Missouri State Rep. Patricia Derges, MD, an assistant physician (AP), is reportedly facing increased pressure from fellow Republicans to step down after being indicted on federal charges that she defrauded patients out of nearly $200,000.
The indictment has brought negative attention to the controversial medical license she holds. Derges, 63, is licensed in Missouri as an AP, which in several states is a type of healthcare profession available for graduates of medical schools who have passed Steps 1 and 2 of the US Medical Licensing Examination but who did not match into residency.
APs, who practice with restrictions, make use of their training as medical school graduates to increase the medical workforce in underserved areas. APs are directly supervised for 30 days (120 hours), after which they may practice in collaboration with a physician, who must be located within 50 miles of the AP's area of service. APs can prescribe drugs from schedules III to V and from schedule II, provided that authority is granted in the collaborating agreement.
Misty Todd, MD, a family physician at Bothwell Regional Health Center in Sedalia, Missouri, said the accusations against Derges, who has been a high-profile champion for the AP program in Missouri, are a warning sign about the program.
"The severity of the claim seems to be out on its own," Todd told The Kansas City Star. "But with her being the talking head, I do think it puts them in a very bad light, that their medical knowledge has significant gaps."
Trevor Cook, MD, who is also an AP in Missouri and is the creator of the Association of Medical Doctor Assistant Physicians, told Medscape Medical News that although he can't comment specifically on the Derges case, the AP role should not be regarded negatively on the basis of accusations against one such physician.
Stem Cell Deception Spread to COVID-19 Claims
The indictment of Derges, from Nixa, Missouri, was unsealed on February 1, weeks after she was sworn in as a state representative. She is accused of defrauding her patients by collecting money for what she claimed was a stem cell treatment but was actually amniotic fluid without cells. She has pleaded not guilty. The case is set for jury trial March 22.
Derges has been stripped of her committee assignments and was removed from the House Republican Caucus, according to The Kansas City Star.
Derges obtained her medical degree from the Caribbean Medical University of Curacao in 2014 but was not accepted into a residency program, according to the indictment.
She organized the Ozark Valley Medical Clinic (OVMC) in 2014, which now operates in three locations in Missouri.
She became an AP in 2017, according to Missouri provider licensee records.
The indictment says that in November 2019, Derges became a distributor for the University of Utah's amniotic fluid products and marketed them under the name Regenerative Biologics.
Included in the indictment are additional charges of illegally distributing Schedule II controlled substances, including oxycodone and amphetamine-dextroamphetamine, to patients she had not personally examined. Her Drug Enforcement Administration registration allows her to prescribe Schedule II controlled substances, the indictment says.
The felony charges together carry a possible sentence of hundreds of years in prison and millions in fines.
Derges claimed to treat patients with regenerative medicine with "prolotherapy, platelet rich plasma, and stem cells," the indictment reads. "In fact, Derges advertised OVMC as a 'Leader in ... Regenerative Medicine' including 'Stem Cells.' "
The scheme ran from December 2018 to May 2020, the indictment says, during which time Derges conducted seminars in which she told interested patients she could treat various medical conditions with stem cells.
The indictment says she administered amniotic fluid to her patients by injection, intravenously, and via nebulizer that "she claimed contained mesenchymal stem cells as treatment for patients who suffered from, among other things, tissue damage, kidney disease, chronic obstructive pulmonary disease, Lyme disease, erectile dysfunction, and urinary incontinence."
The indictment further states, "the amniotic fluid Derges administered to her patients did not contain mesenchymal stem cells, or any other stem cells.
"The University of Utah sold its amniotic fluid allograft to Derges for approximately $244 for 1.0 ml and $438 for 2.0 ml. Derges charged her patients $950 to $1,450 per ml of amniotic fluid allograft," according to the indictment.
Last year, the claims regarding treatment extended to COVID-19.
The indictment reads, "In an April 11, 2020, Facebook post [Derges] wrote of amniotic fluid allograft: 'This amazing treatment stands to provide a potential cure for COVID-19 patients that is safe and natural....' "
The indictment says she further claimed, "All of the components of the God given Amniotic Fluid: Mesenchymal Stem Cells (progenitor cells which are baby stem cells: can become any tissue they want); cytokines, exosomes, chemokines, hyaluronic acid, growth factors and over 800 proteins work together to create a human being: the emphasis on the lungs."
AP Role Under Scrutiny
The indictment has generated renewed negative attention on the role of APs. This is partly because Derges has been a high-profile champion of the role, which hasn't been widely accepted in the medical field.
According to The Kansas City Star, Derges' first bill this year would have allowed her and other APs to become full physicians without residency after 5 years.
Medscape Medical News reported last July on the controversy surrounding the AP role.
Missouri is the primary state for licensing APs; currently, 328 active APs are registered there.
In Missouri, legislation was passed in 2014 that allowed APs to practice. Other states in which APs can practice include Utah (2017), Arkansas (2015), and Kansas (2016). Virginia and New Hampshire have introduced legislation to allow the practice.
The AP licensure program has drawn sharp criticism from organized medicine, including the American Academy of Family Physicians (AAFP).
In a letter to Missouri's legislative leaders in 2019, which was shared with Medscape Medical News, Michael L. Munger, MD, AAFP board chair, wrote, "Acceptable training in an accredited residency program following medical school graduation cannot be bypassed and allowing for the certification of individuals without this training is dangerous for patients and quality health care."
Cook, of the Association of Medical Doctor Assistant Physicians, said the allegations should not take away from the fact that APs have been able to help cover gaps in care, particularly during the pandemic in underserved areas, including the one in which he works.
"I have seen hundreds of COVID patients," he said. "On many occasions, I worked during times when the wait at the local ER was 8 to 12 hours."
He also points out that fraud allegations have been levied against physicians who have been licensed in the traditional way, so the circumstances are not unique to APs.
"The actions ― good or bad ― of one AP do not reflect the intentions and mindset of an entire licensure," Cook said.
Derges' attorney and the Missouri State Medical Association did not respond to Medscape Medical News' requests for comment.
Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune and Nurse.com and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.
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Cite this: Stem Cell Fraud Case Sparks Concern Over Unmatched Docs' Role - Medscape - Feb 22, 2021.