Medical Boards Let Physicians Practice, Despite Drug Abuse (series of articles) Options

[no retreat, no s...]

Medical Boards Let Physicians Practice Despite Drug Abuse

By Cheryl W. Thompson
Washington Post Staff Writer
Sunday, April 10, 2005; Page A01


First of three articles

Over the past 20 years, John F. Pholeric Jr. struggled on and off with cocaine addiction, cycled in and out of rehab and was convicted of a felony. During that time, he also practiced medicine.

Pholeric, 55, an ear, nose and throat specialist in Fairfax and Loudoun counties, admitted snorting cocaine "three to four times per week" in his office in 1999. He stole drugs from hospitals where he worked and wrote more than 40 fraudulent prescriptions for his own use, according to Virginia and District medical board records.

Several times, the Virginia Board of Medicine took up Pholeric's case. But it never took away his license to practice.

Pholeric, who retired last month after he was questioned by a Washington Post reporter about his substance abuse, is not alone. Virginia Board of Medicine records show that an Arlington ophthalmologist who performed cataract surgery under the influence, his hands shaking and his speech slurred, still has his license. So does a Loudoun County gastroenterologist who deprived his colonoscopy patients of painkillers and injected himself with the drugs between operations.

Scores of physicians in the area and across the country have been given repeated chances to practice, despite well-documented drug and alcohol problems, a Post investigation has found. They have stayed in business with the permission of state medical boards and hospitals, even when many have relapsed multiple times and posed a danger to patients, records show.

When physicians were disciplined, the process sometimes was so slow that they moved to another state and became licensed before a paper trail surfaced detailing their transgressions.

According to a review of medical board records, 74 doctors in the District, Maryland and Virginia were disciplined for substance abuse from 1999 through 2004. In five other cases, the boards found that doctors violated the law by abusing drugs or alcohol but took no action despite the doctors' repeated substance abuse. In nine other cases, the physicians surrendered their licenses for the time being to avoid investigation and possible punishment, according to board records.

In the 74 cases in which doctors were disciplined, most had their licenses suspended temporarily. Ten doctors were reprimanded and five others were placed on probation, but their licenses were not suspended.

Seven of the disciplined doctors have been convicted of felony drug crimes. One doctor who was convicted in Virginia and served time in prison once again has a license to practice in the state.

Of the 74 physicians, 53 percent have been disciplined more than once for alcohol or drug use during their medical careers. Nine were sanctioned at least three times by the same board.

The District and Maryland boards do not permanently revoke doctors' licenses. In Virginia, where a license can be permanently taken away only with a doctor's agreement, just one was revoked for substance abuse from 1999 to 2004, records show.

Critics say lenient treatment of substance-abusing physicians flows from a seriously flawed national system of disciplining doctors. At its heart is a network of state medical boards made up primarily of physicians who, critics argue, are unwilling to exact strict punishment on their colleagues. A federal data bank designed to track problem doctors has critical loopholes and is closed to the public. Malpractice lawsuits often end in sealed settlements, adding to a cloak of secrecy that keeps patients from learning a doctor's full history.

Patient advocacy groups say bad doctors are also coddled by hospitals and other employers as part of a culture of clemency and second chances.

"Medicine tolerates behavior that in any other industry would be unacceptable," said Lucian Leape, a physician and expert on patient safety who teaches at the Harvard School of Public Health. "There are patients' lives at stake . . . and that's more important than a doctor's career."

Charles B. Inlander, president of the People's Medical Society, an Allentown, Pa.-based nonprofit consumer health advocacy group, said doctors who are drug addicts are often given too much leeway.

"If a pilot gets caught, they're out. If an engineer gets caught, they're out," Inlander said. "Why does a doctor get special treatment?"

Hospitals and other employers can discipline physicians. But when it comes to a doctor's license, the authority rests with state boards of medicine, which usually are appointed by governors. In the District, board members are mayoral appointees.

The panels also grant licenses and investigate complaints. Although their meetings are usually open to the public, physician discipline is typically discussed behind closed doors.

Many boards prefer not to take away a doctor's license to practice. "Regulators believe that many problems can be resolved with probation and by putting restrictions on a physician's license," according to a release from the Federation of State Medical Boards.

William L. Harp, a physician and executive director of the Virginia Board of Medicine, said he could not comment on specific cases but defended his panel's record. If the Virginia board is aware of an impaired doctor, he said, it moves swiftly to take action.

"The practice of medicine is on the honor system," he said. "Once you get your license . . . the board assumes that you're out there taking good care of patients until we hear otherwise."

But Harp acknowledged that the system has flaws. "You can't catch every single thing."

He said medical boards should become more proactive in assessing doctors and patient safety instead of using the current system, which primarily reacts to complaints.

The Virginia board did not discipline Herman A. Garrett, an anesthesiologist licensed in Virginia. Garrett has struggled with drugs and alcohol off and on since he was a resident at Georgetown University, according to Kentucky medical board records. In 1991, Georgetown officials placed him on leave for his "chemical dependency," the records show. In 1992, he pleaded guilty to driving under the influence in Georgia and received a suspended sentence and fine, according to the records.

"Physicians are no different than any other individual," Garrett said in an interview. "I was just a person who liked to change the way I feel through using chemicals. It may be illegal, but I didn't perceive it as wrong."

Garrett, who injected himself with drugs up to 10 times a day, admitted stealing drugs while working at a Kentucky hospital, medical board records show.

His abuse of fentanyl, a synthetic morphine, was the "crescendo" that prompted him in 2001 to surrender his Kentucky license in lieu of revocation, he said in the interview. He has been in rehab twice. The Virginia board stated in a 2003 order that he was in a "well established recovery monitoring program."

Garrett, 42, argued that he and other physicians have a right to return to medicine despite relapses.

"Do we as a society want to say that because you've had this problem, you're no longer eligible to participate in the capacity that you're trained in?" he asked. "There are some stunningly good professionals in recovery."

Suit Over Drugs


Nancy Rodriguez, a Loudoun County mother of four, claimed in a 2001 lawsuit that gastroenterologist Joseph Shaw Jones used drugs meant for her.

Rodriguez had gone to Jones for a colonoscopy in 1998 on the recommendation of her doctor. When she arrived at Loudoun Hospital Center for the procedure, Jones asked the nurse to go and change the music piped into the room, Rodriguez recalled in an interview.

"That's when he changed the drugs," she said. "That was the only time I was alone with him. That was the only time he could have done it."

Rodriguez was awake during the procedure and told Jones she felt sharp pain, she said. "He said, 'We're almost finished.' I told him it hurt."

She later found out through media reports that Jones had tampered with drugs meant for patients. Nurses reported that "they heard a number of his patients screaming during procedures," according to Virginia medical board records. Hospital staff members also reported that Jones had glassy eyes on one occasion and slurred speech on another.

The Virginia medical board gave Jones several chances. Even though he was battling drug and alcohol addiction in 1989, the board gave him a license to practice. In 1993, the board found that he had violated specific terms of a 1992 order to abstain from drugs and alcohol. And in 1999, after he used drugs meant for patients while performing colonoscopies and endoscopies, board members reprimanded him and fined him $10,000. Still, they let him keep practicing.

"It never even occurred to me that a doctor would be allowed to continue practicing if he had any drug history," Rodriguez said. "If a more serious penalty or punishment would have come down on him sooner, perhaps he wouldn't have continued" practicing.

Jones, 51, settled the case with Rodriguez for an undisclosed amount.

The Virginia medical board suspended him only after he pleaded guilty to drug possession charges in federal court in Virginia, was sentenced in July 2001 to 30 months in federal prison and ordered by the court to surrender his medical license for three years.

But in September 2003 -- two years and two months after he was sentenced -- the Virginia board gave Jones his license back.

After the incidents at Loudoun Hospital Center, Jones received support from the group that oversees physicians with substance abuse problems and from a hospital official, records show. In an Oct. 4, 1999, letter to the medical board, Walter M. O'Brien, president of the hospital's medical staff, said he was "familiar with the current events involving Dr. Jones' drug use . . . and he fully supports his return to practice," according to Virginia board records.

Jones declined several requests for an interview.

"My natural instinct is to use your forum to set the record straight," Jones wrote in an e-mail. "As you know, the events that led to my last meeting with the Virginia Board of Medicine occurred . . . six years ago. Since then, my family and I have moved past the painful fallout of those times and do not wish to revisit them in a public forum."

Jones declined to say whether he is practicing medicine, and the Virginia medical board does not keep track of who is actively practicing, said Karen W. Perrine, the board's deputy executive director of discipline.

In the case of Arlington ophthalmologist Kenneth D. Hansen, 58, Virginia medical board records say that in January 1997, he showed up at Arlington Hospital, now Virginia Hospital Center, late for surgery, "unshaven, his hair was uncombed . . . his eyes were glassy, his speech was slurred and his face and hands appeared swollen."

His hands trembled while performing cataract surgery, and "Patient A," according to the board records, "incurred excessive bleeding," prompting the hospital to suspend Hansen's privileges. The hospital reinstated him less than a month later. A year earlier, he had been suspended from performing surgery at the hospital until he completed treatment for a prescription drug problem. Then in March 1997, after the cataract surgery, he was back in rehab, according to board records. His Virginia license was suspended, then reinstated on probation in 1998. He currently has an unrestricted license.

Hansen, who has a private practice in Arlington, declined to discuss his history. "I've done everything I can to the satisfaction of the board," he said in a brief phone conversation. "Sometimes you have to move on."

Incident in Loudoun


Kim Gardiner, a former patient of physician John Pholeric, said state medical boards and hospitals should bar drug-abusing doctors from the medical field.

"That just angers me," she said. "Nothing is really done about it."

Gardiner knew nothing of Pholeric's history when she went to his Loudoun County office in 1995 on the recommendation of her HMO. She needed surgery for hearing loss in her left ear, a procedure that involved wiring a tiny hammer into her ear drum.

"He had performed it before -- not once or twice, but several times," said Gardiner, now 42 and a mother of three in suburban Atlanta. But she emerged from the surgery at Reston Hospital Center with a dislocated jaw.

"My face hurt, and I had an excruciating headache, like a migraine, and it kept getting worse," she recalled in an interview. She said she was unable to chew and had to sip liquids through a straw for three weeks.

Gardiner sued Pholeric and the hospital, but it was the hospital that settled with her for an undisclosed amount, she said.

When Gardiner went to Pholeric, he was already known to the Virginia medical board for stealing and using drugs in the 1980s. He went to a residential treatment program in 1984 and the next year was convicted in federal court in the District for writing 42 false prescriptions for his personal use. The court placed him on probation and banned him from prescribing certain drugs for two years but did not order him to stop practicing.

The Virginia medical board also allowed him to keep practicing, despite a law requiring that it suspend or revoke the license of anyone convicted of a felony.

After Gardiner sued Pholeric, the Virginia medical board concluded in 2002 that he had stolen cocaine solutions meant for his patients at Countryside Ambulatory Surgery Center and Loudoun Hospital Center. The state board put him on probation but let him keep practicing. He entered inpatient drug treatment again in 2001, and his license was fully reinstated in 2003. The medical board placed him on probation last year after his urine tested positive for marijuana, records show. Pholeric told the board he was "exposed to secondhand marijuana smoke" the night before his drug screen.

Before his retirement last month, Pholeric said in several lengthy e-mails to The Post that drug addiction is an "occupational hazard" that should not end a physician's career.

"Do you throw these people away, or do you treat them, monitor them and assure public safety?" Pholeric wrote.

Pholeric said he was sober for 17 years, from 1983 through late 2000, but 1987 Virginia medical board records show he failed a drug screen, and 1999 records show the cocaine theft. He blamed a "long and difficult" schedule for his relapses but said he has been drug-free since September 2003.

"I am no longer trying to prove a thing," he said in an e-mail. "If patients don't think I am doing a good job, they should go somewhere else."

But Pholeric decided to retire March 7, in part because of the Post investigation, he said in a brief phone conversation.

"Your help in getting me to retire has been excellent, thank you," he said before hanging up.

Relapses


Paul H. Earley, medical director of the Impaired Professionals Program at the Ridgeview Institute in Smyrna, Ga., said it is common for doctors with substance abuse problems to relapse. One in 10 doctors do so within two years, he said. Others, he said, are in and out of rehab for years.

"There are people who can't stay sober . . . and they shouldn't practice medicine," he said.

From 1999 to 2004, nearly 1,400 physicians across the country were disciplined for substance abuse and reported to the National Practitioner Data Bank, a federal clearinghouse for disciplinary action and medical malpractice payments against doctors. Of those, many were repeat offenders: 259 physicians were reported twice; 58 had three reports; and two physicians had six reports, according to data bank records.

The controversy over whether medical boards should treat prolonged substance abuse as a career-ending offense is partially rooted in a much broader debate over whether addiction is an illness or a crime. The same question has come up in other arenas, from the judicial system to disability policy.

Arthur Caplan, chairman of the Department of Medical Ethics at the University of Pennsylvania School of Medicine, said it is common for the medical community to let doctors with a history of substance abuse continue to care for patients.

"Treating impaired doctors with kid gloves has been true since I was on the New York state licensing board in the '70s, and it hasn't changed," Caplan said. "I'm all for rehabilitation, but when you have multiple violations of drug abuse, you can't be near a prescription pad."

James T. Birch Jr., 50, a family practitioner who practiced for years in Norfolk, contends that a doctor with a drug or alcohol problem should be given as many chances as a doctor who is physically ill.

"Suppose you have a diabetic surgeon whose blood sugar drops and he's in the middle of a procedure," he said in an interview. "How many chances do you give him?"

From 1990 to 2001, Birch tested positive for alcohol, marijuana or cocaine seven times and went to four drug treatment centers, one financed by taxpayer dollars, according to Birch and state records. The Virginia medical board suspended his license four times but each time gave it back.

"I think the board was very fair to me," said Birch, who said he has been drug free for nearly four years. "I was given five chances. I think the board understands and recognizes addiction as a disease and not some type of moral turpitude."

Drug use, he said, "never prevented me from staying focused on my work." But he said he became reckless with money, stayed up all night and was always "bone-dead tired." Still, no one at Norfolk Community Hospital knew about his drug use, and "nothing was ever documented" that he harmed a patient, he said.

After he tested positive for drugs in 1990, the Virginia medical board suspended his license for the first time. But it immediately set aside the order, allowing him to keep practicing. If he relapsed, the board could enforce the suspension.

In 1993, a medical board inspector approached him during his 12-hour shift at Norfolk Community Hospital's emergency room and ordered him to stop practicing medicine immediately, Birch said. His license was suspended, she told him, because he had tested positive for cocaine.

"There were people around," Birch recalled. "That was the most humiliating experience of my life."

The cycle continued, with Birch testing positive, losing his license and then regaining it. Birch obtained a Missouri license in 2003 and is on a medical fellowship in the state.

One Chance in Ohio


Some states are less tolerant than others.

In Ohio, for example, "everybody has one chance to screw up," said Lauren Lubow, the senior executive staff attorney for the Ohio Medical Board.

If doctors are impaired, they are evaluated, offered treatment and then allowed to return to practice "without interference from the board," she said. If a relapse occurs, the board takes action, usually a consent agreement immediately removing the doctor from practice, she said. The doctor must meet certain guidelines, including 28 days of treatment, before applying for license reinstatement.

"There is an end to [the board's] patience," Lubow said. "It comes at a point where they are convinced this is not a person who will be able to recover and safely return to practice."

In Massachusetts, an impaired doctor who relapses twice or more must demonstrate at least a year of sobriety before being allowed to return to medicine, according to Nancy Achin Audesse, executive director of the Massachusetts Board of Registration in Medicine. "We give people a couple of chances to get themselves together," she said. "But our primary goal is patient protection."

Maryland, Virginia and the District are more tolerant.

Alexandria psychiatrist Luanne Ruona has been hospitalized for alcohol dependency and been in drug rehab at least nine times since 1991, records show. By her own admission, Ruona relapsed at least 12 times during that period and once tampered with her urine sample so that those who monitored her couldn't detect alcohol, according to Virginia medical board records.

She also has treated patients while under the influence, records show. In March 1999, a patient arrived appearing "distressed" for an afternoon appointment at her home office and was greeted by Ruona at the door, according to records. She suggested that he lie on her couch, then she sat beside him on the floor and held his hands near her face to relax him.

At one point, Ruona excused herself and told him she was going upstairs to phone in a prescription. When she didn't return, the man said, he went upstairs and found her in "lounging attire" asleep across the bed, according to records. He left and reported the incident to another doctor the next day. Five months passed before the board acted, suspending her license for two years, records show.

It was the first time the Virginia medical board took away her license, even though it knew about her alcohol abuse for more than a decade, medical board records show.

In 2001, a physician familiar with her history recommended that the Virginia board allow her to practice again. Another doctor said he "very strongly" recommended reinstatement because "this time, she surrendered to her illness," records show. The board reinstated her license in October 2001. She has relapsed at least three times since then, according to board records.

"I probably over-drank," Ruona, 63, said in an interview. "But I didn't feel like it interfered with my work that much. And it wasn't like I would get up and drink."

After 11 relapses, she was put out of Virginia's Health Practitioners' Intervention Program, which oversees impaired doctors, in March 2004. She surrendered her license in the fall after another relapse and said the board told her that it would return her license in 2006 if she does not drink again.

"They said the ball was in my court this time and told me to come up with a good treatment plan, and if I stayed clean I could get my license back in 18 months," Ruona said. "It's a big relief. I was satisfied and I think the board was, and we all shook hands."

Staff researcher Bobbye Pratt contributed to this report.

http://www.washingtonpost.com/wp-dyn/artic...7-2005Apr9.html

[no retreat, no s...]

D.C. Board Rarely Punishes Physicians

By Cheryl W. Thompson
Washington Post Staff Writer
Monday, April 11, 2005; Page A01


Second of three articles

For more than seven years, the D.C. Board of Medicine knew that something was amiss with Jewel A. Quinn's medical practice.

In 1997, a board investigator, acting on a patient complaint, visited Quinn's office in Northeast Washington and found an "examination table so cluttered and hidden by items that it was not visible" and a "filthy" restroom with no hot water, according to D.C. records.

When Quinn moved his practice to the Holiday Cab Co. offices in Southeast, the same investigator reported that he found a stethoscope and blood pressure cuff atop a desk littered with empty juice and milk containers. Boxes overflowing with garbage sat nearby. Soiled and wrinkled tissue paper covered an exam table. There was no phone, and Quinn could not produce patient records upon request.

But until last year, the District's medical board did not stop him from practicing.

For troubled doctors, the District is a forgiving place. A physician in Maryland or Virginia is roughly twice as likely to be disciplined as a doctor in the District, according to medical board records and statistics from the Federation of State Medical Boards for 1999 through 2004.

Records obtained by The Washington Post for that period reveal a pattern of lax discipline by the D.C. medical board:

• Twenty-six physicians with substance-abuse problems known to the board have not been disciplined, despite the fact that six lost their licenses in other states. In one instance, the board gave a license to a doctor knowing that he had "several alcohol-related arrests."

• Fourteen physicians with D.C. licenses went unpunished by the board although they were disciplined in Maryland and Virginia for criminal convictions, sexual misconduct or questionable medical care. Five have medical practices in the District, and seven have staff privileges at city hospitals.

• The board received roughly 318 complaints against physicians between 1999 and 2004 for allegations ranging from negligent medical care to sexual assault, but only four of the physicians were disciplined.

• The medical board voted to discipline more than a dozen doctors for various infractions but did not follow through on its decision.

William E. Matory, a physician and chairman of the D.C. Board of Medicine, described the board as a "well-working group" that is doing the best it can to protect patients.

"The citizens can be secure that their interests are maintained," said Matory, who is in his second term on the board and is emeritus professor of surgery at Howard University.

He said that the District disciplines so few doctors because their transgressions are often caught by hospitals or medical schools in the area long before they get to the board.

The District's record of taking serious disciplinary actions against doctors has repeatedly ranked at or near the bottom of a national comparison of medical boards by the Washington-based Public Citizen's Health Research Group. The D.C. board has "consistently been one of the worst in the country," said Sidney M. Wolfe, the group's director.

When the District does discipline a physician, it is usually in response to action by another medical board rather than on its own initiative, records show. Between 1999 and 2004, the D.C. medical board disciplined 49 physicians, according to board records. Thirty-four of the physicians -- nearly 70 percent -- were punished based on action taken elsewhere. By comparison, that figure was 16 percent in Maryland and 12 percent in Virginia, records show.

"There's nothing wrong with reciprocal action, but that should not make up the majority of disciplinary action they take," said Wolfe, a physician.

The medical board takes months, sometimes years, to investigate complaints and decide a case. In June 1999, the board took up a complaint from a woman who alleged that her doctor performed a gynecological procedure without her consent. It took two years before the board determined that the investigative report "did not substantiate any violations" and closed the case.

When it comes to fines, physicians in the District often fare better than they would elsewhere. When doctors are caught practicing without a license in the city, for example, the D.C. board levies a fine generally between $10 and $100 for each month they practiced illegally. Virginia, by comparison, can fine as much as $5,000 per infraction; the figure in Maryland can go as high as $50,000.

The D.C. board also has reduced or forgiven many of its fines at the doctors' request. A doctor who worked for the Washington Metropolitan Area Transit Authority practiced without a D.C. medical license for four years while she worked at the agency on a contract. She was fined $4,800 by the medical board. After paying $2,900, she said she couldn't afford any more, and the board forgave the rest in 2001, records show.

Positive Drug Tests Overlooked


Joel A. Guiterman, an internist in the District, tested positive for the painkiller hydrocodone or other drugs several times between 1998 and 2003, D.C. medical board minutes show. The board is aware of his substance abuse and has considered his case behind closed doors at several board meetings, but it has failed to discipline him or take him out of practice.

"He's been monitored," said James R. Granger Jr., executive director of the D.C. medical board.

When Guiterman tested positive in 1999, the board didn't discipline him. It voted to punish him when he failed another drug screen in 2000 but ultimately did not act because "there were no apparent violations" of city law, according to board records. When he didn't pass a drug test in 2001, the board voted to suspend him but never did. That same year, the board granted Guiterman's request and reduced the number of drug tests he was required to take from three per week to one per week "because of the time and financial hardship involved," according to board minutes.

Guiterman declined to discuss the matter or his treatment by the board. "I don't see any advantage to me to have my name in the paper," he said.

In the case of Gary L. Malakoff, Vice President Cheney's internist at George Washington University Medical Center, D.C. medical board officials said they were not told that for five years, Malakoff misused prescription drugs. Granger said neither the hospital nor the D.C. Medical Society, which was supposed to monitor him, informed the board about his drug use.

"Dr. Malakoff has not been on the board's radar screen, although the substance abuse . . . is apparently of long standing," Granger wrote in an internal memo to a health department investigator in July after Malakoff's drug use became public.

Even after learning of his drug use, the board waited six months before suspending his license. By that time, the hospital had suspended him and he was in a rehab program in Williamsburg, according to hospital and board records obtained by The Post.

For some doctors, the city has become a haven, because its medical board has tolerated infractions that Maryland or Virginia considered serious enough to warrant discipline.

In 2000, Maryland's medical board ordered Frank A. Broner's medical and surgical practice to be monitored for a year after a female patient died from a lack of oxygen during surgery, board records show. Broner is an orthopedic surgeon licensed in Maryland and the District.

"It was a terrible experience," said Broner, blaming the incident on an anesthesiologist he claimed was under the influence of drugs. "It was almost impossible to come back from that."

The D.C. board let the matter go without taking action, he said. "I work exclusively in D.C. now," Broner said.

Michael J. Horan, an internist licensed to practice in the District and Maryland, saw his Maryland license revoked in 2001 after pleading guilty in Montgomery County to one count of obtaining a controlled dangerous substance by fraud or deceit, Maryland board records show. He was sentenced to one year of probation and 40 hours of community service. The state restored his license in 2002.

Although the D.C. board threatened to take action against him, it never did, he said.

"D.C. got in touch with me and told me what they were going to do," he said. "But by the time they caught up with me, Maryland had restored my license."

District obstetrician-gynecologist Harold D. Johnson was reprimanded and fined $10,000 by the Maryland board in 2000 for allowing his nurse to examine and evaluate obstetrical patients while he was away. But the D.C. board took no action concerning his license, he said.

Augustus H. Hill, a general surgeon, was reprimanded in 2003 in Maryland for making medical mistakes and prescribing an "excessive dosage" of medication to a patient, according to board records. The Virginia medical board learned of the Maryland action and reprimanded him in 2004. The D.C. board notified Hill in November that he could be punished and had a right to a hearing, but nothing more has been done, Granger said.

"They've written me and told me they were going to take action, but they haven't," Hill said.

D.C. Action Not Publicized


Seven of the 11 members of the D.C. medical board are required to be physicians licensed to practice in the city. They are appointed by the mayor; in some cases, they have been reappointed for several terms.

Critics say that the physician-dominated board -- like others across the country -- is reluctant to discipline colleagues. The doctors close ranks and "tend to err on the side of the physician rather than the patient," said Sharon Baskerville, executive director of the D.C. Primary Care Association, a nonprofit health care reform and advocacy group.

Patients have no easy way of checking out the history of doctors in the District. Maryland, Virginia and nearly every other state have detailed Web sites where patients can learn about a doctor's disciplinary history. When someone searches for a doctor on the District's Web site, there is little information except whether a license is active or not. There are no case details or information on whether a doctor has been sued for malpractice.

Feseha Woldu, who oversees the District's licensing for doctors and other health care professionals, said the city has been working since 2002 to put doctor disciplinary action online. It may be another year before it is accessible, he said, adding that "we're moving forward on that."

Woldu and other board officials blamed the District's administrative problems on a lack of staff and funds. When the board became part of the health department in 1997, its staff was cut from six to three and board member stipends were eliminated because "the District said they needed the money," said Warren J. Strudwick, a surgeon and former board chairman who was appointed by Mayor Marion Barry and who served until 1996.

The board "is not adequately funded so that you can have the personnel that you need to function effectively," he said.

The board has two people to investigate about 45,800 health care licensees, and it shares those investigators with more than 20 other D.C. boards and commissions. The workload is much lighter in Maryland, which has eight investigators, and Virginia, which has 50 full-time and nine part-time investigators.

The lack of resources has had an impact on some of the board's basic operations. Since 1998, for example, it has not submitted annual reports of its activity to the mayor as required by law, Granger said.

Four Years to Pay Fine


Jewel A. Quinn Jr. has been conducting physical exams for cabdrivers in the District since 1989. For $36, the drivers get a physical, photo and paperwork certifying their health and fitness. Quinn, 52, a general practitioner who graduated from Howard University College of Medicine, estimated that he has examined 4,000 taxi drivers, bus drivers, nurses, barbers and cosmetologists and said he has private patients who come to him for treatment of high blood pressure, diabetes and other ailments.

In 1997, the D.C. board received a complaint that Quinn's Northeast office was unsanitary. It was not until two years later that the board ordered him to pay a $1,000 fine within 30 days or have his license suspended, according to records. In the end, the board gave Quinn seven extensions and four years to pay the fine and never punished him. In a written statement, the board said it gave Quinn more time to pay because of "economic hardship" and a reported burglary at his office. It noted that he paid the full amount in 2003.

In December 2002, Quinn's license expired. The board investigated -- but came to no determination -- whether he had continued practicing without a license. But in an April 2003 memo to Granger, Gregory N. Scurlock, the investigator, said he "advised Dr. Quinn to stop practicing medicine in the District of Columbia until his license had been reinstated." Quinn said that his license was renewed in May 2003.

Last year, the same investigator visited Quinn's office and found it in disarray. Quinn was dressed in layers of ragged clothes and dirty sneakers, and the investigator told Quinn to clean things up, according to the investigator's report.

"He and I agreed that I need to do a better job, but he was happy with what I showed him" two days later, when the investigator returned, Quinn said in an interview.

Quinn practiced for several more months until May 2004, when the board temporarily pulled his license for "demonstrating a willful or careless disregard for the health, welfare or safety of patients and professional or mental incompetence."

"They told me I was mentally or physically impaired because I practice in these conditions," Quinn said. But sharing space with the cab company, he said, was "a way to start up without much overhead. And it's convenient for people to find me."

Quinn said the board told him that it would reinstate his license if he had a psychiatrist certify that he was fit to practice, submit to random drug tests and agree to quarterly office inspections.

In its statement, the board defended its treatment of Quinn over the past seven years, saying that the doctor brought his practice "into compliance."

Many Complaints Untracked


In Maryland, about 3 percent of the more than 10,800 complaints the state board received between 1999 and 2004 led to discipline against doctors, according to its records. In Virginia, the amount was about 9 percent of its more than 8,725 complaints during that period. In the District, about 1 percent -- four of roughly 318 -- led to discipline.

The D.C. figures were compiled by The Post from board minutes; the board does not routinely track the complaints it receives.

"It's not a pressing need" to track complaints, Granger said. "I'm not sure what we would do other than marvel at the size of the folders."

But he added that the "vast majority of the complaints do not result in a disciplinary action against the licensee."

In the four cases that led to punishment between 1999 and 2004, the board knew the fate of the complaints. But for those against the remaining doctors, it did not compile how many led to investigations or were summarily dismissed.

For those who have gone to the board to air a grievance against a doctor, the process can be frustrating.

Montgomery County resident Elizabeth Ayala filed a complaint with the board in 2000 alleging that a doctor was rough with her during a procedure and left her feeling "violated."

"I was told they would put [the complaint] in their file and if they had any other complaints, they would take action against him," she recalled. "What I really wanted them to do at the time was make sure he wasn't doing these kind of objectionable practices."

Kim Wilczewski, who lives in Northern Virginia, filed a complaint with the board in 1999 accusing a doctor of violating patient confidentiality by "discussing her diagnosis, prognosis and other matters" with her employer, board records show. The board sent her a letter saying it would ask the doctor for his side of the story but that he wasn't required to provide any information. She said she never heard from the board again.

"I gave them a phone call, and they never responded," Wilczewski said. "They don't require the physician to respond, so why should they? I felt like I was wasting my time."

Penny Willett said she had a similar experience with the board when she complained that a doctor burned her during a procedure in 1999.

"I have permanent damage," said Willett, who lived in Charles County at the time. The board "did nothing. He was not reprimanded in any way, shape or form."

Staff researcher Bobbye Pratt and database editor Sarah Cohen contributed to this report.



http://www.washingtonpost.com/wp-dyn/artic...-2005Apr10.html

[no retreat, no s...]

Despite Deaths, D.C. License Upheld
City Board Chose Less Severe Penalties After Md. Abortion Complications
By Cheryl W. Thompson
Washington Post Staff Writer
Monday, April 11, 2005; Page A09


Two years after OB-GYN Gideon M. Kioko was found by the Maryland medical board to have mishandled abortions in 1989, he surrendered his license, which allowed him to avoid punishment. In one case, the patient died three days after the abortion; in the second, the woman suffered brain damage and died three years later. He petitioned the board for reinstatement a year later but was turned down. Nearly six years passed before the board restored his license -- with conditions.

In the District, however, where Kioko also was licensed, the city's medical board did not take the same hard line. It allowed him to continue practicing after the Maryland incidents.

When the board decided to act in 1996, it ignored an administrative law judge's recommendation to revoke his license. Instead, it placed him on probation, fined him $5,000, ordered community service and banned him from performing abortions in the city for five years. Three months later, the board lifted the abortion ban after a request from Kioko.

"I think they did the right thing," Kioko said in a recent interview. "They should have just left me alone."

Kioko, 65, maintained at the time that he did nothing wrong and in neither case was responsible for the anesthesia that was blamed for the problems. "The old story about me was completely twisted," he said in a recent interview.

In addition to the two deaths in Maryland, which prompted about a dozen people to write letters to city officials urging them to revoke his license, Kioko also had settled a $1 million malpractice lawsuit in 1995 filed by a female patient.

The D.C. medical board reinstated Kioko to unrestricted status in 1999 in an order signed by then-Chairman Robert T. Greenfield Jr., a physician who previously shared a practice with Kioko for 19 years, according to Kioko and board records.

Greenfield, who no longer has a medical practice with Kioko, said he recused himself from board deliberations. But because he was chairman, he said in an interview, "I had to sign it. He came before the board, we looked at his record and . . . deemed him fit to practice."

Kioko said his working relationship with Greenfield did not play a role in his reinstatement.

"Did he give me a break? No," Kioko said. "Should the vice chairman have signed it? Probably."

In August, the medical board received a new complaint about Kioko from Northeast Washington resident Thakerya Drayton, 21, who was referred to Kioko's clinic when she sought an abortion in 2001.

"I didn't know anything about him," she said in an interview.

After the procedure, she said, Kioko sent her to the recovery room for about an hour. "I knew something wasn't right because of the pain," she recalled.

When she got home, she was "bleeding out of control," she said. After a few days, she told her mother, who called an ambulance that took her to Howard University Hospital.

Hospital records state that Drayton suffered an "incomplete abortion."

Kioko said an incomplete abortion is considered a surgical complication and shouldn't warrant a complaint to the medical board.

"I know the medical board will respond if they think there's a serious deviation in standard of care," he said.

The medical board sent Kioko a letter in September with a copy of Drayton's complaint and added that he was not obligated to respond. He said he remembers her handwritten complaint.

"Her letter was so poorly written, I couldn't understand what she was complaining about," he said.

Kioko said he responded to Drayton's complaint in December but heard nothing from the board until he contacted it March 17 after being questioned by The Washington Post about the complaint.

James R. Granger Jr., the board's executive director, told him that the case was closed, Kioko said.

Drayton said that six days later, she received a letter from Granger stating that the case was closed with no action to be taken against Kioko. The board found no evidence of a violation of city law "that would warrant disciplinary action," Granger said in an interview. It was the first time Drayton had heard from the board since filing the complaint six months ago.

"I thought we would have a meeting with the board and Dr. Kioko," she said. But the board, she added, was "no help."

http://www.washingtonpost.com/wp-dyn/artic...-2005Apr10.html

[no retreat, no s...]

After Stealing Drugs, Doctor Goes to Rehab
Anesthesiologist Licensed to Practice in Several States
By Cheryl W. Thompson
Washington Post Staff Writer
Sunday, April 10, 2005; Page A07


When medical boards are faced with how to handle substance-abusing doctors, they often use rehabilitation as a substitute for discipline.

In the Washington area and across the country, physicians who test positive for drug or alcohol abuse are monitored, and sometimes they must agree to therapy or other steps. But rarely are they banned from practicing.

In some cases, medical boards are unaware of the problem. Employers may place doctors in the hands of a monitoring group -- usually independent of the medical boards -- or physicians enter rehab voluntarily. Even when doctors enter residential treatment programs, they often retain their licenses to practice.

California's medical board, for example, took no action against anesthesiologist Lewis M. Satloff when it learned of his drug use because he was already in a monitoring program, known in that state as "diversion."

"It's sort of an unusual circumstance," said Dave Thornton, executive director of the Medical Board of California. "We don't want to penalize a physician who's already in diversion by placing him on probation."

Because the rehab program operates in confidentiality, Thornton said, "we didn't realize he was in our diversion program."

Satloff, 48, who practiced in Baltimore before moving to Southern California, stole painkillers -- Demerol and fentanyl -- from a California hospital in 1999, according to medical board records in Arizona, where he also has a license. The drugs were for cardiac surgery patients, and any left over were supposed to be returned to the hospital's supply at the end of the day. But Satloff was using them himself, the records show.

Arizona's medical board became involved after Satloff admitted on his 2000 license renewal application there that he had been treated for drug use, according to the board records.

At one point, someone from the California hospital's staff confronted him about missing drugs, board records show, and he turned himself in to the state's diversion program. Under California law, the theft of Demerol or fentanyl carries a penalty of up to four years in prison.

The hospital -- Children's Hospital Los Angeles -- placed Satloff on leave in September 1999, and he agreed to get help, abstain from drug use and stop practicing medicine temporarily, according to Arizona medical board records and Steve Rutledge, a hospital spokesman. Three months after he entered outpatient treatment, Satloff worked one day as an on-call anesthesiologist at Midway Hospital Medical Center in Los Angeles and relapsed using fentanyl, according to board records and sources. A hospital housekeeper reported finding him in a bathroom at 10:30 p.m. with a syringe in his arm, according to two hospital sources familiar with the incident.

In a statement through his attorney, Satloff said he believes his drug problem was caused by "secondhand environmental exposure to opiates in the operation room." He said studies have shown that such exposure can cause "drug sensitization" and produce withdrawal-like symptoms, placing anesthesiologists at risk of drug abuse.

"Fortunately, through treatment and hard work, I have overcome that problem and have been working drug-free for nearly five years," Satloff said.

Neither Children's nor Midway reported the incidents to police. Four months later, Satloff entered an inpatient rehab center, which recommended that he not practice medicine where he had access to "potential drugs of abuse," according to the medical board records. Satloff returned to Children's Hospital in September 2001, Rutledge said.

The Midway Hospital sources said the Medical Board of California was notified about the incident but took no action. "We sent the report to them, and it certainly talks about the drug theft and his drug problem," one of the sources said.

California medical board officials said they learned about the drug incidents only after Satloff applied to renew his Arizona license. Satloff is now on probation -- but can still practice -- in Arizona and New York, records show. He surrendered his Massachusetts license in 2002, an action that halted a board investigation there, according to a release by that board. His Maryland license is inactive, but he can practice in Hawaii. California, where he has privileges at three Los Angeles area hospitals, has not disciplined him.

http://www.washingtonpost.com/wp-dyn/artic...7-2005Apr9.html

[no retreat, no s...]

Poor Performance Records Are Easily Outdistanced

By Cheryl W. Thompson
Washington Post Staff Writer
Tuesday, April 12, 2005; Page A01


Last of three articles

Gwyneth Vives was excited about becoming a mother for the first time at age 36. She shopped for baby outfits, attended birthing classes and painted moons and stars on the nursery ceiling for the infant she and her husband would name Alex.

But three hours after giving birth to a healthy boy in 2001, Vives, a scientist at Los Alamos National Laboratory in New Mexico, suffered a complication and bled to death. It was four days before Christmas.

Her husband, Ted, wouldn't learn until later that the doctor who tended to his wife that day at Los Alamos Medical Center had a troubled history.

Obstetrician and gynecologist Pamela L. Johnson had been forced to leave a previous job at Duke University Medical Center in North Carolina when questions arose about her surgical skills and her complication rate from medical procedures. Later, Johnson lied to get her New Mexico license, saying she had never lost hospital privileges, according to an order of the New Mexico Medical Board.

After Vives died, Johnson again lied about her past.

Claiming that she had never lost hospital privileges, Johnson was given a license to practice in Michigan, even before New Mexico could discipline her.

Hundreds of other doctors across the country have done the same: Facing problems in one state, they simply moved and restarted their careers. They were able to do so despite a federally imposed tracking system designed to prevent just that.

Among doctors licensed in the District, Maryland and Virginia, nearly two dozen got in trouble in one jurisdiction and then moved elsewhere to practice, according to a Washington Post analysis of medical board records between 1999 and 2004.

Nationally, 972 physicians during that period were disciplined in one state, then moved at least once more and were disciplined again for a separate infraction, according to federal statistics. Nineteen were disciplined in four or more states over five years.

Doctors who find themselves in trouble can move around because many are never reported to a national repository for doctor discipline records, known as the National Practitioner Data Bank. The aim of the data bank is to allow licensing boards and employers to check on doctors' records before they are hired and to prevent problem doctors from state-hopping.

But nearly 54 percent of all hospitals have never reported a disciplinary action to the data bank, according to the federal Department of Health and Human Services, which oversees the system. Even when hospitals or boards report problems, they don't always do it quickly, allowing doctors to move and get a new license before the paper trail catches up with them.

"It's only as good as the information reporters put in," said Cynthia Grubbs, a former acting deputy director and associate director for policy and analysis for the data bank.

Other weaknesses also plague the system:

• Federal law requires, for example, that hospitals and medical boards be penalized if they don't report to the data bank. But no fine or penalty has ever been levied, federal government officials acknowledged .

• Hospitals sometimes agree not to report doctors they are forcing from their staffs. This concession may smooth the way for a physician to leave without a fight, but it also mistakenly signals to other states and medical facilities that the doctor has a clean history.

• In some instances, physicians' names are removed from malpractice settlements to keep them out of the data bank. Only those who are named in the final settlement must be reported.

In Johnson's case, no one told the data bank that she had been forced to leave her job at Duke, according to records and interviews. Her false statement on her New Mexico application went undetected by the medical board for more than a year, records show.

Johnson's history "appeared in none of the routine investigations we did into her background," said Jenny Felmley, a spokeswoman for the New Mexico Medical Board.

Vives's husband and two other patients in New Mexico alleged in lawsuits that, during that time, Johnson was negligent or botched surgical procedures, accusations she denies. In the Vives case, Johnson denied that she contributed to the death and has said that the cause was an unpreventable embolism that was cited in the autopsy, according to court documents.

Like the state, officials at Los Alamos Medical Center knew nothing of her problems at Duke, according to Dan Green, a spokesman for Banner Health, which owned the hospital at the time. He said Johnson's record at Duke didn't surface when the medical center checked her out before granting her privileges.

Johnson, 46, said she did not knowingly break the rules. "I didn't think I was lying," she said in an interview from Michigan. "My attorney told me because there was nothing in writing [from Duke] that I didn't have to report that I had withdrawn privileges. I understand now that it should have all been reported."

Three Duke University officials, including the general counsel, would not comment on why the medical center did not report Johnson to the data bank. "It's not Duke's policy to discuss personnel issues," medical center spokesman Richard Puff said.

Data Bank's Loopholes


When the National Practitioner Data Bank began collecting reports in 1990, the goal was to stop doctors and some other licensed health care workers from escaping troubled histories by having a central location where any sanctions or malpractice payments could be recorded. Although the names would not be public, they would be available to state licensing boards, hospitals and other health care entities, including federal agencies.



Mark Pincus, who oversees the data bank, said it has "fulfilled its intent" and "does exactly what Congress intended it to do."

But others say that the federal government has done little to ensure that hospitals and others comply with the regulations.

"We have seen efforts to get around it, many of them successful," said Sen. Ron Wyden (D-Ore.), who co-authored the legislation that created the data bank. "There are significant loopholes that need to be closed."

Thomas Croft, who oversaw the data bank from 1991 to 2000, agreed that loopholes exist but said that the system has "added a degree of honesty to the environment." Knowing they've been reported, doctors are less likely to lie about their pasts, he said.

But the sanctions in the law and enforcement are "probably not strong enough," Croft said. "To say we were even aware of 10 percent of the possible violations [by doctors] is probably an exaggeration."

Dale G. Breaden, a spokesman for the North Carolina Medical Board, said hospitals help doctors by limiting discipline to less than 30 days because longer sanctions must be reported.

"Suddenly, everybody was taking action that didn't extend beyond 29 days," Breaden said.

The American Medical Association and other organizations have fought to keep the names of doctors private, arguing that opening the data bank to the public would violate physicians' privacy.

Wyden said he would like to allow the public to get information about "the most flagrant violations." Although that would certainly trigger opposition from the medical community, he said, "I think it's time to end the days when the consumers are the last to know."

High Complication Rate


Pamela Johnson had a promising career when she arrived as a 30-year-old resident at Duke University Medical Center in 1989. Records show that she joined the faculty four years later and was named an assistant professor in 1995.

But in 1997, Charles Hammond, head of OB-GYN, wrote to Johnson that she would have to leave Duke if she didn't "make significant progress," Johnson said in a court deposition. Later, Hammond asked her to stop performing surgery, according to the deposition.

In the deposition, Johnson said Hammond told her that her problems included a "high surgical complication rate" and the "worst QA [quality assurance] file of anyone at Duke." There was pressure from the hospital's risk management office to fire her to avoid paying a higher malpractice premium for the department, she said in the deposition. In June 2000, Johnson's Duke hospital privileges were terminated, according to a New Mexico Medical Board record.

In the interview, Johnson said she was a "fairly good" surgeon but acknowledged that she had "a few little" problems at Duke.

Former Duke employee Monia Thomas was one of three patients in North Carolina to file claims against Johnson for malpractice, accusing her of nicking her intestine during a 1997 tubal ligation. Thomas said in an interview and in her complaint that she ended up in the emergency room, which turned into a 10-day hospital stay. Doctors had to perform a colostomy, which was later reversed, Thomas said in the interview.

Thomas, now 45, said she was unable to work for a year. "I had to wrap my side in towels so that no one sitting next to me in church would hear the noise from the [colostomy] bag," she said. "I was just going in to get a tubal ligation. She told me in a couple of days I would be ready to go back to work."

Thomas sued Duke as well as Johnson. In 2000, the case was settled with Duke for an undisclosed amount, she said.

Johnson said in the interview that she didn't remember Thomas or the operation.

Even though Johnson was forced to leave, Duke gave her something that would help her get hospital privileges in three other states: letters of recommendation.

Three months after her Duke privileges were terminated, she was hired at a practice in Danville, Va., and given privileges at Danville Regional Medical Center. Lenworth A. Beaver, the doctor who hired her, said he didn't know about her troubles at Duke at the time. She quit after five months, he said, because "our practice wasn't making enough to pay her what she wanted."

Johnson, a wife and mother of two girls, landed a job with Los Alamos Women's Health Services -- a New Mexico medical group -- and received privileges at Los Alamos Medical Center, records show. Although the hospital was ignorant of her past, an official said, the medical group was not.

Before it hired her, it knew of at least one surgical complication involving Johnson and that she had been asked to leave Duke, according to a handwritten note by one of the group's partners filed in court records.

Hours After Joy, Tragedy


By the time Gwyn Vives arrived at Los Alamos Medical Center to give birth in December 2001, Johnson had had her New Mexico license for five weeks. Vives was admitted to the hospital by Johnson. Her labor was induced, and with the help of a midwife, she gave birth just before noon. With her husband at her side, Vives was "holding baby, bonding well," according to a hospital report.

But shortly after, things went wrong.

According to a lawsuit filed by Ted Vives, his wife suffered a vaginal tear and other lacerations during the delivery that caused profuse bleeding. While Johnson was repairing the vaginal tear, Vives's pulse rate soared. She was given several medications to stop the bleeding. Johnson left the delivery room about 1 p.m. to assist with another procedure, turning the repair over to the midwife.

The lawsuit alleged that Johnson's "negligence and recklessness" contributed to Vives's death, saying that after partially repairing the vaginal tear, Johnson ignored Vives's "bleeding, tachycardia, cervical lacerations, repeated alarms and signs of shock, abandoning her patient." Johnson failed to call an anesthesiologist or prepare for a blood transfusion, the lawsuit alleged.

Johnson returned to the delivery room about 1:45 p.m. after being paged and tried to repair the lacerations, then ordered that Vives be moved to an operating room. In the operating room, Vives's heart failed, and doctors could not resuscitate her. She was pronounced dead at 3:06 p.m.

The autopsy said that Vives died from excess blood loss due to an amniotic fluid embolism, "a rare complication of childbirth" that is "unpredictable and unpreventable." Cervical lacerations can make a patient more susceptible to such an embolism, the autopsy said.

A former hospital official familiar with the case said that "there were some amniotic cells found in the lung capillaries" but did not know what caused her to bleed to death.

"The bleeding had been going on, and it wasn't treated appropriately," said the former official, who spoke on condition of anonymity for fear of retribution.

"Obviously, [Johnson] didn't know she had an embolism. The transfusion wasn't done. If it had been done and she had died, no one would have said anything," the official said. "They would have said that [Johnson] gave it her best effort. But there wasn't that best effort, and that concerned the executive committee" at the hospital.

The lacerations occurred during the delivery, for which Johnson was not present. Johnson said at the time that Vives's death was due to the embolism, according to court documents.

"They were looking for a scapegoat," Johnson said in an interview.

Ted Vives sued the medical center and the women's health group, the midwife and Johnson, saying the facilities should not have hired Johnson, given her record at Duke.

"Alex was born at 11:55 a.m. I was on the phone to everyone in the family shouting the wonderful news," Vives wrote in an e-mail to The Post. "Three hours later, I had to deliver to these same people the most unimaginable, saddest news: Gwyn was dead."

Lie Leads to Suspension


Gwyn Vives. Jean Challacombe. Tanya Lewis. In each case, patients or their families alleged that Johnson botched what should have been routine procedures at Los Alamos.

Challacombe alleged in a lawsuit that Johnson tore her bowel and uterus while doing a dilation and curettage the same day Vives died. In a separate lawsuit, Lewis accused Johnson of doing an unnecessary hysterectomy. In both cases, Johnson filed documents in court denying the allegations.

Challacombe settled her case in 2003, and the Vives suit was settled last year, both for undisclosed amounts, according to an attorney familiar with the cases who requested anonymity because of confidentiality agreements. The Lewis case is pending.

Johnson's attorney in New Mexico, Ben Allen, did not return two telephone calls seeking comment. Green, the spokesman for Banner Health, said the hospital erred by giving Johnson surgical privileges.

"In hindsight, from a procedural point of view, she probably should not have been credentialed to do procedures in the hospital," Green said.

In March 2002, three months after Vives died, Johnson was told that she must have a proctor present to perform surgery, according to a court deposition.

Los Alamos hospital officials subsequently learned about Johnson's troubles at Duke when questions arose about patient complications and an investigation was conducted. She resigned during the investigation, according to the former hospital official.

In December 2002, 13 months after issuing Johnson a license, the New Mexico Medical Board suspended it for "fraud and misrepresentation," records show, because she lied on her application. But notice of that five-month suspension didn't make it into the data bank until July 2004, after an inquiry from a Post reporter.

"It was an oversight on our part," said Felmley, the spokeswoman for the New Mexico board.

Los Alamos sent a report to the data bank, saying that Johnson "resigned while under investigation," the former hospital official said. But by that time, Johnson had moved to Michigan and been given a license there after, once again, she lied on her application.

When the Michigan medical board discovered the lie more than a year later, it put her on probation and restricted her to practicing in a university residency program in preventive medicine.

State licensing officials acknowledged that they failed to check the data bank.

"We don't check the data bank for new applicants," said Ray Garza, a spokesman for the Michigan Bureau of Health Professions, citing a lack of staff and resources. "We trust people to be honest on their application."

Staff researcher Bobbye Pratt and database editor Sarah Cohen contributed to this report.

http://www.washingtonpost.com/wp-dyn/artic...-2005Apr11.html

[no retreat, no s...]

Red Flags About Md. Man Ignored
With Each New Job, More Accusations of Substance and Sex Abuse
By Cheryl W. Thompson
Washington Post Staff Writer
Tuesday, April 12, 2005; Page A07


Obstetrician-gynecologist Jeffrey M. Levitt needed a job, and Stuttgart, Ark., needed an OB-GYN. So the country town about an hour southeast of Little Rock was prepared to overlook the warning signs.

Board records from Maryland and Florida show that Levitt lost his Maryland medical license in 1993 for having sex with two patients and "had to be asked to not carry a gun" when he worked at Holy Cross Hospital in Silver Spring.

So when he learned about the Arkansas job through a job placement agency, he applied.

"The staff at Stuttgart Regional Medical Center is willing to take a chance on him in spite of the red flags," Noble B. Daniel, then the hospital's chief of staff, wrote in a December 1995 letter to the Arkansas State Medical Board.

Gary P. Wood, the town's retiring obstetrician, warned the Arkansas board to examine Levitt's history in Maryland.

"When folks get into that kind of trouble, they go anyplace people will have them," Wood said in an interview. Stuttgart hospital administrators, he said, "felt that they needed somebody so badly that they could overlook the red flags. Bad choice."

The Arkansas board granted Levitt a temporary license in December 1995, and Stuttgart welcomed him.

But within three months, the situation soured. Levitt said in a recent interview that he was forced from the hospital after "a woman made allegations that I made a pass at her and said something lewd." There were also rumors that he was an alcoholic, he said. He has denied the accusations. "Everything I did, they twisted. I couldn't get anyone to listen to me."

In 1996, Levitt returned to practice in Maryland, which had reinstated his license on probation after a year, despite the three-year suspension in 1993, according to board records.

But in 1998, the Maryland medical board began an investigation after a patient complained that Levitt wrote her prescriptions and told her to bring him some of the drugs for his use, board records show.

Levitt also asked doctors at a Rockville clinic where he worked to write prescriptions for him, sometimes calling them at 2 a.m.

In July 1998, clinic staff said Levitt showed up appearing to be "intoxicated and/or under the influence of medication or controlled substances," according to board records. He performed acupuncture on a patient but abandoned her with the needles still in her body. "That was my fault. I forgot that she was there," he said in an interview, denying that he had been under the influence. "They used that as an excuse to fire me."

The Maryland board suspended Levitt's license in 1999 and revoked it for five years in 2000 after finding that he again had sex with patients, had questionable prescribing practices and practiced acupuncture without a state registration. He is eligible to apply for reinstatement this year. Levitt, 49, now lives in Scottsdale, Ariz., with his wife, a former patient who once filed a complaint with the Maryland medical board, saying that they had a sexual relationship, that he used her to procure drugs and that he had thrown her across the room.

The Maryland board should have been tougher on Levitt, argued Sandra Brown, who claimed he tore her colon 12 years ago during a uterine laparoscopy. Brown, who lives in Prince George's County, said she was in so much pain after the surgery that she couldn't sit up or eat for more than a week.

"I called him every other day about the pain, and he kept telling me it was gas," she said. Eventually, surgeons removed eight inches of her colon, she said.

Brown, 47, sued Levitt. She settled the case for an undisclosed amount in 1997, she said. Levitt said he told Brown that the surgery was high-risk.

"She knew that," he said in the interview. "She had damage, but it wasn't because I was neglectful. With laser [surgery], you don't see certain things."

Another former Maryland patient, Margie Galanos, sued Levitt, alleging that he punctured her bladder and bowel during a laparoscopy in 1991.

"When I got home, I was in so much pain that I just prayed to God to let me pass out," said Galanos, 43, who lives near Athens, Ga.

"I spent 46 days in a critical-care unit after what should have been a simple laparoscopy."



Galanos said she was unable to have children after the procedure. Her suit was settled for an undisclosed amount in 1997.

Levitt denied puncturing Galanos's bladder and bowel and said her problems were caused by contaminated equipment. "It wasn't due to the handling of the practitioner," he said. "She's right. It should have been simple. But lo and behold, [expletive] happens."

Staff researcher Bobbye Pratt contributed to this report.

http://www.washingtonpost.com/ac2/wp-dyn/A...anguage=printer

[no retreat, no s...]

Multiple State Licenses Helped Shield History

By Cheryl W. Thompson
Washington Post Staff Writer
Tuesday, April 12, 2005; Page A07


After physician Joseph S. Hayes was charged in 1999 with fondling female patients -- but before he was convicted -- he simply pulled out a different state license and moved. He left Tennessee and got a job at a wellness center in South Carolina, where he had held a license since 1973.

Because he had kept his South Carolina license active, he said, he could start practicing there without any new applications or background checks.

"As long as they pay that fee to keep their license active, they can move from one state to another and nobody is none the wiser," said Thomas Croft, former head of the National Practitioner Data Bank.

Hayes's move to Greer, S.C., came after several run-ins with the law in Tennessee. He had three criminal convictions since 1987 for drug offenses and assaults, according to court and state medical board records, including choking a patient and possession of a controlled substance, a felony.

Hayes, 59, a family practice doctor, pleaded guilty to assault and resisting arrest after he attacked a police officer who was trying to place him under arrest.

And he was charged with slapping a waitress in a dispute over a restaurant bill. The judge dropped that charge after Hayes agreed to apologize to the woman and stay away from the restaurant.

"The foregoing is indicative of a medical professional who is out of control," according to a 1991 Tennessee board order suspending Hayes's license.

But Hayes ignored the suspension. He saw patients and dispensed drugs, according to board records.

His Tennessee license was revoked a few months later but reinstated in 1993.



South Carolina was not the only alternative for Hayes. He was issued a Virginia license in August 1999, two months after being charged with touching patients in Tennessee, but it was suspended in 2002. He has also held a North Carolina license, which was revoked in 2004.

Tennessee revoked his license in 2001 after he returned there and was convicted of fondling three patients. But in 2002, it was reinstated with limitations, allowing him to perform administrative jobs only in a male prison.

He said he feels the restrictions are unfair. "I had some problems related to drugs and alcohol and went through treatment, and I think I'm a hell of a lot better than some who haven't been treated," Hayes said in an interview.

"I am looking forward to getting an unrestricted license."

Hayes, who said he bought and runs a mold remediation company in Tennessee, said he hopes to return to practicing family medicine or urgent care this month.

Staff researcher Bobbye Pratt contributed to this report.

http://www.washingtonpost.com/ac2/wp-dyn/A...anguage=printer

[no retreat, no s...]