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When medicine goes awry

In "Coronary: A True Story of Medicine Gone Awry," journalist Stephen Klaidman tells the incredible story of two California cardiologists who performed surgeries for profit, not for healing.

In his new book "Coronary: The True Story of Medicine Gone Awry," journalist Stephen Klaidman chronicles the story of two California heart specialists who violate their most sacred oath:"First, do no harm." An FBI investigation into wrongdoing and hundreds of civil lawsuits revealed disturbing facts about America's "medical-industrial complex." Klaidman was invited to appear on TODAY to discuss his book. Here’s an excerpt:

A Historical Precedent

Felix Elizalde's experience in Redding, as unpleasant as it evidently was for him and for his wife, Margaret, did not necessarily have wider implications. It could easily have been a simple case of medical error or just a difference in clinical judgment between two cardiologists. Medical errors occur with much greater frequency than most people are aware or would like to think, even at the best academic medical centers, and variations in clinical judgment are only natural. Cardiology in particular has many gray areas, and good clinicians frequently differ about the most appropriate treatment. The California State Medical Board, like most of its counterparts around the country, requires a pattern of questionable practice to investigate a physician, not just a single complaint, which makes sense. Doctors should not be held to a standard of perfection nor should they be expected to make identical cookbook diagnoses. Malpractice, of course, was not out of the question in Elizalde's case, but neither was it a certainty. And the possibility of fraud had not entered anyone's mind. In retrospect Elizalde had no definitive reason to be suspicious of Redding Medical Center, its owner, National Medical Enterprises, Dr. Realyvasquez, or, to be completely fair, even Dr. Moon.

Yet at the same time there was something potentially relevant to the situation that Elizalde knew nothing about -- a lengthy episode involving National Medical Enterprises that was deeply troubling. In the late 1980s and early 1990s a number of NME-owned psychiatric hospitals had engaged in a cold-blooded scheme that was ongoing at the time of Elizalde's Redding experience and destined to end in criminal convictions. Had Elizalde known about these activities he might have been even more skeptical about his own treatment.

About fifteen months before Moon diagnosed Felix Elizalde with triple-vessel coronary artery disease, late in the afternoon of April 12, 1991, a repainted police car pulled up to Sid and Marianne Harrell's modest ranch house in Live Oak, Texas, a middle-class suburb of San Antonio. The light blue Dodge had a flashing red light on top and the words Sector One painted on the trunk. There was a prisoner cage in the back seat. Marianne and her fourteen-year-old grandson Jeramy watched two bulky, uniformed men get out. One of them told her curtly, "We're Sector One, Mobile Crisis Unit, and we're here to pick up the boy." Marianne thought they meant Jeramy's twelve-year-old brother, Jason, who was undergoing an evaluation at Colonial Hills, a psychiatric hospital in San Antonio owned by a company called Psychiatric Institutes of America. She said, "He isn't here. What did he do?" But one of the men, who introduced himself as "Lieutenant" Joe Saenz, said, "That boy," pointing at Jeramy. She asked again what he'd done, but they wouldn't tell her.

Marianne, Jeramy, Saenz and the other man, whose name was Ulysses Jones, went inside where Sid Harrell, a retired army staff sergeant, was sitting at the kitchen table. Saenz and Jones told the Harrells they were operating under orders from a Dr. Bowlan at Colonial Hills and that if Jeramy didn't go with them they would get a warrant under which he could be held for twenty-eight days. They also indicated that if this happened he would have a police record.

Marianne was both frightened and angry. She called Colonial Hills and was told that the officers were authorized to bring Jeramy to the hospital. When she asked the reason, she was told for substance abuse, truancy, and because he was a victim of child abuse. Sid then called the local police to try to establish whether Saenz and Jones had the authority to take Jeramy. By the time a police officer showed up Jeramy was handcuffed and in the cage in the back of the Sector One car. The officer reviewed the papers the men showed her, which did not include a warrant authorizing Jeramy's detention. Nevertheless, she told the Harrells that Saenz and Jones were licensed security officers and could indeed get a warrant to hold Jeramy for twenty-eight days. If the Harrells let their grandson go with the security officers, she said, they could probably have him released within twenty-four hours. At this point the distraught grandparents gave up and let the two uniformed men take Jeramy away.

Dr. Mark Bowlan's "diagnosis" of drug abuse and the allegation that Jeramy was an abused child had been based solely on Bowlan's interview with Jeramy's twelve-year-old brother Jason. Bowlan, a psychiatrist who at the time had a temporary, limited medical license, which he would lose that summer for falsifying letters of recommendation, waited four days before seeing Jeramy, even though he had asserted that the boy was so dangerous that he had to be brought in by a pair of professional bounty hunters and admitted to Colonial Hills on an emergency basis. After six days, during which time his grandparents, who were his legal guardians, were not allowed to see him, Jeramy was released on a writ of habeas corpus obtained by state senator Frank Tejada. The senator went to the hospital himself and threatened to kick the door down if they didn't let the fourteen-year-old go. A bill for $11,000 followed. Jeramy's younger brother Jason was kept in the hospital for two weeks. His bill was $15,000. Both bills were paid by CHAMPUS (Civilian Health and Medical Program of the Uniformed Services), the U.S. government's health insurance program for members of the military.

Jeramy Harrell's experience of being forcibly taken from his home and being incarcerated in a mental hospital was not unique in the annals of the Psychiatric Institutes of America, a subsidiary of National Medical Enterprises. And, as bad as the Harrell case was, it was far from the most egregious in the company's history. Nor would it be the last. Something seemed to be awry in the corporate DNA.

Excerpted from "Coronary" by Stephen Klaidman.  Copyright © 2007 by Stephen Klaidman.  Reprinted by permission from Scribner, an imprint of Simon & Schuster, Inc.