Empire Medical Training and Dr. Buzz
Today we’ll enter into a world of medical training that frankly I didn’t know existed. In my opinion the dark underbelly of interventional pain management and orthobiologics, but one that is fueling the “stem cell wild west”. Let’s dive into Empire Medical Training and a character I have featured before, “Dr. Buzz”. That will lead us down a bizarre rabbit hole of potentially risky medical education from a provider who had his license revoked.
Training doctors and other healthcare providers used to be the sole responsibility of medical schools and professional organizations. However, about 1-2 decades ago, some entrepreneurs began for-profit medical education courses. Given that many courses can fetch $1-3,000+ for a weekend, there was “gold in them thar hills”.
This trend has created an interesting profit incentive in medical education. For example, medical schools and professional societies have strict criteria on who can walk into a course teaching a specific procedure. However, when profit is the goal, this is a drag on the bottom line. Meaning if you start with 100 interested healthcare providers who would pay to take your course and then you take only 20 that meet strict educational criteria (like they are board-certified in X), you’re leaving 80% of the possible revenue on the table.
Another example is the idea of “pass/fail”. We would all agree that it’s in society’s best interest to fail a doctor in a course because they can’t safely demonstrate the procedure they just learned. However, doing that in a for-profit setting is tough. Meaning it’s a great way to piss off the customers.
Empire Medical Training and Dr. Buzz
If you would have asked me last week whether I had heard of Empire Medical Training I would have said yes, but I probably couldn’t have told you much other than they were a for-profit training outfit. What I found out about yesterday is startling; a company that will train just about anyone to perform advanced interventional pain management and orthobiologic techniques, regardless of qualifications.
This journey down this rabbit hole begins with a Linkedin message that read:
“Chris, Did you know Dr. Roy “Buzz” Korth is a board-certified urologist; an expert, and a teacher of men’s sexual health and stem cells? Last I checked this guy was a Chiro. He just keeps reinventing himself.”
Who is Dr. Buzz Korth? He’s a chiropractor that I covered in a prior blog where I dug into this claim: “…he recently received his Fellowship in Stem Cells from the Metabolic Medical Institute in Conjunction with George Washington University.” When I reached out to George Washington and that program, they stated that none of this was accurate. Meaning that Dr. Korth was not board-certified in this area through their program. Hence, when I began this journey, I was beginning with the knowledge that my prior checks on Dr. Buzz’s claims had come up empty.
In the above message, this link was attached:
Here Dr. Buzz claims to be a board-certified urologist. However, there is no way a chiropractor without a medical degree could be “Board Certified” as the public understands it (through the American Board of Medical Specialities). Meaning a board-certified urologist has 8 years of college and medical school and then 5-years of residency training. Hence, I didn’t dive too much deeper into yet another claim about Dr. Buzz, but what caught my eye was that this course was hosted by “Empire Medical Training”. So when this deep dive began I had only one question. How could a credible medical education group allow a chiropractor to make a claim that he was a “Board-certified Urologist”?
[Note, my screenshot above is from 3/30/22. Empire changed its website shortly after this blog was published on 3/31/22 to now represent Dr. Buzz with a similar biography to the one I debunked in another blog post.]
Down the Empire Medical Training Rabbit Hole
My research began on the Empire Medical Training website by reviewing their course offerings. I soon found out that not only was this company teaching “sexual health” but also “pain management” injections. I’ve blogged before on the problem with teaching any willing medical provider these procedures, especially in the spine as if these procedures are done incorrectly, they can cause severe neurologic injury and death. I then literally gasped when I saw this:
Looks like Empire will train you in all sorts of procedures like cervical epidurals, facet injections, and radiofrequency ablation. The problem? If these procedures are performed poorly without advanced life support capabilities, they can cause severe injury or death. For example, injecting a local anesthetic into the epidural space too deeply so that drug gets intrathecal can cause the patient to abruptly lose the ability to breathe. You then need to support the patient’s breathing with advanced life support until they can breathe again on their own. If you’re trained to do this, no harm no foul. If you’re not, the patient is probably dead. For example, a family doctor here in Denver did this about a decade ago and wasn’t trained on how to support the patient and inadvertently killed a woman. This story is even sadder, as he later killed himself.
So the key question yesterday was, who can get trained in these advanced spinal procedures? The answer should be only a limited subset of board-certified physicians who have had exposure to spinal injections in their residency. So I jumped on the Empire Medical Training chat and this is what I learned:
Basically, anybody can take this course. A physician’s assistant or a chiropractor. You do have to take a basic injection course called “The Pain Show”, but then from what I was told via chat, that provider is eligible to take a course involving potentially dangerous procedures.
The company does provide a disclaimer that it’s up to the states to figure out whether someone can legally perform the procedure they learned. But this begs an obvious question. If the provider wasn’t planning on performing the procedure why would they shell out thousands of dollars to take this course?
For example, Radiofrequency Ablation (RFA) is taught. As we’ve seen in other blogs, which procedures which types of mid-level or alternative practitioners can legally perform in which states is fuzzy. However, according to my chat buddy at Empire, we could have a physician’s assistant or chiropractor learn to perform RFA on the neck. Why is that a problem? If the probe is in the wrong place and the system is made “live”, you can create a permanent spinal nerve or spinal cord injury resulting in a non-functional arm or quadriplegia.
You may be saying to yourself, well that could never happen, right? Wrong. A decade or more ago I got a call from an attorney defending a family physician in a malpractice case. His client had taken a weekend course on how to perform neck facet injections. The attorney wanted to see if I would act as an expert in international spine procedures. He sent over the injection images, where the doctor had been so confused about what he was looking at on the screen, that he inadvertently documented the placement of the needle into the middle of the patient’s spinal cord and then to boot, actually injected radiographic contrast into the cord. That’s a mistake that no competent interventional pain management physician would make and that put this patient into a wheelchair for the rest of their life. I told the attorney that since the images convicted his client of malpractice rather than exonerated him, I couldn’t be involved.
Why did this tragedy happen? Because you can’t learn these procedures and become competent in a long weekend. You need extensive proctoring (i.e. someone standing over your shoulder). For beginners, something as simple as determining where the needle is or isn’t based on what you’re seeing on the screen can be problematic as everyone’s anatomy is slightly different. In addition, just setting up the fluoroscopy beam the right way to get the right image can be challenging as few rad techs know how to perform fluoroscopy for interventional spine procedures. That means that it’s up to the doctor to know how to set these images up the right way.
It’s because of these issues that (in my experience and opinion), credible training courses in these procedures MUST have VERY criteria. For example, at SIS (Spinal Injection Society) or IOF (Interventional Orthobiologics Foundation), you need to have specific training to be able to be eligible to walk into a course. These are then hard pass/fail. Meaning your instructor can fail you if they think you’re not capable of safely performing the procedures being taught. As an instructor at IOF, I have failed physicians who I felt were unsafe. Finally, everyone needs hands-on proctoring. That’s why most of this type of spinal procedure education now happens inside a residency or fellowship program where experienced physicians can serve as guides for those still learning.
What happens without strict entry criteria, pass/fail, and mandatory proctoring? As I’ve documented before, dangerous things can happen. For example, non-physicians without life support training who get over their heads and harm patients.
Who Is Ernest Roman? Why Was His Medical License Revoked?
The Empire Medical Training pain management courses state that they are taught by a physician named “Ernest Roman”. That was a bit weird, as normally these programs have many different instructors because any one of them can’t take too much time away from their practice. However, from what I can tell on the website, this is THE instructor for the pain courses.
On Google, Dr. Roman is a physician who is located in Spring, Texas. I first tried to see if this doctor was “board certified” as claimed by the Empire website, this is what I got:
Hence, I was unable to confirm any board certification with the American Board of Medical Specialties (ABMS). This national group is the one that certifies the doctors in your community who state that they are “Board-certified” in things like urology, neurology, pain medicine, or orthopedics.
Google states that Dr. Roman identifies as an internist, but when I change the search above to internal medicine, I get nothing as well. I’ll discuss board certification below, as that’s another thing about this deep dive that was eye-opening.
Then I found this on Google:
“Roman, Ernest T., M.D., Lic. No. H6938, Spring
On April 13, 2012, the board and Ernest T. Roman, M.D., entered into an Agreed Order requiring Dr. Roman to have a physician monitor his practice for eight monitoring cycles, complete within one year eight hours of CME in medical record-keeping and pay an administrative penalty of $2,000 within 60 days. The board found Dr. Roman did not follow guidelines for the treatment of pain and failed to use diligence in his medical practice.”
Huh. A Texas Medical Board search shows that he has no active medical license in Texas as of February of 2013. This is what his license page states:
“Action Date: 02/08/2013
Description: ON FEBRUARY 8, 2013, THE BOARD AND ERNEST ROMAN, M.D., ENTERED INTO AN AGREED ORDER OF VOLUNTARY SURRENDER IN WHICH DR. ROMAN VOLUNTARILY AND PERMANENTLY SURRENDERED HIS TEXAS MEDICAL LICENSE. DR. ROMAN MUST IMMEDIATELY CEASE PRACTICE IN TEXAS. DR. ROMAN WAS UNDER INVESTIGATION BY THE BOARD FOR ALLEGED IMPROPER OPERATION OF A PAIN MANAGEMENT CLINIC. THIS ORDER RESOLVES ANY AND ALL COMPLAINTS CURRENTLY BEFORE THE BOARD.”
Yikes! In looking into his board action history, here’s what we find:
- 1995-Failing to supervise the activities of those practicing under this supervision and aiding and abetting the unlicensed practice of medicine-Suspended license then with probation
- 2010-Practicing medicine with a physician whose license was revoked-Reprimand
- 2012-2013-IMPROPER OPERATION OF A PAIN MANAGEMENT CLINIC
Given that the Texas Medical Board lookup system is a bit wonky, I can’t get the PDFs that explain this last entry, or maybe they’re sealed? All I get is an error message when I click on them. Even more bizarre is that I found this 2019 press release where Dr. Roman is espousing the benefits of cosmetic Botox, but seems to have lost his medical license in 2013?
What was interesting to me is that Dr. Roman lost his medical license for a series of events where he was supervising or practicing with providers without medical licenses. Now Dr. Roman teaches courses about spine procedures to providers who don’t need a medical license. See the irony here?Join us for a free Regenexx webinar.
Board Certified in Pain?
As you can see, we have a trend here. Dr. Buzz claimed to be board certified through George Washington University. Not true. Then Empire Medical Training claims that he is a board-certified urologist-not in the way that the public would expect (ABMS certification) [which was redacted after this blog was published]. Then Empire claims that Dr. Roman is board certified in one part of the website and then claims that he is a pain management specialist in another part of the website, but I can’t verify any of that. In fact, his medical license in Texas (which is the only place I can find him listed) is revoked.
Maybe this entry on the Empire website explains things:
What is the AAOPM? This isn’t a professional organization. In fact, its website seems to have the same or similar content as the Empire Medical Training website:
The “Advanced Pain Management Training” course I highlighted above on the left is also on the Empire website, but not on this menu. So the AAOPM seems to merely be another website or organization created by Empire to offer “board certifications”. However, this isn’t any kind of recognized board certification like your pain management doctor or orthopedic surgeon down the street (ABMS). In fact, near as I can tell, it appears to be entirely made up by Empire. Hence, as an expert in interventional pain management if a physician came to me looking for a job with an AAOPM certification would it hold any weight? Nope.
Orthobiologics and Empire
Note that the screenshot above of the advanced pain course clearly shows that the course will teach you how to inject “Exosomes”. However, exosomes are an illegal drug product for use in pain management:
The most concerning thing here is that in my opinion, Empire appears to be a big player fueling the stem cell wild west. After all, if the professional societies or medical schools won’t train you because you lack the proper board certification or medical license for their courses, it looks like Empire Medical Training will. So while professional societies like SIS or IOF can have strict entry criteria, Empire serves as one big workaround. So if you ever wonder where a physician’s assistant or chiropractor learned how to inject exosomes into the cervical epidural space and what physician in their right mind would teach that procedure to that type of provider over a long weekend, look no further.
This All Takes Time
Literally from the first moment I read that Linkedin message and clicked on the link to see Dr. Buzz’s smiling face until the last edit, this deep dive has taken about 8 hours. This is the problem with the stem cell wild west, keeping up with it is a full-time job. As a practicing physician and Chief Medical Officer for Regenexx, finding the time to dig deep into this stuff has moved my average wake-up time from 5:30 am to 4 am. So we’ll see how long I can keep that up!
The upshot? I never know what I’m going to find in these deep dives. Who would have thought that clicking on a link would lead to courses taught by a guy who lost his medical license where those who lack the right training and letters after their names can learn how to perform truly dangerous procedures? You just can’t make this stuff up.