The controversy over the existence of Chronic Lyme Disease has been reignited after a Morris County Park police officer was awarded temporary disability status and medical benefits along with hyperbaric oxygen treatment after a fall. Did an episode of Lyme disease back in 2006 precipitate the severity of her injuries? Does the presiding judge understand the long-term effects of Lyme disease?
The officer at the center of the case, Margie Raimondi, claims that she acquired Lyme disease back in 2006 due to riding through wooded areas on horseback patrol. She began working for the county in 2005 and recalls ongoing exposure to tick bites although coudn’t recall specific dates where she was bitten. Having begun to suffer from symptoms of Lyme disease in late 2006, Raimondi’s muscle and joint pain, neck stinffnes, and chronic fatigue were finaly diagnosed as borreliosis via blood test.
While undergoing treatment, Raimondi was off work on sick leave. She soon exhausted this sick leave and then suffered a neurological episode in March 2009 for which she was hospitalized. After being released from the hospital, Raimondi was bed-ridden for the next nine months and was treated for the first six months with intravenous (IV) antibiotics prescribed by her treating physician Max G. DeShaw, M.D. Dr DeShaw is a board certified medical doctor who specializes in infectious diseases, and regularly treats Lyme disease patients; he diagnosed Raimondi with late musculoskeletal Lyme disease in 2009 and it was his opinion that informed the court case.
Judge’s Decision ‘Unsupported by and inconsistent with the law’
After being treated by Dr DeShaw, Raimondi returned to work in December 2009 and was assigned clerical and administrative work until she was put back on mounted patrol in April 2010. A year later she fell on a patch of black ice while on duty, landing on her hands and kness. After intitially returning to work she began to suffer from pain in the neck and upper back, with severe spasms developing. According to the court, as of May 2011, Raimondi has been unable to work.
Raimondi’s physician maintains that the officer has Lyme disease, which was contracted on the job and is the root cause of her current symptoms as exacerbated by the fall (also on the job). A medical expert retained by the Morris County Park Commission presented arguments based on the lack of evidence for the existence of ongoing ‘chronic’ Lyme disease, but the judge in the case rejected this expert opinion, finding in favor of Raimondi.
This week, the case went to appeal with the Morris County Park Police and Commission (MCPPC) arguing that “the compensation judge reached a decision unsupported by and inconsistent with the law and the credible evidence adduced at the hearings, because there was no objective evidence that Raimondi suffered from Lyme disease.”
Furthermore, the MCPPC said that “Even if she suffered from Lyme disease […] there was no evidence that HOT [hyperbaric oxygen therapy] is an appropriate or acceptable treatment for that condition because it is allegedly experimental and risky. In addition, MCPPC challenges the judge’s evidential ruling that barred its expert from testifying to consultations that he had with other doctors about Raimondi’s condition and their opinions about HOT.”
Lyme Disease Treatment Controversial
Despite these arguments, the initial decision by the judge was upheld, leaving Raimondi’s benefits intact. As the US Centers for Disease Control (CDC) continues to maintain that Lyme disease is almost always treatable by a short course of antibiotics, and there is no good quality evidence in support of hyperbaric oxygen therapy for Lyme disease (and, indeed, some evidence that it can be dangerous) it is easy to see why Morris County officials are of this opinion.
However, Dr. DeShaw determined that the accident aggravated Raimondi’s underlying Lyme disease symptoms and Raimondi’s doctor referred her to Jeffrey A. Siegel, M.D., for treatment for the injuries she had suffered in the fall. According to Dr. Siegel’s April 26, 2011 report, Raimondi’s post-accident symptoms were “perhaps” attributable in part to her “history of Lyme disease with central nervous system involvement.”
Compensation to Pay for Unproven Lyme Therapy
The MCPPC did acknowledge that the fall resulted in compensable injuries but make a distinction between that and the 2006 Lyme disease episode. They lost their appeal because they did not provide evidence that Raimondi’s fall had not reactivated her Lyme disease symptoms, nor had they offered an alternative cause for their previous employee’s symptoms. Raimondi’s physician recommended HOT for Lyme disease, at which point she filed another claim specifically to get compensation to cover the expense of such therapy.
What We Can Learn from this Lyme Disease Litigation
There are a number of interesting aspects to this case, with court records showing that Dr DeShaw cited the risk of a Jarisch-Herxheimer reaction (colloquially known as ‘herxing’) with HOT and antibiotic therapy for Lyme disease. The opinion of Dr DeShaw was given considerably more weight than that of the physician brought in as expert testimony by the MCPPC, William S. Kritzberg, M.D., an expert and board certified specialist in internal medicine. In fact, because Dr Kritzberg had no significant experience of treating Lyme disease patients, nor any publications on the subject, his expert testimony was dismissed in the appeal. Had the MCPPC had a Lyme disease expert, say someone from the IDSA or CDC, available to appear as an expert witness, one wonders how the case may otherwise have turned out.
With the success of this case, both in the first instance and at appeal, one also has to wonder if a raft of such cases may now begin to beset public institutions. The medical bills for those treating symptoms perceived as being due to chronic Lyme disease can amount to thousands of dollars a month and are often not covered by insurance because of a lack of evidence for the existence of the infection. Should specialist medically literate judges be drafted in for such cases? Should the existing judges pay closer attention to expert witnesses? Or, are all employees who have ever had Lyme disease diagnosed now able to ascribe subsequent symptoms to such and infection?