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Some Notes on Viola Frymann, D.O.

Stephen Barrett, M.D.

Viola M. Frymann, D.O., F.A.A.O., F.C.A., who founded the Osteopathic Center for Children (OCC) about 20 years ago, advocates cranial therapy and has taught it at osteopathic colleges and to dentists at continuing education seminars. Cranial practitioners claim that restriction of movement of skull bones can interfere with the normal flow of cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) and cause disease and that problems throughout the body can be fixed by correcting the interference [1]. She also advocates osteopathic manipulative treatment for "neurologic developmental problems." [2] These ideas are unfounded [3-4]; and relying on them can cause harm by delaying essential medical care. This article summarizes how Dr. Frymann was disciplined by her state licensing board in two such cases.

Background History.

Dr. Frymann was born in 1921 and is a 1949 graduate of the College of Osteopathic Physicians and Surgeons of Los Angeles [5]. She does not appear to have had any accredited residency training or recognized specialty board certification [2,5,6]. The initials "F.A.A.O." and "F.C.A." indicate that she is a "fellow" of the American Academy of Osteopathy (which advocates several unsubstantiated methods) and the Cranial Academy (an AAO component that makes wild claims for cranial therapy). The biographical sketch on the OCC Web site states that Frymann is "considered a living legend of osteopathic medial leadership by her peers" and lists six awards she has received from osteopathic organizations [2]. It futher states that her center "is concerned with the treatment of all children including those for whom the primary consideration is prevention of sub optimal health, as well as those with deep and complex problems who seek to reach the optimum of their potential." [2]

Frymann claims that 80% of babies have "minor difficulties" with cranial movement that can be detected by osteopaths who are trained to detect them. She claims that these alleged disturbances can be responsible for "spitting up," difficulty in learning to suck, ear infections, hyperactivity, other common problems and that "balancing" the pelvis and lower part of the spine can correct structural problems created by the birth process [7]. Like some chiropractors, she also claims in an article about manipulation:

The injuries sustained at birth ranging from the imperceptible which can only be detected by trained skillful fingers, to the gross which are immediately obvious to the naked eye may provide the first cause on which numerous adaptive effects are superimposed. A car accident in which a whiplash type of injury was sustained is another of these often obscure primary causes which through the years accumulates adaptive changes until the time comes when the accumulation of effects manifests as a gastric ulcer, a heart condition, an arthritis, a colitis, or any other named disease.

Numerous less well-defined complaints such as nervousness, fatigue, insomnia, indigestion, backache, headache, etc. may have persisted so long that they have been taken for granted. But when the structural disturbances produced by that original injury are corrected, the patient is surprised to find that those persistent, habitual complaints have gone [8].

In an article on another Web site, she states:

It is my impression that many cases of childhood allergy can be traced to musculoskeletal strains originating at the time of birth. . . . And vertebral scoliosis occurring in childhood and adolescence is, in many instances, the consequence of cranial scoliosis originating during birth. . . . Thus, recognition and treatment of dysfunction of the craniosacral mechanism in the immediate postnatal period represent one of the most, if not the most, important phases of preventive medicine in the practice of osteopathic medicine [9].

For this reason, she claims:

The craniosacral mechanism of the newborn infant should be examined within the first few days of life. There is probably no field of osteopathic diagnosis where the injuction "if at first you don't succeed, try, try again' applies more than in the examination of the newborn cranium."

. . . the treatment, in summary, consists of finding the point of balanced membranous tension of the mechanism, holding it, and permitting the inherent therapeutic force within to normalize the body [10].

The above ideas are unsubstantiated and lack a scientically plausible rationale.

Disciplinary Record

In 1991, the executive director of the California Board of Osteopathic Examiners accused Frymann of "repeated acts of gross negligence, or of incompetence" in connection with her management of a 1-week-old infant whom she had mistreated in 1990 [11]. According the the complaint, Frymann prescribed vitamin C and cranial manipulation after the mother sought care for fever and diarrhea. Not long afterward, although a blood count suggested that the child had a serious infection, Frymann failed to institute appropriate treatment or make a timely referral -- and the child required hospital care (for a urinary tract infection) that inluded antibiotics. The complaint to the board stated that Frymann had failed to perform a full evaluation, document the child's condition, and arrange for immediate hospitalization. In 1992, Frymann and the Board signed a stipulation under which she admitted mistreating the child. Under the stipulated agreement, she was ordered to undergo approved courses in physical diagnosis, and pharmacology and a pediatric refresher course, and was placed on probation for five years [12]. After she served about half of the probationary period, the board concluded that she had satisfied all of its requirements and that there was "no reason to believe that "she poses a threat to the public health and safety." [13]

In 1999, the executive director of the Osteopathic Medical Board of California accused Frymann of "gross negligence," "repeated negligent acts," and "incompetence" in connection with her management of of a 9-month-old infant whom she had mistreated in 1996 [14]. According to the complaint, the infant had had a history of vomiting, congestion, rash, and sluggishness and had failed to gain sufficient weight appropriate for his age. Although doctors at the University of Caliofnia-Davis has recommended hospitalization, the parents took the child to Frymann for an investigation. Frymann saw the child seven times over a 3-week period during which the child's weight remained abou the same. According the the board's complaint, Frymann did not perform a relevant. physical examination, order appropriate laboratory tests, prepare a growth chart, or record the possible causes of the child's "failure to thrive." Instead, she recorded diagnostic impressions of "phagiocephaly" and "sacral compression," neither of which is a medically recognized condition. Frymann's treatment included "osteopathic manipulation" during every visit, and she continued to recommend against hospitalization even though the child's condition appeared to be deteriorating. Two days after the final visit to Frymann, the parents brought the child to the U.C. Davis emergency room, where he was admitted and found to be suffering from a very serious urinary infection, which, when treated, resolved the child's failure to thrive. In 2000, Frymann and the Board signed a stipulation under which she admitted mistreating the child. The 1999 complaint recommended that Frymann's license be revoked, but under the stipulated agreement, she was merely ordered to pay $3,800 in costs and to undergo five years of probation, which included taking extra course and have her charts ,onitored by a board-certified pediatrician [15].

I believe that cranial therapy is so bizarre that everyone who practices it must have seriously impaired judgment and should be severely disciplined. The board's documents do not indicate why it failed to revoke Frymann's license or order her from doing cranial therapy or manipulating infants. Was it afraid that doing this might lead to a lengthy court battle? Did it believe that Frymann was old enough that she might soon retire? Did it believe that having her charts monitored would enable the board to take further action? (The document permitted Frymann to chose the monitor with board approval, but it didn't say that the monitor should be someone who does share her beliefs in cranial therapy or osteopathic manipulation of infants.) Was the board afraid that attacking these practices would cause political problems either with osteopathic organizations or with other osteopathic practitioners? Or, worse yet, did any board members engage in these practices themselves?

Regardless, Frymann appears to me to have unshakable beliefs in the theories under which she has practiced throughout her career; and she is still advocating and teaching them. Do you think she should be regarded as trustworthy?

References

  1. Common problems. Cranial Academy Web site, accessed Jan 26, 2003.
  2. Viola M. Frymann, D.O., F.A.A.O., F.C.A. OCC Web site, accessed Jan 25, 2002.
  3. Barrett S. Dubious Aspects of Osteopathy. Quackwatch, updated Dec 23, 2002.
  4. Barrett S. Cranial therapy. Quackwatch, updated Sept 23, 2002.
  5. AOA Yearbook and Directory. Chicago: American Osteopathic Association, Jan 1997, p 205.
  6. AMA Physician Select, searched Jan 26, 2003.
  7. Frymann VM. Osteopathy for Parents. OCC Web site, accessed Jan 25, 2003.
  8. Frymann VM. What is osteopathic manipulation? OCC Web site, accessed Jan 25, 2003.
  9. Frymann VM. The trauma of birth -- Introduction. DrFeeley.com Web site, Accessed Jan 26, 2003.
  10. Frymann VM. The trauma of birth -- Examination. DrFeeley.com Web site, Accessed Jan 26, 2003.
  11. Bergmann L. Accusation. In the matter of the accusation against Viola M. Frymann, D.O. No. 91-19, Nov 7, 1991.
  12. Stipulation in settlement and decision. In the matter of the accusation against Viola M. Frymann, D.O. June 19, 1992.
  13. In the matter of the petition for termination of probation of Viola Muriel Frymann. OAH No. N-9411102.
  14. Bergmann L. Accusation. In the matter of the accusation against Viola M. Frymann, D.O. No. 99-18, Dec 15, 1999.
  15. Stipulation in settlement and decision. In the matter of the accusation against Viola M. Frymann, D.O. July 21, 2000.

Disciplinary Action 1991-92 ||| Disciplinary Action 1999-2000
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This article was posted on January 26, 2003.