Doctor’s Misconduct Left Trail of Broken Lives–A Broken Marriage and a ‘Life Destroyed’ – WashPost

Mon, 29 Sep 2003

“I basically lost everything. And my kids? Well, who knows what the long-term damage might be.”

A riveting, detailed, two part report in the Washington Post (Sunday, September 28) describes a pattern of professional misconduct and medical abuse by a prominent Washington / Virginia psychiatrist, Martin H. Stein. The case is significant because it demonstrates how rogue psychiatrists whose professional misconduct and irresponsible dispensing of toxic drugs, and deliberately deceiving patients about imagined sexual abuse, leaves a trail of broken marriages and shattered lives–some dead, some brain damaged. Yet, despite such misconduct, the medical establishment continues to shield the perpetrators within the academic milieu.

The case sheds light on the demonstrable absence of ethical and professional standards in psychiatry. And it sheds light on an insular system of protectionism that rarely disciplines rogue doctors – especially those with credentials such as Stein’s. If disciplinary measures are taken, the process takes too long and is far too lenient, leaving the public vulnerable to abuse.

Stein’s credentials are 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. Stein had been listed among the region’s best psychotherapists in Washingtonian magazine.

However, as the wide range of Stein’s abuse of patients and gross violations of medical ethics demonstrates, impressive credentials are not predictors of high or even acceptable practice standards.

A report issued by the Virginia Board of Medicine, which investigated Stein for two and half years, reveals that at various times Stein meted out diagnoses and drug prescriptions according to his (then) favorite “diagnosis of the year” and “drug of the year.” One wonders whether the Board investigated whether Stein received kickback payments from drug manufacturers to prescribe his then favorite drug? Though unethical and illegal, companies give doctors financial incentives to prescribe their drugs.[**See references below]

Reporters Sandra Boodman and Patricia Davis report: 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.

Anita Kratzke died suddenly while under Stein’s care. “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.”

The Post reports: 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.

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.

Another of Stein’s professional violations under the guise of therapy" was to implant horrific" memories in a 36 year old woman whom he convinced was sexually abused by her prominent, dead, father, who Stein convinced her, had also killed numerous black men" in the family basement.

Stein diagnosed the woman as having eight psychiatric disorders for which he prescribed about 30 drugs. He also urged the woman to divorce her husband and advised her that spending the inheritance would be ‘therapeutic.’ The board noted that the case highlights the life-altering influence a psychiatrist can exert over a patient.

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.”

According to the Virginia board, 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.”

As the Post reporters note, 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.

A culture of silent conspiracy put patients at high risk of abuse: 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.

“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.'” 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.

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.”

Indeed, the Post reports that 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.

The Post reports that Stein has told colleagues and others that he was suffering from undiagnosed bipolar disorder while treating many of the patients cited by the medical board. This raises interesting questions, not just about Stein’s professional integrity but rather the professional integrity of psychiatry. Stein is well aware that psychiatric diagnoses are rendered without benefit of any objective scientific tools – as was recently acknowledged by the American Psychiatric Association. See: http://www.mindfreedom.org/mindfreedom/hungerstrikeapa2nd.shtml And Stein has his staunch defender, including Dr. Jonathan Pincus, chairman emeritus of psychiatry at Johns Hopkins University, who ardently defends Stein as audacious, one who pushes the envelope. Indeed, Stein is hardly unique among the pillars of psychiatry. Former presidents of the APA are on record for abusing their professional status, misprescribing toxic doses of psychotropic drugs that were sure to cause neurological and cardiovascular damage. Stein is also not the only psychiatrist to bilk patients of their money, charging a patient $450 for two-hour sessions, sometimes 6 days a week.

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http://www.washingtonpost.com/wp-dyn/articles/A10967-2003Sep27.html
THE WASHINGTON POST
Va. Doctor’s Misconduct Left Trail of Broken Lives
By Sandra G. Boodman and Patricia Davis

http://www.washingtonpost.com/wp-dyn/articles/A10929-2003Sep27.html
WASHINGTON POST
A Broken Marriage And a ‘Life Destroyed’
By Sandra G. Boodman and Patricia Davis

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.

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In addition to the following reference re: pharmaceutical company kickbacks to doctors, check AHRP website for conflict of interest citations:

Undisclosed Financial Ties Prompt Reproval of Doctor. By MELODY PETERSEN THE NEW YORK TIMES August 3, 2003 http://www.nytimes.com/2003/08/03/national/03CONF.html?pagewanted=print&position=

U.S. Warns Drug Makers on Illegal Sales Practices By ROBERT PEAR The New York Times, April 28, 2003. http://www.nytimes.com/2003/04/28/politics/28DRUG.html?pagewanted=print&position=

Madison Ave. Plays Growing Role in Drug Research. By MELODY PETERSEN. THE NEW YORK TIMES November 22, 2002 http://www.nytimes.com/2002/11/22/business/22DRUG.html?pagewanted=print&position=top

“Institutional corruption in medicine,” Peter Wilmshurst. British Medical Journal. Nov 23, 2002; 325:1232-1235 http://bmj.com/cgi/content/full/325/7374/1232?eaf

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