints. The tribunal's reasoning is spelled out in detail in a 142-page document posted to its Web site. One patient, Yvonne Short, was about 40 years old when sought treatment from Gorringe for eczema, which she had suffered since early childhood. At various times the problem occurred on the backs of her legs, on her buttocks, behind her knees, in the creases of her elbows, on her feet, on her forearms, and occasionally on her face. However, her hands gave her the most problems. Short reported that during her first visit, Gorringe said she did not have eczema but had dermatitis due to chemical poisoning and that he would do tests to determine what substances were involved. He then proceeded to do a test that the tribunal document describes this way: Dr Gorringe requested Mrs Short and her mother to go over to a table away from his desk. As Mrs Short's hands were so cracked and sore, Dr Gorringe said he would test for the chemical through her mother as a "surrogate". . . . Dr Gorringe sat on one side of the table while [Short's] mother and she sat on the other side. She was required to put her hand on her mother's arm. Her mother was required to put her hand over a square metal plate which, she thought, was connected by wires to something under the table. Her mother had to hold her ring finger and thumb together in an "O" shape, and touch little glass vials with a metal rod. Dr Gorringe held his hand over her mother's, so that their hands were touching. . . . There were a lot of little vials which were contained in a number of boxes. Dr Gorringe directed which vials [the mother] should touch. Occasionally when a vial was touched, [the mother's] fingers would come apart. Dr Gorringe told them that he was testing for the chemical that had poisoned Mrs Short. In all, [the mother's] fingers 'reacted' to a number of vials -- probably less than five. . . . Dr Gorringe told them that Mrs Short had reacted most strongly to paraquat and that he needed to test for the amount and strength of the paraquat poisoning in her body. The same testing procedure was conducted again, through her mother again, although on fewer vials. At the end of the process, Gorringe said that Short had a very high dose of paraquat poisoning and should be treated with paraquat injections and undergo "detoxification" with homeopathic "drainage drops" and other products. He also advised her to stop using topical steroid creams and to avoid certain foods listed in an information sheet. The test Gorringe used is called peak muscle resistance testing (PMRT) -- also referred to as bi digital O ring testing (BDORT) -- in which the practitioner observes whether the subject's opposed thumb and fourth fingers can be pulled apart before and after the patient is exposed to various substances. Proponents claim that "weakness" of the fingers means that the person is having a problem with the test substance. According to Gerringe: The principle of the test is that we are challenging the patient's body fields or bio-fields with the any compound which we bring into their field. . . . This might happen to be a chemical, food, or they could be vials made up from infective micro-organisms, or components that a person is in contact with or handling at work, or around the home. We are challenging the patient's body to what is being added into the circuit. The mechanism that best fits the observations is that of electromagnetic resonance. The muscle test, of course, has no scientific basis and has never been validated. Moreover, the idea that contact with substances in sealed vials can affect the body is preposterous, and so is the idea that Short would be tested having her touch her mother while her mother held the vials. During the next six months, Mrs Short saw Dr. Gorringe 12 more times. Although she had a few brief periods of improvement, her condition became generally much worse. During various visits, he retested her and declared that the paraquat was gone but she had an infection. During the tenth visit, for example, he said she had Legionnaire's disease and suggested that they pray. .After the prayer, he muscle-tested her again, noted that her fingers did not react, and declared that the Legionnaire's disease germ was "dead." A few visits later she became disillusioned and filed a complaint with the tribunal. The other patient, 30-year-old Ravaani Ghaemmaghamy, was a diabetic who was having trouble with muscle fatigue; weakness; pain (especially on exertion); blurred vision; concentration and memory problems; and fluctuating temperatures that caused her to feel flushed quite often. During her first visit, Gorringe diagnosed "brucellosis of the intracellular kind" and "maldesen poisoning" and also prayed for her. Four days later she had a standard test for brucellosis, which was negative, and her usual general physician (who ordered the test) faxed the result to Gorringe. At the second (and last) consultation, Gorringe said that the prayer had killed the brucellosis bug and retested her with PMRT to demonstrate that it was "as dead as a doornail." At both consultations, Gorringe used peak muscle resistance testing and prescribed homeopathic remedies. Several months later, after undergoing standard medical evaluations, Ghaemmaghamy's troublesome symptoms recognized as due to fibromyalgia. Although Gorridge denied promising a cure and disputed many of the allegations, the tribunal felt that the testimony of Short, Ghaemmaghamy, and the experts who testified against him were more credible. Here is a summary of the charges that the tribunal considered proved. Patient #1: Yvonne Short Professional Misconduct - Diagnoses Dr Gorringe relied unduly on peak muscle resistance testing (PMRT) in diagnosing paraquat poisoning; and reached that diagnosis when it was not supported by Mrs Short's history or clinical presentation; and failed to carry out any other diagnostic tests to confirm or exclude his diagnosis. In diagnosing cytomegalovirus, Legionella infection and electromagnetic radiation sensitivity Dr Gorringe: (a) Failed to undertake an adequate clinical examination; (b) Relied unduly on PMRT to reach the diagnoses; (c) Failed to carry out any other diagnostic tests to confirm his diagnoses; and (d) Reached a diagnosis not supported by Mrs Short's history or clinical presentation. Professional Misconduct - Lack of explanation - Lack of informed consent - PMRT Dr Gorringe carried out PMRT without adequately explaining this diagnostic technique. In particular, it is alleged he failed to advise Mrs Short of its advantages and disadvantages when compared to conventional and generally recognised diagnostic investigatory techniques; and/or failed to advise her of the degree to which PMRT had been scientifically evaluated for efficacy as a diagnostic tool; and in failing to give an adequate explanation he failed to enable Mrs Short to make an informed choice and therefore failed to obtain her informed consent to PMRT. Professional Misconduct - Lack of Explanation - Lack of Informed Consent - Other Treatments Dr Gorringe provided and/or arranged to be provided various treatments or the combination thereof, namely, homeopathic paraquat injections, homeopathic drops, laser management, and spiritual healing, and also required Mrs Short to forego conventional medical treatment including topical steroid creams and Histafen without advising Mrs Short of the risks, benefits and efficacy of the treatment options; and in failing to give such treatment/management he failed to enable Mrs Short to make an informed choice, and therefore failed to obtain her informed consent to the treatment/management. Professional Misconduct - Exploitation Dr Gorringe knew or ought to have known that the various diagnoses (paraquat poisoning, cytomegalovirus, Legionella infection and electromagnetic radiation sensitivity) were not supported by Mrs Short's clinical presentation and thus exploited Mrs Short for financial gain by: (a) continually advising and/or reassuring her that her condition was improving; and/or (b) by advising her to purchase homeopathic treatment from him; and/or (c) by advising her to attend follow up appointments for the monitoring of her condition and/or treatment. Disgraceful Conduct in a Professional Respect Dr Gorringe, during the period 19 March 1998 and 1 October 1998 in his management of Mrs Short knowing she had been previously diagnosed with chronic eczema and, having diagnosed her variously with paraquat poisoning, cytomegalovirus, Legionella infection and electromagnetic radiation sensitivity required her to cease her then current medication (including Histafen and topical steroid creams) which he knew, or ought to have known, were essential to the ongoing management of her condition (Particular 1.1); and/or Dr Gorringe, during the period 19 March 1998 and 1 October 1998, in his management of Mrs Short when he knew, or ought to have known, of her severe continuing physical and psychological deterioration continued to advise and/or reassure her that her condition was improving and would continue to improve when he knew or ought to have known this was not correct )Particular 1.2); and/or Dr Gorringe, between 27 March 1998 and 1 October 1998 when he knew, or ought to have known, that Mrs Short's physical and psychological condition had deteriorated and was continuing to deteriorate: (a) failed to reinstate her former medication in a timely manner; and/or (b) failed to prescribe other medication appropriate to her condition in a timely manner; and/or (c) failed to advise her to seek further medical care or advice; and/or (d) failed to refer and/or consult with an appropriate specialist regarding her clinical condition at any time during this period. Patient #2: Ravaani Ghaemmaghamy Professional Misconduct - Brucellosis Diagnosis In diagnosing brucellosis, Dr Gorringe: (a) failed to undertake an adequate clinical examination; and/or (b) relied unduly on PMRT to reach his diagnosis; and/or (c) failed to carry out any other diagnostic tests to confirm his diagnosis; and/or (d) reached this diagnosis when it was not supported by Ms Ghaemmaghamy's clinical presentation. Lack of Explanation - Lack of Informed Consent - PMRT Dr Gorringe carried out PMRT as a means of reaching the diagnosis of brucellosis without adequately explaining PMRT and in particular: (a) failed to advise Ms Ghaemmaghamy of its advantages and disadvantages when compared to conventional and generally recognised diagnostic/investigatory techniques; and/or (b) failed to advise her of the degree to which PMRT had been scientifically evaluated, for its efficacy as a diagnostic tool; and in failing to give an adequate explanation regarding PMRT is alleged to have failed to enable Ms Ghaemmaghamy to make an informed choice and therefore failed to obtain her informed consent to PMRT. Professional Misconduct - Failure to Explain - Informed Consent (Homeopathic Medication and Spiritual Healing Based on his diagnosis of brucellosis, Dr Gorringe in his management of Ms Ghaemmaghamy during this period provided/administered and/or arranged to be administered spiritual healing and homeopathic medication without advising Ms Ghaemmaghamy: (a) the manner in which the spiritual healing, as a treatment modality, would be conducted; and/or (b) whether antibiotics were available in conjunction with, or as an alternative to, homeopathic medication and/or spiritual healing; and/or (c) the purpose of risks, benefits and efficacy of the non-conventional treatment, and, in failing to give an adequate explanation to Ms Ghaemmaghamy it is alleged he failed to enable her to make an informed choice and therefore failed to obtain her informed consent to the treatment/ management. Professional Misconduct - Exploitation Dr Gorringe knew, or ought to have known, that the diagnosis of brucellosis was not supported by Ms Ghaemmaghamy's clinical presentation. On being advised she had tested negative for brucellosis, he exploited her for financial gain by advising her she had brucellosis of the intracellular form which would not be detected by conventional blood tests and advising her to purchase homeopathic treatment from him. In October 2003, Gorringe was ordered to pay NZ$104,096 and was struck off the Medical practitioner's register, which means that he can no longer legally practice medicine. However, he has continued to practice as a naturopath. In May 2004, the Medical Practitioners Disciplinary Tribunal concluded that Gorringe had negligently failed to diagnose cancer in patient named Murray Leonard Smith. According to the tribunal's report: During the three years that Mr Gorringe was treating Mr Smith he diagnosed 10 different conditions, one of those being giardia which he diagnosed twice. He diagnosed salmonella, campylobactor, heliobactor, bowel bug, blood fluke, Tordon poisioning, amoebic infection, colitis, and irritable bowel. The Tribunal is concerned that even these diagnoses were done in the absence of any proper diagnostic testing. There were tests available that Dr Fox referred to in respect of these conditions and Mr Gorringe did not avail himself of those further blood, faecal and breath tests and jejunal biopsy which all would have assisted in his diagnoses. Most of these conditions were diagnosed with BDORT and "treated" with homeopathic products. Noting that the Smith had reported blood in his bowel movements and abdominal symptoms over a 3-year period, the tribunal concluded that Gorringe had negligently failed to perform adequate diagnostic investigations and that by the time the another physician diagnosed the cancer it had spread too far to be treatable. Smith died six months later. Quackwatch Home Page This article was revised on July 9, 2004.