|
Dr.
Joel Yelland | Dr. Roy Meadow | Evelyn
Morgan | Saving
Sarah: another case involving | Charles
Smith |
Martin Stein
A Broken Marriage And
a 'Life Destroyed'
By Sandra G. Boodman and
Patricia Davis
Washington Post Staff Writers, September 28, 2003
The patient and her psychiatrist
flew from Dulles International Airport one steamy June Saturday
on an impossible mission: to scour the woman's childhood home
in Illinois for proof of events that never occurred.
The 36-year-old woman's therapy
sessions with psychiatrist Martin H. Stein had been dominated
by horrific "memories" -- that her father, a prominent
lawyer who had been dead for more than a decade, was a leader
of a racist satanic cult. She told Stein she had been sexually
abused by him and other cult members who forced her to kill and
eat a baby. She said she stood on the basement steps of her family's
house and watched her father shoot numerous black men, among
them a handyman who worked for the family.
None of it ever happened, the
woman's family said. The Virginia Board of Medicine said Stein
used hypnosis, suggestion, massage, psychiatric drugs and the
trip to Illinois to evoke the memories -- all of which were uncorroborated
or disproved. The handyman, for example, actually died in a hospital
after a long illness.
The story of the Fairfax County
homemaker -- identified as Patient C in the board's ruling suspending
Stein's license -- is the most extraordinary of the 10 cases
cited by the board. It highlights the life-altering influence
a psychiatrist can exert over a patient and underscores the unusual
nature of Stein's practice.
At the time of their 1998 trip,
financed from the woman's seven-figure trust fund, Stein was
involved in an intense relationship with her, which included
"sexually intimate behavior," according to the board.
Stein urged the woman to divorce her husband and advised her
that spending the inheritance would be "therapeutic,"
the board found.
Their remarkable 21/2-year
relationship is chronicled in a 500-page complaint the woman's
ex-husband submitted to the medical board in November 1999. The
complaint, which includes e-mails, medical records and other
documents, became the basis for portions of the consent order
Stein signed last year when he surrendered his license. It alleges,
in painstaking detail, the destruction of a family and the increasingly
precarious condition of a woman with a history of serious mental
illness who endangered her children and sacrificed her financial
security in a desperate attempt to please her doctor. The woman's
two young children also are among the patients cited in the order.
The board found that Stein
referred the woman to an Alexandria divorce lawyer who is his
friend and diagnosed her as having eight psychiatric disorders
for which he prescribed about 30 drugs. It concluded that he
gave her financial advice, accepted expensive gifts from her
and arranged a meeting with his sister to talk about sexual abuse.
The board found that he showed the woman a videotape and discussed
the treatment of another patient, identified elsewhere as Ruthann
Aron, the Montgomery County politician charged with hiring a
hit man to murder her husband. Stein was a key defense witness
at Aron's trial.
Stein misdiagnosed Patient
C's 4-year-old son and gave the boy and his 7-year-old sister
powerful psychiatric drugs that had not been approved for children,
the board also found.
"What happened here is
that someone who went to a psychiatrist for help comes out of
it with her life destroyed," said Walter, the woman's former
husband, who spoke on condition that his last name not be published
to protect his children's privacy. "I basically lost everything.
And my kids? Well, who knows what the long-term damage might
be."
Walter said his former wife,
whom he sees frequently, has been cautioned by her attorney not
to talk about Stein; the attorney confirmed this. In September
2001, Stein agreed to pay the woman about $200,000 to settle
a lawsuit in D.C. Superior Court alleging medical malpractice,
sexual battery and fraud. All records in the case were sealed
by a judge at the request of both parties. Walter estimates that
his former wife gave Stein $200,000 to $250,000 in fees and gifts.
Walter said his former wife
consulted Stein in September 1997 because she thought she might
have attention deficit disorder. A few weeks after their initial
meeting, Walter said, Stein summoned the couple to his office.
"He told me [she] had bigger problems [than ADD] and started
showing me these devices, including a battered metal baby cup,
that he said were used by satanic cults."
Stories about ritual sexual
abuse by satanic cults -- increasingly fantastic tales about
organized devil-worshippers who abused and killed young children
-- circulated in mental health and law enforcement circles beginning
in the 1980s. The phenomenon had been discredited in mainstream
psychiatric circles well before 1992, when a noted FBI behavioral
scientist, Kenneth Lanning, issued an influential report saying
that despite extensive investigation, there was no evidence of
such cults.
Stein disagreed. In 1995, according
to a teenage patient and her mother, he kept trying to convince
the girl that her estranged father had been a cult member. The
patient, now 22, said Stein threatened her with hospitalization
if she did not "remember" the abuse.
In November 1997, Walter said,
Stein drove Walter's wife to the Psychiatric Institute of Washington,
where he had privileges. Walter said Stein told him at the hospital
-- where Walter's wife spent nine days -- that Walter's nine-year
marriage was over and blamed him for his wife's hospitalization.
"I went home, and I didn't know what to do," Walter
recalled. "I concluded that she was crazy and that I wasn't
going to leave the children."
Within weeks, Walter said,
his wife began spending as much time as she could with Stein.
She left home at 5:30 a.m. to bring Stein coffee and bagels and
returned later than 10 p.m., after she had delivered the psychiatrist's
dinner.
Stein billed her $450 for two-hour
therapy sessions, which were sometimes as frequent as six days
per week, Walter said. The board found that he also allowed her
to fill canceled appointments and rented her a room in his office
for a daily rate of $100 so she could "hang out." She
confided to her sister that she couldn't live without Stein and
threatened to kill herself by starving. At one point, records
show, the woman, who had a history of anorexia and bipolar disorder,
stopped eating and lost 20 pounds. The board found that twice
she took overdoses of medication Stein prescribed, yet he failed
to send her to an emergency room.
Stein seemed to encourage the
patient's dependence: He took her with him when he taught at
George Washington University's medical school and accompanied
her to doctor's appointments, sometimes going with her into the
examining room, according to documents that are part of the complaint.
Six months after she started
seeing Stein, a Merrill Lynch vice president handling her brokerage
account questioned Stein's fees and expressed amazement at the
$60,000 she had given Stein, according to a statement the woman's
sister submitted as part of Walter's complaint. The broker warned
her that if she did not curtail her expenses, her trust fund,
which then substantially exceeded $1 million, would be exhausted
in a few years.
At the same time, Walter said
he and her siblings, alarmed by her condition, consulted a dozen
prominent psychiatrists across the country. Most advised that
they obtain a second opinion, a plan that Stein discouraged,
the board found.
Stein's attentions were increasingly
directed at the woman's children, especially her young son, whom
the psychiatrist decided was seriously mentally ill. The medical
board found that Stein misdiagnosed both children and continued
to be involved in their care over Walter's written objections
and in violation of a court order. On one occasion, the board
found, Stein bound the boy's feet and ankles with electrical
tape in front of his sister because his mother said he was "out
of control."
William Stage, a child psychiatrist
who treated both children for several months, said he thought
at the time that "the kids and their father were okay and
[their mother] was making them sick." The board found that
several other child psychiatrists failed to find any evidence
of the multiple problems Stein diagnosed in the boy other than
depression.
In September 1999, a judge
awarded both parents joint custody of the children but explicitly
barred Stein from involvement in their care, an order the board
found Stein violated.
In January 2000, the relationship
between Stein and the patient ended abruptly, for reasons that
remain unclear. About that time, Walter said, the medical board,
which had received two complaints about Stein in 1999, began
its investigation.
Walter said that his ex-wife
has found a new therapist and that his children are being treated
by a child psychiatrist at Johns Hopkins Hospital and seem to
be coping well. He said he is trying to put the ordeal, which
cost him his marriage and more than $60,000, behind him.
"I lost everything,"
Walter said, "and I had to basically fight this by myself.
Unless you force the board to act, they will protect doctors."
© 2003 The Washington
Post Company
- Va. Doctor's Misconduct
Left Trail of Broken Lives
Medical System Failed To Protect Patients
By Sandra G. Boodman and
Patricia Davis
Washington Post Staff Writers
Sunday, September 28, 2003; Page A01
Anita Kratzke hadn't been feeling
well in the days before she died. Her body was still in bed,
tucked under her comforter, and there were no signs of violence.
So when the Fairfax County
detective who had been called to the Reston home to investigate
Kratzke's sudden death spotted several bottles of pills near
her bed, she called the doctor who had prescribed them.
Martin H. Stein said he was
Kratzke's doctor and would sign the 49-year-old woman's death
certificate, police reports said. No autopsy was performed.
Police said Stein never explained
that he was a psychiatrist treating her primarily for back pain,
not for any life-threatening condition.
"Cardiac arrest,"
Stein wrote on the death certificate. He did not examine the
body, nor had he documented a visit with her in eight months.
Stein, once listed among the
region's best psychotherapists in Washingtonian magazine, would
say later in court papers that he had no idea what killed Kratzke.
More than 21/2 years after
Anita Kratzke's death on March 19, 2000, the Virginia Board of
Medicine ruled that Stein was a danger to public health and that
his signing of the death certificate without proper investigation
was part of a pattern of negligence. The board's 22-page order
details ethical breaches, misdiagnoses and the inappropriate
and excessive prescribing of drugs, including narcotics, in the
treatment of 10 patients Stein saw between 1991 and 2000.
The board found that Stein
had sexual relations with a patient, treated children even though
he is not a child psychiatrist and was responsible for the deterioration
of several people under his care. Despite the severity of the
violations, Virginia's medical board did not revoke Stein's license.
Instead, the 63-year-old board-certified psychiatrist signed
a consent order last Oct. 11 agreeing to surrender his license
for at least a year. He can apply for reinstatement next month.
The D.C. Medical Board issued an emergency suspension based on
Virginia's order and revoked Stein's license July 9.
Stein's story provides a rare,
unusually detailed examination of the failures of a flawed system
that purports to protect the public. His case raises questions
about the speed and adequacy of discipline meted out by medical
boards -- a slow process enveloped in secrecy that critics say
harms vulnerable patients by allowing bad doctors to keep practicing
-- and about the medical profession's ability to police itself.
This report is based on more than 100 interviews with former
patients and their families, physicians, hospital officials,
lawyers and medical board and law enforcement authorities, and
on thousands of pages of documents filed with two medical boards
and courts in the area.
Among the patients cited by
the board were Anita Kratzke, her husband, Robert, and their
youngest son, Chris, whose simultaneous treatment the board called
a "clear conflict of interest." The board found that
Stein's treatment of Robert Kratzke caused him irreparable brain
damage that forced him to retire on disability from his GS-15
engineering job at the Department of Energy. Chris Kratzke got
so sick under Stein's care that he was committed to psychiatric
hospitals for more than a year. The board also cited Stein for
not properly managing more than a dozen medications, including
powerful narcotics, he prescribed to Anita Kratzke.
"He totally wiped out
my family, and we had to start over," said Robert Kratzke,
52, who pulled up three decades of roots to build a new life
in Honolulu for his sons. "Our life was totally destroyed."
Beyond the Kratzkes, the board
found that Stein "engaged in sexually intimate behavior"
for more than two years with a patient to whom he rented a room
in his Arlington office for $100 a day and charged her $200 an
hour to go on shopping trips and visit her home. Stein flew with
the 35-year-old woman to her home town in Illinois -- at her
expense -- to "evoke memories of childhood abuse."
Other documents submitted to the board say Stein encouraged the
woman to "remember" that her father had been active
in a satanic cult that sexually abused her and forced her to
kill and eat a baby. The report concluded that Stein misdiagnosed
and drugged her 4-year-old son, once binding the boy's ankles
with electrical tape after his mother said he was out of control.
None of the patients was named in the board's order.
Stein has declined more than
a half-dozen requests for comment. One of his attorneys, Geoffrey
Gavett, said, "We've reviewed the requests from The Post
to comment, and after careful deliberation we've concluded it's
not appropriate." In court papers, Stein has denied mistreating
his patients and said the care he provided has always been in
their best interests. Although Stein agreed not to contest the
findings of the board, he did not admit they were true. He has
told colleagues and others that he was suffering from undiagnosed
bipolar disorder while treating many of the patients cited by
the medical board.
Stein was well known to the
Virginia board years before his suspension. A 1995 complaint
by the father of a teenage patient was closed in 1998 without
any action. A 1999 letter by a Northern Virginia internist triggered
a second probe that ended more than three years later with his
suspension. In the interim, there was no way a patient could
have known Stein was under investigation. Board officials say
that 85 percent of the approximately 1,500 complaints it receives
annually do not result in disciplinary action and must remain
confidential. Anyone who checked would have been told that Stein
had a clean record. Of the 10 patients cited in the board order,
nine consulted him in 1995 or later.
Nor did the board do anything
to protect the public by suspending Stein's license while it
investigated the complaints. Six malpractice suits have been
filed against Stein since 1995; four are pending, one was settled,
and one was withdrawn.
Even the doctor who reported
Stein to the board was angered by how long the process took.
"The board is incapable of getting rid of bad people,"
the internist said, speaking on condition of anonymity. "I
kept calling and calling, and nothing happened. The fact is,
the public is not being protected."
Medical board officials say
changes are underway and they already have cut the time it takes
to resolve complaints from an average of 2.6 years in 1999 to
1.3 years last year.
Stein's case highlights another
systemic flaw that imperils patients: a lack of oversight that
allows doctors -- especially psychiatrists, who tend to practice
alone in an office -- enormous discretion. Physicians are further
shielded from scrutiny by what patient advocate Peter Lurie calls
"the thin white line" -- the fierce reluctance of physicians
to report a colleague they suspect or know is incompetent, impaired
or dangerous. Under Virginia law, doctors are required to notify
the medical board when they see such conduct, but that rarely
happens.
"The medical profession
does a really crummy job of policing itself," said a psychiatrist
who reported her concerns about Stein to a Washington hospital.
"Nobody wants to say anything critical about a colleague,
because they don't want to get involved, they're worried about
being sued and there's this feeling, 'That could be me.' "
Medical Rebel
Chris Kratzke was 7 years old
when behavioral problems prompted his parents to seek help in
1995. A respected neurologist at Washington's Children's Hospital
recommended that they see Stein.
"We always looked for
the best care for our family, and that's what we thought he was,"
Robert Kratzke recalled.
Stein's credentials were impressive:
degrees from Harvard and Yale, a 12-year tenure as medical director
of a Northern Virginia psychiatric hospital, joint appointments
in psychiatry and neurology to the clinical faculty at the George
Washington University School of Medicine, and a thriving practice
in Arlington.
Supporters and critics describe
Stein as bright and outspoken, a risk taker who delights in challenging
the orthodoxy of his profession.
But, some doctors and patients
say, his rebelliousness breached boundaries psychiatrists are
not supposed to cross. From the earliest days of training, doctors
-- especially psychiatrists -- are repeatedly warned that they
must maintain the proper physical and emotional distance from
patients. Stein, though, sometimes hugged female patients or
held their hands, according to several doctors and patients.
He loved to talk about himself,
revealing intimate details of his life, including his use of
antidepressants, according to four former patients. He once entered
patient Debra Fink's room at Dominion Hospital in Falls Church,
flopped down next to her on a bed and began nibbling a cupcake
she had left on her nightstand, according to Fink's friend Stephanie
Miller, who witnessed it.
An 11-year-old Stein treated
for three years for alleged incest said he stroked her shoulders,
commented on her developing breasts and advised her to gain weight
to stave off unwanted sexual attention. "He told me so much
about his childhood and his family that I felt I knew them,"
recalled the woman, now 22.
Stein's behavior was no secret
among the staffs at the hospitals where he practiced, according
to several doctors. It was the subject of frequent comments,
especially among the nurses. One psychiatrist said she complained
to supervisors at the Psychiatric Institute of Washington that
Stein was behaving inappropriately, holding a patient's hand
and conducting excessively long therapy sessions in unusual places,
such as seclusion rooms. Their response, she said, was, "Marty
does things that way." The psychiatrist said she left the
hospital soon afterward. Administrators said that they found
no record of the complaint and that Stein was never disciplined.
Similar complaints were rare.
Medical experts attribute the silence to doctors' unwillingness
to criticize a colleague and the value they place on clinical
independence. The ability to practice as a doctor sees fit, however
unconventional the method or dubious the treatment, reflects
medicine's most ferociously defended prerogatives: physician
authority and autonomy.
Some physicians fear that blowing
the whistle on a colleague will brand them as traitors and subject
them to ostracism and retaliation.
"There really is a conspiracy
of silence in medicine," said Lurie, a physician and deputy
director of the patient advocacy organization Public Citizen
Health Research Group. "Doctors protect each other. The
whole culture of medicine, going back to the boot camp style
of residency, creates a team mentality. There's a tendency to
protect people who share so much."
Hospitals are equally reluctant
to censure physicians, fearing expensive and time-consuming lawsuits
that could earn them bad publicity and the wrath of the medical
staff on whom they depend for patients. Since the 1990 inception
of the National Practitioner Data Bank, the federal government's
confidential repository of malpractice payments and disciplinary
actions, about 60 percent of the nation's 6,000 hospitals have
never reported disciplining a single doctor. Problems are often
handled informally. Sometimes doctors are given a signal that
their privileges will not be renewed or are advised to resign
to avoid a sanction that will appear on their records.
Howard Hoffman, medical director
at the Psychiatric Institute of Washington, where Stein had privileges
from 1997 to 1999, said Stein's privileges were not renewed there
because "he never completed the re-credentialing process."
In a deposition, Stein said
he resigned as medical director from Dominion in 1990 after 12
years to avoid being fired from that post. Hospital records show
that he chose not to renew his privileges in 1992, said Brian
Dearing, the hospital's chief executive officer.
Professional societies also
seem reluctant to root out problems. A complaint against Stein
filed with the American Psychiatric Association and its local
branch, the Washington Psychiatric Society, in March 2000 by
the former husband of a patient ended three years later when
Stein resigned from the organizations "during the course
of an ethics investigation," according to an APA spokeswoman.
Officials at both groups declined
to explain why the resolution took three years.
A key reason Stein practiced
so long with so little oversight is psychiatry's elastic standards.
Although it is clearly malpractice for a surgeon to cut off the
wrong leg, psychiatric malpractice is less clear-cut and harder
to prove. Diagnosis and treatment tend to be more subjective,
there are rarely witnesses, and the victim, who is being treated
for a mental illness, is regarded as inherently less credible.
But Stein's prescribing of
unusually high doses of medication, often for unapproved uses
and in untested combinations, drew the attention of some of his
colleagues. The medical board cited his misuse or overuse of
drugs in the cases of all 10 patients.
"He was shameless about
using these doses," said one psychiatrist. She recalled
one meeting at which Stein announced that he had a patient on
180 milligrams per day of Prozac, double the maximum dose of
the antidepressant recommended by the manufacturer.
"The whole room went quiet,"
she recalled. "But nobody said, 'Marty, are you out of your
. . . mind?' " Over the years, she said, she has seen patients
of Stein's who "were medicated up and down the wazoo and
were completely dysfunctional. I needed to tell these patients,
'Your doctor's a quack,' which patients never want to hear. Generally
what I'd say instead is, 'You should get a second opinion,' because
there's this whole thing about not bad-mouthing a colleague or
picking off someone else's patients."
Although some doctors consider
Stein a reckless cowboy, others are vocal in their defense of
him as a courageous pioneer.
One of the most ardent is Jonathan
H. Pincus, chairman emeritus of neurology at Georgetown. "People
hate him because he's pushing the envelope most of the time,
and he would mock people within the envelope," said Pincus,
chief of neurology at the Veterans Affairs Medical Center in
Washington, who said Stein is "one of the most talented
and sensitive physicians with whom I've had the pleasure of working."
That sentiment is shared by a number of his patients, who spoke
privately.
But Pincus noted that his opinion
was not widely shared. "Every time his name came up, psychiatrists
would roll their eyes," Pincus said. His requests that Stein
be granted privileges at Georgetown University Hospital were
rebuffed by hospital administrators, who cited the objections
of the psychiatry department. He was rejected despite the facts
that Pincus was an influential chairman with a national reputation
and Stein had referred dozens of patients for neurological workups
and brain surgery.
Pincus observed that "some
of the things Marty said were just off the wall," such as
his diagnosis of epilepsy in patients who showed no symptoms.
To Pincus, this showed that his friend was a "provocateur,"
not that he was impaired or dangerous.
Neurologist Samuel J. Potolicchio,
leader of a weekly epilepsy conference at GWU who has treated
many of Stein's patients, said he respects Stein's abilities.
"If I had a psychiatric problem, I would see him,"
Potolicchio said. "Dr. Stein took care of very difficult
cases. These people would come in, and he was like a god to them."
When William Stage arrived
at Dominion Hospital in 1988 after 10 years as medical director
of child psychiatry at Washington's St. Elizabeths Hospital,
he heard stories about his new boss. He had a favorite "drug
of the year" as well as a "diagnosis of the year."
Stage was skeptical -- until
he flipped through patients' charts. "I saw he was putting
everyone on the same drug, regardless of their diagnosis. One
year it was Tegretol," a potent epilepsy drug that can cause
a fatal blood disorder.
Stage said he agonized about
what to do. He worried that he lacked sufficient evidence of
wrongdoing because he hadn't directly witnessed it and that if
he spoke up, Stein might sue him. His wife, a clinical psychologist,
warned him that blowing the whistle on his supervisor could torpedo
his own career.
"What I saw was never
quite enough," recalled Stage, who now is in private practice
in Alexandria. "Psychiatry is a unique relationship that
by its very nature is more intense, more involved and more intimate
than any other field of medicine. There are not a lot of clear-cut
ethical boundaries. It's very hard to define where the line is
between sloppy work and dangerous work. This is a bright man,
a charismatic man, who worked hard and had good credentials."
Stage kept
quiet.
In August 1999, a Northern
Virginia internist decided he had to act. One of his patients,
a young woman with a history of heroin use, had landed in Fair
Oaks Hospital with an arm abscessed from intravenous drug use.
She told the internist that Stein had prescribed large amounts
of the narcotic painkiller Oxycontin because it alleviated her
depression. The internist said he called Stein, who defended
his treatment and said antidepressants were not helping her.
In his letter to the medical
board, the internist wrote that he had treated other patients
who had seen Stein "whom I felt received excessive and inappropriate
therapies."
"I wrote such a strong
letter they couldn't ignore it," he recalled. "But
then I kept calling the board to find out why nothing was happening."
Worse Instead
of Better
Robert Kratzke said he and
his wife were elated when Stein told them he could help their
son Chris control the disruptive outbursts that stemmed from
his severe learning disabilities. "This is not a big problem,"
Robert Kratzke recalls Stein telling them in 1995. "He'll
be a new boy in a couple of months."
The psychiatrist prescribed
escalating doses of powerful drugs for the boy, whom he diagnosed
with three serious disorders. Soon he was treating Anita Kratzke's
chronic back pain with massive amounts of powerful narcotic painkillers.
Robert Kratzke, depressed about his son's worsening condition,
became his patient, too.
Paul Applebaum, a Massachusetts
psychiatrist and expert in psychiatric ethics who is president
of the APA, said psychiatrists rarely treat members of the same
family, because it poses a problem of divided loyalties.
Instead of getting better,
the family got worse, the board found. Chris became suicidal
and explosive and spent more than a year in three mental hospitals
-- one five hours away in Lynchburg, Va. His father suffered
brain damage from the drugs Stein prescribed, according to the
board. His mother died suddenly at 49.
The board did not conclude
that Stein's treatment caused Anita Kratzke's death but questioned
his signing of the death certificate without examining the body.
After The Washington Post showed
Fairfax Commonwealth's Attorney Robert F. Horan Jr. a copy of
the board's ruling, he assigned a homicide detective to reopen
the investigation into her death. The detective considered having
her body exhumed for an autopsy but was told by experts that
the embalming process would render inconclusive any toxicology
tests. Stein would not talk to the detective, police said.
"In hindsight, there is
a lot of indication that an autopsy was called for," Horan
said. "The [first] officer didn't know the volume of medication
she was supposedly taking. The reality is that without an autopsy,
it's difficult . . . to prove actual cause of death. The known
evidence would lean toward a drug death."
Stein said in court papers
that he was pressured by the funeral home to sign the death certificate.
He said he wanted to say the cause of death was unknown, but
the funeral home said that was unacceptable.
In a lawsuit against Stein
filed in Arlington County Circuit Court, Robert Kratzke alleges
that his wife died from taking multiple, addictive pain medications
prescribed by Stein that the psychiatrist failed to adequately
monitor. In court papers, Stein has denied that and his lawyers
speculate that Robert Kratzke may have poisoned his wife.
Fairfax Detective Robert Murphy
discounts that theory and said his investigation indicates that
Anita Kratzke likely died from an accidental overdose. "I
also believe that her overdose was largely due to Dr. Stein's
failure to properly monitor her condition and drug regimen,"
Murphy wrote in an e-mail to Robert Kratzke. "I believe
the only way we could have known the truth was with an autopsy,
which Dr. Stein thwarted when he signed the death certificate."
Stein's excessive use of numerous
medications and his misdiagnoses formed the core of the board's
findings involving the Kratzkes. The ruling noted that he prescribed
23 drugs for Chris, including those used to treat epilepsy and
psychosis, as well as 160 milligrams per day of Prozac, double
the maximum adult dose. At the time, the drug was not recommended
for children.
Peter S. Jensen, a professor
of child psychiatry at Columbia University and a former official
at the National Institute of Mental Health, called Stein's treatment
of Chris "just astounding. In my career, I've never seen
these kinds of doses before." Jensen, a psychopharmacologist,
called the regimen "extremely dangerous because of the risk
of using medications in a way we have no information about."
Stein failed to respond to
evidence that Chris was "severely deteriorating" and
dismissed concerns that his treatment might be responsible, the
board found.
Martha B. Denckla, a professor
of neurology, pediatrics and psychiatry at the Johns Hopkins
University School of Medicine, who had seen Chris for annual
evaluations of his severe learning disabilities since he was
5, said she was alarmed by the "marked change" in his
condition in 1996 after Stein began treating him. Denckla said
she twice warned the Kratzkes that Chris was seriously overmedicated
and that she saw no evidence of the psychiatric problems Stein
had diagnosed.
"This had been a bright-eyed,
bushy-tailed, smart, charming little kid, and he had become very
unpredictable, explosive and out of it," Denckla said. After
the Kratzkes twice ignored her concerns, she said, she called
Stein and told him she was upset by Chris's condition. Denckla
said Stein agreed that a child psychiatrist she recommended should
consult on the case. He saw Chris briefly, then left for a new
job in California; Stein continued treating the boy.
On Chris's 10th birthday, his
parents took him, kicking and screaming, to Dominion. He was
later moved to a Lynchburg hospital, where he stayed for more
than a year. His oldest brother, Robby Kratzke, 33, said Chris
often cried on the phone, begging to come home and asking, "Why
do I have to be here?"
Robert Kratzke said Stein assured
him that many psychiatric problems could be remedied by treating
chemical imbalances in the brain. "He said if you're still
feeling pain, then your body still needs the drug," Kratzke
said. "I found him believable."
In its order, the board found
that Stein prescribed "inappropriate and conflicting"
medications for Robert Kratzke that resulted in permanent injury.
The board also found that Stein did not respond to evidence that
Kratzke was abusing alcohol as well as prescription drugs, that
he repeatedly passed out behind the wheel, crashing several cars,
and that he was so drugged that he fell headfirst down the stairs.
Fifteen months after he became
Stein's patient, Kratzke, 47, retired on disability after a 24-year
career with the federal government. Stein helped him complete
the paperwork.
Conference
Appearances
Even though Stein does not
currently have a license, he faithfully attends a weekly epilepsy
conference at George Washington University Hospital designed
to teach medical students and residents, according to senior
doctors in attendance.
On a recent Thursday morning,
residents waited expectantly in the hospital's basement auditorium,
ready for the 7:45 a.m. event.
Shortly before the start, Stein,
wearing a hospital ID badge that said "Martin Stein Neurology,"
strode through the double doors and headed for a seat down front.
Stein offered frequent observations
about a trio of patients presented on videotape, although he
can't practice and his teaching appointment at GWU School of
Medicine ended in June 2000, according to records.
An official of the D.C. Medical
Board said it planned to send investigators to the hospital next
week to determine whether Stein was practicing medicine without
a license by participating in the conference.
A spokeswoman for GWU Hospital
said because the epilepsy conference is open to the public, Stein's
participation is permissible. "It does not mean that he
is in any way participating in any decision-making about patients,"
she said.
But she added, "Certainly
we're not happy with the fact that he was wearing his badge."
She noted that the hospital has three times asked Stein to return
it since October 1996, when he last had privileges there.
"I'm appalled that Stein
is attending and contributing at conferences that are intended
to teach residents and students proper patient care," said
Donna Miller Rostant, a lawyer for the Kratzkes. She declined
to discuss the Kratzke cases.
The Virginia board could have
revoked Stein's license but instead permitted him to surrender
it for a year. Deputy Executive Director Karen Perrine declined
to discuss Stein's case but said the practical effect of a suspension
at the time of the 2002 order was the same as a revocation: loss
of his license for a year. In either case, she said, doctors
can apply for reinstatement.
Stein's case underscores years-long
criticism of the Virginia board that is only beginning to be
addressed: that it rarely disciplines doctors, that the process
takes too long and that punishment is too lenient, leaving the
public vulnerable.
"We see a lot of bad conduct
by physicians, but it doesn't get any worse than this,"
patient advocate Lurie said of Stein. "A year seems like
a very short time, given the damage he did -- like less than
a slap on the wrist.
"I think it's outrageous
that someone would be able to reapply for his license, especially
since there's no hoop he has to jump through, no set of clear
criteria about what standards he would have to meet to get reinstated,"
Lurie added.
In August 1999, the Joint Legislative
Audit and Review Commission, the Virginia General Assembly's
investigative arm, issued a report that found that the board
took an average of three years to resolve the most serious cases
involving physicians and usually allowed them to continue practicing
during an investigation regardless of the severity of allegations
-- including the death of a patient.
Until recently, Virginia doctors
faced sanctions for substandard care only if they were grossly
incompetent or negligent. That threshold was so high -- higher
than the standard applied to doctors in nearly every other state
and to other health care workers in Virginia, including veterinarians
-- that meeting it was extremely difficult. As a result, only
3 percent of cases before the board involved substandard care
by doctors.
Earlier this year, the General
Assembly passed a law lowering the standard from gross negligence
to simple negligence and authorizing the board to revoke a doctor's
license for three years, not just one.
William L. Harp, a psychiatrist
who is executive director of the board, said Virginia's system
is "complaint-driven" and does not attempt to uncover
bad doctors. "Unless the board hears that there's a problem,
the doctors are expected to be practicing good medicine,"
Harp said, adding that "the practice of medicine is on the
honor system."
That seems to be the philosophy
of many state medical boards. In 2002, according to Public Citizen,
fewer than 0.5 percent of the nation's doctors -- about 2,800
of nearly 805,000 -- were the subject of serious discipline.
"Too many state medical boards . . . still believe their
first responsibility is to rehabilitate 'impaired physicians'
and to protect them from the public's prying eyes," the
group concluded.
Most boards, advocates say,
are chronically under-funded, dominated by doctors -- there are
14 on Virginia's 18-member board -- and intimidated by the well-funded
legal defenses that are mounted by physicians in trouble.
Physician Joseph A. Leming,
who was president of the medical board during the Stein investigation,
disagreed and said the board is aggressive in disciplining bad
doctors. "I have never seen sympathy for a doctor be an
impediment to the removal of a license," he said. "The
protection of the public is our paramount concern."
Bureaucratic obstacles, Leming
said, prevent a speedy resolution. Cases too often languish for
months or longer before board members receive them. "I've
seen reports that merited immediate suspension, and I felt the
hair on the back of my neck go up, and I've asked, 'Where the
hell has this been? This is a damn catastrophe,' " said
Leming, whose term expired in June. "That was not uncommon."
One problem, he said, is that
investigators do not work directly for the medical board but
for the much larger Department of Health Professions. And, he
noted, the board has no control over its budget, which is set
by the legislature, or its staffing, which is controlled by the
governor.
Funding is critical, Harp said.
Boards that ferret out bad doctors rather than wait for complaints
have many more resources than Virginia's, he said. The scheduled
addition of investigators may help, he said, but may be offset
by an increase in cases resulting from the lower negligence standard.
Some progress has been achieved,
he said. "Resources are the key. . . . [The process] will
never move fast enough for me."
A New Life
Chris Kratzke is not taking
medication now, his father said. At 15, he is doing well in school
and played defensive tackle on the football team. Recently his
artwork took first place in a state competition.
Denckla, who last saw Chris
in 2001, said his dramatic improvement "is a tribute to
some resilience inside the kid. It's amazing how well he's bounced
back."
Robert Kratzke said his primary
focus is constructing a new life for Chris and his older brother,
Mike, 17. Chris, his father said, is angry and "feels like
he lost a good part of his childhood."
Chris says he doesn't recall
much about Reston. He remembers how his mother used to make him
waffles and cut them into tiny pieces for him when he was little.
By contrast, his memories of the mental hospitals remain painfully
vivid.
"It was like being in
jail when you don't deserve it," he said. His worst moments
were the wrenching sadness he felt watching his parents drive
away after their visits. "I used to really want to go home.
But I couldn't."
© 2003 The Washington
Post Company
|
Truth can never be
told so as to be understood, and not be believ'd. William Blake, The Proverbs of Hell
