Bonner, Raymond. "Deaths and a Doctor's Past Transfix Australians," New York Times, 19

 

Bonner, Raymond. "Deaths and a Doctor's Past Transfix Australians," New York Times, 19
June 2005, pp. 1, 14.

BUNDABERG, Australia, June 18 - When Dr. Jayant Patel accepted a surgical post at the
municipal hospital here two years ago, it was a big relief to this farm town, which has had trouble
finding and keeping doctors. Dr. Patel was a professor of surgery at the State University of New
York at Buffalo in the 1980's, and he came highly recommended by several doctors in Oregon,
where he had also worked.

But almost immediately, after he declared a patient to be stable when in fact the patient was brain
dead, at least one nurse worried about his competence. Before long, nurses were hiding patients
from him. One doctor ordered that Dr. Patel not operate on any of his patients, after he saw him
perform an operation without anesthesia. An anesthesiologist nicknamed him "Dr. Death."

On Monday, the state government commission of inquiry here will open a new round of
investigation into whether Dr. Patel, an American citizen educated in India, is responsible in any
way in the deaths of 87 patients. Not least, it wants to know how Dr. Patel was hired without
anyone doing so much as a Google search on his name.

Such a search would have disclosed, as it did this year for a Brisbane reporter, that Dr. Patel had
been disciplined in New York and Oregon, and that he admitted errors to the Oregon authorities
after a review of the cases of 79 of his patients, 3 of whom died from surgical complications.

Dr. Patel has returned to Oregon, with a business-class ticket paid for by the hospital, though it is
not clear that he remains there.

His case is reverberating in Australia and the United States, raising questions about how the
medical profession regulates its doctors, especially those who evade troubled pasts by moving
from state to state - or country to country.

The commission recommended on Monday that Dr. Patel be charged with manslaughter and
murder, saying that when "an impostor pretends to be a medical practitioner, and kills a patient
whilst attempting a surgical procedure," a murder charge is warranted.

Dr. Patel's lawyer in Portland, Ore., Stephen Houze, called the recommendations "outrageous,"
noting they came after just two weeks of testimony. Dr. Patel has not been charged with any
crimes, he said. If he eventually is, it is hard to imagine how he could get a fair trial in Australia,
Mr. Houze said, adding, "We have very grave concerns about this drumbeat of incessant and
prejudicial publicity that is saturating all of Queensland, and indeed all of Australia." He said he
had met in Portland this week with representatives of the Queensland government, who had a
letter for the doctor.

Mr. Houze said he told the officials that Dr. Patel was not a fugitive, and that he was in constant
contact. But he did not say where he was.

Starting Monday, the Australian commission will hear from former patients and the families of
deceased patients. So far, the principal testimony has come from Toni Ellen Hoffman, head nurse
in the intensive care unit during Dr. Patel's tenure.

In testimony bolstered by the hospital's director of medicine, Ms. Hoffman told the commission
that Dr. Patel had performed numerous esophagectomies, operations to remove a cancerous
growth on the esophagus, for which the hospital did not have follow-up facilities.

Dr. Patel, she testified, retorted that he was bringing in half a million dollars a year in revenues
for the hospital. (Queensland hospitals are reimbursed for such operations.)

Ms. Hoffman said that patients had died because Dr. Patel refused to transfer them to the better
equipped hospital in Brisbane; that in many cases, a patient's surgical wounds came apart; and
that he routinely refused to perform CT scans on cancer patients, so that they were operated on
when other treatments would have been better.

Week after week, Ms. Hoffman said, she witnessed troubling episodes. She registered her
concerns, in e-mail messages, letters and orally, with her supervisor, the nurse's union and
hospital administrators. She was told it was a "personality problem," she testified.

She could not go to the local newspaper, because the Queensland state health department bars
employees from talking to the press.

Then in July 2004, a man was brought to the hospital after being crushed by a camper van. At
first, Dr. Patel said the patient, Des Bramich, was not in such serious condition that he needed to
be taken to Brisbane. Then, he said Mr. Bramich was too ill to move. Mr. Bramich died.

"Dr. Patel screamed at patient's wife not to cry," Ms. Hoffman wrote in notes of a meeting she
then sought with hospital officials. Mr. Bramich's 9-year-old daughter "watched her father die,"
she added. "This was the final straw."

She laid out her concerns and asked for an independent audit. The next month, the hospital chose
Dr. Patel as its employee of the month. "It was like a big slap in the face," she said.

More patients died.

Finally, when the hospital was offering Dr. Patel a new four-year contract, in March of this year,
Ms. Hoffman, with considerable trepidation, contacted a Queensland state legislator. The
legislator made a statement in Parliament, which allowed the case to come to light.

Ms. Hoffman was vilified, as doctors and politicians rallied to Dr. Patel's defense. "It's an
absolute disgrace that Dr. Patel has been forced to leave his job," said the president of the
Queensland branch of the Australian Medical Association. "Bundaberg hospital has lost a
surgeon when it could ill afford to do so."

At first, most Bundaberg residents did not believe the allegations either, Lucy Ardern, editor of
The Bundaberg News Mail, said in an interview. Now people do, she said, noting that circulation
had increased noticeably, as residents try to follow the scandal.

The turning point came when a veteran investigative reporter at The Brisbane Courier Mail,
Hedley Thomas, did his Google search, typing in "Jayant Patel." When he called the hospital and
health department officials for comment, Mr. Thomas said he was told that it was the first they
knew of the disciplinary actions in New York and Oregon.

Now Oregon medical authorities, too, are coming under criticism that they moved too slowly.

In 1989, Dr. Patel went to work in Portland for Kaiser Permanente, Jim Gersbach, a spokesman
for the nonprofit health care company, confirmed. He was voted teacher of the year, in 1991 and
1992, and he received one of the distinguished physician awards in 1995.

But by mid-1998, questions about Dr. Patel's work from fellow surgeons led Kaiser to conduct a
peer review and to bring his case to the attention of state authorities.

"We then hired consultants to investigate that case," said Dr. Joseph Thaler, chairman of the
Oregon Board of Medical Examiners. "We acted in 2000 to restrict his license."

The board's findings focused on four botched operations. Three of the patients, ages 65 to 83,
immediately developed complications and were returned to surgery for internal bleeding. All
three died.

The other patient, a 59-year-old man with hernia symptoms, had to have a second operation to
correct a colostomy that Dr. Patel had performed "backwards," according to the board's findings.

The board prohibited the doctor from doing operations involving the pancreas or liver, and
required him to get a second opinion in complicated surgical cases. Dr. Thaler said that the board
sent notice of its decision to three national databases. All should be readily accessible to officials
in Australia, he said. This April the board finally "inactivated" Dr. Patel's license.

Dr. Patel left Kaiser in 2001. Mr. Gersbach, the spokesman, would not say if he was asked to
leave. "Dr. Patel resigned," he said. He took with him at least six recommendations, most from
fellow Kaiser doctors.

"It gives me great pleasure to recommend Jayant Patel," wrote one doctor from Kaiser. Another
wrote that Dr. Patel had "above average knowledge of surgery" and "very high moral standards."

All were written after he had been disciplined in Oregon.

Through Kaiser's public relations office, none of the doctors who wrote the letters would
comment. But Mr. Gersbach noted that before Dr. Patel was hired by Kaiser, "we also received
favorable letters of recommendation from his employers in New York State."

There, in January 1984, after an investigation and hearing, a state board declared Dr. Patel guilty
of medical fraud, negligence, incompetence and unprofessional conduct after he was found to
have filled in medical histories for patients he never examined.

He was reprimanded and censured, and his license was suspended for six months; the suspension
stayed during a three-year probation. The punishment was routine.

"It wasn't anything drastic," Dr. William C. Heyden, who served on the hearing committee, said
about the case. "He hadn't done anything evil to anybody. He hadn't killed anybody or anything."

The reprimand did not stop Dr. Patel from becoming an assistant professor of surgery at SUNY
Buffalo, and the director of surgical education at Millard Fillmore Hospital.

After his troubles in Oregon, Dr. Patel tried to resume practice in New York. But the medical
conduct board concluded that he could be criminally prosecuted for what he had done in Oregon.
Rather than face prosecution, Dr. Patel surrendered his license.

He began looking abroad and contacted a medical recruiting firm in Sydney, Wavelength
Consulting, which had been asked by the hospital in Bundaberg to help find a surgeon.
Wavelength, which was paid roughly $10,000, relied on the documents submitted by Dr. Patel.

"At that time an ‘Internet search' was not considered a recognized or reliable tool for checking a
doctor's history," the company said in a statement after the scandal erupted. "We, too, were
deceived."

Ken Olsen contributed reporting from Portland, Ore., for this article, and David Staba from
Buffalo.



June 25, 2005
On Autism's Cause, It's Parents vs. Research
By GARDINER HARRIS and ANAHAD O'CONNOR

Kristen Ehresmann, a Minnesota Department of Health official, had just told a State Senate
hearing that vaccines with microscopic amounts of mercury were safe. Libby Rupp, a mother of a
3-year-old girl with autism, was incredulous.

"How did my daughter get so much mercury in her?" Ms. Rupp asked Ms. Ehresmann after her
testimony.

"Fish?" Ms. Ehresmann suggested.

"She never eats it," Ms. Rupp answered.

"Do you drink tap water?"

"It's all filtered."

"Well, do you breathe the air?" Ms. Ehresmann asked, with a resigned smile. Several parents
looked angrily at Ms. Ehresmann, who left.

Ms. Rupp remained, shaking with anger. That anyone could defend mercury in vaccines, she
said, "makes my blood boil."

Public health officials like Ms. Ehresmann, who herself has a son with autism, have been trying
for years to convince parents like Ms. Rupp that there is no link between thimerosal - a
mercury-containing preservative once used routinely in vaccines - and autism.

They have failed.

The Centers for Disease Control and Prevention, the Food and Drug Administration, the Institute
of Medicine, the World Health Organization and the American Academy of Pediatrics have all
largely dismissed the notion that thimerosal causes or contributes to autism. Five major studies
have found no link.

Yet despite all evidence to the contrary, the number of parents who blame thimerosal for their
children's autism has only increased. And in recent months, these parents have used their
numbers, their passion and their organizing skills to become a potent national force. The issue
has become one of the most fractious and divisive in pediatric medicine.

"This is like nothing I've ever seen before," Dr. Melinda Wharton, deputy director of the
National Immunization Program, told a gathering of immunization officials in Washington in
March. "It's an era where it appears that science isn't enough."

Parents have filed more than 4,800 lawsuits - 200 from February to April alone - pushed for state
and federal legislation banning thimerosal and taken out full-page advertisements in major
newspapers. They have also gained the support of politicians, including Senator Joseph I.
Lieberman, Democrat of Connecticut, and Representatives Dan Burton, Republican of Indiana,
and Dave Weldon, Republican of Florida. And Robert F. Kennedy Jr. wrote an article in the June
16 issue of Rolling Stone magazine arguing that most studies of the issue are flawed and that
public health officials are conspiring with drug makers to cover up the damage caused by
thimerosal.

"We're not looking like a fringe group anymore," said Becky Lourey, a Minnesota state senator
and a sponsor of a proposed thimerosal ban. Such a ban passed the New York State Legislature
this week.

But scientists and public health officials say they are alarmed by the surge of attention to an idea
without scientific merit. The anti-thimerosal campaign, they say, is causing some parents to stay
away from vaccines, placing their children at risk for illnesses like measles and polio.

"It's really terrifying, the scientific illiteracy that supports these suspicions," said Dr. Marie
McCormick, chairwoman of an Institute of Medicine panel that examined the controversy in
February 2004.

Experts say they are also concerned about a raft of unproven, costly and potentially harmful
treatments - including strict diets, supplements and a detoxifying technique called chelation - that
are being sold for tens of thousands of dollars to desperate parents of autistic children as a cure
for "mercury poisoning."

In one case, a doctor forced children to sit in a 160-degree sauna, swallow 60 to 70 supplements a
day and have so much blood drawn that one child passed out.

Hundreds of doctors list their names on a Web site endorsing chelation to treat autism, even
though experts say that no evidence supports its use with that disorder. The treatment carries
risks of liver and kidney damage, skin rashes and nutritional deficiencies, they say.

In recent months, the fight over thimerosal has become even more bitter. In response to a barrage
of threatening letters and phone calls, the centers for disease control has increased security and
instructed employees on safety issues, including how to respond if pies are thrown in their faces.
One vaccine expert at the centers wrote in an internal e-mail message that she felt safer working
at a malaria field station in Kenya than she did at the agency's offices in Atlanta.

An Alarm Is Sounded

Thimerosal was for decades the favored preservative for use in vaccines. By weight, it is about
50 percent ethyl mercury, a form of mercury most scientists consider to be less toxic than methyl
mercury, the type found in fish. The amount of ethyl mercury included in each childhood vaccine
was once roughly equal to the amount of methyl mercury found in the average tuna sandwich.

In 1999, a Food and Drug Administration scientist added up all the mercury that American
infants got with a full immunization schedule and concluded that the amount exceeded a
government guideline. Some health authorities counseled no action, because there was no
evidence that thimerosal at the doses given was harmful and removing it might cause alarm.
Others were not so certain that thimerosal was harmless.

In July 1999, the American Academy of Pediatrics and the Public Health Service released a joint
statement urging vaccine makers to remove thimerosal as quickly as possible. By 2001, no
vaccine routinely administered to children in the United States had more than half of a
microgram of mercury - about what is found in an infant's daily supply of breast milk.

Despite the change, government agencies say that vaccines with thimerosal are just as safe as
those without, and adult flu vaccines still contain the preservative.

But the 1999 advisory alarmed many parents whose children suffered from autism, a lifelong
disorder marked by repetitive, sometimes self-destructive behaviors and an inability to form
social relationships. In 10 to 25 percent of cases, autism seems to descend on young children
seemingly overnight, sometime between their first and second birthdays.

Diagnoses of autism have risen sharply in recent years, from roughly 1 case for every 10,000
births in the 1980's to 1 in 166 births in 2003.

Most scientists believe that the illness is influenced strongly by genetics but that some unknown
environmental factor may also play a role.

Dr. Tom Insel, director of the National Institute for Mental Health, said: "Is it cellphones?
Ultrasound? Diet sodas? Every parent has a theory. At this point, we just don't know."

In 2000, a group of parents joined together to found SafeMinds, one of several organizations that
argue that thimerosal is that environmental culprit. Their cause has been championed by
politicians like Mr. Burton.

"My grandson received nine shots in one day, seven of which contained thimerosal, which is 50
percent mercury as you know, and he became autistic a short time later," he said in an interview.

In a series of House hearings held from 2000 through 2004, Mr. Burton called the leading experts
who assert that vaccines cause autism to testify. They included a chemistry professor at the
University of Kentucky who says that dental fillings cause or exacerbate autism and other
diseases and a doctor from Baton Rouge, La., who says that God spoke to her through an
87-year-old priest and told her that vaccines caused autism.

Also testifying were Dr. Mark Geier and his son, David Geier, the experts whose work is most
frequently cited by parents.

Trying to Build a Case

Dr. Geier has called the use of thimerosal in vaccines the world's "greatest catastrophe that's
ever happened, regardless of cause."

He and his son live and work in a two-story house in suburban Maryland. Past the kitchen and
down the stairs is a room with cast-off, unplugged laboratory equipment, wall-to-wall carpeting
and faux wood paneling that Dr. Geier calls "a world-class lab - every bit as good as anything at
N.I.H."

Dr. Geier has been examining issues of vaccine safety since at least 1971, when he was a lab
assistant at the National Institutes of Health, or N.I.H. His résumé lists scores of publications,
many of which suggest that vaccines cause injury or disease.

He has also testified in more than 90 vaccine cases, he said, although a judge in a vaccine case in
2003 ruled that Dr. Geier was "a professional witness in areas for which he has no training,
expertise and experience."

In other cases, judges have called Dr. Geier's testimony "intellectually dishonest," "not reliable"
and "wholly unqualified."

The six published studies by Dr. Geier and David Geier on the relationship between autism and
thimerosal are largely based on complaints sent to the disease control centers by people who
suspect that their children were harmed by vaccines.

In the first study, the Geiers compared the number of complaints associated with a
thimerosal-containing vaccine, given from 1992 to 2000, with the complaints that resulted from a
thimerosal-free version given from 1997 to 2000. The more thimerosal a child received, they
concluded, the more likely an autism complaint was filed. Four other studies used similar
methods and came to similar conclusions.

Dr. Geier said in an interview that the link between thimerosal and autism was clear.

Public health officials, he said, are " just trying to cover it up."

Assessing the Studies

Scientists say that the Geiers' studies are tainted by faulty methodology.

"The problem with the Geiers' research is that they start with the answers and work backwards,"
said Dr. Steven Black, director of the Kaiser Permanente Vaccine Study Center in Oakland,
Calif. "They are doing voodoo science."

Dr. Julie L. Gerberding, the director of the disease control centers, said the agency was not
withholding information about any potentially damaging effects of thimerosal.

"There's certainly not a conspiracy here," she said. "And we would never consider not
acknowledging information or evidence that would have a bearing on children's health."

In 2003, spurred by parents' demands, the C.D.C. asked the Institute of Medicine, an arm of the
National Academy of Sciences and the nation's most prestigious medical advisory group, to
review the evidence on thimerosal and autism.

In a report last year, a panel convened by the institute dismissed the Geiers' work as having such
serious flaws that their studies were "uninterpretable." Some of the Geiers' mathematical
formulas, the committee found, "provided no information," and the Geiers used basic scientific
terms like "attributable risk" incorrectly.

In contrast, the committee found five studies that examined hundreds of thousands of health
records of children in the United States, Britain, Denmark and Sweden to be persuasive.

A study by the World Health Organization, for example, examined the health records of 109,863
children born in Britain from 1988 to 1997 and found that children who had received the most
thimerosal in vaccines had the lowest incidence of developmental problems like autism.

Another study examined the records of 467,450 Danish children born from 1990 to 1996. It
found that after 1992, when the country's only thimerosal-containing vaccine was replaced by
one free of the preservative, autism rates rose rather than fell.

In one of the most comprehensive studies, a 2003 report by C.D.C. scientists examined the
medical records of more than 125,000 children born in the United States from 1991 to 1999. It
found no difference in autism rates among children exposed to various amounts of thimerosal.

Parent groups, led by SafeMinds, replied that documents obtained from the disease control
centers showed that early versions of the study had found a link between thimerosal and autism.

But C.D.C. researchers said that it was not unusual for studies to evolve as more data and
controls were added. The early versions of the study, they said, failed to control for factors like
low birth weight, which increases the risk of developmental delays.

The Institute of Medicine said that it saw "nothing inherently troubling" with the C.D.C.'s
adjustments and concluded that thimerosal did not cause autism. Further studies, the institute
said, would not be "useful."

Threats and Conspiracy Talk

Since the report's release, scientists and health officials have been bombarded with hostile e-mail
messages and phone calls. Dr. McCormick, the chairwoman of the institute's panel, said she had
received threatening mail claiming that she was part of a conspiracy. Harvard University has
increased security at her office, she said.

An e-mail message to the C.D.C. on Nov. 28 stated, "Forgiveness is between them and God. It is
my job to arrange a meeting," according to records obtained by The New York Times after the
filing of an open records request.

Another e-mail message, sent to the C.D.C. on Aug. 20, said, "I'd like to know how you people
sleep straight in bed at night knowing all the lies you tell & the lives you know full well you
destroy with the poisons you push & protect with your lies." Lynn Redwood of SafeMinds said
that such e-mail messages did not represent her organization or other advocacy groups.

In response to the threats, C.D.C. officials have contacted the Federal Bureau of Investigation
and heightened security at the disease control centers. Some officials said that the threats had led
them to look for other jobs.

In "Evidence of Harm," a book published earlier this year that is sympathetic to the notion that
thimerosal causes autism, the author, David Kirby, wrote that the thimerosal theory would stand
or fall within the next year or two.

Because autism is usually diagnosed sometime between a child's third and fourth birthdays and
thimerosal was largely removed from childhood vaccines in 2001, the incidence of autism should
fall this year, he said.

No such decline followed thimerosal's removal from vaccines during the 1990's in Denmark,
Sweden or Canada, researchers say.

But the debate over autism and vaccines is not likely to end soon.

"It doesn't seem to matter what the studies and the data show," said Ms. Ehresmann, the
Minnesota immunization official. "And that's really scary for us because if science doesn't
count, how do we make decisions? How do we communicate with parents?"