The Florida Medical Board has reprimanded and fined a physician whose patient — a toddler — died soon after being given a dose of amygdalin (also known as laetrile) to treat her advanced eye cancer.

Amygdalin — whose active component is believed to be cyanide — is not approved by the US Food and Drug Administration (FDA) and is controversial, given its unproven effectiveness and potential for deadly side effects.

Martha Grout, MD, agreed to give up her Florida license and pay a $2,500 fine. The Florida board took action against Dr Grout more than a year after the Arizona Medical Board reprimanded her for her role in the March 2013 death of the 18-month-old girl.

Dr Grout, medical director of the Scottsdale-based Arizona Center for Advanced Medicine, is still licensed in Arizona and Hawaii.

The Florida reprimand was not surprising, given the censure in Arizona, said Stephen Myers, a Phoenix, Arizona, attorney who represented Dr Grout in her proceedings with the Arizona Medical Board and the Arizona State Board of Homeopathic and Integrated Medicine Examiners.

Dr Grout was required under Florida law to report, within 30 days, the disciplinary action in Arizona, but did not. As a result, the Florida state health department instituted proceedings against her in February 2015.

After rejecting a settlement proposed by Dr Grout, the Florida Medical Board initially sought to suspend her license until completion of a training module and permanently bar her from treating minors. In the end, the board voted on October 9 to issue a letter of reprimand and fine Dr Grout $2,500 in return for her agreeing to give up her license voluntarily.

Dr Grout had a Florida license from 1992 to 1998, according to board records. She had not practiced in the state in years, said Myers.

Arizona Boards Split

Dr Grout was licensed in Arizona by both the Arizona Medical Board and the Arizona State Board of Homeopathic and Integrated Medicine Examiners. Only the allopathic board reprimanded her; the homeopathic board cleared Dr Grout in what Myers called a thorough investigation.

According to the August 2014 reprimand from the Arizona Medical Board, the child, Mercy Maynard, had retinoblastoma. She had an eye removed by oncologists in her home state of Maine in February 2013. The biopsy confirmed spread to surrounding orbital tissue. The oncologist urged the Maynards to follow up with a spinal tap for tumor staging, but they instead sought Dr Grout's care in Arizona.

The father signed a consent form with Dr Grout's clinic "that indicated that the safety and efficacy of many homeopathic medicines have not been established in controlled studies to the satisfaction of the FDA and many conventional physicians," according to the state medical board.

Dr Grout gave the child 3.4 milliliters of amygdalin on March 13, 2013. Amygdalin, found in fruit pits, raw nuts, and some plants, is used primarily in Mexico. According to the National Cancer Institute (NCI), amygdalin has not been shown to be effective in any controlled studies. The drug was popular in the US in the 1970s, but it also had the potential to be extremely toxic — mimicking cyanide poisoning — especially in the pill form, said NCI.

Twenty-four hours after Mercy received the amygdalin dose, Mr Maynard told Dr Grout that the child was having shortness of breath and bloating. He was told to come back to the clinic. Mercy almost immediately went into cardiorespiratory arrest and could not be revived, even by paramedics called to the scene by Dr Grout. Mercy died less than 3 hours after her symptoms began.

The hospital contacted the police, who began a child abuse investigation.

The Maricopa County Office of the Medical Examiner concluded that Mercy died from cyanide poisoning, as a result of the amygdalin dose. "This case represents toxicity occurring in the setting of an alternative medical regimen," according to the autopsy report.

"Unprofessional Conduct"

But Dr Grout's attorney disagreed. "There were all kinds of possibilities of what may have caused the death," Myers told Medscape Medical News.

For instance, the autopsy report noted that the retinoblastoma had spread locally within Mercy's skull and distantly to her liver. Even so, there was no presence of bulky disease.

Myers also said that the levels of cyanide found in Mercy's system were far below what would be considered toxic.

The medical examiner concluded that there was "no apparent or stated intent to cause injury or death."

The Arizona Medical Board ruled that Dr Grout deviated from the standard of care by not making sure that the patient had tried all forms of accepted allopathic treatment and not ensuring that the amygdalin would pose no harm.

Dr Grout agreed to accept a reprimand for "unprofessional conduct."

Separately, the Arizona State Board of Homeopathic and Integrated Medicine Examiners conducted "an exhaustive investigation," executive director Chris Springer told Medscape Medical News. The board concluded that Dr Grout had acted within the scope of the laws that govern the practice of homeopathic medicine.

Dr Grout was vice president of the Homeopathic board from 2003 to 2013.

When asked if there was the potential for bias because of Dr Grout's past affiliation with the board, Springer cited the independent and lengthy investigation.

Myers agreed, saying that the board's meeting on the inquiry "was one of the most intelligent, thoughtful discussions I've heard in a long time."