Category Archives: Health

The Pentagon’s New Laser-Based Tool Uses Your Heartbeat to Track You

by Shelly Fan

The government’s hefty arsenal of surveillance tools just welcomed a powerful new member. Rather than monitoring an external device—a bug or a smartphone—or even the exterior features of your face, the new tech aims straight for your heart. Literally.

First reported by MIT Technology Review, the US Pentagon is developing an infrared laser that captures a person’s unique “cardiac signature” from as far as 200 meters—the length of just over two football fields—away, as long as you’re still. According to Steward Remaly of the Pentagon’s Combating Terrorism Technical Support Office (CTTSO), even longer ranges may be possible with higher intensity lasers.

Although chilling, the tech builds on previous ideas.

Contact infrared sensors have long been used to monitor a person’s pulse, in a clinical setting or when traversing high altitudes. Here, the devices shoot infrared light into a finger and measure how much blood flow alters the refraction. Unlike this classic setup, the Pentagon’s new tech—dubbed Jetson—uses laser doppler vibrometry that detects minute movements on the skin caused by heartbeat.

Currently under development by Ideal Innovations, Inc., a veteran-owned biometrics, forensics, and scientific company based in Arlington, Virginia, the goal of Jetson is to positively identify an individual within five seconds using a “heartprint.”

“Existing long-range biometric methods that rely on facial recognition suffer from acquiring enough pixels at a distance to use the face matching algorithms and require high performance optics to acquire visual signatures at significant distances,” explained the CTTSO. “The Jetson effort…is a ruggedized biometric system that will capture cardiac signatures to aid in the positive identification of an individual” from a distance with little lag time.

Jetson is just the latest attempt at surveillance from a distance. Rather than old-school technologies such as fingerprinting or retinal scans, this new generation of surveillance technologies uses biometrics to monitor your every move—be it face, speech, heartbeat, or even brain activity—from a distance.

The tech may sound extreme, but Jetson is using the same playbook as biometrics for security. And to project where surveillance is going, it pays to look at biometrics research as the canary in the coal mine. Using your finger or face to unlock your phone is just the convenient side of things—what makes your biometric signature secure as a passcode is also what makes you identifiable as an individual.

Face Off

Facial recognition technology is no doubt the current crown prince of surveillance technologies. China readily adopted the tech as part of their Social Credit System, which monitors a civilian’s every move in public to generate a numerical score for compliance. Even here in the US facial recognition is welcomed by law enforcement. Amazon’s Rekognition system, for example, is reportedly “supercharging” police efforts in Oregon and other police departments, despite pressure from civil liberties groups, lawmakers, and even its own shareholders.

Surveillance loves facial recognition because the tech is relatively mature and can be done from a distance. And no doubt, there is value for the technology in long-range counterterrorism. For example, the technology can be used to remotely confirm the identity of a suspect—say, an ISIS leader—and in turn allow a state to authorize an attack.

The problem? Facial recognition software is far from perfect. A study by the ACLU using Rekognition found that the system incorrectly matched 28 members of Congress to mug shots, with the majority being African-American. Technological hiccups aside, a face is relatively easy to disguise. The perfect surveillance system needs to be efficient, effective, and low-error. In other words, it needs something more concrete, immutable, and physiological to target.

That’s where cardiac signatures come in.

Beat of the Heart

To Dr. Wenyao Xu at the State University of New York, the heart is a much better surveillance target than facial recognition. “Compared with face, cardiac biometrics are more stable and can reach more than 98 percent accuracy,” he said.

Back in 2017, his team developed a non-contact, remote biometrics device that uses dimensions of the heart as a person’s identifier for security. His system distills the geometry of a person’s heart—measured by refracting sound waves with Doppler radars—to identify the particular shape and size that characterizes an individual. But because it relies on sound waves, the system could only function up to 30 meters away—a fraction of the Pentagon’s ideal distance.

Other cardiac signatures have also been used for security. The Toronto company Nymi, for example, developed a wearable wristband that uses an employee’s electrocardiogram (ECG), which is also uniquely tailored to each individual, as an access passcode for an enterprise’s secure database.

Jetson extends this approach by co-opting an off-the-shelf device that normally measures vibrations from structures at a distance. The device further utilizes a gimbal to hold its laser beam steady, allowing it to keep its measurements on target. According to MIT Technology Review, the current system takes roughly 30 seconds to generate a good return signal, and it’s only effective if the target is staying put—either standing or sitting.

Despite these caveats, Remaly said that Jetson works with an admirable 95 percent accuracy if the conditions are optimal. In practice, though, this means Jetson isn’t accurate enough to be reliable on its own. If adopted into surveillance tech, it would likely work alongside other measures, such as facial recognition or gait analysis, as secondary confirmation.

In addition, unlike faces and fingerprints, cardiac signatures aren’t exactly standard collection data. For the technology to truly impact surveillance, the government needs to build a new database from scratch. However, the team argues, when deployed over a period of time—sufficient to capture the heartprint of an individual seen doing something they shouldn’t, for example—it may still be used to positively identify a person, even if his or her actual identity remains mysterious. What’s more, clothing isn’t a deterrent since the tech blasts right through.

Military use aside, the Pentagon foresees the technology trickling down into the cultural mainstream. A doctor could remotely monitor his patient’s cardiac rhythms, for example, without having to rely on electrical wires. Nevertheless, like technologies using echolocation to track an elderly person’s gait for falls, it’s an open question if the benefits warrant the invasion of privacy.

Biometrics Revolution

Monitoring the heart may be just the first step in a new age of long-distance biometrics surveillance.

Speech is another identifier under attack. According to the CTTSO, the already-completed project Beetlejuice uses a beam-forming microphone array to monitor an individual’s speech, in addition to performing speaker tagging, tracking, and locating. The tech relies on deep neural networks to reduce noise and allow near real-time situational awareness of incoming signals, filtering speaker, messages, languages, and location, the report stated.

“The capabilities will be integrated into a lightweight platform in support of operators on the move and handle a variety of noisy audio media…This unique combination will improve performance in both noise reduction, source location, and human language technologies,” the team explained.

Going even further, Xu and others are working on “brainprints” for security measures. Unlike facial or cardiac fingerprints, the brain offers an “inexhaustible” source of secure passwords based on its response to various stimuli, explained Xu.

Using EEG, which picks up neural electrical activity from electrodes placed on the scalp, the team can extract automatic and unconscious activation patterns as a “brain password” unique to a particular individual. Of course, so far there isn’t a way to remotely monitor someone’s brain activity or construct a database of initial readings. And unlike a face or retina, a brainprint changes when an individual is faced with another stimulus.

Nevertheless, a snapshot of brain activity perhaps most uniquely represents you, as an individual, and technological challenges haven’t exactly been a deterrent to agencies that stand most to gain (hydrogen bombs, anyone?).

If history’s any indication, security measures based on biometrics are ripe for hacking and tracking. Now, thanks to Jetson, smearing paint on your face or wearing thick jackets will no longer circumvent surveillance monitoring. San Francisco and Somerville, Massachusetts both recently blanket-banned facial recognition software in protection of civil rights, with New York likely to follow in narrower domains. It’s worth keeping an eye on what comes next.


Republished with permission under license from SingularityHub.

At least 2% of US public water systems are like Flint’s – Americans just don’t hear about them

by Laura Pangallozzi

More than five years after Flint’s water crisis first hit the news, the city has successfully lowered the lead levels in its water.

The most recently available testing, from the second half of 2018, puts the lead in Flint’s water at 4 parts per billion. That’s well below the level, 15 ppb, that the federal government currently regards as dangerous for public health.

No amount of lead in water is safe, but the lower level in Flint represents a substantial improvement over the 27 ppb reported by the Virgina Tech Water Study at the peak of the crisis in April 2015.

However, even Flint’s highest levels were not atypical for water systems that have problems. Most reports of elevated lead levels cluster in the range between 15 and 20 ppb.

Where lead problems occur

The federal Lead and Copper Rule requires public water utilities to sample home tap water yearly in neighborhoods most likely to face contamination.

If more than 10% of samples exceed 15 parts per billion of lead, the rule states that the water system must take steps to control pipe corrosion – the main source of lead in residential tap water – as well as to inform the public and the U.S. Environmental Protection Agency.

Water systems, especially in rural areas, can report much higher levels than the EPA cutoff. In 2017, for example, an elementary school in Tulare County, California, home to agricultural laborers, reported lead levels of 4,600 ppb. The school distributed bottled water to its students and replaced its well. The same year, a senior living center in Stroudsburg, Pennsylvania, had lead levels of 3,428 ppb. Such drinking water is truly poisonous, especially for children.

Large urban water systems tend to have lower contaminant levels than systems in rural areas, including for lead, because they have expert staff to run facilities. But when contamination occurs in urban systems, it affects more people. Flint’s water system serves 71,500 people and its woes drew the attention of the Obama administration. In 2004, when Washington, D.C. had similar lead levels, Congress intervened to demand a rapid fix.

Right now, Newark, New Jersey – an area that I have studied for more than 10 years – is in the hot seat for lead, but has not drawn similar attention. In June the city reported to the EPA lead samples more than 2.5 times higher than that of Flint at the peak of the crisis, the highest level in a two-year running problem.

The Pequannock facility, one of Newark’s two water treatment plants and the source of the issue, distributes water to the city and several surrounding communities. The Newark Water Department serves a total of more than 290,000 people.

Of cities with more than 100,000 in population reporting issues since the beginning of 2017, nearest in rank to Newark in terms of levels of lead is Pittsburgh; then Trenton, New Jersey; Fort Wayne, Indiana; Suez Water, headquartered in Hackensack, New Jersey, serving multiple communities; Portland, Oregon; Providence, Rhode Island; and Green Bay, Wisconsin.

Most cities reporting issues are in New England and the Middle Atlantic States, where older housing is more likely to have lead pipes that run from the water main into the home.

Shining a light on the problem: Missing data

What’s more, an undetermined number of water systems with lead problems in their water do not report heightened lead levels to the federal government, in violation of the law.

An investigative report commissioned by Congress, publicly released in October 2017, showed that about 2% of public water systems across the country exceeded the federal limit on lead between 2014 and 2016.

The report says that the number of water systems that do not report their problems at all is understated – in some cases badly so. Flint itself initially failed to report its elevated lead levels to the EPA. The congressional report, compiled by the Government Accountability Office, found a host of problems on this score, concluding that “data available from the EPA likely understate the number of sample results, violations and enforcement actions.”

As of December 2016, the end date of the GAO investigation, only about 47% of states had reported as required on their corrosion control methods, the primary way a lead problem is addressed.

The report recommended that the EPA require states to report data for small water systems, those most likely to fail to report, but the EPA folded this initiative into a revision of the Lead and Copper Rule that has not happened.

Without better data collection on lead contamination, Americans will never know how bad the problem really is in their communities.The Conversation


Republished with permission under license from The Conversation

How Black Pharmacists Are Closing The Cultural Gap In Health Care

SHILOH, Ill. — After a health insurance change forced Bernard Macon to cut ties with his black doctor, he struggled to find another African American physician online. Then, he realized two health advocates were hiding in plain sight.

At a nearby drugstore here in the suburbs outside of St. Louis, a pair of pharmacists became the unexpected allies of Macon and his wife, Brandy. Much like the Macons, the pharmacists were energetic young parents who were married — and unapologetically black.

Vincent and Lekeisha Williams, owners of LV Health and Wellness Pharmacy, didn’t hesitate to help when Brandy had a hard time getting the medicine she needed before and after sinus surgery last year. The Williamses made calls when Brandy, a physician assistant who has worked in the medical field for 15 years, didn’t feel heard by her doctor’s office.

“They completely went above and beyond,” said Bernard Macon, 36, a computer programmer and father of two. “They turned what could have been a bad experience into a good experience.”

Now more than ever, the Macons are betting on black medical professionals to give their family better care. The Macon children see a black pediatrician. A black dentist takes care of their teeth. Brandy Macon relies on a black gynecologist. And now the two black pharmacists fill the gap for Bernard Macon while he searches for a primary care doctor in his network, giving him trusted confidants that chain pharmacies likely wouldn’t.

Black Americans continue to face persistent health care disparities. Compared with their white counterparts, black men and women are more likely to die of heart disease, stroke, cancer, asthma, influenza, pneumonia, diabetes and AIDS, according to the Office of Minority Health.

But medical providers who give patients culturally competent care — the act of acknowledging a patient’s heritage, beliefs and values during treatment — often see improved patient outcomes, according to multiple studies. Part of it is trust and understanding, and part of it can be more nuanced knowledge of the medical conditions that may be more prevalent in those populations.

For patients, finding a way to identify with their pharmacist can pay off big time. Cutting pills in half, skipping doses or not taking medication altogether can be damaging to one’s health — even deadly. And many patients see their pharmacists monthly, far more often than annual visits to their medical doctors, creating more opportunities for supportive care.

That’s why some black pharmacists are finding ways to connect with customers in and outside of their stores. Inspirational music, counseling, accessibility and transparency have turned some minority-owned pharmacies into hubs for culturally competent care.

“We understand the community because we are a part of the community,” Lekeisha Williams said. “We are visible in our area doing outreach, attending events and promoting health and wellness.”

To be sure, such care is not just relevant to African Americans. But mistrust of the medical profession is especially a hurdle to overcome when treating black Americans.

Many are still shaken by the history of Henrietta Lacks, whose cells were used in research worldwide without her family’s knowledge; the Tuskegee Project, which failed to treat black men with syphilis; and other projects that used African Americans unethically for research.

“They completely went above and beyond,” says Macon (center) of Vincent and Lekeisha Williams, owners of LV Health and Wellness Pharmacy.

Filling More Than Prescriptions

At black-owned Premier Pharmacy and Wellness Center near Grier Heights, a historically black neighborhood in Charlotte, N.C., the playlist is almost as important as the acute care clinic attached to the drugstore. Owner Martez Prince watches his customers shimmy down the aisles as they make their way through the store listening to Jay-Z, Beyoncé, Kirk Franklin, Whitney Houston and other black artists. Prince said the music helps him in his goal of making health care more accessible and providing medical advice patients can trust.

In rural Georgia, Teresa Mitchell, a black woman with 25 years of pharmacy experience, connects her customers with home health aides, shows them how to access insurance services online and even makes house calls. Her Total Care Pharmacy is the only health care provider in Baconton, where roughly half the town’s 900 residents are black.

“We do more than just dispense,” Mitchell said.

Iradean Bradley, 72, became a customer soon after Total Care Pharmacy opened in 2016. She struggled to pick up prescriptions before Mitchell came to town.

“It was so hectic because I didn’t have transportation of my own,” Bradley said. “It’s so convenient for us older people, who have to pay someone to go out of town and get our medicine.”

Lakesha M. Butler, president of the National Pharmaceutical Association, advocates for such culturally competent care through the professional organization representing minorities in the pharmacy industry and studies it in her academic work at the Edwardsville campus of Southern Illinois University. She also feels its impact directly, she said, when she sees patients at clinics two days a week in St. Charles, Mo., and East St. Louis, Ill.

“It’s just amazing to me when I’m practicing in a clinic setting and an African American patient sees me,” Butler said. “It’s a pure joy that comes over their face, a sigh of relief. It’s like ‘OK, I’m glad that you’re here because I can be honest with you and I know you will be honest with me.’”

She often finds herself educating her black patients about diabetes, high blood pressure, high cholesterol and other common conditions.

“Unfortunately, there’s still a lack of knowledge in those areas,” Butler said. “That’s why those conditions can be so prevalent.”

Independent black-owned pharmacies fill a void for African American patients looking for care that’s sensitive to their heritage, beliefs and values. For Macon, LV Health and Wellness Pharmacy provides some of that vital support.

Avoiding Medical Microaggressions

For Macon, his experiences with medical professionals of backgrounds different from his own left him repeatedly disappointed and hesitant to open up.

After his wife had a miscarriage, Macon said, the couple didn’t receive the compassion they longed for while grieving the loss. A few years later, a bad experience with their children’s pediatrician when their oldest child had a painful ear infection sparked a move to a different provider.

“My daughter needed attention right away, but we couldn’t get through to anybody,” Macon recalled. “That’s when my wife said, ‘We aren’t doing this anymore!’”

Today, Macon’s idea of good health care isn’t colorblind. If a doctor can’t provide empathetic and expert treatment, he’s ready to move, even if a replacement is hard to find.

Kimberly Wilson, 31, will soon launch an app for consumers like Macon who are seeking culturally competent care. Therapists, doulas, dentists, specialists and even pharmacists of color will be invited to list their services on HUED. Beta testing is expected to start this summer in New York City and Washington, D.C., and the app will be free for consumers.

“Black Americans are more conscious of their health from a lot of different perspectives,” Wilson said. “We’ve begun to put ourselves forward.”

But even after the introduction of HUED, such health care could be hard to find. While about 13% of the U.S. population is black, only about 6% of the country’s doctors and surgeons are black, according to Data USA. Black pharmacists make up about 7% of the professionals in their field, and, though the demand is high, black students accounted for about 9% of all students enrolled in pharmacy school in 2018.

For Macon, though, the Williamses’ LV Health and Wellness Pharmacy in Shiloh provides some of the support he has been seeking.

“I still remember the very first day I went there. It was almost like a barbershop feel,” Macon said, likening it to the community hubs where customers can chitchat about sports, family and faith while getting their hair cut. “I could relate to who was behind the counter.”


Republished with permission from Kaiser Health News.

Mired In Medical Debt? Federal Plan Would Update Overdue-Bill Collection Methods

Editorial note by Randall Hill

I was hospitalized recently for three weeks. I was rushed by ambulance to the emergency room, transferred to another hospital for surgery where I spent the majority of my recovery in the intensive care unit (ICU).

Although a hospital is within an insurance provider’s network, the doctors providing care may not be. For insurance purposes, those physicians might be considered “out-of-network” providers, and the insurance company may not cover any of the treatment costs. This from what I understand is a fairly common practice. When this happens, the patient even when covered by insurance has to cover the majority of the medical cost.

Elham Mirshafiei was at the library cramming for final exams during her senior year at California State University-Long Beach when she grew nauseated and started vomiting. After the 10th episode in an hour, a friend took her to the nearest emergency room. Diagnosis: an intestinal bug and severe dehydration. In a few hours, she was home again, with instructions to eat a bland diet and drink plenty of fluids.

That was in 2010. But the $4,000 bill for the brief emergency department visit at an out-of-network hospital has trailed her ever since. Mirshafiei, 31, has a good job now as a licensed insurance adviser in Palo Alto, Calif. But money is still tight and her priority is paying off her $67,000 student loan debt rather than that old hospital bill.

Once or twice a year she gets a letter from a collection agency. She ignores them, and, so far, the consequences have been manageable. “It’s not like electricity that gets cut off if you don’t pay it,” she said.

Mirshafiei has plenty of company. At least 43 million other Americans have overdue medical bills on their credit reports, a federal Consumer Financial Protection Bureau report on medical debt found in 2014. And 59% of people contacted by a debt collector say the exchange was over medical bills, the most common type of contact stemming from an overdue bill, according to the CFPB.

This month, the CFPB proposed a rule to frame what debt collectors are allowed to do when pursuing many types of overdue bills, including medical debt.

Federal law already prohibits debt collectors from harassing consumers or contacting them before 8 a.m. or after 9 p.m., among other things. But the law, which was passed in 1977, didn’t anticipate emails and text messages. The CFPB’s proposal clarifies how debt collectors can use these communication tools. And it would allow consumers to opt out of being contacted this way.

The rule also specifies that debt collectors can make no more than seven telephone calls weekly over a specific debt.

But some consumer advocates panned the effort. “This really doesn’t go far enough to protect consumers and make sure that consumers are not abused or harassed or subject to unfair collection practices in debt collection,” said April Kuehnhoff, an attorney at the National Consumer Law Center who specializes in debt collection.

For instance, the center wants a limit of just three telephone attempts each week on a debt. The seven-call limit could be particularly tough on people with medical debt, Kuehnhoff said. They may accumulate bills from several providers for a single medical event — hospital, doctors, a lab and a nursing home, for example — and all could be in collections separately, potentially resulting in dozens of calls each week.

Debt collectors aren’t necessarily in favor of the seven-call cap either, but for different reasons. They say that limiting the number of calls could lead to more litigation or adverse credit reporting rather than working out a payment plan. Overall, the proposed rule seemed to strike a good balance between collection industry and consumer concerns, said Leah Dempsey, vice president and senior counsel for federal affairs at ACA International, a trade group representing 2,500 debt collectors, asset buyers and related professions.

The general consensus is that people should pay their debts. But taking responsibility for medical debt isn’t always as straightforward as paying off a large-screen TV that someone put on a credit card. Did health insurance pay the correct amount? Was the person screened for eligibility for Medicaid, charity care or financial assistance?

“The actual debt collector problem is often about the lack of accountability that providers have for the people that they pass their debt along to,” said Leonardo Cuello, director of health policy at the National Health Law Program.

When a debt collector calls, consumers who are confused about the bill should ask, in writing and generally within 30 days, that the debt be validated. Debts are often bundled and sold multiple times to different collectors, which means errors may be introduced along the way. “There are no magic words; you don’t need to cite the statute,” said Justin J. Lowe, legal director at Health Law Advocates, a nonprofit law firm in Boston that helps people with low incomes who are having trouble accessing or paying for medical care.

At that point, the collection agency has to stop activities until it proves what the consumer owes. The proposed CFPB rule would spell out verification information that must be provided along with instructions for consumers about how to dispute the debt.

The proposal would also address other practices, including the collection of so-called zombie debt. That refers to a bill that has passed a time limit — or statute of limitations — for bringing legal action, often between three and six years, depending on the state. In many states, if a collector sues someone for such a time-barred debt, consumers can raise the issue in court in their defense. If a judge agrees, the case could be dismissed.

Consumer advocates have long wanted debt collectors to be prohibited from trying to collect zombie debt. After several years, it can be difficult for patients to remember whether a bill has been paid or to locate records, they argue.

The proposed CFPB rule would prohibit debt collectors from suing or threatening to sue consumers for zombie debt, but only if the collectors knew or should have known that the statute of limitations had expired. That puts the onus on the consumer to prove what was in the debt collector’s mind rather than merely showing that too much time had passed to collect.

It’s unclear how the proposed changes announced by the CFPB might affect Mirshafiei’s situation. The statute of limitations in California on written contracts is four years.

One thing someone in Mirshafiei’s situation should be aware of is that making a payment could reset the statute of limitations, Lowe said. The debt collector could argue that by making a payment the person is affirming that he or she owes the debt.

Because of her damaged credit, Mirshafiei needed a relative to co-sign for student loans for graduate school. She worries that if she tries to buy a house, she’ll have trouble getting approved.

“I just hope that in the next chapter of my life I don’t have to be denied things because of this stain on my record,” she said.

As the federal government moves ahead with the rule to address various types of debt collection activities, legislators in a few states have introduced bills that specifically target medical debt. Their efforts often focus on improving access to financial assistance for medical care and limiting predatory debt collection tactics.

Last month, Washington Gov. Jay Inslee signed a law that reduces the maximum interest rate on medical debt prior to a court judgment from 12% to 9%. It also prohibits sending a medical debt to collections until 120 days after the patient is sent the initial bill and requires collection agencies to provide itemized statements to patients for medical and hospital debts and to notify them of their possible eligibility for charity care.

In Oregon, a bill sponsored by Rep. Andrea Salinas would require nonprofit hospitals and affiliated clinics to provide care free of charge to families with incomes up to 200% of the federal poverty level (about $43,000 for a family of three) and charge a sliding scale for families earning up to 400% of the poverty level (about $85,000 for a three-person family).

Like the Washington law, the Oregon bill places limits on the interest charged for medical debt. It also requires health care facilities to screen patients for eligibility for financial assistance and insurance.

The bill passed the House earlier this month. Some hospitals already have strong financial assistance policies, but the playing field needs leveling, said Salinas. “We really need hospitals to be a part of the solution to prevent consumers from going into bankruptcy over medical debt.”


Republish with permission under license from Kaiser Health News a national health policy news service. 


Helpful Links

How to Deal With Medical Debt Collection

Ways to remove medical collections from your credit reports

Facing a Medical Debt Lawsuit? Take These 10 Steps First

A Surgeon So Bad It Was Criminal

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?

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.

Jeff Glidewell had surgery with Dr. Christopher Duntsch in 2013. He was Duntsch’s last patient, and his call to a judge in early 2015 helped bring the case back to the DA’s attention. (Dylan Hollingsworth for ProPublica)

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.

In July 2015, Duntsch was arrested and Dallas prosecutors charged him with one count of injury to an elderly person and five counts of assault, all stemming from his work on patients.

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.

Before Duntsch became a doctor, he doggedly pursued a football career. One teammate remembers Duntsch struggling with basic drills and attributed Duntsch’s success to “sweat equity.” (Via Facebook)

“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.

Duntsch on his first day as a neurosurgeon. (Via Facebook)

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.

Dr. Randall Kirby, left, and Dr. Robert Henderson both worked to keep Duntsch from being able to operate on patients. (Nate Kitch, special to ProPublica)

“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.

Barry Morguloff had what was supposed to be routine surgery with Duntsch. The lasting damage has affected his ability to walk, and as time passes he gradually loses function on the left side of his body. (Dylan Hollingsworth for ProPublica)

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.

Kirby in his office in Dallas. A vascular surgeon, Kirby was present for one surgery with Duntsch and worked afterward to stop him from operating again. (Dylan Hollingsworth for ProPublica)

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.”

Glidewell spent four days in intensive care and endured months of rehabilitation after his surgery with Duntsch. The photo on his iPad was taken the day he returned home, after spending months in the hospital. (Dylan Hollingsworth for ProPublica)

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.”

Henderson was called in to repair the damage to one patient following her surgery with Duntsch. After he saw the damage to her spine, he made it his personal mission to keep him from operating on anyone else. (Dylan Hollingsworth for ProPublica)

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.”

A screenshot shows Duntsch during a deposition. (District attorney's office)

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.


Republished with permission under license from ProPublica a Pulitzer Prize-winning investigative newsroom. 

 

 

 

Why the case of Jahi McMath is important for understanding the role of race for black patients

Yolonda Wilson, Howard University

California teenager Jahi McMath, who suffered catastrophic brain injury as a result of a routine tonsil surgery, died on June 22, 2018.

Her death came after four years of her family fighting in court to continue her care in California. Eventually, they moved her to a facility in New Jersey, a state that accommodates religious views that don’t recognize brain death.

File 20180711 27045 1mmldej.jpg?ixlib=rb 1.1
A photo of Jahi McMath shown at her funeral service at Acts Full Gospel Church in Oakland, Calif. AP Photo/Jeff Chiu

Much of the popular discussion in the case centered on the family’s refusal to accept the diagnosis of brain death. However, as a philosopher who writes on bioethics and race, I believe an underappreciated aspect of the discussion was the role of race – both in how the medical personnel dealt with the family and how the family interpreted their interactions with the medical establishment.

The surgery and outcome

On Dec. 9, 2013, the 13-year-old McMath entered Children’s Hospital and Research Center in Oakland, California, for what should have been a routine tonsillectomy. The young girl was, according to her mother’s account, frightened that something would go wrong. Her mother reassured McMath that she would be okay.

McMath’s post-surgical complications began about an hour after her surgery. A nurse provided a bin to catch the blood that McMath had begun spitting up. Although the nurses indicated to the family that some post-surgical bleeding was normal, two hours later, McMath’s blood filled two plastic bins and the bandages packing her nose were saturated with blood. Her hospital gown was also covered in blood.

According to the family, four and a half hours passed before a physician saw her, despite the family’s repeated pleas for intervention. The hospital has maintained that they can not discuss Jahi’s case in detail because of privacy laws. Bleeding complications, though rare, can occur after tonsillectomy because tonsils are near arteries.

As a result of the immense blood loss, McMath’s heart stopped and her brain was deprived of oxygen. Three days later, on Dec. 12, 2013, the medical staff at Children’s Hospital declared McMath brain dead. Hospital personnel encouraged the family to withdraw life support and donate her organs.

McMath’s family refused to accept the diagnosis, and a court battle to keep McMath on life support ensued.

A judge in California initially ruled that McMath could remain on life support until Jan. 7, 2014. However, the Alameda County coroner issued a death certificate anyway.

A 2015 photo of Jahi McMath is shown on a video screen next to her uncle Timothy Whisenton. AP Photo/Jeff Chiu, File

Philosopher Jeffrey P. Bishop, who holds the chair of health care ethics at Saint Louis University, writing in Harvard Divinity School bulletin noted the ethical oddities of the case. In California, once two physicians confirm brain death, the patient is legally dead. The body is then technically released to the coroner before being released to the family so that they can make arrangements. In the case of McMath, she was still in the hospital and on a ventilator when these procedures kicked in.

From the beginning, the case was tangled up with all sorts of questions regarding the nature and diagnosis of brain death. Although there are long-established criteria, how brain death is determined in practice can vary. These differences in practices can contribute to confusion, particularly among the lay public, about brain death.

Her family rejected the brain death diagnosis alleging the hospital had a conflict of interest and simply wanted McMath’s organs.

Revisiting a history of medical racism

Rather than dismiss the family’s concerns as paranoid or ignorant, it is important to understand the historical realities faced by black patients in their encounters with the U.S. medical system.

There is a long historical record of using African-Americans for medical experimentation. For example, medical experimentation performed by J. Marion Sims, “the father of modern gynecology,” highlights the medical establishment’s disregard for black people.

Sims, who began conducting his gynecological experiments in the 1840s, is credited with developing a surgical procedure to repair vesicovaginal fistula, a hole that develops between the vaginal wall and the bladder, resulting in incontinence. However, Sims achieved his success by experimenting on enslaved women, often without anesthesia.

Sims wasn’t the only one. During the 19th century, medical schools used both enslaved and free black people, often without their consent, to teach their white medical students anatomy, disease progression and diagnosis. This practice continued after slavery.

Additionally, the graves of African-Americans were robbed and their bodies disinterred so that medical students could use black bodies as cadavers. Aware of these practices, African-American communities were deeply suspicious of local medical schools and unsure whether the medical personnel were actually “treating” them or merely “experimenting” on them.

Few examples of the abuse of African-Americans in medical experimentation loom larger than the Tuskegee syphilis experiment – a 40-year-long study of disease progression of syphilis in 600 men in the Tuskegee, Alabama, area that began in 1932. The study was sponsored by the U.S. Public Health Service.

None of the 399 men who had syphilis were ever told of their diagnosis. Nor were these men or their partners treated with penicillin once penicillin became the standard treatment for syphilis in 1945. In 1997, President Bill Clinton issued a formal apology on behalf of the U.S. government to the eight remaining survivors of the Tuskegee experiment.

President Bill Clinton apologizes to black men whose syphilis went untreated by government doctors. AP Photo/Doug Mills

One presidential apology, however, could not erase the sense of mistrust that many African-Americans feel toward health care institutions.

And the medical injustice continues: There are wide gaps in outcomes between whites and African-Americans in a variety of diseases. For example, the American Cancer Society reports that, of all the racial and ethnic groups in the U.S., African-Americans, are more likely to die from most cancers.

Lower quality of care?

African-Americans also report lower quality of health care and greater dissatisfaction with the care they receive. In addtion, they are significantly more likely to report experiencing racial discrimination and negative attitudes by health care personnel than non-Hispanic whites.

Medical mistrust and the resulting dissatisfaction have been connected to patient anxiety, as well as lower engagement in health care decision-making between patient and provider.

This mistrust makes African-Americans less likely to use the health care system. Along with other factors, such as limited insurance status and greater geographic distance from health care providers, it contributes to disparate health outcomes.

It is against this backdrop that one must understand the McMath family’s skepticism regarding both her treatment and diagnosis.

McMath’s mother, Nailah Winkfield, told The New Yorker,

“No one was listening to us, and I can’t prove it, but I really feel in my heart: if Jahi was a little white girl, I feel we would have gotten a little more help and attention.”

Nailah Winkfield, the mother of Jahi McMath, speaks next to husband Martin Winkfield during funeral services for Jahi. AP Photo/Jeff Chiu

Sadly, Winkfield is not alone in her suspicions.

The ConversationIt is possible that the ultimate outcome might still have been tragic. Even with the most attentive care, McMath might have died. However, the family feeling that the medical team did not do all that they could have done for their loved one, and that this, for them, was a function of race, needlessly inflicted additional injury.


Republished with permission under licence from The Conversation.


See our related page, "Medical Oppression"

Not just for the poor: The crucial role of Medicaid in America’s health care system

By Simon Haeder – Assistant Professor of Political Science, West Virginia University

Nurse Jane Kern administers medicine to patient Lexi Gerkin in Brentwood, New Hampshire. Lexi is one of thousands of severely disabled or ill children covered by Medicaid, regardless of family income. Charles Krupa/AP

Despite many assertions to the contrary, Senate leaders are now saying they want to vote on the replacement bill for Obamacare before the month is out.

Front and center is the planned transformation of America’s Medicaid program, which covers 20 percent of Americans and provides the backbone of America’s health care system.

As a professor of public policy, I have written extensively about the American health care system and the Affordable Care Act.

Living in West Virginia, perhaps the nation’s poorest state, I have also seen the benefits of the ACA’s Medicaid expansion since 2014.

To understand how the ACHA’s proposed changes to Medicaid would affect people and our health care system, let’s look more closely at the program.

What is Medicaid?

Created in 1965, Medicaid today provides health care services for 75 million Americans. It is jointly administered by the federal government and the states. The federal government pays at least 50 percent of the costs of the program. For particularly poor states, the federal government’s contribution can exceed 75 percent.

Medicaid was initially envisioned to provide medical assistance only to individuals receiving cash welfare benefits. Over time, the program has been significantly expanded in terms of benefits and eligibility to make up for the growing shortcomings of private insurance markets, including rapidly growing premiums and increasing rates of uninsurance.

Like all health care programs, spending on Medicaid has increased dramatically since its inception in 1965. Today, we are spending about US$550 billion annually. This compares to about $300 billion in 2007.

What does Medicaid do?

As Medicaid evolved, it has become more than just a program for America’s poor. Indeed, it is the largest single payer in the American health care system, covering more than 20 percent of the population. This amounts to 75 million American children, pregnant women, parents, single adults, disabled people and seniors.

To put this in perspective, this is about the same number of individuals as the nation’s two largest commercial insurers combined.

Roughly half of all enrollees are children.

Medicaid also pays for about 50 percent of births in the U.S. In some states like New Mexico, Arkansas, Wisconsin and Oklahoma, close to two-thirds of births are paid for by Medicaid.

Medicaid helps many Americans who are generally not considered “needy.” For example, the Katie Beckett program provides support to families with children with significant disabilities without regard to parental income.

Medicaid is also critical for elderly Americans. It is Medicaid – not the federally run insurance program for the elderly, Medicare – that is the largest payer for long-term care in the United States. These services include, for example, nursing facility care, adult daycare programs, home health aide services and personal care services. It pays for roughly 50 percent of all long-term care expenses and about two-thirds of nursing home residents. And it also provides help with Medicare premiums for about 20 percent of seniors.

Indeed, the vast majority of costs in the Medicaid program, about two-thirds, are incurred by elderly or disabled individuals who make up only a quarter of enrollment.

How did the Affordable Care Act, or Obamacare, change Medicaid?

One of main components of the Affordable Care Act was the expansion of Medicaid to 138 percent of the Federal Poverty Line (FPL). For a family of four, this amounts to $2,800 per month.

However, the Supreme Court rejected the ACA’s mandatory expansion of Medicaid and made it optional. To date, 31 states and Washington, D.C. have chosen to expand their Medicaid program. Not surprisingly, the uninsurance rate in those states has dropped significantly more than in states refusing to expand their Medicaid programs.

Nonetheless, Medicaid enrollment increased by about 30 percent since the inception of the ACA.

The expansion has also resulted in better access and better health for individuals.

It has also helped to fight the nation’s opioid epidemic.

In states that did not expand Medicaid, hospital closures occurred disportionately.

What would the Republican-backed AHCA and the Trump budget do to Medicaid?

Tom Price, secretary of the Department of Health and Human Services, whose department includes the oversight of Medicaid, pictured in the Rose Garden the day House Republicans passed a bill that would overhaul Medicaid. Evan Vucci/AP

Overall, the American Health Care Act cuts more than $800 billion from Medicaid by 2026. The cuts focus on two major components.

First, the AHCA significantly reduces funding for the Medicaid expansion under the Affordable Care Act. These changes reduce the federal government’s contribution from 90 percent to an average of 57 percent. The large associated costs for states would virtually eliminate the expansion in most if not all states.

However, the American Health Care Act goes further. Specifically, it alters the funding mechanism for the entire Medicaid program. Instead, it provides a set amount of funding per individual enrolled in Medicaid. In doing so, it ends the federal government’s open-ended commitment to providing health care to America’s neediest populations.

Over time, these per capita payment are adjusted based on the Medical Consumer Price Index. In states like West Virginia, these increases will not keep pace with rising costs for the state’s sick and disabled.

In addition to the more than $800 billion in cuts to Medicaid under the AHCA, the proposed budget by President Trump would further cut Medicaid by more than $600 billion over ten years.

One major way to achieve this is to further reduce the growth rate of the per capita payments.

What would be the effects of dismantling Medicaid?

Both the American Health Care Act and the Trump budget would be challenging for the program. In combination, I believe they would be truly devastating.

The cuts would force millions of Americans into uninsurance. Confronted with medical needs, these Americans will be forced to choose between food and shelter and medical treatment for themselves and their families. They would also force millions of Americans into medical bankruptcy, similar to the situation prior to the ACA.

The cuts would also affect the broader American health care system. They would create incredible burdens on American hospitals and other safety net providers. Many of them are already operating on very thin margins.

Medicaid is particularly important in keeping doors open at ruralinner-city and essential service hospitals.

The cuts would cause tremendous burdens for million of Americans with disabilities and their families.

They would shrink the program virtually in half over the next decade.

Unable to raise the necessary funds, states will be forced to cut either eligibility, benefits or both.

In my view, both the American Health Care Act and the proposed budget by the Trump administration will cause dramatic, avoidable harm to millions of our families, friends, neighbors and communities.


Republished with permission under license from The Conversation.

Inoculation was introduced to America by a slave

Onesimus (fl. 1706 – 1717), was a slave and medical pioneer. Few details are known about the birth of Onesimus, but it is assumed he was born in Africa,  in the late seventeenth century, although the precise date and place of his birth are unknown, before eventually landing in Boston. 

Onesimus first appears in the historical record in the diary of Cotton Mather, a prominent New England theologian and minister of Boston’s Old North Church. Reverend Mather notes in a diary entry for 13 December 1706 that members of his congregation purchased for him “a very likely Slave; a young Man who is a Negro of a promising aspect of temper” (Mather, vol. 1, 579). Mather named him Onesimus, after a biblical slave who escaped from his master, an early Christian named Philemon.

When asked if he’d ever had smallpox, Onesimus answered “Yes and No,” explaining that he had been inoculated with a small amount of smallpox, which had left him immune to the disease. Fascinated, Mather asked for details, which Onesimus provided, and showed him his scar. 

Onesimus told Mather about the centuries old tradition of inoculation practiced in Africa. By extracting the material from an infected person and scratching it into the skin of an uninfected person, you could deliberately introduce smallpox to the healthy individual making them immune.

Onesimus was one of about a thousand persons of African descent living in the Massachusetts colony in the early 1700s, one-third of them in Boston. Many were indentured servants with rights comparable to those of white servants, though an increasing number of blacks–and blacks only–were classified as chattel and bound as slaves for life.

Excited, he investigated among other Africans in Boston and realized that it was a widespread practice; indeed, a slave could be expected to fetch a higher price with a scar on his arm, indicating that he was immune. 

Mather's writings suggest that, more than most of his contemporaries, he admired Africans, but he also accepted slavery, and had raised no objections when his congregation presented him with a young slave in 1706. 

What Onesimus thought of Mather’s opinions the historical record does not say, nor do we know much about his family life other than that he was married and had a son, Onesimulus, who died in 1714. Two years later Onesimus gave the clearest indication of his attitude toward his bondage by attempting to purchase his release from Mather. To do so, he gave his master money toward the purchase of another black youth, Obadiah, to serve in his place.

Mather probably welcomed the suggestion, since he reports in his diary for 31 August 1716 that Onesimus “proves wicked, and grows useless, Froward [ungovernable] and Immorigerous [rebellious].” Around that time Mather signed a document releasing Onesimus from his service “that he may Enjoy and Employ his whole Time for his own purposes and as he pleases” (Mather, vol. 2, 363). However, the document makes clear that Onesimus’s freedom was conditional on performing chores for the Mather family when needed, including shoveling snow, piling firewood, fetching water, and carrying corn to the mill. This contingent freedom was also dependent upon his returning a sum of five pounds allegedly stolen from Mather.

Little is known of Onesimus after he purchased his freedom, but in 1721 Cotton Mather used information he had learned five years earlier from his former slave to combat a devastating smallpox epidemic that was then sweeping Boston.

Considered extremely dangerous at the time, Cotton Mather convinced Dr. Zabdiel Boylston to experiment with the procedure when a smallpox epidemic hit Boston in 1721 and over 240 people were inoculated. Opposed politically, religiously and medically in the United States and abroad, public reaction to the experiment put Mather and Boylston’s lives in danger despite records indicating that only 2% of patients requesting inoculation died compared to the 15% of people not inoculated who contracted smallpox. Boylston successfully variolate 300 patients with only six of them dying. By contrast, 1,000 of the 6,000 people who acquired smallpox naturally died during the same period.

In a 1716 letter to the Royal Society of London, Mather proposed “ye Method of Inoculation” as the best means of curing smallpox and noted that he had learned of this process from “my Negro-Man Onesimus, who is a pretty Intelligent Fellow” (Winslow, 33). Onesimus explained that he had

undergone an Operation, which had given him something of ye Small-Pox, and would forever preserve him from it, adding, That it was often used among [Africans] and whoever had ye Courage to use it, was forever free from ye Fear of the Contagion. He described ye Operation to me, and showed me in his Arm ye Scar.” (Winslow, 33)

Reports of similar practices in Turkey further persuaded Mather to mount a public inoculation campaign. Most white doctors rejected this process of deliberately infecting a person with smallpox–now called variolation–in part because of their misgivings about African medical knowledge. Public and medical opinion in Boston was strongly against both Mather and Dr. Zabdiel Boylston, the only doctor in town willing to perform inoculations; one opponent even threw a grenade into Mather’s home. A survey of the nearly six thousand people who contracted smallpox between 1721 and 1723 found, however, that Onesimus, Mather, and Boylston had been right. Only 2 percent of the six hundred Bostonians inoculated against smallpox died, while 14 percent of those who caught the disease but were not inoculated succumbed to the illness. Boylston traveled to London in 1724. There he published his results and was elected to the Royal Society in 1726.

Onesimus’ traditional African practice was used to inoculate American soldiers during the Revolutionary War and introduced the concept of inoculation to the United States and variolation remained the most effective means of treating the disease until the development of vaccination by Edward Jenner in 1796.

It is unclear when or how Onesimus died, but his legacy is unambiguous. His knowledge of variolation gives the lie to one justification for enslaving Africans, namely, white Europeans’ alleged superiority in medicine, science, and technology. This bias made the smallpox epidemic of 1721 more deadly than it need have been. Bostonians and other Americans nonetheless adopted the African practice of inoculation in future smallpox outbreaks.

Further Reading

Herbert, Eugenia W. “Smallpox Inoculation in Africa.” Journal of African History 16 (1975).
Mather, Cotton. Diary (1912).
Silverman, Kenneth. The Life and Times of Cotton Mather (1984).
Winslow, Ola. A Destroying Angel: The Conquest of Smallpox in Colonial Boston (1974).


Part of the Court.rchp.com 2017 Black History Month Series


Compiled under fair use exemption, from material originally published by Harvard's Hutchins Center for African & African-American Research and PBS.

Imhotep – The Real Father of Medicine

The Greek physician Hippocrates is known as the father of modern medicine, but a Black Egyptian, Imhotep was practicing medicine and writing on the subject 2,200 years before Hippocrates. Were Ancient Egyptians Black?

In ancient Egypt, there was a ‘Medicine God’ known as Imhotep. Imhotep was a real person that lived in service to a pharaoh during the third dynasty. Imhotep was a polymath (a genius in multiple subjects). He excelled as a mathematician, priest, a writer, a doctor, and he founded the Egyptian version of the studies of architecture and astronomy. He is credited with building the first pyramid created entirely with stone by human hands – the Pyramid of Djoser at Saqqara, near Memphis.

Egyptians, not Greeks were true fathers of medicine

The research team from the KNH Centre for Biomedical Egyptology at The University of Manchester discovered the evidence in medical papyri written in 1,500BC – 1,000 years before Hippocrates was born. Imhotep writings are generally considered the source that the Edwin Smith Papyrus, an Egyptian medical text, which contains almost 100 anatomical terms and describes 48 injuries and their treatment. The text may have been a military field manual and dates to c. 1600 BCE, long after Imhotep's time, but is thought to be a copy of his earlier work.

Edwin Smith Papyrus - believed written by Imhotep 1,000 years before Hippocrates was born
Edwin Smith Papyrus – believed written 1,000 years before Hippocrates was born and based on previous writings of Imhotep

Scientists examining documents dating back 3,500 years say they have found proof that the origins of modern medicine lie in ancient Egypt and not with Hippocrates and the Greeks.

"Classical scholars have always considered the ancient Greeks, particularly Hippocrates, as being the fathers of medicine but the KNH research team findings suggest that the ancient Egyptians were practicing a credible form of pharmacy and medicine much earlier," said Dr. Jackie Campbell.

"When KNH compared the ancient remedies against modern pharmaceutical protocols and standards, they found the prescriptions in the ancient documents not only compared with pharmaceutical preparations of today but that many of the remedies had therapeutic merit."

The medical documents, which were first discovered in the mid-19th century, showed that ancient Egyptian physicians treated wounds with honey, resins, and metals known to be antimicrobial.

Imhotep is also touted as being the only ascended mortal in the Pharaonic pantheon— an advisor to kings, builder of pyramids, and paragon of knowledge who rose to become the god of healing and science. For 3000 years he was worshiped as a god in Greece and Rome. Early Christians worshiped him as the "Prince of Peace."

Ancient Statue of Imhotep, Louvre Museum
Ancient Statue of Imhotep, Louvre Museum

Imhotep, in ancient Egyptian, is translated to mean “the voice (or mouth) of Im”; however, there is no record of a god in Egypt called ‘Im.’ Many are familiar with the “I AM”: EXO 3:14 

“And God said unto Moses, I AM THAT I AM: and he said, Thus shalt thou say unto the children of Israel, I AM hath sent me unto you.”

Unlike the Egyptian god, Thoth who is not generous with his knowledge, Imhotep insisted that knowledge was only useful if it was applied for the good of all. His most important doctrine is that knowledge, science, and magic should be used to help humanity. Magic and the use of herbalism were the first forms of ‘medicine’ though Imhotep practiced surgery and cured people from over 200 diseases – ailments as varied as tuberculosis, gallstones, appendicitis, gout, and arthritis. He practiced dentistry and could look at the hair, nails, skin, and tongue to make diagnoses.

Imhotep was practicing medicine and writing on the subject 2,200 years before Hippocrates, the so-called Father of Modern Medicine was born. Imhotep is generally considered the author of the Edwin Smith Papyrus, an Egyptian medical text, which contains almost 100 anatomical terms and describes 48 injuries and their treatment. The text may have been a military field manual and dates to c. 1600 BCE, long after Imhotep's time, but is thought to be a copy of his earlier work.

The team also discovered prescriptions for laxatives of castor oil and colocynth and bulk laxatives of figs and bran. Other references show that colic was treated with hyoscyamus, which is still used today, and that cumin and coriander were used as intestinal carminatives.

Further evidence showed that musculoskeletal disorders were treated with rubefacients to stimulate blood flow and poultices to warm and soothe. They used celery and saffron for rheumatism, which are currently topics of pharmaceutical research, and pomegranate was used to eradicate tapeworms, a remedy that remained in clinical use until 50 years ago.

"Many of the ancient remedies we discovered survived into the 20th century and, indeed, some remain in use today, albeit that the active component is now produced synthetically," said Dr. Campbell.

"Other ingredients endure and acacia is still used in cough remedies while aloes forms a basis to soothe and heal skin conditions."

Fellow researcher Dr. Ryan Metcalfe is now developing genetic techniques to investigate the medicinal plants of ancient Egypt. He has designed his research to determine which modern species the ancient botanical samples are most related to.

"This may allow us to determine a likely point of origin for the plant while providing additional evidence for the trade routes, purposeful cultivation, trade centers or places of treatment," said Dr. Metcalfe.

"The work is inextricably linked to state-of-the-art chemical analyses used by Metcalfe's colleague Judith Seath, who specializes in the essential oils and resins used by the ancient Egyptians."

Professor Rosalie David, Director of the KNH Centre, said: "These results are very significant and show that the ancient Egyptians were practicing a credible form of pharmacy long before the Greeks.

Were Ancient Egyptians Black?

Legal research animated 250 x 250

European colonialism has distorted or destroyed the history and historical accounts of Africa. In order to justify the enslavement of African people, a false narrative was promoted that Africa was a backward land, full of barbaric primitive people with no history. It would have been difficult to justify slavery if the world knew about the great empires and accomplishments of various groups of African people.

Last Judgement of Hunefer, 1275 b.c.e., papyrus, Thebes, Egypt (British Museum)
Last Judgement of Hunefer, 1275 b.c.e., papyrus, Thebes, Egypt (British Museum)

Growing up, I didn't even realize Egypt was on the continent of Africa, it was never mentioned. The ancient Egyptians always painted themselves with dark skin and they literally left images of themselves carved in stone with what are today considered black facial features.

The Ramsess II Statues at Main Entrance to Abu Simbel Temple in Egypt
The Ramses II Statues at Main Entrance to Abu Simbel Temple in Egypt

Hollywood through propaganda has contributed to the distortion of black history, such as depicting Egyptians as white or at least anything other than black. Charleston Heston portrayed Moses and Elizebeth Taylor portrayed Cleopatra.

The only black images that were ever presented in media concerning Egypt were those of slaves. Unfortunately, even the greatness of Imhotep has been distorted and fictionalized as an evil character in the movies "The Mummy" in 1932 play by Boris Karloff and in the 1999 version played by Arnold Vosloo. A clip of Vosloo's role as Imhotep is below.

Eye Witness Accounts of Sphinx 

Count Constantin de Volney, a French nobleman, philosopher, historian, orientalist, and politician, embarked on a journey to the East in late 1782 and reached Ottoman Egypt where he spent nearly seven months. Constantin de Volney was troubled much by the institution of slavery. His expressed opinion that the ancient Egyptians were black Africans much departed from the typical European view of the late eighteenth century, but it gave many people cause for reflection.

During his visit to Egypt, he expressed amazement that the Egyptians – whose civilization was greatly admired in Europe – were not White!

"All the Egyptians," wrote de Volney, "have a bloated face, puffed-up eyes, flat nose, thick lips – in a word, the true face of the mulatto. I was tempted to attribute it to the climate, but when I visited the Sphinx, its appearance gave me the key to the riddle.

On seeing that head, typically Negro in all its features, I remembered the remarkable passage where Herodotus says:

'As for me, I judge the Colchians to be a colony of the Egyptians because, like them, they are black with woolly hair…

"When I visited the Sphinx, I could not help thinking that the figure of that monster furnished the true solution to the enigma (of how the modern Egyptians came to have their 'mulatto' appearance) "In other words, the ancient Egyptians were true Negroes of the same type as all native-born Africans. That being so, we can see how their blood, mixed for several centuries with that of the Greeks and Romans, must have lost the intensity of its original color, while retaining nonetheless the imprint of its original mold.

"Just think," de Volney declared incredulously, "that this race of Black men, today our slave and the object of our scorn, is the very race to which we owe our arts, sciences, and even the use of speech! Just imagine, finally, that it is in the midst of people who call themselves the greatest friends of liberty and humanity that one has approved the most barbarous slavery, and questioned whether Black men have the same kind of intelligence as whites!

"In other words the ancient Egyptians were true Negroes of the same stock as all the autochthonous peoples of Africa and from the datum one sees how their race, after some centuries of mixing with the blood of Romans and Greeks, must have lost the full blackness of its original color but retained the impress of its original mould."

Sixteen years after Count de Volney visit, another Frenchman, Dominique-Vivant Denon gave a similar description of the Sphinx.

Dominique-Vivant Denon was a diplomat and artist who Napoleon invited to join the Egyptian expedition in 1798. Denon was the first European artist to discover and draw the temples and ruins at Thebes, Esna, Edfu, and Philae. Many of us have heard the disputed tale that a cannonball fired by Napoleon’s soldiers hit the nose of the Sphinx and caused it to break off. Many believe that Napoleon shot off the nose and lips of the Sphinx because he did not like its black features. Denon made the following statement about the Sphinx in the Universal Magazine of Knowledge and Pleasure

"Though its proportions are colossal, the outline is pure and graceful; the expression of the head is mild, gracious, and tranquil; the character is African, but the mouth, and lips of which are thick, has a softness and delicacy of execution truly admirable; it seems real life and flesh." 

Denon's drawing of the Sphinx show it with a broad nose and thick lips, clearly African features.
Denon's drawing of the Sphinx show it with a broad nose and thick lips, clearly depict African features.

Racial identity based on skin color is a relatively modern concept created during the slave trade. Prior to the 16th century, people did not view themselves in the context of black verse white, so the ancient Egyptians or any other group of ancient people would not have viewed themselves from the perspective of being black or white. 

It is estimated that the average person did not travel more than 30 miles from home during their lifetime, so it's hard to imagine that the ancient Egyptian people were a mixture of European and African people. People assume that the current population is representative of what the population looked like during ancient times. The United States is a predominately white country, however, if you were to arrive on this continent 500 years ago, you wouldn't have found any white people. They came later, decimated the indigenous native population, took over their land and claimed it as their own. 


Part of the Court.rchp.com 2017 Black History Month Series

Blacks Suffering Post Traumatic Slave Syndrome?

Are black people in American suffering from a collective unrecognized and untreated mental disease caused by slavery, reinforced by Jim Crow and perpetuated by institutionalized racism?

Post Traumatic Stress Disorder

After years of continuous war, most of us are familiar with Post Traumatic Stress Disorder (PTSD). When in danger, it’s natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This “fight-or-flight” response is a healthy reaction meant to protect a person from harm. But in post-traumatic stress disorder (PTSD), this reaction is changed or damaged. PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes.

Stockholm Syndrome

During a bank robbery in Stockholm, Sweden, several bank employees were held hostage in a bank vault from August 23 to 28, 1973, while their captors negotiated with police. During this standoff, the victims became emotionally attached to their captors, rejected assistance from government officials at one point, and even defended their captors after they were freed from their six-day ordeal.

This phenomenon has come to be known as Stockholm syndrome, a psychological disorder in which hostages express empathy and sympathy and have positive feelings toward their captors, sometimes to the point of identifying with the captors. These feelings are generally considered irrational in light of the danger or risk endured by the victims, who essentially mistake a lack of abuse from their captors for an act of kindness. A similar psychological trait may lie behind battered-wife syndrome, military basic training and fraternity hazing.

Post Traumatic Slave Syndrome

Sister Souljah's original intro to her 1995 recording, "Final Solution: Slavery Back in Effect", which imagines a police state where blacks fight the re-institution of slavery, stated:

If your white great-great grandfather
KILLED my great-great grandfather
And your white great grandfather
SOLD my great grandfather
And your white grandfather
RAPED my grandmother
And your father stole, cheated, lied and ROBBED my father
What kind of fool would I have to be to say,
“Come, my friend!” to the white daughter and son?

What happens to a group of people when they have been subjected to more than two centuries of slavery, another century of slavery by another name, and then a half century of  institutional prejudice and oppression?

Dr. Joy de Gruy Leary makes a compelling argument, which is roughly a connection between PTSD and Stockholm Syndrome to explain some behaviors of Black Americans who have suffered almost 400 years of trauma under slavery, Jim Crow, systemic racism and negative media imagery.