- State health officials have referred to the S.C. Board of Medical Examiners questions about the practices of a longtime Hilton Head Island physician who was involved with a troubled business offering preventive imaging.
The news comes as two more people stepped forward to say they had no contact before their scans with Dr. Paul M. Long of Hilton Head, who ordered full-body CT scans for them at Cancer Check America. Long was the medical director of the business, which closed last month but will reopen next year, according to a company representative.
South Carolina requires medical-imaging equipment to be used under a doctor's supervision and by prescription. Health officials say the regulations are intended to protect patients from unnecessary exposure to radiation emitted by CT scanners.
The Board of Medical Examiners, which regulates and disciplines doctors in South Carolina, got involved after receiving a letter from Charles Ditmer, who oversees the use of such equipment for the state Department of Health and Environmental Control. In a May 26 letter to the medical board, Ditmer said DHEC "shared some of the concerns" raised about Cancer Check America by a retired Hilton Head physician, Dr. Karl Engelman.
Engelman had contacted DHEC because he was concerned about people with no symptoms of illness signing up for full-body CT scans with Cancer Check America, which he said needlessly exposed them to radiation. The sign-ups typically occurred at booths Cancer Check America set up at local festivals and farmers markets.
Cancer Check America encouraged patients to purchase a package of scans -- costing several hundred dollars -- to detect and measure heart disease, lung, colon and other cancers, according to the company's brochures and patients' accounts.
In his letter to the medical board, Ditmer said he inspected Cancer Check America's operations on Hilton Head on May 16. He scheduled the inspection after a national radiation watchdog group and health officials in Colorado notified DHEC of Cancer Check America's link to a similar company operated by the same family that had run afoul of health regulators in other states.
The watchdog group said the company had given CT scans to people in other states without getting orders from their doctors.
ORDERS FOR SCANS
That wasn't the case at Cancer Check America, Ditmer found during his inspection. He said he saw orders from Long on file. He also reported finding a few relatively minor technical violations of DHEC rules.
Engelman, the retired physician who raised questions about Cancer Check America after it opened on Hilton Head in February, is highly critical of DHEC -- and Ditmer in particular -- for not going far enough with the inspection. A Harvard-educated doctor who also taught at the University of Pennsylvania School of Medicine, Engelman questions whether Long properly supervised the scans.
In the latest of a series of communications with DHEC, Engelman complained in a letter Thursday about his "extreme dissatisfaction with the incompetent performance of Mr. Ditmer in his so-called 'investigation' of a serious health threat ... ." He criticized Ditmer for not seeking out people who had scans at Cancer Check America to get their views on Long's oversight.
Six people who signed up for scans have told The Island Packet they had no contact at all with Long or his office before being scanned. A seventh, who canceled her appointment about an hour before she was due at Cancer Check America's office, said she had no contact with Long either.
One of the patients was Mike Platt of Bluffton, who contacted the newspapers in June.
"I wouldn't know him if he walked through the door," Platt said of Long. When he and his wife went to Cancer Check America, "they began immediately pushing for a full-body scan and we never saw a doctor, before or after. ... Someone asked some questions about some personal and family medical history, but they were not medical professionals."
Long disputes such accounts, insisting, "I met with almost all of them."
The 17 patients scanned at Cancer Check America before it shut down signed consent forms acknowledging they understood they'd be exposed to small amounts of radiation, Long said.
"Maybe they didn't know who I was, but I went down there 10 times a day" to oversee the scanning, he said. The office where patients were scanned is next door to Long's own office at 460 William Hilton Parkway.
"I wrote all the orders (for scans) .... Then when I reviewed their charts -- and I reviewed every single chart -- I put a check on the order that I reviewed the chart."
"I looked at their medical history before they got a scan," he said. After the scans, Long said he gave patients a letter urging them to have their doctors review the results.
Long, who said he's been practicing for more than 30 years, is at a loss about why some patients say they had no contact with him.
"If they don't know who I am, then I don't know what to say," he said.
Ditmer, the DHEC official who inspected Cancer Check America, said he did not seek out any of the patients who spoke to the Packet because DHEC lacks legal authority to investigate doctors. DHEC will talk to patients only if they initiate contact with the agency, he said.
Another DHEC official backed Ditmer up: "(W)e don't have the authority to investigate further the legitimacy of the physician's orders," Melinda Bradshaw, the agency's liaison for health regulations, wrote in a letter to Engelman.
For that reason, DHEC turned the matter over to the Board of Medical Examiners, Bradshaw said. DHEC also has provided information to the Beaufort County Sheriff's Office "concerning the possible fraudulent prescription orders for X-ray scans," her letter said.
The Board of Medical Examiners will not comment on the case because of strict confidentiality rules. A case can only be discussed if the board issues an order disciplining a doctor.
It's not clear how -- or whether -- the Beaufort County Sheriff's Office will get involved, said spokeswoman Sgt. Robin McIntosh. The Sheriff's Office hasn't had a chance to consult with DHEC, and it may be best to have the case handled by the Board of Medical Examiners, she said.
State law treats the written orders for imaging scans the same as it treats prescriptions for drugs, according to Jim Knight, a spokesman for the Board of Medical Examiners. The rules for prescribing drugs are set out in the state's Medical Practice Act.
Before prescribing a drug, a doctor must examine a patient, take a medical history and discuss the pros and cons of treatment, the act says. Only in limited circumstances can a doctor prescribe drugs without seeing a patient first.
Ordering scans for a patient without personally examining them -- based solely on the patients answers to a set of questions -- would not comply with the Medical Practice Act, Knight said.
Long said he has never heard of such rules applying to CT scans and knows of no imaging centers that follow them.
'HARD SELL ON PATIENTS'
Until closing in mid-May, Cancer Check America leased space from a company called Advanced Imaging in the same building as Long's office.
Kelly Emrick, CEO of Advanced Imaging's parent company, said the Savannah-based radiology group had no oversight over Cancer Check America. Advanced Imaging technicians received the orders from Long to perform the scans, Emrick said, adding it was Long's responsibility as Cancer Check America's medical director to ensure the orders were appropriate.
"I did see orders from patients' files," Emrick said. "I saw Dr. Long's signature and patients' signatures. But we were not involved in that and don't know if scans were ordered or files reviewed before or after scans were performed." Emrick said.
"We probably should not have gotten involved with them," he said of Cancer Check America.
Cancer Check America owes the radiology group about $18,000, Emrick said, but he can't get hold of company representatives.
"We are trying to disassociate ourselves with that entire operation," he said. " ... Once we recognized they were doing a hard sell on patients and treating the scans like selling timeshares, we put a stop to it immediately."
David Haddad, Cancer Check America's sales manager, was sued by the Indiana Attorney General's Office in 2007, accused of fraudulently selling time-share condominiums. He was ordered to pay $373,652 in restitution and about $97,000 in penalties, according to court records.
Haddad's wife, Lisa, said Cancer Check America plans to reopen in the Hilton Head area "in 2012 with our mobile scanner or at a permanent location." She declined further comment about the company's problems.
Looking back, Mike Platt said Cancer Check America preyed on his health worries -- pressuring him to quickly decide on signing a contract for five years worth of scans.
Platt had a heart attack five years go, and surgeons implanted a stent. His mother and father died from cancer. His wife's family has a history of heart problems.
So the couple decided to get neck-to-waist scans.
"Mom died at 68, and I'm 59 years old and have grandchildren I want to see grow up," he said. "They play on your fears and you become more gullible and receptive to what they're offering, without giving you time to think it over. I should have gone to my doctor first. It was a hard sell. ... I figured they were in with a physician on Hilton Head Island and kept bringing Dr. Long's name into it, and I felt they were a legit outfit."
Now, Platt and other patients are trying to get refunds and have their contracts with Cancer Check America voided.
Hilton Head resident Carolyn Sue Hall also contacted the Packet recently to add her name to the list of people who say they never had contact with Long before or after being scanned.
Hall has filed a complaint with the S.C. Department of Consumer Affairs to recover the $10,000 she said she paid for a package of scans for herself, her two sons and daughter-in-law. She signed up for the scans because her husband died three years ago from a heart attack and her mother died of breast cancer, she said.
Cancer Check America owner Sheila Haddad sent Hall an email assuring her the company is not going anywhere, Hall said.
Haddad maintained the screenings are "a very good service for the public" and "saved 18 lives in nine weeks and found other carcinogens and heart disease that would have never been found without the technology."
Haddad asked for testimonials for Cancer Check America.
She won't get one from Hall.
"I presented the test results I received to my physician and was told they were useless in detecting illness and are more dangerous due to the excess radiation," Hall said. "I never thought I would get caught up in this type of situation."
Follow Tom Barton on Twitter at twitter.com/EyeOnHiltonHead