Patients in Peril: How Virginia's medical system lets dangerous
doctors continue to practice


Illustration by Sam Hundley / The Virginian-Pilot.


By LIZ SZABO, The Virginian-Pilot
© January 19, 2003

More than 250 doctors are licensed by the Virginia medical board
despite records of serious mistakes or misconduct, a review of board
actions since 1990 shows.
They work in every corner of the state, in virtually every specialty.
Their ranks include sex offenders, swindlers, tax evaders, felons,
former drug dealers and even a convicted murderer. Some have been
rejected by a string of hospitals or insurance companies.

Among those still licensed:

- A Norfolk physician who injected cancer patients with medicine made
with tiny amounts of their own feces.

- An Abingdon surgeon who accidentally cut out most of a woman's
bladder and lost another patient just hours after a hysterectomy.

- A Winchester ear, nose and throat specialist who fondled six young
boys during office visits.

- An Army doctor imprisoned for sexual battery of two underage girls
during examinations.

- A Norfolk doctor imprisoned for murdering his wife with a
.22-caliber rifle.

An analysis of the National Practitioner Data Bank, which tracks
physicians, found at least 70 Virginia doctors who have been
disciplined five or more times by state and federal authorities,
hospitals or professional societies. Only 28 of them lost their
licenses.

The Board of Medicine's executive director, Dr. William L. Harp, said
state law forbids him or any board member from discussing individual
cases or decisions.

Robert Nebiker, director of the Virginia Department of Health
Professions, which includes the Board of Medicine, said he does not
feel comfortable ``second guessing'' past decisions without reviewing
all the evidence.

He said the board takes its responsibility for policing doctors
seriously and revokes licenses only after careful consideration.

``A lot of money goes into making a health-care professional, and
there aren't enough of them to go around,'' Nebiker said. ``So when
you kill one off, you are potentially losing a scarce resource.''

The Virginia Board of Medicine, a state body whose 18 members are
appointed to four-year terms by the governor, licenses more than
25,000 physicians and osteopaths. It can vote to reprimand doctors,
fine them, place them on probation, suspend them or revoke their
licenses.

Nebiker noted that the worst examples of physician misconduct
represent a small fraction of the total number of cases that the board
reviews.

Although patient advocates stress that the vast majority of doctors
are capable and honest, they compare impaired or unethical
practitioners to drunken drivers -- few in number but a threat to many
people.

The General Assembly this month is considering a bill introduced by
Del. Winsome E. Sears of Norfolk and another by Gov. Mark R. Warner
that address how the state medical board operates.

``We're trying to rein in the bad doctors, but at the same time you
have to rein in the Board of Medicine and the hospitals,'' said Sears,
a Republican. ``This is about saving lives.''

Sears, who became interested in the issue last year after reading a
report in The Virginian-Pilot about an incompetent Virginia Beach
surgeon, said there have been wide-ranging problems with doctor
discipline for years.

``It's not just about one doctor,'' she said. ``It's a whole host of
people.''

In 1999, an audit by the Joint Legislative Audit and Review
Commission, the watchdog arm of the General Assembly, concluded that
``the Board of Medicine does not adequately protect the public from
substandard care by physicians.''

For too long, critics say, the medical system has focused on
protecting careers rather than consumers.

``The patient should always be put first,'' said Dr. AlanLevinstone,
an internist on the ethics committee at Inova Fair Oaks Hospital in
Northern Virginia. ``It's not just the Board of Medicine. It's the
politicians and the people in Virginia who have not demanded a better
system.''

Board rarely revokes licenses for incompetence
Goettert case
Dr. Judith Goettert of Abingdon
Practice area: Family practice and gynecology
Medical school: University of Health Sciences, College of Osteopathic
Medicine, Kansas City, Mo.
Year completed: 1984
Virginia law makes it difficult for the Board of Medicine to revoke a
physician's license.

Nurses, dentists and others can lose their licenses for ``simple''
negligence, such as a single careless act. But doctors must be found
guilty of ``gross'' negligence, such as a pattern of several serious
mistakes.

A dozen patients suffered serious complications and another died after
surgery by Dr. Judith Goettert, according to a board order, a formal
document in which medical officials record their legal findings and
disciplinary actions.

The October 2000 order catalogs Goettert's mistakes:

- Accidentally removing most of a woman's bladder.

- Operating on a pregnant woman after ``overlooking'' her pregnancy
test.

- Accidentally tying off a woman's ureter, the tube that carries urine
from the kidney to the bladder.

- Perforating the uteruses of three patients.

- Dropping a uterus on the floor during a hysterectomy, then
contaminating her gloves and sterile instruments by picking up the
organ and placing it on a table, according to a hospital incident
report. When meeting with the medical board, Goettert later said that
she caught the uterus in her lap.

One of the doctor's patients, Sharon Raye Santolla, died just hours
after surgery.

In 1999, Goettert settled a civil lawsuit filed by relatives of
Santolla, who died after a hysterectomy at Russell County Medical
Center in Lebanon, Va. Goettert agreed to pay the woman's family
$225,000.

``People like this should not be allowed to practice medicine,'' said
Charles Inlander, president of a national consumer group called the
People's Medical Society. ``It certainly isn't very reassuring to
people like you and me. There should be no room for this in
medicine.''

In 2000, the medical board placed Goettert on probation and allowed
her to continue practicing, with the exception of obstetric and
gynecology surgery.

Last year, Goettert told the board that she had given up obstetric and
gynecological surgery, no longer had hospital privileges and planned
to see patients only in her office. She said she was pursuing not only
conventional medicine but homeopathy, a widely disputed type of
treatment in which minute quantities of natural substances are
administered to improve the body's defense against disease.

Goettert declined to be interviewed for this story.

On Aug. 6, 2002, the board ended her probation and restored her
license to ``full and unrestricted status.''

Sen. Janet Howell of Reston said such stories demonstrate the need for
change.

``It has been clear for some time now that Virginia is protecting
physicians more than patients,'' said Howell, a Democrat. ``The upshot
has been true horror stories of patients suffering from actions of
physicians. . . . It always seemed that the department bent over
backward to defend the doctor.''

Doctors can practice even after ''gross'' carelessness:
The Dunkwu case
Dr. Anthony A. Dunkwu of Alexandria
Practice area: Obstetrics and gynecology
Medical school: University of Florida College Of Medicine, Gainesville
Fla.
Year completed: 1973
Even doctors whose records meet the ``gross negligence'' standard are
sometimes allowed to keep practicing.

Dr. Anthony A. Dunkwu of Alexandria received only a public reprimand
-- the mildest type of sanction -- after botching an abortion.

Dunkwu scheduled the procedure in March 2000 after estimating that his
patient was about 10 weeks pregnant.

Although he performed a pelvic examination, he did not order a
sonogram, according to a board order. Medical experts say sonograms
are not required in the first trimester, although Hampton Roads
abortion providers say they perform them routinely. Experts say the
procedures are recommended in the second trimester.

Dunkwu began the procedure in his office using a local anesthetic.

The abortion quickly went wrong.

The board order states that Dunkwu believed he might have perforated
the woman's uterus and stopped the procedure. A member of his staff
took the patient to Inova Alexandria Hospital so that he could
complete the abortion under general anesthesia.

Dunkwu examined the woman again. This time, he estimated her pregnancy
at 12 to 13 weeks. According to the board order, ``Dunkwu could feel a
separate mass, which he identified as a fibroid,'' a common type of
benign uterine tumor.

He cut open the woman's abdomen and, according to the board order,
discovered that the ``mass'' he had mistaken for a tumor was actually
the uterus. He cut open the woman's uterus and removed a lifeless male
fetus weighing about 2.7 pounds. Dunkwu estimated that it was 20 to 22
weeks old.

In fact, the fetus was 30 weeks old. Babies delivered prematurely at
that age and size usually survive.

Alexandria Hospital placed Dunkwu's clinical privileges on probation
for 29 days, the board order shows.

Punishments that last 30 days or longer generally have to be reported
to the National Practitioner Data Bank, a registry created by Congress
in 1990. Only about 40 percent of hospitals have ever filed a report.

In 2001, when Dunkwu faced the Board of Medicine, he admitted to
making ``an unintentional mistake.'' He also noted that he had begun
routinely performing sonograms for more of his patients considering
abortion, according to the board order.

An informal board committee found Dunkwu to have been ``grossly
careless,'' according to the board order, and reprimanded him.

Dunkwu did not return telephone calls for this story.

Some state officials have questioned the medical board's decision.

``In cases like this, the public is not being protected at all,'' said
Del. Robert G. Marshall, a Manassas Republican. ``We are elected to be
guardians of the public good. If we are not going to pay attention
when the public is not being protected, then we bear responsibility
and we should pay.''

Sex abuse of children fails to trigger revocation
The Timberlake case
Dr. Byron B. Timberlake of Winchester
Practice area: Otolaryngology (ear, nose and throat)
Medical school: Ohio State University College of Medicine and Public
Health, Columbus, Ohio
Year completed: 1964
Virginia's medical board is not limited to disciplining doctors for
incompetence. Only 3 percent of investigations involve medical care
alone, according to the 1999 state audit.

The board also can act in cases of unprofessional conduct. For
example, doctors can lose their licenses for selling drugs or
assaulting patients.

A review of the cases of more than 600 doctors and thousands of pages
of records, however, found that the agency allows more than 40 doctors
to practice medicine despite offenses such as sleeping with patients,
seducing teenage girls or sexually harassing co-workers. About 90
doctors hold licenses in spite of substance abuse or improperly
prescribing drugs.

According to board orders:

- Dr. Daniel M. Calhoun Jr. struck a surgical patient at Riverside
Regional Medical Center in Newport News in 1992. In 1994, he struck a
surgical patient, swore and knocked surgical instruments to the floor.

- Dr. Fang S. Horng, a Luray surgeon, fathered a child with a patient.

- Dr. Antony Joseph, a Richmond psychiatrist, impregnated a former
patient and then told her to ``get rid of it.''

And then there is the case of Dr. Byron B. Timberlake.

Board members concluded that he fondled six boys between the ages of 6
and 13.

The board could have taken Timberlake's license but instead allowed
the Winchester ear, nose and throat specialist to continue practicing.

The abuse began nearly a decade before Timberlake appeared at a formal
hearing of the medical board in 1985, according to an official board
order.

Timberlake saw an adolescent boy 22 times between 1975 and 1977,
according to the board order. On nearly every visit, he took the child
to an operating room alone. Out of sight of the boy's parents or his
staff, he fondled the boy's genitals and, on one occasion, placed his
ear on the child's belly below the navel.

Timberlake got another child alone by telling his mother that he
planned to check the boy's lungs in a different room.

Board officials ruled that Timberlake's bizarre behavior had nothing
to do with a legitimate exam. Officials found that he routinely
examined boys' genitals behind closed doors while a nurse or other
staff member waited outside.

At his hearing, Timberlake testified that he preferred not to examine
children in front of their mothers or chaperones because ``the male
adolescent patient would feel awkward and embarrassed.''

Timberlake did not return telephone calls for this story.

He was arrested in December 1983 and charged with committing
aggravated sexual battery on a child under 13. A jury found him not
guilty in June 1984.

The family of an 11-year-old boy filed a civil suit against Timberlake
in 1985. The doctor settled the suit two years later.

In the lawsuit, filed in Winchester Circuit Court, the boy's family
charged that the ``conduct of the defendant was of such a nature as to
shock the conscience of reasonable men.''

Yet the board was forgiving.

Medical officials found Timberlake ``guilty of fraud or deceit'' and
unprofessional conduct, ruling that his treatment of the six children
was ``contrary to the standard of ethics,'' according to the board
order. He was further found to have practiced medicine ``in such a
manner as to make his practice a danger to the health and welfare of
his patients.''

Authorities revoked Timberlake's license but immediately ``stayed''
the revocation, placing the doctor on indefinite probation, according
to the board order. Officials ordered him not to treat boys under 18
and to see a psychiatrist.

The board commonly issues one sanction and replaces it with another if
it believes there are mitigating circumstances, director Nebiker said.

The next year, in 1986, the board allowed Timberlake to begin treating
young boys again. Officials required that such visits take place ``in
the presence of an appropriate chaperone, preferably a parent,''
according to a board order.

To protect the identity of her son, the mother who sued Timberlake
asked that her name not be used. She is still angry that the board
allows Timberlake to practice and worries that other parents may not
be aware of his history.

``We had such a sound case,'' she said. ``It's just astounding.''

In 1990 -- five years after the board found him guilty -- Timberlake
was taken off probation, and his license was ``reinstated with all
attendant rights and privileges,'' a board order shows.

There are no restrictions on his ability to see children.

Physicians allowed to use discredited alternative therapies
The Speckhart case
Dr. Vincent J. Speckhart of Norfolk
Practice area: Internal medicine and oncology
Medical school: New York Medical College, Valhalla, N.Y.
Year completed: 1958
Dr. Vincent J. Speckhart's unusual brand of medicine has attracted the
attention of state investigators.

At one time, the Norfolk oncologist treated cancer patients with
vaccines made with minute quantities of their own urine and feces, a
board order shows. He also has used a non-standard, experimental
procedure called ``electro-acupuncture of vol,'' in which machines are
supposed to measure patients' electrical activity as a way to diagnose
disease.

In 1993, the board concluded that some of Speckhart's treatments had
no ``accepted therapeutic purpose'' and were ``contrary to sound
medical judgment,'' according to an official order.

The board found that Speckhart, who declined to comment, violated
Virginia law, conducted his practice unethically and endangered
patients, according to the order. He was instructed to stop using the
unusual vaccines and to use the acupuncture procedure only as part of
formal clinical trials.

The board voted to arrange an audit of Speckhart's practice and placed
him on probation, which lasted until 1998.

Speckhart was quoted in The Virginian-Pilot after his 1993 hearing as
saying, "I am grateful to the board for its concern, patience and
diligence in looking after their patients. I feel vindicated . . . I
am a good physician."

The family of Navy Cmdr. Robert A. Rizzi, a 48-year-old cancer patient
who died after being treated by Speckhart, filed suit against the
physician in Norfolk Circuit Court. In 1996, a jury in 1996 found in
the family's favor.

The lawsuit asserted that Rizzi, a Hampton Roads father of three, died
as a direct result of Speckhart's ``failure to comply with the
applicable standards of care.''

Rizzi's widow said she's shocked that Speckhart is still practicing.

``When you have a family member with cancer, you're pretty
desperate,'' said Victoria Rizzi. ``He sure had us fooled.''

- Doctors lose licenses not for medical care, but for criminal
convictions
- Even convicted felons can practice medicine
- A doctor convicted of felonies directly related to patient care is
allowed to keep working
- Even when doctors lose their licenses, it may not be for long

Previous related report: Operating Behind Closed Doors - the Dr.
Robert G. Brewer case