Summer 2003

Investigating What Goes Wrong in Medicine

After 30 years of doing this, a reporter passes along lessons—some serious, some not so serious.

By Paul Lieberman

The fellow who said we learn all we need to know in kindergarten must have been onto something, because he made a lot of loot off that little book. And when I think back on my three decades of conducting investigations into health care issues and atrocities, I see that he’s right—I learned the basic lessons when I stumbled onto such stories while still in the journalistic equivalent of kindergarten.

I say that I stumbled onto my first such story because I can’t remember how I came to “expose” phony psychologists while working my beat of a few suburban towns for $120 a week in New York’s Rockland County. I do recall my sophisticated research technique, though: I went through the yellow page advertisements for psychologists, then checked with the state to see if they were licensed to use that title. Many weren’t. One claimed a PhD based on a certificate from a mail order Bible school. Simple as the premise was, the stories prompted more phone calls than I’d ever received.

Lesson one: Readers care about this stuff.

Lesson two: Be ready for—the twist. With that series, the twist came soon after we published our stories, when the state held hearings on malpractice by therapists. One witness was a woman who went to a psychiatrist because of tension—she mentioned a stiff neck—only to have him subject her to months of very intimate treatments on his couch, charging his full fee all the while. There were gasps from the audience as she recalled his scandalous conduct, and as she stepped from the witness seat a deputy attorney general asked, “And what happened to your stiff neck?”

“Oh,” she said, “that went away.”

Investigating Medical Care

I recall better how I got into medical investigations at my second paper, in New Jersey. Someone on the business side, perhaps in the publisher’s suite, had an experience he wanted the newsroom to check out. (“It’s his sandbox,” a colleague explained, “he can play in it.”) The guy’s kid needed a spinal tap, but the insurance reimbursement had come back low, and his neurologist grumbled that it happened all the time. I went to see officials of the state’s Blue Cross Blue Shield plan and learned another lesson: For all the talk about codes of silence, health care insiders often relish help, even from a 23-year-old know-nothing. The neurologist had confided, for instance, that no doctor he knew really understood how health insurance worked. And Blue Cross allowed me to go through its statewide printouts for two services—spinal taps and neurological consultations—for which, it turned out, half the patients were under-reimbursed.

Was this a conspiracy? No, it was paperwork errors: Clerks filling out the forms often wrote in the wrong number for the service. As unsexy as the answer seemed, the phones again didn’t stop ringing. One call this time was from an employee of the second largest medical lab in the area who offered a confession of a different magnitude: He said he and others often wrote in results for blood tests they never performed. I wound up getting sworn affidavits from several employees saying they fabricated results under orders from the boss. He denied it and threatened to sue, not surprisingly, and invited us to inspect his lab anytime. So we arrived unannounced with a nationally renowned pathologist, whom we’d hired as a consultant.

Another lesson: Make sure you’re right—there’s a lot at stake, both for your publication and the people you write about. In this case, the lab went out of business in the wake of our pieces. We were never sued.

It was then that I decided this kind of reporting was a high calling. That was the Watergate era, when investigative reporting was coming into fashion. But most investigative journalism seemed to target government. Though the press was playing its classic watchdog role by scrutinizing public entities and officials, it struck me that writing about government was—easier. There usually was a slew of public records to work with and, because reporters were writing about public figures, they had libel protection of New York Times v. Sullivan. This meant they could get the stories wrong, in effect, and still have a cushion of immunity. If we’d been wrong about the lab, its owner might have owned our newspaper as well.

When Reporting Leads to Lawyers

But the bigger issue, then and now, is the impact the reporting has on readers. What has the most influence over their lives—what happens in government or what happens in the private sector? I came to believe that the private sector—whether the workplace or the marketplace or the health care system—has more impact on most people than does government.

Despite this epiphany, the last thing I wanted to do was more of the same when, in 1976, I moved to The Atlanta Constitution. But when I arrived, that paper’s investigative good ole boy, Jim Stewart, was waiting with a tip—the senior member of the state medical board had gotten his own medical degree through fraud. The twist on this one? It had to be the only time The National Enquirer picked up one of my stories, or Jim’s. The supermarket tabloid ran a large photo of the poor doc puffing a foot-long cigar.

Several officials of the local medical society sought us out after that piece, and not to gripe that we had disparaged their profession, either. They wanted to talk about other rogues in their ranks who had eluded the disciplinary system. Some wandered from state to state, counting on the reluctance of authorities in each to pass along “negative” information about them. Others simply couldn’t resist easy routes to making money, like a pair of doctors who were running pill mills.

In the ranks of such stories, these situations would not be worth mentioning, but for a moment that approaches the “stiff neck” episode. We sent a couple of novice reporters undercover to confirm how these “pill mills” dealt out prescriptions like playing cards, by gathering groups of patients and asking, “Who wants to lose weight?” and “Who wants help sleeping?” The twist this time came after both doctors were brought up on criminal charges and our reporters were subpoenaed to testify. The newspaper’s lawyers and editors decided that was okay, as long as they merely affirmed what was in print—that the stories presented an accurate account of what had happened to them. But when the defense attorney got his turn, he asked the first reporter, “So what did you do with the pills you got?” Before our attorney could get the prosecutor to object, our young scribe confessed that he’d gobbled ’em.

When physicians complain how they are terrorized by lawsuits, I tell them I understand. “I’ve been sued twice,” I say, “both times by doctors.” One suit was filed by one of the pill doctors after he went to jail. He claimed we’d violated not only civil law, but also the spirit of the Bible, and asked for $20 million. The other suit was filed by a doctor on the state medical board, a friend of the one with the faked diploma. The twist there: He had secretly taped our conversations, a tactic sometimes used by reporters.

Another lesson: Act as if everything you say is being recorded. Don’t spout outrageous things you would not want shared with the world—or a jury. Luckily, I hadn’t in those conversations, and the quotes in the stories matched what was on the tapes. Both suits went nowhere.

I’ve also written a lot about the Mafia over the years. But the first time I was warned to stay away from home was during an investigation about a doctor. He happened to be a congressman as well. Long before he was killed in the 1983 missile attack on a Korean Airlines plane, U.S. Representative Larry McDonald was a darling of the far right. He also was plugged into a network selling laetrile, the cancer “cure” made from apricot pits. Jim Stewart and I spent $600 of The Atlanta Constitution’s money to secure a supply, but that was only an appetizer for the bizarre tale that followed. McDonald and another physician had collected a huge cache of guns that could not be traced to them by getting terminally ill patients to sign the purchase forms. This way the weapons were registered in the names of soon-to-be dead people.

After that article was published, one of the congressman’s lawyers cautioned us that his supporters were, well, not happy. I also heard from another Paul Lieberman in the local phone book, who said he enjoyed my work but that his kids were a bit unnerved by the call threatening to burn down their house.

But, by then, the lesson was: Once you start on these stories, there’s no exit.

A federal drug agent pleaded with us to tackle a ring ripping off truckers around the country by charging big bucks for what looked like amphetamines, but was really caffeine. Someone else mentioned a doctor in Alabama promising miracle cures through “chelation” treatments that cleared out the blood vessels like a Roto-Rooter would a pipe. One owner of the paper was interested in spinal surgery touted as a cure for paralysis. There was no end to the practitioners selling new varieties of hope while offering conspiracy theories for why their easy cures were being suppressed by organized medicine. By then, however, I’d made peace with the fact that, whatever you wrote, some readers would still seek the latest snake oil if peddled with good bedside manners.

An Endless Supply of Stories

If Stewart and I thought we could break the cycle by fleeing to Nieman Fellowships (mine was in 1980, his the next year, in 1981), we were wrong. By the time we’d gotten back to the paper, someone whispered into our ears that some doctors in the Air Force had refused to work with that service’s chief heart surgeon, claiming he had a 50 percent mortality rate while operating on children. The surgeon then had been shipped off to private fellowship where he might have hooked up a heart-lung machine backwards. Like Al Pacino in the last “Godfather” movie, we were “sucked back in,” spending the next year on military health care.

I could have escaped, I suppose, when I switched coasts to join the Los Angeles Times, where riots and earthquakes have a way of diverting your attention. But when I needed a knee operation, it amused me to learn that surgeons generally chose to stay awake when they underwent such procedures themselves, thus avoiding the risks of general anesthesia, yet preferred that their own patients be put under—perhaps so they couldn’t hear some member of the surgical team blurt out an “oops.” What could be the harm in writing a lighthearted piece about that? Or a little magazine story about how radiologists often tried to bill for more than is provided by insurance plans? Or a piece about ….

Understand that during 32 years in the profession, medical reporting has never been part of my job description. Five years ago, I was the Times’s education editor, for example, when someone suggested that I monitor—in my “spare time”—a respiratory therapist at a local hospital who had claimed to be an “Angel of Death,” then took it back. He was only kidding, he said. What was no joke was how such medical “angels” may well be the most common type of big-number serial killer in our society, though we tend to downplay their murder sprees, what with their victims being old and sick and in the hospital or nursing home. That spare-time investigation wound up stretching on for several years, with the results filling seven pages of our paper last year with the story we called “Graveyard Shift.” The hospital worker who was only kidding eventually pleaded guilty to killing six patients with paralyzing drugs, but likely had killed dozens.

If this isn’t a cradle-to-grave subject, what is? It’s not as depressing as it might sound, either, for the same stories that document grim practices by some often spotlight the courage of others, like the fellow doctors who stood up to the chief Air Force heart surgeon, refusing to help him operate on babies any longer. Even back when Stewart and I began putting a spotlight on the Georgia medical board, one member had encouraged us to keep at it, angered by the self-protective politics in his profession. I had not spoken to that doctor in more than 20 years, so I looked him up this spring when I found myself vacationing on the Georgia coast. We met at the perfect place for medical reminiscing, the golf course, and he still gushed over with tales of what various rogues were up to. He was basically retired himself, except for running a therapy group for practitioners with medical and drug problems—doing that work for no fee.

Back when I first stumbled onto this sideline, those of us working at newspapers didn’t talk about “news you can use.” There were just good stories and, for better or worse, causes. But if “news you can use” has now become a catch phrase, what specialty better fills that prescription?

So here are a few more lessons I’ve learned along the way.

When you really get sick, hire someone else to fill out the insurance forms—otherwise the aggravation will kill you before your disease will.

If your plan is supposed to pay all the costs of an anesthesiologist, refuse to sign the sheet of paper they give you in pre-op saying “patient accepts responsibility” for amounts not covered— and dare them to wheel you out of there.

Definitely get those travel medical policies when you go overseas, even if they seem costly—but don’t be surprised when they won’t reimburse you for one item at the finest hospital in London, your bill for “spirits.”

Paul Lieberman, a 1980 Nieman Fellow, now is a cultural correspondent for the Los Angeles Times, based in the newspaper’s New York City bureau.


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