Dejay Cartwright had visited more than 400 lighthouses, and she was setting out to see another. She was an aficionado, so drawn to the charm of these quaint relics that she’d joined the Lighthouse Preservation Society. The home she shared with her adult daughter, Tiffany Cartwright, in Townsend, Del., was teeming with miniature replicas.

She’d invited Tiffany to join her that summer evening in 2015. The trail was longer than anticipated, though, and Cartwright’s walker kept catching in the path. After about a half-hour, she was too tired to continue, and they headed home.

Even so, Tiffany was delighted. It was the first time in years her 62-year-old mother had felt well enough for a substantial walk. Cartwright had been diagnosed with Lyme disease in 2003, and she’d suffered persistent symptoms ever since: coughing, runny nose, joint aches, poor sleep, low energy. She’d been forced to retire from running the family’s child-care business and now spent much of her time playing games online. Over the years she’d tried all sorts of treatments. Nothing helped. But she’d recently started seeing a new specialist, Henry Childers IV, in Georgetown, a 90-minute drive to the south, and felt encouraged. Childers had strawberry-blond hair, a strong jaw, and an authoritative manner, and he came recommended by Cartwright’s primary-care doctor.

.Childers was licensed to practice medicine in Delaware, but he largely eschewed traditional treatments. During an initial consultation in July, he proposed starting Cartwright on a nine-week program. Four times a week she would drive to his private clinic, Delaware Integrative Medicine LLC, for infusion procedures, typically involving the mixture of ozone gas or vitamins with her blood. Cartwright called her mother, Dee, from Childers’s office, sounding optimistic. The cost would be around $9,700, all out-of-pocket. Dee volunteered her credit card number so Cartwright could start that same day.

Not long into the treatments, to prevent the frequent venous draws from becoming uncomfortable, Childers sent Cartwright to Christiana Hospital in Newark, Del., to have a port surgically inserted in her chest. This would allow the infusions to be done via a central line, as is done for chemotherapy. After a couple of weeks, Cartwright was feeling hale enough to scout for lighthouses.

On Thursday, Sept. 24, Childers sent her back to the hospital to have the port replaced because it had become clogged. Over the next several days, the skin surrounding the new port became inflamed and hot to the touch. When Cartwright returned to Childers’s practice on Monday, according to assertions contained in court filings, she reported flulike symptoms. Clinic staff carried on with her treatment, and again the following day. (Childers says there was no inflammation at the clinic, calling the site “unremarkable.”)

The next morning, Cartwright collapsed in her bathroom. She recovered and continued going in for her next infusions, during which clinic records indicate she had an elevated, irregular heartbeat. On Oct. 1, Cartwright said she was in pain, so the clinic sent a blood sample to a lab.

The following morning, Tiffany found Cartwright lying on her kitchen floor. As Tiffany went to help, Cartwright lost consciousness. Tiffany called an ambulance to bring Cartwright to the emergency room at Christiana Hospital. Physicians there removed the port, which was infected, and began treating Cartwright with antibiotics, transferring her to intensive care.

When the bloodwork came back, it showed that Cartwright had MRSA, an aggressive staph infection resistant to many antibiotics. It had spread throughout her bloodstream and was too advanced for effective treatment. (The sample taken by Childers’s clinic later confirmed the diagnosis.) She spent the weekend on life support, drifting in and out of consciousness, surrounded by family. On Monday, Oct. 5, Tiffany and Dee instructed doctors to discontinue life support, in keeping with Cartwright’s wishes. She died within minutes.

.That Cartwright’s original symptoms were commonplace had made their cause difficult to pinpoint. The affliction she thought they traced to, Lyme disease, is most often caused in North America by bacteria from the species Borrelia burgdorferi, typically transmitted via bites from infected ticks. Roughly 30,000 cases are reported each year to the U.S. Centers for Disease Control and Prevention, though the agency estimates that the true prevalence is closer to 300,000 cases. Symptoms include fever, headache, fatigue, and a bull’s-eye-shaped rash; left untreated, the infection can spread to joints, the heart, and the nervous system. The recommended remedy is a course of antibiotics lasting two to four weeks. If treated right away, most patients make a quick and full recovery.

In some cases, though, Lyme patients continue reporting symptoms for months or even years after treatment. The CDC recognizes these cases, describing them collectively as post-treatment Lyme disease syndrome, but says there are no proven treatments for them and they’re not likely the result of an active infection. Some patient communities have adopted the term “chronic Lyme disease” to describe their symptoms. Many say their concerns often aren’t taken seriously by traditional doctors, which has created an opportunity for hundreds of alternative practitioners—some licensed medical doctors such as Childers, some not—who call themselves “Lyme-literate medical doctors,” or LLMDs.

The results include a pattern of harm. Patients, family members, physicians, and government officials describe LLMDs routinely misdiagnosing Lyme disease instead of other, treatable conditions and injuring patients. Many of these stories have effectively been buried—quashed by confidentiality agreements struck during litigation, papered over by bureaucratic procedure, stuck in limbo between agencies, or redacted as they pass through layers of compliance. But internal government documents obtained by Bloomberg Businessweek through a Freedom of Information Act request show that physicians at the CDC are aware of malpractice allegations at a constellation of private clinics. Since around 2013 they’ve tracked dozens of reports of significant harm, including several deaths, that were the direct consequence of procedures ordered or administered by LLMDs. And yet, even those who’ve been reprimanded have tended to face few professional repercussions. Often, they’ve continued to practice.

In 2017 the CDC published a collection of anonymized reports about practitioners whose Lyme treatments had led to a patient’s hospitalization. The cases followed a pattern: A patient received a Lyme diagnosis, sometimes without evidence, from an alternative doctor who recommended unproven IV treatments via a central-line catheter. The catheter then became a site of life-threatening infection. Long-term use of these devices, which include chest ports and peripherally inserted central catheters (PICCs), requires ongoing care by trained professionals. Even then, problems can occur.

Dr. Christina Nelson, a medical epidemiologist at the CDC Division of Vector-Borne Diseases and an author of the publication, says it was intended to raise awareness in the absence of a robust surveillance system for alternative Lyme treatments. “A lot of these patients have had symptoms for years, and they’re desperate for answers,” she says. But with alternative therapies delivered through indwelling lines or ports, “the risk-benefit balance is completely skewed to the risk side. And there’s no proof that there’s benefit.” After receiving multiple reports of complications related to such treatments and to misdiagnoses, Nelson says, she became concerned. Her alarm grew as she researched the practitioners and turned up scathing reviews on public sites such as Yelp.

Among the reviews she found was one from a patient in San Diego who described being diagnosed with Lyme and high levels of toxic heavy metals. Following treatments with chemicals the doctor said would remove heavy metals, the patient began to experience severe pain, for which the doctor prescribed fentanyl patches and at-home blood-thinning injections. The pain persisted, landing her in an emergency room, where she learned that the real issue was leaking silicone implants. The alternative doctor, she wrote, “acted in a way that was both dangerous, and reckless in his treatment. I feel very fortunate that I survived.”

Most prospective patients researching alternative treatments or doctors online will swiftly land on a clinic homepage. Childers’s website features video clips of people who say they improved under his care. In one, a patient wearing an olive-green T-shirt and seated in front of a ship replica introduces herself as a 26-year-old with Lyme disease undergoing ozone therapy and other infusions through a chest port. She describes symptoms such as brain fog, joint pain, and inflammation. Since beginning treatment with Childers, she says, she’s had more energy. “I’m definitely able to not have those days of feeling bedridden.”

Nelsn had heard that beyond the testimonials were negative experiences with various doctors that might have been obscured by patient privacy concerns or legal settlements. She started compiling records of misdiagnoses and adverse events, first drawing from reports to the CDC and online reviews, then by writing to infectious-disease physicians in search of case reports. Dozens rolled in: patients who’d experienced complications from treatment with intravenous garlic or with intravenous silver compounds. One who’d been diagnosed in Connecticut with Lyme but in fact had leukemia. A 37-year-old woman in Maryland who developed sepsis and died after being fitted with a PICC line to receive antibiotics.

Time and again, Nelson found that practitioners had previously been reprimanded for malpractice. Time and again, they’d been allowed to go on treating patients, resulting in casualties that might have been prevented. “We continue to hear of concerning situations that patients are put in and concerning treatments that they’re undergoing,” she says.

Eventually, he and his wife “designed an Integrative Treatment for Lyme Disease,” he wrote. “The initial version saved Alexa’s life.” He began to market himself as a Lyme disease expert and to advertise his private clinic as the Sponaugle Wellness Institute, a destination for pricey, unconventional treatments for Lyme and chronic illnesses.

Outcomes were uneven. Insurance records show that in 2004, a detox patient in Sponaugle’s care allegedly experienced inflamed blood vessels after being given Adderall unnecessarily, leading his insurer’s risk-management division to say it had counseled Sponaugle on safety. The same year, according to court filings, a patient suffered a permanent brain injury following detox treatment with Sponaugle; the doctor won the resulting malpractice lawsuit. In 2006 a patient sustained nerve damage during a detox infusion with Sponaugle at Helen Ellis, leading to a malpractice lawsuit and a subsequent $95,000 settlement payment. (Sponaugle didn’t respond to an emailed request for comment on these cases.) In 2013, Sponaugle sued a dissatisfied detox patient for defamation and won.

The same year, the CDC published guidance warning that anesthesia-assisted detox treatments could have adverse effects. Sponaugle had by then left Helen Ellis, pivoting to focus on alternative treatments for Lyme and for ailments posited, without scientific proof, to be related to mold and chemical toxicity. His star rose: Reality-TV personality Yolanda Hadid shelled out $30,000 to be treated by him, and he spoke at an ILADS conference in 2016.

Sponaugle offered hope to families such as the Burgesses. Growing up in Jena, La., Anna Burgess listened to classic rock, wrote poetry, and fashioned dream catchers by hand. Over time, though, fatigue, aches, and other symptoms damped her bubbly nature. Her struggles made attending high school difficult and her ambition of becoming a physician seem unattainable. After a Mayo Clinic doctor diagnosed Burgess with POTS, an autonomic nervous system disorder, she and her parents, Gawan and Sherrie, a former school administrator and a nurse, respectively, found Sponaugle online.

When they visited his clinic in Oldsmar, Fla., in the fall of 2016, he told Burgess she suffered from a variety of conditions, including Lyme (for which she’d previously tested negative) and toxicity caused by mold and chemicals. He recommended she enroll in his 12-week treatment program. Clinic staff fitted her for a catheter so they could administer antibiotics and other compounds through her arm. In the following weeks, she developed severe new symptoms, including stomach pain, a burning sensation in her head, and tremors. She started coughing up dark fluid. “The tremors and head pressure are returning,” she wrote on Facebook on Nov. 25. “Unsure what the next course of action is.”

Sponaugle continued to increase Burgess’s antibiotics dosage and prescribed sedatives, explaining that she was experiencing a “biofilm burst” as toxins left her body. Each visit to her bedside cost her family $1,000, on top of a sum in the low six figures for the treatments and affiliated accommodations. To defray the costs, Sherrie started a crowdfunding campaign.

In court filings, Burgess’s parents say her condition continued to worsen until, in the early morning hours of Nov. 29, emergency medical services transported her to a local hospital, where diagnostic tests indicated she was suffering from pancreatitis. Sponaugle arrived with a nurse. Lacking privileges to practice at the hospital, he instructed the nurse to rotate the security cameras so they wouldn’t capture him administering eight vials of the antioxidant compound glutathione to Burgess’s IV drip, according to allegations made by Burgess’s parents in court filings. She died in the hospital the following day, her 19th birthday, with her fiancé, Ben Ketchens, still en route to her bedside. “I just felt like my whole body was tearing up,” he says. “It was gut-wrenching.” Gawan and Sherrie sued over Burgess’s death in 2017.

After court proceedings began, the Florida Department of Health issued a public complaint against Sponaugle for malpractice in a different Lyme-related case involving a 27-year-old man treated in 2014. The complaint, signed by the state’s surgeon general in February 2018, requested that the state licensure board revoke, suspend, or restrict Sponaugle’s license or take other corrective action such as a fine. No action has been taken, though Sponaugle has requested a hearing on the matter, according to the health department. His license remains active, as does his practice. Sponaugle denies wrongdoing in this case and the Burgesses’ but declined to comment further for this story, citing ongoing litigation.

When regulators have tried to publicly intervene in cases involving alternative Lyme treatments, they’ve struggled to make their judgments stick. State boards can investigate complaints, issue warnings, and suspend or revoke professional licenses, but their decisions tend to be enforced only upon referral to state prosecutors. Some LLMDs continue to helm lucrative practices despite a record of sanctions.

In 2017, for example, Daniel Cameron, of Mount Kisco, was charged by the New York State Department of Health Office of Professional Medical Conduct with violations including gross incompetence, gross negligence, and failure to keep appropriate patient records. Cameron disputed the allegations but ultimately signed a consent order subjecting him to three years of probation. That year the board also charged Bernard Raxlen, who ran the clinic Lyme Resource Medical of New York, with a similar set of violations; he, too, signed a consent order submitting to three years of probation. Cameron continues to practice in New York, while last summer New Jersey granted Raxlen a license, and he now sees patients in Guttenberg.

Dejay Cartwright had visited more than 400 lighthouses, and she was setting out to see another. She was an aficionado, so drawn to the charm of these quaint relics that she’d joined the Lighthouse Preservation Society. The home she shared with her adult daughter, Tiffany Cartwright, in Townsend, Del., was teeming with miniature replicas.

She’d invited Tiffany to join her that summer evening in 2015. The trail was longer than anticipated, though, and Cartwright’s walker kept catching in the path. After about a half-hour, she was too tired to continue, and they headed home.

Even so, Tiffany was delighted. It was the first time in years her 62-year-old mother had felt well enough for a substantial walk. Cartwright had been diagnosed with Lyme disease in 2003, and she’d suffered persistent symptoms ever since: coughing, runny nose, joint aches, poor sleep, low energy. She’d been forced to retire from running the family’s child-care business and now spent much of her time playing games online. Over the years she’d tried all sorts of treatments. Nothing helped. But she’d recently started seeing a new specialist, Henry Childers IV, in Georgetown, a 90-minute drive to the south, and felt encouraged. Childers had strawberry-blond hair, a strong jaw, and an authoritative manner, and he came recommended by Cartwright’s primary-care doctor.

.Childers was licensed to practice medicine in Delaware, but he largely eschewed traditional treatments. During an initial consultation in July, he proposed starting Cartwright on a nine-week program. Four times a week she would drive to his private clinic, Delaware Integrative Medicine LLC, for infusion procedures, typically involving the mixture of ozone gas or vitamins with her blood. Cartwright called her mother, Dee, from Childers’s office, sounding optimistic. The cost would be around $9,700, all out-of-pocket. Dee volunteered her credit card number so Cartwright could start that same day.

Not long into the treatments, to prevent the frequent venous draws from becoming uncomfortable, Childers sent Cartwright to Christiana Hospital in Newark, Del., to have a port surgically inserted in her chest. This would allow the infusions to be done via a central line, as is done for chemotherapy. After a couple of weeks, Cartwright was feeling hale enough to scout for lighthouses.

On Thursday, Sept. 24, Childers sent her back to the hospital to have the port replaced because it had become clogged. Over the next several days, the skin surrounding the new port became inflamed and hot to the touch. When Cartwright returned to Childers’s practice on Monday, according to assertions contained in court filings, she reported flulike symptoms. Clinic staff carried on with her treatment, and again the following day. (Childers says there was no inflammation at the clinic, calling the site “unremarkable.”)

The next morning, Cartwright collapsed in her bathroom. She recovered and continued going in for her next infusions, during which clinic records indicate she had an elevated, irregular heartbeat. On Oct. 1, Cartwright said she was in pain, so the clinic sent a blood sample to a lab.

The following morning, Tiffany found Cartwright lying on her kitchen floor. As Tiffany went to help, Cartwright lost consciousness. Tiffany called an ambulance to bring Cartwright to the emergency room at Christiana Hospital. Physicians there removed the port, which was infected, and began treating Cartwright with antibiotics, transferring her to intensive care.

When the bloodwork came back, it showed that Cartwright had MRSA, an aggressive staph infection resistant to many antibiotics. It had spread throughout her bloodstream and was too advanced for effective treatment. (The sample taken by Childers’s clinic later confirmed the diagnosis.) She spent the weekend on life support, drifting in and out of consciousness, surrounded by family. On Monday, Oct. 5, Tiffany and Dee instructed doctors to discontinue life support, in keeping with Cartwright’s wishes. She died within minutes.

.That Cartwright’s original symptoms were commonplace had made their cause difficult to pinpoint. The affliction she thought they traced to, Lyme disease, is most often caused in North America by bacteria from the species Borrelia burgdorferi, typically transmitted via bites from infected ticks. Roughly 30,000 cases are reported each year to the U.S. Centers for Disease Control and Prevention, though the agency estimates that the true prevalence is closer to 300,000 cases. Symptoms include fever, headache, fatigue, and a bull’s-eye-shaped rash; left untreated, the infection can spread to joints, the heart, and the nervous system. The recommended remedy is a course of antibiotics lasting two to four weeks. If treated right away, most patients make a quick and full recovery.

In some cases, though, Lyme patients continue reporting symptoms for months or even years after treatment. The CDC recognizes these cases, describing them collectively as post-treatment Lyme disease syndrome, but says there are no proven treatments for them and they’re not likely the result of an active infection. Some patient communities have adopted the term “chronic Lyme disease” to describe their symptoms. Many say their concerns often aren’t taken seriously by traditional doctors, which has created an opportunity for hundreds of alternative practitioners—some licensed medical doctors such as Childers, some not—who call themselves “Lyme-literate medical doctors,” or LLMDs.

The results include a pattern of harm. Patients, family members, physicians, and government officials describe LLMDs routinely misdiagnosing Lyme disease instead of other, treatable conditions and injuring patients. Many of these stories have effectively been buried—quashed by confidentiality agreements struck during litigation, papered over by bureaucratic procedure, stuck in limbo between agencies, or redacted as they pass through layers of compliance. But internal government documents obtained by Bloomberg Businessweek through a Freedom of Information Act request show that physicians at the CDC are aware of malpractice allegations at a constellation of private clinics. Since around 2013 they’ve tracked dozens of reports of significant harm, including several deaths, that were the direct consequence of procedures ordered or administered by LLMDs. And yet, even those who’ve been reprimanded have tended to face few professional repercussions. Often, they’ve continued to practice.

In 2017 the CDC published a collection of anonymized reports about practitioners whose Lyme treatments had led to a patient’s hospitalization. The cases followed a pattern: A patient received a Lyme diagnosis, sometimes without evidence, from an alternative doctor who recommended unproven IV treatments via a central-line catheter. The catheter then became a site of life-threatening infection. Long-term use of these devices, which include chest ports and peripherally inserted central catheters (PICCs), requires ongoing care by trained professionals. Even then, problems can occur.

Dr. Christina Nelson, a medical epidemiologist at the CDC Division of Vector-Borne Diseases and an author of the publication, says it was intended to raise awareness in the absence of a robust surveillance system for alternative Lyme treatments. “A lot of these patients have had symptoms for years, and they’re desperate for answers,” she says. But with alternative therapies delivered through indwelling lines or ports, “the risk-benefit balance is completely skewed to the risk side. And there’s no proof that there’s benefit.” After receiving multiple reports of complications related to such treatments and to misdiagnoses, Nelson says, she became concerned. Her alarm grew as she researched the practitioners and turned up scathing reviews on public sites such as Yelp.

Among the reviews she found was one from a patient in San Diego who described being diagnosed with Lyme and high levels of toxic heavy metals. Following treatments with chemicals the doctor said would remove heavy metals, the patient began to experience severe pain, for which the doctor prescribed fentanyl patches and at-home blood-thinning injections. The pain persisted, landing her in an emergency room, where she learned that the real issue was leaking silicone implants. The alternative doctor, she wrote, “acted in a way that was both dangerous, and reckless in his treatment. I feel very fortunate that I survived.”

Most prospective patients researching alternative treatments or doctors online will swiftly land on a clinic homepage. Childers’s website features video clips of people who say they improved under his care. In one, a patient wearing an olive-green T-shirt and seated in front of a ship replica introduces herself as a 26-year-old with Lyme disease undergoing ozone therapy and other infusions through a chest port. She describes symptoms such as brain fog, joint pain, and inflammation. Since beginning treatment with Childers, she says, she’s had more energy. “I’m definitely able to not have those days of feeling bedridden.”

Nelsn had heard that beyond the testimonials were negative experiences with various doctors that might have been obscured by patient privacy concerns or legal settlements. She started compiling records of misdiagnoses and adverse events, first drawing from reports to the CDC and online reviews, then by writing to infectious-disease physicians in search of case reports. Dozens rolled in: patients who’d experienced complications from treatment with intravenous garlic or with intravenous silver compounds. One who’d been diagnosed in Connecticut with Lyme but in fact had leukemia. A 37-year-old woman in Maryland who developed sepsis and died after being fitted with a PICC line to receive antibiotics.

Time and again, Nelson found that practitioners had previously been reprimanded for malpractice. Time and again, they’d been allowed to go on treating patients, resulting in casualties that might have been prevented. “We continue to hear of concerning situations that patients are put in and concerning treatments that they’re undergoing,” she says.

Eventually, he and his wife “designed an Integrative Treatment for Lyme Disease,” he wrote. “The initial version saved Alexa’s life.” He began to market himself as a Lyme disease expert and to advertise his private clinic as the Sponaugle Wellness Institute, a destination for pricey, unconventional treatments for Lyme and chronic illnesses.

Outcomes were uneven. Insurance records show that in 2004, a detox patient in Sponaugle’s care allegedly experienced inflamed blood vessels after being given Adderall unnecessarily, leading his insurer’s risk-management division to say it had counseled Sponaugle on safety. The same year, according to court filings, a patient suffered a permanent brain injury following detox treatment with Sponaugle; the doctor won the resulting malpractice lawsuit. In 2006 a patient sustained nerve damage during a detox infusion with Sponaugle at Helen Ellis, leading to a malpractice lawsuit and a subsequent $95,000 settlement payment. (Sponaugle didn’t respond to an emailed request for comment on these cases.) In 2013, Sponaugle sued a dissatisfied detox patient for defamation and won.

The same year, the CDC published guidance warning that anesthesia-assisted detox treatments could have adverse effects. Sponaugle had by then left Helen Ellis, pivoting to focus on alternative treatments for Lyme and for ailments posited, without scientific proof, to be related to mold and chemical toxicity. His star rose: Reality-TV personality Yolanda Hadid shelled out $30,000 to be treated by him, and he spoke at an ILADS conference in 2016.

Sponaugle offered hope to families such as the Burgesses. Growing up in Jena, La., Anna Burgess listened to classic rock, wrote poetry, and fashioned dream catchers by hand. Over time, though, fatigue, aches, and other symptoms damped her bubbly nature. Her struggles made attending high school difficult and her ambition of becoming a physician seem unattainable. After a Mayo Clinic doctor diagnosed Burgess with POTS, an autonomic nervous system disorder, she and her parents, Gawan and Sherrie, a former school administrator and a nurse, respectively, found Sponaugle online.

When they visited his clinic in Oldsmar, Fla., in the fall of 2016, he told Burgess she suffered from a variety of conditions, including Lyme (for which she’d previously tested negative) and toxicity caused by mold and chemicals. He recommended she enroll in his 12-week treatment program. Clinic staff fitted her for a catheter so they could administer antibiotics and other compounds through her arm. In the following weeks, she developed severe new symptoms, including stomach pain, a burning sensation in her head, and tremors. She started coughing up dark fluid. “The tremors and head pressure are returning,” she wrote on Facebook on Nov. 25. “Unsure what the next course of action is.”

Sponaugle continued to increase Burgess’s antibiotics dosage and prescribed sedatives, explaining that she was experiencing a “biofilm burst” as toxins left her body. Each visit to her bedside cost her family $1,000, on top of a sum in the low six figures for the treatments and affiliated accommodations. To defray the costs, Sherrie started a crowdfunding campaign.

In court filings, Burgess’s parents say her condition continued to worsen until, in the early morning hours of Nov. 29, emergency medical services transported her to a local hospital, where diagnostic tests indicated she was suffering from pancreatitis. Sponaugle arrived with a nurse. Lacking privileges to practice at the hospital, he instructed the nurse to rotate the security cameras so they wouldn’t capture him administering eight vials of the antioxidant compound glutathione to Burgess’s IV drip, according to allegations made by Burgess’s parents in court filings. She died in the hospital the following day, her 19th birthday, with her fiancé, Ben Ketchens, still en route to her bedside. “I just felt like my whole body was tearing up,” he says. “It was gut-wrenching.” Gawan and Sherrie sued over Burgess’s death in 2017.

After court proceedings began, the Florida Department of Health issued a public complaint against Sponaugle for malpractice in a different Lyme-related case involving a 27-year-old man treated in 2014. The complaint, signed by the state’s surgeon general in February 2018, requested that the state licensure board revoke, suspend, or restrict Sponaugle’s license or take other corrective action such as a fine. No action has been taken, though Sponaugle has requested a hearing on the matter, according to the health department. His license remains active, as does his practice. Sponaugle denies wrongdoing in this case and the Burgesses’ but declined to comment further for this story, citing ongoing litigation.

When regulators have tried to publicly intervene in cases involving alternative Lyme treatments, they’ve struggled to make their judgments stick. State boards can investigate complaints, issue warnings, and suspend or revoke professional licenses, but their decisions tend to be enforced only upon referral to state prosecutors. Some LLMDs continue to helm lucrative practices despite a record of sanctions.

In 2017, for example, Daniel Cameron, of Mount Kisco, was charged by the New York State Department of Health Office of Professional Medical Conduct with violations including gross incompetence, gross negligence, and failure to keep appropriate patient records. Cameron disputed the allegations but ultimately signed a consent order subjecting him to three years of probation. That year the board also charged Bernard Raxlen, who ran the clinic Lyme Resource Medical of New York, with a similar set of violations; he, too, signed a consent order submitting to three years of probation. Cameron continues to practice in New York, while last summer New Jersey granted Raxlen a license, and he now sees patients in Guttenberg.