The Dr. Biter Story: Just the Facts, Ma’am, With a Side of Speculation

There has been an uproar in “natural” birth advocacy circles about the recent suspension, reinstatement and resignation of OB/gyn Dr. Robert Biter from Scripps Encinitas Hospital. Biter is known as “Dr. Wonderful” by many “natural” birth advocates for his support of non-interventive childbirth.

Supporters, lead by actress Ricki Lake, have staged rallies and given interviews excoriating Scripps and demanding Biter’s reinstatement.

There are very few facts available about the issue, but there has been a great deal of speculation, not to mention downright falsehood, regarding the reasons for both the hospital’s and Dr. Biter’s actions.

Let’s start with facts:

Fact: Dr. Robert Biter’s OB privileges were suspended by Scripps Encinatas Hospital on May 7, 2010.

Fact: It was announced that Dr. Biter’s OB privileges had been reinstated on the afternoon of May 21.

Fact: Several hours after the announcement of Biter’s reinstatement, it was announced that Dr. Biter had voluntarily resigned all his privileges from Scripps Encinitas.

Fact: Neither Dr. Biter nor Scripps has made any public statement regarding the reason(s) for his suspension, reinstatement or resignation.

Now for some speculation and counter-speculation:

Speculation: Dr. Biter was suspended “for no good reason.” ~ Lynn Wolf, blogging at My Best Birth

Fact: Only Dr. Biter and those involved with the decision to suspend him know the reasons for the action. Nobody else can accurately judge whether or not those reasons were “good.”

Speculation: Scripps suspended Biter’s privileges “with no warning” ~ Natural Baby Pros Blog

Fact: Scripps could not legally warn the public that Biter was about to lose his privileges. As Dr. Biter has made no public comment on the topic, we don’t know whether or not he was warned prior to his suspension.

Speculation: Dr. Biter may have had some advance warning of a possible suspension. Barring a sudden and serious event—e.g., the death of a patient (and there is no indication that this was the case)—hospitals don’t generally suddenly suspend a physician’s privileges without prior discussions with the physician regarding the potential for suspension; to do so could put them at legal risk. If he did have prior warning, the responsibility to warn patients that he might be unavailable to attend their births or otherwise provide care was his.

Moreover, several  posts by midwife Barbara Herrera on her blog suggest the possibility that Dr. Biter has been concerned about his standing since late 2007:

“I hear through the grapevine that doctors are getting more and more pissed at your growing, fawning clients. I hear they are unhappy that you spend so much time with your clients, that you are so personal with them, that you don’t have the proper OB boundaries.” (Dec. 8, 2007)

“For reasons I cannot disclose at the moment, I am looking for other Dr. Wonderfuls around the United States.…If you know of progressive OBs (they have to be obstetricians or family practice docs, the higher on the rung the better), please email me asap.” (Jan. 24, 2009)

“A variety of reasons bring me to share who [Dr. Wonderful] is at this time.

1) He could use some fantastic vibes from everyone, including strangers….” (Feb. 6, 2009)

(ADDENDUM 5/26/10) The “I Love Dr. Biter” Facebook fan page provides additional evidence that Dr. Biter knew his status at Scripps might be in jeopardy. A January 14, 2010 discussion thread titled “No letters, just money” reveals that a doula group had mounted a letter-writing campaign to Scripps on Biter’s behalf, but that it “…seem[ed] to have made things worse.”

The poster added that Dr. Biter requested the group stop writing letters, and asked instead for help raising funds for his birth center because “…the sooner he raises the funds, the sooner he can move on.”

Speculation: Scripps Encinitas “refuses to give a reason [for the suspension], and Dr. Biter is legally unable to comment at this time.” ~ birthsupport, blogging at Bring Dr. Biter Back!

If you reverse that statement, it might be closer to the truth. Scripps would put itself in serious legal jeopardy if it made the reasons for Biter’s suspension public. Dr. Biter may be free to comment, or he may be enjoined from doing so if he has a confidentiality agreement with Scripps. If he is considering legal action, his attorney has most likely advised no comment.

Speculation: “Dr. Biter has never had an OB malpractice case” ~ birthsupport, blogging at Bring Dr. Biter Back!

Fact: According to records available from the San Diego County Superior Court, Dr. Biter is the primary defendant in five open civil cases, and a co-defendant in another. Four were for medical malpractice, one for professional negligence, and one appears to be personal injury/wrongful death (although I cannot find a clear definition of the acronym used in the case report.) In three of these, Scripps is named as a co-defendant and as the primary defendant in another. We have no way of knowing which, if any, of these were related to OB services, as there are no details available. [Updated to reflect that one of the seven listed cases appears to be an amended version of another case.]

Speculation: One of these cases was most likely related to gynecologic surgery. News media has reported as much, and one of the cases specifically lists Scripps Surgery Center, which is where such surgery would likely be performed, as a co-defendant. Maternity services are provided by Scripps Memorial Hospital, which is a separate entity, and which is named co-defendant in two cases (another lists Scripps Health, which includes the entire Scripps network, as co-defendant). It is highly unlikely that all seven cases are gyn-related, given that Dr. Biter’s gynecology privileges were never suspended, however we simply don’t know.

Fact: The six lawsuits were filed in the five years between 2005 and 2010. That’s more than twice the career average of 2.79 for California OB/gyns, according to ACOG’s 2009 survey. Five of these suits were filed within the past year.

Speculation: Scripps may have wanted to get rid of Biter, but not because he “doesn’t do enough c/sections,” as some supporters claim. Due to his reputation as “Dr. Wonderful,” Biter probably brought in a fair number of insured patients, which would have been good for the hospital’s bottom line, however the increasing number of lawsuits filed against Dr. Biter would likely have alarmed Scripps.

Unsupported allegation: Scripps committed “at least one HIPAA privacy rule violation” ~ About Carol, blogging at Bring Dr. Biter Back!

The writer doesn’t make entirely clear what this alleged HIPAA violation was, but she later suggests:

“If you have been contacted by Scripps Encinitas hospital & were encouraged to birth your baby with their on-call doctors, but never filled out pre-registration paperwork or were only getting prenatal care with Dr. Biter in preparation for your homebirth, you can file a complaint for HIPAA privacy violations at:
1-877-696-6775”

Speculation: If such contact occurred under the conditions described by the writer, the initial HIPAA violation (if it existed) was made by Dr. Biter’s office, not Scripps. If the women contacted had filed no paperwork or otherwise notified Scripps of an intention to deliver there, the contact information for  Biter’s pregnant patients could only have come from his office. If his patients had undergone treatment or testing ordered by Dr. Biter and performed at Scripps, the hospital did not violate HIPAA regulations in contacting these patients directly.

Interestingly, on the Facebook fan page for Dr. Biter,  commenter Laura Fairchild writes:

“So I just saw Channel 7 News and wanted to tell you all when we were out there earlier today to let people know the rally was cancelled we saw the interviewee named “Leslie” who made a horrible accusation about Dr. Biter. A staff member of Seaside Women’s Health was also there during her interview and recognized her name as a woman who called his office 2 weeks ago and demanded from her a cash payout or she would make these accusations about Dr. B at the rallies and with the media.”

If “Leslie” was in fact a former patient at Seaside Women’s Health (where Dr. Biter practices), the staff member Fairchild describes may have committed a HIPAA violation if she disclosed to anyone that “Leslie” had been a patient, whether or not “Leslie” was attempting to blackmail Dr. Biter.

Fact: Dr. Biter resigned all his hospital privileges with Scripps hours after announcing his reinstatement. He has made no statement regarding his reasons.

Speculation: Dr. Amy at The Skeptical OB writes:

“By law, the hospital was required to notify the Board of Medicine within 15 days if his privileges were suspended or revoked, automatically triggering an investigation by the board that could lead to the loss of Dr. Biter’s license.^[1] However, he managed to avoid that investigation by promising to voluntarily resign if his privileges were reinstated.”

Fact: Dr. Biter’s OB privileges were suspended on Friday, May 7. He was reinstated and subsequently resigned on Friday, May 21—one day prior to the reporting deadline.

Speculation: Some supporters suggest that he resigned all his privileges in a show of principle, however Biter’s resignation does not suggest a show of great principle so much as an example of cutting one’s losses.

Fact: Dr. Biter’s resignation has left all his patients—not just the pregnant ones—in the same predicament over which his supporters expressed such concern and such anger at Scripps.

Speculation: If Dr. Biter always puts his patients’ needs first, as supporters claim, why would he not stay at Scripps long enough to provide care for the patients whose babies or surgeries had been scheduled for the next few weeks? Unless, of course, his immediate resignation was a requirement of the agreement to reinstate his privileges and avoid the mandatory report to the medical board.

The loss of hospital privileges is, of course, a blow to any ob/gyn. However, Dr. Biter could conceivably continue to provide office gynecology, and could proceed with opening the birth center he had planned without hospital privileges. If, however, his medical license were ultimately suspended or revoked as a result of a mandatory inquiry, he would be limited to an administrative role in his birth center, which would almost certainly hinder marketing efforts that are likely to hinge on “Dr. Wonderful’s” reputation among the “natural” birth set and threaten the financial viability of the birth center.

What can we take away from all this?

Not much, other than that Dr. Biter is extraordinarily popular, and that his supporters are less concerned with the actual reasons for his suspension and the subsequent events than with their personal feelings about him.

Some of Biter’s most vocal supporters would like to frame their protests and unsubstantiated accusations against Scripps as an attempt to strike a blow for women’s rights to give birth in the way they prefer, but this is a pleasant delusion.

In the glaring absence of facts, their willingness not only to blindly support Dr. Biter, but to attempt to very publicly bully Scripps into reinstating him is profoundly disempowering for themselves and the women they claim to represent.

Empowerment entails having choices based on facts.

Thanks in part to the actions of Dr. Biter’s supporters, we may never know the facts behind this story.

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1. 1. California Business & Professional Code, § 805, subd. (b) stipulates that a report be filed when a physician’s staff privileges are suspended or revoked “as a result of an action of a peer review body…for a medical disciplinary cause or reason.” This is defined by the statute as “that aspect of a licentiate’s competence or professional conduct that is reasonably likely to be detrimental to patient safety or to the delivery of patient care.”