Dr. Jozef Krop
The Notice of
Hearing contained the following allegations of professional misconduct:
1. Dr. Krop failed
to maintain the standard of practice of the profession in the
management, treatment and care of six patients.
2. He has displayed
in his professional care of patients a lack of knowledge, skill
or judgment or disregard for the welfare of those patients of
a nature or to an extent that demonstrates that he is unfit to
continue in practice.
3. Dr. Krop failed
to maintain the records that are required to be kept respecting
4. Dr. Krop sold
or otherwise supplied drugs or biological preparations to patients
at a profit.
Dr. Krop trained
in Poland as a paediatrician. After arriving in Canada and obtaining
full licensure in the mid-1970ís, he practised family
medicine. Since the early 1980ís, however, he has confined
his practice to what he characterized as environmental medicine.
His patients are roughly equally divided between adults and children.
First, the Committee
wishes to emphasize that the focus of this hearing was the practice
of Dr. Krop as it related to his management of the six patients
whose charts were entered in evidence. "Environmental medicine"
was not the issue being deliberated. Indeed, in the course of
the hearing it became apparent that Dr. Krop's methods
differ significantly from the majority of the practitioners tendered
by the defence as knowledgeable in environmental medicine.
The central role
of Vega testing in Dr. Krop's practice appears to be unusual.
It was claimed by Dr. Krop that the Vega machine -one electrode
of which was held by a patient while the other electrode was
applied to the patientís toe - assisted him in arriving
at diagnoses. He used the Vega apparatus to screen for a broad
range of sensitivities (as the only method of evaluation in at
least one patient), as an integral part of the provocation/neutralization
procedure in a number of patients, and as a means of adjusting
previously prescribed treatment sera.
The six patients
whose records were the focus of this hearing presented with a
wide variety of complaints: chronic dry and cracking skin, recurring
respiratory infections, bloating and diarrhea, skin rashes, headaches,
stomach aches, chronic fatigue, cognitive difficulties, flu-like
symptoms, recurrent rhinitis, urinary tract infections, chronic
groin pain, and depression.
Despite the wide
range of symptoms, the patientsí assessments were remarkably
similar. All completed exhaustive "environmental" and
"food sensitivity" questionnaires, all charts contained
the same physical examination check-list, and virtually all received
the same battery of tests. All were "screened" with
Vega testing. Intracutaneous testing with serial dilution end-point
titration was foregone only in the case of the child and an adult,
in the latter instance because of cost. All but one underwent
provocation/neutralization sublingual testing. All underwent
extensive conventional hematologic and biochemical testing, the
results of which were uniformly unremarkable. In a number of
patients, subsequent treatment was modified by repeat Vega testing.
or recommended were similarly formulaic. Injectable sera for
a variety of inhalants, including fungi, were prescribed in three
patients. Some were given sublingual drops. All were given or
recommended oral antifungals and three received the systemic
antifungal ketoconazole. The rotary/elimination diet was recommended
in all but one. In addition, a yeast-free diet and acidophilus
supplements were recommended to several, as were vitamin and
mineral supplements, organically-grown food, evening primrose
oil, Vitamin E, and bottled water.
In the Committeeís
view, the testing techniques and treatment approaches employed
by Dr. Krop have in common a lack of scientific validation. This
judgment includes, in particular, the Vega machine which Dr.
Krop additionally used to assess a wide variety of putative stressors,
to screen for occult disease, and to adjust treatments which
in themselves are questionable. Our conclusion also includes
the diagnostic/therapeutic technique known as provocation/neutralization,
hair analysis, the rotary diet, the use of staph lysate, autogenous
vaccines made from serum and sputum, "thymus extract"
injections, repeated high dose parenteral Vitamin C infusions,
and sauna therapy. It includes the diagnosis of "candida-related
complex" and thus the treatment that flows from that diagnosis.
The experts called
by the College reviewed each of these diagnostic and therapeutic
modalities. All condemned their use. Two expert witnesses stated
that Dr. Krop's use of these techniques in the six patients
in question constituted a failure to meet the standard of practice.
accepted the evidence of the College experts in preference to
that of the experts called by the defence. The Committee did
not view the latterís evidence as worthy of equal weight
in that it lacked the authority of acceptable scientific evidence.
therefore, finds Dr. Krop guilty of professional misconduct in
that he failed to maintain the standard of practice of the profession
in the care of the patients in question in that he:
- employed inappropriate
tests, including the use of the Vega machine, provocation/neutralization
and hair analysis;
diagnosed food, chemical and other allergies and sensitivities;
recommended sauna therapy for chemical detoxification;
- made inappropriate
diagnoses of systemic candidiasis;
- prescribed inappropriate
antifungal agents, both topical and systemic;
- prescribed inappropriate
treatments including sublingual drops, injections of various
types including Vitamin C, "vaccines" derived from
serum and sputum, staph lysate, thymus extract calcium and magnesium.
lifestyle changes, including such unproved measures as a "rotary
diet" based on the above diagnostic methods.
OF ABUSE OF PROCESS
The issue of
abuse of process was raised by the defence both at the commencement
of the hearing and in final argument.
At the outset,
a voir dire was held regarding the admissibility of the patient
records to be tendered as evidence in the proceeding. This in
turn led to a review of the manner in which Dr. Krop's
practice came to be investigated and in which the resulting referral
to the Discipline Committee was made. The Committee held at the
conclusion of the voir dire that the investigation into the practice
of Dr. Krop was carried out with the authority of, and in compliance
with, Section 64 of the Health Disciplines Act. It further found
that Dr. Krop and his position was dealt with by the College
with the degree of fairness that was appropriate at each stage
of the investigation and referral process. The process by which
patient records were selected did not breach the privacy rights
of the patients involved nor did it constitute unreasonable search
AND REASONS FOR PENALTY
Counsel for Dr.
Krop called six witnesses, all patients of Dr. Krop. Two were
among those patients whose office records had been the focus
of this hearing; the third witness was the mother of a child
whose medical records had also been entered in evidence. All
testified to their satisfaction with the care provided by Dr.
Krop, and to his good reputation among those who know of his
work. Counsel further submitted three volumes of testimonial
letters from satisfied patients, and read from a number of them.
Counsel for the
College proposed a penalty that would include a recorded reprimand
and the imposition of a number of conditions on Dr. Krop's
certificate of registration. These would require Dr. Krop to
adhere to the specified recommendations of the Report of the
Ad Hoc Committee on Complementary Medicine of the College of
Physicians and Surgeons.
Counsel for Dr.
Krop proposed that no penalty be imposed. He stated that there
was at least some support for just about everything Dr. Krop
did, that no physical harm had befallen any patient, that Dr.
Krop should not be penalized for the tactics employed by his
former legal counsel, that Dr. Krop had demonstrated in the care
of his patients both considerable effort and compassion, and
that the decade-long period of investigation and hearing had
taken a toll on both Dr. Krop and his family. He stated that
patients have a right to choose based on informed consent, and
that there was no evidence that Dr. Krop does not follow the
principles espoused by the Report of the Ad Hoc Committee on
however, found that Dr. Krop did not provide the six patients
who were the focus of this hearing with the information upon
which they, in turn, could give him truly informed consent for
the diagnostic tests and treatments he used. The Committee, in
its decision, stated that it must be made clear to the patient
where scientific evidence exists ó and by extension where
it does not ó for both diagnostic methods and treatment
It is important
to add that the principle of informed consent extends to the
naming of diagnoses. "Systemic candidiasis" and "multiple
chemical sensitivity syndrome" are controversial labels.
The former lacks any credible scientific support as a diagnosis.
In the case of the latter, while there are generally acceptable
epidemiologic definitions to identify it as a syndrome, there
are no known scientifically acceptable means to either diagnose
or treat it in a specific individual.
It is with these
findings in mind that the Committee firmly rejects the proposal
and rationale put forward by Dr. Krop's counsel, and accepts
the penalty recommendation of College counsel.
has no doubt that Dr. Krop is sincere, hard-working, and devoted
to the well-being of his patients. It is clear that, as was stated
in the course of the hearing, many of his patients believe he
is the "physician of last resort", the individual to
whom they have turned because they have been unable to find relief
from conventional physicians. His caring approach undoubtedly
plays a major role in their healing.
Dr. Krop owes a debt of honesty to his patients. While he may
hold strong beliefs in the appropriateness of his diagnostic
methods, his diagnostic conclusions, and his methods of treatment,
he must make it clear to his patients that they are simply that
ó beliefs. He must be candid in stating that they are
unsupported by scientifically acceptable evidence.
believes that Dr. Krop would be of even more help to his patients,
and to society at large, if he would subject his beliefs to the
same level of scientific scrutiny expected of any innovation
in the field of medicine today. Given the size of his practice
and the current climate of openness to alternative methods of
treatment, he has had ó and with this decision still has
ó an opportunity to do just that.
Dr. Krop apparently continues to believe that his approach to
diagnosis and treatment has been scientifically validated and
that he does provide his patients with the basis of truly informed
consent. Because of this, Dr. Krop must hear in no uncertain
terms that he has failed to meet the standard of practice.
the penalty proposal put forward by the College, the Committee
notes that Dr. Krop's primary obligation is to approach
each patient in accordance with the standard of practice. To
paraphrase the Report of the Ad Hoc Committee on Complementary
Medicine, he is to carry out a history and physical examination
relevant to the presenting complaint, investigate utilizing generally
accepted modalities pertinent to the problem at hand, reach a
conclusion that a reasonable physician would reach, supported
by the data, and advise the patient of the usual and conventional
treatment options. The Committee believes that Dr. Krop would
be wise to document this in the patient record.
The penalty does
not forbid Dr. Krop from going beyond this, nor does it prohibit
his employment of any of the testing procedures, diagnostic labels,
or treatments referred to in the foregoing. If Dr. Krop chooses
to do so, however, he has an obligation to provide each patient
with the basis upon which truly informed consent can be given
and paraphrasing the Report of the Ad Hoc Committee on Complementary
Medicine, Dr. Krop is obliged to ensure that his patients are
told the degree to which tests, treatments or remedies have been
evaluated, and the degree of certainty and predictability that
exists about their efficacy and safety.
In order to reassure
the College that Dr. Krop has understood and acted upon the particulars
of this decision, the Committee has a number of recommendations
it wishes to urge upon Dr. Krop. While these are recommendations
and not requirements, the Committee believes they are both prudent
and consistent with our Order:
- The Committee
recommends that Dr Krop ó for each and every instance
where he employs diagnostic tests, diagnostic labels, and treatment
protocols that this Committee has determined fail to meet the
accepted standard of practice - furnish in writing - sufficient
information for his patient to provide informed consent.
- The Committee
further recommends that Dr. Krop adopt the practice of having
the patient in question acknowledge - in writing- having received
this information, its specifics, and having provided consent.
In a similar vein, the Committee believes that general patient
information, such as the "Ecology Guide", sold to or
given to patients or potential patients, should be edited to
reflect the principles of the Collegeís penalty recommendation.
- Dr. Krop might
consider providing the College with copies of the patient information
he intends to use to assist him in obtaining informed consent,
as well as copies of the consent forms themselves, and invite
comment on the degree to which such material is consistent with
the terms of this Committeeís decision.
is aware that some of the areas in which Dr. Krop has failed
to meet the standard of practice will undoubtedly evolve. The
Report of the Ad Hoc Committee on Complementary Medicine makes
a final recommendation, one which urges those who enter into
"areas of less well proven efficacy" to "collaborate
in the collection of information that can be appraised qualitatively
or quantitatively, so that new knowledge is created, to be shared
with, and critically appraised by, the profession." Dr.
Krop, should he choose to do so, could make a significant contribution
in this area. The penalty recommendation envisions such a possibility.
therefore orders that:
1) A reprimand,
with the fact of the reprimand to be recorded on the Register;
2) Dr. Krop's
certificate of registration is to be subject to the following
(a) Dr. Krop
is required to adhere to the recommendations with respect to
members, from the Report of the Ad Hoc Committee on Complementary
Medicine, for assessing patients, treating patients and advancing
(b) In addition,
prior to any use of Vega testing, provocation/neutralization
testing, serial dilution end-point titration testing for non-inhalant
sensitivities including candida-related sensitivity, and hair
analysis when not used in the diagnosis of heavy metal toxicity
or essential element deficiency, Dr. Krop:
(i) is required
to provide to the patient sufficient information to make informed
(ii) is required
not to misrepresent information or opinion; and
(iii) is required
to give the patient the general degree of certainty or uncertainty
of efficacy of the test(s), notwithstanding his individual beliefs.
recommendations from the Report of the Ad Hoc Committee on Complementary
Medicine to the Council of the College of Physicians and Surgeons
of Ontario are modified to refer specifically to Dr. Krop:
patients, Dr. Krop should henceforth be expected to:
1. perform a
pertinent history and physical examination, (sufficient to make,
or confirm, a conventional diagnosis) and to meet the appropriate
standard of practice of the profession;
when necessary, utilizing generally accepted modalities pertinent
to the complaint;
3. reach a conventional
diagnosis that reasonable physicians would reach, supported by
4. advise the
patient of the usual and conventional treatment options, their
risks, benefits and efficacy as reflected by current knowledge;
5. document all
of the above in accordance with the regulations.
patients, Dr. Krop should henceforth be expected to:
1. have demonstrated
education, knowledge, skills and currency in his area of practice;
2. act honestly
and always in his patientís best interests;
3. provide sufficient
information to allow patients to make informed choices, and to
refer to, or consult with, others when the practitioner requires
assistance or when the standard of practice requires it. It should
not be misconduct to refer a patient, honestly and without conflict
of interest, to unconventional or complementary practitioners
when appropriate and where there is no reason to believe such
a referral would expose the patient to harm;
4. not misrepresent
information or opinion; patients must be given the general degree
of certainty or uncertainty of efficacy of a given therapy, notwithstanding
the practitionerís individual beliefs.