Some patients and family members who came to the Houston hospital for liver and lung transplants have complained about the quality of care provided. A St. Luke's spokeswoman says the transplant programs still meet national benchmarks and argues against focusing on outcomes from a single calendar year.
This article first appeared November 30, 2018 on ProPublica.
During the summer of 2017, Baylor St. Luke's Medical Center posted a banner on its website, celebrating its liver and lung transplant programs as "#1 in Texas."
That declaration was based on the latest publicly available data, which showed stellar one-year survival rates for patients who received liver and lung transplants at St. Luke's between 2014 and the middle of 2016.
But soon after the hospital published those marketing materials in August 2017, both of those transplant programs began to see increases in patient deaths, an investigation by the Houston Chronicle and ProPublica has found.
Of 85 patients who received a liver transplant at St. Luke's in 2017, at least 15 have died within a year, up from previous years and worse than the national average. That's according to preliminary data provided to reporters by the Scientific Registry of Transplant Recipients, a Minnesota-based group that measures transplant outcomes on behalf of the federal government.
Also last year, according to data provided by the registry, at least seven of the hospital's 54 lung recipients died within a year of their transplants, double the mortality rate at the hospital during the previous two and a half years.
These figures do not include patients who received livers or lungs as part of multi-organ transplants or those receiving second transplants after having previously received new organs.
Both the lung and liver programs at St. Luke's have slowed down in 2018, with the number of transplants performed down 40 percent and 16 percent, respectively, through October, compared with the same period last year. Both programs also have had patients suffer unusual complications this year, according to a review of medical records and interviews with surviving family members.
In February, a patient's new lung flipped over inside her chest, an event so rare that experts sometimes document individual cases in medical journals. Another patient developed a serious tear in his airway following his December 2017 lung transplant and never recovered from the setback. And in July, a 36-year-old single mother undergoing a liver transplant died in the operating room, prompting friends to seek donations to pay for her funeral and care for the daughter she left behind.
These deaths came as St. Luke's was facing scrutiny for poor outcomes in its heart transplant program. In May, ProPublica and the Chronicle reported on an outsized number of deaths and complications in that program, which had prompted a couple of St. Luke's cardiologists to refer some patients elsewhere for transplants.
As was the case with the heart program, some patients and family members who came to St. Luke's for liver and lung transplants have complained to administrators or contacted reporters about the quality of care provided.
St. Luke's officials and doctors declined to be interviewed for this story. In a written statement, spokeswoman Marilyn Gerry pointed out that the hospital's liver and lung programs met national benchmarks in the latest official report from the transplant registry, released in October, which measured one-year survival for transplants performed between the start of 2015 and the middle of 2017.
Gerry said it was "misleading" to focus on a single year of data from 2017 rather than the entire two-and-a-half-year period examined by the registry.
"Because of the complex nature of organ transplant cases, natural fluctuations will occur" in a hospital's outcomes from one year to the next, Gerry wrote.
This year, when the Chronicle and ProPublica were reporting on below-average heart transplant outcomes at St. Luke's, hospital officials said something different. They discouraged focusing on the heart program's poor scores in official reports, saying they were based on "old data" and "don't reflect the current transplant outcomes at our institution."
In August, the Centers for Medicare and Medicaid Services terminated federal funding to the heart transplant program after concluding St. Luke's didn't do enough to correct problems that led to poor outcomes dating back to 2015. The hospital is appealing and has said that Medicare's decision has not affected its other transplant programs.
It's too soon to say whether the increase in liver and lung deaths in 2017 will cause those programs to slip below national standards in future registry reports or put them at risk of sanctions from Medicare. That will depend, in part, on how the programs perform in subsequent years, as well as any changes in the way the federal government regulates transplant programs.
Many factors can cause a transplant program's outcomes to dip, experts say, from patient selection to the quality of medical care offered in the months following a transplant. A one-year decline in outcomes may not put a program in jeopardy of falling significantly below national benchmarks, experts say, but it could if a hospital fails to correct the trend.
"Every transplant program has down years," said Alexander Aussi, a San Antonio-based transplant consultant. "But a good program recognizes those trends early, works to understand what is going wrong and then makes proactive changes before things get out of control."
St. Luke's leaders announced in October that they had hired a new executive to oversee all of the hospital's transplant programs and had recruited surgeons to help with heart and lung transplants.
The hospital also has launched a new marketing campaign in recent months celebrating patient success stories, in web vignettes and full-page newspaper ads, often emphasizing St. Luke's willingness to treat the most critically ill patients. One of those was Godfrey "G.W." Biscamp, a 64-year-old former test pilot from Houston who was turned away by two other local transplant programs before getting a new set of lungs at St. Luke's in July 2017.
"I was just about burned out with hospitals," Biscamp said in an interview. "When I went to Baylor, I was kind of expecting the same old song and dance. But those people saved my life."
Biscamp and another organ recipient featured in the ads told reporters they were pleased with the care provided by nurses and physicians throughout their stays at St. Luke's.
Marilyn Chambers, whose husband, John, died in April, more than three months after receiving a double-lung transplant at St. Luke's, tells a different story. She filed several complaints about the care provided to her husband and pressed hospital leaders to explain why he did not survive, leading to a pair of meetings with the hospital's president, Gay Nord.
Chambers said she wasn't satisfied.
"I felt in my soul," she said, "that they did something wrong."
Last year was momentous for the lung transplant program at St. Luke's, following two years of turnover in its surgeon ranks.
The senior surgeon who had led the lung program since 2012 left in the summer of 2015 to practice at a hospital affiliated with Harvard University. The surgeon hired to replace him stopped performing lung transplants soon after his arrival in early 2016, after some of his initial patients experienced complications. And the junior surgeon who stepped in left a few months later, also for a job at a Harvard teaching hospital.
Finally, in the spring of 2017, St. Luke's recruited a 41-year-old surgeon from Minnesota, Dr. Gabriel Loor, and the lung program quickly ramped up. The surge in transplants that year came after another nearby hospital, Houston Methodist, significantly scaled back its lung volume after too many transplants failed within a year.
In Loor's first four months alone, St. Luke's performed 30 lung transplants, nearly matching the hospital's total from all of 2016 and double the number performed in 2015. But soon the program hit a rough patch. At least two of the six patients who received new lungs at the hospital in May 2017 did not survive a year, according to data provided by the United Network for Organ Sharing and interviews with friends and family members.
One of the patients was Leonard "Johnny" Arsement, a former railroad switch operator who came to St. Luke's from Louisiana with pulmonary fibrosis. Days after his transplant, doctors told his family that the donor lungs were not working properly, and he never recovered. He died in December at age 72.
Daniel Butler, an artist from Houston, also received a double-lung transplant that May. The new lungs never seemed to work properly, said his best friend, Tim Johnson. After a series of setbacks early this year, Butler asked St. Luke's doctors to stop providing life-saving medical care, and he died a few days later. He was 62.
"It was just very mysterious to everybody why these lungs wouldn't take," Johnson said. He spoke highly of the doctors and nurses who cared for his friend during his eight-month hospital stay, despite the outcome.
More deaths followed later in the year, threatening to put a drag on the lung program's survival rate in future transplant registry reports. In the two-and-a-half-year period ending in December 2016, 94.2 percent of St. Luke's 58 lung transplant recipients survived one year, better than the hospital's expected rate of 89.7 percent, according to registry figures.
In 2017, though, during the surge in transplant volume, the program's one-year survival rate was down to 87 percent, a couple of percentage points below the national average. The transplant registry does not calculate expected rates for periods shorter than two-and-a-half years. The 2017 survival rate is current as of mid-November and could drop further if any additional lung recipients die in the final weeks of 2018, within one year of their transplants.
The liver transplant program at St. Luke's was in the midst of its own difficult stretch in 2017.
For several years, the liver program had posted outstanding results. Between 2014 and the middle of 2016, 93 percent of its patients survived at least a year, slightly better than the national average of 92 percent and its own expected rate of 91.3 percent.
But that began to shift at the end of 2016, according to an internal chart obtained by the Chronicle and ProPublica. The line graph, used by programs to track transplant outcomes in real time, appears to show the liver program on a steady path toward worse-than-expected outcomes by the end of last year.
All told, one out of every five liver transplants performed at St. Luke's in 2017 have failed within a year, about double the national rate. This includes two St. Luke's patients who had their new livers fail but who were still alive as of this month, likely after receiving another transplant.
Gerry, the St. Luke's spokeswoman, said the internal chart obtained by reporters represents "one piece of a confidential report provided to transplant programs by the [the transplant registry] for peer review and continuous improvement."
A day before Hurricane Harvey slammed into southeast Texas last year, Paul Guillory sat up in a hospital bed at Baylor St. Luke's, telling jokes.
Guillory, a 74-year-old retired barber from League City, was in a good mood, thinking about the months he had waited for a new liver after being diagnosed with cancer, and about the prospect of another decade of life to watch his grandkids grow. His wife, Barbara, scribbled a note in her day planner to document the moment when staff wheeled her husband into surgery on Aug. 24, 2017: "He was so happy," she wrote.
But in the operating room that afternoon, according to medical records, Paul suffered significant blood loss and required multiple transfusions — a complication likely triggered by his liver disease and his body's inability to form blood clots. By the time he'd been wheeled into a recovery room late that night, family members said doctors were expressing grave concerns about the viability of his new organ.
"Liver not performing as it should," Barbara wrote the next day in her pocket calendar, hours before Harvey made landfall. "Storm was coming in."
The hurricane came and went that weekend, but Paul never recovered, even after receiving a second, emergency liver transplant later that week.
Barbara said she wasn't surprised when she learned from a reporter that Paul was one of 15 St. Luke's patients who died following liver transplants last year. She and her family said they had concerns about the care he received.
Barbara signed a release allowing St. Luke's to speak to reporters about her husband's case; the hospital did not answer questions about his care.
Hours before Paul received his second liver transplant, about a week after the first one failed, Barbara and her children recalled watching in horror as he started to have a seizure in his hospital bed.
After several minutes, a doctor was summoned; he noted the "seizure like activity" in Paul's medical records and gave him drugs to bring the tremors under control. Two hours later, Paul was taken for his second liver transplant.
A day later, on Sept. 1, 2017, Barbara noted her husband's progress in her calendar: "Seizures have continued. Have tried many different medications, but they continue."
Barbara continued taking notes throughout Paul's month-long hospital stay, documenting his steady decline.
She sat next to her husband for several days, squeezing his hand and singing love songs, hoping to see a flicker. It never came, however, and she and her family together made the decision to let him go.
On Sept. 23, Barbara jotted one last note.
"I was able to lay with him and love on him," she wrote. "Was holding him when he took his last breath."
John Chambers was nervous when he got the call from St. Luke's three days after Christmas last year. The 56-year-old former FedEx deliveryman from south Houston knew he would eventually need a transplant after years spent struggling with an inflammatory lung disease, but he'd been breathing easier in recent months, and now he was having second thoughts.
Chambers reluctantly went ahead with the double-lung transplant that day, his wife said, fearing he wouldn't get another chance. But more than a month later, he still couldn't sit up or breath on his own.
"He was in worse shape than when he went in," said his wife, Marilyn.
Finally, in late January 2018, doctors said they identified a major cause of his continued struggles: A tear had formed in John's respiratory tract where the transplant surgeon had connected the donor lungs to his air passageway.
Such airway complications occur in between 5 percent and 10 percent of lung transplant patients, experts say, but rarely are they as severe as the "Grade 4 dehiscence" that had opened in John's respiratory tract.
Despite doctors' efforts to repair the airway, St. Luke's officials would later acknowledge that the complication triggered other serious problems — infections, pneumonia, inflammation, organ failure — that ultimately led to John's death in April.
Marilyn believes there were other factors. She repeatedly complained to hospital staff about the care provided to her husband. The concerns are documented in a series of letters between her and hospital administrators.
In one instance, a nurse used a harness to lift her husband out of bed, Marilyn said, and in the process tore open his surgical wound, soaking his gown in blood. Other times, she said, staff inadvertently jostled lines connecting her husband to life-support equipment or failed to follow doctor's instructions.
"It was one thing after another," Marilyn said. "I couldn't believe the way they treated him at that hospital."
In the written statement, Gerry, the hospital spokeswoman, noted that St. Luke's has maintained "magnet" status in nursing care for two decades, signaling that the hospital meets quality standards laid out by the American Nurses Credentialing Center.
"We have full confidence in our nursing professionals in the care they provided to the patients you highlighted and are aware of the patient concerns you relayed," Gerry wrote, referring to the care provided to all of the patients included in this story. "We reviewed and responded to families' questions and comments, and immediately followed up as necessary."
In August, three months after John's death, Marilyn met with Nord, the hospital's president, along with Loor and others, to address her complaints. Chambers recorded the conversation and provided reporters with a copy of the audio.
During the meeting, Nord acknowledged that her hospital staff could have done a better job and said the hospital had educated staff based on some of her complaints.
Loor assured Marilyn that he and his team had done everything they could for John and that they were heartbroken with the outcome. Although it was another surgeon who performed John's lung transplant, Loor said he was confident that it was done correctly. He said that the tear in John's airway was likely the result of a common complication known as "graft dysfunction," in which a set of donor lungs goes into shock after being implanted in a patient.
Loor explained that he had hoped that John was going to recover from that setback, but the infections and other problems eventually became too much.
"Ms. Chambers, I'm really sorry about all of this," Loor said during the July meeting. "And I know it's got to be really hard for you, but I know that you're strong, and I know that he [John] is with us. I feel him with us. And we get better and I get better, we all get better from talking about these things and learning from these things. … We're going to take this to heart."
In early February, three days after doctors discovered the tear in Chambers' airway, Edmund Flores sat in a waiting room, praying for his wife while she underwent a double-lung transplant. Patsy Flores, a 58-year-old mother of two adult children, had spent more than a year struggling to catch her breath as result of high blood pressure in her lungs and a devastating autoimmune disease.
It became clear a day after her transplant that something was wrong.
When Loor and another surgeon reopened Patsy's chest two days after the transplant, they made a tragic discovery, her medical records show: One of the new lungs had inexplicably flipped over, pinching arteries and choking off blood flow to the organ. The complication, known as lung torsion, is so rare after lung transplants that only 12 cases had been publicly documented as of two years ago.
Researchers who examined each reported case concluded that the deadly complication can be mitigated in some instances if detected right away and corrected. But by the time St. Luke's doctors flipped Patsy's left lung back over, much of the organ had essentially died, according to her medical records.
In a statement, hospital spokeswoman Gerry wrote that initial X-rays following Patsy's surgery did not indicate any twisting of the lung. "Additionally," she wrote, "all of our standard intraoperative monitoring procedures confirmed correct alignment and orientation. … However, continued monitoring over the next 24 hours detected a misalignment in one of her lungs and a procedure was completed to address the alignment."
In an effort to save her, Loor removed the damaged lung and doctors put Patsy back on the transplant waiting list, in urgent need of a replacement. Within days, they accepted another lung for her and implanted it.
But it was not enough. Patsy spent nearly four months connected to life support, her medical records show. Her kidneys failed. She suffered repeated infections and bedsores.
Edmund also complained to hospital staff about his wife's care. A chaplain recorded some of the complaints in Patsy's medical records. Edmund said there were not enough nurses on staff overnight and on the weekends, leaving his wife to sometimes wait too long for assistance.
A few weeks after his wife's surgery, a nurse ripped open Patsy's surgical wound while attempting to lift her out of bed, Edmund said, the first of two times that happened: "From that point forward," he said, "it was taking that much longer to heal."
Patsy smiled in photos as her family gathered around her hospital bed to celebrate her 59th birthday in April. But physically, she continued to decline. She lost weight. Her organs shut down. Infections spread through her body. And finally, on June 1, she aspirated vomit into her lungs and died two days later.
A month later, Edmund sat looking through photos of his wife at their home in Channelview, a blue-collar town east of Houston.
"Woo boy, she was something else," Edmund said, fighting back tears. "She was a beautiful woman. Strong, vibrant, full of life."
Edmund said that he understands Patsy was critically ill, and that she wouldn't have survived much longer without a transplant. But he's struggling to come to terms with the rare complication that caused her first transplant to fail, and with what he felt were lapses in care from seemingly overworked nurses and other medical staff in the months that followed.
"The nurses were doing a fantastic job," he said. "But there was only so much they could do because they were stretched so thin."
Since Patsy's death, Edmund has received two anonymous letters in the mail. He suspects they were from someone who was involved in his wife's care, or another hospital employee.
The first note alleged that there were problems with Patsy's transplant and claimed that her death "should have been avoided!!!" The second mentioned other lung transplant deaths this year and encouraged him to contact a Chronicle reporter.
"I need you to know that the lung twist was avoidable," the letter read, "and the whole team feels so so bad for you and your family."
Flores doesn't know what to make of the notes.
For now, he has filed them away with other records documenting his wife's stay at St. Luke's.
After becoming the nation's busiest lung transplant program six years ago, the hospital scaled back the number and difficulty of transplants it performed. For some patients, that meant having to look elsewhere for treatment.
This article first appeared November 30, 2018 on ProPublica.
By Mike Hixenbaugh
Godfrey "G.W." Biscamp could barely breathe. After months of struggling with an inflammatory lung disease, his doctor told him he was in need of a transplant, and in 2013, he sent him to Houston Methodist.
There was no better transplant program in the country for patients in need of new lungs, one physician told him. But by the time Biscamp arrived, the program had begun to change.
Biscamp spent more than a year as a patient at Methodist, hoping for a lung transplant that never came. Instead, after numerous appointments and tests, he said doctors reversed themselves in early 2015, saying his condition was too perilous to risk a transplant.
Biscamp did not realize that, behind the scenes, Methodist had been struggling with a high rate of failed lung transplants, or that the hospital had significantly scaled back the number and difficulty of transplants it was willing to perform. Those issues have never before been reported publicly.
"I walked into Methodist at a time when the word on the street was, these guys are blowing and going," Biscamp said. "They are transplanting people left and right, and they are the best in the business. Then all of the sudden while I was there, apparently it blew apart, but nobody told me."
Biscamp, a 64-year-old former military test pilot, had the misfortune of needing a new set of lungs during a period of instability and change among Houston's transplant hospitals. His four-year struggle for new lungs demonstrates the human consequences that can follow when a transplant program falters. And it shows the challenges facing patients with advanced organ failure while trying to decide where best to seek treatment.
After leaving Methodist, Biscamp transferred to nearby Memorial Hermann, which was launching a new lung transplant program led by one of his former Methodist doctors. But after two years, Biscamp recalled doctors there telling him his case was too risky, again leaving him to seek care elsewhere.
With his inflammatory lung disease worsening, Biscamp was expecting to be disappointed when he arrived at Baylor St. Luke's Medical Center in early 2017, another Houston lung transplant program that has undergone significant changes in recent years.
But doctors at St. Luke's surprised him. Biscamp arrived at the hospital around the same time as its new lead lung transplant surgeon, and within a few months, he received a new set of lungs.
More than a year later, he knows he's fortunate to be alive.
"I got shuffled around big time," Biscamp said. "I got run through the bushes."
There was a reason Biscamp's doctors initially sent him to Methodist. A year earlier, in 2012, the hospital performed a staggering 143 lung transplants, making it the busiest program in America. The hospital's willingness to travel farther for donor lungs, to treat sicker patients and to attempt new and unconventional surgical techniques drew national media attention.
But as the program was growing, so was its rate of poor outcomes.
Between the beginning of 2012 and the middle of 2014, about a quarter the 289 patients who received new lungs at Methodist had their transplants fail in less than a year, a rate significantly higher than the national average and worse than expected based on its own patient and donor characteristics, according to data compiled and analyzed by the Scientific Registry of Transplant Recipients.
In an interview earlier this month, top Methodist officials acknowledged the below-average outcomes and said they proactively made changes to turn things around, ultimately avoiding the sort of federal crackdown that caused St. Luke's to lose Medicare funding for heart transplants this year. (St. Luke's says it has made numerous improvements, including hiring new surgeons, and it is appealing the decision.)
Turning things around at Methodist meant hiring additional medical staff for the lung program, improving administrative oversight and — unfortunately for some patients — performing fewer high-risk transplants.
"Even before these results came out, we had started our improvement efforts," said Roberta Schwartz, Methodist's executive vice president, emphasizing that the hospital's lung outcomes have steadily improved since then and are now in line with national standards.
Dr. Osama Gaber, a surgeon who oversees all of Methodist's transplant programs, said he commissioned an extensive review of the lung program in 2013 and determined that doctors had been taking on too many high-risk cases, including patients over the age of 70 and those seeking a second or third lung transplant.
Transplant outcomes are measured on a curve, taking into account dozens of patient and donor characteristics in an effort to ensure hospitals are not punished for treating sicker patients than their peers. That includes a patient's age and whether they received a transplant previously.
Nonetheless, the hospital reformed its patient selection standards and hired additional staff members beginning in 2013, Gaber said, and soon outcomes began to tick upward. By 2015, the year Biscamp was turned down for transplant, Methodist performed a total of 75 lung transplants, about half as many as in 2012, according to publicly reported data.
Gaber said patient privacy rules prevented him from commenting on the reasons Biscamp was turned down for transplant. But, Gaber said, cases like his should be seen as a testament to the range of treatment options offered to patients at the Texas Medical Center in Houston.
Gaber acknowledged that the hospital's improvement efforts meant fewer patients received new lungs. He said that is a tragic consequence of the federal government's requirement that transplant programs meet national benchmarks for one-year patient survival.
"Every program that's been flagged [by the government] shrinks," Gaber said.
Dr. Scott Scheinin, Methodist's lead lung transplant surgeon until late 2017, disagreed with the notion that patient selection was the main cause of below-average lung outcomes. He noted that, even when the program was treating sicker patients, the hospital was achieving above-average one-month survival rates, indicating to him that the problems weren't related to surgical outcomes, but with the care that followed.
Scheinin said he does not believe Methodist had adequate medical staffing to care for the hospital's huge population of lung recipients in the months following their transplants. All organ recipients are given anti-rejection medications that suppress their immune systems, making them vulnerable to illnesses and death following transplant.
"We had a slew of people who would die between eight and 14 months after transplant," said Scheinin, who has since gone to work for a transplant program in New York. "To me, that means somebody is not paying attention to them. Something is wrong."
When asked about Scheinin's comments, Gaber said the hospital's improvement efforts included hiring additional staff and strengthening post-transplant care.
Although lung outcomes have gotten better in recent years, Gaber said he and his team are continuing to look for ways to make improvements.
"This is not like a speedboat; this is like a airplane carrier," Gaber said. "You've got to move it very slowly."
The plan sets up a clash with Democrats, who say the administration is thwarting congressional intent and will starve the VA health system to pay for private care.
This article first appeared November 15, 2018 on ProPublica.
Last June, President Donald Trump signed a landmark law on veterans' health care after months of tense negotiations. At the ceremony in the Rose Garden, Trump said the bill would deliver on his campaign promise to let veterans see private doctors instead of using the Department of Veterans Affairs' government-run health service: "I'm going to sign legislation that will make veterans' choice permanent," he said.
Standing behind him, the leaders of major veterans groups looked around uncomfortably. What Trump called "choice" these veterans groups called "privatization," and they'd been warning for years that it would cost taxpayers more money and deliver worse care for veterans. The veterans groups had endorsed the bill, but Trump's description of it was not what they thought they were there to support.
The moment left no doubt that the Trump administration is determined to use the new law to expand the private sector's role in veterans' health care. The administration is working on a plan to shift millions more veterans to private doctors and is aiming to unveil the proposal during Trump's State of Union address in January, according to four people briefed on the proposal. The people spoke on the condition of anonymity because they weren't authorized to disclose information about the administration's plans.
The cost of expanding private care is hard to predict, but VA officials have told Congress and veterans groups that it will range from $13.9 billion to $32.1 billion over five years, the four people said. Since the administration opposes lifting overall government spending, Democrats say the increased cost of private care will come at the expense of the VA's own health system. Some lawmakers said the administration's plan defies the purpose of the law they passed.
Trump's first VA secretary said he was forced out by ideologues determined to privatize the department, which he called, in a New York Times op-ed, "a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans." The new secretary has repeatedlydenied that privatization is the administration's goal. But the fact is that Trump is doing exactly what he said he would do: The share of VA care delivered in the private sector has grown to 36 percent from 22 percent in 2014, and the administration is weighing policy changes that would move up to 55 percent of veterans to private providers, according to the people briefed on the deliberations.
VA spokesman Curt Cashour wouldn't comment on those figures. He said the new policies are still under development but "will ensure that VA delivers veterans the best and most timely care possible with maximum continuity — whether it's at VA or in the community."
As a candidate, Trump spoke often about improving veterans' care, and as president, he has returned often to that rhetoric. At his post-midterm press conference, he said, "I've done more for the vets than any president has done, certainly in many, many decades, with choice and with other things." But he has plunged the VA leadership into turmoil and stirred anxiety over privatization, which many veterans oppose. And just this week, he was criticized for not participating in any public events on Veterans Day.
Democrats are eager to use their new House majority to stymie the Trump administration's plans for the VA. "I am deeply concerned about efforts to profiteer off of veterans by undermining VA-administered care and expanding VA's reliance on private care," Rep. Mark Takano, a California Democrat who's hoping to chair the House veterans committee, said in a statement. "It will be extremely important for the new Congress to conduct effective and frequent oversight of VA leadership so that this legislation is implemented properly."
Despite the VA's scandal-tainted reputation, studieshaveshown that the quality of VA health services compares favorably to private providers, and otherresearch suggests private doctors are generally not prepared to handle veterans' complex needs. Yet the politics of health care reform have made the VA a target for conservatives; they have attacked it as the epitome of bloated bureaucracyand held it out as living proof of the dangers of "socialized medicine."
The VA has been purchasing private care to supplement its health system since 1945, and there's broad consensus that doing so makes economic and medical sense in many instances. But in recent years, conservatives such as the Koch brothers have made it a political priority to shift more veterans to private doctors, under the banner of choice.
In 2014, after a scandal over long waits for appointments at the Phoenix VA, Congress created a new program, called Choice, to send veterans to private doctors if they would have to wait more than 30 days for a VA appointment or lived more than 40 miles from a VA facility. By the start of the Trump administration, the Choice program was running out of money and suffering from payment and scheduling problems.
Lawmakers got to work on overhauling the program and consolidating the VA's various channels for buying private care. Sen. Jerry Moran, R-Kan., wanted to establish across-the-board guidelines, known as "access standards," for when veterans could see private doctors. When the Senate veterans committee took up the proposed amendment, all the members, Republican and Democrat, voted against it, except Moran.
"The overwhelming majority of veterans in this country, despite a lot of bad media, as I think you understand, believe the VA provides quite good-quality care for them," Sen. Bernie Sanders, I-Vt.,saidto Moran before the vote. "I feel a drip-by-drip effort — not by you, but just an overall drip-by-drip effort — to end up moving toward the privatization of the VA."
Despite the committee's 13-1 rejection, Moran's proposal found a key ally in the White House: Darin Selnick, who used to work at a group backed by the billionaire brothers Charles and David Koch called Concerned Veterans for America and had signed onto an infamous proposal to dismantle the VA health system.
Officials in the VA, then led by Secretary David Shulkin, warned in meetings with lawmakers that what Selnick and Moran were seeking to do would explode the government's costs by $60 billion to $80 billion a year, forcing the VA to cannibalize its own health centers to pay for private care, four people involved in the talks said.
"If you get the access standards wrong, it can have disastrous effects," Shulkin said in an interview. "Whether intentionally or not, you could end up diluting the ability to maintain a strong VA. If access standards are too broad, the impact on the budget could end up being so significant that it would essentially become a system that's spending out of control."
But a bill to overhaul the Choice program couldn't move forward without the White House's support. So lawmakers struck a deal, according to four people involved in the negotiations. They adopted the access standards from Moran's failed amendment, but added the word "designated." That word meant the VA secretary would have the authority to decide, or "designate," which access standards would make veterans eligible for private care and which were merely guidelines.
VA officials reassured Democrats that Shulkin would designate only three access standards, limiting the circumstances when veterans would automatically get referred to the private sector, the people said. Moran and Selnick, meanwhile, successfully got access standards into the bill. According to the people involved in the negotiations, both sides walked away thinking they would have their way later on, in the implementation.
The negotiations on the bill repeatedly put Shulkin at odds with other Trump officials, creating confusion about the administration's position. After Trump fired Shulkin, at the end of March 2018, some VA officials warned that without his moderating influence, the Trump administration would use the bill to dramatically expand private care. "It's dangerous now, it's like a loaded weapon — they're going to take access standards and run with it," a former official involved in the negotiations said. "But everybody wanted to get a bill."
"If access standards are too broad, the impact on the budget could end up being so significant that it would essentially become a system that's spending out of control."
—David Shulkin
With a looming deadline to act before the Choice program ran out of money, the compromise bill, now known as the VA Mission Act, gained the support of traditional veterans groups as well as conservative groups like Concerned Veterans for America. The nonpartisan Congressional Budget Office analyzed the bill's cost on the assumption that it wouldn't significantly increase the rate of veterans going to private doctors.
The Mission Act passed the House over the objection of Democrats who said it failed to address how the VA would pay for it, meaning the private care would come at the expense of the VA's own hospitals. In the Senate, proponents waved off that concern. "We can work through this. This is a lot easier to work through than getting this bill to prime time," ranking member Jon Tester, D-Mont., said at a press conference. "This is a minor issue."
But soon after the Mission Act became law, the White House made clear that it opposed increasing the VA's funding in order to pay for it — exactly as House Democrats had warned. "This funding can and should be provided within the existing non-Defense discretionary spending cap, and the administration opposes efforts to increase or adjust the cap," Office of Management and Budget director Mick Mulvaney and then-acting VA secretary Peter O'Rourke said in a July letter to Congress.
Rick Weidman, the policy director for Vietnam Veterans of America, said Trump was breaking his campaign promises to veterans by refusing to fund the law he signed. "He got all the plaudits, then said we're not going to pay for it," Weidman said.
The same people who were pushing for more private care during the legislative negotiations are now the people leading the Trump administration's implementation of the Mission Act. Selnick briefly returned to Concerned Veterans for America before becoming an adviser to the new VA secretary. Selnick was replaced in the White House by Drew Trojanowski, a former aide to the late Sen. John McCain, R-Ariz., who worked closely with Moran on the access standards proposal.
"Darin Selnick is a veterans health care policy expert who helped write the Mission Act," Cashour, the VA spokesman, said. "There is no one more qualified to advise on the law's implementation."
It isn't surprising, then, that Selnick's interpretation of the bill has gained the upper hand: The VA is planning to "designate" all the access standards as making veterans eligible for private care, according to veterans groups and congressional staff briefed on the plan. Congressional aides said that would expand the use of the private sector much more than they expected.
"Attempting to keep more veterans in the VA's brick-and-mortar health care system would be a huge mistake."
—Dan Caldwell
"The fact that Congress put 'designated' in there, there was an assumption some would be designated and some would not be," a staffer involved in the negotiations said. "Why else would you have the word?"
Selnick did not respond to a message seeking comment.
Concerned Veterans for America's director, Dan Caldwell, defended the administration's interpretation. "It doesn't make sense to create a set of standards and only use some of them," he said. "The VA has been moving for years, even before the Mission Act, toward a model of using more community care. Attempting to keep more veterans in the VA's brick-and-mortar health care system would be a huge mistake."
The three Trump associates who've secretly steered the VA from Mar-a-Lago have also supported spinning off VA medical services to private providers. In a September 2017 email, the trio's chief, Marvel Entertainment chairman Ike Perlmutter, proposed inviting private health executives to help the VA divvy up services that should be outsourced to private facilities. The new VA secretary, Robert Wilkie, said he never discussed privatization with the Mar-a-Lago trio and he's not aware of any ongoing contact with them.
The VA official who's currently running the Mission Act implementation, Assistant Secretary for Enterprise Integration Melissa Glynn, came from the same consulting firm as another member of the Mar-a-Lago trio, lawyer Marc Sherman. Sherman didn't initially put forward Glynn's name, but he did recommend her for the job, according to a person with direct knowledge of the matter. Glynn and a representative for Sherman declined to comment.
The Mission Act gives the VA until March to finalizethe new access standards. Wilkie has not yet advanced a proposal to the White House and has rejected several drafts, three people familiar with the process said.
Wilkie has described the Mission Act as increasing veterans' access to the private sector, but not with the goal of privatizing the VA. "It opens the aperture for a veteran who seeks health care on his own terms, which means that if VA cannot provide the care that veteran needs, and in a timely manner, that veteran will have the opportunity to seek care in the private sector," Wilkie said in a recent NPR interview. "We're not replacing. This is not privatization."
Yet the access standards that Wilkie is considering could dramatically expand the VA's use of private care, according to recent VA briefings to Congress and veterans groups. The numbers are hard to predict because more veterans might switch to using VA benefits instead of Medicare or private insurance if the VA would pay for them to see private doctors with no copay, and private doctors might bill the VA for more services because they're paid by volume (whereas VA doctors are salaried). A 2016 commission on VA health care founded that if veterans could see private doctors without first getting a referral from the VA — because, for example, the VA failed to meet certain access standards — costs could increase by $96 billion to $179 billion a year.
"Any effort to automatically send veterans into the community, based upon arbitrary standards alone, would run counter to congressional intent and dramatically increase costs," Tester said in a statement. "Notably, this comes at a time when the president has ordered all agencies, including the VA, to submit plans for significant budget reductions."
The House veterans committee is planning an oversight hearing before the end of the year focusing on how the administration is implementing the Mission Act, according to the panel's outgoing Republican chairman, Phil Roe of Tennessee. In a statement, Roe said the committee will "evaluate whether provisions are being enacted per congressional intent."
Defibrillator paddles did not work during a patient's heart transplant in January, and a backup set was not nearby. The transplant ultimately failed, and the patient died two months later. His case was featured in a May article.
This article first appeared October 31, 2018 on ProPublica.
The federal government has cited Baylor St. Luke's Medical Center in Houston for not having working defibrillator paddles in the operating room during a January heart transplant. The transplant ultimately failed, and the patient died two months later.
During a review this month, the federal Centers for Medicare and Medicaid Services found that "there were not sufficient quantities of emergency equipment (internal defibrillator paddles) immediately available during cardiac (open chest) surgery," according to a copy of the report provided by the agency at the request of ProPublica and the Houston Chronicle.
The Chronicle and ProPublica reported in May on the death of that patient, James "Lee" Lewis. The surgeon in his case, Dr. Masahiro Ono, said he tried to use a defibrillator to jolt Lewis' new heart into rhythm during a key stage of the transplant. But the device did not activate, and Ono told reporters he had to pump the organ by hand while staff searched for a backup.
It was two months before Ono or anyone on the hospital staff told Lewis' wife, Jennifer, that nearly 10 minutes passed before backup equipment was brought into the room.
"I was so frustrated," Ono said in an interview in April. "I tried my best to preserve the function of the heart but it couldn't make it. That did happen, and I'm very sorry about that."
Lewis' failed donor heart was later replaced with an artificial heart. He endured nearly 20 follow-up surgeries and procedures before dying in March after yet another mishap. During a procedure, a thin wire got sucked into his artificial heart, causing it to malfunction. For the next 45 minutes, according to medical records, Lewis went without normal circulation, likely starving his brain of oxygen-rich blood.
In a statement Tuesday, St. Luke's spokeswoman Marilyn Gerry said the hospital conducted its own review following Lewis' initial transplant surgery "and found that necessary equipment and supplies were available during the procedure, adhering to commonly held processes and standards of medical care."
She said multiple backup defibrillators were nearby and readily available.
"In our subsequent review of the case," Gerry wrote, "it was determined that the defibrillator paddles — not the machine itself — were the source of the inoperation. We since increased inventories of backup paddles in the sterile surgical core [near the operating room] and enhanced our testing procedures of paddles. This includes not only daily checks of defibrillators and paddles, but additional checks in advance of each relevant surgical procedure."
These measures go beyond standard requirements, Gerry said.
Lewis was one of three patients who died following heart transplants during the first five months of 2018. The second and third deaths prompted the hospital to suspend the heart transplant program for two weeks in June. Officials said they "did not identify systemic issues related to the quality of the program" but made changes to its staffing and policies when it reopened.
Following a separate review, CMS cut off Medicare funding for heart transplants at St. Luke's in August after concluding that the hospital had not done enough to correct problems that led to a high rate of patient deaths following transplants in recent years. St. Luke's is appealing the decision.
In October, the hospital announced the hiring of two surgeons, effectively replacing the surgical director of the program, Dr. Jeffrey Morgan, though he will remain on the hospital's staff and retain his academic titles at the affiliated Baylor College of Medicine. Ono left St. Luke's in May to lead a heart transplant program in San Antonio.
The inspection related to Lewis' surgery was conducted despite the funding cutoff because the hospital itself is still certified to receive Medicare funding and therefore subject to federal requirements. Though the report found the hospital out of compliance with Medicare standards, the violation does not carry a penalty.
The federal report offered more details about what went wrong in the operating room during Lewis' transplant. Lewis' new heart began quivering out of sync and "multiple attempts [were] made to defibrillate but defibrillator failed to discharge," according to medical records cited by inspectors. The paddles were disassembled and reassembled by staff in the operating room and they were successfully used on Lewis.
Later during the surgery, Lewis' heart again began to show an irregular rhythm. The original paddles failed to go off again and staff "went to the cardiovascular operating room sterile core area to obtain a replacement set of internal defibrillator paddles and none were immediately available." They ultimately got functioning paddles from elsewhere in the hospital.
In the statement, Gerry said: "It is important to note that the patient was on a heart/lung bypass machine during this time, which maintained blood flow throughout the process. Our prayers continue to be with Mr. Lewis' family."
Lewis' widow, who previously expressed anguish at her husband's death, declined to comment for this story through an attorney.
The hiring of two outside surgeons comes after Medicare terminated funding to the heart transplant program, citing poor outcomes in recent years. Hospital leaders also hired a new top transplant administrator, saying the new staff members will help move the program forward.
This article first appeared October 19, 2018 on ProPublica.
Baylor St. Luke's Medical Center announced Friday that it has hired two new cardiac surgeons to lead its embattled heart transplant program as it works to regain Medicare certification.
The surgeons, Dr. Kenneth Liao and Dr. Alexis Shafii, will together take over leadership posts previously held by Dr. Jeffrey Morgan, the heart program's surgical director since 2016. A St. Luke's spokeswoman said Morgan is still a member of the medical staff at St. Luke's, but she did not directly answer whether he will continue performing transplants.
Morgan declined to comment through a representative, and the hospital did not make Liao or Shafii available for interviews.
The staffing announcement comes two months after the Centers for Medicare and Medicaid Services cut off funding for heart transplants at St. Luke's, long regarded as one of the nation's top hospitals for cardiac care. The federal agency concluded that the Houston hospital had not done enough to correct problems that led to a high rate of patient deaths following transplants in recent years.
Liao comes to St. Luke's after several years as the top heart transplant surgeon at the University of Minnesota Medical Center in Minneapolis. When he arrives in January, he will be St. Luke's senior cardiac transplant surgeon, serving as the hospital's new chief of cardiothoracic transplantation and mechanical circulatory support.
Shafii joined St. Luke's in September after a stint as the surgical director of the lung transplant program at the University of Kentucky Transplant Center. At St. Luke's, Shafii has already taken over as the surgical director of heart transplants.
Additionally, St. Luke's announced it has hired Deborah Maurer, a longtime transplant program administrator in Chicago and Arizona, to serve as vice president of transplantation, a newly created position overseeing clinical and administrative operations for all organ transplant programs.
"The addition of two expert surgeons and an experienced executive who specializes in transplant program administration demonstrates Baylor St. Luke's continued and growing commitment to heart and lung transplants," said Gay Nord, St. Luke's president, in a statement announcing the new hires.
These changes follow a series of investigative reports by ProPublica and the Houston Chronicle into troubles at St. Luke's. In recent years, the articles revealed, the hospital's heart program performed an outsized number of transplants resulting in deaths or unusual complications while continuing to promote itself based on its storied past.
In 2015, seven out of 21 heart transplant recipients at St. Luke's died within a year of their surgeries, significantly higher than the national average. Hospital leaders said that the program slowed down that year and identified subtle ways to improve care. At the start of 2016, the hospital brought in Morgan to replace the program's longtime leader, Dr. O.H. "Bud" Frazier.
St. Luke's officials have said the heart transplant program's one-year survival rate improved in 2016 and 2017 under Morgan's leadership. But some heart transplant recipients suffered unusual complications since then, the ProPublica and Chronicle investigation found, including two who had major veins stitched closed during surgery, according to numerous sources. In one of those instances, Morgan has said the man's previous cancer treatments complicated his surgery. He has declined to comment on the other, citing patient privacy.
Several physicians left the program in recent years, including a couple of top cardiologists who said they expressed concerns to administrators about the care provided to heart failure patients and started sending some to other hospitals for transplants.
In an earlier interview and responses to written questions, Morgan defended his leadership of the heart program, which he said has improved under his watch.
"We only have had one year with below-expected outcomes in the recent past, 2015, and that's been corrected," Morgan said earlier this year.
In June, following the ProPublica and Chronicle reports, St. Luke's temporarily suspended the heart transplant program in order to review deaths of two additional patients in May following heart transplants. Hospital officials reactivated the program after two weeks, saying they had found no "systemic issues related to the quality of the program."
Two months later, Medicare cut off funding after concluding that St. Luke's leaders had not done enough to fix the problems that led to poor surgical outcomes. The termination prohibits the hospital from billing federal health plans for heart transplants and, according to experts, could threaten the program's overall viability. St. Luke's is appealing the decision.
In announcing its new staff members on Friday, hospital officials characterized the moves as part of "ongoing efforts to strengthen the program which started in January." When reporters met with Nord and other St. Luke's leaders that month, they did not mention any ongoing efforts to make improvements. Instead, they said the heart program had already completed changes necessary to improve outcomes and was operating at a high level.
In the statement Friday, Nord said the hospital would continue striving to make improvements: "Advancing our hospital programs is a never-ending process, and these latest appointments are part of our ongoing commitment to our patients, our physicians and staff, and our community."
Asked about Morgan's future role, spokeswoman Vicki Amalfitano said, "Dr. Morgan's status has not changed," emphasizing his continued position on the St. Luke's medical staff and on the faculty at Baylor College of Medicine, where he holds the academic title of chief of cardiothoracic transplantation and circulatory support.
When pressed on whether Morgan had been replaced as the hospital's surgical director, Amalfitano said, "The announcement is about the new staff, so I'd love to focus on them."
In a follow-up email, she clarified: "I can confirm that Dr. Morgan no longer holds the title of 'Surgical Director, Heart Transplant & Mechanical Circulatory Support' at Baylor St. Luke's Medical Center."
Alexander Aussi, a San Antonio-based transplant consultant, has been critical of St. Luke's handling of problems within its heart program. But he said the changes in surgical leadership announced Friday seem to indicate that the hospital is now taking meaningful steps to improve.
Aussi also applauded the decision by St. Luke's to add a high-level executive to ensure that all of the hospital's transplant programs meet regulatory requirements.
"These changes are a good indication that the senior administration is committed to rebuilding the program," Aussi said, noting that the hires amount to a multimillion-dollar commitment to a transplant program that still must regain Medicare approval.
"Given that they recruited really a star surgeon and made these other changes, that's obviously a commitment from senior administration to move the program forward."
The hospital's chief medical officer resigned last month after failing to disclose company ties in medical journals. Now researchers, including chief executive Dr. Craig B. Thompson, are updating their own conflict-of-interest disclosures.
This article first appeared October 12, 2018 on ProPublica.
Update, Oct. 12, 2018: This story has been updated to reflect a third updated disclosure by Dr. Michelle Bradbury, which was posted on Thursday.
Top researchers at Memorial Sloan Kettering Cancer Center have filed at least seven corrections with medical journals recently, divulging financial relationships with health care companies that they did not previously disclose.
The hospital's chief executive, Dr. Craig B. Thompson, disclosed his relationship with companies including the drugmaker Merck, and Dr. Jedd Wolchok, a noted pioneer in cancer immunotherapy, listed his affiliations with 31 companies.
The corrections followed the resignation in September of Dr. José Baselga, the cancer center's chief medical officer, who had failed to disclose his company ties in dozens of articles in medical journals, including prominent publications like the New England Journal of Medicine. Baselga's omissions, including payments totaling millions of dollars, were first reported last month by ProPublica and The New York Times.
Since then, medical centers around the country, including Dana-Farber Cancer Institute in Boston and NYU Langone Health, have urged their researchers to review whether they properly reported relationships to outside companies.
According to a correction posted Sept. 17 in the Journal of Clinical Investigation, Thompson's conflict-of-interest statement had not been included in an article published in January. The updated disclosure noted his role as a founder of Agios Pharmaceuticals, a cancer startup, and his position on the boards of two publicly traded companies, Merck and Charles River Laboratories, which assists research in early drug discovery.
Thompson received $300,000 from Merck in 2017 and was paid $70,000 in cash by Charles River, plus $215,050 in stock, according to the companies' financial filings. His compensation package as Memorial Sloan Kettering's chief executive is $6.7 million.
Thompson resigned from both company boards on Oct. 2, after weeks of internal turmoil at the nonprofit hospital and public scrutiny of its leaders' financial relationships with for-profit companies.
In a statement, Mike Morey, a spokesman for Memorial Sloan Kettering, said the hospital had instructed its researchers to review their conflict-of-interest disclosures and submit corrections where necessary.
Morey also said that a "patchwork" of disclosure requirements by different publications has complicated matters. "In many cases, researchers are now disclosing above and beyond what is asked for and required, even when their disclosures have no connection to the research they conducted," he said, adding that Memorial Sloan Kettering has created a task force to establish its own standards. "This is a massive, industrywide problem."
In a statement, Thompson said his correction arose from the broader review. "I was no different," he said. Of the more than 70 articles he published since arriving at the hospital in 2010, he said, "I identified one study in my review, of which I was a secondary author, that I thought should be updated."
Some of the omissions were extensive. In an updated disclosure, Wolchok, director of the Parker Institute for Cancer Immunotherapy at the hospital, outlined his ties to many companies, including receiving consulting fees, owning stock options or being a co-founder. The list of companies that pay him range from major manufacturers like Bristol-Myers Squibb and Merck, for whom he works as a paid for consultant, to startups like BeiGene, Apricity and Adaptive Biotech, in which he reports owning stock options.
Other Memorial Sloan Kettering researchers on Wolchok's papers also updated their interactions with industry, including Dr. Matthew D. Hellmann, Taha Merghoub and Dr. Michael A. Postow.
"Although the below additional disclosures are not directly relevant to the published work, the authors put them forward in the spirit of full transparency," one correction said. "The authors apologize for any inconvenience."
Wolchok did not disclose most of his 31 relationships in articles recently published in other journals, including the New England Journal of Medicine, JAMA and Lancet Oncology. Wolchok has been paid more than $90,000 from major drug companies since 2014, according to a federal database that only includes payments from companies whose products received approval from the Food and Drug Administration. Most of his relationships are with early-stage startups.
Wolchok said he conducted a review of more than 300 articles and decided to submit updated disclosures on some of them "out of an abundance of caution." Some journals, including Cancer Discovery, "have rejected these updates because they have determined they are not relevant to the subject matter," Wolchok said in a statement.
Morey said that existing disclosures in the other articles, including those published in the New England Journal of Medicine, were appropriate, based on Wolchok's interpretation of the journals' guidelines.
Although medical journals vary in their requirements, many urge researchers to err on the side of revealing a company relationship. One set of guidelines published by the International Committee of Medical Journal Editors advises authors: "You should disclose interactions with ANY entity that could be considered broadly relevant to the work." As an example, it says for a researcher studying a particular aspect of lung cancer, "you should report all associations with entities pursuing diagnostic or therapeutic strategies in cancer in general."
Other corrections involved Dr. Michelle Bradbury, who is the head of a research laboratory at Memorial Sloan Kettering and a director in the radiology department. In twocorrections published Monday in the journal Chemistry of Materials, Bradbury and other study authors said that they should have disclosed that two of them, as well as their institutions — Memorial Sloan Kettering and Cornell University — have a financial interest in Elucida Oncology. The original articles were published in 2017.
A third correction involving Bradbury was posted Thursday. That article, for which Bradbury was one of several authors, was published in ACS Applied Materials & Interfaces in 2017.
Bradbury is a co-founder and serves on the scientific advisory board of Elucida, which is exploring the use of nanoparticles in cancer detection and treatment, a focus of the articles. Another author, Dr. Ulrich Wiesner of Cornell University, is also a company co-founder and a member of its scientific advisory board. (Wolchok is also on the Elucida scientific advisory board, which he noted in one of his corrections.)
The corrections also said that "one or more" patent applications had been filed by the authors on topics related to the articles. The corrections to Bradbury's studies were first reported by the website Retraction Watch.
"In a handful of cases, even though the research in these publications was very early stage and rooted in basic science, my co-author from Cornell and I decided we would update them," Bradbury said in an email. A spokesman for Cornell referred comment to Memorial Sloan Kettering.
Baselga has also corrected his conflict-of-interest disclosures in several journals, including twoin the New England Journal of Medicine, three in Clinical Cancer Research and two in Cancer Discovery, where he is still one of two editors in chief. The American Association for Cancer Research, which publishes Cancer Discovery, said it had formed a panel of experts to evaluate whether he should remain in a leadership role.
He has also revised disclosures with the American Society of Clinical Oncology, which said that if Baselga participates in future meetings, "his slides will be subject to review in advance of his presentation and the session will be audited by ASCO staff and volunteers for any evidence of bias." ASCO also said that if Baselga again does not disclose his interactions properly, he would be "prohibited from presenting in any capacity (author, session chair, discussant, etc.) at an ASCO-sponsored meeting for the following two years."
Beyond revisiting disclosures, Memorial Sloan Kettering is undertaking a broader review of its staff's interactions with the health care and pharmaceutical industries, including whether senior leaders should sit on the boards of publicly traded companies. It also said it would hire an outside law firm to investigate specific allegations made following Baselga's departure.
Christopher Duntsch's surgical outcomes were so outlandishly poor that Texas prosecuted him for harming patients. Why did it take so long for the systems that are supposed to police problem doctors to stop him from operating?
This article first appeared October 02, 2018 on ProPublica.
By Laura Beil
The pain from the pinched nerve in the back of Jeff Glidewell's neck had become unbearable.
Every time he'd turn his head a certain way, or drive over bumps in the road, he felt as if jolts of electricity were running through his body. Glidewell, now 54, had been living on disability because of an accident a decade earlier. As the pain grew worse, it became clear his only choice was neurosurgery. He searched Google to find a doctor near his home in suburban Dallas who would accept his Medicare Advantage insurance.
That's how he came across Dr. Christopher Duntsch in the spring of 2013.
Duntsch seemed impressive, at least on the surface. His CV boasted that he'd earned an M.D. and a Ph.D. from a top spinal surgery program. Glidewell found four- and five-star reviews of Duntsch on Healthgrades and more praise seemingly from patients on Duntsch's Facebook page. On a link for something called "Best Docs Network," Glidewell found a slickly produced video showing Duntsch in his white coat, talking to a happy patient and wearing a surgical mask in an operating room.
There was no way Glidewell could have known from Duntsch's carefully curated internet presence or from any other information then publicly available that to be Duntsch's patient was to be in mortal danger.
In the roughly two years that Duntsch — a blue-eyed, smooth-talking former college football player — had practiced medicine in Dallas, he had operated on 37 patients. Almost all, 33 to be exact, had been injured during or after these procedures, suffering almost unheard-of complications. Some had permanent nerve damage. Several woke up from surgery unable to move from the neck down or feel one side of their bodies. Two died in the hospital, including a 55-year-old schoolteacher undergoing what was supposed to be a straightforward day surgery.
Multiple layers of safeguards are supposed to protect patients from doctors who are incompetent or dangerous, or to provide them with redress if they are harmed. Duntsch illustrates how easily these defenses can fail, even in egregious cases.
Neurosurgeons are worth millions in revenue for hospitals, so Duntsch was able to get operating privileges at a string of Dallas-area institutions. Once his ineptitude became clear, most chose to spare themselves the hassle and legal exposure of firing him outright and instead let him resign, reputation intact.
At least two facilities that quietly dumped Duntsch failed to report him to a database run by the U.S. Department of Health and Human Services that's supposed to act as a clearinghouse for information on problem practitioners, warning potential employers about their histories.
"It seems to be the custom and practice," said Kay Van Wey, a Dallas plaintiff's attorney who came to represent 14 of Duntsch's patients. "Kick the can down the road and protect yourself first, and protect the doctor second and make it be somebody else's problem."
It took more than six months and multiple catastrophic surgeries before anyone reported Duntsch to the state medical board, which can suspend or revoke a doctor's license. Then it took almost another year for the board to investigate, with Duntsch operating all the while.
When Duntsch's patients tried to sue him for malpractice, many found it almost impossible to find attorneys. Since Texas enacted tort reform in 2003, reducing the amount of damages plaintiffs could win, the number of malpractice payouts per year has dropped by more than half.
Duntsch's attorney did not allow him to be interviewed for this story. Representatives from one hospital where he worked also would not respond to questions. Two more facilities said they could not comment on Duntsch because their management has changed since he was there, and a fourth has closed.
In the end, it fell to the criminal justice system, not the medical system, to wring out a measure of accountability for Duntsch's malpractice.
The case was covered intensely by local and state media outlets. D Magazine, Dallas' monthly glossy, published a cover story in 2016 with the headline "Dr. Death"; the nickname stuck.
Last year, Duntsch was convicted and sentenced to life in prison, becoming the first doctor in the nation to meet such a fate for his practice of medicine.
"The medical community system has a problem," Assistant District Attorney Stephanie Martin said in a press conference after the verdict. "But we were able to solve it in the criminal courthouse."
Glidewell was the last patient Duntsch operated on before being stripped of his license to practice medicine.
According to doctors who reviewed the case, Duntsch mistook part of his neck muscle for a tumor and abandoned the operation midway through — after cutting into Glidewell's vocal cords, puncturing an artery, slicing a hole in his esophagus, stuffing a sponge into the wound and then sewing Glidewell up, sponge and all.
Glidewell spent four days in intensive care and endured months of rehabilitation for the wound to his esophagus. To this day, he can only eat food in small bites and has nerve damage. "He still has numbness in his hand and in his arm," said his wife, Robin. "He basically can't really feel things when he's holding them in his fingers."
Neither Glidewell, nor the prosecutors, nor even Duntsch's own attorneys said they thought his outlandish case had been a wake-up call for the system that polices doctors, however.
"Nothing has changed from when I picked Duntsch to do my surgery," Glidewell said. "The public is still limited to the research they can do on a doctor."
For Duntsch, the path into medicine was unconventional and, perhaps, a reflection of his tendency to fixate on unlikely goals.
The first of these had been college football. Duntsch's father had been a gridiron standout in Montana and Duntsch, though not a particularly talented athlete, was determined to follow in those footsteps. He trained hour after hour on his own and played linebacker on his high school team in Memphis, Tennessee. Classmates remember him as a turbine of sheer determination.
"He had his goal, his sight on a goal and whatever it took to get there," said one classmate, who did not want to be named. "He wanted to go to college and play, and I can recall he was like 180 pounds and said, 'I need to get to 220' in order to be a linebacker at Colorado or Colorado State."
He did get a football scholarship, but it was to Millsaps College in Mississippi. He yearned to transfer and play linebacker for a Division I team. He set his sights on the Colorado State Rams his sophomore year and made it as one of the few walk-on players. Chris Dozois, a fellow linebacker with the Rams, recalled Duntsch struggling, even with basic drills, but begging to run them over and over.
"He'd be, 'Coach, I promise I can get this, let me do it again.' He'd go through; he'd screw it up again," Dozois said. "I gathered very quickly that everything that he had accomplished in sports had come with the sweat equity. When people said, 'You weren't going to be good enough,' he outworked that and he made it happen."
Homesick, Duntsch left Colorado after a year and transferred again to what was then Memphis State University, now the University of Memphis. He had hoped to play football, but he tearfully told Dozois his multiple transfers had taken away his eligibility.
It was then, Dozois recalled, that Duntsch set his sights on his next goal: to be a doctor. And not just any doctor — a neurosurgeon, operating on injured backs and necks.
After getting his undergraduate degree in 1995, Duntsch enrolled at the University of Tennessee at Memphis College of Medicine, in an ambitious program to earn both an M.D. and a Ph.D.
As part of the program, he worked in a research lab, studying the origins of brain cancer and the various uses of stem cells. For a time, after he earned his dual degrees in 2001 and 2002, it seemed he might make a career in biotechnology rather than treating patients.
As he did his surgical residency, Duntsch teamed up with two Russian scientists, recruited by the University of Tennessee, to explore the commercial potential of stem cells to revitalize ailing backs. They patented technology to obtain and grow disk stem cells, and in 2008, they launched a company, DiscGenics, to develop and sell such products. Two of Duntsch's supervisors from the university were among the first investors.
While Duntsch appeared to be thriving during these years, more unsavory aspects of his life simmered below the surface.
In sworn testimony from 2014, an ex-girlfriend of one of his closest friends described a drug-fueled, all-night birthday celebration for Duntsch about midway through his residency. Revelers drank and used cocaine and pills, she said. At dawn, Duntsch slipped on his white coat and headed for rounds at the hospital.
"Most people, when they go binge all night long, they don't function the next day to go to work," she said in her deposition. "After you've spent a night using cocaine, most people become paranoid and want to stay in the house. He was totally fine going to work."
One of the early investors in DiscGenics, Rand Page, said he was initially impressed with how Duntsch presented himself and the company, but as time passed, Page became wary of his new business partner.
"We would meet in the mornings, and he would be mixing a vodka orange juice to start off the day," Page said. Once, he stopped by Duntsch's house to pick up some paperwork. He opened a desk drawer to find a mirror with cocaine and a rolled-up dollar bill sitting on top of it.
Ultimately, Duntsch was forced out of DiscGenics and his partners and investors sued him over money and stock. (Representatives of DiscGenics declined to be interviewed for this story.)
The University of Tennessee said it could not comment on Duntsch, citing the confidentiality and privacy of medical students' records, but Dr. Frederick Boop, chief of neurosurgery at the hospital where Duntsch did his residency, appears to have known about Duntsch's substance abuse.
In a 2012 phone call recorded by a Texas doctor who contacted Boop because he was alarmed by Duntsch's surgical errors, Boop acknowledged that an anonymous woman had filed a complaint against Duntsch, saying he was using drugs before seeing patients.
In the phone conversation, Boop said university officials had asked Duntsch to take a drug test, but he had avoided it, disappearing for several days. When he returned, he was sent to a program for impaired physicians and closely supervised for the remainder of his surgical training, Boop told the Texas doctor. (An attorney for the University of Tennessee said Boop would not respond to questions for this story.)
It's not clear how much training Duntsch actually received, however.
After his arrest, the Dallas district attorney's office subpoenaed every hospital on Duntsch's CV for records of his surgeries, including those during his residency and subsequent one-year fellowship.
According to the Accreditation Council for Graduate Medical Education, a neurosurgery resident does about 1,000 operations during training. But according to records gathered by the DA, by the time Duntsch finished his residency and fellowship, he had operated fewer than 100 times.
Despite what Duntsch had told friends when he headed off to medical school, Page said Duntsch had staked his fortune on being a businessman, not a doctor.
"I don't think his plan was ever to become a surgeon," he said. When Duntsch was kicked out of DiscGenics, "I think the decision was made for him that he was going to have to enter into the medical community to support himself."
Duntsch's first job as a practicing physician was at the Minimally Invasive Spine Institute in the affluent Dallas suburb of Plano, which hired him in the summer of 2011, when he also received privileges to operate at Baylor Regional Medical Center.
The hospital welcomed Duntsch with a $600,000 advance. While no one from the practice agreed to be interviewed, they sent an email describing the recommendations they had gotten from Duntsch's supervisors at the University of Tennessee medical school in Memphis.
"We were told Duntsch was one of the best and smartest neurosurgeons they ever trained, as they went on at length about his strengths," they said in the email. "When asked about Dr. Duntsch's weaknesses or areas for improvement, the supervising physician communicated that the only weakness Duntsch had was that he took on too many tasks for one person."
In 2010, Boop faxed a recommendation for Duntsch to Baylor-Plano, checking off "good" or "excellent" in boxes asking about his skills and noting, "Chris is extremely bright and possibly the hardest working person I have ever met." Another supervisor, Dr. Jon Robertson, who was an old family friend of the Duntsches and an investor in DiscGenics, noted on his recommendation that Duntsch had an "excellent work ethic." (A University of Tennessee attorney said Robertson could not respond to questions.)
A vascular surgeon who operated at Baylor-Plano, Dr. Randall Kirby, said he met Duntsch soon after he started and found him to be an arrogant know-it-all.
"I would see him maybe once a week at the scrub sinks or in the doctor's lounge," Kirby said. "He is among giants up there, and he was trying to tell me over and over again how most of the spine surgery here in Dallas was being done inappropriately and that he was going to clean this town up."
Duntsch lasted only a few months at the spine institute, not because his patients had complications, but because of a falling out with the other doctors over whether he was fulfilling his obligations.
One weekend in September 2011, Kirby said, Duntsch was supposed to be taking care of a patient. He went to Las Vegas instead. One of the partners, Dr. Michael Rimlawi, "was notified by the administration that the patient wasn't getting rounded on, and Dr. Rimlawi then dismissed Dr. Duntsch after that," Kirby said. (Rimlawi declined to comment for this story.)
Nonetheless, Duntsch still had privileges at Baylor-Plano, and on Dec. 30, 2011, he operated on a man named Lee Passmore.
At the time, Passmore was an investigator in the Collin County Medical Examiner's office, just north of Dallas. He had undergone successful back surgery once before, but the pain had returned. Passmore's pain specialist told him he didn't have a back surgeon to whom he routinely referred patients, but that he'd gone to lunch recently with one who "seemed like a guy that knew what he was talking about," Passmore recalled in court testimony.
Vascular surgeon Mark Hoyle assisted with the operation. In later testimony, he said he watched in alarm as Duntsch began to cut out a ligament around the spinal cord not typically disturbed in such procedures. Passmore started bleeding profusely, so much so that the operating field was submerged in a lake of red. Duntsch not only misplaced hardware in Passmore's spine, but he stripped the screw so it could not be moved, Hoyle testified. At one point, Hoyle said, he either grabbed Duntsch's scalpel or blocked the incision — he could not remember which — to keep Duntsch from continuing the procedure. Then Hoyle said he left the operating room and vowed never to work with Duntsch again. (In response to a request for comment, Hoyle sent a note saying he was through talking about Duntsch.)
Passmore did not respond to requests for comment for this story. Passmore has testified that he lives with chronic pain and has trouble walking as a result of Duntsch's errors.
The next patient Duntsch operated on was Barry Morguloff.
Morguloff ran a pool service company. He had worn out his back working in his father's import business, helping to unload trucks. "It took a toll on my back even with back supports and exercise and a strong core," Morguloff said. His pain returned after an earlier back surgery, but the surgeon recommended exercise and weight loss, not another procedure.
A pain specialist gave Morguloff Duntsch's card.
"Everything that I read when we first got his card — outstanding reviews, people loved him. I read everything I could about this guy," Morguloff said. He set up an appointment and found himself impressed by Duntsch's easy confidence.
"Phenomenal, great guy, loved him," Morguloff recalled. Most importantly, he added, "I was in pain and somebody, a neurosurgeon, said, 'I can fix you.'"
His surgery, an anterior lumbar spinal fusion, took place on Jan. 11, 2012. At the request of a head-and-neck surgeon also on the case, the vascular surgeon assisting Duntsch was Kirby. Kirby said it should have been a routine case.
"In the spectrum of what a neurosurgeon does for a living, doing an anterior lumbar fusion procedure's probably the easiest thing that they do on a daily basis," he said.
But Duntsch quickly got into trouble. Instead of using a scalpel, he tried to pull Morguloff's problem disk out with a grabbing instrument that could damage the spine. Kirby said he argued with Duntsch, even offering to take over, but Duntsch insisted he knew what he was doing. Kirby left the room.
Morguloff awoke in excruciating pain.
His previous surgeon testified at Duntsch's trial that the procedure had left bone fragments in Morguloff's spinal canal. The surgeon said he repaired what damage he could, but Morguloff still walks with a cane. As scar tissue builds up, his pain will worsen and his range of motion will decrease. One day, he will likely be in a wheelchair.
"As time goes on, the scar tissue and everything builds up, and I lose more and more function of that left side," he said. "I do my best to stay active. But some days I just can't get moving. The pain is continuous."
Soon after the Morguloff surgery, Duntsch took on a patient who was also an old friend.
Jerry Summers had played football with Duntsch in high school and helped with logistics at the research lab during his residency. When Duntsch took the job in Dallas, he asked Summers to move with him and help set up his practice. They lived in a downtown luxury high-rise while Duntsch shopped for a house.
In a deposition he gave later to the district attorney, Summers said he asked Duntsch to operate on him because he had chronic pain from a high school football injury that had gotten worse after a car accident. After the February 2012 surgery, however, Summers couldn't move from the neck down.
According to doctors who later reviewed the case, Duntsch had damaged Summers' vertebral artery, causing it to bleed almost uncontrollably. To stop the bleeding, Duntsch packed the space with so much anticoagulant that it squeezed Summers' spine.
For days after the operation, Summers lay in the ICU, descending into a deep depression. "Jerry was calm with Chris," said Jennifer Miller, then Summers' girlfriend, "but all Jerry would say to me is: 'I want to die. Kill me. Kill me. I want to die.'"
One morning, Summers began screaming and told several nurses that he and Duntsch had stayed up the night before the surgery doing eight-balls of cocaine. In truth, the night before the surgery Summers and Miller had dinner at a local restaurant and watched the University of Memphis basketball team play Southern Mississippi on the bar TV.
In his 2017 deposition, Summers acknowledged he made up the pre-surgery cocaine binge because he felt Duntsch had abandoned him, as both his surgeon and his friend.
"I was just really mad and hollering and wanting him to be there," Summers said. "And so I made a statement that was not something that was necessarily true. … The statement was only made so that he might hear it and go, 'Let me get my ass down there.'"
Baylor officials took Summers' accusation seriously and ordered Duntsch to take a drug test. As at the University of Tennessee, he stalled at first, telling administrators he got lost on the way to the lab. He passed a separate psychological evaluation and, after three weeks, was allowed to operate again, but he was told to stick to relatively minor procedures.
His first patient after his return was elementary school teacher Kellie Martin, who had a compressed nerve from falling off a ladder as she fetched Christmas decorations from her attic. During the surgery, records show, Martin's blood pressure inexplicably plummeted.
As she regained consciousness after the surgery, the nurses tending to Martin testified that she began to slap and claw at her legs, which had turned a splotchy, mottled color. She became so agitated the staff had to sedate her. She never reawakened. An autopsy would later find that Duntsch had cut a major vessel in her spinal cord, and within hours, Martin bled to death.
Baylor-Plano again ordered Duntsch to take a drug test. The first screening came back diluted with tap water, but a second, taken a few days later, came up clean. Hospital administrators also organized a comprehensive review of Duntsch's cases, after which they determined that his days at the facility were over.
But — importantly — they did not fire him outright. Instead, he resigned, leaving on April 20, 2012, with a lawyer-negotiated letter saying, "All areas of concern with regard to Christopher D. Duntsch have been closed. As of this date, there have been no summary or administrative restrictions or suspension of Duntsch's medical staff membership or clinical privileges during the time he has practiced at Baylor Regional Medical Center at Plano."
Since Duntsch's departure was technically voluntary and his leave had been for less than 31 days, Baylor-Plano was under no obligation to report him to the National Practitioner Data Bank.
The databank, which was established in 1990, tracks malpractice payouts and adverse actions taken against doctors, such as being fired, barred from Medicare, handed a long suspension, or having a license suspended or revoked.
The information isn't available to the public or other doctors, but hospital administrators have access to the databank and are supposed to use it to make sure problem doctors can't shed their pasts by moving from state to state or hospital to hospital. Robert Oshel, a patient safety advocate and former associate director of the databank, says that hospitals are required to check all applicants for clinical privileges and once every two years for everyone who has clinical privileges.
Many hospitals, however, hesitate to submit reports to the databank, worrying that doing so may hurt doctors' job prospects or even prompt lawsuits.
"What happens sometimes is that doctors are allowed to resign in lieu of discipline so that the hospital can protect its perceived legal liability from the doctor," said Van Wey, the Dallas trial lawyer. "If Dr. Duntsch was unable to get privileges at other hospitals, theoretically Dr. Duntsch could have sued Baylor and said: 'Look, I could be making $2 million a year here. … You owe me $2 million for the rest of my life.'"
According to a report by Public Citizen, a consumer watchdog group, about half the hospitals in the country had never reported a doctor to the databank by 2009. A more recent analysis didn't find much change, said Dr. Sid Wolfe, a founder of Public Citizen's Health Research Group.
Despite his string of problems at Baylor-Plano, Duntsch also wasn't reported to the Texas Medical Board, the state's main purveyor of doctor discipline. Such boards often move slowly, but if hospital officials submit material they've gathered to justify letting a doctor go, boards can act to protect patients from imminent harm.
"Had Baylor's action been reported appropriately, I would anticipate the board would have met within days to have an immediate suspension," said Dr. Allan Shulkin, a Dallas pulmonologist who was on the medical board in 2012.
The board would still have conducted an investigation, but Duntsch would not have been allowed to operate while it was going on, Shulkin said. He was visibly angered by Baylor-Plano's failure to report. "What's the worst that can happen, a lawsuit?" he said. "Come on. These are people dying, and we're stopping because you're afraid of a lawsuit?"
Two years after Duntsch left Baylor-Plano, the hospital's decision not to report its review of his work or its results prompted an investigation by state health authorities. The hospital was hit with a violation and fined $100,000 in December 2014, but a year later, the citation and penalty were withdrawn. The Texas Health and Human Services Commission would not explain why, saying the records were confidential.
Hospital officials declined to be interviewed for this story, submitting a written statement instead.
"Our primary concern, as always, is with patients," it said. "Out of respect for the patients and families involved, and the privileged nature of a number of details, we must continue to limit our comments. There is nothing more important to us than serving our community through high-quality, trusted healthcare."
Duntsch's next stop was Dallas Medical Center, which sits outside Dallas' northern edge in the city of Farmers Branch. Baylor-Plano officials might have thought any future employer would contact them before hiring him and they could share information confidentially, but Dallas Medical Center granted Duntsch temporary privileges while its reference checks were still going on.
On July 24, 2012, Duntsch operated on Floella Brown, 64, a banker about to retire after a long career. She had come to Duntsch for cervical spine surgery to ease her worsening neck and shoulder pain.
About a half hour into Brown's surgery, Duntsch started to complain that he was having trouble seeing her spine.
"He was saying: 'There's so much blood I can't see. I can't see this,'" said Kyle Kissinger, an operating room nurse. He kept telling the scrub tech "'suck more, suck more. Get that blood out of there. I can't see.' That's really concerning to me because, not only that he can't do it correctly when he can't see that but, why is it still bleeding?"
Brown bled so much that blood was saturating the blue draping around her body and dripping onto the floor. The nursing staff put down towels to soak it up.
After the operation, Brown woke up and seemed fine, but early the next morning she lost consciousness. Pressure was building inside her brain for reasons that were unclear at the time.
That same morning — with Brown still in the ICU — Duntsch took another patient into surgery.
The patient's name was Mary Efurd. She was an active 71-year-old who'd sought Duntsch's help because back pain was keeping her off her treadmill.
Duntsch arrived at the hospital about 45 minutes after Efurd's surgery had been set to start, Kissinger said. He spotted a hole in Duntsch's scrubs. "It's on the butt cheek of his scrubs. He didn't wear underwear. That's why it really shined down to me," Kissinger said. The nurse realized he'd seen that hole for three straight days — Duntsch apparently hadn't changed his scrubs all week. Kissinger also noticed that Duntsch had pinpoint pupils and hardly seemed to blink.
When Duntsch arrived, the staff told him that Brown, his patient from the day before, was in critical condition.
Soon after beginning Efurd's surgery, Duntsch turned to Kissinger and told him to let the front desk know he would be performing a procedure on Brown called a craniotomy, cutting a hole in her skull to relieve the pressure in her brain. Problem was, Dallas Medical Center did not perform those, or even have the proper equipment to do them.
As he operated on Efurd, Duntsch quarreled first with Kissinger and later with his supervisors, insisting on a craniotomy for Brown, according to court testimony. All the while, the operating room staff questioned whether Duntsch was putting hardware into Efurd in the right places and noticed he kept drilling and removing screws.
In the end, Duntsch did not perform a craniotomy on Brown. She was moved to another hospital but never regained consciousness. In court, her family said they withdrew life support a few days later. A neurosurgeon hired to review her case would later determine that Duntsch had both pierced and blocked her vertebral artery with a misplaced screw. The review also found that Duntsch misdiagnosed the source of her pain and was operating in the wrong place.
The day after her surgery, Efurd awoke in agony. She couldn't turn over or wiggle her toes. Hospital administrators called Dr. Robert Henderson, a Dallas spine surgeon, to try to repair the damage.
Shortly after he arrived at the hospital, Henderson pulled up Efurd's post-operative X-rays. When he saw them, he said, "I'm really thinking that some kind of travesty occurred." That impression only grew when Henderson reopened Efurd's freshly made incisions the next day. "It was as if he knew everything to do," Henderson said of Duntsch, "and then he'd done virtually everything wrong."
There were three holes poked into Efurd's spinal column where Duntsch had tried and failed to insert screws. One screw was jabbed directly into her spinal canal. That same screw had also skewered the nerves that control one leg and the bladder. Henderson cleaned out bone fragments. Then he discovered that one of Efurd's nerve roots — the bundle of nerves coming out of the spine — was completely gone. For some inexplicable reason, Duntsch had amputated it.
The operation was so botched, Henderson recalled thinking Duntsch had to be an impostor passing himself off as a surgeon. Even after Henderson's repairs, Efurd never regained her mobility and now uses a wheelchair. (In an email, Efurd said that discussing what happened to her again would take a toll on her health.)
By the end of the week, hospitals administrators told Duntsch he would no longer operate at Dallas Medical Center. But, as had happened at Baylor-Plano, Duntsch was allowed to resign and the hospital didn't notify the National Practitioner Data Bank. Dallas Medical Center officials said the hospital had different managers when Duntsch worked there and that current administrators could not comment on his work or the circumstances under which he left.
Duntsch would continue to operate. In fact, his career in Dallas was only about half over.
After Duntsch's disastrous run at Dallas Medical Center, he was finally reported to the state medical board. The first report came from Shulkin, the Dallas physician who served on the board, who had been told of the surgeries on Efurd and Brown. Other doctors started complaining, too.
"Once I heard about those cases, I called the medical board," said Kirby, the vascular surgeon who had been present for Morguloff's surgery. "I said: 'Listen, we've had egregious results at Baylor-Plano. He was not reported to the databank. We've had egregious results at Dallas Medical Center. He's got to be stopped.'"
After being called in to help Efurd, Henderson, too, made it his personal mission to stop Duntsch from operating. He called Boop at the University of Tennessee to ask about Duntsch's training and spoke to officials at Baylor-Plano hospital. He also called the state medical board.
When a couple of months passed and they didn't hear about more bad outcomes, Henderson and Kirby said they assumed perhaps Duntsch's mistakes had finally caught up with him.
Then, in December 2012, Kirby was asked to help Jacqueline Troy, a patient suffering from a severe infection. (The Troy family would not comment for this story.) Troy was being transferred to a Dallas hospital from a surgery center in the suburb of Frisco. She'd had neck surgery, but the surgeon had cut her vocal cords and one of her arteries. When Kirby learned the details, he asked the doctor who referred the case to him about the surgeon: "Is it a guy named Christopher Duntsch?"
It was.
Duntsch had managed to get a job at Legacy Surgery Center, an outpatient clinic. (The ownership of the clinic has changed and the new owners declined to comment for this story.)
Soon after Troy's surgery, Duntsch was finally reported to the National Practitioner Data Bank, though not by any of his previous employers. A report dated Jan. 15, 2013, obtained by an attorney representing one of Duntsch's patients, shows that Methodist Hospital in the Dallas suburb of McKinney had reported Duntsch after denying him privileges six months earlier. Their rejection was based on Duntsch's "substandard or inadequate care" at Baylor-Plano. (Methodist McKinney declined to comment for this story.)
But even after the report to the databank, Kirby was stunned to discover another hospital had given privileges to Duntsch. In May 2013, he was invited to a "Meet Our New Specialist" dinner thrown by University General hospital at a Dallas restaurant. The event was to celebrate the arrival of a new neurosurgeon: Christopher Duntsch.
"I called down there and raised holy hell," Kirby said.
University General, formerly known as South Hampton Community Hospital, had a troubled history: two bankruptcies and a former CEO sentenced to prison for health care fraud. Purchased for $30 million in 2012 by a Houston-based company, University General was one of only three hospitals serving Dallas' southern half, an area that spans 200 square miles and includes more than 560,000 people. The surrounding community was hoping for a turnaround.
The hospital is now closed, and its administrators from that time did not respond to questions about why they hired Duntsch.
It likely came down to simple economics. According to the health care analysis firm Merritt Hawkins, the average neurosurgeon is worth $2.4 million a year in revenue to a hospital.
"That's a dream for a hospital administrator," Kirby said.
It's also a virtual employment guarantee for a doctor with Duntsch's credentials, Dallas neurosurgeon Dr. Martin Lazar said.
"I don't think it's because of our charm," Lazar added dryly. "We are like a cash cow."
It was at University General that Glidewell had his neck surgery, knowing none of Duntsch's by then two-year history of botching operations.
Glidewell's back problems had begun almost a decade earlier, in 2004, when he broke his back in two places in a motorcycle accident. After a year of rehab, he tried to go back to his job working on air conditioning systems but lasted only months before the pain stopped him. He left his first meeting with Duntsch elated and filled with hope.
"I was actually so happy with the way it went that I called my wife and my mother and said, 'I think I found somebody on my insurance that's gonna fix my neck,'" he said.
The day of the surgery began ominously. That morning, "We pulled out of the driveway, and soon as we started going forward down the street, a black cat ran across the front of the car," Glidewell said. "I said, 'Oh, Lord, this is not good.' We turned the corner, and when we got on the first county road, and another one. Turning into the hospital, another one."
Three black cats on the way to the hospital. "I said, 'We need to just turn around and go home.'"
Once at the hospital, Glidewell and his wife waited. And waited. Three hours late, they said, Duntsch finally arrived in a cab. "He had on jeans that were frayed at the bottom," Glidewell said. "He didn't look like he was ready for a surgery."
Reluctantly, Glidewell went ahead. But hours later, Duntsch came out and told Glidewell's wife that he had found a tumor in Glidewell's neck and aborted the procedure.
"I was devastated, crying," Robin Glidewell recalled. She went to see her husband in the recovery room. "Immediately, Jeff was: 'Where is the doctor? I can't move my arm or my leg.' He was having trouble even talking and said, 'Something's wrong, something's wrong.'"
There was no tumor, but Duntsch had made a series of errors after mistaking a portion of Glidewell's neck muscle for a growth, according to a review of the case.
The owner of University General heard about what happened to Glidewell and called Kirby to try to mitigate the damage.
"I, with reluctance, went down there and met the Glidewell family and took care of him," Kirby said. Glidewell was spiking fevers and was transferred to another hospital for care. He would remain there for months.
"This was not an operation that was performed," Kirby said. "This was attempted murder."
By the time Duntsch operated on Glidewell, the state medical board had been investigating him for about 10 months.
Frustrated by the board's inaction, Henderson had called the lead investigator six months earlier to beg for faster intervention. In a recording Henderson made of the call, he says, "This is a bad, bad guy, and he needs to be put on the fast track if there's such a thing." She tells him she wishes they could suspend his license while they investigate, but the board's attorneys wouldn't go for that.
Kirby sent the board a five-page letter on June 23, 2013, spurred by what had happened to Glidewell. "Let me be blunt," it said. "Christopher Duntsch, Texas Medical Board license number N8183, is an impaired physician, a sociopath, and must be stopped from practicing medicine." Robin Glidewell also sent a letter, describing what happened to her husband.
By then, Brett Shipp, a reporter from Dallas' ABC affiliate, had gotten tips about the board's slow-moving investigation of Duntsch from a friend of one of Duntsch's patients and a plaintiff's attorney. "Very shortly after I contacted them," Shipp said, "they suspended his license."
On June 26, Duntsch was ordered to stop operating. The head of the medical board at the time, San Angelo family physician Dr. Irvin Zeitler, said the investigation took a while because "it's not uncommon for there to be complications in neurosurgery."
It also struck the board as highly improbable that a surgeon fresh out of training could be so lacking in surgical skill.
"So none of us rushed to judgment," Zeitler said. "That's not fair, and in the long run, it can come back to be incorrect. To suspend a physician's license, there has to be a pattern of patient injury. So that was, ultimately that's what happened. But it took until June of 2013 to get that established."
Even after the board acted, those most involved in trying to keep Duntsch from operating were afraid it would not be the end of his career.
"I was terrified of that term, 'suspended,'" Henderson said. "I mean, that indicates that he might get it back at some point in time, and I was already aware of the fact of how glib Dr. Duntsch was, and how disarming he was, and how friendly and intelligent he appeared whenever he introduced himself to people that he wanted to impress. I was concerned that he would do the same thing in getting his license back whether it was six months later, a year later, two years later."
Kirby, Henderson and another doctor decided to contact the district attorney, convinced that Duntsch's malpractice was so egregious it was criminal. They met with an assistant DA but got little traction.
On Dec. 6, 2013, the medical board permanently revoked Duntsch's license.
He left Texas, moving in with his parents in Colorado and filing for bankruptcy, claiming debts of around $1 million. His life seemed to go into a free fall. In January 2014, he was pulled over by police in southern Denver around 3:30 a.m. Officers said he was driving on the left side of the road with two flat tires. When he opened the window, they smelled the sour tang of alcohol and spotted an empty bottle of Mike's Hard Lemonade on the floor of the car. A full one was sitting in the console. After a breath test, Duntsch was arrested for DUI and sent to a detox facility.
Even though he was living in Colorado, he continued to return to Dallas to see his two sons. His older son had been born back when he at Baylor-Plano. His girlfriend, Wendy Young, had a second son in September of 2014.
The following spring, in March, police were called to a bank in Northeast Dallas after passers-by noticed a man with blood on his hands and face beating on the doors. It was Duntsch, babbling about his family being in danger. He was wearing the shirt of his black scrubs. It was covered in blood. Officers took him to a nearby psychiatric hospital.
In April, Duntsch went to a Dallas Walmart because his father had wired him money. According to a police report, he filled a shopping cart with $887 worth of merchandise, including watches, sunglasses, silk neckties, computer equipment, a walkie-talkie and bottle of Drakkar Noir cologne. He put them in bags he swiped from a register. He then then picked out a pair of trousers and put them on in a dressing room. He put his own pants into the cart and rolled the cart out the front door without paying for the pants he was wearing. Moments later, he was arrested for shoplifting.
By then, reporters were following every twist in the Duntsch saga. In May 2015, the Texas Observer published an article with the headline, "'Sociopath' Surgeon Duntsch Arrested for Shoplifting Pants." In the comment section underneath the article, Duntsch responded with a series of diatribes against everyone he thought had conspired against him. His cybermanifesto ran to more than 80 pages when printed out.
In one comment directed at Kirby, he wrote, "You use the word without explanation impaired physician and sociopath. Since I am going to sue you or [sic] libel and slander of a criminal nature, this might be a good point to defend this comment." He called Morguloff's surgery "a perfect success."
Kirby took the comments to the district attorney's office. By then, a judge who knew Glidewell had also brought the case to the DA's attention.
Prosecutors began discussing the case anew and one assistant district attorney, Michelle Shughart, found it particularly interesting. In 13 years with the Dallas DA's office, she'd prosecuted drug dealers, robbers, but never a doctor. "I went and started doing my own research," she said. "I just ended up taking over the case."
One of the biggest challenges was that there hadn't been a case like it before.
"We did a lot of research to see if we found find anyone else who had done any cases like this, any other doctors who had been prosecuted for what they had actually done during the surgery," Shughart said. "We couldn't find anyone."
As she and other prosecutors contacted every person Duntsch had ever operated on or their survivors, they struggled to figure what crimes he could be charged with. They settled on five counts of aggravated assault arising from his treatment of four patients, including Brown and Glidewell, and one count of injury to an elderly person, because Efurd was over 65.
In Texas, this charge carried a potential life sentence, but prosecutors had to race to file the case.
"We had about four months left before we were going to run out on the statute of limitations" on Efurd's case, Shughart said. "I spent those four months just digging as hard as I possibly could, trying to gather as much information as I could. And by the time we got down to that July, I had overwhelming evidence to indict him."
Duntsch was taken into custody on July 21, 2015.
For some of his patients, the criminal case offered a last chance at justice they couldn't get through the civil courts.
Since Texas capped damages in medical malpractice lawsuits, limiting the amount plaintiffs can be awarded for pain and suffering in most cases to $250,000, the number of suits filed and amounts paid out have plummeted.
The suits that go forward often ride on economic damages, such as lost earning power, which the law does not limit in non-death cases. But many of Duntsch's patients were disabled when they came to him, or older, or had lower incomes. Some had pain that was hard to economically quantify. Despite having clear-cut claims and serious, irreversible injuries, three patients I talked to said me they had trouble finding attorneys to take their cases.
"It is not worth an attorney's time and energy to take on a malpractice case in the state of Texas," Morguloff said.
Ultimately, at least 19 of Duntsch's patients or their survivors obtained settlements, but 14 of them were represented by Van Wey, who said she's taken them on more out of a sense of outrage than out of any financial upside.
Morguloff was told no so often, he was surprised when attorney Mike Lyons finally took his case. He received a confidential settlement but said, "It wasn't much." He took more solace from the criminal case.
"To get this guy off the streets so nobody else got hurt again was important," he said. "The public needed to know that there was a monster out there."
Duntsch's trial began on Feb. 2, 2017, and focused on the charge related to Efurd, injuring an elderly person.
She testified, but first, to show that her botched surgery was part of pattern, prosecutors — over objections from Duntsch's attorneys — put a long line of his other patients and their relatives on the stand.
"You had people in walkers. You had people on crutches. You had people that could barely move. You had people that had lost loved ones," Robbie McClung, Duntsch's lead defense attorney, said. "You had all sorts of things that had gone wrong. Before we even get to Mary Efurd, you can see that it's just ... it's going downhill. I mean, it's going downhill fast."
Duntsch held up remarkably well, seeming calm in the certainty that he really was a good surgeon.
"I always thought when I looked at him, even when he was in his jail clothes, he exuded a confidence," Richard Franklin, another member of the defense team, said. "And I could certainly understand why patients would trust him."
Then Lazar and other experts walked the jury through a litany of Duntsch's surgical missteps. Duntsch's attorneys noticed a change come over him. He deflated before their eyes.
"I think that he thought he was doing pretty good," Franklin said. "Really and truly, in his own mind. Until he actually heard from those experts up there."
A key prosecution witness was Kimberly Morgan, who had been Duntsch's surgical assistant from August 2011 through March 2012 and was also his ex-girlfriend. Morgan described Duntsch's mercurial nature, vacillating from being kind and caring to patients to being angry and confrontational behind closed doors.
The prosecutors had Morgan read parts of an email Duntsch had sent to her in the early morning hours of Dec. 11, 2011, three weeks before he operated on Passmore at Baylor-Plano, the first of his surgical disasters.
The subject line of the email was "Occam's Razor." Occam's razor is the idea that the simplest explanation for anything is most likely the right one. The email rambled on for five profanity-laced pages, but Morgan delivered the most startling passage.
"Unfortunately, you cannot understand that I am building an empire and I am so far outside the box that the Earth is small and the sun is bright," Duntsch had written. "I am ready to leave the love and kindness and goodness and patience that I mix with everything else that I am and become a cold blooded killer."
It took the jurors just hours to find Duntsch guilty of knowingly injuring Efurd. He was sentenced to life in prison. He's currently incarcerated in Huntsville, about an hour outside Houston. On Sept. 18, his attorney filed an appeal in a Dallas court, arguing that the testimony on cases other than Efurd's and the email read by Morgan unfairly influenced the jury.
In February, I visited Summers, Duntsch's old football buddy-turned-patient, in his small apartment in downtown Memphis.
He remains in much the same condition as he awoke in after Duntsch operated on him, unable to move from the neck down. He requires 24-hour caregivers and sat, tipped back, in his power wheelchair, as I talked to him about Duntsch.
Summers seemed resigned to his injuries, to his friend's role in them and to the systemic weaknesses that allow problem doctors to keep practicing. He said he tries not to think about Dallas anymore.
I asked him why he'd trusted Duntsch to be his doctor. He couldn't say. He looked out the window.
He knew his friend could barely drive a car without getting lost, he said. He just assumed he had been better trained for neurosurgery.
The executive told Memorial Sloan Kettering staff that the hospital did not do enough to limit the industry conflicts of its chief medical officer, who has resigned.
This article first appeared October 01, 2018 on ProPublica.
The chairman of the board of Memorial Sloan Kettering Cancer Center bluntly disparaged the hospital's former chief medical officer on Monday, telling the hospital staff that he "crossed lines" and went "off the reservation" in his outside dealings with health and drug companies.
The remarks by Douglas A. Warner III, the chairman of the center's board of managers and overseers, as well as Dr. Craig B. Thompson, the chief executive, went beyond previous hospital statements about the former chief medical officer, Dr. José Baselga. Until Monday, the hospital had said he followed internal policies and had mainly just failed to disclose his industry affiliations in some medical journal articles.
"I have to say, while we pushed back on a lot and discussed a lot, we were not as effective as we should have been," Warner said, according to a preliminary transcript of a meeting with the hospital staff that was inadvertently emailed by the hospital to a reporter for The New York Times. "He crossed lines that we should have done more to stop."
Baselga did not respond to phone calls or an email message requesting comment.
Monday's meeting between hospital executives and its employees is the latest in a series held by the cancer center as it conducts a broad review of policies about the nonprofit institution's ties to outside industries. Memorial Sloan Kettering has been forced to re-examine its rules governing board memberships and compensation in the wake of articles by The Times and ProPublica that revealed insider deals with startups that were poised to reap millions of dollars for breakthroughs in cancer treatments and biotech advances.
The hospital's highest executives have come under scrutiny in recent weeks, leading Warner to question on Monday whether Thompson would be permitted to continue sitting on the board of Merck, which makes the blockbuster cancer drug Keytruda. In addition to Merck, Thompson is also a director of Charles River Laboratories, a publicly traded company that assists research in early drug development.
Thompson received $300,000 in compensation from Merck in 2017, according to company financial filings. He was paid $70,000 in cash from Charles River in 2017, plus $215,050 in stock. The compensation for the two corporate boards was in addition to what he was paid as chief executive at Memorial Sloan Kettering. In 2016, he earned $6.7 million in total compensation from the cancer center and related organizations, according to the most recent Internal Revenue Service filings.
"Should Craig continue to sit on the Merck board? We have no policy on that," Warner said during the meeting, explaining that he had discussed the board membership with Thompson when he joined the hospital in 2010. And while it was viewed as a "good thing," Warner added that "we need to step back from that now and ask ourselves whether that continues to be appropriate, whether it's appropriate in the future."
In a memo late last week and again at Monday's meeting, the New York-based cancer center emphasized the need to overhaul its policies, which had failed to address some of the potential conflicts made public recently at a time when investors are tossing vast amounts of money at startups developing promising treatments.
Thompson said Monday that working with for-profit companies remained a priority. "We cannot be shy about the importance of investments in bringing forward these advances," he said.
Neither his resignation letter nor the hospital's statement about it suggested that he was fired. But in his remarks, Warner indicated that Baselga was forced out. "I have to say it's a tragedy. I liked José. I like José a lot," he said. "But unfortunately, José left us no choice."
Baselga, one of the world's leading breast cancer researchers, has also resigned from the boards of the drugmaker Bristol-Myers Squibb and Varian Medical Systems, a maker of radiation equipment.
Christine Hickey, a hospital spokeswoman, said: "Dr. Baselga resigned, he was not fired. Mr. Warner was making the point that we had no choice but to accept his resignation."
She also said Warner and Thompson were referring not to his ties to outside companies but to a "conflict of commitment."
"Dr. Baselga wanted to take on more, join more boards, be involved in more outside efforts," she said. "He was overextended."
On Monday, Rep. Debbie Dingell, Democrat of Michigan, sent a letter to Thompson seeking answers to a series of questions about the deal with the company, Paige.AI, giving it the right to access images of 25 million tissue slides analyzed over decades. Her letter questioned how the hospital planned to ensure patient privacy, among other issues, many of which had been raised by hospital doctors at the internal meetings once the deal became public.
Also on Monday, The New England Journal of Medicine published a correction on two of Baselga's articles. The correction lists Baselga's relationships with 15 companies. An editor's note appended to the correction states: "Dr. Baselga failed to disclose in these articles his multiple, substantial financial associations, which are now apparent in the updated disclosure forms. When we learned of this breach of trust, we conveyed our concern to Dr. Baselga's institution, Memorial Sloan Kettering Cancer Center."
In his own comments to the staff, Thompson apologized for what he described as his poor handling of the recent crisis and said Baselga had not acted appropriately.
"José reported to me, and I wish I had done more to keep him away from the line," Thompson said, according to the partial transcript of Monday's meeting. "While Dr. Baselga has acknowledged his mistakes and resigned, this has not brought closure to MSK. It has led to discussions of whether we still know where the right side of the line is."
Warner, a former chairman of JPMorgan Chase & Company, acknowledged "widespread anger" among staff members and that the hospital's reputation had been harmed.
"The question that you're asking quite properly is: Where the hell was management and the board in all of this, you should have protected this institution," Mr. Warner said. "The fact that you're angry is all about the passion that you feel for this place, that love that you have for this place, that commitment that you have to this place, and I wouldn't have it any other way."
A vice president at Memorial Sloan Kettering received a stake of nearly $1.4 million in a biotech company for representing the hospital on its board. He will give back his stake as the cancer center grapples with questions about conflicts of interest.
This article first appeared September 29, 2018 on ProPublica.
A vice president of Memorial Sloan Kettering Cancer Center has to turn over to the hospital nearly $1.4 million of a windfall stake in a biotech company, in light of a series of for-profit deals and industry conflicts at the cancer center that has forced it to re-examine its corporate relationships.
The vice president, Dr. Gregory Raskin, oversees hospital ventures with for-profit companies. As compensation for representing the hospital on the biotech company's board, Raskin received stock options whose value soared when the startup went public a little over a week ago.
The move to hand over his stake is one of several steps now underway as the cancer center tries to contain a crisis that has already led to the resignation of its chief medical officer and a review of its conflict-of-interest policies. Several board members and some executives of the nonprofit institution have maintained close ties to the health and drug industries at a time when stunning cancer breakthroughs are generating excitement among investors and spawning a flurry of biotech startups.
At other cancer centers and research institutions, employees are barred from accepting personal compensation when they represent their institution on corporate boards. But Memorial Sloan Kettering had no such prohibition until now.
Raskin has been involved with the startup, Y-mAbs Therapeutics, since 2015 when he signed off on the deal with Memorial Sloan Kettering, where the company's experimental treatments for children with cancer have been developed. His vested stock options are worth about $675,000, at least on paper. Stock options that will vest in the future are worth about $616,000 more. In addition, shares he had personally purchased earlier at a discounted price are now worth about $106,000 more than he paid for them.
After ProPublica and The New York Times asked about Raskin's compensation, Memorial Sloan Kettering said it would change its policy so that he and other employees in similar roles would not profit personally from such arrangements, and that all proceeds would revert to the hospital and its research.
On Friday, the hospital issued a memo to thousands of employees, announcing that it would restrict some interactions with for-profit companies. It said it was imposing a moratorium on board members investing in or holding board positions in startups that originated with Memorial Sloan Kettering.
For now, the moratorium on board investments only applies to new deals, the hospital said. It would not affect the exclusive deal the hospital made with an artificial intelligence company, Paige.AI, to license digital images of 25 million tissue slides. Three insiders, including a member of Memorial Sloan Kettering's executive board, were company co-founders, and three other board members were investors. Staff turmoil over the deal caused Dr. David Klimstra, the chairman of the pathology department, to announce that he would divest his equity stake in Paige.AI.
Memorial Sloan Kettering said in the memo, "We have determined that when profits emerge through the monetization of our research, financial payments to MSK-designated board members should be used for the benefit of the institution."
The proposed policies stopped short of barring hospital executives from receiving compensation for their work on outside boards, although officials have said that is a move they are considering. Dr. Craig B. Thompson, the cancer center's chief executive, sits on the board of the drugmaker Merck. Dr. José Baselga, the chief medical officer who resigned under fire this month after an article in The Times and ProPublica about his undisclosed industry ties, sat on the board of the drugmaker Bristol-Myers Squibb and Varian Medical Systems, a manufacturer of radiation equipment. He resigned both positions after he stepped down from his role at the hospital.
In an email, Raskin said that all of his compensation for work with Y-mAbs "is being committed to Memorial Sloan Kettering and the amazing work we do." He said he "couldn't be prouder of the work we've accomplished at Y-mAbs in extending children's lives. I am grateful that I have the opportunity to lend my expertise in biotech business development and licensing intellectual property to bring MSK's unique and critical discoveries to cancer patients."
Christine Hickey, a spokeswoman for Memorial Sloan Kettering, said Raskin brought the matter to hospital leadership on Sept. 21, the same day that Y-mAbs began trading publicly and a day after the article about Paige.AI was published online. She said he had fully disclosed his ties to the company, as required by the hospital.
Before joining Memorial Sloan Kettering in 2012, Raskin was vice president of the venture capital arm of AllianceBernstein, focusing on biotechnology. He now leads the cancer center's Office of Technology Development.
Hospitals and universities have long assisted researchers with tasks like registering patents, but Raskin's field --- known as technology transfer --- has expanded in recent years. Technology transfer offices have become increasingly involved in helping to set up companies, said Stephen Susalka, the chief executive of the Association of University Technology Managers. More than 1,000 startups originated at universities, hospitals or research institutions in 2017, according to his group, up from about 550 in 2007.
Research institutions have varying policies when it comes to allowing employees to represent them on the boards of companies. Some, like the Cleveland Clinic and the University of Texas MD Anderson Cancer Center, permit employees to represent the hospital on company boards, while others, like the University of Utah, do not.
The Cleveland Clinic said it prohibits employees from personally profiting when they are representing the interests of the institution. A spokeswoman for MD Anderson said that its head of technology transfer serves on one corporate board as a hospital representative, but that position is uncompensated.
Karin Immergluck, the executive director of the Office of Technology Licensing at Stanford University, said she would not serve on a company board in her position overseeing the commercialization of research discoveries at Stanford.
"It looks very conflicted, and I would think people from the outside might ask who you are representing," the nonprofit institution or the for-profit company, she said.
Y-mAbs, based in New York, was formed around immunotherapy treatments developed by the lab of Dr. Nai-Kong V. Cheung, a pediatric oncologist at Memorial Sloan Kettering. As part of a commercialization agreement, he received a stake worth $64.5 million on Friday. Researchers whose discoveries lead to new drugs are not covered by the new policy.
With help from those promising therapies, the company's market value has skyrocketed to nearly $867 million.
"Memorial Sloan Kettering couldn't be prouder of the work of our colleagues --- who persisted over a 20-year period --- to develop antibodies against different forms of advanced neuroblastoma; they are literally saving children's lives," Hickey said.
Y-mAbs is hoping to win approval for its two lead products, naxitamab and omburtamab, to treat neuroblastoma and other cancers. Both drugs were given a breakthrough designation by the Food and Drug Administration, which means the agency will give them an expedited review because there is evidence they could be a substantial improvement over existing treatments.
In August 2015, Raskin signed off on the licensing deal between Memorial Sloan Kettering and Y-mAbs. Within weeks, he had taken a seat on the Y-mAbs board. After that, he had to recuse himself from hospital decisions about the company and was not allowed to sign agreements between Memorial Sloan Kettering and the company, officials said.
The company said Raskin received the same package of compensation as others on the nine-member board who are not company executives.
Between 2015 and 2017, Raskin also served on the board of another company, Sellas Life Sciences Group, that was created to commercialize a cancer vaccine developed at the hospital. Memorial Sloan Kettering said he was not serving as the hospital's official designee, and Raskin received $30,000 for his service in 2017, according to financial filings. He will now give that to the hospital to benefit research, Memorial Sloan Kettering said.
Memorial Sloan Kettering Cancer Center has abruptly changed the focus of an annual fundraising campaign amid a widening crisis that has already led to the resignation of its chief medical officer and a sweeping re-examination of its policies.
The campaign, initially titled "Harnessing Big Data," was to have focused on the cancer center's research into the use of artificial intelligence in cancer treatment, according to a brochure on Memorial Sloan Kettering's website.
Pathologists at the hospital complained that their work was being commercialized for private gain and that patients were not being informed that images of their tissue slides were being shared with an outside company. The hospital and its officials said they did nothing wrong, but acknowledged that they could have communicated better.
Kenneth Manotti, the cancer center's senior vice president and chief development officer, made a reference to the article in an email sent Friday to board members of the Society of MSK, the hospital's volunteer fundraising arm, and an affiliated committee. It said the fundraising effort, which would have accelerated the center's research on artificial intelligence, would be postponed "under the current circumstances, as we navigate through the issues at hand."
A spokeswoman for Memorial Sloan Kettering said Tuesday that the Society of MSK would instead focus on patient care and would proceed. The society's annual campaign typically raises funds ranging from roughly $800,000 to $1 million for the hospital, she said. Over all, the society raised more than $20 million a year for Memorial Sloan Kettering, according to its annual reports.
The change highlights the fundraising challenges faced by Memorial Sloan Kettering, which is one of the nation's most prestigious cancer centers and recently completed a $3.5 billion multiyear fundraising drive. Earlier this month, the hospital's chief medical officer, Dr. José Baselga, resigned under fire after an article by ProPublica and the Times revealed that he had failed to disclose his extensive industry ties in dozens of medical journal articles in recent years.
At meetings and in online forums, patients and staff members have expressed concern about the institution and the way in which it interacts with the health and pharmaceutical industries. The hospital has announced a task force to study its conflict-of-interest policies and said Tuesday in a note to the staff that it would hire an outside law firm to conduct a "focused review" of unspecified concerns that had been raised internally. The leaders said they believed the concerns were without merit.
That uneasiness was reflected at a staff meeting on Thursday, when a pediatric neurologist told the leaders that she was a little embarrassed about the institution even though she is a spokeswoman for Cycle for Survival, a Memorial Sloan Kettering charity that raises money for research. She asked for advice on how to move on, according to several attendees.
Dr. Craig B. Thompson, the hospital's chief executive, responded that it was important to focus on the cancer center's dedication to treating cancer, including the rare cancers that are the focus of Cycle for Survival, according to the attendees. Cycle for Survival raised $39 million this year. The hospital spokeswoman, Christine Hickey, said the 2019 Cycle for Survival event was already planned and would proceed.
The fallout has led medical and academic experts to call for tighter disclosure rules on potential conflicts of interest in the cancer research fields and among major nonprofit organizations. Thompson and Dr. Lisa DeAngelis, acting physician-in-chief, acknowledged the issue of low morale in an email to the staff on Monday.
"We and our board are very aware of the disappointment and distress that many of you are experiencing after recent events at our center," they said in the memo, which was obtained from hospital staff members. "We share these concerns and are deeply sorry that you feel let down. As your leaders, we recognize that nothing is more important than maintaining the integrity and reputation of MSK and its staff."
Fundraising can quickly dampen when charities sustain a reputational hit, said Sophia Shaw, the co-founder and managing partner of Acorn Advisors, which advises nonprofits. "They're exactly like investors in a for-profit company," Shaw said of donors. But rather than expecting a return on investment, donors are expecting a return on the charity's mission. "If the donor doesn't feel that their money is furthering that mission, then they could be reluctant to give it away at that time."
Consultants for nonprofits said major donors were unlikely to be easily rattled by news reports, but that could change depending on what happens next and how the hospital responds.
"Individual funders — and also foundations and corporations — don't like bad news," said Richard Mittenthal, president and chief executive of the TCC Group, which advises nonprofits. "And when there's bad news, there's always a question of — is there any more bad news?"