In the Crucible of Chronic Lyme Disease: Collected Writings & Associated Materials

By Kenneth B. Liegner M.D.

Following completion of his medical training and a one-year stint as attending physician on Howard Champion's Surgical Critical Care Service and MedStar Unit at Washington Hospital Center in the District of Columbia, Kenneth Liegner, M.D. returned to Westchester County, home of his Alma Mater, New York Medical College, to start a private practice. Unwittingly, he had 'plunked himself down' in the heart of a burgeoning epidemic of Lyme disease. His patients confronted him with puzzling syndromes that defied 'tidy' formulations of the illness and thrust him in to a Maelstrom of medical controversy.

Lyme disease, a new poorly understood disease, emerged hand in hand with the rise 'managed care'. Physicians caring for persons with Lyme disease, loyal to the Hippocratic Oath and serving what they saw as patients' best medical interests, found themselves on a collision course with a new Corporate Medical Ethic dedicated to maximizing profit.

One practitioner's work over 25 years is presented here along with correspondence with many principals in the field. Documentational in nature and not written as a narrative, the materials, nonetheless, convey the intensity of the struggle to characterize the nature of Lyme disease and the desperate fight for proper diagnosis and treatment upon the outcome of which patients' very lives depended. The volume includes protocols useful as reference materials for patients and practitioners alike, as well as photographic images of many persons important in the history of Lyme disease.

Foreword by Pam Weintraub, Senior Editor of aeon digital magazine and author of award-winning book Cure Unknown: Inside the Lyme Epidemic.

Preface by Paul W. Ewald, Professor of Evolutionary Biology at the University of Louisville and author of Plague Time.

• Language: English
• Publisher: Xlibris US
• Release date: Oct 8, 2015
• ISBN: 9781503587359

Kenneth B. Liegner M.D.

Dr. Kenneth Liegner is a Board Certified Internist with additional training in Pathology and Critical Care Medicine, practicing in Pawling, New York. He is on the medical staffs of Northern Westchester Hospital Center in Mount Kisco, NY and The Sharon Hospital, Sharon, CT. He has been actively involved in diagnosis and treatment of Lyme disease and related disorders since 1988. He has published articles on Lyme disease in peer-reviewed scientific journals and has presented poster abstracts and talks at national and international conferences on Lyme disease and other tick-borne diseases. He has cared for many persons seriously ill with chronic and neurologic Lyme disease. His work has focused on the serious morbidity and (occasional) mortality that can eventuate from this aspect of the illness. He has emphasized the urgent need for widespread clinical availability of improved methods of diagnostic testing and for development of improved methods of treatment for Lyme disease in all its stages. He holds the first United States patent proposing application of acaricide to deer for area-wide control of deer-tick populations as a means of reducing the incidence of Lyme disease. Dr. Liegner is a currently a member of the Board of Directors of The International Lyme and Associated Diseases Society (I.L.A.D.S. www.ILADS.org) and is a member of the Association of American Physicians and Surgeons (www.aapsonline.org).

Book preview

Copyright © 2015 by Kenneth B. Liegner, M.D.

Library of Congress Control Number:   2015911615

ISBN:                    Hardcover                 978-1-5035-8736-6

                              Softcover                   978-1-5035-8737-3

                              eBook                        978-1-5035-8735-9

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Front cover photograph, Joyce Dopkeen, New York Times, all rights reserved, under license Redux Pictures.

Rev. date: 11/04/2015

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Contents

Invocation

Dedication

Omnia Pro Aegroto

Acknowledgments

I Foreword, Pam Weintraub

II Preface, Paul Ewald, Ph.d.

III Author’s Introduction

General Remarks

A Word To The Reader On

Organization Of The Materials

About The Title

Apology

IV Preparation & Prelude

Poems: To Bert

             Nautilus

Reflections Of A Critical Care Physician

Psychiatric Aspects Of Terminal Illness

The Girl Without A Face. Part I

V Published & Unpublished Works & Abstracts, With Appertaining Newspaper Articles

Lyme Disease: Overview & Review Of The Literature (Unpublished) March 1988

Lyme Disease (Ltr) New Engl J Med Feb 15, 1990

Evidence For A Borrelial Etiology And Pathogenesis In A Series Of Patients Carrying A Diagnosis Of Multiple Sclerosis (Abst). 45Th International Northwestern Conference On Diseases In Nature Communicable To Man. August 12-15, 1990. Hamilton, Mt

Lyme Or Ms? Misoulian August 15, 1990

United States Patent # 5,050,539 Acaricide Dispenser (A.k.a. Deer Gazebo) September 24, 1991

New York Times Patents. Edmund L. Andrews. A Way To Spray Deer To Fight Lyme Disease. September 28, 1991

Difficulty Of Distinction Between Borrelial (Lyme) Encephalomyelitis And Multiple Sclerosis (Abst). 47Th International Northwestern Conference On Diseases In Nature Communicable To Man. August 16-19, 1992. Vancouver, British Columbia

Minocycline In Lyme Disease. Journal Of The American Academy Of Dermatology. 1992

Minocycline In Lyme Disease. Journal Of The American Academy Of Dermatology. Letter To The Editor By Goldberg & Author’S Reply January 1993

Reporter Dispatch, May 1992. Barbara J. Durkin. Spinal Tap Helps Doctor Spot Infection

V International Conference On Lyme Borreliosis, Arlington, Va. May 30-June 2, 1992. Abstracts

Culture-Confirmed Treatment Failure Of Cefotaxime And Minocycline In A Case Of Lyme Meningoencephalomyelitis In The United States

Global Cerebellar Atrophy In Lyme Borreliosis

Lyme Borreliosis Studied With The Rocky Mountain (Rml) Antigen Capture Assay In Urine

Claude Garon: Graph Comparing Results Of Rocky Mountain Laboratory Antigen-Capture Assay In Urine Against 3 Cdc Lyme Elisas In Serum

More Accurate Way To Detect Lyme Disease May Be Near. New York Times. June 17, 1992

Prevention Of Lyme Disease After Tick Bites (Ltr). N Engl J Med. Jan 14, 1993

Recurrent Erythema Migrans Despite Extended Antibiotic Treatment With Minocycline In A Patient With Persisting Borrelia Burgdorferi Infection. J Amer Acad Derm. Feb 1993

Antimicrobial Prophylaxis After Tick Bites (Ltr). N Engl J Med, May 13, 1993

Lyme Disease: The Sensible Pursuit Of Answers. J Clin Microbiol. August 1993

Letters To Editor

Elisabeth Rosenthal, Md. Lyme Disease: Does It Really Linger? New York Times Science Times. August 24, 1993

VI International Conference On Lyme Borreliosis. June 19-22, 1994. Bologna, Italy. Abstracts

P012m: Chronic Lyme Disease: A Costly Dilemma

P014t: Fatal Chronic Meningoencephalomyelitis (Cmem) With Massive Hydrocephalus In A New York State Patient With Evidence Of Borrelia Burgdorferi (Bb) Exposure

Seek And Ye Shall Find – Expanding The Envelope. Guest Editorial. Journal Of Spirochetal And Tick Borne Diseases. December 1994

"Ixodes Scapularis Larvae: A Possible Vector Of Lyme Disease?(Ltr). J Spirochetal And Tick Borne Diseases. 1995

VII International Conference On Lyme Borreliosis June 14-21, 1996. San Franciso, Ca. Abstracts

D624: Rhabdomyolysis Occurring During Prolonged Intravenous Antibiotic Therapy With Ceftriaxone In A Patient With Lyme Encephalopathy

D625: Cytoplasmic Micro-Packets Containing Unusual Membrane-Limited Structures Adjacent Brain Capillary Endothelium Revealed By Transmission Electron Microscopy (Tem) In A Fatal Case Of Chronic Meningoencephalomyelitis (Cmem)

D626: Serial Brain Spect Scanning With Technitium99 Hmpao In Patients With Chronic Lyme Encephalitis And Encephalopathy Undergoing Prolonged Intravenous Antibiotic Treatment – Preliminary Report

D627: Lyme Disease And The Clinical Spectrum Of Antibiotic-Responsive Chronic Meningoencephalo-Myelitides

Forward To Polly Murray’s The Widening Circle. St. Martin’s Press. 1996

Lyme Disease And The Clinical Spectrum Of Antibiotic-Responsive Chronic Meningoencephalomyelitides. J Spirochetal And Tick Borne Dis. Fall 1997

Lyme Disease Foundation 10Th Annual International Scientific Conference On Lyme Borreliosis And Other Tick Borne Dis. April 28-30. Nih. Bethesda, Md. Abstract

Simultaneous Elisa And Western Blot Testing In Evaluation Of Patients For Suspected Lyme Disease

Guidelines For The Clinical Diagnosis Of Lyme Disease (Ltr). Ann Int Med. September 1998

VIII International Conference On Lyme Borreliosis And Other Emerging Tick Borne Diseases. June 20-24, 1999. Munich, Germany

P380: Fatal Progressive Encephalitis Following An Untreated Deer Tick Attachment In A 7 Year-Old Fairfield County, Connecticut Child

P252: Incidence Of Lyme Disease Affecting Family Members

13Th Annual International Conference On Lyme Disease And Other Tick Borne Diseases. Lyme Disease Foundation. March 25-26, 2000. Farmington, Ct. Abstract

Pavia Cs, Butler G, Liegner K, Niazi Z. Preliminary Findings With Hyperbaric Oxygen Treatment (Hbot): In Vitro Activity Against Borrelia Burgdorferi (Bb) And In Vivo Effects During Experimental Borrelial Infection

Liegner Kb. Open-Ended High Dose Long-Acting Amoxicillin: An Alternative In The Treatment Of Chronic And Neurologic Lyme Disease

14Th Annual International Scientific Conference On Lyme Disease And Other Tick-Borne Disorders, Lyme Disease Foundation, Farmington, Ct April 21-23, 2001. Association Of Motor Neuron Disease (Mnd) And Lyme Disease (Ld)

Lyme Times. August 2002. Rejected Abstracts Ix International Conference On Lyme Borreliosis And Other Tick Borne Diseases. Hyatt Hotel, New York, New York

ICLB Should Allow For Expression Of A Diversity Of Views (Editorial)

Progressive Neuroborreliosis – Treated And Untreated

Exacerbation Of Meningoencephalitis By Methotrexate (Mtx) And Etanercept (Etrcpt) Applied In A Case Of Initially Undiagnosed Lyme Disease Presenting As Rheumatoid Arthritis – Effect Of Antibiotic Therapy On Neurologic Disease Expression

International Lyme And Associated Diseases Annual Conference, National Harbor, Maryland, October 24-25, 2009. Lyme Neuroborreliosis (Lnb) Vs. Multiple Sclerosis (Ms): Problematic Differentiation

Valley View: Major Initiative Needed To Fight Tickborne Infections. August 22, 2012. Poughkeepsie Journal

Raw Data Contradicts Cdc’s Lyme Position. (Letter To The Editor). July 9, 2013. Poughkeepsie Journal

Photographs Section A

1. Polly Murray

2. Karen Forschner

3. Tom Forschner

4. Karen Forschner With Bob Lane, Ph.d.

5. Michael Ledtke, M.d.

6. Andrew Lautin, M.d.

7. Lou Magnarelli, Ph.d.

8. James Miller, Ph.d.

9. Stephen J. Nostrom, R.n.

10. Paul Lavoie, M.d.

11. Charles Pavia, Ph.d.

12. Scott Samuels, Ph.d.

13. Steve Schutzer, M.d., Mark Golightly, Ph.d. & Eli Mordecai, Ph.d.

14. Debra Solomon, M.d. & Wendy Clough, M.d.

15. Kirby Stafford, Ph.d.

16. Ron Schell, Ph.d. & Richard Tilton, Ph.d.

17. Elizabeth (Betsey) White, N.p.

18. Theresa Yang, M.d.

19. Andrew Franks, Jr., M.d.

20. Patricia Coyle, M.d.

21. Gloria Wenk

22. Willy Burgdorfer, Ph.d. & Julia Rawlings, Ph.d.

23. Willy Burgdorfer, Ph.d. & Karen Forschner

24. Willy Burgdorfer, Ph.d. & Lou Magnerelli, Ph.d.

25. Ed Bosler, Ph.d.

26. Carolyn Britton, M.d.

27. Connecticut Attorney General Richard Blumenthal

28. John Anderson, Ph.d.

29. Steve Callister, Ph.d.

30. Tracey Mcnamara, Dvm

31. Ylene Larsen, M.d. & Polly Murray

32. Charles Crist, M.d.

33. Ed Masters, M.d.

34. Marian Rissenberg, Ph.d.

35. Armen Manasar, Dmd

36. Paul Duray, M.d.

37. Brian Fallon, M.d., M.p.h.

38. Joseph J. Burrascano, Jr., M.d.

39. Charles Ray Jones, M.d.

40. Amiram Katz, M.d.

41. Marilynn Barkley, M.d., Ph.d.

42. Sandy Berenbaum, L.c.s.w.

43. Martha Agricola, F.n.p.

44. Dave Dorward, Ph.d.

45. Claude Garon, Ph.d.

46. Reinhard Straubinger, D.v.m., Ph.d. & Jarmo Oksi, M.d.,Ph.d.

47. Tom Grier

48. Ira Auerbach

49. Nick Harris, Ph.d.

50. Jyotsna Shah, Ph.d.

51. Richard Horowitz, M.d.

52. Kenneth Liegner, M.d.

53. Ellen Lubarsky & John Coughlan

54. Dan Cameron, M.d., M.p.h.

55. Steven Bock, M.d.

56. Carl Brenner

Section VI Formal Scientific Presentations, Nurse Practitioner Protocol, Suggested Protocol For Cerebrospinal Fluid Examination, Political Speeches And Miscellaneous Items

Lyme Disease Up-Date: Controversies In Lyme Disease. October 17, 1990. St. Francis Hospital, Poughkeepsie, Ny

Controversies In Lyme Disease

Food For Thought. March 25-26, 1991. Niaid/Niams State-Of-The-Art Workshop. Lyme Disease Diagnosis And Treatment. Washington, D.c.

Practice Protocol For Nurse Practitioner. Diagnosis And Treatment Of Lyme Disease. March 17, 1993. References And New York State Education Department, Office Of State Board For Nursing Letter Of Protocol Acceptability

Up-Date To Practice Protocol For Nurse Practitioner. February 2009

Protocol For Intravenous Antibiotics, May 2015

Protocol For Intra-Muscular Ceftriaxone, May 2015

Chronic Persistent Infection And Chronic Persistent Denial Of Chronic Persistent Infection In Lyme Disease. Lyme Disease Foundation 6Th International Conference On Lyme Disease And Other Tick Borne Diseases. May 5-6, 1993. Atlantic City, New Jersey

N.i.h. Consultation On Chronic Lym

E Disease - Suggestions October 1994

Disseminated Lyme Disease: Diagnosis & Treatment. Lyme Disease Foundation, Illinois Department Of Health, Illinois Academy Of Family Physicians And Cook County Department Of Health. March 23, 1998. Chicago, Illinois

Remarks Before The New York State Assembly Committee On Health, Hon. Richard Gottfried, Chair. November 27, 2001. Albany, New York

My Adventures With The Opmc – Kenneth B. Liegner, M.d. 2002

Tick-Borne Diseases And Cardiomyopathy - Presentation Of 3 Cases With Discussion. I.l.a.d.s. Conference, Newton, Ma October 28, 2007

Suspected Lyme Disease In A 12 Year-Old Girl With Reflex Sympathetic Dystrophy And Immune Complex Phenomena. Lyme Symposium, University Of New Haven, May 17, 2008

Submission To Present Before The Infectious Diseases Society Of America Lyme Disease Review Panel. March 16, 2009

Text Of Actual Presentation Before The Infectious Diseases Society Of America Lyme Disease Review Panel, July 30, 2009. Hemisphere A. Ronald Reagan Office Building. Washington, D.c.

Remarks: World Wide Lyme Rally & Protest Friday, May 10, 2013 Union Square New York City

Photographs Section B

1. Pat Smith

2. Pat Smith, Amy Tan, Brian Fallon

3. Congressman Chris Smith

4. Dorothy Pietrucha, M.d.

5. Mitch Hoggard, Pharm

6. Leslie Fein, M.d.

7. Martin Fried, M.d.

8. Paul Fawcett, Ph.d.

9. Elizabeth Jordan, D.v.m.

10. Robert Bransfield, M.d.

11. Richard Brown, M.d.

12. Qingcai Zhang, M.d. & Dan Cameron, M.d., M.p.h.

13. Leila Zackrison, M.d.

14. Stephen K. Wikel, Ph.d.

15. Ernie Visconti, M.d.

16. Virginia Sherr, M.d.

17. Bea Szantyr, M.d.

18. Constance (Happy) Dickey, R.n.

19. Rafael (Ray) Stricker, M.d.

20. Sheila Statlender, Ph.d.

21. William Spaulding

22. Harold Smith, M.d.

23. Kenneth Singleton, M.d.

24. Ritchie Shoemaker, M.d.

25. Ginger Savely, Dnp

26. Richard Rhee, M.d.

27. Bernard Raxlen, M.d.

28. Steve Phillips, M.d.

29. David Owen, M.d.

30. Maureen Orr

31. Garth Nicolson, Ph.d.

32. Kris Newby & Leo Shea, Ph.d.

33. Jim Moeller, Ph.d.

34. Judith Miklossy, M.d.

35. Douglas W. Fearn

36. Rich Marconi, Ph.d.

37. Alan Macdonald, M.d.

38. Ben Luft, M.d.

39. Jill Livengood, Ph.d.

40. Tony Lionetti, M.d.

41. Jennifer Lilly & Dr. Liegner

42. Leo Shea, Ph.d.

43. Dan Kinderlehrer, M.d.

44. Kornelia Keszler, M.d.

45. Herbert Geiser, O.d. & Lorraine Johnson

46. Elizabeth Maloney, M.d.

47. Jenny Lion & Mitch Hoggard, Pharm

48. Rich Horowitz, M.d.

49. Steve Harris, M.d.

50. Karen Gaudian & Jennifer Reid

51. Phyllis Mervine

52. Maggie Shaw, R.n.

53. Judith Leventhal, Ph.d.

54. Elliott Pollack, Esq.

55. Elliott Pollack, Esq. With Charles Ray Jones, M.d.

56. John Senechal, M.d. And Anne Doremeus, Cmeb

VII Grouped Correspondence

Deer Gazebo patent-related Group

Letter To Durland Fish, Ph.d., Medical Entomology, New York Medical College. August 1, 1990

Henry Wm. Barnett, Member Of Assembly, New York To Dr. Liegner. August 14, 1990

Dennis White, Ph.d., New York State Department Of Health To Dr. Liegner. August 22, 1990

James R. Colquhoun, Chief, Bureau Of Environmental Protection, New York State Department Of Environmental Conservation To Dr. Liegner, September 24, 1990

Richard I. Coombe, Member Of Assembly New York State To Dr. John C. Feeley, Center For Infectious Diseases, Cdc, Atlanta, Ga. August 7, 1991

Nita M. Lowey. Member Of U.s. Congress, New York 20Th District, To Dr. John C. Feeley, Centers For Infectious Diseases, Cdc, Atlanta, Ga. September 10, 1991

Henry S. Cassell, Iii. Grants Management Office, Dept. Health & Human Services, Public Health Service, Centers For Disease Control & Prevention To Liegner, Advising Grant Application Disapproved. September 10, 1991

Liegner To James R. Colquhoun, Chief, Bureau Of Environmental Protection Nys Dec. January 21, 1992

Dennis White, Ph.d., New York State Department Of Health To Dr. Liegner, Apprising Of Ranking Of Deer Gazebo Pre-Proposal. December 31, 1992

Liegner To Richard Ostfeld, Ph.d. Institute For Ecosystem Studies (I.e.s), Millbrook, Ny. July 20, 1996

Richard Ostfeld, Ph.d., I.e.s., To Liegner. July 24, 1996

Liegner To Durland Fish, Ph.d., Yale University School Of Medicine, Rich Falco, Ph.d., American Lyme Disease Foundation And Tom Daniels, Ph.d., Louis Calder Center Of Fordham University. July 26, 1996

Liegner To Durland Fish, Ph.d., Yale University School Of Medicine, Tom Daniels, Ph.d., Calder Center, Rich Falco, Ph.d., Aldf, And John George, Ph.d. Agricultural Research Service, United States Department Of Agriculture (Ars/Usda). September 22, 1997

John E. George, Ph.d., Ars/Usda To Liegner. November 3, 1997

Richard Ostfeld, Ph.d. I.e.s. To Liegner. November 21, 2000

Millbrook Round Table, February 22, 2001. Editorial: Smart Science In Dutchess

Remarks At Dutchess Conference On Biocontrol Of Ticks. May 7, 2001

Hyperbaric Oxygen Therapy-related Grouping:

Liegner To William Fife, Ph.d., Hyperbaric Laboratory Texas A&M University. October 17, 1996

Willam Fife, Ph.d., Texas A&M To Liegner. December 14, 1996

Liegner To Charles Pavia, Ph.d. December 14, 1996

William Fife, Ph.d., Texas A&M, To Liegner. January 21, 1997

Liegner To Dr. Niazi, New York Group For Plastic Surgery & Rehabilitation, Burn Center, Westchester County Medical Center. February 9, 1997

William Fife, Ph.d., Texas A&M, To Liegner. April 4, 1998

Liegner To Glenn Butler, Hbo Clinical Director, Mount Vernon Hospital, New York. September 16, 1999

Sydney M. Finegold, M.d., Editor, Clinical Infectious Diseases To Liegner, With Reviewers #1, #2 & #3. January 7, 1997. Not Accepted, With Invitation To Submit Revised Manuscript

Liegner To Finegold, Manuscript Revisions. February 14, 1997

Finegold To Liegner. Rejection Of Revised Manuscript, With Reviews #1 & #2 (Reviewer # 3 ‘Purged’)

Consent For Disclosure Of Medical Information, Vicki Logan. June 22, 2001

Consent For Disclosure Of Medical Information, Next Of Kin (Robert Reitman). November 5, 2003

Report Of Culture Isolation Of B. Burgdorferi From Cerebrospinal Fluid. Cdc Fort Collins, Co. February 18, 1992

Roy Campbell, M.d., Ph.d., Cdc Fort Collins, Co. To Liegner. September 29, 1992

Liegner To Dave Persing, M.d.,Ph.d., December 25, 1992

Liegner To Paul Duray, M.d., Brigham & Women’s Hospital, Department Of Pathology, Boston, Ma. June 2, 1993

Liegner To Elisabeth Rosenthal Md, New York Times. July 10, 1993

Liegner To Sherwood Miller, M.d., Assistant Medical Director, Medical Policy & Research, Empire Blue Cross & Blue Shield. July 29, 1993

Liegner To Elisabeth Rosenthal, M.d., New York Times. August 25, 1993

Liegner To Paul Duray, M.d. September 7, 1993

Sherwood Miller, M.d., Empire Bc&Bs, To Liegner September 20, 1993

Liegner To David Dennis, M.d., M.p.h., Roy Campbell, M.d., Ph.d., Duane Gubler, Sc.d., M.s., Leonard Mayer, Ph.d. & Joe Piesman, Ph.d. Cdc Fort Collins, Co. October 20, 1993

David Dennis, M.d., M.p.h., Cdc Fort Collins, Co. To Liegner. November 6, 1993

Liegner To Sherwood Miller, M.d., Empire Bc&Bs. November 8, 1993

Liegner To David Dennis, M.d., M.p.h. Cdc Fort Collins, Co. January 16, 1994

David Dennis, M.d., M.p.h., Cdc Fort Collins, Co. To Liegner. February 8, 1994

Liegner To David Dennis, M.d., M.p.h., Cdc Fort Collins, Co. March 27, 1994

David Dennis, M.d., M.p.h., Cdc Fort Collins, Co. To Liegner. April 7, 1994

Liegner To David Dennis, M.d., M.p.h., Cdc Fort Collins, Co. June 1, 1994

Sherwood Miller, M.d. Blue Cross Blue Shield To Liegner, August 9, 1994

David Dennis, M.d., M.p.h., Cdc Fort Collins, Co. To Liegner. August 23, 1996

Richard Sanchez, M.d. Senior Vice President, Empire Bc&Bs To Liegner. November 19, 1996

Liegner To Richard Sanchez, M.d. Sr. Vp, Empire Bc&Bs. November 22, 1996

Liegner To David Dennis, M.d., M.p.h., Cdc Fort Collins, Co. February 25, 1997

Adrianna Marques, M.d., N.i.h. Clinical Center To Liegner. May 27, 1997

Lori Cavanagh, R.n., Empire Bc&Bs To Liegner. February 12, 1998

Dagmar Hulinska, Ph.d., Director Borrelia Reference Laboratory Of The Czech Republic, To Liegner. November 1, 1998

Testimony, Richard Sanchez, M.d., Former Senior Vp Empire Bc&Bs, In Logan Et. Al. Vs. Empire Bc&Bs, Supreme Court, State Of New York, County Of Westchester. February 23, 1999

Liegner To Franklin L. Brosgol, M.d., Senior Medical Director, Empire Blue Cross And Blue Shield, April 7, 1999

Michael B. Finkelstein, M.d., F.a.c.p. Senior Vice President For Medical Affairs, Northern Westchester Hospital Center To Liegner, June 14, 1999

Liegner To Alan Sokolow, M.d. Vice President And Chief Medical Officer, Empire Blue Cross And Blue Shield, June 16, 2000

Franklin L. Brosgol, M.d. Senior Medical Director, Empire Blue Cross And Blue Shield To Liegner, July 25, 2000

Liegner To Franklin L. Brosgol, M.d., Senior Medical Director, Empire Blue Cross And Blue Shield, September 6, 2000

Hand Notes Of Telephone Conversation With Franklin L. Brosgol, Senior Vice President, Empire Blue Cross And Blue Shield, September 13, 2000

Liegner To Franklin L. Brosgol, M.d., Senior Meidcal Director, Empire Blue Cross And Blue Shield, September 19, 2000

Franklin L. Brosgol, M.d., Senior Medical Director, Empire Bc&Bs To Liegner. October 25, 2000

Liegner To Franklin L. Brosgol, M.d. Sr. Medical Director, Empire Bc&Bs. November 10, 2000

Franklin L. Brosgol, M.d., Senior Medical Director, Empire Bc&Bs To Liegner, February 28, 2001

Vicki Logan, Lab Report Of Positive Lyme Pcr In Whole Blood, Medical Diagnostic Laboratory, March 16, 2001

Vicki Logan, Lab Report Of Positive Lyme Pcr In Whole Blood, Medical Diagnostic Laboratory, July 8, 2001

Vicki Logan, Letter To Lara Kassell, Legislative Associate To Hon. Richard Gottfried, Chair, Nys Assembly Committee On Health

Logan, Vicki, Report Of Research Assays On Cerebrospinal Fluid Performed 2002 On Frozen Csf Specimen Collected June 20, 2001, Research Laboratory, State University Of New York At Stony Brook, Ospa And Ospc Antigen-Capture And Borrelia-Specific Igm And Igg Immune Complexes

Jarmo Oksi, Md To Liegner

Liegner To Medical Ethics & Quality Improvement Committees, Northern Westchester Hospital Center. April 11, 2002

Liegner To Kathy Kuhmerker, Director, Office Of Medicaid Management, New York State. April 26, 2002

Discharge Summary From Northern Westchester Hospital Center, Vicki Logan, May 1, 2002

Liegner To Thomas Fanning, Ph.d., Assistant To The Director, Office Of Medicaid Management, New York State. May 10, 2002

Thomas R. Fanning, Ph.d., Director, Division Of Policy & Program Guidance, Office Of Medicaid Management, New York State To Liegner. May 28, 2002

Liegner To Robert Reitman. January 31, 2003

Hand Notes Of Telephone Conversation With Nys Medicaid Personnel Seeking Carve-Out To Enable Further Intravenous Antibiotic Therapy, June 26 – July 9, 2003

Hand Notes Of Telephone Conversations With Pathologist At Hudson Valley Hospital Seeking Performance Of An Autopsy

Liegner Letter To James Goldman, M.d., Yvonne Milewski, M.d. And Jenny Libien, M.d., Department Of Neuropathology, New York Presbyterian Hospital / Columbia-Presbyterian Center, August 15, 2003

Autopsy Report, Vicki Logan, New York Presbyterian Hospital/Columbia-Presbyterian Center. Autopsy Performed,July 22, 2003. Neuropathology Report Signed November 6, 2003. General Autopsy Report Signed November 17, 2003

Photograph, Coronal Section Of Brain, Post-Mortem

Photograph, Meningocerebellitis, Post-Mortem

Fatal Encephalitis in a 7 year-old Fairfield Connecticut Child

Letter To Third Party Administrator Review Physician For Ibm

Fatal Meningoencephalitis: Case of Martin Eisenhardt

Mary Lou Eisenhardt, Consent For Disclosur Of Medical Information

Letter To Peter C. Welch, M.d., Ph.d., Senior Vice President For Medical Affairs, Northern Westchester Hospital Center. August 4, 1992

Testimony Of Mary Lou Eisenhardt Before The New York State Assembly Committee On Health Lyme Disease Hearing, November 27, 2001

Autopsy Report, Martin Eisenhardt By Pathologist Jeffrey Hubbard, Md, Bender Hygienic Laboratory. July 3, 1993

Cerebrospinal Fluid Research Assays, Laboratory Of Patricia Coyle, M.d., Suny Stony Brook

While Living, May 1992

Post-Mortem, July 1993

Photograph, Coronal Section Of Brain, Post-Mortem

Photograph, Meningocerebellitis, Post-Mortem

Letter To Claude Garon. September 18, 1995

Letter To Claude Garon. January 22, 1996

Letter To Dagmar Hulinska, Ph.d. Borrelia Reference Laboratory, Czech Republic. March 25, 1996

Dagmar Hulinska, Ph.d. To Liegner April 2, 1996

Liegner To Dagmar Hulinska, Ph.d. April 17, 1996

Eisenhardt Case: Cytoplasmic Micropacket Group

Claude Garon, Ph.d., Rml To Liegner. October 17, 1995

Claude Garon, Ph.d., Rml To Paul Duray, M.d. October 31, 1995

Claude Garon, Ph.d. To Liegner With Transmission Electron Micrograph # E639@ 15.5 K X 3 And Hand Notes (6 Pages)

Liegner To Sverre-Henning Brorson, Ph.d. Dept. Pathology Ulleval University Hospital, Oslo, Norway And Oystein Brorson, Ph.d. November 27, 1998

Sverre-Henning Brorson, Ph.d. To Liegner. January 8, 1999

Liegner To Sverre-Henning Brorson, Ph.d. & Oystein Brorson, Ph.d. January 14, 1999

Sverre-Henning Brorson, Ph.d. To Liegner. January 21, 1999

Sverre-Henning Brorson, Ph.d. To Liegner. July 7, 1999

Liegner To Sverre-Henning Brorson, Ph.d. July 20, 1999

Liegner To Sverre-Henning Brorson, Ph.d. June 5. 2014

Sverre-Henning Brorson, Ph.d. To Liegner. August 4, 2014

Death due to Inappropriate Management of a Complication of Extended Intravenous Antibiotic Therapy Required in a patient with Chronic Neurologic Lyme disease Group

Liegner Cover Letter To Sherwood L. Gorbach, M.d. Editor, Clinical Infectious Diseases. April 14, 2001

Liegner Letter To The Editor, Clinical Infectious Disease Re: Patel, Et. Al.

Sherwood L. Gorbach, M.d., Editor, C.i.d., Rejection Letter To Liegner. May 4, 2001

Ylene A. Larsen, M.d. To Liegner

Two-tier Testing Deficiency Group: Jennifer Lilly

Jennifer Lilly, Consent To Disclosure Of Medical Information

Liegner To Frederick, Maryland Department Of Health`

Laboratory For The Diagnosis Of Lyme Disease, Suny Stony Brook. Lyme Elisa & Western Blot, Jennifer Lilly. October 26, 2010

Lyle Petersen, M.d., M.p.h., Director Cdc National Center For Emerging And Zoonotic Infectious Disease, Division Vector-Borne Disease (Ncezid), Fort Collins, Co To Liegner. July 1, 2011

Liegner To Lyle Petersen, M.d., M.p.h., Cdc Ncezid. November 23, 2011

Ron Rosenberg, Sc.d. Associate Director For Science, Cdc Ncezid To Liegner. December 7, 2011

Liegner To Ron Rosenberg, Sc.d. Cdc Ncezid. December 8, 2011

Photographs Section C

1. Norman Latov, M.d., Ph.d.

2. Corey Lakin

3. Andrea Gaito, M.d. & Steve Phillips, M.d.

4. Barbara Buchman & Andrea Gaito, M.d.

5. Susan Davis

6. Eric Davis

7. Kathy Corbera, M.d.

8. Joseph Jemsek, M.d.

9. Andy Wilson Abrahams & Kris Newby

10. Nettie Mayersohn

11. Joel Miller, D.d.s.

12. Adam Bradley

13. Allison K. Delong, M.s.,Pstat®

14. Sam Shor, M.d.

15. Sarah Fletcher, M.d.

16. Pam Weintraub

17. Monte Skall

18. Lonnie King, D.v.m., M.a., M.p.a.

19. Nicole Baumgarth, D.v.m., Ph.d.

20. C. Ben Beard, M.a., Ph.d.

21. Eva Sapi, Ph.d.

22. Janis Weis, Ph.d.

23. Kim Lewis, Ph.d.

24. John Aucott, M.d.

25. Linden Hu, M.d.

26. Monica Embers, Ph.d.

27. Dave Martz, M.d.

28. Joe Brewer, M.d.

29. Christine Green, M.d.

30. Benjamin Asher, M.d.

31. Andreas Kogelnick, M.d., Ph.d.

32. Madelaine Cunningham, Ph.d.

33. Emir Hodzic, Ph.d.

34. Sam Telford, Ph.d.

35. David Younger, M.d.

36. Marina Makous, M.d.

37. Ahmet Burakgazi, M.d.

38. Joseph Forrester, M.d., Ph.d. & Pat Smith

39. Richard Gottfried

40. Kemp Hannon

41. Chris Gibson

42. Meredith Johnson & Steve Bulger

43. Didi Barrett

44. Jill Auerbach

45. Holly Ahern, M.s.

46. Rick Ostfeld, Ph.d.

47. Kerry Clark, Ph.d., M.p.h.

48. Debbie Siciliano & Diane Blanchard

49. Harriet Kotsoris, M.d.

50. David Roth, Staci Grodin, Charles Balducci

51. Jennifer Weis

52. Rachelle & Vanessa Holden

53. Eva Haughie

54. Andy Schlafly, Esq

55. Carin Rollins

56. Mary Beth Pfeiffer

57. Abigail Dumes

58. Berkshire Stompers

VIII Additional Correspondence, Chronologically Arranged

Liegner To Alan Macdonald, M.d., Attending Pathologist, Southhampton Hospital, Southhampton, Long Island, New York. June 18, 1989

Liegner To Paul E. Lavoie, M.d., Rheumatology, San Francisco, Ca June 18, 1989

Liegner To Karen Vanderhoof-Forschner, President, Lyme Borreliosis Foundation, Tolland, Ct October 28, 1989

Joe Piesman, D.sc. Lyme Disease Vector Section Chief, Division Of Vector Borne Infectious Disease (Dvbid), Fort Collins, Co To Liegner. December 4, 1989

Liegner To Paul Lavoie, M.d. December 22, 1989

Poster: Dr. Liegner Presenting On Lyme Disease At A Seminar, Cdc, Fort Collins, Co April 12, 1990

Liegner To Joe Piesman, D.sc. Cdc Fort Collins, Co April 20, 1990

Barbara J.b. Johnson, Ph.d., Molecular Biology Branch, Cdc Dvbid, Fort Collins, Co To Liegner. April 23, 1990

Leonard W. Mayer, Ph.d. Cdc Fort Collins, Co To Liegner. May 15, 1990

Polly Murray, Post Card To Liegner. June 13, 1990

Liegner To Thor Hansen, President, National Multiple Sclerosis Society, Nyc. January 2, 1992

Liegner To Victoria Harden, N.i.h. Historian May 20, 1991

Victoria Harden, N.i.h. Historian, To Liegner June 17, 1991

Liegner To Richard C. Tilton, Ph.d., Editor, Journal Of Clinical Microbiology. January 3, 1992

Liegner To Allen C. Steere, M.d., Division Of Rheumatology, Tufts New England Medical Center & Tufts University School Of Medicine, Boston, Ma January 11, 1992

Diane Kindree, B.s.n. Vancouver Lyme Borreliosis Society To Liegner. February 20, 1992

Liegner To Kostis Georgilis, M.d., New England Medical Center, Boston, Ma. September 1, 1992

Liegner To Kathy Cavert, Lyme Patient-Educator, Independence, Mo. October 26, 1992

Liegner To Thomas T. Haupl, University Of Erlangen, Germany. November 12, 1992

Liegner To Mark Klempner, M.d., New England Medical Center & Tufts University School Of Medicine, Boston, Ma. December 5, 1992

Liegner To Patricia Coyle, M.d. Department Of Neurology, State University Of New York (Suny) At Stony Brook. December 11, 1992

Liegner To Andrew Pachner, M.d., Georgetown University, December 26, 1992

Liegner To Claude Garon, Ph.d., Chief, Laboratory Of Vectors & Pathogens, Rocky Mountain Laboratory (Rml) Of The National Institute Of Allergy & Infectious Diseases (Niaid), Hamilton, Mt. January 3, 1993

Paul E. Lavoie, M.d. To Liegner. March 8, 1993

Liegner To Carol Mcgann, Director Of Services, National Multiple Sclerosis Society, Hawthorne, Ny. May 19, 1993

Ed Masters, M.d., Family Physician & Lyme Clinical Researcher, Cape Girardeau, Mo. To Liegner. July 26, 1993

Liegner To Paul Zamecnik, M.d., Worcester Foundation For Experimental Biology & Sudhir Agrawal, Ph.d., Hybridon. August 14, 1993

Claude Garon, Ph.d., Rml Niaid, Hamilton, Mt To Liegner. August 24, 1993

Liegner To Patricia Coyle, M.d., Dept. Neurol., Suny Stony Brook. August 28, 1993

Liegner To Claude Garon, Ph.d., Rml Niaid, Hamilton, Mt. August 31, 1993

Liegner To Kathy Cavert, Independence, Mo. August 31, 1993

John Lombardi, Supervisor, Town Of North Castle, Westchester County, Ny To Liegner. August 31, 1993

Liegner To John Lombardi. September 3, 1993

Liegner To Alan Macdonald, M.d. Beaumont, Tx. November 11, 1993

Vera Preac-Mursic, M.d., Max Von Pettenkoffer Institute, Munich, Germany To Liegner. November 22, 1993. (Original, In German)

Vera Preac-Mursic, M.d. To Liegner. November 22, 1993. (English Translation By Ken Fordyce)

Liegner To Mrs. Paul Lavoie. February 7, 1994

Liegner To Jonathan Edlow, M.d. Physician-Author. Newton Center, Ma. April 24, 1994

Liegner To Claude Garon, Ph.d., Rml Niaid. April 30, 1994

Liegner To Arthur Weinstein, M.d., Chief Division Of Rheumatic Diseases & Immunology, New York Medical College, Valhalla, Ny. May 28, 1994

Liegner To Vincent Marshall, Ph.d., Council Bluffs, Ia. August 21, 1994

Liegner To Mark Golightly, Ph.d., Laboratory For The Diagnosis Of Lyme Disease, Suny Stony Brook, Ny, December 21, 1994

Ed Masters, M.d., Cape Giardeau, Mo. To Liegner. January 26, 1995

Liegner To Carl Brenner, Presently Senior Staff Associate, Lamont-Doherty Earth Observatory, Columbia University & Who Went On To Serve As A Member Of The Scientific Advisory Committee For Nih-Funded Lyme Treatment Trial Reported By Klempner Et. Al. In Nejm In 2001. January 29, 1995

Liegner To Jim Oliver, Jr., Ph.d., Callaway Professor, Department Of Biology, Georgia Southern University, Statesboro, Ga. February 20, 1995

Liegner To William Brown, M.d., Portland, Or. May 8, 1995

Liegner To Mario Phillipp, Ph.d., Tulane Regional Primate Center, Covington, La. May 8, 1995

Dan Ardrey, Author Of Dead End Host, To Liegner. May 22, 1995

Liegner To Dan Ardrey, Brookline, Ma. May 30, 1995

Ed Masters, M.d. To Liegner, July 27, 1995

Liegner To Dale Morse, M.d., M.s. Director Division Of Epidemiology, Nys Department Of Health, Albany, Ny. September 14, 1995

Liegner To Max Appel, Ph.d., James Baker Institute For Animal Health, Cornell University, Ithaca, Ny. July 5, 1996

Liegner To Nicholas Bodor, Ph.d. & Lazlo Prokai, Ph.d., Center For Drug Discovery, University Of Florida, Gainesville, Fl. July 5, 1996

Liegner To Duane Gubler, Sc.d., Cdc Fort Collins, Co & Bob Lane, Ph.d., Department Of Entomology, University Of California, Berkely, Ca. July 5, 1996

Liegner To Mark Klempner, M.d., New England Medical Center & Tufts University School Of Medicine, Boston, Ma July 6, 1996

Liegner To Elyes Zhioua, Ph.d., University Of Rhode Isand, Kingston, Ri. & Howard Ginsberg, Ph.d., July 20, 1996

Liegner To