During Nakouzi’s treatment of Mary, her husband racked up over $40,000 in charges.  The treatment — which involved a variety of pills and supplements and “bioresonance” therapy, a technique that measures electrical activity at the skin—failed. In early 2007, Mary passed away at the age of 42.

When he sought Nakouzi’s help, Nedlouf’s wife was “in and out of consciousness,” he said in a recent interview. Desperate for a cure at the time, he “didn’t think much. I wanted to help her. She was dying.”

Nedlouf said that, in the end, he believed he was “taken for a ride.” So he filed a complaint with the Connecticut Department of Public Health (DPH), in hopes the board would punish Nakouzi for his misrepresentations.

Although the complaint was filed in 2007, it wasn’t until September of 2011 that Nakouzi was disciplined with a $5,000 fine, two years’ probation on his medical license, and practice restrictions.

The delay that Nedlouf experienced is not unusual in Connecticut, where it can take two years or longer for complaints against physicians to result in license suspensions, revocations and other disciplinary actions by the state Medical Examining Board, working with the DPH.

A review of disciplinary decisions in the past 18 months shows that the medical board rarely acts within a year of an incident occurring – and sometimes the process takes as long as four years, with physicians still practicing freely in the interim.

Reasons for the delays vary. In some cases, it takes time for the DPH to prepare charges against physicians, allow for responses and schedule hearings. In other cases, there is a lag between the alleged lapse in care and a complaint to the DPH that triggers an investigation.

Last month, for example, the medical board imposed six months’ probation on Dr. David Wilterdink, who has a family practice in Danielson, for giving a patient, who was also an employee, early refills of Ativan and Fioricet without an adequate review of the patient’s medical record or proper documentation. The violation dated back to 2011.

Similarly, in July 2012, the medical board imposed a civil fine on East Hartford physician Mahmood Yekta for ordering numerous unnecessary diagnostic tests on a patient without documenting the reasons. The charges stemmed from a 2007 complaint.

DPH spokesman William Gerrish maintained that such cases are unusual, explaining that lengthy cases, such as Nakouzi’s, are sometimes caused by “the time required to locate a physician expert to review a case.” He added that DPH recently reviewed its processes and is “continually working to improve the timeliness of its investigations.”

Anne Doremus, outgoing chair of the medical board, said that delays can be frustrating for board members, as well as patients. She said some of the delays stem from a protracted hearing process, noting that Connecticut is one of a few states in which the medical board lacks its own staff of investigators and lawyers and instead relies on DPH to staff the panel.

“Certainly, we would like to see any case completed within at least 18 months,” Doremus said. “But remember, the board is made up of volunteers, most of them working people. And DPH has (15 licensing) boards to work with.”

Over the last decade, Connecticut has consistently ranked in the bottom fifth of states in the rate of serious disciplinary actions taken against physicians, according to the watchdog group Public Citizen.

The membership of the medical board was recently expanded from 15 to 21 members, which Doremus said may help to speed up dispositions of cases.

Meanwhile, the process can be grueling for patients and physicians alike.

Nedlouf was told that in his case, the length of the investigative process was largely based on the lack of standards for homeopathic physicians in Connecticut. He said outside experts in homeopathic medicine had to be called in, and finding a suitable expert took time.

Nakouzi declined to comment on the case.

According to a Connecticut DPH consumer guide, the average length of an investigation is six months. However, the investigation itself is only one part of the disciplinary process and does not reflect the length of time between the reporting of an incident and the board’s final decision.

Recent cases adjudicated by the board after a significant delay include:

• Dr. Michael Waldman, a former New Milford Hospital radiologist, was investigated by the DPH for an April 2010 incident in which he perforated a patient’s spleen during a procedure. DPH records say that Waldman “recognized that he had perforated the spleen,” but sent the patient home without telling him what happened or undertaking proper monitoring. The 74-year-old patient died three days after the procedure. Not until April 2012 did the medical board impose discipline: a one-year probation, a reprimand and practice restrictions.

• Dr. Gerald Micalizzi of Bridgeport was charged with improperly accessing the records of hundreds of patients at Griffin Hospital in 2010. He used the passwords of other radiologists to access the hospital’s system and download patient information, records say. The medical board disciplined him with a civil penalty, license reprimand and six months’ probation in June 2012.

• Dr. Marc Aronson, a Middletown psychiatrist, was found to have given a patient a high dose of an anti-seizure and mood-stabilizing drug in 2009 without proper justification, records show.  An investigation was opened in 2010. The board disciplined him with a license reprimand in January 2013.

• Dr. Leslie Domalik was charged in 2010 with prescribing an excessive dose of an anti-diabetic drug over the phone to a patient in 2009, while working at William Backus Hospital in Norwich. The board fined her $7,500 in January 2013.

Four recent cases of wrong-site medical procedures each took more than a year to adjudicate after cases were opened.

Jean Rexford, a patient-safety advocate who serves on the medical board, said cases can take “easily two years” from complaint to board action.  She blamed the delays on bureaucratic inertia. She said the commissioner of DPH, Dr. Jewel Mullen, has been supportive of improving the effectiveness and transparency of the disciplinary process.

Dr. Jeffrey Lane, a gynecologist and cosmetic surgeon practicing in East Lyme, recently went through the process. He was accused of prescribing controlled substances to family members and an employee without accurate records; instructing unlicensed assistants to help him with procedures; and failing to adequately document sterilization practices.  The investigation took two years from the initial complaint in early 2011 to the board’s action in January 2013.

“I’ve been through hell, despite the fact that not a single patient of mine was injured, we never had any serious complications, and no patient ever filed a complaint,” Lane said of the disciplinary process.  “The system is broken.”

Lane took issue with several aspects of the investigation. He said that after he signed a consent order in 2011 to try to settle his case and avoid the threat of a license suspension, the DPH proceeded with a lengthy investigation. The medical board fined him $2,000, imposed a one-year probation and placed restrictions on his practice.

Lane described the process as “totally devastating — financially, professionally and emotionally.”

Lane’s hearing, before a three-member panel, lasted two days. But because of scheduling issues, his hearing days were a month apart.  After the second hearing on April 17, 2012, Lane said it took six months for the decision to be reached.

“Why it took six months, I have no idea,” he said, speculating that the DPH “may have a big backlog.” He also said he was concerned that the medical board’s decision would not be objective because the panel is so closely linked to the DPH.

“I felt like my head was in the guillotine. It’s only a matter of time until it’s going to drop,” Lane said.

Under Connecticut’s system, the DPH is responsible for investigating complaints against doctors, including obtaining records, interviewing witnesses and seeking expert opinions from physicians with the same specialty, when appropriate. In many cases, the DPH will not act until it has retained a physician reviewer.

DPH investigators confer with attorneys to draft charges. In some cases, the department tries to negotiate a settlement with the physician; in others, the case goes to a hearing before a three-person panel, which makes a recommendation to the full board.

Gerrish said the DPH and the board have distinct roles, with the panel’s gubernatorial appointees acting independently. He said the DPH is focused on “conducting fair and timely investigations, and prosecuting physicians when we have determined that their conduct has deviated from the standard of care in Connecticut.” In some cases in which physicians are found to pose a clear threat to patient safety, the board takes immediate action by suspending their licenses.

Public Citizen, a consumer advocacy group, takes the position that more physician discipline leads to better patient protection.  In its 2012 report on the rate of state medical boards’ serious disciplinary actions against physicians from 2009-2011, Connecticut ranked fifth-lowest. The advocacy group cites adequate funding, strong leadership, and independence from other state agencies as keys to expediting and improving the work of medical boards.

In Nedlouf’s case, Connecticut officials initially told him that his complaint about Dr. Nakouzi’s treatment of his wife did not have much of a chance because of the lack of standards for homeopathy, he recalled. He said there were “so many steps” in the process, as the DPH had to find probable cause to investigate and then extensively examine Nakouzi’s files.

While the delays were frustrating, he said he was relieved that some action eventually was taken.

“To get to that point, after we thought we had no chance, it was symbolic in ways,” Nedlouf said. “It sheds a light, brings it to public attention.”

The board took the action in the case of Liane Leedom, who was sanctioned for allowing her then-husband to practice medicine without a license. Her ex-husband was arrested and sentenced to five years in prison and five years’ probation for posing as a doctor and sexually assaulting women at the clinic where Leedom was medical director. Leedom now maintains on her website that she was a victim of her ex-husband’s actions as a “con artist.”

Dr. Liane Leedom

Leedom had sought the change in a state order because she has been offered a part-time position seeing patients in a facility where the supervising physician may not always be there, state Department of Public Health records show. The change made by the board will allow her to work when other licensed health care providers will be present. Leedom’s medical license remains on probation under a 2010 state consent order.

In 2005, the state reprimanded Leedom and restricted her to non-clinical practice, barring her from running any health care facility or treatment center. That action was based on allegations that between August 2002 and March 2003, she allowed her then-husband, Barry Lichtenthal, to practice medicine without a license at Noah’s Ark, a methadone clinic in Bridgeport where Leedom was medical director, state records show.

The state’s 2005 consent order with Leedom said that Lichtenthal, who called himself Michael Taylor, performed private physical examinations on several of the facility’s patients and sexually assaulted female patients.

In 2004, Lichtenthal, a former investment counselor, was sentenced to five years in prison and probation for sexually assaulting women at the clinic, the Connecticut Post has reported. While Leedom was on maternity leave, Lichtenthal performed sexual experiments on young women at the clinic before giving them methadone, the Post reported. In one case, according to the Post, he connected wires to two women’s breasts and attached the wires to an EKG machine because he said had to determine if the women were lesbians before giving them medication.

Lichtenthal was sent back to prison for 30 days for violating his probation after police said he again posed as a doctor, the Post reported in 2011.

Leedom was charged with putting patients at risk and defrauding the Medicaid program, according to the Psychiatric Crime Database operated by the Citizens Commission on Human Rights in Los Angeles. The fraud charges were dropped, but Leedom pleaded no contest to conspiracy to misuse the title “doctor” and two counts of reckless endangerment and was sentenced to two years’ probation, according to the database.

In 2010, the medical examining board issued a reinstatement consent order for Leedom, placing her license on three years’ probation and imposing permanent restrictions.

On her web site “Justlikehisfather.com,” Leedom said she “made the mistake of her life” when she unknowingly married a “con artist.” While she does not name Lichtenthal, she said she had a son with him in 2002. When her husband was arrested, the “truth regarding his character became apparent to me,” she wrote.

In other business, the state board:

• Reprimanded Dr. Ralph V. Tremaglio of Naugatuck for prescribing medication to his wife, while not maintaining a medical record, from May 2011 to June 2012.  According to DPH, records indicate that about 21 Ambien prescriptions and one prescription for Sonata were written during that timeframe.

• Reprimanded Dr. Thomas Kucharchik of Mystic for prescribing medication that did not meet the standard of care, according to DPH.  Kucharchik treated a patient from March 2008 to March 2009, while employed at the Community Health Center in New London.  The patient had a history of hepatitis-C, depression, PTSD and anxiety, and ultimately died of oxycodone toxicity.  Kucharchik was cited for failing to recognize the patient’s potential or actual abuse of the controlled substances he prescribed.

The board placed a restriction on Kucharchik’s license requiring that after May 31, he may practice in Connecticut only after notifying DPH 90 days in advance.   Kucharchik notified DPH that he is leaving for South Carolina to take a job at the Hampton Regional Medical Center as of June 1.

• The board denied Dr. Jeffrey Lane’s request to modify a memorandum of decision.  In December, the board fined the East Lyme gynecologist $2,000 for lapses in care during cosmetic surgery and placed him on probation for a year. State investigators found that he did not properly instruct his staff in how to sterilize equipment prior to 2011 and allowed an unlicensed employee – his wife – to perform laser procedures, records show.   State officials also found that Lane had prescribed drugs to relatives or employees in 2009, 2010 and 2011 without maintaining proper records, reports show.

Dr. Jeffrey Lane, a gynecologist who performed liposuction and laser treatments at a clinic in East Lyme, was also placed on probation for a year. State investigators found that he did not properly instruct his staff in how to sterilize equipment prior to 2011 and allowed an unlicensed employee – his wife – to perform laser procedures, records show.

State officials also found that Lane had prescribed drugs to relatives or employees in 2009, 2010 and 2011 without maintaining proper records, reports show.

David Tilles, a staff attorney for the state Department of Public Health, said Lane has already paid a $5,000 fine to the U.S. Drug Enforcement Agency for the prescription violations.

Lane asked the board Tuesday for a lesser penalty, saying that he has lost $100,000 in business and is facing $45,000 in legal bills due to the state investigation. He said he admitted his mistakes and has corrected lax sterilization procedures at his clinic.

“A fine and probation are not necessary and will likely end my career,’’ Lane said before the board went on to impose the fine and probation.

In other business Tuesday, the board revoked the Connecticut medical license of Dr. Michael Anthony of Shrewsbury, Mass., a psychiatrist who also had an office in Putnam, CT.

It took the action based on findings in Massachusetts that Anthony had violated patient confidentiality and had an inappropriate sexual relationship with a female patient.

Massachusetts officials revoked his license in 2011 after concluding he had acted unprofessionally in treating the woman. Anthony had argued that his judgment was impaired following a traumatic brain injury he sustained in a motorcycle accident in 2007. But the Connecticut board concluded his testimony was not credible, citing evidence of unprofessional contact, such as visiting the patient at work, before his brain injury.

Officials also concluded he knowingly falsified a diagnosis that the woman had a borderline personality disorder and erotomania when there was no evidence of such a diagnosis in her medical chart, Connecticut records show.

In a statement to the board, Anthony apologized for his behavior. He said he has been practicing in Connecticut for the past four years.

The board voted to suspend the license of Dr. Mary Jane Brackett of Watertown pending a hearing. In October, the board had fined her $1,000 and placed her on probation for six months after state officials found that Brackett had made a false accusation against a patient’s father to state child protection authorities.

Public health department lawyers recommended the suspension Tuesday because they say that Brackett failed to pay the fine, take a course in medical documentation or hire a consultant to monitor her practice. The lawyers also said in state records that she has also been accused of additional charges of disruptive and unprofessional conduct with pharmacists, a patient and a patient’s mother.

The board also approved a consent order that fines Dr. Carolyn McDonald, a radiologist at a Veterans Hospital in Tampa, $2,000 for lying on her Connecticut license renewal application that she had not been disciplined by a state in the past year. In 2011, California suspended her medical license based on a 2010 suspension of her license in Minnesota due to an alcohol addiction. The Connecticut board Tuesday placed her on probation for five years.

McDonald’s attorney, Michael D. Neubert, said her problems stem from “an alcohol binge” in 2007 but that she has not used alcohol or drugs since receiving treatment that year. He said state officials in Pennsylvania and New York are considering or have taken action similar to what has been done in Connecticut. He said McDonald has no plans to practice in Connecticut.

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